How I'm faring..

I truly have the most amazing family. My mom is coming here on the 31st, and she will stay till the 12th. I leave the country just a few days after that, my ticket is booked.  I didn't go anywhere yesterday. Not to work, not to the birthday celebration of a friend, not to Philly to be with the friend who came down for the ultrasound (she really wanted me to be around people). Instead, I stayed home, holed up, read books, watched endless episodes of White Collar.  I did not even cry once, nor was I particularly sad. I was just  numb-- anybody familiar with that feeling where all of life comes at you in slow motion, like you are underwater? Today has been more of the same, though there was a bit of  a crying jag in the morning.  I am going to make myself to go out later, wear pretty clothes instead of ratty pajamas and hang out with actual people. I'm also in limbo.  I'm waiting to be rid of the physical presence of this pregnancy, and I'm eager to get karyotyping reports and the bloodwork, and then I just want to move on. Enjoy the silly, stupid things that make life colorful and fun.

I'm really looking forward to India. I'm looking forward to vegging out with family, I'm looking forward to not working,  I'm looking forward to getting seriously cute (and hot) outfits for my brothers wedding. Looking/feeling cute while you are knocked up is really not an option (since people would have looked at the unwed, visibly pregnant sister of the groom like they would a whore at church), and while I'd MUCH rather have been pregnant and scandalizing all and sundry and being the ultimate social rebel (I was planning to be open about the SMC route), I'm going to bloody enjoy the alternative since its been force-fed to me.

In my post titled 'Why does Miscarriage hurt so much' I'd expressed the desire to be more matter of fact and less attached during any particular pregnancy, so, if I had to go the distance and do this many, many times to have one healthy child, I would have the emotional where-withdrawal  be able to do so. I wanted a miscarriage "to be a stumble instead of a giant fall". The ghost of a silver lining is, I think my psyche has managed it. My first pregnancy loss hurt like crazy, the sheer unexpectedness of it knocked me for a six. I thought my second loss would finish me off, but surprisingly, the recovery was faster, which I attributed to being around family. This time, I'm actually recovering faster than even the second time--I'm getting desensitized to early pregnancy loss, for whatever that is worth.

The only things that are really bothering me:
a) The minor one: Feeling like such a screw-up. Other people have babies so easily and I've failed time and again. Its what has kept me from telling many people who I care about, but who manage to reproduce easily. I'm both proud and competitive. These are utterly pointless, foolish qualities, that keep one from truly evolving as a human being, and are utterly ridiculous applied to the area of biology, where none of us have any control about how we turn out and what issues we face. In this regard, what I'm going through may actually end up teaching me a valuable lesson, which might leave me a better person. That lesson is most definitely still a work-in-progress though- Being sad is fine, but I'm also pissed off and mainly, embarrassed that I keep screwing this up. Ugh. Stupid me.
b) The major one: I'm so, so very scared about what I might have to do, and how far and how difficult this road might be. I don't know what I'd do, if I could not have a child. I honestly just can't imagine it.

But for now-emotionally, I'm truly ok. Physically, I've started cramping a little though, no spotting yet. My mom is coming in Tuesday morning, I hope I can hang on and manage not to start miscarrying till that point.

Over

The 3rd time, is not the charm apparently. The baby measured 6w5d, with no heartbeat. I am so very thankful my friend from Philly was there, she literally held my hand through that and the staff of OB clinic was very kind. They immediately whisked me off for the full RPL panel, an eye popping 22 tubes.

I'm too chicken for a natural miscarriage, and it also makes it harder to collect the fetal material for karyotyping. So a D&C will be scheduled at the earliest, latest by next Thursday. I don;t want to wait too long, just in case they cannot make the fetal cells grow. Its imperative that I get that karyotype done. I really want a chromosomally abnormal verdict, the alternative points to a much harder to deal with scenario. 

Somebody called me resilient, and I most definitely am that. I will get through this, and I'm pretty determined to not let it bury me under a shadow for too long. I really, really want my mother, especially for the day of the D&C though, and for after. As I told my friend- its better to have people around you, but they have to be the right people, only the ones you love and trust to that degree, who you can allow to see you break down, temporarily. And my mother heads up that short list. But she is in India, she has a medical practice that she just can't abandon. We'll see, I'm really dreading telling them tonight.

And of course- what is going on as a refrain in my head- WTF is wrong with me? Why does this keep happening? And..the hardest one to face- can it EVER be fixed?

I'm don't have the problem of declining egg quality and I thought my *maybe* PCOS was tackled, or so I believed. Very boggy, scary ground indeed, but in a while, everything may be hopefully clearer than it is now.

95%

I'm sure some of you reading are wondering why I freak out when there seems to be no cause to freak out- my pregnancy so far looks pretty routine, with everything checking out, even the little lag in growth seems like no cause for alarm at this point.

I've seen my way through 2 textbook 'perfect' pregnancies so far. Great HCG rises, great progesterone. They say, after you see a heartbeat, your chances of success are 95 %. I had perfect ultrasounds at the 6-7 week point for both pregnancies, with strong heartbeats in both.   In the first pregnancy, by the end of the 7th week the baby was almost 6 days behind, and that was a red flag, but nobody was concerned, because hey, the bad stuff happens to other people. My second pregnancy was perfect almost to the end of the 9th week. With a predicted 95 % chance for sucess in both cases,  I miscarried twice.

I'm just trying to explain why I cannot relax, or trust the excellent odds I've been given. Augusta bought up a terrific point, that we just keep expecting the past to repeat itself, its human nature. But I also remind myself that each pregnancy is like a snowflake- truely unique. The problems that ended the first pregnancy were nothing like what ended my second pregnancy, and if I can be reasonably certain of anything, it is that this pregnancy is likely to be nothing like my first two. That is not any sort of guarentee that it will continue, only that it is likely different.

About how I'm feeling- OMG, do I have a baby bump now. There is no weight or mass gain, its just that internally, everything is redistributed and my belly is significantly distended. It probably is more apparent because I am super petite.  I think that old wives tale is true- you do show faster in subsequent pregnancies. Overall, I've lost a couple of pounds- I'm not even eating that much, just having small things throughout the day. I've also been feeling vaguely ill the past couple of days, its *almost* a queasy feeling, further limiting quantity of food consumed. I've also been feeling twingy & crampy in the uterus region today, which is new for this pregnancy.

Mildly twingy & crampy is ok, but around the time that my second pregnancy ended (on the day the heartbeat stopped), I had seriously strong, painful cramps that night. I was out with friends, we were playing boardgames, I remember this rush of adrenalin around the time the cramps began, my heart was almost trying to beat its way out of my chest, I was so very unsettled and did not know why. The timing of that with the stoppage of the heartbeat was an interesting coincidence, sometimes, you have to wonder whether your body registers it at a subconscious level. For now, there is none of that. Just mild twinges. Yay. One day at a time.

I wrote this post for one reason--Lots of new pregnancies everywhere, I see the excitement caused by good news at the early ultrasounds, the optimism, the hope. And that is what the people who come reading are comfortable with, I don't think most people know how to react to the darker, more pessimistic tone of the posts I'm putting out-- its like- why is she so afraid?  I hope this one goes towards explaining that.

But with the fear, intermingled in that, is beautiful, amazing hope. Right now she is kept tethered to my subconscious, with my conscious taking up a wait-and-see approach, but she is still there.

Ramblings from pregnancy brain

I've now entered that zone where time moves like molasses, and I'm far too preoccupied with the million dollar question: What is the Fate of this Pregnancy?

Although some my earlier posts sounded alarmist, for the most time, I was actually able to not obsess on this subject and life was fairly comfortable.But each ultrasound produces such upheaval.  Its literally like waiting for the Sword of Damocles to drop.

For the first 24 hours after the last one, it was awful, I could barely think of anything else. That night, I went out to a Broadway play (Newsies---review, its decent, not fabulous). This question was running in the background all the bloody way. I've done so many google queries on delayed growth, I'm now sick of the subject. The verdict is (drumroll please) it can go either way. DOH. Thank all of you who chimed in with stories. They really, really helped. I absolutely know that this can end well, its just that I also remain painfully aware of the alternate scenario.  But anyway, as predicted, I've calmed down now and am just going with the flow. Still time is moving by a bit too slowly. Should have a post on possible distractions.


This pregnancy remains completely abstract to me. I cannot possibly bring myself even to put up the pregnancy countdown widget, and find out what is developing in my baby at this very minute. I dug up some photos of how an embryo is supposed to look at this point, and compared it to my 2nd ultrasound pic, which is sharply defined, and its slightly reassuring when I play the utterly pointless game of comparing it to pregnancy #1, which was chromosomal normal, but with rapidly slowing growth between week 6-8 and looked entirely formless at both ultrasounds (yes, I am nuts and this is entirely illogical and ultrasounds are effected by the angle implanted, yada yada, but whatever makes me sleep better at night, right?). Is'nt it also amazing how different each pregnancy looks? I have not found 2 ultrasounds on the internet that look the same,even at the very same point.

I occasionally talk to my uterus, doing my best to let this baby know how much I love him/her and how I'd give anything for him/her to be ok, and how there is a world of people waiting to take care of him or her, but  that is it. I am utterly unable to process the likely miraculous potential of what is happening in me at all. I guess its an innate defense mechanism.

There is a part of me that is sadly envious of anybody who can get excited about a beating heart. I never even got excited and squealy like most people get on seeing that heartbeat, it was more been more like, been here, seen that, what is the next part?? It is painful (and sad) to lose that joy, to instead obsess about this process from the perspective of how many bloody millimeters the fetal pole has grown, and where you will be 2 weeks later.  I hope that this with this round, I get the privilege of reclaiming that simple wonder somewhere along the way. I think it can come back partly with new milestones crossed, lets see if I get to cross any of them.

This pregnancy is different in another way, this time, I have a friend with me always. Next week, the person who has been coming with me (love ya, V) is out of town. Another friend (instrumental in shoring up my sanity through this process) is traveling from Philadelphia for the day, just to be there for me. Words fail me as to how amazing that gesture and this person is. I hope we get good news, for her sake as well as mine. People other than me are going to be genuinely hurt if this one does not work out. I don't even want to think about how this might hurt my family.

Anyway, if I don't post again (like I can hold out that long), the ultrasound will be next Thursday, when I'll be 8 weeks and 2 days along. I'm not going to my RE (since he can see me only in the mornings), but I found an OB, which works better for my friend who will get here by afternoon. This practice sounds fancy, I'm excited!

On a side note: I had people email me that they were having issues commenting to discus- If you have problems, could you let me know?  If its a widespread problem, I'll have to look into deleting it. 

6w6d U/S

Well, the good news is the baby has clearly grown, and is still alive. Heartbeat was 110. Just on seeing it on the screen, I felt better. The part where everything in  me just sank was when the RE did a CRL- the fetal pole measured 6w2d. I'm 6w6d today, or rather, I'm at the start of the 6th day of the 6th week, since this was around 9:30 am. By that token, it is measuring at least 3 days behind, if not 4.  If I compare this to my 2nd pregnancy, by 6w6d, my baby was measuring 6w5d and the heartbeat was 130.  So its looking crappier than the last time, which looked almost perfect at this point.

Current pregnancy 6w2d,
 apparently measuring 6w1d(really?) by CRL

The good news is  that it visually appears like there has been growth. Its highly likely that the first measurement (of 6w1d at 6w2d) was rubbish given we could barely see anything. In the second ultrasound, the embryo looks a little curved to the right of the yolk sac (do you see it?) and I wonder if that could mess up the CRL too. Impossible to say, but please, throw in your inputs.

 Current pregnancy, 6w6d, 
apparently measuring 6w2d by CRL

I did some googling for delayed growth at similar timepoints. The results are very mixed- I found  a couple of instances where miscarriage occurred within a few weeks, and quite a few instances where things turned out to be just fine. Its really impossible to say, all options remain on the table, with a probably slightly raised risk for a unfavorable outcome within the next few weeks. Apparently, trisomies are supposed to show delayed growths. I've been mostly relaxed (or so I thought) before my first ultrasound and in the gap between this one and the last.  But when I came home and burst into tears, and cried for a good half hour, I realized the stress I'm under. Its insane. Nobody should have to go through this.

I'll be fine by tomorrow and will probably remain comfortably numb (with that tantalizing, beautiful flicker of hope still thrown in) for the most part, till the next terrifying ultrasound rolls around, which should be in the middle of the next week. It will be with my RE again- no graduation to OB yet. After realizing that it was behind, he called me in for round 3, mostly I think to reassure me. This scared me a little though because the nurse had said that if the RE deemed it was a good U/S, I'd be released to the OB at that point.

I know this can go south, in any number of ways. I know this could end well. If any of you have any anecdotal stories to share about being behind at this point ending well, then please, share. I really could use the momentary reassurance.

Like something the cat dragged in

Remember how I said I felt no symptoms of pregnancy? Well, I jinxed it, and I had had definite queasiness when I woke up 3 days in a row too. 2 days later (the evening of my 6w2d ultrasound), I ended up throwing up in a restroom in JFK when I went to pick up my cousin.  Then, the next day, it kind of faded away and its been gone 3 days, but I refuse to get worried by this. On balance, I'd rather I did not have nausea as a symptom to deal with. Despite the reassurance, you cannot possibly enjoy it (though I did feel a little happy while throwing up), and when it stops, you only get far more alarmed.  Women in my family often go through their entire pregnancy without feeling nausea, so its not even like its a requisite for a healthy pregnancy.

I've been exploring Manhattan like a fiend with my cousin. Both Friday and Saturday, we spent about 6-7 hours walking around the city. Saturday morning, I woke up with a sore throat, but I really did not let that stop me. Today, I woke up feeling like dog shit. My entire body hurts, it feels just awful. I've spent the day staying in with my poor cousin. This is my second infection in like 4 weeks since getting pregnant, I am most certainly immune-compromised. Gah.

So basically, between throwing up, feeling sick, feeling breathless, having what occasionally feels like hot flashes, I feel most definitely pregnant. My baby had better be hanging on, or its just another reason (like I would'nt have enough) to shake my fist at the universe. Ultrasound tomorrow morning, this is all effin terrifying.

6w2d U/S

It was most decidedly underwhelming, and not altogether reassuring, but nor was it a cause for alarm either. The gestational sac was visible, in the uterus, immediately and looked to be a decent size and was the prettiest part of the picture. It was really hard to see the fetal pole, but I definitely got glimpses of what could be the fetal pole as he kept moving the wand around, but it kept disappearing a second later. It was difficult to visualize because it was completely tucked into a corner of the gestational sac.

My heart stopped in the first few minutes, where we could not see the fetal pole. After we found it (he had to press down on my uterus to see anything), it was hard to see a heartbeat, I thought I could at times, but what do I know?  My RE said he saw a heartbeat too, but it was faint.  I asked him to do a CRL (difficult as we could barely see the thing) and it measured 6w1d, but the measurements were crude at best. The RE said he could see the yolk sac, but it was hardly the clear round thing of my previous pregnancy. The picture we got was god-awful. I don't have access to a scanner right now, but I took an iphone picture of the ultrasound.
 
I asked him if he thought things looked fine for this stage, and he said yes. He asked me to go back on Monday, which is what I will do.

I marvel at the change in myself. In the first ultrasounds in previous pregnancies (which were 2-3 days later in the 6th week), I saw better and more reassuring images, but I was still unsatisfied that things were not *perfect*, with the CRL lagging behind by like 2 days or something like that. Now, I just listened to the doctor, with a fetal pole I could barely see and a heartbeat that looked barely apparent, and left things to rest. I think the best way to describe me now is 'impassive'. The fate of this little one remains utterly unpredictable, and shrouded in fog, but que sera sera. I can get through this weekend, run around town with my cousin and have fun. That is the bottom line right now.  When I go back on Monday I have 2 people (my cousin and my friend) coming with me, can't ask for more.

I also spoke to my boss and told him I want to stop working by the middle of August. That conversation went surprisingly well. PIs (Primary Investigators, the nomenclature for professor at the head of a research lab in academia) can be unpredictable creatures, and there was a strong possibility that he would make life difficult for me after. But, so far, so good.   

Ultrasound tomorrow

I will be 6w2d tomorrow, and will be going in for an ultrasound with my RE.  I've seen heartbeats and  approximately age-appropriate growth in the past 2 pregnancies at the 6w3d and 6w4 timepoints respectively, so it should not too early.

I have barely any pregnancy symptoms-if this is indeed a healthy pregnancy, then its awesome as to how unaffected I am. I have no cramps, if I had not seen visual evidence of the HPTs getting darker till around 3 days ago (where the test line became as dark as control)  I would have been more worried. The only indications are the sore boobs from hell and  the definite expansion of my uterus, evidenced by the distention of my abdomen (I look like I'm already around 2-3 months along!). But there is absolutely no fatigue, which still amazes me, given how my last 2 pregnancies were. I can stay up late, I've been walking all over the city, in order to counteract my diet (my favorite and most often consumed meal is Cajun-spice tossed fries, butter, salt and nutella comprise my favorite food groups), with no ill effects, even the heartburn that plagued me (from 4-10 DPO) is almost gone.  I should qualify (before you think I'm utterly useless) that, in between the salt and the oil and the sugar, I do eat somewhat healthy (post coming up on that soon).

Another great thing- I'm not at all backed up (like I completely was) during pregnancy # 1. Interestingly, its a problem I have not had in pregnancy since taking thyroid hormone. Interestingly, constipation IS in the symptom list of thyroid insufficiency in pregnancy.

Although I've been looking at OBs, I'm far too afraid to call one before finding out where things stand. This can work. It *totally* could work. Yet, I find myself yet utterly unable to even make a prediction as to whether it shall or not. I had a sense, an intuition of sorts about 'Turbulence', my nickname for my second baby, about the day after conception, it just came to me that she was a girl, and indeed, she turned out to be  one. With this little one (I cannot even decide on a name for him or her), I'm completely in the fog in every way. It just does not seem real, in any way, other that the evidence of the changes in my body.

My cousin gets here tomorrow evening. The ultrasound is in the morning, a truly awesome  friend is coming with me to offer moral support. Going armed with sunglasses and eye-makeup remover, which I now never leave home without. If its bad, I'm determined to somehow put it out of my mind so I can somewhat enjoy my time with my cousin, we are so close and I've been looking forward to this visit for ages. The one thing the past 2 years have taught me: No matter what, life goes on, and it should. That is the only way one can last if one is in for the long haul. But hopefully, no such fortitude need be called upon, and I only get good news tomorrow. Its definitely possible.

The plan (for now)

I always marveled at anybody who can bang out a post or more per day, I could never find that much to say. Well, get pregnant after multiple losses, win a trip to the land of neuroses and you can find plenty to say. I'm so glad I have this outlet, it keeps me from appearing insane in real life.

After reading my post below (or rather the update), my friend IRL bawled me out,well basically for acting crazy. Getting nervous that shoulder pain mean a ruptured fallopian tube, if you have no other symptom of an ectopic is NOT rational in the slightest. If you google 'shoulder pain in early pregnancy' comfortingly, I found many women shared the same neuroses. Its nice to have company in cray-cray land.

It was also surprising to find out that the tubes rupture as early as 6 weeks in an ectopic pregnancy. Few women have ultrasounds to confirm uterine pregnancies by then, and the majority of pregnant women never check doubling betas or progesterone. A ruptured tube in an ectopic pregnancy is often fatal or life threatening, so why wait till 8 weeks to see a pregnant woman for the first time, as is the norm? I guess the thing is, most women do have symptoms of spotting or pain at least,which hopefully gets them to a doctor in time. There are a few unlucky ones who don't have these symptoms (a few ectopic pregnancies are reported to be absolutely symptom free, but hopefully some anomaly atleast shows up in the beta levels or the progesterone values), but still, as few in the population check these, and can often be oblivious to the fact that they are even pregnant, that is moving into dangerous territory.

It is mind boggling to me that many in the population are clueless--there was this article recently about women who go through the entire pregnancy without even realizing they are pregnant. Apparently, there are quite a few of these kinds of people. A friend of mine was telling me about somebody in her family who thought she was having food poisoning, they show up at the hospital, and voila, she is in labor with a  baby on the way. That poor child was born with cerebral palsy though- her mother's diet was supposedly awful and no prenatal folic acid was consumed. I asked my friend if her relative (the mother) felt guilty, but my friend replied that she probably has not even made the connection that one was responsible for the other yet. Facepalm moments, all of these.

Anyway, going off the topic of ectopic pregnancies and happy (moronic) oblivion, I spoke to another nurse in my RE's practice, and she said something different from the first person I talked to- I can come in anytime in the week, not merely on a Monday when my RE is around. So right now, the plan is to go in on 6w2d, which is Thursday, and pray that I can see stuff. I'm still torn about the timing, if I learn I'm in trouble, I will probably effectively destroy my cousin's weekend. But waiting 4 more days past Thursday may be a bit too much for me.

5w6d or 6w6d (updated at the end)

I finally am at that stage where I can think about when to go for that oh-so-terrifying first ultrasound. And I was informed by my RE's office that it can be only once a week, on a Monday, between 7 and 9 am because that is the only time my RE will be in to do a pregnancy ultrasound. Seriously? Can't somebody else do it, if say, I want to go in on Thursday? Super strange rules at NYU fertility, I've have to say.

So I can go in this coming Monday (5w6d) or the following Monday (6w6d). For somebody with a history of pregnancy loss, I have to say, waiting until I'm nearly 7 weeks along is no picnic. The only reason I'm even agreeing to wait that long is it does not seem like the pregnancy is ectopic, so there is no reason to hurry to find out. And going in at 5w6d is so risky, you may not see anything and you will buy yourself a week of torture for no good reason.  Plus, I'm terrified of the actual ultrasound itself.  My cousin is coming in on the weekend of the 14th and leaves on the 16th (Monday).  If this pregnancy has ended/looks to be in trouble, I'd rather find out at the end of her visit rather than immediately preceding it. Plus, its nice to have her for moral support through this, since I will be scared shitless.

But OMG, I'm going to have to wait for over 10 days for my first ultrasound. AArggh! I'm doing the right thing by not going in at 5w6d right?

Based on all of your own advice, and my own flickers of common sense, I was going to hold off on the u/s till the 6w6d point. Then this morning, post shower (and a workout yesterday which included girlie push ups), I start getting shoulder pain. Cue in instant low-grade freakout (this is a symptom of tube rupture in ectopic pregnancy, yes, Damn you Dr. Google, for giving me access to such information!!!).  Now, I have no other symptoms of an ectopic pregnancy, no spotting, no pain, normally doubling betas, a fairly decent progesterone level, etc. But I still spent minutes trying to figure out if I needed to go to the ER today. My shoulder pain never escalated and went away, and more importantly, I have no signs of going to shock at blood loss, ie, I am just fine and my fallopian tubes are still hopefully intact.

 Then I googled when tube rupture happens in ectopic pregnancy- its around 6 weeks apparently. I've seen the effects of a tube rupture happening to somebody in my family, even though she survived it, it ruined her quality of life, saddling her with a lifelong pelvic pain syndrome. It freaks me out, there is no way I'd consider risking it. Nor do I want to spend the next week getting nervous everytime a bodypart like my shoulder starts twitching. So I want to go in this Monday(5w6d), and a) be assured by a gestational sac in in the uterus and b) not be freaked out by no heartbeat, if possible.  Argh..fear is a terrible thing, it only breeds more of itself, and its odious cousin, stress.

Life in bullet points: 5w1d

• First, I saw this awesome test on Earlypregnancytests.com. Instead of drawing blood for repeat betas, if one is relaxed enough, they could use this: It can detect Beta HCG levels at 25,100,500,2000 and 10000 IU. (!!!) Should keep one sane until their 6 week ultrasounds, without getting jabbed repeatedly. If you wanted to detect to 20000 IU, you theoretically could as well (collect urine, dilute with  exactly equal amount of water) and test. That is the scientist in me talking. Slinking away now.

• I'm now waiting for my toxoplasmosis IgG/IgM test. Since I have a cat, I want to be sure I have prior immunity to Toxoplasma gondii, a nasty parasite can live in your cat and be shed in the poop. Has the potential to cause havoc in pregnancy. According to one source, around 30-50% of the world's population has had prior contact with this parasite and is protected by IgG antibodies against it. Infection is asymptomatic and usually causes no issues (though a recent study linked T.gondii in the brain (ack!) to increased suicide risk), but can be potentially deadly if contracted during a pregnancy, especially the first trimester.

• Sadly, it now looks that I'd have to stay here (in the US) till the end of my first trimester. I'm doing this so in case any of my screenings (nuchal translucency or AFP) raise flags, then I can get tested with the Sequenom Tri21plus test, which is an alternative for amniocentesis/CVS for the detection of Trisomies 13, 18 and 21.  Unlike amniocentesis or CVS which are needle biopsies into your uterus, this is just a blood test. Unfortunately, this would not be available in upon moving to India. The thought of getting an amniocentesis there (or in most places here as well) makes my blood run cold. Amniocentesis is a test where you should have only the best of the best, who have done it like 5000 times before, preferably perform. One of the worst horror stories I've heard is about a woman who had an amnio done, at Scripps (allegedly). They did not disinfect the skin properly and contaminated the sac with skin bacteria. She lost both her babies within hours. So be very, very careful about where you have an amniocentesis or a CVS done, if it comes down to that. Its worth traveling and paying out of pocket, to be able to go to somebody with a good reputation.

• Its going to be nerve wracking being here, sans family, ultrasound to ultrasound, if this pregnancy keeps progressing, which I hope and pray it will. I can anticipate being kind of a wreck during my 'danger period' of around 8-9 weeks where both my previous pregnancies ended. I'm really glad I have you all to virtually hold my hand through this.

21 DPO results

I''ve gotten zero work done today, I'm truly a disgrace. Just got this in, after badgering my amazing endocrinologist, who thankfully, does not mind being badgered. Seriously, If you live in NYC, and can go here, then pick Dr. Robert Lind as your endocrinologist, if you need one. 

21 DPO values
Beta HCG =2486.5 (doubling time of 32.66 hours from 17 DPO)
Progesterone = 28.2  (slightly worrisome, but it does seem to yo-yo, different from the first two, but I've thankfully stopped trying to interpret things).

I have not started Crinone yet (have not even picked up my prescription). Right now, I'm taking the call to go au naturel all the way. Also FYI, for now, I've dropped my vitamin D dosing too. Previously, I'd take 2000 IU every night, with 1000 IU in my prenatal. Now, I take 2000 IU every other day, and 1000 IU (in prenatal) daily.  I've not yet checked my vitamin D, because it requires a walk to Labcorp, and my veins are just too poked and prodded.

Today is also a day of BIG decisions. My housing is provided (or rather, subsidized) by my work, and I just found out that moveouts can only be at the end of the calendar month. So I can stay here till August 31st, or I can stay till the end of July.

Right now, for my own sanity, I'm picking the end of July. But having made that decision (I have not even told my boss yet, he is away on vacation), I'm starting to freak out. OMG. A brand new country. A totally different way of life. A new healthcare system. ACK!

I've started investigating medical care in India. If I go back around week 9, then I have to be bloody darned sure that the kind of prenatal testing I want, is available there. If anybody visiting this blog has gone through a pregnancy in India (or had one for say, your surrogate), I'd appreciate it if you could chime in.One thing sticks out, I want to have Sequenom's Tri21plus blood test done. Calling them now for information, will update.

This is the information I got after talking to a Genetics Counselor at Sequenom:

• The test (which checks cell free fetal DNA in the maternal blood for Trisomies 13,18 and 21)  can only be done if the blood is mailed in from a US location. Interestingly, she bought up that a company in Hong Kong now offers a similar test. Tried to dig, but could not find it.
• It can be done at the earliest of 10 weeks of pregnancy. You need to be 'high risk' to qualify at Sequenom, less they mess up their false positive/false negative rates: Criteria: advanced maternal age, evidence of an earlier trisomy in a previous pregnancy, or any abnormalities showing up in a screening test.
• She did chime in that while previously only high risk people were getting referred, they are now starting to hear from 'patients like yourself'-- she was too polite to say 'paranoid as hell'. In a while, this may change sequenom policies (globs and globs of dollars waiting to be made) but right now, the  policy above stands.

I was mentally pushing back my departure date to the end of August when she bought up the criteria. Right now, I don't qualify (which is a good thing, really). But she said she would talk to her boss to see if my earlier Turners (Monosomy  45X) qualifies me. Waiting to hear back.

Life in bullet points: 4w5d

I think at this stage, most of us get blogsphere addiction. I'm posting even though there is nothing new to report.

• Had a fun weekend on the town with friends. Mostly stress/tension free, which has been just wonderful.
• HPT sticks are getting dark, a doubling from day 17 is hard to tell at this point, but it looks like it may be increasing.
• Another (this time, welcome) difference from my last pregnancies: No debilitating exhaustion. My energy levels remain steadfastly unchanged, whereas in my last pregnancies,  I was going to bed early, with waves of exhaustion would unexpectedly crash into me, yada, yada. I wonder why that is, was it just that my HCG levels were higher?
• No weight gain (actually 2 pounds lighter) but the progesterone(?)-induced bloat is tremendous. Body shape has definitely changed, actually it changed maybe starting like 5 days in (which was when the horrible heartburn had begun). I think your body retains a 'memory' from previous pregnancies and starts the change process much earlier in second, third and so on pregnancies. 
• Got my hair cut yesterday, while having to contend with seriously strong hair relaxer fumes in a tiny salon---ack!! I played the pregnancy card immediately, they were seriously nice, they opened the door, sat me far away from the woman having all that foul-smelling, ammonia-laden gunk slapped on, but of course, being a paranoid bunny, I'm still nervous about what those many minutes of exposure might have done.
• Never have noticed how many people are out smoking- the streets of NYC are like a dodge-the- cigarette-smoke obstacle course, GRR.
• Moving on the the sciencey bits: My beta HCG  levels in my first 2 pregnancies were higher than around 90 % of all recorded pregnancies. As this pregnancy has shown levels closer to the population median, I've been trying to understand what it might mean. On reading the literature on HCG levels and pregnancy outcomes, I'm finding (to my surprise) many, many studies show an adverse effect of the highest HCG levels and negative outcomes, particularly fetal defects,stillbirths preeclampsia, etc. Unfortunately, these studies look at HCG levels in the 2nd and 3rd trimesters. If the story of vitamin D reducing HCG is true, then its logical, because low vitamin D levels are linked to higher risk for many of the same things anyway (pre-term labor, preeclampsia, infection and related complications, the list is seriously long). 
• The one study I'm trying to find but I cant- a correlation of HCG levels in the first and later trimesters: ie, are the women with the very high HCG levels in the beginning likely to have the highest levels later as well? Though one may thing this is so, it may not necessarily  be. One study looking at HCG in the first trimester seperated women into 3 groups, over the 9oth percentile, 'normal' and below the 10th percentile. They found increased incidence of fetal growth retardation and increased early miscarriage only in the lowest HCG group, but no other thing was significant. And of course, these are just trends. Many women with low HCGs go on to have perfectly normal pregnancies.