Dr. D

Well my research is done and I'm going to try to schedule my first consultation soon. I have heard nothing but wonderful things about Dr. D. She has had personal struggles with both infertility and RPL - and because of that she is said to be extraordinarily compassionate. I don't want someone to hand hold me or sugar coat things. But I also do not want someone who views RPL as nothing more than a clinical diagnosis.

I'm nervous and anxious, but I know we need to do this.

About Progesterone

I mentioned in my Ramblings post a couple days ago that my progesterone was REALLY low on 11/8 - the day the m/c was discovered.

It was 4. Yes F-O-U-R.

That is a level that will not only not support pregnancy, but won't even support getting pregnant. (P should be between 5-10 post ovulation just to support implantation. It should be well over 15 to support pregnancy until the placenta takes over that function sometime around 12 weeks.)

So let me repeat. Mine was fucking four.

What does this mean? It either means that the embryo ceased to be viable and my progesterone tanked immediately OR my corpus luteum failed, and my lack of progesterone is what terminated the pregnancy.

What do we know? We know the embryo grew a fair bit between the 2 ultrasounds. So even though we don't know exactly when that amazing little heartbeat stopped flickering, the amount of growth would indicate it was closer to when we did the second ultrasound than the first. So would a normal progesterone level (should have been well over 20) plummet in just a day or two down to 4? Don't know, but doesn't seem likely to me.

What seems more likely is that my progesterone may have been on the edge the whole time. I hadn't had blood drawn since I was 5 weeks along, so I don't know this either. But it's a lot easier to imagine that my progesterone was falling over time and ended up so low that viability ceased somewhere along the way.

Why else is this the most likely culprit in my head? Because thyroid and progesterone are very tightly related and we know that my thyroid levels are not ideal for pregnancy. (Despite being blown off by my doctors.)

My doctor said she would prescribe progesterone the next time I was pregnant - even though we'll never know whether or not the death of the embryo caused the P drop or the other way around. But she said nothing about looking into my thyroid as a culprit.

Just one of the many reasons I'm moving onto a specialist in RPL.

Can of worms

I have so much pain and anger and sadness bottled up inside. I ache everyday to have just one of these pregnancies back. I fear that I am so broken that no one will be able to fix me. I have emotions I don't even fully comprehend.

And I carry this burden mostly alone. Sure, my husband knows everything. And my best friend does too. But for most of the people around me, I put on my happy face, and no one has noticed any cracks in the facade...yet.

But the holidays are coming, and our son will be 2 in a couple weeks. Spending time with family at a time we hoped to be announcing our most recent pregnancy, and the inevitable questions about when we are having another child...I don't know if I will be able to hold it all in.

Why am I holding it all in? I don't want to share this pain with others. I don't want people to feel sorry for me. I don't want to talk about it. I don't want to hurt my family over the fact that this has been kept from them all along. I don't want to open a can of worms that I will never be able to close again.

But the end of this secret may be near through no choice of my own. If I need a D&C or if any of our RPL testing requires anesthetic procedures, my husband has said (and I agree) that I have to at least tell my mom. I can't go in for surgery and not tell her. That's not fair.

So I feel like if this can of worms has to be opened that I should just go ahead and do it. But I'm still not sure if I'm ready. We'll see...

Beta Update

Even though I thought I passed the "products of conception" Tuesday and ended up not passing them until this morning, my HCG levels are plummeting which is awesome.

11/8 - 9,000 (Day m/c was discovered)
11/15 - 2,900 (I originally thought I miscarried fully the night of the 11/15.)
11/17 - 490 (This was taken to confirm a large drop after the 11/15 event.)

Considering what I passed this morning was the missing piece of what should have happened Tuesday night, I expect a significant drop next week as well.

I know my body too well . . .

I, in fact, did not miscarry on Tuesday 11/15 at 9w5d. I painfully labored for the entire evening and passed a lot of clots and lots and lots of blood, but I knew there should have been more. I knew it.

I told my doctors. I told my husband. I told 2 friends who are unfortunate enough to be close enough to me to get the gory details. I even said it in my last post. My doctors assured me that you don't always see or feel what you may expect and that everything sounded normal and not to worry. But I knew it.

With no cramps, and no warning whatsoever, I miscarried this morning on a routine trip to the bathroom. 11/18, 10w1d. This was what I knew was supposed to happen Tuesday.

Have I mentioned how lucky I am to work from home? Because if that had happened at work, I would have freaked out. Mildly traumatizing considering I thought this was behind me. Yikes.

I called my doctors. They are fine with letting me wait everything out through the weekend. As long as I don't continue to bleed heavily and don't pass any more clots, I am probably fine and this is probably over. The concern being that OBVIOUSLY my body did not get rid of everything when it was laboring. So there could potentially be more "stuff" left.

Please, please, please, please let this be the end for real this time.

The end. (I hope.)

Tuesday night, 11/15, should have been 9w5d. It happened. It was extraordinarily painful - hours of actual labor. (My first m/c was not nearly as intense.)

I won't go into detail about comparing the products of one m/c to another, but let's just say I was expecting more.

I relayed my concern to my doctors, but until we see what my blood work does, there is really no way to know if my body took care of this or not.

My HCG needs to drop precipitously from week to week. Here's what we know already:
11/8 - 9,000 (day m/c was discovered)
11/15 - 2,900 (morning the day the m/c started)

Please let this be over. If I end up needing a D&C, I will be really pissed.

"How are you doing?"

Pardon my profanity, but how the fuck I supposed to answer that question???

If my doctors ask me that question one more time I am going to flip out and lose my shit. My husband says they are just trying to check on me. Yeah, I get it. So ask, "Is there anything we can do for you?" Or say, "Please call us if you need to talk." But, "How are you doing???"

Perhaps I should say what goes through my head every time they ask. "I just LABORED for 6 hours to flush my dead baby down the toilet. How am I supposed to be doing???"

Ramblings

Well today I should be 9w4d pregnant. And instead I am on my 3rd day of spotting in what is proving to be a VERY slow beginning of the end.

I have follow up bloodwork and an appointment with my midwife tomorrow. I am researching like a mad woman to find out what questions I need to ask and where we need to go for answers. The obvious starting point is an RE, but the more and more I research, the more I realize that recurrent pregnancy loss (RPL) is not something that many people have a great understanding about. Sure there are standard tests, and we will have them all done and hope for some answers. Forgive me for not being hopeful right now. My mind is already trying to figure out how to push further when all those tests inevitably tell us we have no problems. Not the right attitude to have, but I'm about to lose my 4th pregnancy in 18 months. I don't think it's possible to have a different attitude.

Unless things substantially pick up in the next 24 hours, I will be asking for Cytotec or a D&C tomorrow. This embryo has been dead for at least a week (probably longer based on what my progesterone levels were last week). I want it out of me. ASAP.

In all of my research today, I came across a quote that really struck a nerve. Most things strike a nerve lately, but I had made it all day without crying until I came across this -

"You are sad not just because of what you have lost but because of what will never be."

Truer words have never been written.

8w5d - No heartbeat

The measurement last week was worrisome. The lack of symptoms this whole time was worrisome. But our beta results gave me hope. That heartbeat last week gave me hope. Hope fucking sucks. Our follow-up ultrasound today showed a lifeless embryo and a sac that is starting to detach from the uterus.

Loss #4. Is this even real? I'm angry, numb, devastated, and pretty much hopeless.

Houston, we have a heartbeat!!!

Ahhhhhhh. I guess tears would have been the outcome of my first ultrasound no matter what the result. Within seconds of starting the ultrasound the tech said, "I see a heartbeat." And I cried. Relief. Excitement. And honestly a little bit of disbelief. It was overwhelming. I kept telling myself the entire car ride in that if there was nothing there that it would be okay. And I hadn't really let myself believe that it would all be okay.

But in the spirit of having something else to worry about, the baby was in a very difficult position to measure, and was measuring very small. It was only measuring 6w4d, and considering I had gotten positive pregnancy tests (both urine and blood) 4 weeks earlier, that is a little alarming. (You don't get a positive test at 2 1/2 weeks - you just don't. Conception occurs at ~2 weeks and implantation takes another 6-12 days then another 2-3 days for a test to become positive.)

So there are 3 possibilities for what may be going on:

1) The way our little bean is snuggled up against the wall of my uterus made it impossible to measure him/her from more than one angle. The u/s tech was not confident in her measurements at all. She said if she could have seen from every angle then she would be comfortable with the measurement, but she just wasn't okay with a measurement that far behind based on what she could measure.

2) Our little one got off to a slow start. Not unheard of at all. It used to be believed that in very early pregnancy all embryos grew at the same rate. Now it seems that theory is a little less black and white and there can be variability in the rates of development even during early pregnancy.

3) Our little one is not growing appropriately.

So what does all of this mean? I go back on November 8th for another ultrasound to find out. Even if our little bean is still nestled in an awkward position, we should be able to determine if there has been appropriate growth in the last week. If we can rule out #3, then honestly I don't really care whether the explanation is #1 or #2.

If the answer is #1, then I'm not sure what we do if we can't get a good measurement again this week. If the answer is #2 then we adjust my due date, and instead of being 8 weeks pregnant today I'm only 7 weeks pregnant.

Here's the breakout of my possible due dates:

Based on my last menstrual period: 6/14/11
Based on when I know I ovulated: 6/17/11
Based on current u/s measurements: 6/21/11

So until Tuesday, I am just super thankful that we seem to have a living child inside of me and I hope that we see good growth when we go in!!!