Two Month Postpartum Update

I can't believe I was ever this small.

One of the readers of this blog has requested an update regarding how I’m doing post partum and specifically what happened with regards to readjusting my medications after my baby was born.
It’s been about two and a half months since my first child, conceived by IVF, was born. My child was born via vacuum extraction and was healthy other than slight jaundicing. As I have bipolar disorder and a hypothyroid disorder (suspected Hashimoto’s) I was kept in the hospital for several days post birth. Also, since the baby was born via vacuum and was slightly wheezy at first and slightly jaundiced (elevated levels of bilirubin) they would have kept me there longer than the typical one night or so that they keep women for in Victoria when they have an uncomplicated vaginal birth.

While in the hospital my blood was taken more than once to test medication levels. And the child had light therapy for a day in our room to lower the bilirubin levels.

I can't get over the little feet . . .

I was not a fan of being in the hospital for that long. The nurses tried to emphasize that it was great for me because I could rest or I didn’t have to cook or do laundry. While that may have been true, I found it detrimental in a lot of ways. Firstly, resting in the hospital is very difficult even in a private room (none were available when I arrived, but there was an empty double room and they never put anyone in with me because I have bipolar disorder and they told me I needed to be able to rest so as not to risk an episode, especially postpartum). Well, the hospital is loud, including beeping of machines, babies screaming down the hall, the busy nurses’ station which was outside my door, and people constantly barging into one’s room to do tests, clean, deliver food, take away trays, deliver medication, and check on the mother or baby. Secondly, cleaning of the room was always at an inconvenient time when I was trying to rest or have a shower, etc. so it would either hamper me showering or napping at a convenient time when the baby was sleeping or I’d send them away and they would get annoyed at me for sending them away and sometimes just barge in later even with a do not disturb sign on. Thirdly, the food in the hospital was abysmal. They feed the mother, but not the father, so while I would be trying to eat whatever horrible items were delivered (even with food orders being taken daily the order was often wrong), my husband would go off to find something in the hospital (not many choices there) or nearby at a store. After several days of bad food, almost no sleep, and constant interruptions (even when the do not disturb sign was on the door), I was really owly and I told my interim perinatal psychiatrist (my regular one was away, so a colleague supervised my medication change while in the hospital) that I wanted out of there as soon as possible. I’ve always thought that home was the best place to recover from anything anyways (and it’s not like giving birth is an illness).

. . . and little hands.

I was in the hospital five nights total. I was told that they sometimes suggest that patients with psychiatric conditions stay for up to ten days to re-establish and stabilize medications. I cannot imagine staying for that long. But, it’s certainly better to sort things out there and make sure you’re stable than to go off the rails at home and risk ending up in the psychiatric section of the hospital. I was told by a previous psychiatrist that in England where she did a practicum years ago they had a hospital ward where mothers receiving psychiatric care could stay with their babies. In Canada, I’m not sure if that’s done anywhere, but it certainly isn’t in Victoria. If you require hospitalization here, you will be separated from your baby. The baby could visit with your partner or someone, but not stay with you. Obviously, this is not ideal and I think it would make treatment even more distressing and probably dissuade many people from even seeking treatment (and this is really not what we want our medical system to do).

So, to the medication changes at the time of birth and post-birth.

When my labour started, I stopped taking lithium carbonate. Because I wasn’t sure how long prelabour would go on for, I took lithium the night before I went into full labour when I had prelabour pains. In the middle of that night the contractions were getting worse and I went to the hospital early in the morning. That night while I was labouring I did not have my usual dose of lithium carbonate. This is because when one gives birth the rapid loss of fluids can lead to lithium toxicity if one’s on the higher dose that one was on during one’s pregnancy (some people may not find their dose goes up in pregnancy, but most people do go up a higher dose as the increased levels of blood and fluid in the body and higher body weights often require a higher dose of lithium in order for it to still be in a therapeutic range).

My dose of lithium pre-pregnancy was 900 mg. It went up to 1050 mg about halfway through my pregnancy (my levels were tested at the lab every month). After I gave birth, I was given a very low dose of lithium, 300 mg in the evening. They started at this very low dose because sometimes people become hyper sensitive to lithium apparently. I was sure dose this would not be enough to be therapeutic for me. It was not. My blood was tested in the hospital and my levels were far below therapeutic. My dose was increased to 600 mg and this was also not therapeutic. A prescription was written for 900 mg of lithium carbonate, as pre-pregnancy, and I was released from the hospital with a requisition to repeat my lithium levels in a week. Then I would go see the interim perinatal psychiatrist again at the hospital to check in with how things were going. Other than fatigue, I felt relatively good. My husband and I were both at the meeting with the interim perinatal psychiatrist and she had no concerns. She said my lithium levels looked good and told me to continue at 900 mg. She booked me to see another perinatal psychiatrist in a few weeks to check in.

The meeting with the other perinatal psychiatrist was disappointing. I was exhausted on that day after a sleep of only a few hours in total (broken into several pieces) the night before. I was asked to come in two hours earlier than my original appointment because she had a cancellation. Even though this was hard to do, I did it (getting out of the house is a lot harder when it’s not just yourself anymore). Then the psychiatrist was 30 minutes late. I was really annoyed by this disrespectful behaviour. She didn’t apologize for her lateness either. Then she stared at me for two seconds after meeting me for the first time and said, “I think you’re depressed.” Wow. If there’s any wonder left as to why people with psychiatric conditions or even concerns don’t seek treatment, this illustrates part of the problem (and what a 180 turn from the other two perinatal psychiatrists who I had dealt with who were very professional and kind). Having myself judged and/or diagnosed (and incorrectly) when I now have a child and have even more to lose if I end up being prescribed even more drugs or worse yet I have to go to the psychiatric hospital for a stay (I’ve done this a couple of times and cannot imagine having to do this now and be separated from my baby for possibly weeks).

Back to the judgmental psychiatrist though, she said she had no idea why she was meeting with me and that I should have not been seen again till later (even though my medication level was being reviewed post delivery and I had gone to the lab for another level test prior to this appointment). She also said that once I’m out of the post-partum period, about a year after birth, that I should be discharged to my GP instead of to another psychiatrist. She says the system is too overburdened for “regular” people to have psychiatrists. Then after a very short meeting she asked to see my child. I showed her the child, sleeping in the carriage, and when I smiled at the child, she pronounced in a most condescending way “oh, a smile, good, I can see you’re bonding with your child.” Right, well I’m glad this isn’t my regular perinatal psychiatrist, because I never want to see her again. And if I had actually been receiving good psychiatric care prior to going through IVF, I’d be upset about being discharged to my GP, but in light of the spotty care I was receiving pre-pregnancy, I’d rather let me GP manage my bipolar disorder in the future after I’m discharged from my regular perinatal psychiatrist. I’m booked in to see my regular perinatal psychiatrist towards the end of September (about three months post birth) for another review of my medication level and how I’m doing postpartum.

One more item, obviously it’s important to do regular blood tests for not just lithium level, but also occasional tests of kidney function as lithium carbonate can impact this significantly. I asked for a lab requisition so that I could test my lithium level before I see my regular perinatal psychiatrist in September (since obviously it would be useful for her to know if I’m on the right dose by checking what my blood serum level is). The psychiatrist who I saw was reluctant to give me one. She didn’t seem to think it was useful at all. While I am on the same dose of lithium carbonate as I was pre-pregnancy, things can change post-pregnancy and it’s important to check the blood serum level every once it a while to not just check that the lithium level is in the therapeutic range, but also to make sure that it’s not at a toxic level. Lithium carbonate for all its benefits for people with bipolar disorder, is also a powerful drug that can poison when not given at the right dose (and if it’s not at a therapeutic level, the patient can relapse with an episode that may cause them considerable distress, require PRN medications, land them in the hospital, or at the worse lead to suicide).

I think the takeaway here is that as with other areas of our medical system, one has to be one’s own advocate. If something doesn’t feel right, even if you feel like you’re being pushy, get the care you need. If you don’t demand it, you might not get it.

My pictures at the doctor before were usually solo selfies . . .

. . . now I have someone else to take a selfie with.

There have been a couple of times post birth where the lack of sleep combined with stress has pushed me and I’ve started to feel very anxious, have panic attacks, trouble sleeping, and feel like I’m starting to go a bit hypomanic. The PRN medication that I have used in the past and was prescribed to me in pregnancy as well if I felt unwell, is Loxapine. I have used this a couple of times postpartum and it has reset my mood and sleep enough to make me feel better without having to see a psychiatrist or anything more drastic like go to the hospital. It is more important than ever before for me to be self-aware and to catch things early if they start to slip so that I can avoid bad episodes or having to go on heavy doses of Loxapine or be hospitalized (I haven’t been hospitalized, both times were voluntary, for just over four years and I would like to never, ever return to that place).

Going on walks to stay healthy.

Regarding my thyroid medications that I take for suspected Hashimoto’s (hypothyroidism), these were stopped when I went into labour (also due to the rapid loss of fluids and the fact that I was on a much higher dose of levothyroxine than pre-pregnancy, so the doctor wanted me to not go into a state of hyperthyroidism). The day after the birth of my child, my endocrinologist sent a prescription to the hospital for a new lower dose of my levothyroxine. My liothyronine was kept at the same level as it had not changed during pregnancy. My serum levels were tested in the hospital and were retested a few weeks post birth (my endocrinologist reviewed my results online and sent me instructions so that I did not have to come into the office unnecessarily now that I have a child; he’s a real professional and so considerate). My endocrinologist was satisfied with the levels of T3, T4, and TSH. He booked me an appointment to see him about four months post birth and I will repeat blood tests before then so that he can check how my levels are at that point and make any adjustments as necessary.

Because I was on lithium while pregnant, my child was tested a couple of times for thyroid function to make sure that there was no problem from the lithium exposure in utero. There was no problem. The child is healthy and well on track.

Finally, a note on breastfeeding while on lithium carbonate. I was initially told that I should only breastfeed for a week or two to give the baby my colostrum, but no longer so as to minimize the baby’s exposure to lithium. Once the baby is born, it has to process the lithium itself instead of the placenta preforming this function and as the baby is so small the impact of the lithium on the baby is much greater without the help of the placenta. I read several studies on lithium and breastfeeding before, during, and after my pregnancy. Unfortunately, there are not a lot of studies and they are not very large or long term. It is not fully known what impact lithium has on infants who are breastfed in the long-term. Some women have breastfed for months, others for very short time periods. As I mentioned above, lithium for all its benefits for someone with bipolar disorder, is a toxic drug which can poison people at the wrong doses and tends to make people who don’t have bipolar disorder just feel really sick (I’ve heard it makes people throw up and while it can be hard on the stomach even for people with bipolar disorder, especially if taken on an empty stomach it, doesn’t have this same impact for most people with bipolar disorder, in fact it generally makes us feel better).

While I was in the hospital, I discussed breastfeeding with both my interim perinatal psychiatrist who thought that around a range of a few weeks was reasonable without endangering my child. Then they sent a perinatal pharmacist up to my room to discuss the pros and cons of breastfeeding on lithium. This was very useful as I had someone to further discuss some of the aspects of medical literature I had read. She went away to further clarify some points we discussed and then came back and we discussed breastfeeding again. She thought that I could breastfeed safely for up to four weeks before I was starting to enter into a grey and potentially hazardous area. Part of the problem is that while we test blood serum levels on adults, the infant who is breastfeeding and being exposed to lithium doesn’t get tested for their lithium serum levels so we have no way of knowing what their levels are like or if they’re dangerous or even when they are tested (this has been done before) what these numbers even mean for an infant as opposed to an adult with bipolar disorder.

The other issue is that while I was in the hospital, the child spent the first night in NICU due to the vacuum birth and some slight snuffly breathing (they wanted to observe the baby). They advised that the baby should be fed formula and breastmilk to help the baby gain weight (the baby was a healthy average weight) and heal from the vacuum birth (it’s tough on their tender little heads). It was also discussed that as I have bipolar disorder it would be helpful to get the child’s father involved with formula feeding in the night to increase the amount of rest I was able to get, especially at the beginning when I was exhausted from birth and potentially fragile with all the hormones coursing through me.

Especially in light of the fact that I was supplementing breastmilk with formula, the perinatal psychiatrist and pharmacist were both comfortable with me breastfeeding for four weeks. This is what I did instead of the original plan of breastfeeding for two weeks.

When I saw the other perinatal psychiatrist a month after giving birth, she was glad that I had stopped breastfeeding. The perinatal psychiatrist's reason for me stopping breastfeeding was multifaceted. High serum levels of lithium in my blood of about 0.8 (really this is just above where lithium become therapeutic) and the baby's inability to process lithium as adults can now that they are no longer in utero. She also mentioned the lack large long term studies in impact of lithium exposure in infants (and blood testing in infants isn’t really done here and we don’t know what the number really mean in infants anyways). She confirmed how formula fed infants can be fed by anyone and tend to sleep longer than breastfed infants so more sleep might be had by a mother who was using formula (and sleep is crucial to bipolar patients). The final reason she mentioned and one that I had not really considered was the complex feedback loop in brain that is created when breastfeeding. The hormonal implications of breastfeeding can make a bipolar mother more prone to episodes.

Bipolar disorder is made more complex in women because of the hormonal fluctuations that happen with not just a woman’s cycle, but also the hormonal changes that occur with pregnancy, childbirth, and breastfeeding. Among the factors that can exacerbate bipolar disorder are hormonal fluctuations, various brain chemicals, sleep, nutrition, drugs and alcohol, levels of light, seasons, personal circumstances, stress, etc.. That is what makes bipolar disorder so complex to manage. But with careful management and self-awareness, it is possible to live a healthy and stable life and have children when one has bipolar disorder.

I hope this helps others who may be seeking information on medication changes postpartum, breastfeeding while on lithium, and just generally dealing with bipolar disorder and hypothyroidism postpartum.

For all the stress and sleepless nights, I've never been more grateful for anything in my life.

Is this a footnote?

23 Weeks Pregnant: Daily Walks, My Husband Away During the Week, A Forced Visit to the Naturopath, Planning a "Babymoon," Ruminations, Worries About the Future, and Was That It Moving or Am I Having Weird Indigestion?

Current mood . . .

I honestly never thought I'd make it this far into the pregnancy. After years and years and years of trying to get pregnant, having a miscarriage, and then being told the mournful statistics of how unlikely it was for me to have  a live birth from each round of IVF at my age by my reproductive endocrinologist, Dr. Hudson (28% chance of a live birth at my age), I just kind of assumed I'd have to try several rounds of IVF or that I'd get pregnant and miscarry again or that I'd just never be pregnant again. Being already pessimistic, going to law school, practising law for years, and then having years of bad luck really did a number of me. But here I am, 23 weeks pregnant today from a single round of IVF at the Victoria Fertility Centre.

This week, I have been experiencing continuing ups and downs with sleep (including nightmares, trouble getting comfortable, having to go pee really often through the night, and sometimes waking from panic attacks). My ears keep plugging and unplugging. This seems to be an extension of my congested sinuses that couldn't be connected to those two colds anymore and must in fact be from all the increased blood flow that I'm experiencing because of pregnancy (congested sinuses and ears are common in the second and third trimester). My hands seem to be more swollen than they were and I'm wondering how long it will be before I have to take off my wedding ring and engagement ring. My shape is changing steadily with each passing week too. I've had a bit of eczema acting up this week (some women get eczema acting up, while others notice an improvement during pregnancy).

On the advice of my perinatal psychiatrist, who told me that I need to get out of my head and house more and walk every day, I have been walking every day (except for over last weekend when my husband was at home and I wanted to spend every precious moment with him before he left again for the week, plus I was exhausted). I must say that while it's been nerve racking leaving the house, on some days more so than others, it has felt good once I am out of the house. While I started with a few kilometers per walk, I went up almost immediately to 6.5 km most days and even did 9 km on Wednesday (but that was overdoing it, as I was even more sore and was so exhausted the next day that I could only walk a couple of kilometers).  My hips and legs have been sorer than they would usually be going for long and brisk walks (and it's hard to be as brisk as I used to be between hauling around extra weight and gasping for air while being pregnant), however, it seems to make me less uncomfortable at night in bed when I go for a walk that day.

With views like this a walk seems like a reward on a sunny day.

Another benefit to the regular walks is that I have been sleeping much better on days when I go on long walks than on days when I don't walk or go or a short walk (like last night when I slept just 4 hours). The beauty of the walks I can go on near to my house is breathtaking (and that's not just the breathlessness of pregnancy). I have been watching early spring come to Victoria, including spotting the first cherry blossoms in my area two days ago. I don't mind it when it rains much and I've been lucky lately (especially considering that I have no raincoat that fits). I would say that the daily "exposures" to my anxiety over leaving the house (exposure therapy is used to treat panic disorder and anxiety by forcing a patient to do exposures where they face their fears by doing what they're afraid of repeatedly until it becomes less scary and then hopefully not scary at all- this is one of the most effective treatments for panic disorder and one that I had do extensively a few years ago when I was first diagnosed with panic disorder) have been beneficial in more than one way (sleep, less restless uncomfortable feelings at night, a mood boost, and lower anxiety). I have also had a friend come on a couple of walks and having someone to talk to other than the cat has been a treat (since my husband is away all week for work).

There's a herd of deer that spends the spring and summer in the Ross Bay Cemetery.

They make themselves at home.

The first cherry blossoms that I spotted this year.

I would say that even having my husband away all week, every week, has been easier to deal with since I've been walking daily. My psychiatrist is right that getting out of my place and seeing something other than this place has been good for me. A man even stopped to tell me a joke in the graveyard when I was wandering through there the other day alone and this gave me a laugh and a brief fleeting moment of social interaction when I otherwise would have had none.

I've been craving fruit like crazy.

My husband made me delicious blueberry pancakes last weekend before he left again.

I received a message over the weekend from my old naturopath (the one that my husband and I went to for months and months and received supplements and acupuncture from in the hopes of avoiding IVF and conceiving "naturally," only to find that we had to get IVF after all). She said that in order to keep selling me the prenatal vitamins that I buy from her (and sometimes probiotics too), she would have to see me for a follow up visit, since it had been almost a year and "the college" requires naturopaths to do this (all I could think was what?! They require an annual visit to dispense multivitamins and yet they let all this other crazy stuff that we read about in the newspaper happen with naturopaths? Shouldn't they focus on making sure naturopaths advise people, including parents of seriously sick children to get medical advice when they need it, instead of giving them herbs or whatever and in some cases having tragic things occur?!). But I digress. Since I like the prenatal vitamins that she has there (they have real folate instead of folic acid and some people may have difficulty converting folic acid into folate and since she got me scared about this a year and a bit ago, I've only taken folate to be on the safe side- I can't help the risk aversion being a recovering lawyer), I scheduled a visit.

Having to go for an unnecessary visit made me grouchy.

I was told that my visit to the naturopath could be quick, but of course it ended up being not quick. I was there 45 minutes updating her on what medications I'm taking (still all the same) and how the pregnancy is going (normal, maternity doctor has no concerns at all). While she does have some interesting nutritional suggestions (she really got my husband and me onto turmeric last year), some things really annoy me. One example was when I told her that I had managed to get a few okay sleeps with daily walking and she said in that smug manner that all people who have had children before seem to use "well enjoy it while you can because you won't be resting for the next few years." (chuckle, chuckle). No, it's not funny, especially when you suffer from bipolar disorder and a series of bad sleeps can trigger an episode. I don't need to be any more terrified of being a parent than I already am. Anyone expecting a child, unless they are the calmest person in the world or delusional, is terrified about the future, they don't need your sanctimonious and smug laughter and stories to scare them more. It's not helpful, just leave out comments like that. Everyone knows that new parents don't sleep well. Sorry you didn't get a gold medal for your sleep deprivation, but there's no need to boast about it to me because I'm not going to give you an award either.

Another example of an annoying thing in my appointment with the naturopath was when she started in on breastfeeding counselling. I told her that because I'm on lithium carbonate for bipolar disorder (which she had just confirmed that I was still taking), unfortunately I will only be allowed to breastfeed for a couple of weeks to give the baby the colostrum and then I will have to feed the baby formula. She initially seemed to protest, until I reminded her that lithium carbonate can be toxic and that when we can't test the levels in an individual they are dangerous. Despite this, she prattled on and on about strategies for breastfeeding and co-sleeping. As if I don't feel bad enough that I won't be able to breastfeed my child when everyone in my family has harped on and on about it my whole life. I already feel like a failure (even though according to research, I shouldn't feel a failure, and this is more common of an issue than people talk about due to the militant breastfeeding shaming in our society that currently occurs).

She took my blood pressure and pulse and confirmed what my doctor always says that I do NOT have high blood pressure and that I seem perfectly healthy.

Quit prodding at me and give me my prenatal vitamins.

At the conclusion of the appointment, which I was trying to rush along, as I had really had enough, she gave me a packet of various articles on pregnancy and a recipe for an easy cereal to make ahead of time for eating while I'm trying to feed the baby in the morning and beseeched me to come back in my third trimester. She also tried more than once to tell me that I should have a doula present with me when I deliver despite the fact that I have a doctor and I'll be delivering in a hospital (years of law school and practising personal injury and medical malpractice ensured that I would choose this route for childbirth). The whole interview was kind of annoying, but at least it's over with and I have some articles to read and a couple of recipes I could try if I needed to. I'm not opposed to approaching health and pregnancy in as well rounded a way as possible, I just don't like it when I'm made to feel guilty for having an incurable mental disorder which requires me to be on a particular medication for life and that medication makes me unable to breastfeed. What am I supposed to do? Go off of my lithium and then destablize, get hospitalized in the psychiatric ward again (this time pregnant), and spend the remainder of my pregnancy there and get put back on psychotropic drugs, or worse yet, wander off, do harm to myself, and then have an even worse tragedy occur? No thanks, I'll stay on my prescribed psychotropic drug that is effective for treating my potentially lethal mental disorder and I will follow my specialist's advice. Yes, it's too bad I can't breastfeed, but that's life, and I might not have a life if I didn't take lithium carbonate (bipolar disorder has the highest suicide rate of any mental disorder).

I spent a good part of this week making lists for our trip, finalizing accommodations (quite difficult on some of the more remote islands in French Polynesia and requiring me to start polishing up my rusty French), communicating with various travel insurance providers over specifics of their travel insurance policies as related to pregnancy, and starting to make piles of stuff to bring (and trying on bathing suits- nope those won't work, I'll have to go shopping). I'm anxious to go on vacation while I'm pregnant, but I'm also excited. I think the time away and intensive time with my husband will be very good for me. I can't believe we're going back to French Polynesia, where we had our honeymoon nine years ago, to have our last vacation before the baby comes. Read more about the vacation (or "babymoon" as some people call it) on our travel blog, Two Restless Wanderers.

As beautiful as spring in Victoria is, I'm looking forward to French Polynesia.

I will miss him though.

But being in French Polynesia again will make up for missing my kitty.

I had a lot of trouble falling asleep last night. I couldn't get comfortable despite all the pillows (including the rip off defective maternity pillow from eBay that the crook seller refused to refund) and only sharing the bed with the cat (who takes up roughly 1/3 to 1/2 of the king size bed). I had a bit more caffeine than usual yesterday and a bit later than usual, so maybe that contributed, but I couldn't stop worrying about things that could go wrong on the trip, where we're going to live when we have the baby or what if we still have to keep living here, and thinking about my family. I don't think the pregnancy book that I was reading before bed helped, it was going on about preparing the baby's room in the part I was reading last night, letting your partner paint it, etc. The book also irritatingly keeps talking about how you should not be surprised when your mother is obsessed with your pregnancy and keeps talking to you about it, giving you suggestions, and talking about when she was pregnant with you or when you were a baby.

What if no one in your family talks to you or takes any interest in your pregnancy? What if your mother is dead, is a alcoholic or drug addict, is incapacitated by a mental disorder, or is generally absent from your life? Why do almost all the pregnancy books I've read keep going on and on and on and on about how your family will react and all saying the same thing? Not everyone comes from a functional family or a family at least that will take any interest in a pregnancy. Some of us either don't have one or more parents, have parents who are addicted to alcohol or drugs, have mental disorders, and/or can't or won't be actively involved in their pregnancy.

What the books are saying makes me feel even more alone, even though I know I'm not alone. Rates of drug and alcohol abuse in the world are extremely high (and this is with them being underreported) and mental disorders impact many families (and underdiagnosis means that more people are impacted by them than official numbers would indicate). Plus some families are just assholes. Not everyone is going to have someone asking them about their latest ultrasound (or any of them), wanting to know what the sex of the child is, giving helpful suggestions or commiserations over what's like to be pregnant and afraid of the future, or helping to pick out things for the nursery (if you happen to have one). Some of us will not have their family talking to them or wanting to know anything about the pregnancy or the future grandchild, nephew, or niece (or even wanting to know which it is) or even if the fetus is still alive or if you're still alive.

I lay awake thinking about how if I were to find a place to move to, unless I wrote about it on this blog, and someone in family happened to read this blog, they would not even know that I had moved. I thought about what it will be like having a child and my family not even knowing that I've had the child, what the child is, what the child's name is, what the child looks like, what it will be like not having any help at all. But my psychiatrist says that I can't allow myself to stay in the pattern I've been in with my family. I must set boundaries and keep away from abusive and unhealthy behaviours by them for my sanity and for the good of my future child. I can't allow myself to have family members hurling abuses at me (sometimes when drunk, sometimes when sober), then denying that they said these things (whether because of a blackout from alcohol, forgetfulness, or pride) or justifying why they said these monstrous things to me, never apologizing for hurting me, acting in an okay manner for a while, and then exploding again shaking my soul to its core and causing me further anxiety and depression.

This pattern that has been with me my whole life with my family cannot continue now that I have a dependent creature to think of that's not feline. It's excruciating to not have my family involved at all, but I can't risk the child being exposed to what I was (not that my family wants to be involved at present). My psychiatrist was unequivocal that unless things were to change drastically that I should not expose my child to my family and the chaos that surrounds it. I must think of what is best for the child even if it feels painful. I wish that people would stop saying how great it is that I live in the same town as my parents and sibling when it's really not and they have no idea what it's really like for me. Quit assuming everyone, it's making an ass out of u and me.

So, to the writers and editors of these lacklustre pregnancy books that I've been reading, not everyone is in the same boat and you shouldn't make it seem like they are. It hurts worse to hear about perfect, functional families when you are pregnant and hormonal than it would when you're not (even though it does then too). It wouldn't take much to add a couple of sentences to these books about how you can turn to a close or trusted friend(s) or to your in laws or even to just your partner if your family is not supportive (in my experience, people will come out of the woodwork or step up in ways you never imagined before and while it may not be the same as having your family involved in the pregnancy, it's your reality, it's different, but it's okay). Or perhaps just state that not everyone will experience support from their family, but that they will find a way to get through it. But all of these books are written in such a simplistic and summary manner, I doubt that they will ever add something as complex as this. It's out of their depth (especially since some of these books seem to spend inordinate amounts of time on frittering things like being bored of your limited wardrobe in pregnancy, being afraid of how your appearance has changed, and how to decorate a nursery- come on!).

I was feeling kind of worried at the end of last week, after having seen my doctor about the hemorrhoid (it's getting much better with the epsom salts baths and Proctol ointment and witch hazel by the way) and him asking me if I was feeling the thing move inside me. I hadn't really been feeling it move, or at least not what I could recognize as movement. I had in the past a bit (I think), but then I didn't for about a week. Last Friday night, I felt some twitching again. I felt more movement many of the days this week. The thing seems to like it when I'm in the bath and sometimes when I'm in bed.  It feels stronger than it did before, so I think it's not indigestion, gas, or a muscle twitch in my abdomen, it must be the thing! It's so strange. This morning when I was trying to fall asleep, I felt like I had a tiny eel thrashing around in my abdomen. My husband has tried putting his hands on my abdomen when I've told him I feel something strange (when he's around on the weekend), but he can't feel anything yet of course, it's too faint.

It must be really hard for the partner of a pregnant person to not be able to feel for quite a while what their pregnant partner is feeling. My husband is much more liberal with talking to my abdomen and stuff though than I am, so he is bonding in his own way. I still feel pretty scared to get attached in case it doesn't work out, but with each passing week, I have felt my fear falling away a little. I suppose it will just take time. And maybe seeing it in the flesh in about 17 weeks will be believing.

23 weeks pregnant.

22 Weeks Pregnant: Another Visit to the Maternity Doctor, Perinatal Psychiatrist, and Chiropractor, and Planning One Last Vacation as a Couple

Current mood . . .

Before my husband took off to go back east for work, we celebrated St. Valentine's Day early by going out for dinner. We went to our favourite Japanese restaurant in town, Sen Zushi. He also brought me home two beautiful bouquets since he wouldn't be here for the actual day.

We also discussed further one last vacation before we become parents or a "babymoon" as some people term it. We debated at length again various locales, the pros and cons of each, and finally decided we were going to go back to where we had our honeymoon, French Polynesia (but we're going to try some new islands on this trip as well as going back to a couple of the ones we visited before). We've always wanted to return to French Polynesia, it cast quite the spell on us, so it seemed fitting to have our one last hurrah before children there. A honeymoon and nine years later a babymoon in paradise. I researched extensively diseases and dangers and concluded that if we weren't idiots, it would be safe for a babymoon. Plus as a French Colony, part of the EU, and the recipient of lots of money from France, they have a higher standard of living that many tropical islands and a good medical system (they've been Zika free for 2 years, too). Yes, the main flight will be a bit long (8.5 hours from LA to Tahiti), but the prospect of spending three and a half weeks in the place we consider the most beautiful place in the world was too tantalizing. Plus we'll pace ourselves accordingly this time. Less tours, less long walks, and more relaxing. To read more about the vacation visit our travel blog, Two Restless Wanderers.

We've been waiting nine years to get back to French Polynesia.

I saw my perinatal psychiatrist on St. Valentine's Day. She was the only person I saw that day as my husband was back east for work. When she asked me how I had been feeling the past month and if things with my family were better, I burst into tears. I hadn't expected to cry in the appointment, but I just couldn't help it. I was overwhelmed by melancholy. I told her about my frequent panic attacks, high anxiety, and low moods and how I had tried two different courses of Loxapine to remedy my mixed state. She decided that I need to get out of the house more and not just for medical appointments. No matter how frightened I feel at being outside, she told me I should walk every day, even if it is only the two blocks down to the ocean and back to my place (in my panic attack group that I used to attend shortly after my diagnosis with bipolar disorder, we call facing a fear when you are anxious an "exposure" and this method is really quite effective for panic disorder). She said that I need to get out of my head more, as well as my house. She also said I'm far too isolated. My medication was left the same as my lithium level was good in the last lab test. I will retest my lithium level once more before I go on vacation and if the level is off or I'm feeling awful, I'll see her. If not then I'll see her when I return.

At VGH hospital for a visit to my perinatal psychiatrist.

My valentine was less than enthused.

One of the parts of pregnancy that a lot of people don't talk about, though many experience it, is problems with veins. This could be varicose veins, spider veins, or hemorrhoids. The latter two have flared up in me now. The spider veins are benign, but the hemorrhoids are really a pain in the . . .. I finally went to see my maternity doctor again this week as my soaks in the tub and witch hazel were not working. He prescribed a cortisone ointment with analgesic and antibiotics (mine is called Proctol). I didn't want to just start something like this without his advice, as the sources I've read say that one ought to weigh the benefit with the risk when pregnant. He says it's fine to use this ointment though and that this is a very, very common problem in pregnancy due to the increased blood flow, pressure, and weight, as well as constipation that many women experience. I have not been enjoying the experience, but I just remind myself that I'm lucky to be pregnant and I count it as a blessing every day after all the years we tried to get pregnant, the miscarriage, and having had to undergo IVF.

At the doctor's office.

The other part of my visit to Dr. Down was asking if it was alright for me to go on a vacation in the next few weeks. He has no concerns about my pregnancy, but warned that sometimes babies even come as early as 24 weeks and if they do they need hospital facilities as they are viable at this point (some survive, some don't). It's highly unlikely, but one should consider the possibility. He queried whether French Polynesia had adequate hospitals and if our travel insurance would cover the infant's medical bills as well as my own if I should labour early. Naturally, travel insurance is a very important thing to have when you travel and knowing the particulars of the policy is crucial. I used to practise in the area of insurance litigation, so I'm hyper aware of this issue (whether or not an insurance company will actually pay rightful claims is another matter altogether- we're still waiting for a response back to our latest letter to our insurer over the prescription drug costs from IVF that they refused to pay.) Each policy is different, so it's important to understand exactly what your policy covers.

Our cat will not be happy that we're going away, but I'm sure that with enough tuna he'll forgive us.

I was at the chiropractor today for another adjustment. He says that my back and neck are starting to settle down, but I'm still quite tense in the mid to upper back (this would explain the spasms in my right trapezius sometimes). I'll be back in about three weeks, just before I leave for my vacation for another adjustment.

I'm 22 weeks pregnant today. I must say that it's getting harder to deny that I'm pregnant when I look in the mirror. In less baggy clothes, my stomach is starting to become more and more obvious. I'm still monstrously uncomfortable in bed at night and not sleeping well. My stupid maternity pillow finally arrived from the crook I bought it from on eBay.  It was almost three weeks in coming from the U.S. to here in Canada. It was vacuum sealed and arrived flat as a pancake. Having read online that people put maternity pillows into the dryer for a few minutes on low to fluff them up when they arrive by mail and having no instructions to the contrary with the pillow or on the pillow's tag, I took of the zippered cover to wash it and put the pillow itself in the dryer. When I pulled it out a few minutes later, it was oozing fluff from several different areas as the cheap plasticy papery mesh covering had disintegrated. I struggled alone to stuff it into its zippered case and slept with this obese lumpy corpse alone that night. It was hideously uncomfortable and not at all as described ("This Total Body Pillow delivers the ultimate comfort and a restful sleep. Embrace your entire body in complete relaxation. This body pillow is an exceptionally comfortable addition to your bedroom, living room, college dorm. This pillow can provide relief from the discomforts of pregnancy and is perfect for side sleepers.") When I contacted the seller about this defective piece of junk, they wouldn't respond. The second time, they blamed it on the dryer and said I shouldn't have even used one. I have not heard from them since then. So, I guess the moral of the story is that sleeping when you're pregnant is hideously uncomfortable and nothing will help this problem and that there are many people waiting to profit from your misery and desperation for a good night's sleep. It seems in maternity there are countless people lined up and waiting to rip you off.

Yeah every pillow's supposed to look like this the first time you use it. What a rip off.

Since I saw the psychiatrist, I have been going for a walk every day. It has been scary getting outside, but when I'm actually out there, I've been enjoying watching spring progress into Victoria, even on the days when the weather is not so great. Since only a few of my wool coats fit and they're all too heavy for walking and my raincoat doesn't fit across the chest anymore, I've been layering a couple of old Addidas sweaters over my workout leggings and top. This is an economical solution, as I don't want to buy a coat just for the couple of months when I might need it in winter/spring in Victoria while pregnant.

Pictures from my various walks this week.

I'm still not really feeling any movements from the thing. The doctor doesn't seem particularly concerned. He says people feel it at different times ("quickening" as they call the first movements). I haven't been feeling any of the weird feelings like I was last week, so I don't know what's going on. But I guess I'll know when I know that it is actually the fetus moving and not just indigestion. In the mean time, since I have no indication that anything is wrong, I will continue to take this pregnancy one day at a time.

22 weeks pregnant.

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.

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 . . .