18 Weeks: Fetal ECG and Anatomy Scan

Our day started early today, as we needed to be downtown this morning for our fetal echocardiogram at Sick Kids Hospital. Traffic was surprisingly light, given that we were heading down during the morning rush hour, and we made it to our appointment in good time. 

  
Sick Kids is a really neat place. As its name implies, it’s a hospital for sick children, and as such looks like a friendlier and more fun place than any old hospital. There are several sections of the hospital, and we were in the atrium section, which was constructed with an underwater theme. Sea creatures decorated the walls, there were sitting pods on all upper floors, that kind of looked like submarine windows, the metal work and elevators also matched the submarine kind of look. We saw lots of kids that were sick or injured, but all seemed in good spirits and smiling.

  
(A hallway in Sick Kids, photo from http://vikpahwa.com/photos/20140126-the-hospital-for-sick-children-atrium-1993-in-toronto-is-reminiscent-of-ontario-place/)

The fetal ECG went well. The actual diagnostic ultrasound took over an hour, and the dim lighting and warmth in the room made me nod off throughout most of it. DW was there with me, sitting at the end of the medical table and kept holding and squeezing my feet, which was sweet.

Dumplin’ heart anatomy and function looked perfectly fine.

Next, we headed across the street to Mount Sinai for our anatomy scan. The waiting room in that place is huge, and full of pregnant ladies. Most looked very pregnant. The last couple of times that we’ve been there, I’ve kinda felt self-conscious about how “unpregnant” I looked compared to everyone there. I also noticed that the women there all seemed to be either of advanced maternal age, or really really young (and accompanied by a parent). There were very few women that looked my age, which was weird to me, but I guess this is a department for high risk pregnancies…. So I guess that makes sense.

The anatomy scan went well. Dumplin’ is a stubborn little fetus, refusing to change position despite several agitations by the ultrasound sonographer, me laying on my sides, me getting up and moving, or me making exaggerated physical movements. Today he had his back to the world, tucked right into mama. Our sweet stubborn boy!

  
(Dumplin’ sleeping on his side- that’s as far as he would move for us.)

He is also huge! He’s measuring 19 weeks, and we are 18 weeks. His head is big and his femurs are long. 

All of Dumplin’s parts look normal, except he has bilateral choroid plexus cysts in his brain. Now, as an isolated finding, this is benign. Sometimes, it is a soft marker for trisomy 18, but when it is, it is usually accompanied by other soft markets such as: intrauterine growth restriction (IUGR), hands in a permanently clenched position, and major heart defects. Since our NIPT stated with 96.4% reliability that Dumplin’ does not have trisomy 18, our geneticist isn’t at all concerned about the cysts. Apparently they are a normal variant in 1-2% of the population, and do not affect the function of the brain at all. Dumplin’ also is huge for his age (so no IUGR), showed us his opening and closing of his hands, and has a normal heart. As his mama, it’s hard to not be worried even though it’s nothing. 

 
(Dumplin’s choroid plexus cysts- the holes in the two oval structures above.)

The geneticist said that this cyst thing isn’t even worth pursuing, it’s so benign, but to calm my maternal worrying, they’re sending us for fetal biometry at 28 weeks, which is just another ultrasound that measures things and gives the measurements a score, then a combined overall score for all of the measurements. It basically gives a summary of the baby’s growth compared to the normal range. Y’all know I’m a data nerd, so I’m happy with doing this ultrasound, especially since I’m with midwives, we won’t likely get to see Dumplin’ again until he’s born. 32 weeks is a damn long time people!

In other news, I’m up 25lbs since pre-IVF. Yup, twenty-five pounds! And I’m only 18 weeks! This number was a shock to me, but my boobs are ginormous (seriously the skin is so tight that it feels like my boobs are going to explode), I can’t fit my thighs into my regular pants, and my bump is bumpin’. So I see where the poundage is going. 10 of those pounds were gained in the past 7 weeks (normal according to my midwife), so 15 lbs were gained between my IVF stims, retrieval, and the end of my first trimester. To be honest, I blame a lot of those first 15 lbs on the prednisone… Such a nasty drug that gave me moon face and efficient fat storage! However, also a miracle drug that calmed my immune system enough to allow Dumplin’ to thrive. So I’ll take the increased body fat if it means I get a baby.

I will take a new bump photo this weekend and post it sometime soon. 

These days, I’m brainstorming things Dumplin’ will need, so that I can prepare myself for budgeting for it. I’m stuck on a couple of items that are costly and so personal in terms of different people’s habits (like strollers). Maybe I will do another post in a couple of days and elaborate on this.

Lots of love to y’all and have a wonderful weekend! 

14 Weeks… Welcome to the 2nd Trimester!

  I am so grateful to have made it to this milestone. After our 3 first trimester losses in the past year (2 DW’s, 1 mine), the second trimester seemed like a pipe dream. I am not sure if it’s the intralipids, prednisone, or fragmin, but I’m glad that I strong-armed our RE into implementing a more aggressive protocol after my NK cytokine findings in October.

Pregnancy has been nice lately. I’m still a bit pukey at certain times in the morning, usually when I have been slow to get food into my belly, or when I’m brushing my teeth. I’m still on the 4 Diclectin daily, as it’s allowing me less food aversions, so I’m eating healthier. I’m up about 12lbs from pre-pregnancy, and up 17lbs from pre-IVF. I’m starting to not care so much about the weight gain, as my bump begins to show more. 

Sleep has been terrible, as my anxiety has been high from this elevated NT crap. I’m a little less obsessed with it now that the NIPT has been sent off, and there’s just waiting to do now. It’s out of my hands. Work has also been stressing me out, as we are 99.99% going on strike, and that means “bye bye salary!”. As a two-teacher household, we are hit even harder. We have money saved (that was supposed to go towards a minivan), and there is a strike fund that we’ve been paying into for years and years which will start to pay us back and definitely soften the blow. It’s all just crazy town over here though. DW’s is leading her school in this strike, and has been stressed out worse than I’ve ever seen her be. 

I started weaning down from my 10mg of Prednisone last week. Last week I went down to 7.5mg daily, and today I go down to 5mg daily. Next week I will be down to 2.5mg daily, and then off of it completely. During December’s failed FET, they didn’t give me proper weaning/tapering instructions and told me to go off cold turkey. My body didn’t respond well, as I had full-body aches, was exhausted to the point of bed-ridden, and I was super hypotensive (my normal BP is around 100/70, and it went down to 90/70). I’m hoping to avoid all of that this time. I have developed a wider “moon face”, and have probably gained more weight than I would’ve without the prednisone, so I’m looking forward to going off of it soon. I’m still on the Fragmin though, and will probably ask to stay on blood thinners until 6 weeks postpartum because while I don’t have a thrombophilia, my sister had a DVT and my grandpa died of a pulmonary embolism. I’m supposed to stay on the aspirin until the end as well.

My hair remains a mess. The front half has been combed out, but the back is still in dreads. DW likes to say that I’m “all business in the front and party in the back”, which makes me laugh my ass off. A couple of days ago, I had a meltdown because I regretted taking out those hard-earned mature dreads. I hate my hair not in dreads. It’s this super fine, wavy sometimes curly always frizzy mess. I have to put way more work into my “normal hair” than I do with my dreads. DW came home to me bawling my eyes out over this one day, and agrees that I should just redread what I took out. I always wanted my dreads a bit thinner, so I might take this as an opportunity to get what I want. It’ll take a while, but I’m glad I didn’t continue to take more out.

I’m definitely showing now, and DW has been coming home and greeting both me and my bump. My belly kinda asserts itself in our hugs now too, which is kinda fun, thinking that Dumplin’ is part of our hug. Clementine has been guarding my belly more closely now, insisting on lying such that her front legs rest on my belly, in Sphinx pose.

  
I’m getting more and more excited about Dumplin’, and have been itching to pull out the boxes of baby clothes that were handed down from my BIL and SIL almost five years ago. We’ve got lots of shuffling to do of stuff in different rooms. We’re moving the entertainment stuff from the rec room to the living room, the office stuff into the rec room, and turning the office into Dumplin’s room. We chose to keep the spare room as the guest bedroom, because all of our family is from out of town and do often stay over. 

I’ve been visualizing good things for us, partly because it helps me get through this tough time, but also because I’m trying to believe in the law of attraction. In my mind, Dumplin’ is perfect. Early next week, the NIPT results will show no/low risk for all trisomies, and we can breathe a sigh of relief. We start moving furniture in preparation for Dumplin’s room, making space for him/her in our home. The next week, at our early anatomy ultrasound, Dumplin’ measures normal on everything, especially his/her heart. We start setting up Dumplin’s room. Two weeks after that, he/she measures normal for everything at the anatomy ultrasound and fetal echocardiogram. We celebrate by washing, sorting, and putting away the baby clothes we’ve been waiting so long to finally be able to use. The rest of the pregnancy is full of happiness, laughter, and love shared between myself, DW, Dumplin’, and those we care about. We have a wonderful summer spent at the cottage or travelling. We celebrate our fifth wedding anniversary with a baby moon. I return to work in September and love being back at my old school. I am able to work until close to Dumplin’s due date. Dumplin’ is welcomed into the world through a meaningful, intense, birth without fear. He/she continues to be wonderful. These are my hopes and prayers. 

Cent Cinquante Neuf

All-day pregnancy sickness has kicked me in the ass this week. I’m basically doing the bare minimum in terms of daily tasks (feed self, feed dogs, bathroom tasks), and then trying to sleep away the nausea in between. When I am awake, I feel like I’ve got the worst hangover of my life- nausea, headache, flu-like symptoms. My food aversions are terrible too- all foods are grossing me out. I had a bottle of Diclectin (Diclegis) leftover from last pregnancy, and finally decided that it was time to take it. I started it last night, and so far, it hasn’t kicked in yet (heard it can take several days to work) and makes me feel super groggy. I’ve never responded well to Unisom or Benedryl as a sleep aid- it keeps me drowsy but unable to sleep, contrary to what many other people experience (Diclectin as a wonderful sleep aid). 

This morning I dry heaved several times because I didn’t get my oatmeal in my tummy fast enough. However, I was able to finish an entire lunch and had a snack this afternoon. That’s progress!

So today was my viability ultrasound. 

And I have good news….

We have a heartbeat!

Dumplin’ is measuring 6 weeks 6 days (a little short of the 7 weeks 3 days that is based on my IVF dates), and has a heartbeat of 159!

There was also another empty sac measuring 0.6cmx0.4cmx0.3cm that could either be a subchorionic hemorrhage or a second gestational sac. Judging by the shape of it (sphere-like vs. crescent-like), RIP Dumplin’s Vanishing Twin.

So I’m not sure if we’ve graduated from the fertility clinic, but given the congratulations!, random loot bag they gave me, plus the requisition for my OB or midwife to sign off on (for me to do a 12 week screening ultrasound there), I’m guessing we did!



Loot bag (with a post-it note that says ” For OB patients only”)

What was inside the loot bag.

So yeah! They want me to start tapering off my prednisone in two weeks, but after consulting with some other RPL friends as well as investigating other protocols for NK cytokine activity, I’ve decided to go rogue and start tapering at 15 weeks instead. 

The progesterones and Fragmin they want me to stop abruptly at 12 weeks.

The aspirin I continue until 32 weeks. 

The synthroid I will continue as per my endocrinologist’s recommendations.

This week I will have my last intralipid infusion as well.

We are very happy to have viability. Given our losses, it’s difficult to be as bright-eyed and bushy tailed about it, as we know anything can happen. But we are taking it day by day, and are grateful that this little soul chose us.

And of course, we celebrated with some awesome authentic Chinese food for lunch! 



Tomorrow, we meet with our midwives for the first time! 

Thank you everyone for keeping us in your thoughts. Please continue to, as the next five weeks will be difficult as well. 

IVF#2: Embryo Development Day 2

(Image from: http://www.advancedfertility.com/4cell.htm )
On day 2 of development, embryos should have 4 cells. The grading of them depends on the level of fragmentation.

Of our 13 fertilized embryos:
7 have 4-5 cells, and are graded as good
5 have 4-5 cells, and are graded as average
1 has 2 cells, but is still alive and could catch up

I asked the embryologist to give us daily updates, which they don’t normally do. I am so grateful that she is doing this for us, and appreciate the time she takes to answer our questions.

OHSS watch:
Weight: up 0.2 of a pound
Waist measurement: up 1 cm

How I’m feeling: Ovaries are still sore, especially with movement, peeing and pooping. The Dostinex is still making me super nauseous despite taking it at night and with food. DW made me a great breakfast in bed: GF grilled cheese and soft boiled eggs, with a side of Gravol.

Today, I start all of my embryo transfer meds:
– prednisone 10mg
– endometrin (progesterone suppositories)- 100mg x 3 times a day
– prometrium (progesterone orally)- 300m at bedtime
– Fragmin injections

*TMI Warning*
Shoving the Endometrin in my vagina was a real treat this morning (not!). My vagina is clearly still in the early stages of healing after all the egg retrieval punctures. I couldn’t get the suppository more than two inches inside, because everything was clenched and hurt.

I’m a little worried about the Prednisone, because last time (failed FET) it caused major comfort food cravings, as well as water retention. This time, I’m trying to stave off OHSS, and the last thing I need is to crave bad food and retain water. However, a nice therapeutic effect of the prednisone is that it made my digestive issues go away. Honestly, my usual IBS and Celiac issues seem to go away when I’m on the Prednisone, which is wonderful.

FET#4: Protocol

There are a lot of meds involved in our FET this round, and I thought that I’d like to document it, both for myself, but also to help anyone else who is also going through this. The days refer to cycle day, and non-medical supplementation is in brackets (Chinese Medicine herbs).

Days 3-16: Estrace 6mg daily

Days 3+: ASA 81mg daily

Day 13: Intralipids

Day 17+:
7:30am: Prednisone 10mg, Estrace 2mg, Pink PregVit, 100mg Endometrin, (1000IU Vitamin D, Yuan Support Formula- 4 tablets)
3:30pm: Endometrin 100mg, (Yuan Support Formula)
Dinner time: ASA 81mg, Blue PregVit Folic 5
11:30pm: 5000IU Fragmin, 2mg Estrace, 300mg Prometrium, 100mg Endometrin, levothyroxine 25mcg, (omega 3 fish oils, Yuan Support Formula)

Day 21: Frozen Embryo Transfer

Day 31: HCG beta test

Day 33: Repeat HCG beta test

Sometime after Day 33: Intralipids

Tips:

– Set time alarms on your phone so that you take your meds at the proper times.

– But a pill schedule case like this to organize yourself:

– inject the Fragmin super slowly

– protect your underpants from leaky Endometrin using long and wide, but super thin panty liners. Better yet- make your own cloth ones, they are so much more comfortable

– clean your lady parts after Endometrin messes, or else it seems to burn down there

I just started the huge combo of meds today, and let me tell you, the Fragmin burns like a B$&@H! I was perfectly fine with the Lupron, Follistim, and Ovidrel injects during my stimulation phase, but this needle would not break the skin without significant force, and while I plunged very very slowly, the medication itself causes a strong burning sensation. I had DW hold my fat roll for me because I needed two hands to steadily depress the plunger, and it felt like she was pinching me as tightly as she could with fingernails (she wasn’t- that’s just what the Fragmin felt like going in). Anyway, I will find a way to make it work, as it needs to be done daily, but right now it is a not-so-distant unpleasant memory. Some advice: have someone else inject it for you, inject the drug very slowly, stop and catch your breath after the burning feeling, inject some more, and so on.

We also keep a stash of homemade organic tea tree and witch hazel wet naps by the toilet to help me “wipe up” any nasty Endometrin leakage (vaginal suppository). I am back to wearing large Cadillac-sized panty liners again too (so as to not ruin my underwear), so the wipes help to prevent some of the chaffing I experienced last pregnancy.

Happiness Cycle Day 14: Downtown

DW took the day off work today, as we had a day of medical appointments, in town and out of town. She has also been so busy and overworked so far this semester that she really needed a “mental health” day as well.

I must mention that I finally had a good sleep last night, after almost a week of terrible anxiety-induced insomnia.

This morning DW made me a decaf coffee (such a nice treat to be served coffee in the morning), we gave the dogs got some consolation pats on the head, and we were on our way.

Our first stop was the fertility clinic’s satellite clinic, which is in our city. I needed to have my blood work and ultrasound monitoring again. Things are on track, with my uterine lining measuring 9.4 today, up from 8.7 of two days ago. I also got a “present” from one of the receptionists, who wasn’t working today, but had mentioned last time I was in that “she’d give me a troll to put down my pants”. I wasn’t sure what she meant by that, but she meant Treasure Trolls, those dolls from the 80’s, for good luck. We joked about for a bit- especially the part about putting one down my pants. Anyway, today, the phlebotomist nurse gave me this on behalf of the receptionist:

So thoughtful and sweet!

After that, we headed downtown, to see my family doctor. I was really nervous and stressed about this appointment, not knowing how to describe and explain the overwhelming emotions and feelings that I have been experiencing since the miscarriage. When we got there, my family doctor was super attentive, gave me room to talk, listened patiently and compassionately, and gave some good advice. I shared with her how depressed and anxious I have been feeling, how it has continued to affect my sleep and made me weary of socializing with friends who aren’t aware of our situation. She had me complete some forms: a depression questionnaire, an anxiety questionnaire, and a survey on the impact of my feelings on my activities of daily living. It was the first time that I had taken inventory of various aspects of my depression and anxiety, and how it has been affecting me beyond just my feelings and sense of hope for the future. This whole time I’ve been so consumed and obsessed with our miscarriage(s) and getting back to making babies that I completely lost sight of how I have been doing as a person. I mean, I knew that I was depressed, and I knew that I had an anxiety problem, but I had always placed them under the context of the miscarriage, and not really that they themselves are focal points that need to be addressed.

I have battled depression before, and had reached a nice homeostasis with Wellbutrin for years. When I first met DW, I had already been on it for many years, but like most people with mental health issues, because I felt better, I thought “why not, let’s try life anti-depressant free!”. That was a couple of years ago, and for the entire time, I have been fine. However, with the fertility challenges and heartbreak of three miscarriages, I think my dear friend depression has snuck back into my life, and has brought his asshole friend anxiety along as back-up.

I have mentioned my emotional struggles on my blog many times, but didn’t realize how bad it has gotten until I answered those questionnaires, and saw and felt the true concern in DW’s and my family doctor’s feedback on how I seem, and have been behaving. I guess this is sort of what an intervention feels like. I’ve been so caught up in my own head, and needed to hear what other people are observing. My depression and anxiety are a big concern right now, and my family doctor is concerned enough about it to suggest that I start some medications right away. She suggested Cipralex, which is an SSRI, and is effective for both depression and anxiety. I would love feedback from anyone who has taken it before. She says that it is safe before, during, and after pregnancy, even though Dr. Google claims otherwise. But I am convinced that you can search anything and find support for it in the form of a online support forum. This I have learned from the all-consuming world of TTC.

She wants me to double check with the RE that he Cipralex won’t interfere/interact with all of the other stuff that I will be on: estrace, prometrium/endometrin, aspirin, fragmin, prednisone, intralipids. I’ve emailed the RE’s nurse, so hopefully I will hear back soon.

I have mixed feelings about taking the Cipralex. On one hand I think that it would be better for me to just tough it out, that it’s normal to have feelings of sadness and despair, or constant worry, given what I’ve been through. On the other hand, it is becoming more and more apparent to me that my depression and anxiety levels are abnormally high, and the culmination of evidence is that that can negatively impact our potential pregnancy even more than the small risk of cardiovascular defects and autism that have been reported but not confirmed. I look at DW, and some of you who seem “recovered” from your miscarriages, and wonder why I’m still stuck in this destructive loop of depression and anxiety. I realize now that it’s because I am struggling with an extra layer of mental illness.

Work has been harassing me again as well. In the past seven days, the person in charge of leaves has called me three times and emailed me once. This is after talking to her already the first time. She didn’t have anything new to discuss the subsequent times, but rather has been very negative and pushy in her tone. DW says that if she calls me again, that we should complain to the union. The last thing you want to do when you have an employee suffering from a mental health challenge is harass them.

Anyway, after my doctor’s appointment we went out for lunch at our favourite Vietnamese place.

Then grabbed some baked treats down the street at this great little bakery we found by accident one day the last time we were here. I got a gluten-free chèvre cheesecake, and DW got “the best butter tart ever”, as well as a pear almond tort-like thing that has a fancy French name that I don’t remember.

We then went shopping at our favourite outdoor store: Mountain Equipment Co-op, where we caught up on some much needed shopping, and bought a couple of early Christmas presents (me mostly).

We also got a call from our primary nurse today. I am supposed to start my long list of meds on Saturday, in preparation for our embryo transfer on Wednesday morning!

I hope that time moves fast, as I’m anxious for our last embryo to come home, but I also feel like I need some time to process everything that has happened today. The good, and the bad new.

Happiness Cycle Day 13: Intralipids

I’ve got two hours to kill while hooked up to an IV bag of intralipids, so I thought I’d type up a post with my left hand. It’s harder than it seems!

I had a crappy sleep last night, as something’s up with my digestive system. I had the worst bloating and gas, which continued overnight and into the morning (poor DW). My diet is so clean right now, that I have no idea what could be causing it. My colon felt like a balloon that was inflating and reaching its maximum stretching ability. As I lay here hooked up to a bag of mayonnaise, all I wanna do is fart. But because they’re checking my vitals frequently, and I’m in a closed room, I’m trying to hold it in. Unpleasant!

Anyways, I’m happy to be doing the intralipids. It gives me some hope for this FET. While I wish we had two embryos to transfer, that’s nothing I can change. All I can do is give all of my love and hopeful energy into this embryo. The RE finally reviewed all of my immune results and wants to put me on prednisone, fragmen, and baby aspirin, in addition to the estrogen and progesterone that I will be starting someday soon. I’m happy that it seems like we’re finally being taken seriously now. Fingers crossed that our embryo is a good one, and that he/she thrives inside me.

As for the intralipids, today I’m having 100mLs injected into a bag of saline, to create a 20% mixture. Then the mixture is introduced to my bloodstream via IV cannula. I’m glad that I brought a blanket, because I feel so cold not being able to move. I also brought my iPad, a decaf vanilla Earl Grey Tea almond milk latte, and two slices of the paleo banana bread that I made last night. I haven’t been able to do much other than type on my iPhone.

Once I get a positive beta, there’s another infusion (approx four weeks), and then one more after the six week ultrasound. Each treatment is $750, and out of pocket.

The cannula hurt going into my arm, but is fine now that it’s in. I can’t feel the intralipids at all, though I feel colder than usual overall.

The nurse comes by every 30 minutes to check my temperature, blood pressure, and heart rate,

It’s been about an hour and a half, and I’m almost done:

Tomorrow I have to go in for monitoring blood work and ultrasound again. Hopefully we will find out when our transfer will be. We also meet with our family doctor, who will hopefully agree that it’s in my best interest to continue being off work until I’m in the right state of mind to deal with those additional stresses. DW has taken the day off tomorrow to support me.

More updates tomorrow!