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.