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.

Eve of My Seven Week Ultrasound

Current mood . . .

Today I am seven weeks and five days pregnant. I hope.

Tomorrow morning, my husband and I will be at the Victoria Fertility Centre for my seven week ultrasound. (it would have been sooner but was postponed a few days due to my husband's work schedule). I will be seven weeks and six days pregnant tomorrow if we are fortunate. If not, I will be shattered.

And the cat says "I can't take this smothering love anymore. Please save me."

There have not been any signs that something has gone awry. I haven't been bleeding (although 25% of women experience bleeding in early pregnancy), I have had pregnancy related symptoms, and I seem to keep expanding (though I have still not gained a single pound from when I started hormones for IVF on September 1st). I have been religiously taking my prescribed hormones, Estrace (estradiol) and Endometrin (progesterone), and abstaining from lifting anything heavy (including my big cat), or doing much activity. I have been eating well and resting as much as I can. I have been going to all of my doctor's appointments (including specialists- perinatal psychiatrist and endocrinologist for my thyroid) and getting all the associated blood work done (I was in the lab again this Monday). I have been going to acupuncture once a week to support the pregnancy (may help but the jury is still out as far as scientific literature is concerned, I figure it can't hurt). I have been trying to keep my stress level down (easier said than done- I keep worrying about the possibility of a second miscarriage in the same year and what I would do if that happened).

Being a rebel and taking a photo at the lab.

But there is really not much that one can do to prevent a miscarriage. They just happen as I found out earlier this year. I only hope that we'll get some good news for a change tomorrow at the ultrasound. It may be too early to hear a heartbeat, but from my reading on the internet, the blueberry sized fetus should be just visible if it exists (in other words if it's not just an empty sac).

One of my Amaryllises is re-blooming right now and putting on quite the show.

I hope I see the most beautiful sight tomorrow at the ultrasound.

For those of you wondering what is happening with our extended medical insurance claim for the prescription drugs that I had to take for IVF, they have still not paid us a cent. The policy said that they would cover 100% of the costs (my husband looked up each IVF drug and made a spreadsheet before I even signed up to get IVF and checked that each and every possible one that they could use in IVF was covered and they all were), we paid the premiums, and now they don't want to pay. My husband has been going back and forth with them to decrease the stress on me, but I feel really furious about this. I used to be a litigation lawyer and most of my cases involved one kind of insurance or another (I always represented the plaintiff) and I saw insurance companies rip off vulnerable people every day at my job (one of the only reasons I kept practising for so long, despite how much I didn't enjoy the career, was because I felt so angry about the insurance companies savaging honest policy holders). I figured that our insurance company would do this to us just based on my experience, but hoped that I would be wrong. Well, I wasn't. Now apparently the claim has been "escalated" just because we asked for the address of their legal department after their latest refusal to pay us. It remains to be seen if they will pay any of the thousands of dollars that they owe us (I think about $9,000.00) or if we will have to take further action. As if IVF isn't stressful enough, you don't need dishonest insurance companies refusing to pay for the drugs that they say they are going to cover and that you have counted on them covering.

I saw my perinatal psychiatrist out at Victoria General Hospital (all obstetric services are at this hospital in Victoria, it's quite the drive for me as it's outside of town) yesterday. She said that while my blood levels of lithium carbonate are rather lower than usual for me, they are still therapeutic and she is reluctant to raise my dose just yet because it will probably nauseate me even more than I'm already feeling nauseated. She says to wait until I'm off of the prescription hormones (9 weeks gestation, in a week and a half) and then see if my mood is still low (progesterone can cause depression). If it is, we can raise the dose, if not then I will repeat the blood tests in a month and see her in a month and she may raise my dose of lithium carbonate then. She says though that it is very understandable that I would feel kind of down and anxious given the difficult IVF process, my history of having a miscarriage and being afraid of another one, the pregnancy hormones themselves plus the prescription hormones on top of that, and all of the uncertainty.

I went to the acupuncturist today for my once weekly acupuncture appointment to support my pregnancy. Again, my bladder could not quite make it through the hour long appointment, so the needles had to come out. She put needles as usual in my lower legs, one in my upper stomach, two in my chest, and several in my head. She also put the tacks in my forearms for nausea. I haven't really been nauseous much since Friday and my one tack from last week stayed in my left forearm until Monday night when it started to feel irritated. I'm not sure if the tack helped or if my body is just moving on to other symptoms/side effects (and having a Band-Aid over the tack really helped cut down on irritation and made it stay in much longer).

Needles in my head and chest.

After I finished at acupuncture, I went for my appointment with my endocrinologist. As I mentioned above, I weighed myself this morning in preparation for the appointment since he weighs me every appointment. I was sure I had gain several pounds since my last appointment three weeks ago (everything seems tighter), but I had not even gained part of a pound. I was still exactly the same weight that I was at September 1st when I started the hormones for this first cycle of IVF. Ten and half weeks later, after taking copious hormones, being almost eight weeks pregnant, and I have not gained a pound. And yet, I normally can't maintain my weight when I'm not in this bizarre chemically engineered process of IVF. My weight is always up and down; it's very strange.

My endocrinologist reviewed my blood test results and pronounced that my thyroid levels are currently "perfection." My thyroid medications, levothyroxine and liothyronine will remain at the same dosage until my next follow up with him. I will repeat my lab tests before the next appointment which he said should be in about three weeks but definitely not more four weeks away. The office assistant found me a spot a little less than four weeks away (no easy feat in his very, very busy schedule).

When my endocrinologist weighed me and confirmed that I had not gained any weight, he said I didn't need to gain any weight at all in pregnancy (this sounds unrealistic to me, I know I'm overweight, but it still seems like it would be difficult if not impossible to do). He said that the metabolism increases during pregnancy and it takes an enormous amount of energy to create a baby plus with feeling under the weather I may be eating less, so, me not having gained weight makes sense to him.

My endocrinologist also said that I should choose an obstetrician, a GP who specializes in pregnancy, or a midwife at this point. He said that my GP (who works in the same office) and he had been discussing my pregnancy (I am happy that they work together so well and it's convenient having them in the same office- in fact I would not have a GP if it weren't for my endocrinologist who got me in with my very, very busy GP who was not really taking patients at the time). My endocrinologist said that since I have a thyroid disorder, I would qualify to be with an obstetrician right away instead of just a GP or midwife, but that that wasn't always the best option (he says they are often very focussed on just looking for what is wrong with you and if I need one later if I have complications, I can be referred to one immediately). So I told him I'd like to go with the GP that my sister used for her pregnancy and liked very much. He said he would send a referral letter to him.

I then returned home to take care of tasks around the house, write, and wait for my husband to return from over a week away on a business trip. I feel very grateful that he'll be at the ultrasound with me tomorrow, because I am feeling very nervous about it and it's always better not to be alone for something as momentous as this.

Lamont is definitely not excited about the prospect of any kind of a sibling.

But he was excited by my new heating pad when it arrived and he claimed it immediately.

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.