Continuing Prenatal Acupuncture, End of Prescription Hormones, First Visit with GP Specializing in Maternity, and Nine Weeks Pregnant

Current mood . . .

This week has been difficult. While I was initially thrilled after the ultrasound, my doubts about whether or not the fetus would survive resurfaced very quickly. I keep worrying about if I'll make it through the first trimester (I'm 3/4 through now), if I'll make it through the second trimester, if the baby will survive to birth, and then if it will survive after that. Having the miscarriage was very traumatizing and it's still fresh in my memory having only happened five month ago. Also, my husband has been away for work and the cat is not the greatest confidant for my fears.

The weather reflecting my mood.

I wondered if my oscillating moods that seemed to be going distinctly dark were due to the prescription hormones, the pregnancy, my dropping lithium level, the uncertainty and anxiety associated with pregnancy especially after fertility treatments and having a history of miscarriage, or a combination of all of the above. But my perinatal psychiatrist had clearly directed me not assess my mood until after I came off of the prescription hormones, because they were no doubt impacting my mood and making me more nauseous, so adding extra lithium while on them would likely make me intolerably nauseous.

The cat did not enjoy his bath, but he had a rash and was all itchy, so it had to be done (it was awful without a second person to help- the cat's like a 50 pound Coho in a river thrashing around as if his life depended upon it.)

I had my weekly acupuncture appointment on Wednesday. Stephanie at Elements of Health put needles into my lower legs, one in my very upper stomach, into my neck and shoulders for neck and shoulder tension I've been having, and several into my head. She again put a tack into each inner forearm for nausea. I put Band-Aids over these and still have both of them in. I can't tell if they do help my nausea or not, but I certainly don't want it to get any worse, so out of an abundance of caution, I'll take them thank you very much. My insurance coverage for acupuncture ran out a couple of sessions ago. All subsequent visits (after the first one) are $85.00 each. I keep wondering how long I should keep going for. I know that all paramedical professionals will try to get you to go indefinitely, but when does cost outweigh benefit? I'm just not sure and really don't want to risk losing this $15,000 plus pregnancy. A second miscarriage this year would destroy me. Plus the thought of going through even an abbreviated version of this, getting a frozen embryo transfer, does not appeal to me at all.

Before acupuncture on the table.

During acupuncture, note the needles in the head, in my neck and on my shoulders (some are hard to see).

After acupuncture.

Yesterday was my last day on prescription hormones. The dispensary at the Victoria Fertility Centre seems to have miscounted the Endometrin I required, because I was short one yesterday. My nurse coordinator assured me that missing the last Endometrin in the evening was okay, so I didn't have to drive all the way out there thankfully. My last Estrace was with dinner last night. It felt strange this morning not taking an Estrace with breakfast and inserting an Endometrin after my shower (not complaining, just saying it's a change of routine). I worry about whether or not the end of the hormones will cause my pregnancy to end. I know that some women are on them until 12 weeks, but other women have no prescription hormones at all and their pregnancies succeed, so I just have to stop worrying. It's not like there's anything I can do about it at this point. I've done everything I possibly could. But waiting and living with this uncertainty is agonizing. I have not noticed any withdrawal type symptoms, but it's tough to tell what is what when my body is constantly changing and topsy turvy from pregnancy. I'm just hoping that not having an extra helping of progesterone and estradiol will make me feel somewhat less awful.

The last Endometrin!

Almost three months of different hormones comes to an end. I will miss the effervescence though. Not!

Today, I am exactly nine weeks pregnant. According to sites that compare fetuses (yes the embryo apparently crossed over into fetus territory today) to fruit, the fetus is the size of a cherry this week. I'm feeling pretty nauseous, have a horrible headache as usual, and I'm totally exhausted today even after 10 hours of sleep.

I'm exhausted after ten hours of sleep. Am I becoming a cat?

Also today, I met with the GP who will be covering my pregnancy, Dr. Hugh Down (my own GP does not do maternity care). He was my sister's maternity doctor and she recommended him highly. I can see why now that I've met him. His MOA took a urine sample from me upon arriving (okay I gave it to her, she didn't take it with force or anything) to test for glucose levels, etc. and I gave her the chart materials that Dr. Hudson had given me to give to Dr. Down. Since Dr. Hudson had already done so many blood tests, that didn't seem to be required. The MOA took me into an exam room and weighed me before the doctor arrived.

The colours of the wall could only mean one thing, I'm in a doctor's office . . .

Dr. Down asked me standard questions about allergies, past surgeries, current medications and medical conditions, and discussed testing that could be done in the second trimester to determine genetic abnormalities (from the $500 test not covered by the public system that Dr. Hudson likes down to the less reliable publicly funded test). He let me ask the questions I had about whether or not I could do anything for my very sore throat other than gargle with salt and take the occasional Tylenol (better not to take any other medications since nothing is proven safe in pregnancy, especially in first trimester when everything is forming), if I could go back to the chiropractor (my neck and shoulders are so tense that my right jaw is hurting- he says as long as the chiropractor is not really rough and you let them know you're pregnant then it's fine)), and if it was true that my weight lifting would be limited to 15 pounds during pregnancy (it seems this is the case since I could be risking hernias etc., so I guess the 40 pound medicine ball will be lonely for a while). He took a lot of time with me and was very kind, funny, and knowledgeable (he even knew what pseudocholinesterase deficiency is which not all doctors do, so I was impressed). He says that he'll see me again in about one month.

The lilies in the bouquet that my parents in law gave me when they surprised us with a visit last weekend smell divine. I clipped the anthers off because lily pollen (and other parts of the lily as well)  is deadly to cats and  can cause kidney failure. Fortunately, this is one smell that I can tolerate in pregnancy.

My husband is back late tonight for one day before he leaves again, so he can spend time with me, the cat, and the cherry.

The cat is preparing for his father's return by practising his cutest poses.

The Seven Week Ultrasound

I didn't sleep much last night. I kept catastrophizing, thinking about what I would say in this blog post if the doctor only found an empty sac or something else that would indicate that I wasn't pregnant or wasn't pregnant anymore or something was really wrong with the fetus in the ultrasound today.

This morning I felt hot, nauseous, and exhausted as my husband and I drove to the Victoria Fertility Centre. Despite going pee twice before the ultrasound at the office, by the time I was on the table, I felt like I had to go again. Literature says that around this time, the uterus doubles in size or so and that puts pressure on everything in its vicinity including the bladder, hence having to the go to the washroom all the time.

In the waiting room at the Victoria Fertility Centre anxiously awaiting my seven week ultrasound.

We were both really nervous.

On the examination table waiting for the ultrasound.

Dr. Hudson performed an internal ultrasound on me this morning. He let me take pictures for the blog as usual. I was focussed on zooming in and getting the phone camera focussed on the ultrasound screen. When he said "this is your baby," I couldn't believe it. Did I hear that wrong? Then he pointed out the top image in the uterus (the dark shape in the middle of the greyish white on the ultrasound image), a small white shape and said that that was the baby. The small whitish mass under that is the yolk sac (this is the first aspect of the gestational sac that is seen in humans. It conveys blood and nutrients to the fetus, later the placenta develops more and takes over this function).

The black mass is my uterus.

In the dark mass that is my uterus there is the top mass which is the fetus and the bottom mass which is the yolk sac.

Closer up view of fetus and yolk sac. This is very magnified. The fetus is about the size of a raspberry right now.

The measurement top to bottom of the fetus is at the bottom, as you can see, it's very very small right now.

He kept moving the ultrasound wand around and then he said "this is your baby's heartbeat." Suddenly, we could hear its heartbeat and I burst into tears. He said the heartbeat of the baby is 150 beats per minute. He said that everything looks "perfect."

I couldn't believe it. I then completely lost it and sobbed uncontrollably. It took me a few minutes to collect myself before we met Dr. Hudson down the hall in his office. He gave us some information on tests we could have performed in the second trimester (like amniocentesis) and told us that he would meet us once more in 3-4 weeks and then I would be discharged from the Victoria Fertility Centre. He said that in the mean time I should call and get an appointment with a doctor who specializes in pregnancy and he gave me a referral letter to give to that doctor.

I bought more prescription hormones from the dispensary at the office to last me for the next week that I have to take them (I can send the receipt to the insurance company but I doubt I'll see a cent unless I fight them since they are still refusing to cover our fertility drugs).

As we left the office, I was in complete shock. Reality has still not sunk in and I still feel so emotional thinking about hearing that heartbeat for the first time and seeing the tiny baby that only measures 14.45 mm (or 1/2 an inch for you imperial users) "head to foot" right now. Week seven the baby is about the size of a blueberry and week eight about the size of a raspberry or about 1.5 cm or 15.00 mm. I am seven weeks and six days pregnant today, so it seems that the fetus is right on track and as he says perfect.

Naturally though, there is still the risk of miscarriage. We won't be out of the first trimester for another four weeks and one day. Since we have heard a heartbeat though, the risk of miscarriage has dropped considerably. But having been through a miscarriage already this year, I remain mindful of the fact that I may not have that baby that I've always wanted and that I must still be cautious. After all, people even have miscarriages in their second trimester and onward.

I must take Endometrin (progesterone) and Estrace (estradiol) for another week (until the end of eight weeks gestation). Starting week nine, next Friday, I will no longer be shovelling down Estrace three times a day and inserting Endometrin twice a day. I suspect that the deletion of these prescription hormones from my life may make me feel less awful, but who knows.

I tried calling the doctor who my sister used for her pregnancy, but he was already gone for the weekend, and their voicemail doesn't take messages, so I suppose I'll be calling on Monday to try to get my first appointment with a pregnancy doctor. Dr. Hudson says that I should see one before my next appointment with him, as soon as I can.

My husband told one of the nurses at the Victoria Fertility Centre, as he held up the three printed pictures of our baby from the ultrasound that this was the best birthday gift that he could ever remember. I agree.

One of the printouts from the ultrasound today. The fetus' heartbeat can be seen at the bottom.

Seven Weeks Pregnant- The Highs and The Lows

Current mood . . .

Today, I am seven weeks pregnant. It's been a very up and down week emotionally (and event the dizziness and nausea has been up and down with no predictability). Since it's been eight days since my last post, I thought I'd post an update.

Last Friday, when I woke up and found that I wasn't bleeding, I couldn't believe it. I was six weeks pregnant, the longest I have ever been pregnant (my miscarriage in June started on the day I was supposed to be six weeks pregnant). Relief flooded me. Yes, I was only halfway through the first trimester (when most, but not all miscarriages occur), but I was one step closer to actually having a baby.

Over the weekend though, my mood deteriorated. I became depressed and anxious again (the hormones are known to do this and I'm getting extra of progesterone and estradiol from taking Endometrin and Estrace by prescription). Then my mood dropped even more. I became darker than storm clouds gathering over an angry sea. I ruminated on the fact that there was nothing saying that I couldn't miscarry twice in the same year, this time at a later gestation point than before. I also knew that my husband would likely be leaving on another business trip in the upcoming week. I felt really, really bleak and alone. And the panic attacks came back to roost.

Weekend mood.

I have been feeling quite alone through this whole journey. Firstly, I don't personally know anyone who has ever had any fertility treatments, so I feel like an alien (the only person I've ever met- who's admitted to having fertility treatments at least- is my acupuncturist). Secondly, it's been a really bad year, which has completely shaken my confidence to the core (from signing up for IVF for the first time to a miscarriage to having to sign up for IVF a second time and actually go through IVF to having our claim for the prescription drugs required for IVF denied by our insurance company so far to family discord and friends who have abandoned me in my time of need). Thirdly, no matter how sympathetic anyone I know is, they still can't relate to what I'm going through, not even my darling husband, who is once removed from this whole pregnant/miscarriage/IVF/pregnant for the second time in a year thing (I mean that the trauma is happening to my body not his). Even well meaning family members who try to tell me what pregnancy was like for them, just don't get that I'm not going through a "normal" pregnancy, because I'm on bucket-loads of hormones on top of being pregnant, so it magnifies everything (more dizziness, headaches, mood swings, bloating, etc.), I'm worn down from being on a hormone rollercoaster for over two months, and that IVF does not result in a "normal" pregnancy experience for these reasons (plus who pays around $15,000 to get pregnant normally? Oh, and the insurance company denying almost two thirds of that cost, which are the prescription drugs that they promised to pay for under our insurance policy and now they suddenly have a problem with paying up- not that I'm surprised since I used to do plaintiff insurance litigation when I was a lawyer and I saw this time of bullshit all the time). Plus I'm going through this pregnancy right after the miscarriage that I suffered in June and the wounds are still fresh. I am really scared.

I have found some comfort in reading the "VFC 2016" thread of the IVF.ca boards and contributing to it is as well. This particular board is full of people from all over the west of Canada who attend the Victoria Fertility Centre for fertility treatments and share in each other's triumphs and tragedies. It's a very supportive place. IVF.ca has boards for different clinics and different categories as well, but I have only been reading and participating on the VFC 2016 thread. I am just grateful to find that I am not alone in having to go through this infertility journey. It seems a little less daunting when I remind myself that I'm not alone even if I feel it.

After a meltdown from Sunday into Monday morning, my mood leveled out pretty well again. My husband left Wednesday morning on a business trip and I went to acupuncture for my weekly treatment. For about one hour (we cut it short this last time because I had to pee so badly- another pregnancy/ prescription hormone side effect) I lie around on a table with needles sticking out of my head (about six this time), chest, upper stomach, and lower legs. She also put the tacks in my inner forearms again for nausea. I left those in, but one of them came out an hour later. The other one is still in (secured with a Band-Aid, so it doesn't move around and feel as irritating- I'm not sure if it's helping as I've been having some really nauseous days this week).

Ready to get poked full of needles again.

This morning, I kept expecting to find that I was bleeding. It seemed too good to be true that I am seven weeks pregnant. But no bleeding occurred, so maybe I am still pregnant. I still feel wretched, nauseous, dizzy, gastrointestinal distress, and very tender breasts, etc., all good signs in early pregnancy (and some of this is probably coming from the progesterone and estradiol I have to take until I am 9 weeks gestation, two weeks from now.)

I started my morning out with a blood test to track my level of lithium carbonate (I have an appointment with the perinatal psychiatrist on November 8th). The lab technician I had this time wouldn't let me take a picture of my blood test (I had already taken one of myself while I was waiting). She said it was preserve the confidentiality of other patients at the lab- I had never been told that before so I guess this blog is full of no no photos.

A photo at the lab which apparently a no no.

Had to take this photo in the car.

I then went to get a flu a shot at the public health clinic on Cook Street (the Victoria Fertility Centre recommended that I get a flu shot as I am pregnant- it can help protect me from getting a flu, which could give me a fever and consequently damage the fetus and it immunizes the baby, once it is born, for the season).

My left arm has a bandage now too! What a morning.

People are starting to talk about this baby like it's real and that scares me a lot. The last time people around me did that I lost the baby and then there was a gaping hole in my life and heart as I had let myself get attached and accustomed to the thought of being a mother. I am afraid to admit that this baby is real or to get attached. I am afraid of being hurt again. I'm trying to pretend that nothing is different, but of course this is impossible with my physical symptoms, my prescription medicine regime, the medical appointments and lab tests, and my pronounced mental cartwheels.

Serenity now . . .

Next week I have another blood test scheduled for Monday morning to take my thyroid levels. The next day I have an appointment with the perinatal psychiatrist to check in and review my lithium carbonate blood levels to see if my prescription needs to be changed. The day after, I see the endocrinologist to review my thyroid levels and review if my prescriptions for my thyroid need to be changed again.

Thursday, my husband (he gets back into town the night before) and I will be going to the Victoria Fertility Centre to have our ultrasound. I am so worried that things will not be all right and I don't know how I'll cope if they're not. I have barely survived this year thus far. I can't take anything else bad happening.

With luck, one week from now, I'll be eight weeks pregnant and I will have heard my baby's heartbeat for the first time the day before. If not . . . well, one day at a time . . .

One of my amaryllis bulbs is about to bloom again.

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.

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 . . .