Wednesday, December 29, 2010

WOW (edited)

For those of you who are following the vitamin D3- AMH story, here is the latest.

3 weeks ago, I was in the deficiency/low range for both Vitamin D3 and AMH.
Vitamin D3= 16 ng/ml, AMH= 1.1 ng/ml.

The low AMH sparked off an avalanche of fears about diminished ovarian reserve. Then I took gigantic doses of Vitamin D (60000 IU weekly) for 2 weeks

Then I gave blood again,  and tested both Vitamin D3 and AMH.
Vitamin D3 = 70 ng/ml (perfect) and most amazingly AMH= 5.18 ng/ml  (high and now in PCOS range)

Overall, a four fold increase in AMH levels (going from 'low fertility' to 'optimum fertility' in the lab classifications), which I found just incredible. Its always possible the first lab really messed up the test, but I think that there is really a fair chance (based on the study I posted about) that AMH went up because Vitamin D did. Anyway, I've let the group at Stanford studying this know and maybe one day a formal study might be launched. 

Right now, the primary emotion is  massive relief that I'm not dealing with a case of low ovarian reserve here.

Interestingly, my testosterone levels also changed dramatically, they went from being fairly high in the Vitamin D deficient state to being low after my deficiency was corrected.

Currently, my theory (derived from combining very few facts with a lot of speculation and intuition) is that my problem could be two-fold,  first low vitamin D3 (found in about 40 % of cases with PCOS ) and a possible undetectable issue with insulin resistance, which could be addressed with metformin.

Other than the now corrected Vitamin D deficiency, my only PCOS parameters are lots of antral follicles and now high AMH and slightly high DHEAS- The million dollar questions are:
1)  is this messing up egg quality and thus responsible for my two losses?
2) Is it tied to sugar metabolism and be fixed by metformin?

I have a very strong family history of type 2 diabetes (practically everybody in my father's side develops this), though I could find no indication whatsoever of insulin resistance in me. But still, metformin has been shown to help even when there is no overt insulin resistance. Nothing is a sure-fire fix. Last time I attempted conception I was praying the thyroid hormone would be the magic fix I needed. The next time, I will be hoping its all of this.

Friday, December 24, 2010


About 3 days ago I finally became negative on the urine beta HCG tests. Having gotten this green flag,  I finally went in for my antral follicle count today.

And...phew. AFC is 15 follicles per ovary(!!!).  Ovaries look polycystic but thankfully, ovarian volume looked normal. Most reassuringly, this definitely does not correlate with low ovarian reserve, which was my one gigantic fear since I found AMH was low.   I also gave blood to retest for AMH and (for good measure), Vitamin D3 since I've been on massive doses of the latter for the past two weeks. Testing in India is cheap so I go nuts. Off topic, but I'm also getting Vitamin B12 tested (nothing to do with fertility that I know of), but Vitamin B12 deficiency is really common in the Indian population and has also cropped up in my family. Interestingly, severe deficiency of this vitamin seems to cause some mental issues (periods of rage, stress etc).

So, overall,  it looks like I might have ovulatory PCOS (which according to my Indian RE may be compromising egg quality) but the jury is still out of the diagnosis. I'd be glad to have a confirmation, at least we would have something to treat.

Thursday, December 23, 2010

On vitamin D

I came across two things which I beleive I should share. The first was a news report about a finding presented at a fertility conference. This group at Yale tested blood levels of Vitamin D in 67 'infertile' women. 93% of women had levels that were low or clinically deficient. That is pretty amazing, IMO.

The second is this recently published study, where they basically found that higher the vitamin D levels in your follicular fluid, the higher your chances were of achieving pregnancy in IVF.

My advice to everybody struggling to get or stay pregnant- do a blood test for this vitamin. Its not the most expensive thing and seems like a reasonable thing to check out.  Testing your levels before taking vitamin D supplementation would be prudent because you would have to tailor your dosage to your blood level.  I was clinically deficient. Granted I had taken my last vitamin D supplement 2 weeks before this blood test, but while I was pregnant, I was consuming around 1500 IU/day, which is about 6 times the daily recommended dosage, and my levels 2 weeks later were still abysmal.

Switching gears now.  In my last post I had said none of my theories have been right.  I just realized that was not true, I have been proven right in the most horrible way. As my second IUI rolled around, I had become really scared as I had looked at my cycle and realized that it was one with fewest days of peak estrogen ever and I was nervous that egg quality might be compromised. (Prophetic blogpost here) 

I went ahead with the insemination because on ultrasound, everything looked decent and nobody knows what parameter really determines egg quality. I did conceive but it was my worst fear realized- a genetically abnormal egg. Its been only a month since that horrible ultrasound, that awful day.  I'm doing very well though, all things considered. I guess I should thank god for small mercies.

Tuesday, December 21, 2010


Welcome! I had put myself on the last ICLW, only to discover that my baby had died 2 days into it.  Needless to say, not much commenting got done. This time I want to actually participate.

To sum up, I started 2010 eager to become a mommy. Given my age (30), my family history (a bunch of bunnies all) and initial testing results, I confidently thought it would be a breeze. Well, the good news, I got pregnant both times I tried. The bad, I lost both my angels, late in the first trimester.  Two pregnancy losses in less than 6 months can either shatter you or make you stronger and tougher than you were before. Thankfully, the latter has happened. I'm facing demons I never thought I'd never have to face, or more to the point, never could face; recurrent pregnancy loss, the possibility that I might never have biological children, and I'm still standing. 

The other thing, I'm a science geek. I'm an immunologist and am intimately familiar with human biology to start with. Now, after countless hours of reading, inventive google searches, trawling of message boards etc  I've learned enough about reproductive science to give REs a run for their money.   A lot of this blog is about the science and the mechanics of it all, and if any of you want to wade thorough it, there is a lot of discussion on things like PCOS, thyroid issues, egg quality etc. Though I'm really scared, I'm also fascinated by the biology and love talking about diagnosis, treatments, clues, both my own and anybody else's!

So welcome, and I look forward to reading your stories!
The rest of this post is actually about science stuff (indulge me and read if you feel upto it!)

On Vitamin D and AMH

It looked like I might have PCOS which was compromising egg quality.  To investigate this further, we tested AMH, a hormone that seems to be elevated in women with PCOS. To my utter horror, AMH levels came back low, similar to that of a 37 year old's.  Interestingly, I had also found that I was Vitamin D3 deficient (I think every woman who has undiagnosed fertility problems and is not a lifeguard or something similar should get this one checked out).

On a hunch, I decided to look whether there was any link between VitaminD3 and AMH.  A google search yielded one single clue, this article (which basically says that vitamin D3 is capable of stimulating AMH production) written by a group at Stanford University.

I wrote to the scientists explaining my situation of low AMH and vitamin D3, and asked them if they knew of any studies correlating the two, and whether they were planning to do any.    This is the response I got back:

Thanks for your message which I will forward to Dr. Malloy.
The original connection of AMH and PCOS we made was not based on a study but an unusual finding we made in a child with a mutation in his vitamin D receptor. In other subsequent work it is clear that in some organs of the body, vitamin D stimulates AMH. There is no proof that vitamin d deficiency causes AMH deficiency. In any case, you should have your vitamin D deficiency treated. If it turns out that your AMH rises after treatment, I hope that you will let me know. We have considered such a study but to my knowledge no data bearing on this point are yet available.

It was definitely my POA to restore D3 to normal levels and then retest AMH. It is kind of exciting to know that if AMH goes up,  my story might assist in starting a new study which might end up identifying a major problem, if D3 indeed regulates AMH.  Its a pretty long shot, but at this point, a logical one.

Plus, I'm praying AMH goes up, I do not want to be saddled with a rapidly falling ovarian reserve at age 30 , that would really, really suck. So I'm praying Vitamin D is the answer that will fix all my problems, because right now, I have no other candidates to play biological white knight.

Disclaimer: I've had many theories, always inventive and sometimes even logical in the past few months.  Each and every one of them has been shot down by the evil universe.  The mental image I have of the process is Peeves the Poltergeist zooming over my head, laughing maniacally as he drops dung bombs on my theories.  One day, I will be right about something- looking forward to it!

Friday, December 17, 2010

random musings from the fevered brain

I'm sick. I've got a noseful of snot, a fever of over a 100 degrees (thank god for anti-inflammatory drugs) and a really nasty sounding cough. Very happy I've got people to pamper the crap out of me. Unfortunately we also had a weekend getaway planned to see another large family cluster of cousins and nephews and nieces. Sucky timing, I was *really* looking forward to it.

Anyway, back to talking about baby-making. Currently, I'm grouching over the impossibility of predicting CD1, sans period.   I had my D&C 18 days ago, and I'm still showing up positive (though its almost gone to nothing) on pregnancy tests. I always figured that once the beta levels dropped to nothing, that would be when my true cycle began. The point of this exercise is repeating an antral follicle count and then AMH early on in the new cycle.

Right now I want to talk about uncertainty. The RE I consulted with told me,  I guarantee you, 100%, that you will have a baby one day.  I have none of his certainty. All of my confidence ( in making a biological child) is gone. I'm confident I'll still be a mother, by what route though, I now do not know. Oddly enough, I have faith in one thing- destiny. I believe that you will end up with only the child(ren) you were destined to have, period.  I see people suffering so much, with repeated losses, with years of infertility trying so hard to have that biological child, and failing. I keep thinking, do these failures occur because there is another child waiting for them, and they have to make their way to him/her?? Maybe its a child that somebody else has created. Maybe its from a donor embryo.  Or that  its not yet time to have the biological child, because the right combination of sperm and egg has not yet been achieved.

These are at the heart of philosophical debates- is everything that happens just an accident, or is everything by universal design?

Right now, I instinctively believe that everything is preordained. Its a belief that sustains me. My mom said to me, if Turbulence was meant to exist, if she was meant to have a rich life that touched so many others, it would have happened regardless of the Turners. I believe that, and it brings me peace. In this baby-creation game,  we can do whatever we can but we have no idea what the universal plan is, all that is in our power is to try and then accept whatever comes, no matter how painful or joyous.

If adoption or donor embryo are waiting at the end of the road for me, then I want to be at peace with that idea. Why am I concerned about either? Because I'm a control freak and its unfamiliar.  When choosing my donor, I looked at over 200 candidates, and I found ONE that made me happy. Because I spend so much time thinking about it, genetics IS important to me. But this fear I can deal with.  A part of me is aware that it does not matter, genetics is a crapshoot anyway and all people are unique and beautiful individuals, that nurture is about as important as nature.  The problem is, its the great unknown that I'm having issues with.. You don't KNOW the birth parents, while I know and I'm comfortable with the bagload of genetics I carry. I respect my family. I respect their intelligence, their values, their kindness, everything about them.  If my kids turned out to be like my mom or my dad, I'd be ecstatic. I'm deeply in admiration of my donor's genetics too. Overall, from both sides, the genetics are admired, but more importantly, they are familiar.  I'm afraid of adoption or DE because I have no clue what I'm dealing with in terms of parental genetics. The sensible thing, of course, is to cross these bridges only when you get to them. But this is one area of my life that I need resolution with, now, to be at peace.

Cherry on top

 The rules: link back to the person who gave you the award, pass it on to five (or a bunch of) other blogs, and leave them a comment telling them of the award.
Babychaser at  The Baby Chase Project, Randi at Fervently Wishing and Aronahui at My Cheap Violin have kindly awarded me the "Cherry on Top ' Award. All of these are strong women who write beautiful blogs. If you have not discovered them already, please go over!

A lot of blogs have already been awarded this. I've been trying to find other blogs from my list who have not- here goes.

 Life and Love in the Petri dish 


Park Slope Purgatory

A litte blog about the big infertility

The Pause

Skating on the edge of madness

These are all women that I feel privileged to know, if only virtually. Suffering builds character, and it also makes for great writing, exemplified here. Go over if you don't read them regularly already!

Wednesday, December 15, 2010

'There is more to life than reproduction'

This is what my mother (in exasperated mode) said to me this morning. We were getting ready, and I was talking about testing and logistics. She turned to me and said, you don't really think about anything other than this, do you? I truthfully replied that that is kind of correct- no matter what else I'm doing or pursuing, this is always at the back of my mind.  I've never really pursued anything this vehemently and determinedly.

My mom let it go but she hates what this journey is doing to me, and her view of all of this is so very removed from mine. She does not want her baby to suffer, and she sees this process primarily as one that has hurt me more than anything else ever has and so she wants me to ease up and step back, for my own sake. Me, I'm incapable of it for the most part.

In addition to fighting infertility, you also have to fight the perceptions that others have. Not blaming them for those perceptions, but boy, its exhausting.

On the test front: This journey is littered with clues that may well be red herrings. Another such one has come up. I had Vitamin D3 checked- my levels are low (16 ng/ml for anybody interested). This vitamin is low in PCOS. I also spent a while asking Dr. Google in creative ways if AMH and Vit D3 are linked, and lets just say I found one tantalizing paper saying they were (Vitamin D binds to the AMH promoter and stimulates its production).

So I'm starting Vitamin D supplementation (that part is fine and sensible, 16 ng/ml is clinically too low)  the part that irks me is that I'm looking at this issue and hoping and projecting it to be the magic fix for all my problems, just like I did with the thyroid.  I'm so tired.

Monday, December 13, 2010

Shattering my preconceived notions (karyotyping results)

I got the karyotyping results back and they were what I had been praying for since I heard my child's heart had just  stopped- a chromosomal abnormality, Turners syndrome (45 X0).   It does not seem that way, but I actually got lucky. Turners is a genetic condition with wide variation. In the least severe cases,  the child can survive, but have some serious physical issues, including heart defects and sterility.  Chances are, had this loss not occurred, I would have detected it in  the 5 month ultrasound and would have been faced with the agonizing decision whether to terminate or not. I thank god, the universe, whatever, that it did not take me to that place.

I would put this down to really crappy luck, except, though, as an effort to determine the PCOS diagnosis, we finally tested my AMH.  To my absolute amazement, it came back  on the low end, at 1.1 ng/ml. The reference range for the testing lab is 1.23- 8 ng/ml. AMH is touted to be the most accurate predictor of your ovarian reserve. The lower it is, the fewer eggs you have and the closer you are to menopause. My value, while not abysmally low, indicates that my ovarian reserve may not be as good as I thought it to be.

What this has told me- don't have preconceived notions about your own biology. I always thought that I had plenty of good reproductive years left. My grandma gave birth to my dad, her 9th child, at 45.  My cousin conceived her one and only child (a perfectly healthy boy) at the age of 43!  My mom got pregnant every time she wanted to, and produced 3 healthy children. Reproduction is NOT an issue with my family. When I had confessed my plans to that cousin who reproduced  (by accident) at 43, she tore into me for not waiting any longer, because according to her, I could have have done this comfortably even when I was skimming 40, given our history. At that point, I thought I could too. Now I don;t know anything anymore.

We have not yet confirmed that its a failing reserve we are dealing with here.  Overall, my test results can be summed up in one word- confounding. I'm baffled, nothing seems to add up.Adding weight to the PCOS diagnosis,  I have high-ish male hormones (though still within normal reference ranges). PCOS is associated with insulin resistance, with fits with my family history of type 2 diabetes. Because the universe has decreed that nothing should ever add up, I have the opposite,  insulin sensitivity- low insulin, normal sugar in fasting levels. With respect to ovarian reserve too I'm scratching my head.  At the last test around 4 months ago, the other good indicator of ovarian reserve, antral follicle count came back ridiculously high at 34. So we don't have the full picture yet, we need to determine if I have PCOS, or a close-to-failing reserve. Of the two problems, I'd pick PCOS I think, though its choosing between the devil and the deep sea.

Sometimes, things happen that really make you wonder if there is a gran plan to things, even if  a particularly perverse, slightly evil one. The day Turbulence was conceived, something told me it was a girl. After the loss,I've been praying it was a boy because then I thought, for some weird reason it would not hurt so much. It also it takes the guesswork out- if your karyotyping results are a chromosomally normal female, you will always be left a little in doubt, it might have been your cells they examined by mistake. But all in all, I was really anticipating an answer that would definitively give me the gender of my child. I've even been very mildly obsessive about this point.  When I got this result, I started laughing (the alternative was to cry). With an XO genotype, my child was essentially genderless.  Talk about the universe telling you, in a creative, slightly evil way of course, that sometimes, there are no answers.

Sunday, December 5, 2010

On the haves and the have-nots

My mom has told me repeatedly that she is proud of me for how well I'm coping.  I'm proud of me too, but boy, do I want to be doing better than what I'm doing.

One part of me occasionally wallows in all the reasons why I feel I'm being singularly picked on by the universe. My biggest gripe is that I have to go through the hell of RPL while being single.  I read 'Coming to Term' and there are some stories in there that make you break out the kleenex while  breaking out in a cold sweat, you could not believe that anybody could be tortured that much. I kept thinking, well, atleast they had each other. But at the end of the day, you realize one thing: you should not compare yourself to other people (even the happily married fertile mrytles who get pregnant every time they blink and pop out broods with no issues) not because of a matter of right or wrong, but just because its an exercise in futility that hurts only yourself.

This post is about envy and gratitude.

The envy lists

I could be jealous of somebody who has had just one miscarriage and went on to have healthy kids after.

I could be jealous of anybody who has ever gotten past a week 20 u/s, especially since there is a part of me that cannot even imagine that I would be so similarly blessed.

I could be jealous of somebody who has had a loving partner to share in her grief, and who has somebody to brainstorm the future with.

But then, on the plus side, there would be people who look at my situation and envy my advantages

I get pregnant every time I try.

Because of my unique situation, repeated IVF and surrogacy is an economically viable option for me.  I don't have to break the bank to pursue these lines of action,  or failing that, adoption.

I have family that are the most supportive that anybody could ask for, I have a work situation that allows me the right levels of flexibility.

I can afford to take a year off(or two) from my career and return to a land of cheap IVF and plentiful surrogacy to focus on the holy quest that is baby-making.

When you put all of this together, you realize envy is pointless. I have my blessings and I have my trials, and these are mine alone. Forget about what other people might or might not have, this is MY lot in life and I have to deal with it. This is the mental attitude that is keeping that monster called self-pity at bay for good amounts of time. Don't get me wrong, self pity drops by a lot, and I hate each and every visit. That is why I said I want to be doing better.

Then there are also gratitude lists:

I'm grateful that I'm not bitter. After I've lost these little precious embryos that would have been my two babies, I've let go and just accepted that they were not meant to be. Its not been easy and there is plenty of grief, but still there is acceptance without rage. Bitterness is something that corrodes one's spirit, and I'm thankful it has not visited me yet.

I'm grateful that if there is something wrong with my babies, the defect is enough to end the process at 8 weeks instead of me finding out during a 16 or 20 week u/s that things have gone very, very south. There was a bit in 'Coming to term' talking about this, and you realize that a lot of the time, miscarriage is not about nature being cruel, its about nature being kind. The cruel part was that there was something wrong to start with, but after that has happened, if nature steps in and halts the process early, you get spared a lot of pain.

I'm grateful that I've realized what I need to do to get through the next few years comfortably- make peace.

I don't know how exactly to achieve this but the two steps I'll be taking is seeing a shrink (who needs to help me not to cope with grief but the thought of giving up my dream to have biological children without falling apart) and then seeking spirituality to make sure that my happiness does not end up depending on any of the goals I have set. This is not at easy but but I'll be making a start in this while I remain in India.

The most important goal is always, always, always, to limit damage to ones self. And that is something really hard to do when battling infertility of any sort.  Its a lesson that also spills over to the rest of life- things do not  become cushy and rainbow filled because you have children, those are actually when the real battles can begin.

I wish myself and everybody else attempting this luck with this horrendously difficult task. We have no control over our own biology. What we can attempt to control, are our selves, our emotions and our reactions.

Thursday, December 2, 2010

Grand plans

I met with this RE in India who came up with an interesting potential cause for my losses: PCOS that was affecting egg quality.  My regular RE had thought my ovaries looked slightly polycystic (~17 antral follicles in each ovary), and he had checked DHEAS and testosterone. DHEAS was in PCOS range (over 200) but testosterone was low, so the PCOS diagnosis had fallen by the wayside. This new guy now wants to recheck antral follicles and also LH and AMH (both of which are elevated in PCOS, and have never been examined in my case).  This offers a possible answer and the fix would be metformin both before and during pregnancy.

I know that there is still a higher than normal risk for miscarriage with the next pregnancy. This is, after all, only an emperical treatment. On suggesting gestational surrogacy, he flatly refused. He told me by all accounts, that I had a healthy uterus, and using surrogates just because I could would be premature and wrong at this point. In all fairness, I have to agree with him. But, I'm not ready to face the prospect of another short lived pregnancy and loss, while back in the States and alone.  I need a good support system and I can get this only if I  a) magically find Mr. Right and get hitched or b) come back to India and try here while being with family. All in all, I've reached the end of my tether as far as going-it-alone is concerned.

Setting the stage for short term return to India will take one year.  I'm willing to put off babymaking for that long. I''ll be only 32 at that point, and by all indicators, would have plenty of eggs left. The only real hurry has always been in my own head. To stay sane, I need plans with contingencies upon contingencies, so here goes.

The Plan 

1)Check genetics (mine and babies) and run every RPL test under the sun. If all is normal, then do nothing for 1 year. Enjoy life and return to the the person I used to be before pregnancy loss.

2) Return to India, start TTCing with unmedicated IUIs after 3 months on metformin.

3) If a loss occurs, then do IVF using 2 different donors ( including my original, who I just don't want to give up on yet) and THEN (with  this RE's blessing),  go to gestational surrogates. This is the part which can be repeated again and again, if need be. 3 losses would be when I'd stop using myself a s a guinea pig, its just too much. With surrogates and a shitload of dough though, its a different thing. I'm really lucky to have these options,.

4) If multiple tries here fail too, then that implies the issue is genetic and with my eggs.  At this point, go to donor embryos and use my body to carry them (hoping that all parts are still functional at the end of this and the issue was never with my uterus in the first place)

5) if this fails too-adoption in India. 

I can deal with the prospect of short-lived pregnancies and more losses, but I need to choose my battleground wisely. Having lived through the last few days mostly easily, I know being at home will do it.  But importantly, finding real peace requires preparing myself  for the final 2 options which involve letting go of a biological child. Once I become ok with this concept (its going to take work) then who cares how long it takes to get there? Life is making me work for a child, I have faith that it has something good (even if its not what I originally envisaged) waiting for me.

Tuesday, November 30, 2010

On coping.

My thoughts and feelings are tangled and twisted at the moment and maybe writing it out will offer catharsis and well as clarity.  Surprisingly, I'm actually doing ok about 80% of the time. Surrounded by my family, with its collection of 2 dogs and one cat, I'm coping far better than I ever would have had I stayed in San Diego.

But, there still is that 20%.  There are short horrible stretches when you feel like you are drowning and cannot figure out how to stay afloat. Last night, I was jet lagged and could sleep for two hours at a time. Each time when I woke up, I was filled with the most negative, bleak feelings and I started crying, and I ended up waking up my mom. She asked me this, why on earth am I hell bent on torturing myself? She told me I HAD to figure out a way to make this stop. Tough love, but she is absolutely right.  When you are a person struggling with infertility, failure is like corrosive acid on your psyche. Fear is a demon and we welcome it in, we wallow in  it and our pain, and to what end? Its not going to give us the ending we want and it achieves nothing

So whatever happens, I have to find a way to make peace.  If I have to wait 5 years or 10 to get that child I want, by whatever route, I have to find a mental balance, a state of tranquility in that period. I have to find a way to go back to the happy and even keeled person I normally am and stop wallowing like a pig in self pity. Oh I lost 2 babies. Oh I have to go back to my sucky real life in a month, compounded by a  move to a bitterly cold city (biggest gripe, ha) when I know no one  Oh I don't know why, despite being pretty good at getting pregnant., something strong and nasty and unidentifiable is killing my babies. Yeah these things suck, but turning into a basket case in response serves no purpose. I'm young, healthy, have options, and there is still plenty in life that offers joy, I just have to turn myself to those things while life makes me wait, for however long, to have that baby. Most importantly, I also have to make peace with the remote possibility that the child I will eventually have might not be related to me by blood.

How do I do this? Giving myself this pep talk really helps. For the first time in my life, I'm going to see a shrink. I don't know what else will do it,  but I have to figure it out, and nobody can tell me how.  Its a really important life lesson and my managing to learn it would be the silver lining in this process.

Infertility is a bitch and I'm not going to let it slap me around.

Friday, November 26, 2010

What needs to be done.

I'll be flying out to India tomorrow, I'll have the D&C there and they can do a karyotype of the embryo. After that, the healing process begins.

I keep thinking, why does this tear us up so much? There is the love you have for that 7-20 mm mass you have growing inside you which was going to be your baby, but honestly, that bereavement is much easier to handle than losing your baby after having known him or her, or even at birth- that pain has to be unimaginable. You cannot really bond with you baby this early on, never having felt him or her, but yet you love the idea of them so much that letting go of that is not easy.  But you have to. Its easier if you believe in destiny. Bighead was not meant to be, neither apparently, was Turbulence. So I have to let them go, their souls were meant for other places, other bodies and I pray that wherever they end up, they are happy.  You still mourn though, I've broken down over my first baby so many times, and I'm sure there will be many moments in the future when I'll be doing the same for the second. But this is not the hardest part.

Neither is physical pain/ discomfort involved. When involved, in itself  pain is a trigger for depression. But, in my case, physical discomfort is pretty minimal. Right now, physically, I'm fine. I've never been through the pain of a real miscarriage, I'm in the pink of health both before and after the D&C.

The real torture of one early loss, or repeat early losses, is fear. Fear that your dreams will ultimately be ashes, that you will never have a baby. Fear that you have to go through this again. Fear of walking into an ultrasound and having the doc coldly inform you that he does not see a heartbeat (both  my losses, I've had non-empathetic jackasses for docs). Fear of walking around with a dead baby inside of you. Fear of getting your hopes up and seeing them dashed into the ground. And that is the true torture

As I told my mom, this is like a boxing match, and you are up against nature. You can keep getting back up to fight, but it has all the power. If it knocks you down, you keep getting up until a) you either give up and change course or b) it lets you win. To this, my mom said, so go into the fight unemotionally. You know what needs to be done, just do it without engaging your hopes and dreams and fears and letting this trio jerk you around like a puppet.

A good idea in theory, impossible to do, or maybe somewhat possible after being knocked out repeatedly numbs you to everything.  I'm not there yet. The prospect of an other loss, of walking into an ultrasound and finding out the worst, has me literally whimpering.

But are what are my advantages? Lots of easily fertilzable eggs. Financial freedom (I've got a good amount saved up and my family is well off as well). Lets also throw in that I'm pretty darned pragmatic, resourceful and don't really care how I get to my current end goal  (a healthy child with my genetics in my arms). I also get pregnant very easily, but don't count this as an advantage any more because I do not know if  this is about genetics or my body is killing off my babies.

Because I can, I  am seriously considering taking my body out of the equation.  These losses are hell on me, and its much harder to face because I don't have that supportive partner who is suffering as much as I am at the moment.  I'll get through this one much more easily because I am flying 24 hours (not fun) to be with my family, but I cannot do that every time I have a loss.

I looked into gestational surrogacy in India, I contacted a clinic yesterday, and this is what I got back.

Program Fees  
The charges (in USD $) for Single Gestational Surrogacy program are as given below.
Stage I $ 8,900 (three free attempts for surrogate, SI charges and lawyer charges)
(Surrogate booking; Agreement; IVF / ICSI procedure; Pregnancy test)  
  • Surrogate investigations, preparation, endometrial priming & booking  
  • Legal (agreement) charges, Surrogacy India fees
  • Follicular monitoring, Procedural (IVF / ICSI) charges, Hospital stay, semen freezing, ET, surrogate care, pregnancy test.

Stage II $ 7,900
(Antenatal care; Medications, investigations, special care, special accommodation, child care, diet, lost wages, Insurance, surrogate clothing)  
  • First trimester (3 months)  
  • Second trimester (3 months)  
  • Third trimester (3 months)  

Stage III  $ 5,900
(Delivery; Post natal surrogate care; Visa assistance)  
  • Delivery process (normal / caesarean)
  • Birth Certificate
  • Surrogate care (2 months) (Medications, stay, care, diet, lost wages)

Mulling it over. Its affordable, for sure. And possible for me, because this is the city where my parents live and resources are not an object.

What the future holds is unclear. But I'm trying to get to the end goal with minimal additional damage to myself.

Thursday, November 25, 2010

8w6d ultrasound: no heartbeat

Its pretty much my biggest nightmare come to life. We found at this ultrasound (8w6d) that though the baby had grown (4 days worth of growth in 5 days), that the heartbeat had inexplicably just stopped. It probably happened yesterday. I will go for an ultrasound to radiology to confirm, but a no hearbeat is pretty conclusive.

Given the pattern, its probably what happened with my first pregnancy too, and probably around the same timeframe as well. What this means I do not know. When we do the chromosomal analysis again, think there is a fair bet that this one will come back with a 'normal' karyotype too.

I'll have to switch donors for my next try, because everything is screaming genetics at this point.  Its a possibility ( though definitely not confrmable) that me and the donor are genetically incompatible in some bizarre way.

I'm dealing with this as well as one can in the the circumstances- lots of crying involved, but you realize how tough you are when you realize you are already planning the next round in your head, and that you are willing to be knocked down again and again in the hope that one day you produce one healthy child.

Either my dad will fly down here or I go to India to be with my family for the D&C. We can do this if they can analyze products of conception there by karyotype as well.

I'm utterly thankful for my parents now- they are here for me, no questions asked and can take care of me better than anybody else can.

Not sure what else there is to be thankful for though.

Tuesday, November 23, 2010

Happy ICLW!!

This is the first one I've participated in, and I'm excited! My story can be pretty much summed up here and by taking a quick glance at my timeline, on the sidebar.

I never thought I'd be a blogger and I got into the blogging world to escape- I had all these thoughts and feelings about pregnancy and loss and this overwhelming, all-encompassing desire to be a parent (that nobody in my real life could even remotely get) and this blog was a much-needed outlet. Now though, its kind of transformed, I'm not here because of necessity so much anymore, I'm here because I'm a wee bit addicted.  This sucks you in, I tell you. I've met many wonderful and extraordinarily brave people here, its been a wonderful experience so far, and I'm happy I've gotten so sucked in.  Thank you for stopping by!

Sunday, November 21, 2010

8w1d u/s

The ultrasound was yesterday; its the first one that's left me unequivocally happy, with no doubts or worries whatsoever. She is exactly on time (8 weeks 1 day), and the heartbeat was 'eyeballed' to be at 150. I had a 2 minute crying jag after I saw her, it was just so perfect. In this picture, it almost looks like she has a neck, but that can't be right, its too early!

With my last pregnancy, the last ultrasound  where I saw my baby alive was at was at 7w4d, and the baby was 4 days behind and judging by the growth between ultrasounds, was growing at just around 0.7 mm per day (1 mm per day is normal). So, by the same milestones, I can finally say that this pregnancy is looking better than the last, with this one growing at about 1.1 mm/day, judging by the difference between the 2 ultrasounds.

I'm now starting to believe that this *might* actually be. My due date is July 1st, almost a year (to the day), after my D&C. Somebody who has been dealt as painful a blow as a pregnancy loss will be forever wary of fate pulling another unbelievably nasty trick, but that wariness aside, I'm hopeful and optimistic now.

I am also feeling a bit like Goldilocks, I'm either metaphorically too hot or cold, never just right. I complained I had no cramping right? Well tonight, I'm cramping so hard its scaring me a little.  This baby-building business is joyful, but boy, do you EVER get to relax?

Thursday, November 18, 2010

Wanting to feel crappy

Until the start of this week, Turbulence was a very, very good girl. She made me upchuck the entire bag of greasy popcorn I had consumed at the movies on Sunday. She made me cramp on and off too. I was miserable, but ecstatic to have such proof that she is doing well. Who cares if you look horrible and green outside when you are beaming mentally within?

Past three days, there has not been so much going on. There is the occasional mild wave of nausea (so mild I convince myself that its *really* there). Not much heartburn. Very little to no cramping. And of course, I'm miserable. I alternate between feelings of optimism and doom so violently I'm giving myself whiplash. 

My ultrasound is tomorrow, and it won't be a moment too soon.

And of course, my brain being the hyperactive thing that it is, I'm running through my mental lists. What is the possibility of a second miscarriage at this point?

Very, very low. Thyroid ( a possible issue in the last pregnancy), has been dealt with. I don't seem to have other antibody-related autoimmune issues. As far as overactive T and NK cells (linked to the thyroid issue by certain studies) go,  who knows, but those are usually an issue with implantation, and as we all know, I have absolutely no worries in that area.

About the thrombophilias, it seems highly unlikely. I had read a paper a while ago which looked at Indian women with recurrent m/cs. The authors examined the possible causes and found thrombophilias did not crop up. Also, there is my vast, unbelievably fecund family. Everybody reproduces without trying. My family does NOT have pregnancy losses, atleast, not that I know of. What they have, is lots and lots of babies. They are the disgustingly fertile lot everybody wants to desperately be, myself included.   
And finally, there is genetics. Although chromosomes  were normal, my overactive imagination has conjured up scenarios where there is a highly unusual single gene incompatibility between me and my donor, in such a case, 25 % of all of our kids would be at risk. Yes, knowing too much is an UTTER curse, combine with this a tendency towards neurosis and you've got yourself a nail-biting monster on your hands. I wish I was like my mom, she is calm, thinks positive, and nothing ever rattles her.  She is the calm center in any crisis. Wish those genes had not passed me by!  Hopefully they will skip a generation and show up in Turbulence.

My one loss was an unusual and mostly inexplicable one so I've got some reason to be nervous .But then, the possibility of a second loss is statistically very low and a lot of bases have been examined and covered.  This much fear is unreasonable. I'm just utterly glad I'm having frequent ultrasounds, and right now I just wish I would upchuck and cramp so I could get through the days in between comfortably.

Sunday, November 14, 2010

The thyroid sagas

This post is mostly reads like a cross between a science lesson and science fiction. Most of you will be bored senseless, but for any of you with thyroid issues, this might be a little informative. Anyway, its cathartic to just put it all out here, so here goes.  If you attempt to follow this and your head hits your keyboard as you fall asleep reading, I apologize! 

Your body temperatures are controlled by hormones. Estrogen is a hormone that pushes your basal body temperatures down, while progesterone elevates it. These are not the only players, the other big ones are the thyroid hormones.  This is scientific fact, known hopefully by everybody who graduates from med school (yeah, I'm still in my annoyed with docs funk. RE is spared though, he is the one person who actually attempted to LISTEN to me).

During my first pregnancy, the thing that struck me was that I was so cold, so often.  2 days after I got my positive pregnancy tests, my temperatures nosedived by a DEGREE.  For somebody whose BBTs run like a precision clock, this was huge. My progesterone, the hormone you would think was responsible for this, was utterly normal. My temperatures stayed low my entire first pregnancy, and so many times I'd be cold to my bones. I told my doctors this. They shrugged, said 'temperatures are utterly erratic in pregnancy, don't you worry your little head about it'. Did ANY of them stop to think, oh gee, thyroid hormone requirements go up in pregnancy, maybe this girl's temperatures nosedived because her body needed more hormone because her body was cooking a baby and this gobbles up thyroid hormone (scientific fact).  No.  Temperatures are an irrelevant, its not in the handbook, so why bother even throwing it in the mix?

According to the tests, I was 'euthyroid' in my last pregnancy. Which meant my thyroid hormones were in 'normal' range. But its now known that for women with anti-thyroid antibodies, simply being 'euthyroid' is not enough.  If your baby is not getting enough thyroid hormone, things can go catastrophically wrong. Your TSH, the hormone measured to determine thyroid sufficiency, needs to be low in pregnancy.  Mine was not (it was probably over the limit now considered the upper end of ideal for pregnancy). So, in retrospect, its logical that I was so cold the last pregnancy. This is utter TMI, but I had the worst case of holding it in as well, if you know what I mean. Like we are talking, 2-3 days.  That is also a thyroid insufficiency symptom, thankfully one not at all present in this current pregnancy. Coincidence or the hormone I'm taking?

This time, since I've been on daily thyroid hormone supplements, I've been warm.  Hot even. It's blissful. For the first time in years, I actually have warm feet! My BBTs have stayed up, my waking temps are usually 98.2, and during the day, its stays in the 99s. I know this because I randomly check temperatures multiple times a day.  But even this has started to falter recently (I start feeling cold, check temps and find they have fallen by a DEGREE again).  This is because (my theory) that with advancing pregnancy, my requirements are starting to rise. Its supply and demand really. If demand overcomes supply, then my body reflects it by dropping the body temps. I told my perinatologist about the falling temps. He was like, body temperatures, who cares about that? They mean nothing, don't worry your little amateur head about it. I literally wanted to hit him at that point, all of these guys are so by the book, they are like horses wearing blinders.

I think I have fixed the problem myself though.  2 things can be given to improve thyroid function. The first of course, is thyroid hormone. The second, is selenium. This is required for converting the less active thyroid hormone (which is what we get as the supplement synthyroid) into the super-active version (called T3).  When I first started taking synthroid, I think it was just about how much I needed, or maybe a little more. At this point, I wisely stayed away from selenium in case it made me thyrotoxic. But as this pregnancy has progressed, I think my thyroid requirements have started to increase, and I think my body needs more of the very active form., T3. I have oodles of T4 (because I'm supplementing with that and my blood levels are sky high), but it may not be what is really needed, and there is probably a cap on the conversion rate of T4 to T3. So I've started selenium once a day. I first started it on the day I started freezing and my non-waking temperatures were around 98.4. Several hours later, my temps were back up to the 99s, and they have stayed that way. Today, they fell again (the freezing is an instant clue).  Its really scary I tell you, because danger signal or not, I associate it with things going wrong. I took my selenium. I've been waiting and the temps are going back up, and I'm feeling hot again. Coincidence or not? Who knows.

I'm frustrated because I have to navigate this scary world by myself, and try to fix all of this amateur style. If I tell a doctor this (first they have to sit down to actually listen to you for 5 minutes and that may be too much to ask), they'll just shrug it away. If they don;t have a textbook answer for you, they will not even speculate and will just wave you away. And I really, really dislike that. Our body tells us a lot of things, and NOTHING is ever random. If something changes with your physiology, there is a reason for it. Sure the body is complex enough that you might never be able to know the mechanism behind it, but sometimes you can make an educated guess. Who knows, you might even be close to the mark!

Friday, November 12, 2010

6w6d u/s

I had my ultrasound yesterday morning (preceded by a hysterical 5 minutes in tears when the nurse suggested the doctor might *not* do an ultrasound with that visit. Yeah, I was kinda on the edge, especially yesterday).

Anyway, here is Turbulence! And yes, UCSD has truly crappy u/s machines, Another reason to be waiting till the 12 week mark when I graduate to radiology with their fancier equipment.

The doctor tried measuring the heartbeat, but the machine did not allow it so he 'eyeballed' it to be around 130 bpm, up from 108. She has grown too, and has almost caught up to gestational age (6w6d).

And finally, there is the yolk sac, so utterly clear even on the poor resolution machine. I think any way you went in, with whatever machine, its just too bright to miss, so this is truly different from the last time. What the implications are I cannot guess.

I've been very guarded about this pregnancy, almost refusing to believe that this may be real and just adopting a wait and watch attitude, because everything was ALMOST this good with the last pregnancy. The doctors were just utterly confident that all would be well, nobody could conceive that anything could happen to a pregnancy that started out that strongly.

But this ultrasound has given me some real hope, because of many things, the quick catch up in the growth, the difference in the yolk sac appearance.  I'm now guardedly optimistic, which feels nice.

After my loss, I've tried to prepare for the worst case scenarios by never ever discounting that they might come about, but what is the point in that attitude? With my last pregnancy, until they showed beyond a doubt that my baby was dead, I had felt very little fear or apprehension, those 2.5 months preceding that awful moment were really happy. Even if fate kicked me in the teeth, I was really thankful to have had those days.

Now, its very nice to feel some hint of what I felt then, again. Joy should be snatched up wherever you find it, because god knows what will happen tomorrow.

Please keep Mo in your thoughts. She should have been posting her u/s picture too, the unfairness of life is mind boggling.

Wednesday, November 10, 2010

Life is horrible

As you wander in this universe of blogs, populated by women who are have struggled with conception for years, with birth loss mothers, with people who have experienced stillbirth, with women who have had multiple losses, you know, that to some, life can be be bloody utter BITCH.

After many weeks of pregnancy roller coasters, and much hope and prayer from so many people, Mo and Will  found out that this pregnancy too, had come to an end at 7 weeks and 3 days. There are no words.  Please go over and let them know they are in your thoughts.


Just yesterday, I felt my teeth hurt, something that made me go cold. I'm not getting enough calcium, mostly because trying to consume it from food based sources is a PAIN. How much yogurt can you drink in a day anyway? Or orange juice?

So I've been looking, from my last pregnancy, for a good calcium supplement. And because I'm somebody that now reads the labels and fine print on everything, am utterly unsucessful.

Rejected supplements
Tums- the colored ones, have lovely carcinogenic dyes (such as Yellow 5 and Red Lake and all these innoucuous sounding ones), not to mention other crap.
Tums- the white ones have talc and mineral oil!
Citrical-recommended by my idiot OB- has titanium dioxide and a paragraph of stuff that sound distinictly unwholesome while consumed in a pregnancy. Its also supposed to have minute quantities of lead.
Os-Cal- recommended by this idiot website has parabens!
For what parabens are, go here
Rainbow Light has food based calcium sources, which made me want to dance a jig till I realized they throw in other unwanted crap like bioeperene and horse nettles in.

I'm tired and I'm out of options. My prenatal has almost no calcium ( they say because calcium interferes with the absorption of iron, the two are best taken separately) and I'm not having enough from food sources. I need a supplement but everything I find on the market comes with its own variety of crap.

Sigh, sometimes ignorance is bliss. Maybe I should just shut up and consume talc and mineral oil (I draw the line at parabens) or I'm  headed for root canals.

Tuesday, November 9, 2010

She is in there!

 Turbulence 6w4d

Don't know why, but I'm convinced Turbulence is a girl.  Anyway, I went in for a hideously overpriced u/s with my RE this morning, and yes there is a sac, yes there is a little embryo in there, with a heartbeat of 108 bpm!! That is in an acceptable range for this gestational age (6w4d) according to this website

There is also an extremely clear yolk sac. I was shocked as to how clear it was, its definitely not what I remembered from my last ultrasound!
Bighead,my poor angel baby at 6 weeks and 5 days
This was my poor little bighead at around the same point (6w5d). There is a yolk sac (probably on the right of the embryo) but its really indistinct.

I don't know why my last pregnancy failed. I've tried to find the answer in tests, in ultrasound pictures, in crown rump length measures- no luck whatsoever, other than the maybe-maybe not findings with the thyroid.

But now, I'm struck my the difference in the yolk sacs between the first and second times. Did my first baby have a not so great yolk sac? The doctors never commented, but I think they just give all of this the most cursory of attention. I also don't know if its because of different ultrasound machines used (my RE's office, sadly has the better ones). Seems doubtful though, the difference between the two pictures is stark. If any ultrasound wizards are lurking, please speak up.

The RE who did this ultrasound pronounced it 'textbook perfect' for this timepoint. I really don't know what to think. The thing that makes me the most nervous is Turbulence is kind of small, probably 2-3 days behind in CRL measurements. And then there is the yolk sac. The doc did not say it was abnormally large, she said it was a nice looking one. I've been here before. The kind of nice looking ultrasounds at early time points, people patting you on your head and telling you everything looks great.  I cannot trust anything, or have faith now. I need to see the proof of a baby past 3 months. That is what it is going to take, and its going to be a long few weeks ahead.

Next u/s is on Wednesday morning. Followed by 9 days of staying home.

But for now, all is well.

Monday, November 8, 2010

Oh crap (with update)

I'm, well, bleeding. Its brown and stringy and clearly old blood mixed in with a lot of mucous. If you talk to Dr. Google, this can be innocuous, it can be the sign of impending doom, it can be everything or nothing. Oh, and there is also slight cramping to take the fear to higher levels

In my first pregnancy, I often frequented the baby and bump forums, and I'd find all these women coming up with thread tittles like, 'I'm bleeding, please help!'. The last part always used to surprise me, like how on earth can a bunch of women on message boards (or even qualified doctors) help you??? This is between you and nature, and if nature decides to wallop you, then that is what is going to happen.

But now I understand what they mean by help (or somewhat do). But the one person who could help now, would be my mother. I wish she was here. Going through this alone is so bloody tough.

Ok, its the end of the day, and the bleeding (if you can call it that, several little strings of very dark red stuff, maybe enough to fill up a teaspoon at best) lasted only the morning. And I had tons of creamy CM with it. Now its all dried up, there is nothing.
I've been on thyroid hormone for around 6 weeks now and my TSH is very low now, but according to the docs, still in normal range. If your TSH is very low or undetectable, then its a good indicator that you may be hyperthyroid, that you got too much hormone. According to the last test (2 weeks ago) I'm not there yet, but then I'm nervous because it has been two weeks since and things might have changed.  Its fairly illogical at this point but in my head I'm linking hyperthyroidism to increased risk of m/c (and maybe blaming it for the bleed too); Does not add up scientifically but try telling that to my panicky brain!

I still have the symptoms of high progesterone, the sore boobs and the other pregnancy symptoms. After every meal today I've felt like I might throw up.  I have no idea what to make of any of this.

Right now, I'm feeling neither positive, nor negative---I'm just numb, and kinda sleepy, which helps tremendously. Hope this will not be one of those nights when the fear is so great it wakes you up at odd hours.

Sunday, November 7, 2010


I woke up at 6:45 am on a Sunday. It would be entirely horrifying but for the fact that its a pregnancy symptom, hence it makes me ecstatic. Yes, pregnancy brain is a very weird thing indeed.

This next bit is a rant.

My  perinatologist flatly refused to get me tested for any of the thromobophilias (factor V leiden/ MTHFR) saying a) that the test results are hard to interpret and b) I've only miscarried once. Its like saying, lets wait till you do it once or twice more (because each time is so much fun) before we test you further. Its the same attitude my old OB had when she refused to order any more tests after they got the normal fetal karyotype result back. She assured me that in 99% of the cases (even the repeat miscarriers) they *never* find a cause, despite running all these oh-so-expensive tests.  Then I come back positive for the anti-TPO antibodies which are found in 10 % of the population AND are linked to miscarriage. Even more damning are the facts that a ) I do have an incredibly strong family history of hypothyroidism and b) TPO antibodies are found in  a lot of women with TSH levels in the normal range! If they had ordered those tests and stated treating me, I think there would have been the slight possibility that my first baby would have made it. Still, that is water under the bridge now, but when I think of all this, its only natural when I feel like I SHOULD be now second guessing my doctors.  Still, I think the possibility of me testing positive for the thrombophilias are really, really low, so I'll let this one go.

But still, I think this is a topic that strikes close to home to a lot of people- how much do you have to go through before your doctors 'waste' some of your insurance's money and decide to test you? Are series of wasted tests worth it for even the slightest possibility that one might actually find something?

Wednesday, November 3, 2010

happenings in pregnancy land

I think I need to write something even if I have nothing real to report, its a compulsion. Anyway, I'm hanging in there, just have to have faith and patiently wait till November 10th, when my first u/s will be. I'll be 6w5d at that point.

As for now,I have heartburn and heartburn-induced (if such a thing is possible) nausea.  I was taking Tums (had to look hard to find the white ones) then I realized they have crazy stuff like mineral oil and talc in there- why the #$#%# does the industry feel compelled to put crap in everything it makes? Now, if things get worse, I'll have to find  some source of heartburn relief and I have  feeling I'll find something objectionable in everything I look.
There is also the bizarre sleeping habits- my usual bedtime is about 1 am (I kid you not), and my slap-the-snooze-button ritual starts at 7.45 am and goes on for about half an hour.  Now I'm in bed by 10 pm and wide awake by 7 am, its utterly shocking.

I pray for cramps, which I take as a sign of the uterus stretching and  accommodating itself for the little one, but I have not had much of that lately. Again, this is where the faith bit kicks in.

As far the doctor front goes, I now have a reproductive endocrinologist, a perinatologist and a regular endocrinologist ...a bit exhausting to think about.  Have my first consult with  the endo today, and we'll be talking about whether I am skating on the edge of thyrotoxicity or not.

Update about thyroid : I met a very junior endocrinologist (= easier to bully, and I'm definitely the bullying kind of patient, the kind that tries to make their doctor order all sorts of tests they think they need). She (and the older un bully-able doctor she bought in later)  pronounced my super-low TSH (0.4) and total T4 (10.5) absolutely perfect for pregnancy.  I'll be retested on a regular basis but right now they think everything is dandy.

On another note- scientists really do make the most exasperating patients.. I know somebody else who has this rare and undiagnosable condition resulting in a  pretty scary potassium deficiency, he actually sequences his own genome and  makes powerpoint presentations to take in to his poor doctors. Compared to that, I'm probably not so bad.

Congrats again to the newly pregnant S and HopefulCC, and I'm keeping  Mo in my thoughts- looks like things are going well!

Saturday, October 30, 2010

A panicky idiot

That is what ONE loss makes out of you. Seriously.

First let me start out with the best news I've had all week: my anti-cardiolipin antibody levels have dropped from the 'maybe-something-to-worry-about' zone to the 'its negative' zone! The bad news- I think my doctors are going to collectively put a hit out on me before this is over because, boy, I might just end up being the patient from hell.  Now I'm wondering whether I should get the risks for thrombophilia (factor V Leiden, MTHFR) etc investigated. There is not really a good medical reason to do this, except that it will make me sleep easier at night.

My first ultrasound is at 6 weeks and 5 days, which is November 10th.  As far as first trimester TLC goes, I'm very tempted to make them see me *almost* every week. The good thing is I've already run this by them and they didn't even blink. I'm debating paying 160 bucks out of pocket and going to an RE for an even earlier ultrasound (maybe 5 weeks and 5 days) which is just plain silly, especially given that I might go into a panic if they see no heartbeat that early. Plus, why waste the money when I can have a u/s for the cost of a copay in a week's time? But still, I'm so tempted.

I want to relax and go into the the 'nothing-bad-can-possibly-happen-because-everything-looks-so-gosh-darned-good' mindset I had in my first pregnancy but that is just not going to happen. I'm trying to curb some of my more drastic impulses though, wish me luck!

In the meantime, 'Turbulence' is continuing to earn her nickname- I skipped out on my customary glass of yogurt before I went to bed last time- she woke me up at 3 am with the most horrific hunger pangs ever. Its like feed me NOW or I'll make you pay. Had to stumble out to get that glass of yogurt- my 4th time up last night!! And I'm enjoying every second of it, in a weird, perverse way :-)

Wednesday, October 27, 2010

bloodwork part 1

The best idea I ever had was to start a blog during this process. When you get results back, you WANT to share, but who really is willing to listen? Nobody other than you guys and I love you all for it!

18 DPO beta- 1702 (last time was 2500 at 19 DPO, so sounds about the same)

See the  betabase link for that day.

The rest is horribly technical but I'm sad to say too many of the people reading will actually be able to interpret these values easily,  oh for those days of blissful ignorance.

TSH- 0.4!! (nosedived from 2.86- its quite a dive down, but I guess I'm not hyperthyroid yet)
T4- 10.5 (close to upper limit of the normal range)
Lupus anti-coagulant DRVVT test ratio is 1.07- the same down to the decimal point as last time 5 weeks ago! You are considered positive for Lupus anti-coagulant (scary stuff highly likely to kill your baby) if your ratio is 1.2 or above, from this lab.

If I were a betting woman, I'd say the cardiolipin IgG value will come back as the same, which will probably get me put on aspirin. God knows what any of this means anymore.

I told my mother I was pregnant (I can never keep anything from her long) and she was 'not surprised'. She kept telling me not to be negative- man, I have to say, the pressure to 'stay positive' is itself stress inducing.

Monday, October 25, 2010


I need to start this post with the confession that I am quite unable to give my babies cute nicknames, only wacky ones. Sorry, my little ones. My first baby got stick with the moniker 'Bighead' at the second ultrasound when I was utterly struck by how huge his head was compared to the rest of him. This new one- well read on.

This post is about all my darkest feelings. As I continue to feel more of this new pregnancy every day (nausea, heartburn, uterine cramps), there is a part of me that is happy and hopeful but there is this sick, dark place inside me waiting for the Sword of Damocles to drop again, for me to go to an ultrasound and find out its all over all over again.

A huge part of this fear is because I have no idea what went wrong. Often when babies are lost its a case of slow doubling or low betas, when chromosomal abnormalities are discovered or at least, strongly suspected. My last pregnancy was not like that. My first baby ( poor little Bighead) was a champion to start off with. His betas were off-the-charts, unbelievably good and they doubled perfectly. His chromosomes were beautifully normal.  You cannot ask for a better start to any pregnancy, and yet, he was dead probably at the 10 week mark. Everything suggests to him being fine, that it was something else that went wrong. How can you box at shadows?  I'm hopeful yes, but there also lives this horrible place inside of me which is just mentally steeling itself for the worst.  I cannot shake it off, no matter how I try. Its almost like a defense mechanism, that horrifying news will be better tolerated if its anticipated. That of course is a load of crock, nothing can soften the blow if it comes at you again.

All of this fear is made worse by the fact that they DID find something wrong with me. If its just thyroid, then that, I think can be easily dealt with.  But then there are also the anti-cardiolipin antibodies. I had my consult with the perinatologist, and the verdict (which I had also come to) is to retest for them. If the repeat value comes back even at the slightly elevated, neither-here-nor-there value,  they start me on aspirin. Now, all the studies suggest that aspirin by itself possibly is not enough in case there is a real clotting problem. But my levels are not high enough to justify heparin, and moreover, giving somebody heparin when they don't need it is inviting trouble, you can have a bleed beneath the placenta which can itself result in pregnancy loss or you could end up in a potentially dangerous situation yourself. I will give blood to test for TSH and the dreaded cardiolipin IgG value this week.

I just need to genuinely believe that this will work, that my new baby (named 'Turbulence' because of the fact that she is tiny but already causing quite a bit of it,) will be ok.  She, like her older brother, is a strong, healthy baby.  I NEED to believe that my body will allow her to make it..I just don't know how. The proof is in the pudding, and I haven't seen the darned thing yet!

So everybody, put your hands together and pray for 'Turbulence'!

Sunday, October 24, 2010

Bloodwork Results

To cut a long story short, I had my test for beta and progesterone yesterday, which is 15 DPO- beta is 457 and progesterone is at 46.9.  Both levels look fine, a quick check on the betabase for my day was very reassuring. My beta in the first pregnancy was probably a tad bit higher (17 DPO was 1180) , and my progesterone was a touch lower (42 ng/ml at 17 DPO), but all of it looks good overall.

The best part about this pregnancy so far is the difference in BBT charts from the last time.

The last time, at 12 DPO, inexplicably, my temperature started to plummet, coming down to the pre-ovulatory range in 2 days and staying there. When that happened, that fertility friend software actually removed the green line indicating pregnancy.  I still have no idea why this happened- I had checked progesterone and that was fine, and the pregnancy progressed normally for maybe another 5 weeks.

This time, my luteal phase chart looks completely different and my temperatures have stayed in the peak luteal range!  Such a little thing, but so nice to see. I'm also not cold like I was the last time. Your body is supposed to turn into an incubator during pregnancy, and its nice to see that happen!

Thursday, October 21, 2010

Drive-by posting

First, thank you all for your kind words. I'm thinking of all of you in the 2ww, and waiting and hoping for you. It has been a crazy week, I have long experiments everyday and I'm packing to move this Friday, so I just have time for a quick update.

The RE's policy is that the blood beta is determined in a single draw at 17 DPO, which will be on Sunday. So I have to wait. The thing that is keeping me sane is the the urine HPTs are steadily and clearly getting stronger, clearly in a 24 hour period and without doubt in a 48 hour one. Shannon's point that these are too crude to be accurate definitely stands, but its reassuring to see the darkening nonetheless.

Tuesday, October 19, 2010


I wish this process did not have the nasty habit of taking you up to the stratosphere one minute and smashing you down to the ground the next- its been a super eventful 2 days, in other words.

Day 10 was when I got my BFP the last time. So I start testing, and past 10 in the morning, I start getting the faintest of tantalizing smudges on my test. I'm excited, but am waiting for a clear line to be sure. I wake up early this morning, expect the 'concentrated' first morning urine to give me a clear test- and nada. I freak out, but pee again 5 minutes later, and test this- super faint but distinct line! Holy schmoley I'm pregnant! Then comes the afternoon where I have my consult with my perinatologist. I request a urine test, because as you know, we all have a sick love affair with peeing into cups.  The nurse comes in after my consult is done and tells me indignantly (like I'm a crazy person who likes to invent fake pregnancies) that the urine test was negative (!!!) I leave in a daze, go to work, shut it all out for a few hours. I break down on the way home though- I'm so utterly sick of crying while driving; I've done it far too many times this year.

I get back home- take another of my cheap internet sticks- get a faint, but clear line again. By this time, I'm utterly sick of ambiguous results, so I run to the drugstore and spent 40 bucks on TWO brands of pregnancy tests (Clearblue digital and First Response)- see results!! I AM knocked up, as of now. I guess OTC tests are more sensitive than the machines the department of reproductive medicine at UCSD has-but I'm so mad at them for putting me through this nonetheless.

I'm frankly nervous about the beta increases, mostly because I've been spoilt from the last time- my first baby just LIT up the tests, and the early doubling increases were clear enough to catch even with the cheap sticks, even in a timeframe of 12 hours (!!) He was above the 95th percentile of the betabase results for any given day that we tested blood betas;Based on the earliest results (especially the increases) this little one is not like that, but I guess a detectable beta by day 10 is nothing to scoff at. I'll be honest- scary thoughts like chemical- or worse, ectopic are going through my head. I need to get the blood tests done- and the blood draws begin. More about what my perinatologist said in another post.

This should have been an utterly happy day for me- and I am kind of there now, but I'm pretty darned shaken.

Friday, October 15, 2010

Confessions of a POAS addict

Be warned- this is an orgy of TMI.

The 2ww has the potential to be biggest, most evil tease ever.  How many people out there have had 'symptoms' up the wazoo only to be visited by Aunt Flo in a few days? The last time I went through this, I  was perfectly fine till 3 days past ovulation, when I started feeling chills, nausea, sore boobs and quite a bit of CM. My symptoms were kind enough to work in concert, I'd poke at my chest to make sure it was till sore and the nausea would come up- bliss. If you ever catch a woman playing with her own chest- she is probably not a nut or a pervert, she is just in the 2ww. All of these 'symptoms' turned me into a gibbering google junkie and drove me to start testing from 5 DPO!! Nobody, not even Octumom, could have had a positive that early. Thankfully, I had purchased super cheap but good sticks off the internet which allowed me to indulge in my twice daily ritual with no dent in my walletBy the morning of the 10th day, I'd lost all hope but I still kept going only to be caught completely by surprise by a clear BFP that very evening.

This time- I have some of the 'symptoms' back- I've got the boobs that feel like they are going to burst out of their skin and Torquemada came back from hell just to create some very painful clamps for them, I've got the crazy and plentiful CM, I've even got the nausea. I'm missing the 'implantation' cramps, or atleast the biggest wave is due tomorrow and I'll be pretty darned unhappy if they don't show. I've been POASing exactly like the last time and nothing yet- its only 7DPO and I'm be terrified if I actually got a BFP this early.

I still know that despite all of this, its possible this cycle may not have worked. Its a very unusual one for me and clearly estrogen and progesterone are high and having  a party inside of me but that does not necessarily translate to pregnancy. If  its a BFN, it just translates to a very unusual cycle (not good, I like the fact that my reproductive system is normally as as predictable and efficient as a German-designed instrument), but what can ya do.

All I can say is, thank god for sensitive internet cheapies; I've got 50 of them in my bathroom and I'm going through them rapidly!

Tuesday, October 12, 2010

The usual 2WW madness

I''d forgotten how angst-ridden they are and how they turn you into a google junkie.  Everytime, the 'symptoms' you get are going to be different. This time there is something definately eyebrow- raising happening, and this is kind of gross, so if you are not a TTC veteran (which would make you utterly comfortable with discussions involving bodily fluids), stop reading now.

On 2 and 3 days DPO, I got tons of egg white cervical mucous (!!!).  Today, I used the clear-blue easy fertility monitor because I was curious about my estrogen levels, and it registered high fertility = high estrogen! I usually don't get much CM at this point, though in the last 2WW, it was decidedly more that usual and creamy, but not the egg-white kind and definitely not such abundant floods. One thing is for sure, my lining is probably approaching La-Z-Boy plushness given the floods of estrogen.  I'm slightly concerned that I have a cyst but I don't know how high your estrogen levels have to be before the doctors start looking for one. There is also the tantalizing observation floating through message boards that women who get pregnant can sometimes notice more fertile quality CM in the 2ww. Having found no scientific page stating the same, I think it just might be 2ww urban legend.

So I've googled the same query in about 15 different ways, posted the question about whether this is even normal on every message board I can find , asked my RE too, and have heard back from nobody, which of course whets my desire to know so much more. 

I recently told one of my friends about Plan B and the fact that I'd had an insemination that very morning. She is all seriousness turns to me and says, 'Doesn't that mean that you will find out in two days?' Bless her- wish she was right!

Saturday, October 9, 2010


I'm home early today and have nothing to do, so I decided to write a blog post. This stuff is addictive I tell you- soon I'll be one of those poeple who cannot shut up about themselves...ACK!!!!

The reason I'm home is I had a mucocele (trapped salivary gland in my mouth) cut off today. I now  have a lipful of stitches that stick out like whiskers, I look like Angelina Jolie gone wrong and I'm on a-don't-eat-anything-you-need-to-chew diet. So I had a ginormous glass of home-made creamy yogurt for lunch and dessert is going to be this---------->
In TTC-related news, I woke up this morning and my temps had not shot up like I was expecting them to. So I panic and fall back on the doctor's plan of going in for an ultrasound today to decide if I need a 2nd insemination.  Turns out I did ovulate yesterday, they could see the start of the corpus luteum.  As soon as the doctor and the nurse see the lining, they say in unison- 'beautiful!', but I  freak out a little when the doctor measures it at 8.5 mm instead of 9.. how could it have shrunk? They then assure paranoid little me that different operators can come up with different numbers (yesterday I had the head honcho and today I had the junior partner). But still, I was concerned that it had not grown between yesterday and today- I'm obsessed with size apparently. I want to be a 12, but I'm only 8.5-9. I wanted my follicle to be a 21, instead its only 17. Boo hoo.

As you could probably tell, I'm angry with myself- why the obsession with numbers and patterns, with all the resultant anxious overanalysing?? Why the wish to be 'perfect', especially when you cannot identify what are the factors that lead to successful creation of a baby in 9 months? This road may be long drawn and twisty, and if i don't just let go and let nature take whatever course its determined to, I'm going to end up in a self-created hell.

Its quite annoying when you can clearly identify all the issues with the way your brain and personality function, but cannot fix any of them. I'm trying though. Every time my idiot brain tries to come up with a new worry-inducing permutation and combination, I've been repeating to myself  'Let go and let god' like a mantra.
Lets hope it works.

Thursday, October 7, 2010

And its a green light!

My doctor looked at my insides this morning, and my lining was what he described as 'great' at just over 9 mm. Its also triple stripe. Since I've had a lining of 14 mm at 2 DPO in a similar cycle, I was initially not as enthusiastic, but I'm definitely bowing to his superior judgment. Also I'm not sure if the lining continues to thicken for the next few days- anybody know the answer to this one, holler!

Usually I've gotten the impression that my right ovary produces the dominant follicle. This time, its the left one in play with a 17 mm follicle.  The right had one at 14 mm.  So all of this looks adequate, even if developed under less than stellar conditions (by my usual standards).

The swimmers are thawing as we speak. I could not sleep last night when confronted with the enormity of what I am about to do.  I'm not half as afraid of a BFN as I am of going through another loss, this time because of a 'bad' egg.  As somebody pointed out, it is an utter fool's errand to try to micromanage this process, and waiting for that perfect cycle seems pointless because no matter what, you CANNOT accurately calculate the odds of something even the experts barely understand.

So, although I'm agnostic, I'm praying very hard as we speak!

UPDATE: The deed is done!  Let the egg pillage begin!  I feel so much more relaxed with things now once the die is cast.

Note: Lesson learned from comparing this insemination to the last- make sure your RE rewashed your sperm even if it is already 'IUI-ready'! The last time I was curled up in a fetal position cramping horribly after my IUI , and I suspected that was because the sperm still had trace amounts of semen components such as prostaglandins in them because my lazy ass RE did not bother rewashing. With my new RE, of course it was re-washed and I'm utterly comfortable. What a difference a good RE makes!

A less than perfect egg??

First, I have to apologize for this is a horribly technical post.

I can safely say that I'm very attuned to my cycles, so much so that I've recognized that they fall into one of two patterns (ovulation either on day 16 or day 20) based on my day 3 temperatures. Based on which pattern is in play, I will know  what day ovulation will happen, what day post-surge my temperature will rise, I can even somewhat predict what my BBT will be on any particular day, its that spookily accurate.

What is important for egg maturation? Well, lots and lots of estrogen. Now, in addition to charting temperatures and monitoring cervical mucous like the KGB, I also use the clear blue easy fertility monitor. Once you switch to high fertility, it means your estrogen levels have shot into the stratosphere.

So the point of this post is: I started my surge today, and based on a) cervical mucous and b) estrogen levels (from the clear blue easy fertility monitor) that this is a a cycle where I've had the least days of high fertility( ie high estrogen) ever.

If you compare this cycle to the last time I had this cycle pattern, I had 4 more days of high fertility + 2 days of peak fertility. In this one, I've gone directly to peak, and this is scaring the crap out of me.

I explained all of this to my nurse, who actually understood what I was talking about right away. So I asked to have an ultrasound tommorow to see how things look, and if that is good, ONLY then thaw the sperm. We put this plan to my RE and he agreed that it was the most sensible thing to do.

This is such a huge gamble. This has to be MY worst cycle, but if you compare it to the average woman's, its probably still decent. God only knows what determines egg quality, and how these things differ among different people.  I feel like a poker player going all in on a substandard hand, but its just too hard to wait any more.