I went to Life Labs for a repeat of my hCG, progesterone, and TSH levels with my standing order from the Victoria Fertility Centre. They had explained that the hCG should double (every 48-72 hours), the progesterone should maintain, and the TSH should not climb much more (if it was over 2.5, it would be a problem).
I waited in the waiting room of the lab under a mural of some anonymous and fit woman on the wall.
Then I waited some more in the blood drawing cubicle.
The woman who was drawing my blood went with my somewhat less reticent right arm, but still had trouble getting blood from me and after I protested in pain, she abandoned the one site and tried again in the same arm to get a cooperative vein. She eventually succeeded, but I was left with a very handsome double cotton ball and tape look.
I then drove over to the gorgeous old hospital that houses my psychiatrist's office. Who knew hospital architecture could be so graceful?
I waited in the beautifully lit waiting room of the old hospital for my psychiatrist.
My psychiatrist congratulated me and explained that a medical resident would be sitting in on the meeting for learning purposes. That was fine with me.
He said that he had referred me to a perinatal psychiatrist. I said that he had not and that I had had to go to my GP to get a referral because his receptionist had told me that he could not do it. He was baffled. He said that he had just written my referral last Friday and that he was going to have to talk to the receptionist to figure out how his message had become so scrambled. He apologized for the confusion. I was annoyed because it meant that I had had to take another visit to yet another doctor unnecessarily, but that's this medical system for you.
My psychiatrist gave me a requisition for yet more blood tests. He will be testing my renal function as well as my blood levels of my medication to ensure they are at a therapeutic level and safe for the pregnancy. Of course, as we discussed, it is really not completely safe to be on most medications for pregnancy, but it is more dangerous if the mother deregulates, has a mixed, hypomanic, manic, or depressive episode, as this puts undue stress on the fetus. Really, it is a balancing act where the lesser of two evils is chosen. In my case, the perinatal psychiatrist who I consulted with two and a half years ago, said that I need to stay on my medication and just be monitored frequently during pregnancy. She also added that while older clinical trials had claimed some increase in birth defects from using the medication during pregnancy, more recent trials had failed to demonstrate an appreciable risk to the fetus versus the risk if I stopped the medication and destabilized.
My psychiatrist told me to keep track of my moods (I do this daily using a mood tracker form) and if they are low, do a QIDS inventory to keep track of what my depression score is week to week. I have done this in the past and it can help to assess how effective any PRN medications you are taking are (PRNs are medications that you add on to your regular medications in times of need for instance for conditions like anxiety, panic attacks, sleep problems, hypomanic or mixed symptoms, or depression).
He told me that if my mood destabilizes, I should book in to see him earlier than the two month follow up appointment that he was going to book for me. When I explained that it was almost impossible to get into see him because his schedule was always so full and that the receptionists almost keep him on lock down, he seemed dismayed that it was so difficult for me to get in to see him. He said that using the keyword "pregnant" was the way to ensure that they would fit me in.
He also said that if I ever had to go back to the hospital due to destabilization of my mood or for a dramatic adjustment to my medication, he could put me on a wait list so that I could skip the horrendous emergency triage for psychiatric treatment (PES) that we have in Victoria, BC. I told him that that would probably take months (how long other patients in the hospital had been on the wait list before being able to go straight to the hospital for treatment without having to go through the seventh circle of hell, PES). He said it should take about two to three weeks. I told him that usually when moods get that bad you don't have that amount of time to wait and you need to hospitalized immediately. He agreed, but he said that all we can do is try to work with what we have in this system. How depressing.
He told me to review my lab test results online and if my blood level of medication drops below the therapeutic range that he gave me, I should call him to get in early to see him. If the level was good, then I could wait four weeks to retest. If the level was bad, I should retest in two weeks. Once I'm into August and see him again, I should probably be testing my blood medication level every two weeks to ensure that the level is therapeutic as my weight and blood volume increase.
I went home and waited for the lab test results to appear online that evening so that I could see where my hCG, progesterone, and TSH were. My husband and I reviewed them together and were instantly concerned.
The hCG level was exactly the same (it should have increased dramatically from the last test), the progesterone had basically halved, and the only good news was that the TSH (which my endocrinologist says is a useless measure that should not be relied upon) was slightly lower.
It was too late to hear from my nurse coordinator, so my husband and I did what anyone would do now, scour the internet for comfort. Some sites seemed to say that hCG could be lower and things could still be okay and that it might not be a reliable measure. Some sites said that we were still at an okay level of progesterone for our number of weeks. We felt really worried though, as we had been told something completely different by our nurse.
In the morning, I called my nurse coordinator. She reviewed my first set of lab tests and then the most recent one. She said the most recent test did not look good at all. She said she'd never seen something like this in her twenty years in the industry (the hCG staying at the exact same number between two tests). She said she was 95% certain I would not have a baby this cycle. She said that it was too soon to tell, but it could be an ectopic pregnancy or the blastocyst could have implanted and then lost steam and that it was just burning out now. She said the only way we could know more was for me to get another lab test done the next day. She was very gentle and sympathetic, but I wanted off the phone as soon as I could. I felt like I couldn't completely lose it in front of this kind and professional stranger.
I was devastated and texted my husband to call me when he could. He called me immediately. I told him the horrible news. He said he would come home early. I told him not to bother, because there was nothing he could say to make me feel better and there was nothing we could do in any event. We were completely helpless and trapped, a position we have been in far too many times in the past six years.
When my husband arrived home (early as he had suggested), we took turns bawling our eyes out. Our dreams are shattered. I feel like I'll never come back from this. The chance that we are actually still pregnant with a viable embryo is less than 5%. Those odds are far worse than the flip of the coin odds (50%) that we were given for becoming pregnant with IVF or staying pregnant after successful IVF, 75% to 80% (and those odds already sounded dicey enough to us).
We then had to tell our currently elated families that their dreams of a grandchild, niece, or nephew had been dashed all in a single lab test. We could hear the helplessness in their broken voices as we tried to keep ourselves together enough to tell them the untellable. Any advice that was given by our families (keep your head up, just relax, don't worry you'll get pregnant again, just give it some time) fell on deaf ears burning with rage and sorrow.
I don't know how I'm going to keep it together enough to go to the lab to have the next test done tomorrow. I cannot believe I'm not in a nightmare, but wide and very painfully awake.
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