Immune testing and IVIG #3

Thank you for all of your encouragement and support. I really, REALLY, appreciate it. It was so reassuring to see the little embryo waving about yesterday. Seemed definitely there - maybe it's sinking in that I'm pregnant, finally. That only took 8 and a half weeks! I succeeded again with self-administering the PIO injection last night and Ms. Moxie has had her twice daily constitutionals (dog walker is taking her for the third one)...so I'm making it through the week as a pregnant solo dog parent so far.

I have been lightly spotting again since last night, damn it all...which has me feeling keyed up and anxious about things. It's light. More a pink/brown tinge than anything...but still. I wish it would stop, already! I try to tell myself it's no big deal, but it scares me, and I realize that's maybe sillly, because it is really very little. But I don't want to have any spotting or blood at all! None, I tell you!

In other not-so-exciting news, at 5pm today, a nurse is coming to my apartment to administer IVIG treatment #3.

Blech. Just thinking about it makes me nauseated and tired. I'm chugging water right now, as a matter of fact, because that supposedly helps prevent the pounding headache/migraine I had the first time I did it (although I drank gallons of water then too, so who knows...).

Like last treatment, I'll be doing this infusion in my home, reclining in my comfy bed, which hopefully will make it less onerous. And although I'm really not sure if it is helping or not, I would do anything to keep this pregnancy afloat.

I went back to the reproductive immunologist at the end of February and had some of the immune markers redrawn to see if they were improving with the IVIG/ prednisone/ lovenox triumvirate.

And things look decidedly better...but according to the doctor, not quite normal yet. Hence this third treatment.

Apparently, my natural killer cells are much better, but my %CD3, which is one part of the natural killer cell assay, is still elevated at 86.7 (upper limit of normal is 85...I'd say close enough...but he disagreed).

My TNF-alpha levels, which are part of the TH1:TH2 ratio reproductive immunologists love to look at is also slightly elevated at 31.6 (upper limit of normal is 30.6...again, I'd say normal enough, but he begs to differ).

So a third IVIG treatment it is. I am hoping it is the last. I hate the side effects, and I really hate the $3,000 price tag, especially since the research evidence doesn't compel me.

Here's hoping this does the trick and I am all done with these treatments after this. I'm feeling pregnant enough to feel like I'm definitely putting the two of us through this, this time. Sorry embryo! I hope this stuff doesn't make you feel as yucky as it makes me feel! And I'm hoping it helps you stick around for the long haul. Please.

Just to help motivate me (and hopefully not give me nightmares!!), here's a picture of a natural killer cell supposedly destroying an embryo. This is what we are trying to prevent. Hopefully it's working!! (or it's not even a real issue...either one is acceptable to me...).

Yo, NK cells! Get away from my embryo!!!

Mo

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Still alive

I went in before office hours to my new OB this morning.

She is so, so nice and saw me right away.

The embryo is still there, tiny heart beating away. Baby measuring on track, 8 weeks, 2 days. You could see little arm and leg buds this time. That's new since last Thursday. With the waving arm and leg buds, it is now a very cute blob, instead of just a blob.

In other news, I managed to inject myself successfully with the progesterone in oil and walk Ms. Moxie last night and again early this morning. All by myself. Feeling very advanced over here. I think the injection actually hurt less than when Will does it for me. Hmmm...

So in summary:

Phew!

For now.

We'll go back next Wednesday and see what's what.

That'll be a big hurdle. We've never made it that far before.

Praying all's quiet in the uterus until then.

Mo

Illustration Credit: jocelyn cheung

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8w1d...and spotting

I'm trying not to freak out over here, but yesterday evening, I noticed I was lightly spotting. A mix of pinkish brown, very light. A little bit of uterine discomfort too. Not cramping exactly, but not feeling so happy in there either.

Hopefully no big deal. Hopefully... (said without conviction).

Unfortunately, it feels like it might be a very big deal. I have had spotting twice before during pregnancies, and each time, it has marked the beginning of the end. So it's hard not to worry and suspect that's what's going on.

To make things even scarier, Will leaves town later today and will be across the country until next Saturday. I've been worried already that I may struggle to handle the PIO injections by myself and that taking care of Ms. Moxie's walk schedule without his help will be a challenge. Now, I'm afraid to move. But Moxie must be walked, so I guess I will rise to the challenge. I'm not even sure about going in to work tomorrow. I just want to sit very still and hope that whatever was going on last night will heal if I just take it very, very easy (ie, recline and lie as still as a statue).

My RE has been out of town this week, so I can't get a reassurance scan from him today. I'm supposed to see my OB for an ultrasound check on Thursday, but I had been thinking I would cancel since Will would be away, and wait for him to return before taking another peek. We had the unfortunate experience of me finding out about a lost baby in his absence during pregnancy #1 and both never want to repeat that again...But now...I'm not sure what to do.

On the positive end of things, I don't seem to be bleeding further today. On a negative, since seeing the spotting, I'm barely hanging on to sanity by a thread.

I know time is what's needed - there's nothing for me to do, nothing I can do to keep the pregnancy going if it's destined to miscarry. But ugh. UGH. You know?

Mo

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Things that go bump in the night

photo credit: tome chan

All is looking good. As good as good can be right now.

Our big hurdle - both real and psychological - is time. Just needing to get through the next few weeks or so - past the date of our latest loss, further into the pregnancy where things would be a bit safer. We're thinking that might make things start to seem more real, more likely to stick around.

And considering everything we've been through - the six losses, the five years getting to this point - I think we are holding up damn well. For the most part, I am not angst-ing too much or for too long.

There are some back-of-my-head worries, some middle-of-the-night worries, the type that you don't see so clearly, but maybe hear in the background sometimes, late at night bumping around in your head and your heart.

My main fear that I can pinpoint at this stage is a fear that this pregnancy is another triploidy. We've had beta numbers this high once before - during pregnancy number 5 - and it was a triploidy, 69 XXX. Actually, my beta numbers during that pregnancy were lower than my hcg numbers this pregnancy. Gulp. Which I'll be honest, does worry me some. (edited to add: I mean lower at the same day in time...much earlier than now - back in the beginning of a pregnancy when you usually get betas drawn....)

The embryos we transferred this time were tested ahead of time and were deemed normal by microarray analysis. Because the Denver clinic was worried about repeat triploidy in our case (usually a spontaneous, non-age related, not likely to repeat event), they also did FISH testing to specifically look for this. The FISH failed to work, however, on two of the three blasts we transferred this time. So we know there is no mismatch with the chromosomes - no trisomies - but there could be an entire extra set again, which is what triploidy is (microarray only looks for a mismatch between the chromosome numbers, not how many sets there are).

Cue the fear.

I talked to the OB about it last week and she reassured me some. She said that it's unlikely to be a triploidy, but that if it is, I'll miscarry in the next few weeks. If I don't miscarry in the next few weeks, and if the quad screen, nuchal, etc. comes back ok, we can pretty much rule that fear out.

May not sound like much reassurance, but it worked for me. Nothing I can do to change it if this is a triploidy, so it's a wait and see game at this point. OK. I can do that. I can wait and see.

I also contacted the genetic counselor in Denver, just to see if she could put my mind at ease at all. She also said triploidy is unlikely (which I know, but don't these folks realize that Mo and Will are especially prone to rare and unlikely events?). She affirmed what I thought, which is that because we did ICSI, we know only one sperm fertilized each egg, which is one way triploidy occurs. She also confirmed that the Denver clinic checks for the expulsion of the polar body from the egg, which is another way triploidy can occur (the egg doesn't shed its extra set of chromosomes, so you end up with 3 sets). I was also hoping to find out if the embryologists tried to visualize the 2PN stage that confirms fertilization (because I think in triploidy you'd have a 3PN, not a 2PN stage, but she didn't answer that part of my question...oh well).

So rationally, it seems unlikely this is another triploidy, except that my beta numbers are a little out of this world. And I realize to those without a crazy bad history, these thoughts and fears may seem crazy, or super negative or something. But I don't think so. I think this is what happens when you've rolled the dice as many times as we have and have come up wanting each time. It's hard to believe your luck may finally have changed. You keep looking for the catch. You keep looking for the asterisk. The "just kidding!" in small print at the bottom of the page.

Mostly I'm not thinking too much about this. Mostly I'm actually in the now...this fear is just a little niggling thought in the back of my mind sometimes. It helps so much to know that whatever is going on in there is out of my hands. I can't unmake a triploidy if that is what is growing. I also can't mess up a perfectly normal baby if that's what we're lucky enough to finally have.

It helps that I'm still feeling guarded, have not launched head over heels into this pregnancy with my heart wide open yet. I feel a little guilty about that, but am trying to be understanding of myself and Will. We are gun-shy. We are wounded. We are taking this a day at a time, and that's ok.

So these are some of the things that go bump in the night for us. If we can just get a bit farther along, these particular fears will be put to rest. And that will be a very good thing.

Mo

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FET #2: weekly blood work results 7w6d

Thank you guys for all of your well wishes and congrats! This all still feels so surreal, I have to say, but reading your excitement and encouraging words makes it feel a little more real.

I received my weekly hormone check and it appears all is still going well.

Estrogen = 732

Progesterone = 39.4

Beta HCG = (yikes!) 140,934

That last number must be why I feel like I'm about to toss my cookies at any moment.

Which I'm not complaining about. It's a good thing. A good thing! That said, I'm hoping to wrap things up here at the office a bit early and tuck myself into my nice comfy bed for a little early evening slumber. I'm soooooo tired!

Despite all evidence to the contrary (the bloating, the fatigue, the nausea, the ultrasounds and blood work), my  main thought remains, Is this really happening? I keep thinking I'm going to wake up and realize this was all just some elaborate and very detailed dream. I hope not.

Mo

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