Monday, September 23, 2013

The utter suckiness of ultrasound days

Thank you all for chiming in. The day of the ultrasound is always incredibly stressful for me, and no matter what, I'm always shook up that day. I spent Saturday evening crying, and my father told me that I needed to not get so emotional during this process. I told him that I'm only emotional in fits and bursts, and that I would be fine on Monday. Turns out, that was true. I'm fine today, and I will continue to be so till  the next scan in 2 weeks, at which point I'll turn into a wreck again, unless things look picture perfect, and they never probably will.

There is no telling what will happen now. The lag in growth IS a bad sign. Does it mean 100%  that it will translate in miscarriage? No,  but it sure does raise the odds.

Then again, as somebody commented, miscarriages can come out of the blue. Pregnancy # 2 grew at just over 1 mm per day, and had a pretty normal seeming hearbeat (150 at 8w1d), and everything stopped 5 days later.

Btw, here is an interesting fact: while there can be a larger variability in measuring the sac, inter operator variability in measuring CRL is much lower: one interesting study noted that one person measured 6 mm, a second person would measure between 5.4 and 6.7 mm, a +/- error of less than 1 mm. So no matter who is measuring, I'm behind.  
Reproduced from
Right now, I'd give myself a 50-50 chance of making it. I found this very interesting study from England. They got a batch of patients who looked like they may miscarry in the early ultrasounds, and took 2
ultrasound readings in the first trimester, and looked at what cutoff of CRL growth predicted miscarriage most accurately. Note that normal growth in most viable pregnancies is about 1 mm per day.

All the pregnancies shown in blue made it, while the ones shown in red did not. Based on this, the authors concluded that if CRL increased at less than 0.2 mm  per day, you had no chance. If the increase was 0.4 mm per day, you had a pretty high frequency of loss, but some did make it. Note that the authors only observed them till 11-12 weeks; some of these may have been the viable trisomy category (which is the absolute worst case scenario). At around 0.7 mm growth per day, things seem split down the middle, and that is where I stand. My chances are definitely lowered, but things may turn out to be okay.

And very importantly, today, I am okay. And I'll be okay no matter how things pan out here.

Saturday, September 21, 2013

Not looking good

There was a heartbeat, nice and strong, at 178.  There has been growth too, up from 2 mm the last time to 15 mm today. The problem is, at the last ultrasound at 5w6d, it was measuring 5w6d.  Today, at 8w3d, the embryo is measuring 3-4 days behind, at 15 mm (16 mm is supposed to be the normal 8 week CRL).
Normal growth everyday is supposed be 1 mm. This baby is growing at 0.7 mm every day, which is exactly the value I calculated in my first pregnancy. I then had freaked out, everybody pooh-poohed me, and then my mom left, and I discovered my first miscarriage 5 weeks later, which just made it all so much worse.

When the doctor at RMA NJ was asking about my pregnancies, he specifically asked me whether there had been a slowing of growth between 2 ultrasounds (measuring on target at one point, and then behind the next).

According to the conversation I had with him, and reading the accounts of many many women freaking out, it is fine if you are consistently behind (For example, if you measure 6 weeks when you are supposed to be 7, but at the next ultrasound, the lag remains the same and does not increase). But if your growth lag increases with every passing week, then that pregnancy is *probably* on its way out.  This is borne out by both what the RMA-NJ doctor said they observe frequently, this study, anecdotal accounts on the internet,  and what I observed in my first pregnancy.

However, the other thing is that J has been barely eating, because her nausea is so bad. I'm hoping the slower growth is due to poorer nutrition;while that is far from ideal, many women who starve through the first trimester go ahead with no issues. She is also having dizzy spells, which make me wonder how her iron levels are. My RE advised against iron supplementation right now because it makes the nausea worse, but I wonder how anemic she is at this point, especially if she is feeling dizzy. I don't know if poorer nutrition retards growth, or rather, how poor the nutrition has to be to achieve this. She is atleast taking folic acid (and some vitamin D), but nothing else. I had a really long conversation with her about nutrition today, and her options.  We'll see how much good it does.

I've almost resigned myself to the fact that this one may end. If it does not, it will be a very pleasant surprise. My parents talked me out of testing again in one week, because if the lag has only increased but the heartbeat is still there, that just creates more stress. But, on the flip side, if the heartbeat stops soon, I don't want to wait weeks to discover that, for multiple reasons. As a compromise, we agreed to retest in 2 weeks.

What a good place to be in, again. I don't want to be the one freaking out. But I've seen warning signs in each pregnancy (except my second, which looked close to perfect till it was over) and when I talked about them, everybody told me to stop drawing conclusions on insufficient information and stop worrying for "no good reason." Unfortunately, I was right then. I'd really, really like to be proven to be completely wrong in this instance.

Friday, September 20, 2013

All the goodwill in the world

A fellow blogger Paige lost her first baby to pPROM in 2010. I just found out she lost her twin boys, possibly to incompetent cervix. I found out about Paige's pregnancy a few weeks ago, and I was hoping so badly for a happy ending for her, and everybody wanted things to go well for her, so very much. All the goodwill in the world---we feel like it should be a powerful thing, and yet it is but a leaf in the wind that proves utterly ineffective all the time. Who has the power? Who decides these things? Is it the most likely possibility decided by "n" number of biological variables working with or against each other, unaffected  by outside influence? Or is it the universe's will?

My mother keeps telling me that no matter what I do, I have to have the sanction of destiny for it to work out. Maybe, maybe not.  Its a question that my brain keeps circling around, and will continue to circle forever.

I'm heartsick because of Paige. This is her blog: I request you all not to go there to silently watch, but only go if you want to truly commiserate.  

I'm sorry I've been silent about my situation: the ultrasound was delayed this week because my RE's receptionist did not book an appointment well enough before hand and could not get a slot. It will happen hopefully tomorrow. J would be about 8w4d along. Don't know what I will find...mostly comfortably numb, except for moments of that familiar heart-in-your-throat panic when I actually think about it. If the baby is still fine, this would be the furthest any pregnancy of mine has come. I know there is a lot of goodwill coming my way too. I wish something like that could have been the deciding factor, instead of an unseen, incomprehensible power running the show.

Sunday, September 8, 2013

Rambling along

First, I owe the Indian lab testing establishment a bit of an apology, it appears that THEY do follow the TSH mandates; the normal reference range according to a leading testing lab (Metropolis) during the first trimester is 0.5-2.5 microIU/mL.

J (very thankfully) is anti-thyroid peroxidase antibody negative, and her TSH has decreased from 2.77 to 2.3. How I believe this happens: your need for thyroid hormones increases during pregnancy. Soon after you become pregnant, you body increases its production of TSH. This causes your thyroid to make more T4 and consequently, T3, and these in turn, through negative feedback regulation, could suppress your TSH.

This is what happens when your thyroid function is normal. If you do have anti-TPO antibodies, this process could be out of whack, and your TSH could be elevated during pregnancy, as in my experience: I have anti-thyroid antibodies and my TSH levels increased during pregnancy because my body may have not been able to meet my thyroid needs: In my opinion, the prudent thing to do is check TSH twice, once before, and after, you get pregnant. If your TSH is high and you turn out to have anti-TPO antibodies (seen in one of of every ten women), then, you should treat with thyroid hormone.

Unfortunately, J is vitamin D insufficient (20 ng/mL), and this is after I gave Vitamin D pills (2000 IU/day). I believe she took them for a while, because her levels are not terribly low, especially for a newly pregnant Indian woman: Indians on the whole tend to be more deficient, for whatever reason, that white people, while people of African origin appear to be even more deficient than Indians, and I don't know the situation for Asians.

Insulin resistance is rife among Indians today, and one reason for the this increased incidence may be the seemingly endemic-nature of Vitamin D deficiency. Studies now suggest that if you are vitamin D-deficient during pregnancy, even if everything goes well, your child, depending on his or her genetic vulnerabilities, will be at increased risk for wheezing and asthma, schizophrenia, multiple sclerosis, type 1 diabetes mellitus, and insulin resistance. And maybe even the most scary thing of all, Autism.

The good news is that J is still having nausea. Unfortunately, this makes her unable to gulp down pills. I'll now have to make her have the Vitamin D sachets, which have ridiculously high dosages of 60,000 IU per sachet.

The next ultrasound is in 10 days, according to the handler. That should be just short of 8 weeks.

Thank you Augusta and Sloper (and indirectly, the wonderful Adele), for what you said. I am thankful that there are many people out here who truly get what I am going through. On the other had I'm also sad that they get it, because the only way you can is to have gone through one or multiple losses.

I still have no faith that this will work, I'm just watching and waiting. That faith can only come with time. Like I commented on Jo's blog (who has successfully crossed the 12 week point, YAY!) is that while we can feel optimistic about somebody else's chances, it is hard to summon up a similar optimism about our own situations, especially if you have had "normal" ultrasounds at the 6-week point end in in miscarriages at the 8-week point, thrice. What Augusta said a while ago, that it is human nature to keep expecting history to repeat itself, is something I remind myself of regularly:  I know it does not mean it HAS to, again. It is just hard believing that in my heart.

Friday, September 6, 2013

First ultrasound

This has to be the most chilled out ultrasound I've ever had, and I'm saying that because I was not there for it: I was flying somewhere high above the Atlantic when it happened and was probably watching a Ryan Gosling movie during the event. Best.Ultrasound.Ever.

The baby is measuring on track(ish) (5w6d), with  a really high heart rate (139) (!!). The normal range for this time period is supposed to be 80-110, so that is mildly eye-brow raising.  The shitty bit with knowing too much is that I know that while slow heart rates are definitely associated with aneuploidies,  higher heart rates (as measured a bit later) are associated with Trisomy 21. I am not really stressing out about it, because hey, what would be the point? Plus its not crazy high right now: it would be if it were 190+ a week later. If it just coasts or increases only mildly, then there should be be no cause for worry. If anybody has any crazy high early heart rates producing healthy babies, please, chime in. Yes, we worry every which way, and we can't help it.

Chiming back in with an update on my understanding of heart rate in Trisomy 21 pregnancies: it looks like it may be low in the 6th week,which is  seen for most aneuploid pregnancies. However, an elvation at a much  later point (past 10 weeks-ish, not sure) has been observed for Trisomy 21 pregnancies. 

Based on an explanation I read, this may be the deal: In a healthy pregnancy, the heartrate starts out slow, and keeps increasing till it peaks at 9 weeks at around 180, and then rapidly declines a little. The theory is that this decrease may not occur normally in Trisomy 21 pregnancies, which is why late elevations are associated with this condition. However, I want to reiterate that there are many many women with high fetal heart rates at late points whose babies are absolutely fine: don't want to worry anybody!

Either way, at this point, I have no logical basis for worry on this score.

In between all of this, I am, just for shits, giggles, and my own peace of mind, ordering a blood test (I have the fun task of having to arrange it myself) to rule out that the surrogate is anti-thyroid peroxidase antibody positive. If she is not (and I pray she is not, and she most likely is not) then I have nothing to do here, which is absolutely awesome.

The poor woman is also feeling really wretched; nausea and giddiness, and its so bad that I want her to keep feeling wrecked for a while....but what can you do? We've all heard the story about disappearing symptoms, though I'm sure that it has proven to be nothing in many a case.

I am starting to look at early screening (CVS), while debating the need for this level of screening.

It is so unbelievably scary when you are waiting for a baby to develop, especially when "normal development" has been applicable to everybody other than you. I mean...who has normally developing babies, other than almost everybody who gets to this point? Yet, I cannot even comprehend being that lucky. I don't even want to know when the next ultrasound will be, but I will not be able to stop myself from asking.