The Past Ruling the Present, Being Afraid of the Future- Trying to Deal with a Past Miscarriage When You're Pregnant Again

Current mood . . .

A lot of people suffer from miscarriages. But they don't talk about it. That is unless you start to talk about it. Then people start emerging from the woodwork to tell you about the miscarriages that they have suffered from or those of someone close to them. I had no idea that so many people who I knew or was casually acquainted with had suffered from miscarriages in the past until I had one in June of this year.

While it's comforting to know that you're not alone when you've had a miscarriage and that people do survive miscarriages and even go on to have healthy children and seemingly normal and functional lives, it doesn't quite move you past the trauma of having suffered from a miscarriage. I never thought that I'd suffer from a miscarriage. I suppose that almost no one thinks that they ever will (unless you have a family history of it that is openly discussed and not hidden). I think that I took it even harder than I might have otherwise (if that's possible), because it had taken me so many years to become pregnant and at the age of 36 I knew that my time to have children was running out (and that my risk of miscarriage was rising with each passing month). Also, it was on the eve of getting IVF for the first time that I became pregnant naturally, so I felt enormous relief that I would be avoiding IVF. Well, as anyone who has been reading this blog knows, I did not avoid IVF in the end and in fact have now gone through a full cycle of IVF attempting to get pregnant for a second time (and hoping to actually have a baby this time).

I am pregnant now. I will be six week pregnant tomorrow. This fills me with terror. I should explain that my miscarriage in June started the day I would have been exactly six weeks pregnant. And the bleeding continued heavily for a week. I was physically, mentally, and emotionally shattered by the experience and continue to suffer from flashbacks to it.

Now that I'm pregnant again, I'm even more preoccupied with this trauma that I had tried to suppress and/or move past in the last few months. I cannot imagine having a second miscarriage, especially in the same year. I know that many women go through more than one miscarriage, but how do they survive it? How do they have the strength? I feel like I'm in such a fragile state now (copious amounts of hormones from not just the pregnancy, but also the hormone prescribed to me until week 9 of my pregnancy by my reproductive endocrinologist are no doubt not helping this emotional rollercoaster) that I would never survive if I had another miscarriage. And if I did have another miscarriage, I'd never be the same again (of course those who have read the Greek philosopher Heraclitus will remember his opinion that no one can ever step in the same river twice, we're different people each day, change is the only constant, etc.). I don't know if I'd ever get up the nerve to try to get pregnant again if I lost this pregnancy.

This IVF process has been a nightmare. I've now been on artificial hormones constantly for two months (but changing types and doses of hormones from week to week) and I feel utterly worn down physically, mentally, and emotionally. I know that we have five embryos stored and that I wouldn't have to go through a full cycle of IVF unless we used up every one of those frozen embryos first, but even in order to get a frozen embryo transfer done, one has to go on hormones, stay on hormones until one is pregnant for at least a couple of months, and go through the nail biting wait again to find out if one is pregnant, if one is going to stay pregnant, and whether or not the baby is healthy etc. Maybe it's just not meant to be.

But I have to bring it back to the present moment. I have to remind myself that I am safe in the present moment. I am trying to meditate and practice mindfulness, but this is a great challenge. Fear is a primal emotion that can easily take over especially when we are feeling exhausted, weak, vulnerable, and unwell. I certainly feel that right now. Hormones are making me even more prone to catastrophic thinking than I normally am.

I am probably still pregnant. I feel absolutely wretched and that's probably not all the prescribed hormones (progesterone and estradiol). They say it's a good sign to feel crappy in early pregnancy. Also, I have not had any bleeding. My hCG numbers doubled appropriately and started from a very good number. My endocrinologist is carefully managing my thyroid levels. I have excellent care from a reproductive endocrinologist who has 30 years of experience with IVF. I have followed all the instructions. I have been resting, eating well, sleeping as much as I can, and taking all the medications as prescribed.

But I won't find out till November 10th when I have my first ultrasound if there is actually a heartbeat. Maybe there won't be a heartbeat. Maybe the pregnancy was false or I have miscarried again. This is such an agonizing wait. And I think it's made worse by not having any children, being older, being constantly reminded of my high chances of a miscarriage (20-25%), and the fact that I've had a miscarriage in the past. I also don't think it's helped by the fact that I have gone through a two month hormone laden journey getting IVF and it's not even over yet (three more weeks and one day of hormones left). It's expensive (well over $14,000 now and our insurance company is refusing to reimburse my prescriptions so my husband is having to fight with them about this just to add to the stress)), it's stressful, it's alien, and almost no one understands what it's actually like. I've never felt more alone in my life. I have met some lovely people through social media on IVF.ca in the VFC 2016 chat board, but it's not the same as actually being able to talk to people in person (the only person I've been able to do this with is Stephanie from Elements of Health who does my acupuncture).

My husband just returned from a business trip the night before last. He was only gone a few days, but when I found out that he might be leaving again soon for another trip and having to take regular trips for the next two and half months perhaps every week, I felt really upset. It's not that I can't handle being alone, it's that I've never felt more alone in my life (and he's the closest person to me in this infertility nightmare because we're both sharing in the pain of being a childless couple when we always wanted children). This infertility journey has been the loneliest one I've ever taken. And it's not because no one has offered love or support, it's because no one knows what it feels like and I just feel like I can't relate to anyone anymore (even my husband doesn't know what it feels like to be on mind warping artificial hormones for two months and counting, having painful medical procedures for IVF repeatedly, get tests all the time, to have suffered physically from a miscarriage, and to be pregnant for a second time not knowing if I'll have a second miscarriage).

I get that I can't control the future and there's nothing that I can do that I haven't already done already to prevent a miscarriage, but this helplessness is an awful feeling. It is terrible to sit with this discomfort and to try to accept that I am helpless. When people have had a childhood where they lacked stability, the feeling of helpless is probably an even worse feeling than it is for those who had stability.

This past week I have been plagued with even more physical wretchedness and a deeper feeling of gloom. Progesterone can cause depression and I'm getting more than my fair share due to the prescribed twice a day dose of Endometrin (progesterone) on top of the pregnancy produced progesterone. I'm sure the Estrace (estradiol) isn't helping either. This isn't just a "normal" pregnancy due to the added hormones because of the IVF.

The cat's expression sums up my mood lately.

As soon as last Friday hit (5 weeks pregnant), my feelings of nausea, gas pains, food aversions, and sense of smell increased a lot (I had to leave a supermarket on Saturday because some smell in there was making me sick). I feel absolutely grotesque. I had to ask the Victoria Fertility Centre if I could take Simethicone or not to help with the horrible gas pains that had me doubled over in agony and were interfering with my sleep earlier this week. I was allowed to take it and it seems to have  helped and the gas pains seem to have decreased now. This process is just so uncomfortable in every way.

Prune juice, Metamucil, and gas relief pills . . . ah life is grand.

The dizziness, low blood pressure, unsteadiness, and terrible headaches continue to plague me. I feel irritable, depressed, and anxious. The Dexamethasone withdrawal is making me achy, stiff, sore, and wretched. Generally, I feel like an old grouch.

Just leave me alone.

I went for acupuncture yesterday. I am still going for weekly hour long session with Stephanie at Elements of Health. These sessions are supposed to support my pregnancy and help alleviate some of the symptoms of pregnancy and the side effects of the drugs that I'm on because I had IVF. There is a big bruise on my chest from one of the needles last week, other than that I haven't had any bruises from acupuncture. The human body is pretty amazing. With all of those blood vessels and capillaries, I don't know how people don't bleed to death or at least bruise more often. She put the needles in my lower legs to connect to the meridians that support the uterus, needles in my chest to help with anxiety, one needle in my very upper stomach to help with the upsurge in energy in my stomach (and associated heartburn, gas pains, nausea, constipation, etc.), and needles in my head for lifting and holding the pregnancy.

Before I got onto the acupuncture table and cried my eyes out thinking about my last miscarriage and the possibility of another one.

You can see the bruise on my chest from my last acupuncture session a week ago, as well as needles in my head and chest.

On hearing that I was suffering from worse nausea, Stephanie suggested that we try the points on my inner forearms again that had bothered me last time (I'm one of those people with a shallow nerve in that area that doesn't like being poked by a needle- but that's the best point in the body for nausea), but instead of using a needle, she would try a tack this time. It's not as horrifying as it sounds, they're like the seeds that acupuncturists use on ears, but they have a tiny point on them that sticks into the skin a bit and then a bit of bandaid-like tape over that holds it onto your skin. I said I'd give it a try since I was barely keeping it together at that point (I was sweating from the waves of nausea by the time I entered her office). The one on my left arm had to be removed at the end of our session, because it was really bothering me, but I left the one on my right forearm on. She said it could be left on as long as it didn't bother me for even a few days. This afternoon after a shower it fell off and I'm not fussed because I don't know if it helped me that much and it was feeling painful and itchy on and off, so maybe it was time for it to come off. I had a slight red pinprick mark on my right inner arm where it had been.

The little bandaid thing on my forearm has a tack under it sticking into me.

At the bottom of the picture a slight red mark shows where the tack was sticking for about 24 hours.

The tack up close.

Exactly two weeks from today, my husband and I will be having our first ultrasound hoping to hear our baby's heartbeat (I will hopefully be seven weeks and six days pregnant by then). I only hope that we will hear a heartbeat and not the sound of our dreams of ever having a child shattering further. It's very hard not to let your past rule your present and make you fear the future.

I just want to sleep away this uncertainty, unfortunately my sleep is still not very good. Luckily, I have the cat as inspiration.

Next Steps, Endocrinologist, My Current Medication Protocol

Autumn is filled with a haunting kind of beauty that makes me smile even when I'm preoccupied with dark thoughts.

The Victoria Fertility Centre called early yesterday morning. My nurse coordinator said that my blood test results were normal and the hCG had doubled as it was supposed to, so no more blood tests were required. She booked me in for an ultrasound at the Victoria Fertility Centre on November 7th. Thankfully this one will be with an empty bladder. We discussed when I should come by to pick up more Endometrin (progesterone), as I only had enough to last me through today. She said yesterday would be better, so I said I'd be dropping after I left my appointment with the endocrinologist.

My appointment with my endocrinologist was scheduled for noon yesterday. I appreciate that he fit me into his very packed schedule, at the last minute, to review my thyroid levels and ensure that they are maintained at an optimal level, as this is absolutely crucial in pregnancy, not just to help maintain the pregnancy (miscarriages can be caused by suboptimal thyroid levels), but also for the health of the fetus (harm like brain damage can be caused to the fetus if thyroid levels are not in healthy ranges).

In preparation for the appointment, I weighed myself to mentally prepare myself for him weighing me, which he does every appointment (I hate this aspect of the visits). Six and half weeks ago, the day I was starting my first hormone before the first cycle of IVF, I weighed myself and I was sure that I must have gained weight, since almost nothing that I own fits now and I look very bloated, especially in the abdomen. But I had not gained a single pound. The human body continues to confound me. Sometimes in the past when I've weighed myself expecting to have lost weight, I've gained weight, and the opposite as well, and now this.

My endocrinologist was not satisfied with my thyroid levels (but it certainly wasn't the TSH level that bothered him- he says that TSH levels are not very useful and can be wrongly interpreted, especially when women are pregnant owning to the identical back end of LH, FSH, and TSH which leave them vulnerable to being misinterpreted on lab tests). He raised my levothoroxine dose from 100 mcg to 112 mcg. He left my liothyronine dose at 15 mcg. I'll be retesting my thyroid levels at the lab just before my next appointment, which will be in three weeks (normally it would be in four weeks for pregnancy, but he want to make sure he gets my levels optimal as soon as possible). He weighed me and commented that I hadn't gained any weight since my last appointment (two months ago), despite the hormones/pregnancy, but that "we don't necessarily want to see any weight gain in your pregnancy." I am overweight (or according to the BMI which many say is not a reliable measure of fitness, obese), but I doubt I'll be able to go through a full pregnancy without gaining a single pound. But one battle at a time. As we parted, my endocrinologist congratulated me, but warned me that it is very early yet (believe me, I don't need any more doom and gloom over my head about the chances of a miscarriage- I'm producing enough of that on my own).

My thyroid levels on Monday October 17th.

My thyroid levels on Wednesday October 19th.

I picked up my new prescription of levothyroxine at the pharmacy. However, as usual my endocrinologist gave me instructions on how I could use up the old 100 mcg dose tablets (he's really good about the waste not want not, unlike other doctors who just advise you recycle the old doses and buy the new dose).

In between the pharmacy and the pharmacy at the Victoria Fertility Centre, picking up all my meds.

I drove out to the Victoria Fertility Centre to pick up more Endometrin (progesterone) to last me until my first ultrasound. At the same time, I rescheduled the ultrasound for November 10th, as my husband had an appointment come up at work and wouldn't be able to make the original time/date. The two more boxes of Endometrin only set me back $200.00, which after the injectables seems cheap. I have enough Estrace (estradiol) to last until the ultrasound. Dexamethasone I'm weaning off of and I have enough of that to last me until I stop it in a week and a half. I'll need to pick up more Estrace and Endometrin after my ultrasound to last me until I'm at 9 weeks gestation (four weeks from today).

In addition to the Endometrin and Estrace and the Dexamethasone that I'm weaning off of, the prenatal vitamins, extra folic acid, and vitamin D continue as well. The schedule of medications requires dosing twice a day for Endometrin, three times a day for Estrace, once a day for Dexamethasone, and a different combination of vitamins three times a day, but at least there are no needles now.

Arriving at the Victoria Fertility Centre again.

The side effects that I'm currently experiencing are hard to separate from what might be considered symptoms of early pregnancy. I'm five weeks pregnant today. I'm still suffering from migrainous headaches, dizziness and low blood pressure, unsteadiness on my feet at times, and some nausea. I'm still having some gastrointestinal distress and constipation. I have tender and swollen breasts. I am very bloated in the abdomen. Also, I'm exhausted, but I'm still having broken sleeps interrupted by getting up to pee (increased urination during the day as well) and sometimes having trouble falling back asleep. Food tastes weird and my appetite is all over the place. On the mental front, I'm still feeling anxious and having some panic attacks. Also, I've been feeling kind of depressed. I know that I should probably feel happy, since I really wanted this pregnancy, but I can't help but feel that if I act too happy, the rug will be pulled out from under me again like it was last time (the miscarriage in June of this year). Plus I think that the extra hormones between the prescribed hormones and the pregnancy are making me moody and emotional.

The withdrawal from Dexamethasone is certainly producing noticeable symptoms. Dexamethasone is a corticosteroid hormone (glucocorticoid) used for conditions like arthritis, but for IVF it is used to suppress the body's immune system response to make the body more cooperative in the IVF process (it has to be discontinued because I'm pregnant now). I feel like an old woman. I'm achy and sore in the joints and muscles.

Fortunately the cat is always up for snuggling in bed when I'm not feeling well.

When I realized that I'm five weeks pregnant exactly today, I felt commingled excitement and terror. I feel really nervous about being five weeks pregnant because I miscarried at exactly six weeks pregnant last time and that's only one week away. I know that I need to try to relax and not be overly anxious, but it's really difficult to not believe that history will repeat itself again and I'll be left broken, shattered, and unable to ever recover again.

My husband boosted my spirits yesterday by bringing home a beautiful bouquet for me.

I'm looking forward to a week less filled with medical appointments next week than this week was. My nurse coordinator from the Victoria Fertility Centre emailed me today to ensure that the endocrinologist had looked at my thyroid numbers and had given me advice and to make sure that a psychiatrist is reviewing my medication now that I'm pregnant. I was happy to report that I have my endocrinologist's advice and a perinatal psychiatrist is following me. Next week, so far all I have scheduled is acupuncture. I'll be having acupuncture once a week for an hour to support the pregnancy for the next while.

I was actually out of my pajamas tonight.

My husband suggested a stroll tonight and we walked a few blocks from our place to a restaurant in Cook Street Village for dinner. It had been two weeks since I last tried going for a walk (also with my husband) and I had a lot of trouble with dizziness and being unsteady on my feet again. It confirms for me that I can't go out for even a short walk alone (the last thing I need is to fall and hit my head). The medications seem to wreak havoc on my equilibrium and blood pressure and I keep on feeling like I'll faint and having to grab onto my husband's arm. But at least I have someone to lean on.

The autumn colours are glorious.

The Second hCG Test Results, Thyroid Testing, and More Acupuncture

As mentioned in my last post, I was scheduled for a second hCG test this morning at Life Labs. At the same time, I had my thyroid levels tested (TSH, Free T4, Free T3) as I suffer from hypothyroidism and optimum thyroid levels are crucial to the success of a pregnancy and the development of a fetus (thyroid levels that are even slightly off of optimal can lead to miscarriage or harm to the fetus like brain damage).

But first, let me go back to yesterday. I received a call at 8:00 AM from my nurse coordinator at the Victoria Fertility Centre. She was very concerned by my elevated TSH level (this test was added onto my Monday hCG test after the fact by Dr. Hudson). The level of 5.17 was on the high side. She advised me to increase my levothyroxine (thyroid) medication. I told her that I had already put in a call to my endocrinologist and I would be receiving advice from him.

My endocrinologist specializes in thyroids. In fact, that's the only gland he deals with, unlike many endocrinologists. I had to fire my first endocrinologist after a series of bad experiences and his failure to bring my wayward thyroid under control (which led to an escalating level of health problems and having to take a leave from my job which I was eventually laid off from as my absence stretched out from weeks to many, many months). It was difficult for anyone to stabilize my thyroid (a family doctor, a naturopath, and an endocrinologist all tried without success.) However, my current endocrinologist after time and patience managed to do what no one else could and achieved optimum thyroid levels in me. Yes, my thyroid is considered brittle, so it can just flare for no reason. Yes, I still don't have a confirmed diagnosis of what exactly my thyroid disorder is (it's "suspected" Hashimoto's Thyroiditis or Disease). Yes, my thyroid is slowly dying and the levels need to be tested relatively often and the medication adjusted regularly to maintain my thyroid levels. And yes, I'll be on medication for my thyroid the rest of my life. But, he's taken me off the wild thyroid rollercoaster ride that I was on for years and has given me back some semblance of stability. And given his hard work and expertise, I would never take advice from anyone else on whether or not to increase my thyroid medications, especially not based on just a TSH level.

My endocrinologist doesn't believe that TSH levels are useful at all. He called into Life Labs and added on Free T3 and T4 level tests to my blood test that was done on Monday after I called him (and the results popped up Tuesday online- see above). His assistant has managed to squeeze me into his tight and always overloaded (and very wait-listed) schedule tomorrow. He will tell me if I need to adjust my thyroid medications (I take levothyroxine and liothyronine- he's one of the few endocrinologists that uses this adjunctive therapy for difficult cases of thyroid disease) and I will only listen to him. I used my requisition from my appointment with him two months ago to have my thyroid levels tested again this morning to ensure that he has the latest numbers for our appointment tomorrow (I wasn't supposed to see him for another month, but he insists on seeing any of his patients who become pregnancy immediately to ensure that their thyroid levels are perfect, to decrease the chances of miscarriage or damage to the fetus from suboptimal thyroid levels).

When I pulled up my sleeve to get my blood test this morning, I could still see the mark from my blood test on Monday. But I get blood tests so often, it's just routine now.

Waiting for my blood test.

First vial.

Second vial.

My fancy arm dressing.

After my blood test this morning, I wandered to the pharmacy across the street, Forbes IDA, which has a great selection of natural foods, dried fruits, nuts, dark chocolate, Dutch licorice, and interesting spices and random items that come and go. I killed some time there (and picked up some prune juice since my intestines are still very sluggish).

From the pharmacy, I had a good view of the "snake building" as I call it. That's where that lab is (and the Chamber of Secrets).

I drove to my next appointment of the day, which was my once weekly acupuncture session of one hour with Stephanie of Elements of Health. I arrived early and read one of the numerous books in the waiting room and had a glass of water. She has an excellent selection of books on hormones, reproductive health, pregnancy, etc. in her waiting room.

Waiting for acupuncture.

Stephanie asked what my number was on my hCG test. She said that 440 is a very good/solid number for the first hCG test. I asked her if it's true that hCG numbers should double in 48 hours. She said that that's what they look for and if it doesn't double then it's a red flag that something could be wrong (but not necessarily- sometimes the number will catch up a little later/ sometimes in the ultrasound three weeks later everything is okay despite hCG numbers that were not doubling). She said that I'll probably not have to take another hCG test after this one, unless the number on this test doesn't look as it should (that's what happened to me last time I was pregnant and then I had to keep returning to the lab until my hCG levels were in the non-pregnant level to ensure that my body had actually aborted everything and I didn't have lingering tissue or an ectopic pregnancy).

Stephanie said that if the numbers look normal on the hCG test today, then I'll be waiting for an ultrasound at the Victoria Fertility Centre in about three weeks (this is earlier than people with "normal" pregnancies get an ultrasound and they get theirs at one of the lab/imaging places around town). Unless there is abnormal bleeding or something that seems off, my first ultrasound will be at the Victoria Fertility Centre. If there is abnormal bleeding or some other concern, then I would be sent to one of the imaging places in town. Sometimes people with seemingly normal hCG numbers go for their first ultrasound and then they can't find a fetal heartbeat or the sac doesn't look right and that's when they find out that they won't be having a baby after all. I don't know how I'm going to breathe for the next eight months (if I'm lucky enough to make it that far).

Stephanie put needles in my lower legs to connect to the meridians that support the uterus, my chest to calm me during this anxious wait for my next set of hCG results, and into various points in my head for my headaches from the medications (temples and between the brows), calming (between the brows), and then the top of the head for lifting and holding and supporting the pregnancy. Nothing went in my stomach or anywhere near it since the pregnancy is confirmed.

On the treatment table at acupuncture.

I find it really helpful having someone knowledgeable and not only experienced, but personally experienced to talk to about IVF matters. I have really found Stephanie to be a useful resource (in addition to her training and skill as an acupuncturist).

Needles sticking out of chest and my head everywhere.

I spent the hour on the acupuncture table trying to meditate and focus on my breathing with various degrees of success (and failure, as my mind swept me away over and over again and I fretted and catastrophized).

Needles removed, I'm ready to leave acupuncture.

#carselfie

I returned home and spent time doing housework and writing. My husband asked three and half hours before we had agreed to check the results whether they were up yet. I said that I hadn't checked and continued with my day. I didn't want to keep checking like I did on Monday. That only increased my level of anxiety. I need to try to not let fear dominate my life. But it's really hard. So much is riding on this blood test. It's not like it's just some routine thyroid level test or medication level test. I want to know if the fetus is actually progressing or if we'll be left like we were on our second hCG test in June, finding out that the fetus is not growing for some reason or another, a wait to do another test, and then the confirmation that I'll be miscarrying, again. I know that sometimes everything goes right for a pregnancy, but when so much has gone so wrong for me, especially in the last few years, it's hard to believe that I could ever have a normal or good result. And even if I do, when will I ever be able to relax and breathe? I've always been anxious (and I have a diagnosed anxiety disorder), but a series of bad events in my life has made being anxious a protective habit.

My hCG test was done approximately 48 hours after the first one (give or take ten minutes in the time I scheduled the appointments for), so my hCG level should have roughly doubled. My hCG was 440 on Monday morning, so it should be 880 or so this morning. I feel sick with worry.

At 2:00 PM,  my phone rang. I ran to find it. It was the Victoria Fertility Centre. My heart stopped. One of the nurses there was calling (not my regular nurse coordinator). I interpreted her tone as grave and I stopped breathing. But she was just calling to say that while I was on the list for them to check for result before the end of the day, since they leave at 3:30 PM and the results are not in yet, it looked like mine might not be in before they left. She said that if I didn't hear from them, I would hear from them tomorrow morning instead. It was very nice to have a courtesy call like that (you don't get that with other types of doctor's offices), but I'm so highly anxious right now that I had trouble recovering my heart rate for a while after that call.

I texted my husband about the call just after 2:00. It was one hour before we were originally going to check for the results. He suggested that we just check to see if they're up yet, since he couldn't concentrate either. I logged in to the My eHealth website that displays Life Labs results online. All of my results were still pending, hCG and thyroid levels. AAARRRGGGGG!!!!

At just after 3:00 PM, our original appointed time for checking the lab results, my husband and I called each other and I logged on. The results were still not up. The wait is agonizing.

Even though we said 4:00 PM for checking the results again, at 3:30 PM I logged in to get my thyroid results from two days ago to put up on the blog and the summary page said that the results from today were final. I called my husband and then I opened up the first test summary. It was my thyroid results. They were similar to two days ago (unsurprisingly). But this was not the test that was making my heart leap into my throat and my breath catch. I wanted to know what the hCG number was.

I opened the hCG test results holding my breath. They should have been around 880 if they had doubled, which would be a good sign. The hCG number posted is 925. I couldn't believe it. My husband and I both let out sighs of relief. I am four weeks and five days pregnant today.

Obviously it's too soon to relax, but at least this is one step forward. As my husband said, we're now in uncharted territory. We've never had a second hCG test that was at the level that it was supposed to be at. The Victoria Fertility Clinic was closed when the results were posted, so I'll have to wait until tomorrow morning to hear from them what my next step will be. In the mean time, I will go to the endocrinologist tomorrow at noon. Also this week, I must go to the Victoria Fertility Clinic to pick up more medication, so that I can maintain my Estrace (estradiol) and Endometrin (progesterone) regime (until 9 weeks gestation). I am not looking forward to more than four weeks more of supplementary hormones (the side effects remain troublesome and at times quite intense), but to keep this pregnancy I would do anything.

And now we wait . . .

Pregnancy Test and Where Do We Go From Here (The Results of the $14,000+ Crapshoot)

Yesterday, my husband and I made vanilla ice cream with our not often used ice cream maker. We used vanilla beans from our honeymoon in French Polynesia. We tried to let the smell of the heavenly vanilla take us back to a time when our marriage was only filled with hope and the days stretched out in front of us endlessly, white sand beneath our feet, aqua waters rippling the shore, infertility just a vague concept that would never impact us.

We tried to keep ourselves busy, tried to distract ourselves from the question that had been weighing on our minds heavily for the past 11 days- did the embryo transfer result in an implanted embryo and thus a pregnancy or did the embryo not implant and would I as usual not be pregnant?

The ice cream we were making was for our only niece's 1st birthday party. We don't have any nephews, just one niece. She's a delightful little girl, who looks so much like my younger sister did when she was a baby. But even though a niece can bring joy, she's also a reminder that we're painfully childless, not by choice, but by unexplained infertility. This can be very difficult and the timing of the blood test the day after her 1st birthday was unfortunate as it left us anxious and not as good of company at her party as we would have otherwise been. Nonetheless, we tried to enjoy the birthday celebration and not get too bogged down in thoughts of doom and endless what ifs.

I only cried a few times yesterday, which I suppose isn't bad given the amount of hormones I'm on (estradiol and progesterone) and the stress of this process (plus being grated down by one bad sleep after another, the physical side effects, and the mental ones as well).

This is a momentous blood test. Plus there's nothing we can do to influence its outcome. It's not like in school where if you try hard and study diligently you might do better than you would if you didn't do anything (but not necessarily). In this case, you have no control. You just wait and wait and wait and wait and wait and wait. This has been the longest 12 days that I can remember in recent history.

This morning I had an appointment to get my hCG blood test (to test for pregnancy) and my lithium levels done at the same time at Life Labs at 8:50 AM. I almost always book appointments now online, so I don't have to wait a long time for blood tests (when you drop in sometimes it takes more than an hour to get a blood test done).

On the way to yet another blood test.

I arrived early and nervously waited. I told the lab technician that I was nervous and she interpreted this as me not liking blood tests or that I hadn't had one before. I told her that I had had tons of blood tests, but that this test would tell me if the cycle of IVF I had just had had worked or not.

Waiting for another blood test.

Naturally, most people don't understand the magnitude of this test. If you haven't struggled with infertility (and for years and years and years) and then consented to pay $14,000 for a crapshoot chance at a pregnancy (and even less of a chance of a live birth due to the high risk of miscarriage, especially as the mother's age increases, but this can also be influenced by the age of the father), undergone the months of hormones, uncomfortable physical tests and side effects, and emotional turmoil, you're just not going to get how momentous this one blood test is.

Same place, different day.

Assuming the position . . .

Good luck finding that vein . . .

I felt less squeamish than I had ever felt taking pictures of the lab technician giving me the blood test today. I suppose people are right when they say that if you have a fear, the best way to get over it is to do it. Needles are not as high up on my list of fears anymore. I fear much more the results of this hCG test.

Needles make me way less squeamish now than they used to.

Second vial of blood . . .

Beautiful cotton and tape arm accessory.

Over the past almost two weeks all I have been able to think about is this test, its results, and what they will mean to my life.

What if I am pregnant? Are people going to start making me talk about "the baby?" Will I be asked about names? Will I be asked if I think it's a boy or a girl? This happened last time. Will I be forced to think about the life growing inside me and get attached to so that if I lose that baby like the one I lost in June my soul, which has already been rent into pieces, will shatter so much further that it will be irreparably destroyed and I will cease to exist in an insignificant implosion or perhaps a spectacular explosion? Will I become a black hole sucking everything around me in until there is nothing left? Will I run away and never come back? Or will I actually give birth to a living baby? Will I finally become a mother?

The fear of having another miscarriage, especially a second one in the same year, keeps me fearful of a positive pregnancy test. We were in this situation in June when we found out we were pregnant. When I took the next blood test two days later, the hCG levels hadn't increased as they were supposed to. The nurse told me that that was NOT a good sign. Then I took another hCG test and the number had decreased and it was confirmed that the fetus was definitely dying and I would be having a miscarriage. Then the agonizing physical and emotional medley of the miscarriage in mid June which shattered me further than I had already been feeling prior to the miscarriage from the years of struggling not just with infertility, but also with other health problems. This has been the worst year of my life and if anything else goes wrong, I don't know how I'll survive. I can't even believe that I am still alive.

But what of the other alternative? What if the hCG test shows that I'm not pregnant? Then we will have just paid $14,000 (not including other things like vitamins, acupuncture, etc.) for IVF to still not be pregnant. Yes, we have five embryos frozen and I could get a frozen embryo transfer done, but this means more hormones, physical discomfort and awful side effects, emotional pain, uncertainty, more money (though not as much as a full IVF cycle), and more time. I feel completely shattered physically and mentally. I would like to be prescription hormone free for a while, but I can't leave it long either if I'm serious about ever having a child. I'm aging. My chances of a miscarriage are going up, up, up and my chances of ever having a child are sliding into the dark abyss.

I feel trapped. In high school they made it seem like if you even thought naughty thoughts about a boy that you'd be instantly knocked up, but for some people nothing works. What if I get a frozen embryo transfer done and that doesn't work? Then the next doesn't work? Then the next doesn't work? Then we have no embryos left? Or what if the embryos don't survive thawing (there a small chance of this)? What if I have to go through another full cycle of IVF? Would I survive this? Can I put myself through this again? And the cost. What if it doesn't work? What if nothing works? Am I going to be left broken and alone, bitterly thinking about the life I'll never have, while I wander the streets of Hong Kong and run a rescue cat society trying to fill in the crater in my soul left by never having the children that I always wanted to have?

While I ruminated on the above (with increasingly "cat"astrophic scenarios filling my head), I tried to distract myself with writing, photography, and picking the last few flowers from outside. The late sweet peas jumped out in the greyness of the October day.

Last of the summer.

This morning, I received an unexpected call from my regular psychiatrist's office. The medical office assistant said that he wanted me in for a "regular follow up" on October 31st. I explained to her that he told me that he couldn't treat me while I was undergoing IVF due to the hormones being used and his lack of familiarity with their impact on my condition and that he had referred me to a perinatal psychiatrist who I was now in the regular care of (remember that five month epic battle to get in for an appointment?). She said that I still had to come in for an appointment with him because I was under his care. I asked her if I had to now be under the care of two different psychiatrists. She said that I had to come for this appointment at least. Great, so I have no oversight for five months during the hardest part of the year while I had a miscarriage and underwent a full cycle of IVF and now that this cycle of IVF is ending, I'm under the care of two different psychiatrists. That makes a lot of sense! Our medical system absolutely outrages me. I just can't believe how our system wastes resources. No wonder half of every tax dollar goes towards our medical system; it's a black hole of despair and waste. When you need care you can't get it and when you already have care or don't need it, it gets piled on double. How infuriating!

My husband and I decided that we would call each other when I checked for the blood test results online. We set a time for 1:00 PM, but then couldn't wait till then. We checked at 12:20 PM. Annoyingly, Life Labs chose that exact moment for me to have to go through a password reset that added extra time and frustration to the process. Anyways, by the time I got into my account, three and a half hours after my blood test, the results were still pending. My husband said that he'd get back to work. I told him "good luck." Both of us have the attention span of a fruit fly right now. This is the longest day ever.

My husband called back before our next agreed upon check in time of 2:00 at 1:30 PM. We again checked to see if the online blood test results were up. They were not.

At 3:00, I called my husband and logged into my Life Labs online account. The final results for both of my lab tests were posted and one of them had the big letter "A" beside it, indicating abnormal. That test was the hCG level. If you want a positive pregnant result then you want an abnormal result beside this test. I was rather stunned.

The last time I was pregnant, my hCG result at about 5 weeks pregnant was 132. Four days later it remained unchanged at 132. The nurse at the Victoria FertilityCentre had never seen this happen before and told us that it was not a good thing (it should have increased by a lot in the intervening days). I still have flashbacks to that call with my nurse coordinator, the nightmare unfolding blood test after blood test until the miscarriage hit and I couldn't pretend anymore that everything might be okay.

On my lab test today, my hCG level today is 440 and I would be four weeks and three days pregnant today according to the reckoning of online IVF pregnancy dating calculators (normally one would count the gestational date of a child from day one of the cycle, but when IVF happens, things get a little more complicated- if I had become pregnant naturally, I would be four weeks and four days today). HCG numbers are somewhat odd. For instance, for the fourth week of pregnancy normal hCG levels can go from 10-750. What's important is that the hCG level keeps going up in early pregnancy (it's tested often every two or so days in early pregnancy to check that the pregnancy is progressing and is not ectopic). If the numbers aren't going up noticeably between each test then the embryo has run out of steam and a miscarriage will happen (or it might be an ectopic pregnancy, which is very dangerous).

My lithium level was 0.70 which is a perfect low therapeutic number that works very well for me. So nothing to worry about there. I retest my lithium levels in one month with my standing order from the perinatal psychiatrist.

I promised my endocrinologist that I would call his office immediately if I found out that I was pregnant, so after leaving a message for my nurse coordinator at the Victoria Fertility Centre, I called my endocrinologist's office. The lovely assistant was very congratulatory and told me that she would tell him and then find out when he wanted to see me next (because he may want to see me before my next appointment which is scheduled in mid November- I suffer from hypothyroidism and keeping my thyroid levels optimum is key to maintaining a pregnancy and the health of the baby). I told her "well, we'll see if it sticks this time." I just can't celebrate. I feel like if I get too cocky, I'll lose the pregnancy again and/or get hurt.

I talked to my nurse coordinator at the Victoria Fertility Centre at 3:30 PM. She had not even looked at the results yet, but when I read her out the hCG number she was very pleased. She said that that was a very good number (440) for 4 weeks pregnant (they like to see over 100). She told me that I must go for another lab test for hCG levels (with my standing order) on Wednesday (she called Life Labs to add on a TSH level test to my standing order to make sure that my thyroid levels are optimum for pregnancy). We will talk Wednesday afternoon. In the mean time, I must stop taking the low dose aspirin and she will send me instructions for weaning off of Dexamethasone (it has a complex two week wean off schedule to prevent withdrawal). When she congratulated me, I couldn't help but throw out there "well, we'll see." She reassured me that it was a very good hCG number.

After TSH was added to my hCG test, it showed up as abnormally high (ie. my thyroid is working really hard right now, but hopefully I'll hear back from my endocrinologist soon- he'd be the best person to address this and in any event he doesn't believe in TSH as a valid measure of thyroid function, so I'm not too worried. He'll measure my Free T3 and T4, which will give a more accurate read of what my thyroid is up to.)

Later in the week, I will also be picking up more Endometrin at the Victoria Fertility Centre. As mentioned previously, I must continue Endometrin, Estrace, prenatal vitamins, extra folic acid, and vitamin D. Endometrin and Estrace continue until nine weeks gestation. So I can look forward to being super super hormonal for almost five more weeks until I will be able to cease the extra hormones and hopefully my body can just function naturally. My activities restrictions continue until my first ultrasound in about three weeks. No exercise, just the bare minimum day to day activities. I feel awful from the hormones anyways, so I doubt I'll feel like going to spin class or climbing a mountain. After the ultrasound, they will reassess if I can return to pre-IVF activities. I wonder what having a natural pregnancy feels like?

Since I am pregnant, I scheduled a follow up appointment with my acupuncturist, Stephanie at Elements of Health. I will be continuing with the once a week, hour long acupuncture to support my body in pregnancy. I see her on Thursday morning.

I really don't know what to think about the pregnancy test results. I feel stunned and somewhat numb. I guess I'll just have to take it one day at a time, one blood test at a time. But it's hard to not to let my mind sink back into the nightmare of last time when we were so hopeful with the first hCG test result and then had the hope crushed out of us in the following week of recurrent (and worsening) blood tests. Then we had to experience the tragedy of a miscarriage when I was 6 weeks pregnant. While I obviously don't want that to happen again, I must be realistic that I have a very significant chance of experiencing that again (20-25% chance for my age group) and I must be prepared for this possibility.

Therefore, I will not be celebrating just yet. Neither will my husband. I doubt that either of us could breathe easy until I gave birth to a healthy baby. We just won't be able to be like so many other couples who take pregnancy for granted. Having a child is a miracle of biology and everyone who is lucky enough to have one or more should revel in this wonder every day.

I have scheduled my next hCG blood test for 8:40 AM this Wednesday, October 19th. I only hope that my second hCG test of this, my second pregnancy, will show the "doubling" or appropriate increase in level that indicates that I have a healthy pregnancy.

Fate loves me, fate loves me not, fate loves me, fate loves me not . . .