Showing posts with label diagnosis. Show all posts
Showing posts with label diagnosis. Show all posts

Countoff Day 8 & 7 – In the hospital

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Day 8:  Well, I was really excited about Day 8 and was going to write all about it.  The weather was gorgeous in Seattle, I had a friend call and invite me out for lunch.  She drove and we had a great time, nice conversation and excellent fried calamari with a site of hummus and pita bread.  We came home and I relaxed laying on the couch for a couple of hours.  I was invited out to dinner at a local pub with 6 friends and since I was feeling fine and given the green light by the docs I went along.

Bad move.

I ate, laughed, and generally felt fine.  I will say that the wooden chair I was sitting on was uncomfortable after a while.  I got up after about an hour to use the bathroom and there it was…pink on the TP.  Dangit.  No problem, I thought, I’ll just call it an evening.  Dinner was over we were all just hanging around and chatting anyway.

So I got my hugs, excused myself and drove the 2 miles home.  No big deal.  When I got in the door, I felt a wetness and headed straight to the bathroom.  More pink, now redder and things were…wet.  Too wet,  Not a lot, not a gush, but something very unusual.  I went straight to bed, lay down on my left side and called my ObDoc’s office.  My doc was on call, I explained what was going on.  I let her know that I didn’t feel any more wetness since the initial event but needed advice.  She told me to get myself to labor and delivery.  MrBeep came home about 20 minutes later and off to the hospital we went.  I could feel my little sweetie monsters squirming around, we got their heartbeats so I knew that for now they were doing fine. My ObDoc was the one to take care of my examination, take a sample and check the slide.  She couldn’t find any conclusive evidence in the sample that there was any amniotic fluid leakage, but she didn’t like the description of the event or how much blood and moisture she saw.  I was monitored for contractions all night and only had one or two after the pelvic.  I was admitted for getting IV anitbiotics and monitoring.  MrBeep stayed with me the whole time, took care of my every need.  He held my hand, kissed my forehead and helped me make it through the night.  I was so scared that a membrane had ruptured, but there was no evidence of any other leakage.  Both my ObDoc and the L&D nurses said that this was a very good sign.

Day 7:  MrBeep slept in the little bed next to me in a labor and delivery suite.  Today I’ve had no additional leakage or watery bizarreness.  I’ve had no contractions all day.  I had barely any spotting.  I’ve received doses of IV antibiotics (just in case) and was supposed to get an ultrasound to check the fluid levels of the babies to see if that would show any evidence of leakage.  Unfortunately, there was some mix up and I will get that scan tomorrow.  I talked with the TopDoc from my MFM clinic.  He apologized for the ultrasound mix up but suggested another day for observation and antibiotics was pretty standard given the fact that I am only at 23 weeks.  He did say that he felt very good that there was no other episodes after the first report, that the sample slide didn’t show anything to indicate amniotic fluid and he felt it would be extraordinarily unusual to rupture a membrane behind a cerclage that was looking good the day before.  After speaking with him, I felt about a thousand percent better.  This entire episode may just be another bizarre result of the previa.  Everyone (ObDoc, TopDoc, L&D nurses, MrBeep) has told me that this unusual thing was not my fault and that I didn’t do anything wrong to cause it, but man…it is very hard to let go of that guilt and worry.

I will be seen on Saturday (day 6) by DrGav who will take a look with ultrasound see if everything is looking good.  If so, then I will be discharged from hospital.  MrBeep needed my computer for work, so I was unable to read or update.  He put several hours of the Olympics we recorded on Tivo to DVD, so we watched them together.  I will try to catch up and update tomorrow.  The most important thing is the babies are fine, I am fine. A couple of more days down and more lessons learned the hard way.

Countoff Day 9 –Dr Appts & Photo Challenge

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Good news!  I went to both DrGav and my ObDoc today.  First the Peri/MFM appointment:  The cervix check shows all is looking great, staying a steady 3.5 cm and the cerclage is still looking good.  Both grrl monsters had good heart rates and bloodflow.  I have been taken off my medication and don’t need to come back for 2 weeks (where I will get my 24 week growth ultrasound).  His take on my Friday achiness and spotting is that it is nothing to be worried about.  Then I went to my ObDoc  for a routine check.  Blood pressure, pee in a cup, weight check , and doppler.  Wiggles kicked the doppler when the nurse was trying to get a reading.  We both laughed.  My awesome ObDoc arrived all smiles. I got an internal pelvic exam **YOWCH!** where she proclaimed things seemed long and were holding well.  When I told her about my Friday scare she was a little more concerned.  She told me if I begin to feel uncomfortable to lay down on my left side, drink some water and take things easy.  If things don’t seem to get better after an hour to call them.  She said that the next 7 weeks were really critical and she’d rather know that I am resting easily at home with some liberties rather than being a “long term guest” at the hospital.  I completely agree.  All in all very good results, maybe I spooked myself a bit, but I’d rather be cautious than sorry.  It is just another thing that will really help me make it through the rest of my countdown.

And now for something completely different…I had an idea for this week’s Photo Challenge, so I pulled out my fab macro lens. 

Photo Challenge this week's theme: WHAT IS IT?

WhatIsIt

Take a guess about what this photograph is.  To see a larger version, click on the pic.  My only hint is that it is more than what you think at first glance. I'll post the answer Friday with the other folks who took the challenge. I’m horrible at guessing but found it a fun little inspiration for photography.  Rotten – why aren’t you getting into the challenge!  C’mon!

(The Photo Challenge aims to allow creative ways to explore a weekly theme through photography).  The Weekly Photo Challenge is brought to you by The Steadfast Warrior (aka Lindsay) who also gave me this advice for dealing with my fears:

The reality is, you've got a lot going on and it's okay to be scared, hell if you weren't terrified a little, I'd think you were in denial. The only advice I have is to take solace in the movements and the special moments that come up.

She also said a little extra to warm my heart and offered a present to dry my eyes:

You are a lovely and strong woman. You and the Monsters WILL be okay. I can keep repeating it if you like? ;) (HUGS) to you, since sometimes that is what we need the most. I've left a little present for you at my blog…

Her gift was an absolutely stunning photograph taken from her balcony in beautiful Vancouver, BC.  You have to go over and see it.  I saved it as my desktop wallpaper for this 10 day countdown.  Every time my computer boots up I see it and smile.  Lindsay has a little girl, born just a little while ago, she is taking things one day at a time and writes with such honesty that I feel truly privileged to read and support her.  Thanks so much Lindsay.

I ended my Day 9 with “Weekly Series Night” – a special evening MrBeep and I spend with friends watching though a TV series together.  We finished watching The Venture Brothers – Season 3.  It was also really fun to have some company, laugh and joke around.  I love counting off a great day.

Emergency cerclage & bedrest

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I went for my weekly cervix check with my peri, DrGav, on Tuesday.  I was a pretty happy and healthy little chick as I bebopped into the office. Things were great, I could feel the babies move here and there, a little tap, a slight jiggle when I didn’t expect it.  I had a walk in the sun the day before.  Life felt normal and good.  Got results back from karyotyping amnio test, but am still awaiting the final CGH microarray results.  So far no problems, but I want to save that post until all results are in.

As you may or may not recall, during my 16 week ultrasound, they noticed a blood clot right behind the top my cervix.  DrGav was concerned about this as it could cause irritation to the cervix and wanted me to see him for a cervical check every week until things looked fine.  A week later, I had a tiny bit of spotting and while the cervical check measured 3.5cm and closed, I was asked to come again in one week for another check.  On week later, two days ago, Tuesday came and I went in for my cervical check, which involves our good friend, dildocam, aka “Wanda”.  The babies were checked briefly, their heartbeats were fine and they seemed active.  Then the ultrasound tech started checking my cervix.  She looked both with the abdominal and vaginal transducer.  She had me move a bit and push to see how it was reacting.  She was very nice and didn’t give away too much, but at the end of the exam, told me to stay put and wait for DrGav as he may want to double check things himself.

He checked me out with Wanda and then started talking to me and the ultrasound tech.  He pointed out that the internal cervical os was completely open, that there was significant funneling (even I could see it with my untrained eye) and while my external os was currently closed, I had the beginnings of effacement.  The diagnosis:  Incompetent Cervix.  My cervix had gone in one week from 3.5cm and closed to .6cm with funneling.  I felt absolutely no cramping, no pain, no contractions and there was no spotting.  It’s very scary to know that it all could have been lost so easily.  The only thing keeping my babies from harm was my placenta previa.  The edge of the placenta of baby A was still stretched over the top of the cervix and acting as a bridge, keeping it from splitting wide open.  The previa was moving and getting near the edge of when it was going to break free.  A manual check of my cervix was also found to be very soft, which could allow for dilation starting at any time. 

DrGav and I discussed the situation.  We decided that this was all looking very dire.  His recommendation was to place a cervical cerclage.  He did an excellent job of answering all of my questions and describing the procedure, why he was choosing to do it, what type of stitch, etc.  He explained that he preferred the Shirodkar stitch technique. He also wanted to make sure the stitch was placed very high, closer to the internal os as he felt this has worked better for patients in the past.  I was actually very worried about having an incompetent cervix due to my prior uterine surgeries, so I had done many hours of reading on this subject.  I had no problem agreeing to the procedure.  Anything to keep them in here and safe was best.  Even with strict bedrest at 18 weeks, it was very unlikely that they would make it to viability, much less term.  DrGav checked his schedule and the OR at the hospital and we decided to do a cervical cerclage that same day in a few hours.  I went to the hospital, was put on intraveneous antibiotics and had the procedure with a general anesthetic four hours later.  MrBeep came to be with me after work and arrived a few minutes before I went to the OR.  He met with DrGav and discussed the procedure and asked questions.

According to DrGav (he talked to MrBeep after the surgery was complete) it went very smoothly.  I had no bleeding from the placenta, everything seemed to go very well and with no complications.  They checked the babies whose heartbeats were both doing fine. I awoke in recovery with little pain, was dispatched to a maternity ward room and rested for a couple of hours.  The contractions monitor they put on me showed no contractions after the procedure.  I had a tad bit of crampiness, like the day before AF arrives with a vengeance, but it was managed with medicine. I went home that night around 9pm.  I didn’t want to stay in the hospital and DrGav said I could go home if I felt fine.  I had a little bleeding just after the surgery and it’s fading to a smaller amount and today it is just a little bit of pink on the TP.

I am on modified bedrest until my next appointment with DrGav on Tuesday 2/2.  I have a friend who is unemployed right now over as my “official babysitter” for the next few days.  We are giving him a little $ to help him out.  He cooks my food, keeps me company and we needed to do some movie production work this week, so it really turned out well for us both.

Even though this all seems scary and nerve wracking, I am glad and so relieved that we caught it in time.  Many women who have an Incompetent Cervix don’t find out until they have had a pregnancy loss.  It is more common with twins and is most likely to happen between 18-22 weeks.  DrGav is hoping if the cerclage is holding well that I won’t have to be on bedrest for too long, but we’ll see.  I have my little countdown calendar on my browser.  I have 36 days to go until viability (24 weeks), my first goal.  Hoping that in the end it all works out and my monsters are with me for as long as possible. 

Chillaxing

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Not much to report over here in the dark and soggy Pacific Northwest.  As Sunny mentioned, it has been pretty gray and rainy for a while.  I don’t mind it a bit, but a break for an outdoor walk would have been nice.  I’ve been mostly chillaxing since last Tuesday when I had my full anatomy ultrasound and amniocentesis.  After the amnio I went home and did as DrGav instructed.

“You are to be a couch princess for the rest of the day, take it easy the next few days.”

I am happy to report that I was very successful in my assigned task.  I endeavored to be a regal and gracious princess, ruling my dominion with dignity and benevolence.  MrBeep was a most attentive royal servant, I may have to knight him.  I puttered around on my computer. I read some magazines and books. I watched the Dakar 2010 rally updates with MrBeep each night. 

On Saturday I went out to a local coffee shop and played many hours with a gaming group.  I was able to get in on two games.  First I played a really fun game called “Jamaica.”  I think that I will buy this one to take down the next time I see my niece and nephews.  You are a pirate, sailing around an island trying to get treasure, food and gunpowder.  You are in a race with the other players and can also get into battles against them. The rules aren’t too complex, there is some randomness via dice rolls but there is an element to thinking ahead and strategy too.  The second game I played, called “Agricola” – currently ranked #1 on boardgamegeek.com - was much more complex and required a lot of strategy.  It was the first time I tried the game and came in last place, but it was very fun and I would love to play it again.  You have a plot of land and are trying to improve your house, build a farm, plow fields, harvest grains and add members to your family (more people = more turns).  Guess who took the longest to add members to their family?  Yeah, me.  Not by a little, but by several turns.  Really?  I have to be the infertile in a danged board game too?  Had to shake my head with the irony on that one.

The weekend was good.  I am doing fine.  I had very little cramping following my procedure, maybe a twinge or two.  I’ve had no pain, spotting or fever.  Now I just get to wait it out a bit for the results in a couple more weeks.  And now for a couple of questions:

Question 1 from Anonymous: “There was a result called "FISH" or something for the CVS that came after 2 days with the bigger results coming at 2 weeks. Does amnio have that?” 

Yes.  Amnio has the option for doing FISH.  We considered it.  I asked about the cost.  It costs about $500 and you get the answers for a couple of conditions, down syndrome, tri 13/18 in about 2-3 days.  We decided that even though insurance pays for the test that we would just wait it out to save money.  I was not considered a significant risk and we would want the full results no matter what.  If we had received a worrisome screening test, then I would have absolutely insisted on FISH.  This is an excellent article that includes some useful and detailed information: http://www.enotes.com/nursing-encyclopedia/amniocentesis

Question/comment 2 from mekate: Hope EVERYTHING is perfect and that no difficult choices need to be made. YOu are so brave doing the amnio! (I am scared of the big needles, never mind the rest of it).

Thank you dear sweet mekate. I’ll be honest.  DrGav recommended that I watch the ultrasound monitor and I took his advice.  I didn’t want to flinch or move at the exact wrong moment so I just kept my eyes glued to the screen.  He described what he was doing, what I was seeing.  The truth is, after all of the really painful and nasty stuff from IVF, like a pinchy speculums or being punched in the ovary, an amnio needle was a cake walk.

The comments I received were so heart-warming.  I am delighted at the wonderful support of the ALI community.  Thank you all for your kindness and good wishes.  I appreciate it so much.  The votes on the poll are very interesting.  I am, like you, very excited to find out the results very soon.

16w4d ultrasound – so far so good

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I’m glad to report that we came back from an ultrasound yesterday afternoon at the MFM clinic and the quick report is that everything looks good.  DrGav wanted to do a full anatomy ultrasound early and then do subsequent ones every 4 weeks to make sure that the growth of the monsters is on track.  If growth does not seem to be progressing normally, then I may get put on lovenox or heparin.  I weighed in and am up about 7 lbs since the start of things, so that is looking fine. 

MrBeep sat at my side, touched my shoulder and kissed my forehead.  A full anatomy ultrasound takes a while as each thing is scrutinized and measured.  For over an hour I got to lay back and watch the monsters jiggle and wiggle. I saw happy squishy brains, thumping hearts and kidneys and stomachs and bladders.  I got to see the profile of each face, accompanied by waving arms and legs, twitchy hands and feet. I counted 5 fingers on a wee hand held out and easy to see.  I got to see eentsy little toes.  I watched so hard my eyes started to water and by the end my vision was blurred.  I couldn’t help it!  I guess I forgot to blink but the perma-grin was wide on my face.  

It’s amazing how reduced the room is in there compared to 5 weeks ago at the NT ultrasound.  No easy turns doing back flips at will.  They’ll just have to practice to be in Cirque du Soleil once they are in normal gravity like the rest of us.  The ultrasound technician got a couple of shots from under each baby’s legs, she asked me to guess, but I had no idea – remember it’s only 16 weeks along.  She is pretty sure the sex on one and the other is an educated guess, it’s legs were held tight together.  The internal ultrasound showed my cervix was long and closed, that is another very good thing.  DrGav warned that with twins, they want internal cervical checks every two weeks as things can change very quickly and a month span is too long between checks.

DrGav also said that the measurements on both babies looked good.  He needs more time to review all of the pictures to look closely at the placentas, etc.  We expressed our interest in amnio before the appointment and he said that it was really up to us, but that the measurements again put the risks for DS and Trisomy 13/18 as really low (1 in 650).  In the end, we still wanted to do the amnio.  The procedure went well.  DrGav explained each step and all the precautions he took for good results.  My belly was swabbed with iodine.  The ultrasound was on and referenced the entire time.  One quick poke for each twin’s sac/fluid. I watched on the ultrasound and all seemed to go fine.  The babies heartbeats were measured right on track after the procedure.  I have had an easy time afterwards so far.  No spotting, no leaking, no high temperature.  I have felt the babies flutter happily all night and day.  I have added a poll to the right column so you can guess what flavor the monsters are.  I get the results in about two weeks.

Why decide to do the amnio?  Folks, I’m 41, MrBeep is 46.  These are my own old eggs, his own sperm.  I’m going to be very honest, if one of these babies has a condition that is incompatible with life and puts the other baby at great risk, I need to know. I have to think of more than myself.  Screening tests are highly educated guesses, they are not diagnostic and they do not have the real genetic answers.  Also, D/S and Tri 13/18 are only 3 things.  Amniocentesis karyotyping tests for over 40 and we are also getting a prenatal CGH microarray that looks at over 100.  The real risks for continuous scan amnio with a highly qualified specialist like DrGav are significantly lower than 1:200.  They are actually more like 1:1,600.  Please believe that I don’t think that my preferences and decisions are right for everyone, but they are right for us.  In two weeks I’ll either have the hardest decision of my life or I’ll get to finally breathe a little easier for the first time in years.  I am happy to answer any questions for those of you who need to know more, just post in the comments or email ifoptimist.at gmail.com.  I would appreciate understanding and not judgment.  If you have strict religious beliefs and ideals, I respect them.  Please my friends, I’m scared and I’m crying. I will meditate.  I will try to instill calm in my heart.  Now again with a wholly new kind of 2 week wait, I will embrace Hope in all its bright sunshine, glowing at the end of a dark cave. 

Talking to the Big Guns

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Last week I went to the Maternal Fetal Medicine specialist office and I met DrGav.  He seems like a very intelligent and thoughtful man.  My ObDoc loves him, says he’s a sweetheart.  I started off the appointment by answering a ton of personal and family medical history questions with the MFM nurse who stayed during our appointment the whole time.  MrBeep was with me, sitting opposite in a chair, his serious face set and ready.

DrGav arrived and looked over my medical and family history.  We discussed my heterozygous MTHFR issue with the added knowledge about my brother’s thrombosis a couple months ago.  He said that he was glad to know my homocystine level was normal, that was a very good thing.  He was also glad ObDoc kicked the folic acid dosage up and that I was taking a baby aspirin per ObDoc’s instructions.  He said that he didn’t want to put me on any heparin for now because he thinks the baby aspirin and folgard will do fine.  He does want me to take 2 baby aspirin per day instead of 1 because I am carrying twins.  So one in the morning and one in the evening.  Taking two baby aspirin is means the kiddos will get a daily dose of aspirin. They’re so small.  This makes MrBeep nervous which therefore makes me nervous, but we will go with his expert advice.  He said that in order to monitor the babies, we’ll get an ultrasound at 16 weeks and then compare it to future ones to make sure their growth seems on track.  If it is not, then we will assume the MTHFR is causing placental problems and I will go on heparin or lovenox.

They took more blood to check my thyroid.  The results showed all is fine and normal.  DrGav did notice that I had a slightly elevated pulse.  He seems convinced that I will get high blood pressure during this pregnancy because my mom had high blood pressure before her kidneys finally gave out.  I don’t know.  I guess it may be likely.  I have, on his recommendation, bought a home blood pressure monitor (so we can see if it is slowly elevating over time) and I am also cutting out excess sodium.  The blood pressure pre-judgment frustrates me because I have always had normal or low pressure. My mom had it from the time she was in her early twenties, she smoked a pack a day, etc.  I know it can still happen but c’mon.  Honestly it is really hard to take someone’s advice you have just barely met, but I have done my research on this practice and the specialists and they are top notch.  I must admit I agree with him it is important to monitor and try to prevent a serious condition before it happens.  A proactive approach is wise. 

I talked to my mom and my brother and jokingly whined at them that their health problems are causing me grief from my doctors and would they please take better care of themselves.  They promised to do their best.  I see my ObDoc on Wednesday afternoon for a routine check-up.  It’s been three weeks since I heard the little monster’s heartbeats.  Every time I get close to a doctor’s visit I get extra nervous.  Anyone else crazy like that?

It’s interesting how many nice comments say things akin to “Wow. 15 weeks sure did fly by.”  I want your time machine folks because my weeks seem like they are really dragging.  I alternate between nervous terror and excitement.  A small part of me wants to go to sleep and wake up 15 weeks from now, but most wants to savor every minute.  I lay awake in the quiet of the night and try to feel them move.  Sometimes I think I can sense a fluttering and other times I’d swear it’s just my pulse.  C’mon my monsters, Mommy is looking forward to Squirmfest 2010.

An early Christmas gift

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I received an early Christmas gift today, no not a Red Ryder BB Gun.

Last week I posted “Houston, we have nasal bones” with details on my NT ultrasound and first trimester screening test. The genetic counselor from my maternal-fetal medical specialist gave me a call.  The results are in!  We received good news that the results are normal and show a decreased chance of trisomy 13/18/21.

I understand that these are screening tests and not diagnostic tests, but they do allow me to breathe easier for the next month or so before we will get amnio test and results.   

Here’s what we’ve got.  The genetic counselor started with Trisomy 21 (Down syndrome).  Given my age, the normal statistics for a child with Down syndrome is 1 in 62, or a 1.61% chance.  After the screening results, that number is now 1 in 627 for Baby A (.15%) and 1 in 660 for Baby B (.15%).  Going from roughly a one-and-a-half-percent chance to one-tenth-of-a-percent chance is very heartening indeed.  I was pretty happy about that.

For trisomy 13 and trisomy 18 she said the normal listed risk at my age was 1 in 109 or .9% to 1 in 2161 (.04%) for both Baby A and B.  Again this is very good news. 

I feel right now like one of my very favorite Christmas songs…

I am merry, my heart is light.  Big hugs and much love –- Traci.

I am NOT a Drama Queen

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Well, I am officially off of bed rest for now and I’ve made it to 13 weeks and that is another reason to say “so far, so good.”  Thank you all for your well wishes.  I have had no other spotting or bleeding since the first incident and am taking it very easy from now on.  I went to my ObDoc for a routine appointment on Thursday.  I was weighed (hard to accept that gaining a pound in a couple of week is a “good thing”), we got culture samples and my ObDoc checked my uterus. We were able to hear two separate heartbeats at 149 and 155 bpm on the doppler gizmo so that gave me a little bit of breathing room.

Before I get to the next part of my tale, I just wanted to state this for the record.

BabyJane002

I am NOT a drama queen.

I hate drama, I don’t want drama.  Keeping drama to the movies I watch is the only place I want that shit in my life.  I don’t thrive on it.  I am not an attention hog.  I want to be normal and boring and typical when it comes to this stuff.  I’m not a person who goes out of their way to create tension or strife.  Hell, I’m even a happy drunk…BTW…“I love you man.”  I like zany, I like snarky, I like laughing ‘til my face hurts.  I like good food and drink, fun conversation and a night of playing board games. 

Imagine my face then when three days ago my ObDoc’s office calls and lets me know that after my big bleed episode of the prior week (I had 12 vials of blood taken for various tests) it seems that I was tested and have come back positive for a blood clotting disorder, specifically for compound heterozygous MTHFR. 

MoTHerFuckeR.

BabyJane003 Here is an awesome blog I found that has a good tutorial.  Here is a good page on Thombophilias from the March of Dimes website.  The ObDoc’s office immediately put me on a prescription for FOLGARD taken twice daily.  Each pill is a mega-dose of folic acid 2.2mg, B-6 25mg, and B-12 1mg.  I have also been put on low-dose aspirin.  Hopefully these things will help.  If you have a MTHFR mutation your body does not absorb folate properly and you are also at greater risk for blood clots affecting you and baby.  MTHFR mutation complications and risks (some mutations are more serious than others) published in scientific papers in peer reviewed journals have been linked to multiple miscarriages (including early 1st, late 1st and 2nd term loss), implantation problems, congenital heart defects, preeclampsia, and clots that affect baby’s placenta, causing growth problems and pre-natal death. 

Great.  Think at 41 you make it to 13 weeks with kiddos looking fine you can perhaps maybe breathe just a little bit easier.  F-You IF Optimist, what do you think?

<Sigh>

BabyJane001

I am NOT a drama queen.

Here is what I am.  I AM a bit ticked off that no one found this out earlier so I could have taken better precautions, I mean I was tested for just about everything under the sun between my RE and my myomectomy ObDoc.  I AM grateful for my current ObDoc, a fine and intelligent lady.  I AM happy that even though I have this, it isn’t the most dangerous form of the mutation and can be managed by doctors.  I AM concerned because I have read of ladies losing their babies in the late part of their pregnancies because of clots in the placenta or umbilical cord.  I AM relieved to know that most of those who had tragic losses were untreated for their MTHFR and once they were aware, properly monitored and treated, went on to have healthy babies.  I AM worried because remember me having to take off to Florida to take care of my brother?  That was because of deep vein thrombosis (a blood clot in the leg) leading to a pulmonary embolism.  I AM glad that although my brother had this serious condition, he was a two-pack a day smoker while I have never smoked (he has since quit smoking).  I AM glad that although they found the MTHFR mutation, currently my homocystine levels were normal.  I AM extremely happy that I have made it this far in the pregnancy.  I AM also very glad that the NT scan looked good, so I hope I am doing OK for folate absorption. 

As I said earlier, I found out about MTHFR on Tuesday so both MrBeep and I were spending a lot of time on Dr. Google, NIH and PubMed to find out more, make sure we understand the dangers, etc.  I didn’t want to post until I had a much clearer understanding of my current situation.  I did come up with a list of questions for my ObDoc.  I now have a little red moleskin notebook that I will take notes and write questions so I don’t forget for my doctor’s appointments.  After our routine exam was completed, here were the questions I asked her:

Q:  My brother was just hospitalized for 6 days due to a deep vein thrombosis and subsequent pulmonary embolism. He is 1.5 years older than I am.  He is also 80 lbs overweight and a 2 pack a day smoker.  While my homocystine levels tested normal, does this put me at greater risk? 

A:  (At this information her face dropped a little and her tone became more serious) I want you to call the MFM specialist, get an appointment and let him know this.  I think we are good with the extra Folgard and the baby aspirin, but he may want to put you on lovenox.

Q:  I am curious to know what prompted to you test me for MTHFR?  Was it the big bleeding episode?

A:  Actually, it was because of your chemical pregnancy back in June.  We also tested you for other common clotting disorders including Factor V, Protein C, Protein S, Lupus, etc.  You tested negative for all other clotting factors which is a very good thing.

Q:  Do you think that my big bleeding episode last week was caused by the Total Previa or the MTHFR issue?

A:  Previa.  MTHFR doesn’t normally cause that type of bleeding, even with the clots you had.  Also it is a common thing with a total previa, even in early pregnancy.

Q:  My homocystine levels were normal.  How often will this be tested to make sure there is no increase?  Also, I was not fasting when the blood was taken, are you concerned about this?

A:  We’ve found that these levels rarely change this far into pregnancy.  I’m not concerned about the fasting, studies show no difference.

Q:  I have been reading about people with this condition getting Lovenox.  When is this prescribed versus just extra Folgard and baby aspirin.

A:  Typically it is prescribed if you have had several losses, have had  known clot or thrombosis yourself, or if you have more than one clotting disorder. 

So, my friends.  That was my week.  I have a call into the Maternal-Fetal medical specialists who will consider whether or not I should also receive injections of Lovenox in addition to my current vitamins.  While I don’t like having additional factors to worry about, I am actually really glad we caught this early.  I am very very happy that I found a good team of doctors who are proactive and on the ball.  I get to decorate the house for Christmas tonight with MrBeep, my MIL and FIL.  My ObDoc (I promise to write more about her later) has been able to put me at ease with her great personality, superb knowledge and professionalism.  She did say this to me, “well won’t it be great to have these two kiddos out for Christmas next year?”  I was so happy at that thought I could cry.  I just said, “I hope so.  That would be really wonderful.” 

Houston, we have nasal bones

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I celebrated my birthday on the couch with great news!  So far so good.  While we won’t get the official screening results for the first trimester combined screening for about 10 days, we do have many things that indicate improved results.

  1. We have easily recognizable nasal bones
  2. Crown-rump length is good for their gestational age
  3. Neural tube measurement is 1mm on each behbey
  4. NT measurement/Crown-rump length is excellent

BabyA At the Maternal-Fetal Medicine office, they actually do a full anatomy scan when they do the nuchal translucency (NT) measurement.  I don’t know if this is standard everywhere or not.  I had not read that this was a normal part of a NT scan on any WTF2Expect web sites.  Our lovely ultrasound technician started by checking each twin’s crown-rump length.  They are growing right on time to a little big, that is good news they are measuring 12w1d for Baby B and 12w3d for Baby A.  I was officially at 12w0d.  She looked at the BabyBplacentas and seemed to think that the previa was  partial and not complete, but I don’t know.  Then she checked the NT measurement after waiting for Baby A to move into a better position.  It was moving, but never in the right way.  She kept saying, “Come on little one, just a little more” and finally took the ultrasound tranducer that was on my belly and gently bounced it up and down, saying “here we go.  Move a little.”  AND IT WAS SOOOOOO AMAZING because we watched on the monitor while both wiggled and moved TwinMonstersa bit after the bouncing of the tummy.  MrBeep and I  laughed and I was getting teary-eyed.  Finally they were in good places and she measured separately each one’s NT neck area and they were at 1mm.  Then she checked the heart rate, they were good and strong, around 155 for Baby A and 145 for Baby B.  Then she started at the top of their heads and looked at the following things, brain, each arm, each hand, each leg, each foot.  She also located and pointed out the bladder and then the stomach.  She explained that since she could see the bladder and stomach clearly that the babies are making urine and swallowing, so they will be able to make amniotic fluid.  That was another good indicator.  WHEW!!!  The anatomy scan took about 30 minutes and we got to watch those kiddos move.  It was the best birthday present ever, especially after my scare.  Things are looking up.

wallace-gromit-complete-blu-boxThanks so very much for all of your kind wishes and offers to join me for a couch party.  I would have loved to enjoy a nice cup of…eh…chocolate milk with my bloggidy pals.  I did get a very nice present from my MIL and FIL:

WALLACE & GROMIT
The Complete Collection on Blu-Ray!!!

It’s got four short films:
A Matter of Loaf and Death
A Grand Day Out
The Wrong Trousers
A Close Shave

IMG_0198

I was so glad to get some encouraging news for my birthday.  MrBeep was grinning and kept saying, “A great birthday sweetie, are you happy?”  I’d smile back and say, “Yes. Very, very happy indeed.”

The birthday dessert was…<drumroll>…eggnog gelato!  It was super yummy and MrBeep put in as many candles as he could without it melting right away. 

I closed my eyes and made a big wish for everyone.  I won’t tell you my secret, but know this…I was thinking of me, monsters and all of you.  May all our wishes come true.

A Monster-sized Heart

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Monday was a very very hard day.  It didn’t start that way.  It started happy, sending MrBeep off to work, grabbing my laptop and working on a writing project I promised for a friend.  In the early afternoon I was nodding off in my chair and decided that a nap in bed would work better, so I meandered upstairs, flopped down and happily dreamed for an hour or so.  I woke to a wet feeling and put my hand down.  It was covered in blood.  I got up and ran to the bathroom where the horror show began.  I lost a lot of blood and passed big clots, then after a minute it stopped. I felt no cramping and no pain at all.  I started shaking.  I grabbed a towel and ran to the phone to call my husband.  As soon as I heard his voice, I started crying and begging him to come home.  “I think I lost one sweetie, maybe worse.  I need you please please come home.”  He asked me some quick questions and made sure I didn’t need to call 911, but it seemed that after the initial large loss that I wasn’t bleeding much more.  I told him I was going to call the doctor after we got off the phone. He told me he was on his way.  I got into an empty bathtub and closed the drain.  I knew they would want me to save whatever material I could for analysis.

I had my cordless phone and knew my RE’s number by heart, so I called them for advice.  The receptionist put me on hold and immediately ran to get a nurse.  Nurse Sarah got on the phone, I told her in a shaky and crying voice what had happened and that I didn’t know what to do.  She made sure that my symptoms didn’t seem to require calling 911 and then told me we need to call my ObDoc’s office.  She asked if I knew the number, but I didn’t.  She told me she would look it up and get it for me.  She gave me the number and told me she would call me back in a few minutes to make sure I got through and they were able to see me.  I hung up and got hold of my ObDoc’s office.  I explained what happened and they immediately transferred me to Carolyn, my ObDoc’s nurse.  She found out my current condition, confirmed I had someone who could drive me to their office.  She told me to go to their ultrasound suite and I would be the next person helped and we would see how things were.  I hung up with her and called my mom and dad’s house.  My dad answered the phone.

“Daddy,” I said, “where’s Momma? I need Momma.  I think I’m losing the babies, there’s blood everywhere.”  He started to cry and told me he would get her.  They stayed on the phone with me, made sure that MrBeep was on his way and comforted me.  I thought of all my bloggidy friends who are having a hard time, thought of my own situation and asked, “Why Momma?  Why can’t we catch a break?”

After a few minutes Sarah, the nurse from my RE’s office called back to check on me.  She said the whole office was very upset and were all praying and sending good thoughts my way.  When she told DocO he said, “Tell her that if the Ob can’t see her for an ultrasound, we’ll help her in any way we can.”  I let them know that as soon as MrBeep arrived and drove me to the clinic/hospital (a 7-8 minute drive), we were going to be helped right away.  I let Sarah know I was on the other line with my mom.  She wished me well, told me to hang in there and that she would check on me tomorrow.

After about 10 minutes on the phone with my parents, MrBeep came home.  I was sitting in the empty bathtub and asked him to stay back and not to look but to get me a plastic container.  He came anyway and kissed and comforted me.  He made sure I wasn’t in any immediate danger and then went to get a container and a paper bag to conceal it so we could bring everything to the ObDoc’s office.  I rinsed off, dressed and we headed out. 

Arriving at the Ob’s office, we were luckily in the reception area alone.  The ultrasound tech was currently with a patient, but we were the very next to be helped after waiting about 5 minutes.  I used the restroom, got my paper gown and we used a wand to see what was going on.  She zoomed in and there was a little baby, lying on his back.  “There’s one” she said and then pointed to his heartbeat, “heartbeat looks nice and strong, we’ll measure it in a sec.”  Then she swung the wand around a bit and another little kiddo showed up, “here’s baby B and…there’s the heartbeat.  Also looks very good.”  She looked at me and smiled.  Now let’s take some measurements and we’ll check the sacs and the placentas. 

I was overcome with surprise and absolute wonder.  While she was measuring, I was still scared and softly crying.  MrBeep came up and kissed my forehead and said, “Be happy for now sweet girl.  Look at that little guy.”  He pointed to the TV where the ultrasound was displayed in duplicate for patients to have a clear view.  Twin A was being mellow, just chillaxing, waving and twitching a little.  Twin B was like, “Hey, don’t worry.  Look what I can do.  He wiggled and did a 360 spin on his back and then twirled around and faced us.  Then he just looked straight out of the screen and sat there, seemingly staring right at MrBeep.  “That little monster is mad dogging you,” I giggled, wiping away tears.  My monsters.  There they were, alive and with me.  3 monster hearts.  Baby A, Baby B and the monster-sized one I grew right then.

She measured the babes and they were right on track.  11w5d for Baby A and 11w3d for Baby B.  She closely examined the sacs and then said, “it appears that the gestational sacs are completely intact.  That’s a good thing.”  Then she scrutinized the placentas, and measured the heartbeat rates.  We got a strong 140 on Baby A and every time she tried to get Baby B (the acrobat) kept wiggling out of the way.  He would slide left, she would try to measure then he would slide right.  We all chuckled a little bit and boy that kiddo sure cheered me up.  I needed it.  We eventually got Baby B too and he was also right about 140 so that was great.  At the end of the scan she told me that everything that she could see looked good, but I had a total placenta previa.  The placenta of Baby A is sitting right on top of my cervix and this can cause serious bleeding.  “I want you to get dressed and head over to see your ObDoc.  I’ll give her the sample you brought us.  You didn’t overreact, this is a lot of material and you were absolutely correct to call.  You ObDoc will explain more about the total previa and she’ll give you instructions for your care.”  I went into the room to get dressed, washed my face and came back into the ultrasound room for MrBeep.  The ultrasound tech looked at me and said, “oh honey, you look like you need a hug.”  I did, I was still so nervous and shakey.  She was so nice and gave me a great big hug. 

I headed across the hall to my ObDoc’s office where I met her nurse in the hall.  She smiled and told me I needed to the other suite for the ultrasound.  I let her know that I just came from there and was told to come here now.  She looked concerned. 

“How are we doing?” she asked. 

“Well, the babies are wiggling with good strong heartbeats, and what appears on ultrasound to be intact sacs, but she says I have a total previa,” I responded.

“Oh thank heavens,” said the nurse, “that we can handle.  Come on back and we’ll take care of you.”

And they did.  They explained my condition, what could have caused the big bleed, made me understand the severity and told me that I was required to be on complete bed rest from now until the two days after any type of spotting.  Lying down. Bathroom breaks and that’s it. “You need to be absolutely clear of any spotting for two whole days.  One smidge of red or brown counts and resets the clock.  Absolutely clear?”

I was absolutely clear.  I have been given an enormous gift from the universe on this one.  I wasn’t going to screw it up.  I have been in bed/lying on the couch since Monday night.  Yesterday I got permission to sit up in bed, which is soooooo awesomepuss I can’t hardly express it…well other than to use the word awesomepuss.  I’ve been trying my best to keep up on your blogs and now that I can sit up, I will get back to commenting.  I had written half of a light-hearted post on prenatal vitamins, but I will delay that.  Next, I will write more about placenta previa using my ObDoc’s excellent demonstration and will post links to useful medical sites. We are not totally out of the woods, there is still much to fear, but hopefully with care and luck, we’ll make it to the other side.

I wanted to say that even in my darkest hour I thought of you all, my friends, who have been so supportive and have shown such kindness, both to me and wherever I read any comments throughout the ALI community.  It genuinely restores my faith in humankind.  I was so scared, I was so worried, but at no time did I ever feel alone.  Thank you from all of the places in my monster-sized heart. 

Whose got two thumbs and monsters on board?

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<Pointing at herself with thumbs up>  THIS GAL!

We got to see DocO today and he was grinning from ear to ear when he saw us in the lobby and gave me two thumbs up.  When he arrived in the ultrasound room, he asked me how I was doing and I explained I was nervous due to my loss of symptoms.  He looked a little concerned and gently said, “You don’t have to be miserable in order to be pregnant.  Let’s have a look.”  The date with Wanda had begun.  First thing he zoomed in on one and pointed and said “there’s the heartbeat” then he immediately swung around the wand to find the other one and point out the heartbeat, “and that looks good too.”  I love that he did that for me.  He allayed my fears first thing and then went to do his meticulous measuring.  DocO is a very compassionate man and I am so lucky to have been taken care of by him and all the other wonderful people at the practice.  The measurements were spot on, these little guys tripled in size in 2 weeks (Wow!).  The heartbeats were at 178 and 180 bpm.  I am so very happy about all of these good indicators.  Go little monsters! 

Their duck monster and frog monster likeness has morphed into more shrimp-like beings that look the same.  You could see their little arms and feet waving, which was really cool.  I got a CD with the images and videos that are fun to watch.  There are much monster gesturing and wild party dancing moves going on in there.  I think the conversation in the womb must have been something like this…

Most importantly MrBeep was laughing while he watched and was smiling at me and squeezing my hand.  I got lots and lots of hugs and kisses for a job well done.  I’m so excited, I can’t believe I have to get an OB/GYN now.  I have “graduated” from the RE office.  Yikes. I’m off to make a bunch of phone calls. 

So far so good.  Mommy loves you very much and keep waving and monster mashing.

What the ultrasound saw…

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I won’t tease you, I haven’t really been holding out.  My ultrasound appointment was on Sunday at 3:00 p.m. pacific time. 

After we went to the RE for the ultrasound, we went for a little grocery shopping and then out to dinner.  I had delicious salmon with spicy zesty soba noodles.  When we came home, we watched a terrific movie and I went to sleep early because, whew, I am sure tired lately.

I fall asleep sitting in a chair like an 80 year old man.

Can’t imagine why.

And my b00bs are really weighty and sore.

Ain’t that unusual?

Oh and I get a little queasy from time to time.

Guess I need some pepto.

Or…

Maybe….

It’s because of what the ultrasound saw.

AnimationMonsterUS1 

That’s right.  I’ve got two monsters in here (I photoshopped a little animated GIF to better illustrate what the ultrasound really saw).  “A” (who looks like a duck, am I right?) measured fine and had a heartbeat of 150.  “B” (totally a little frog) also measured fine (estimated a few days older) and had a heartbeat of 144.  DrKAwesome was my RE on Sunday and she also checked out my ovaries and said they were the right size and doing a great job making progesterone. 

So wow.  Two.  We checked them out on 7w2d and are due back for our next ultrasound two weeks from now (Golly, another two week wait?  Who woulda thunk it possible?) that will put us at 9w2d and if all is well I will “graduate” to a real OB/GYN.  MrBeep has been patting my tummy and grinning at me.  I had a perma-grin on Sunday and kept getting all teary-eyed.  We keep saying “so far so good”. 

Lots of love and good wishes and prayers from people near and far have brought me a long way and have been a comfort to me in difficult and nervous times.  It still seems a little unreal, but today I am bursting, full of hope and promises and wishes that may finally come true. 

Taking a shot on goal (aka why I chose to wait)

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All I can feel right now is how truly sick I am of waiting.  It seems like 90% of this game is spent waiting for the right time.  I want to be active.  I want to participate.  I want to roll up my sleeves and get to work.  I want to take my shot.

I had to wait for a BFN every month while TTC on our own. I had to wait for the right cycle days to go through tests and procedures.  I had to wait through two uterine surgeries and recovery.  I had to wait for results and healing.  All that waiting took over 4 years.  Even now that we have achieved the place where we are down to business/on to the big stuff/major intervention-o-rama, in the last 10 months I have only been able to try 2 IUI’s (1 clomid + 1 natural) and 1 IVF cycle.  In 10 months.  Everything else has had waiting due to tests and clomid causing cysts and/or a thin uterine lining, now embryo lab closure and recommended months off and now cysts again.  3 out of 10 months that had a shot in hell to work.  Those really aren’t good odds for success.  While I am a very patient person…Yes. Thank you for asking, I AM very sick of waiting.

So back to last Thursday afternoon.  Our IVF coordinator nurse called and told me that the doctors discussed the 14mm ovarian cyst and decided that it was just too borderline for them feel comfortable starting IVF this cycle.  As DocO said to me in the exam room, “the size of the cyst makes it really come down to a judgement call.  It is absolutely on the dividing line in terms of size for when we would postpone.  Obviously if we go ahead and it’s successful and you get pregnant then we would call it the right choice, but if we had to cancel mid-cycle or get bad results then we would call it the wrong choice, but there is just no way to know which on which side this coin would fall.”  The nurse, said that after DocO, the embryologist and the other doctors discussed the case, they thought it would be best to postpone.  I asked about aspirating the cyst and she said they discussed it while reviewing my case, but preferred not to aspirate.  She explained it is an invasive procedure and there is no guarantee there would not be complications or sometimes a cyst just returns anyway.  She asked me if I had any questions and how I was doing.  I started to talk to her about a few details and then just lost it.  I hate it when I cry in front of strangers, but I couldn’t stop myself.  I talked to her between sobs about how frustrating it seems that I am always soooo damned close.  I had some minor success last time, the baseline gave me excellent results and now here I am waiting again. I’m terrified that I’ll just be in the same place a month from now. Which is just one more month of being closer to 41 and do you know how bad my chances become as each month goes by?   She did say that it was really borderline and that if I wanted to continue anyway or get the cyst aspirated that they would do it. She said that if I wanted to talk to DocO that she would have him call me right away and that they understand how upsetting this all can be.  They just wanted to give me the best shot.  They wanted my starting point to be perfect to ensure the best chance of success.

I called MrBeep and told him the news that the IVF nurse was talking to DocO and will call me back soon.  I didn’t know what was the right decision.  Should I wait for the next cycle or just get the cyst aspirated and risk it?  MrBeep comforted me and told me whatever I wanted we could do.  We discussed our options.  We considered if we started the cycle and it was cancelled or failed, then it would be 2-3 months before we could try again.  If we waited, it would be 1 month.  We decided to just aspirate next month if another one came up.  I did have to take birth control a very long time, (14 days) due to the lab closure, and perhaps a shorter length would remove this complication.  One month would probably not be the make or break for my eggs or hormones.  Those have been looking good lately, but the waiting is still very hard on me. I am a person who acts, who has always worked hard to achieve things and that drive does little for me here.  There always seems to be some impediment, some obstacle in my way.  I can’t even get to anything close enough to call utter failure so I can just give up or move on.  I seem to be stuck forever on the bench, waiting to just get in the game.

GoMightyBeaversMrBeep used to play hockey on his college team. (Go Mighty Beavers!)  He explained it to me this way -- the more shots you take the better your chances to make a goal.  So we definitely need to be aggressive to take as many good shots as possible.  But sometimes your best option is to wait a little, get closer and take your shot from the best angle.  Sometimes you have to skate around to wait for that perfect shot.  The truth is we are impressed with our doctors, we consider their knowledge and advice to be very important.  They’re the coach recommending waiting for a different play, better circumstances to get that best shot at goal.  

After discussing it with MrBeep and calming down, we both knew that waiting a month was the right decision.  After talking to him all of my tension disappeared, I didn’t feel like crying anymore and some hope for the future was restored.  He does that for me, he calms my soul.  I am a better person for knowing him, but it is still very hard.  When the IVF nurse called back, I told her I was OK and we would wait.  She was really kind to me and suggested that I enjoy some wine and maybe get a massage some time soon.  She also talked to me a little about a wellness program in the area for ladies going through IVF.  I may check into this.  In the meantime I will do my best to keep my spirit up and practice my slapshot.

Ultrasound and status – Part 1

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It’s very late (1:45 am) and I have friends with their 2 adopted boys staying with us from out of town. I will have to break this post into two sections.  If you haven’t already done so, please take an extra second to visit Mo and Will.  They had some heartbreaking news today.  We need to give them lots of love and support.  I opened up my blogger for a few seconds before bedtime and posting and, well…it is just so awful and made me cry and why do these things happen?

I went in this morning to the RE’s office for an ultrasound.  The plan was to check and see if the cyst on my right ovary had collapsed now that the birth control pills were done and the “withdrawal bleed” has begun.  For more information or to catch up, you can read my prior post, “Are you kidding me?”  MrBeep was nice enough to come with me to the appointment to offer support and well…gosh darn it he is just so smart and reasonable.  He thinks of questions that elude my addled brain and I love when he comes to the appointments so he hears directly from the Doctor what is going on.  So we meet DocO, get right down to business with the wand and…

it’s still there. 

The measurement of the cyst hasn’t gone up or down even a millimeter.  Good ole lefty is hanging tough with no issues.  After the exam I sit there with my paper drape with MrBeep by my side and we discuss the situation with DocO.   The cyst is considered by DocO to be borderline.  A little smaller they wouldn’t think it was a big deal, a little bigger they would be very concerned how it would affect the cycle.  We discussed the possibility of aspirating the cyst.  He said it was an option, but he was concerned about putting me through a medical procedure that may not solve the problem and has the potential for complications.  He made an excellent comment.  “It’s all really a judgement call.  If we go forward, do nothing and it’s a problem that cancels the cycle, that’s bad.  If we aspirate and it acts up, that’s bad.  If we aspirate and it works well then that’s good.  It we leave it alone and it works, then that’s good.  But what we are talking about is something that is likely to affect the cycle and whether we think it is a good idea to take that risk or wait another month.”

I asked him why an ovarian cyst is considered a problem for an IVF cycle.  He explained that having a cyst can affect how well the eggs grow in that ovary.  You can get fewer eggs at retrieval time, you can have problems with the cyst growing larger due to the meds, you can have problems with your overall hormone levels, etc.  Keep in mind this cyst is here before the cycle has officially begun, I have not yet taken any stimulation medication.  Some folks who commented on Sunday had cysts appear after stimulation had already begun or they were many days into their IVF cycle.  I think that REs view this differently than one in the early stage.  This is just my impression.  To read a little more about ovarian cysts, here is a good article.

DocO told me to hold off on taking my first day lupron injection.  He said he planned to take today’s results and discuss the case with his colleagues. (This is their standard operating procedure – more brain power on the problem.  FYI-I love and respect that.)  He said they would call after the meeting in a few hours and tell me what the plan is, whether we will start the IVF cycle or wait until next month. 

After the appointment I walked MrBeep to his car, we talked and I wished him a good day at work.  Then I went home to wait for the call…(to be continued)

Techie Tuesday: Semen analysis a go-go

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Welcome to another Techie Tuesday. I am going to provide a few links to some IF techie things. I want to state clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net.  I read many articles and want to provide links to the ones that have some great info.  Are you like me?  Desperate to research the tests and procedures that have been recommended to you?  I get it.  I’ve been there.  I am still there.  Let’s a go-go.

According to the CDC’s 2005 statistics report, among couples who have ART cycles, male factor counts for 18.3%, multiple factors (female + male) is and additional 18.5%  The report defines male factor: “Any cause of infertility due to low sperm count or problems with sperm function that makes it difficult for a sperm to fertilize an egg under normal conditions.” 
http://www.cdc.gov/art/ART2005/index.htm

So you are having problems getting pregnant.  The RE puts us gals through a lot of embarrassing and uncomfortable tests and procedures.  Well men should get tested too.  I can’t believe sometimes reading about how long some ladies go through infertility work and testing before getting their male counterparts get tested too.  If your OB/GYN or RE hasn’t tested the other half, it’s time to ask why.

The men get their own chance at humiliation with the Semen Analysis and SPA.  I won’t get into any junior high jokes about providing samples in the doctors office.  OK.  Well…maybe one.  MrBeep and I joke about removing all of the standard RE office provided pR0n and replacing it with entirely hard core male-to-male manlove material.  We snicker about the RE docs saying something like “Wow, the SA sample rates are sky-high this month.  More volume than ever!” 

Back to bloggidy work…so the male counterpart gives his sample and then a couple of weeks later you get the results paperwork.  Once you get this Semen Analysis (SA) report and are thinking (as I did) “eh, so?  What does all this mean?” I understood that our test was labeled “abnormal” and that some numbers were below the reference range.  Other numbers were in the normal range, so how bad are things?  How does this affect our chances? 

I don’t really know.  I know they are affected enough that even with my 28-day on-time like-clockwork mad ovulation skillz we can’t get pregnant.  I know that over two years trying on our own we can’t.  I know DocO and the report recommends IVF with ICSI (which worked in IVF #1 very well.  6 eggs mature, all 6 fertilized using ICSI and 4 made it to 3 day transfer).  Below is a sample of how our results chart was laid out.  I have included links to the articles that I feel either explain the test item in better detail or where I have found useful information.

SEMEN ANALYSIS REPORT

Test/Result

Reference Range

IF Optimist Notes

Volume Normal: 1.5-4.5 ML if the volume is too low or too high it can indicate fertility problems.  This site gives an excellent definition.
Sperm
Concentration
Normal: 20-150 Million/ml commonly known as sperm count, which is different from total sperm count (see below).  Oligospermia is a term for low sperm count and azoospermia is a term for a complete absence of sperm in the ejaculate.
Total Count Normal: > 40 Million/ml A calculation of the number of moving sperm in the entire ejaculate.  Volume (cc) x concentration (million sperm/cc) x motility (% moving)
Motility Normal: > 50% What percentage of the sperm are moving normally.  Sperm that don’t move normally cannot swim up the female reproductive system to find the egg.
Progression Normal: 3 - 4 This describes how well the sperm that are moving are making progress. Only when the motility (% moving) is combined with the forward progression is an accurate picture of sperm movement obtained.
Viability Normal: 60 – 95% Sperm may be alive, but not moving. A specialized staining technique is used to determine what percentage of the sperm are alive.
Sperm Agglutination   Sperm agglutination (sperm sticking together) can be caused by various inflammatory conditions, and are most commonly seen with the presence of antisperm antibodies
Viscosity The desired viscosity is +1 on a scale of +1 to +4, with liquefaction complete within 10 - 30 minutes. Viscosity is the rate at which semen liquefies. Semen is initially thick and viscous; the thicker the semen, the more difficult it is for sperm to travel.
Round Cells Normal: < 3 Million/ml A large number of round cells may indicate an infection
WBC Normal: 1 Million/ml All semen samples have white blood count (WBC) in them. If greater than 1 million WBC per 1 ml are present, there is concern of infection.
Morphology Normal: > 10%
Suboptimal: 5-9%
Abnormal: < 4%
Normal sperm have an oval head with a long tail. Abnormal sperm may have head or tail defects — such as a large or misshapen head or a crooked or double tail. These defects may impair the ability of the sperm to reach and fertilize an egg.
Acrosome Reaction (test using Sperm Penetration Assay) Normal: > 9%
Abnormal: < 7%
Levels below normal indicate problems of sperm fertilizing egg.  ICSI is recommended if this is the case.

Here are a few more articles I found on the internet that may help you better understand the test and the data breakdown.

Babyhopes.com: What does Semen Analysis Entail?

WebMD:  Infertility and Reproduction Guide – Semen Analysis – on page 2 this article gives a very detailed breakdown on what abnormal may indicate.

Wikipedia – Semen Analysis:  a pretty good article with lots of links to other sources.

An excellent and comprehensive page on Semen Analysis with good definitions.

Another really excellent page of information about sperm evaluation and testing.

An interesting article on a British website on semen and sperm quality.

Video that describes a little about IVF and shows an egg being fertilized using ICSI.

I know that there are a lot of other bloggers out there who have done some excellent research on male factor.  I would really appreciate it if you were to comment with any articles, websites or any previous blog entry (including your own) that you feel particularly useful.  It is all so overwhelming.   Techie Tuesdays are all about making it easier for others who need to find information when first dealing with infertility diagnosis and testing.  Thanks.

Are you kidding me?

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I went in this morning for my suppression check.  I have been put on the micro-dose lupron protocol, and I have just finished 14 days of birth control pills.  The first part of the suppression check is getting a blood draw.  The good news is I got my favorite phlebotomist. She is awesome.  I hardly feel a pinch and she never leaves a bruise.  The test today is for checking my estrogen (E2) level.  They do this to make sure that there is no rise in estrogen.  A rise would indicate the birth control pills weren’t doing their job to suppress my natural  hormone response.

Next I was taken into the changing room and given my paper sarong.  I asked the nurse what they were looking for in the ultrasound.  She said they are looking to see all of the follicles in the ovary were still roughly the same size and that there wasn’t a follicle growing much larger than the others.  They are also looking to make sure there are no cysts present.

The doctor called me into the exam room (DrT) and thus began my date with the dildocam.  First she checked the state of my uterine lining, then she measured my uterus.  Both looked OK.  She checked my right ovary next and there it was.  A large black follicle much larger than any of the others and measured at 14mm.  Even I could tell right away it was a problem. 

Dammit.  FFFFFFFFFFFFFFFFuck.

By the way, I think that it sucks I can now understand what I am seeing on a pelvic ultrasound.  DrT then checked the left ovary and that one was fine.  No large empty spaces, no indication of cysts.  Good ole lefty.  “OK.  So what does this big follicle mean?” I asked DrT.  She said that my estrogen levels are an important indicator to determine what comes next.  If they are high, then it means this large follicle may have and egg and may be producing lots of estrogen.  Since it would be way ahead of the other follicles it would be bad to start IVF drugs.  If my estrogen level is low, then this may be just a cyst and we might be able to proceed.  I was told to go home and wait for the test results.  I went home and told MrBeep <sigh>.

Several hours later my phone rang and I talked to the nurse.  The good news is that my estrogen level is low (40 = yay!) and that I should order my meds on Monday.  I am scheduled to come in again on Thursday morning where they plan to do another ultrasound.  The nurse explained that now I am no longer taking birth control pills that I would likely have a “withdrawl bleed” and they are hoping that the cyst will collapse on its own during that time.  I am to bring my lupron with me and if it looks good I’ll take the shot at the RE’s office and the cycle will proceed. 

I  did notice yesterday while I was working on my laptop that my right side had a few sharp pains just left of my hip bone, like it does when I have, oh I dunno, a cyst perhaps?  I thought, “Shit.  I hope that’s not what I think it may be.”  It was.  Anyone want to come over and punch me in the ovary?  Maybe that’ll pop the bastard.

Just for the record, I didn’t have a cyst two weeks ago during my baseline ultrasound. I watched the monitor.  DocO was very thorough in checking.  All looked wonderful.  I was curious and decided to google ovarian cysts.  Do you know what they recommend to prevent them?  C’mon fancy a guess?  Birth control pills.  Exactly what I’ve been taking for the last 14 days. Are you kidding me?

So I’m where?  Oh yeah, that’ right.  Waiting.  Again.  More to come on Thursday.

Game On!

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OK.  Here’s the scoop.  I went early this morning for a blood draw, then came back an hour later for my baseline ultrasound with DocO.  He started out by saying he could clear things up.  While the lab “officially” opens for all RE office business on the day of my estimated retrieval, they always make sure that everything is ready for patients who need egg retrieval 2 days earlier (that is also a part of their normal routine when shutting down the lab for cleaning).  DocO said if it looked like we would need to retrieve 3 days early, then the cycle would be cancelled or converted anyway, because that is just too early to retrieve good eggs.  As for taking BCP for 14 days, it is totally within the protocol and no cause of concern.  The way he explained the lab schedule was totally clear to me.  I “got it” right away.  I immediately felt better, then we got on to the baseline ultrasound.

First we checked out “lefty” who had 13 follicles percolating.  Wow!  Then we checked the right ovary and there were 14 more.  Another wow!  Anyone need a 27 egg omelet?  My blood work came back pretty good too.  FSH is 8.4, E2 is 51.  DocO said everything looked great, all of the numbers look better than last time and it is a very nice start.

There it is.  I shouldn’t have got myself all excited and worried, but this is all just so important, you know?  I can’t help get a little edgy from time to time.  Sorry about taking you all on my wild ride. I really appreciated your comments and ideas.  I ran down to check my computer first thing this morning before heading off to the appointment.

I start taking BCP tomorrow. (Cool, now MrBeep and I can do it like bunnies and not have to worry about me getting knocked up! What a relief!)  In a couple of weeks I will take two small doses of lupron twice daily then add stims into the mix.  I’ll write more on micro-dose flare protocol as I learn it myself.  Thanks again to all who gave me some ideas and encouragement.  Maybe my new IF Haiku will be good luck all around (thanks for posting MeKate).  I hope you all enjoy the rest of your weekend, I’m off to walk in the sunlight and enjoy a decaf iced somethingorother with my girlfriend Ali.

Day 3 Baseline Ultrasound and blood work

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I have to take a second and be paranoid, OK?  Bear with me.  I went to my RE’s office for my baseline ultrasound and blood test.  It is the first item on my protocol sheet.  So the lady took some blood, she was an absolute pro, was funny and cheerful.  It was a nice way to start my way too early day.  After the blood draw I waited in the reception area to be called for my ultrasound.  And about 15 minutes of waiting a doctor walked by with his coat/briefcase/etc.  The front desk person mentioned something to him as he walked by that she thought he was scheduled earlier in the morning or something like that.  I smiled.  No worries.  I figured they accidentally scheduled me before the doctor was due to arrive. 

I did ask for the earliest appointment so I could get to a (suprise!) resolve.org Washington State Family Building Conference in Seattle that started at 9am.  Two of the doctors from my RE’s office were going to give a talk on different subjects and there was a presentation scheduled to take you through what happens to the retrieved eggs once they hit the embryology lab after transfer.  The geeky side of me is totally fascinated by all this sci-fi stuff.  I didn’t want to be too late.

After another 5 minutes or so I was asked to come back and get undressed, don the totally chic paper sarong and head into the ultrasound “lounge”.  We took a look with the ole trusty dildo cam and everything looked good.  My cysts (a drug reaction to Clomid) were all gone and both ovaries were looking good and each showed about 8-10 follies percolating along.  Not bad for an old gal who hasn’t been on any meds for a couple of months now.  The doctor said that looked very good, uterus seemed fine, etc.  The cam got put away, I was able to sit up and then the Dr. said  something to me that was surprising.  He wanted to know why I decided to do another IVF cycle.

“Ummmmm” I said, “I’ve never done an IVF cycle.  I’ve only done two IUI’s.”  I then went on to explain the fibroids, the surgery to remove them, my DH sperm issues, the D&C to remove polyps/adhesions and now jumping to IVF is what was recommended by two doctors at his office.  After my quick history was told to him he said something similar to Oh yes.  Well that’s fine.  And then he left the ultrasound room.

I didn’t think too much of it at the time but since then my mind keeps going over and over the interview.  Why did he seem to be concerned about an IVF cycle?  Was it because things looked good enough that I didn’t need it?  Did he see something that I should be concerned about?  Am I missing something?  I know that it is probably because he was rushed and didn’t have time to read and absorb my file.  He may have read IUI but thought IVF, but man…the whole thing makes me worried and a little sick inside. <sigh>  Maybe I should learn to keep my mouth shut and find out more by listening?  Am I making too much of a little comment?  Any advice or opinions out there?

Oh well…off to the Resolve.org conference. 

Techie Tuesday: SHG (Sonohysterogram)

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Welcome to another techie Tuesday.  I am going to spend a few moments providing links to some IF techie things. I want to state pretty clearly that I am not a medical professional.  I am a computer geek/IT professional with over 20 years in the computer and biotech industries. A geeky gal who likes to research her condition/situation/whatever. My supreme computer nerdiness has enabled me to dig up some good places on the net where I have found some good info.  I wanted to provide those links so others who are in the same situation as I have been.  Desperate and wanting to find out as much as you can about the procedures that have been recommended to you.  I get it.  I’ve been there.  I am still there.
 
After getting my HSG check earlier in the month. I was also scheduled at the RE’s office to get checked out with a SHG (sonohysterogram).  Sonohysterogram is a fancy way to say “ultrasound-whoohaa-checker-upper”.  My doctor recommended this test in addition to the HSG because this tests gives the doctors a better look at the inside walls of the uterus while it has been expanded with sterile saline. 

Here is a some good description on HSG from my clinic's website:

Sonohysterogram (SHG)
The sonohysterogram (SHG) is similar to the hysterosalpingogram (HSG) in that it helps us to evaluate the uterine cavity. But, with the SHG, saline rather than an X-ray dye is instilled into the uterus and the progress of the saline is tracked with ultrasound rather than X-ray. The SHG provides clear views of the uterine muscle along with the endometrial cavity. Thus, we are able to see abnormalities like fibroids by SHG that cannot be seen by HSG. Also, by using ultrasound, we can utilize new 3D ultrasound technology that allows us to rotate the image of the uterus to obtain the best diagnostic picture. Even the most subtle abnormalities can be clearly seen with SHG allowing for accurate treatment planning. Unfortunately, the SHG does not provide any information on the fallopian tubes so it cannot replace the HSG.

I also found that this article has a good description of the procedure
 

Why would your Dr. recommend a SHG?

Well the way I see it, your RE clinic should perform this test to determine the following thing:

1. Do you have any uterine abnormalities that may be causing your infertility?
A few years ago it was with a combination HSG/SHG that we found a fibroid that was likely to be a source our infertility.  After it was surgically removed, a new SHG test showed some adhesions (scar tissue) and polyps that may cause PID (pelvic inflammatory disease).  This can also affect whether or not you can become and stay pregnant.  Some ladies who have unfortunately miscarried have had fibroids found that may been attributed to their loss.  I don’t have endometriosis or PCOS, so I can’t talk on those subjects, but if anyone has a blog that discusses the methods of their diagnosis, I would  be happy to provide a link.

Here is a good web article about using ultrasound to diagnose IF problems:
http://www.webmd.com/infertility-and-reproduction/guide/ultrasound-for-infertility

How does an SHG feel? What is involved from the patient's point of view?

Going through a SHG for me was relatively easy.  You are asked to arrive at the doctor’s office with a full bladder.  OK. Well, good point.  Trying to go through your day getting enough liquid in your system to make a “full bladder” without overdoing it, desperately hoping you don’t piddle on the floor like some excited cocker spaniel can be a bit tricky.  But I digress…

After taking off your clothes below the waist, you are given what I call “the paper hula skirt” to wrap around you for privacy/modesty/who are we kidding?  Then you enter the ultrasound room and are asked to sit in the exam chair (y’know the one with the stirrups).  In my RE’s office I have never had a technician perform the ultrasounds.  It has always been one of the 4 RE docs who perform and interpret the exam.  I like this aspect a lot.  They get to see first hand what is going on.  This is yet another reason why I dig my RE’s office.  I have been poked and prodded by all of the doctors at one time or another.  I find that they are all stellar professionals.
 
And now on to the fun part…once in the exam chair, they put the ultrasound goop on your belly then smear it around with the barcode reader looking thingy.  When that is in place, a speculum is used to access the cervix and a catheter with saline solution is introduced.  Then the speculum is removed and they insert the dildocam (what is the real name for this thing anyway?  The vagascope? Pooterviewer?).  I was able to watch while they inflated the uterus with saline and DocO pointed out some fleshy bits where the endometrial lining was supposed to be smooth.  “Yup.  It looks like a few polyps and adhesions.  The good news is that I don’t see any new fibroids affecting the cavity.  A simple D&C and polypectomy will take care of that.  Then I expect we can get a really good looking lining to help with implantation for the IVF.”
 
How did it feel?  A little uncomfortable, but mostly because they are moving the wands around inside and out while your bladder is full.  The saline push didn’t cause me any discomfort, especially since the HSG earlier in the month was quite uncomfortable, but this was because they were trying to open up the constricted fallopian tubes.  All and all I was very happy with the result.  Knowing a cause to something that may have negatively affected the results of my earlier IUIs made me feel better and helped me keep optimistic that things would look better in the future.
 

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