Wednesday, July 29, 2015

OK at 9w4d

Today was our first prenatal visit.  I admit that I was very nervous.  Up to this point everything was with our infertility clinic - a familiar environment for me.  Now we were venturing into uncharted territory.....

Luckily our GC has had two successful pregnancies of  her own and has an OBGYN that she really likes.  She had talked to her doctor while we were still in the exploration phase this spring to make sure that her OBGYN and her OBGYNs staff would be comfortable and supportive of a surrogate pregnancy.  

This is actually a very important step in the exploration process.  The lawyer that we used for the GC contract actually runs an agency.  He was extremely helpful in offering advice along the way that we would not have thought of or known to ask.  One of the things that he recommended was to make sure that the OBGYN was comfortable with this special arrangement.  Unfortunately he has run into a doctor or two along the way that had some strong biases and added some extra stress to an already stressful situation.

Everyone was really nice and was very supportive of our situation.  

It is strange situation.  There is the pregnancy and health history of our GC, but also my and Mark's history that all needs to be incorporated.  While our GC's history is hopefully indicative of how this pregnancy will go (I say hopefully because each pregnancy is different, and our GC is now over 35 which carries extra health risks), my and Mark's history is indicative of the health of the baby and potential of birth defects.

There is the important phrase - birth defects.

Because our GC has a very healthy and normal uterus, I have not been scared of miscarriage due to structural issues.  I have, however, been very scared of miscarriage due to chromosomal issues.  Or, even worse, having to make a tough decision due to chromosomal issues (not all severe birth defects lead to miscarriage or stillbirth).

I admit that this fear is probably higher than it should be.  Our risk factor of birth defects is only around 2% and our miscarriage risk is around 15% (birth defects could be a contributing factor to this risk).  Each week that passes decreases our miscarriage risk.  Now we need to look into how to assess our birth defect risk.

I am all about doing as much testing as possible as early as possible to assess our birth defect risk.  Probably to a fault.  I am ready to go right to diagnostic tests vs. screening tests.

Birth Defects Testing - Types of Tests

You and your doctor can choose from several tests. What you choose depends on your wishes, where you are in your pregnancy, your family health history, and what tests are available in your area. You may have no tests, one test, or several tests.

Screening tests show the chance that a baby has a certain birth defect. Diagnostic tests show if a baby has a certain birth defect.

Screening testsWhen they are usually done
First-trimester screening (first part of integrated screening)10 to 13 weeks
Nuchal translucency (usually done as part of the first-trimester screening)11 to 14 weeks
Cell free fetal DNA (an option for women at higher risk)10 weeks or later
Triple or quad screening (second part of integrated screening)15 to 20 weeks
Ultrasound (pictures of baby's body)18 to 20 weeks
Diagnostic testsWhen they are usually done
Chorionic villus sampling (CVS)10 to 12 weeks
Amniocentesis15 to 20 weeks

Screening tests have little to no risk, but they also only indicate if there is a chance of a birth defect.  Diagnostic tests have risks - miscarriage being the biggest risk - but they also show for sure that there is actually a birth defect.

Going into this appointment I am pretty much convinced that I want to do CVS so that we definitely know if we have birth defect, and would find out in the first trimester.  If we do need to make a tough decision, the earlier that decision can be made the better for all parties involved.

Thankfully our OBGYN is pretty awesome, immediately senses that I am stressed beyond belief and talks through my fears on the issue.  I acquiesce to her expertise that the CVS is very risky and that we can do other noninvasive tests first.  She also recommends a genetic counselor visit to discuss our risks and discuss further screening.

Now that we are past that it is finally time to hear the heartbeat.  I really need this reassurance that there is still a heartbeat.  I am really bummed that she attempts it via doppler.  I want an ultrasound!  I want to see for myself that Maybe Baby is still there, and is developing on track.

Well, nothing is happening.  There is no heartbeat.  We are all getting very, very tense.

Our OBGYN explains that we are still a little early to hear the heartbeat via doppler and we proceed to the ultrasound room.

Not only is Maybe Baby still there, Maybe has a very normal heartbeat, and has little arm and leg buds like Maybe is supposed to at this time (the "gummy bear phase" as my friend likes to call it).  Maybe was even moving around!

Phew.  Huge sigh of relief.

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