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 . . .