Friday, July 10, 2015

Cautiously Optimistic

Today we had our confirmation of pregnancy ultrasound.  We are at 6 weeks 6 days pregnant.

Now I know that this sounds ridiculously early to most people since the first ultrasound is typically performed between 18-20 weeks unless the pregnancy is considered high risk.  All IVF pregnancies are considered high risk.  Add being over 35 to an IVF pregnancy and your are super high risk.

In a typical pregnancy, you are supposed to schedule a confirmation of pregnancy appointment with your ObGyn after you have had a positive pregnancy test.  At this appointment they will typically perform a variety of tests such as a urine test, blood work (mainly infectious disease screening and tests for anemia), a physical exam and a pelvic exam.  The doctor will also listen for the heartbeat via Doppler (an external ultrasound without pictures).

When you have had infertility treatments you get to have a normal first ObGyn appointment only after you have endured a few appointments with your RE.

You have a beta (blood test) at approximately 4 weeks pregnant.  You then have a second beta two days after that to ensure that the hcg level is rising appropriately - it should at least double every two days.  If the hcg level is not rising appropriately you will have more beta tests in addition to the normal two.

Once the pregnancy is at least 6 weeks, you will have a confirmation of pregnancy ultrasound to determine viability of the pregnancy.  At six weeks, the heartbeat can be detected via vaginal ultrasound.  The doctor will also take several measurements to determine if the fetus, the uterus and the placenta are all developing at a normal rate.  You will also have a blood test to check your hormone levels to determine if your medicine levels are appropriate (remember that in IVFs and IUIs you are taking progesterone and estrogen which is essential until the placenta develops enough to produce its own.  Since you have "forced" your body into pregnancy it would not have released these hormones on its own as it would in a normal pregnancy).

If everything is measuring on track, you are told to set up an appointment with your OgGyn within a few weeks.  You need to return to the clinic for at least one more blood test to check your hormone levels (most people are off the hormones between 8-10 weeks), but at this point you have been essentially released by your RE.

This is a bittersweet moment.

At this point, we have spent countless hours at the clinic in consultations, ultrasounds, blood work, and procedures.  We have laughed, cried and hoped together.  And now that we are pregnant their job is done and it is time for us to move on.

Our ultrasound was an interesting experience.  The room was typical in that it had a curtain around the exam table and a chair in the corner of the room outside of the curtain for the spouse/significant other to sit.  We laughed that there was only one chair.  Obviously there isn't typically more than one person outside of the curtain.  Our clinic has been pretty awesome in making a strange situation seem normal - they made another chair appear before we even asked.

We had a little time to chat before the nurse came back for the ultrasound.  Our GC commented on the vaginal ultrasounds.  Before this process she had never had one (despite two normal pregnancies).  I never thought this was strange since I have had sooooo many throughout this process, plus the infertility diagnosis, plus a few troublesome ovarian cysts over the years.  I never realized that you could go through your entire life without ever having a vaginal ultrasound!

The process began and immediately we saw our maybe baby.  Keep in mind at this point Maybe is only around 9 mms.  The one thing that we could see clearly was the heart sack, which was constantly flashing like a little strobe light.

I starting firing off questions - "How does everything look?"  "Is everything measuring normal?" "Is the heart rate normal?"  I also started babbling on about how Maybe is the size of a blueberry and kind of looks like a baby otter at this point (I have secretly been out on checking out the pregnancy by the week section).  The nurse thought I was pretty amusing.

The nurse assured me that everything was measuring right on track including the heart rate.  Our RE then talked to us about next steps.   Our GC was to have a blood draw before we left to check her hormone levels.  Based on the results they would set her next blood draw visit.  We were also to set up an appointment with an ObGyn in 3 weeks.  Our GC is cleared for mostly normal activity, but no high impact exercise, heavy lifting, or sex (our GC's husband is really taking one for the team).  They want you to be very careful until the placenta is fully formed (10ish weeks).  Our RE also went through vitamins and supplements with our GC and stressed eating carbs.  She was worried about protein - our RE said protein is important but right now it is carbs, carbs, carbs.

Our RE starting closing by letting us know that the takeaway of this appointment is that we are measuring normal at 7 weeks.....not guaranteeing us a "take-home baby".  He reminded us that even at this point, after hearing the heartbeat, our chances of miscarriage are still at 15%.  This is primarily due to my age - Maybe was produced when I was 38.  If Maybe was produced today our miscarriage chances would be even higher.  To end on a positive note, he said that this also means that we have an 85% chance of success.

Trust me.  Our RE wasn't telling us anything that I did not already know.  I am fully aware of the risk factors that we have due to age and history.  We are at increased likelihood of miscarriage and birth defects.

The risk for miscarriage increases with age. Studies show that the risk of miscarriage is 12% to 15% for women in their 20s, rises to about 25% for women at age 40, and jumps to 80% at age 45. The increased incidence of chromosomal abnormalities contributes to the age-related risk of miscarriage.

Our GC said that her pregnancy symptoms have been increasing, with a noticeable uptick over the past few days (very normal at around 7 weeks).  So, as long as her symptoms continue at a normal rate that means that everything is normal, right? 

My RE and I looked at each other and I knew that we were thinking the exact same thing.

The answer to that question, unfortunately, is no.

In a lot of cases, you are pregnant until you are not.  Many people who have suffered miscarriages report that their symptoms stopped suddenly right before they miscarried and that they had all of the normal symptoms right up to that point.

With age there is also an increased risk of missed miscarriages.  A missed miscarriage also known as a silent miscarriage, occurs when a fetus dies, but the body does not recognize the pregnancy loss or expel the pregnancy tissue. As a result, the placenta may still continue to release hormones, so the woman may continue to experience signs of pregnancy. A missed miscarriage is usually diagnosed during a routine checkup, where the doctor will fail to detect a heartbeat. A subsequent ultrasound will show an underdeveloped fetus.

Most missed miscarriages are caused by chromosomal abnormalities in the fetus, which do not allow the pregnancy to develop.

Infertility treatments can increase the likelihood of missed miscarriages due to the fact that medications such as progesterone are taken to support the pregnancy until the placenta is fully formed and begins to release hormones on its own.  The progesterone taken can continue to support a pregnancy that would not otherwise be able to sustain itself, thereby masking a miscarriage and delaying the inevitable.

To sum everything up.  The ultrasound today was a good check point.  We have progressed in our pregnancy....but we are not completely out of the woods yet.  Our check in at 10 weeks will be be a critical check point, as well as the completion of screening and diagnostic tests for birth defects.

While I am happy that we have made it this far, I am still very scared....and rightfully so.

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