Meiotic non-disjunction strikes again

After a great deal of haranguing, I got the results.  Meiotic non-disjunction (which, in English means, the chromosomes did not separate properly during the process of making an egg or sperm) has happened again.

During my second pregnancy, it happened in the form of a monsomy of the X chromosome, which means either the egg or sperm had one less X chromosome that it should have. Monosomies are considered to be more likely a sperm error (a sperm that is missing a chromosome is lighter, can swim faster, yada, yada).

This time, it was most likely to be an egg error- a Trisomy, of chromosome 4. And it was a girl.

On googling, my blood ran cold- trisomy 4 appears be one of the rarer ones, and more often its a partial trisomy, (you have a 3rd copy of only one half of that chromosome) and the child can make it to birth, but obviously, with major, major issues. Thank god  my baby and I was spared that. Often, miscarriage is not about nature being cruel, its about nature being kind, and nature was kind here, but only AFTER the bloody trisomy had resulted. Bloody nature.

I'd had a bad feeling about this pregnancy from the time that the first beta and progesterone values had come in, because they were both far lower than my levels for the first 2 pregnancies (though, in normal range for the population) and the progesterone fell sharply by the 7th-8th week period-this was all in keeping  with the observation that some (but not all aneuploidies) can have lower progesterone and beta-HCG levels. Its fascinating, apparently trisomy 21 has higher HCG levels, but Trisomies 13 and 18 have lower progesterone and beta-HCG levels---wow, this suggests that complex mechanisms behind aneuploidy of different chromosomes, just because we don't understand it in the slightest, does not necessarily mean that its completely random. Chromosome 4 aneuploidy has not been studied, because its too rare, but my scenario also points to reduced hormone levels with this one.

What next? IVF with PGD obviously, but I'm trying to end up with a method more accurate than FISH, which does not analyze all the chromosomes, and would (probably?) have not caught this one.  The goal is to get microarray done with IVF in India-- this one has several logistical issues, lets see how they can get worked out. 

But as for now, I'm so very glad to have an answer. The point where we get grateful for small mercies is a sad one indeed.

Over

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

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

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

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

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

95%

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

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

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

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

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

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

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

6w6d U/S

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

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

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

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

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

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

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

Like something the cat dragged in

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

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

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

6w2d U/S

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

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

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

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

Ultrasound tomorrow

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

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

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

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

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

The plan (for now)

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

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

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

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

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

5w6d or 6w6d (updated at the end)

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

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

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

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

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

Life in bullet points: 5w1d

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

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

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

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

21 DPO results

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

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

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

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

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

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

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

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

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

Life in bullet points: 4w5d

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

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

17 DPO results

I'm literally sitting and physically shaking with releif here. First, my home HPTs finally got darker yesterday evening, giving me some peace of mind and the ability to go out for a friends birthday party,in a Beer Garden of all places, where I spent the evening trying to dodge plumes of cigarette smoke (ARGH) while enjoying a spectacular outdoor view of South Manhattan.

Today's blood work

Beta = 324 (up from 137, doubling time of  38.65 hours)
Progesterone = 33.5 ng/ml (going in the right direction)

Right now, I'm holding off the Crinone (have not started it).  This news will hopefully tide me over this weekend. Sadly, my cousin cancelled her trip now and rescheduled for the weekend of the 14th, where I will be probably be going in for U/S # 1. I really want her visit to be a fun one, but she has been warned of the possible circumstances if things go south.

I have several pregnancy related superstitions from past experience a) I will feel reassured and relaxed before shit hits the fan, I'll never see the blow coming and b) I always receive horrible news before a holiday (my last 2 miscarriages were like 2 days before the 4th of July and Thanksgiving weekends, respectively). The only big holiday on the horizon is the 4th of July, so lets hope for a good beta on Tuesday.

Let us pray that neither comes to pass, and things actually work. I'll believe it when I see it, but now, I can heave a beautiful, heartfelt sigh of releif. 

Willpower---wazzat?

Ohkay, so my intention of holding out till Tuesday lasted till this morning, where I POASed  this morning and got a line that was looked almost the same as yesterday (15 DPO) and the day before (14 DPO). I then sat blindly staring into space for like half an hour, caught somewhere between hope, fear and bleakness. To say that this limbo is messing me up is putting it mildly. I then emailed my awesome Endo and asked him to put in a blood test for beta and progesterone tomorrow. I have to say, this blows. I can deal with a clear failure in my own way, or good news (no trouble at all :)), but this in-between stuff is what truly kills me. I bitched about my previous pregnancies, about having no indication that something bad was coming, but I have to say, the alternative is far worse.

You know that adage? Don't ask a question if you can't deal with the answer? well, I don't deal well with uncertain answers, but apparently, nor can I leave well enough alone. A non-doubling would probably reduce me to a mess for a few hours (with my cousin coming in sometime tomorrow). I feel horrible at the possible at the prospect of  hitting her with this mess, but I think with somebody around, I would manage to be decent company after. I hope. We usually have a blast together, and I hope we will manage one despite the circumstances, even if they are very negative.

I'm naturally a creature of impulse,with little discipline or patience. It amazes me that I have achieved as much as I have in life with this combination of undesirable traits, but, to counterbalance it, I have a pretty strong will. With work, I've forced my dreamy and  unfocussed nature away and dragged in the discipline it takes to achieve stuff, but the TTC process plays hell with my work habits. I've still been getting stuff done in the past 2 weeks, but its been a struggle. Its far, far worse when I'm afraid, as I am now. I'm being unfair to my job when I TTC, because I've definitely not giving it the attention it deserves.

Whatever happens here, I either have a viable pregnancy or not, I'm going to stop working for the next phase. If this pregnancy is non-viable, I'll go back to India, stay unemployed for atleast a few months during which I'll try my hand at IVF. If it IS viable, I'll still go back to India, chill and have all the time in the world to bite my nails and figure out what my next step is professionally. I'm glad that I have this option, and I'm really, really looking forward to not working.

My RE's office just called and offered me the choice of crinone or a (generic?) vaginal progesterone suppository. Which is better? Do either raise your blood progesterone levels?

15 DPO values in

I went in for a blood draw at 45.5 hours exactly.

Progesterone = 23.4 (fallen just a little from the last time)
Beta = 137

Last time was 71, so its almost doubled ( I plugged it into beta base, it gives a doubling time of 48.51). The median doubling time for this range on the betabase is 37.28 hours, so I'm below average here.

In other words, I'm not reassured, the only thing keeping me off the metaphorical ledge is the study I found. But it scares the crap out of me that the progesterone is falling, not rising.

This is what I'm going to do- I'll ask for supplemental progesterone (Suppositories, not PIO). Then, I'm stopping all blood tests till next Tuesday, which will be 21 DPO. I want to have a normal few days and I wont be able to if I'm constantly obsessing and worrying myself sick about this.

This can play out three ways (two of which are very bad indeed) and the 3rd is a happy outcome.

I pray its door # 3, but my plan is not to obsess and nitpick (wish me luck with that!). I'll know when I know.

In which science makes me feel better

The first thing I did after getting my results back, was google vitamin D and beta (HCG). Unfortunately I used Google Scholar, which pulled up irrelevant papers(with the most citations first). Today, I used pubmed, and I found something that makes me feel a 100 times better- it was exactly what I was looking for. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2245969/?tool=pubmed

Its this study, which basically shows that increasing concentrations of vitamin D directly downregulate Beta-HCG expression over long periods (24 hours) of exposure in cultured human placental trophoblasts.  More the vitamin D, more the inhibition. Interestingly, what the article also quotes is a study which shows that HCG is higher in women with pre-eclampsia, and of course such women tend to have lower blood vitamin D levels.

I know vitamin D is a hormone with a finger in about 3000 + pies, I'm glad to see that it may be in play here, whatever biological weirdness ensures, I can blame it on the increased D and feel better.

Because, right now, that is the bottom line-- I need to feel ok. By whatever means possible. This pregnancy will go however it is destined to go, but right now, I just want MY head not to be messed up.  My cousin is coming down this weekend, I want to be able to run around town with her, just be happy. Please, Universe, if that is not too much to ask for.

Off for repeat beta in around an hour. Lets hope I get the results today, and that it shows doubling.

feeling slightly more steady

Thank you all for your support. I honestly don't know what I'd do without this medium to vent in. I came home early from work, have been completely messed up the entire day, and hope that one day, I can look back at this and laugh at how alarmist I was. Really. 

A lot of you commented on maybe how being different from my earlier pregnancies might be a good thing. I'd want to see it that way, but the issue is, its kind of hard to imagine where lower progesterone levels might signify a better outcome. I know a lot in my physiology has changed after taking vitamin D (you change the levels of something that regulates over 3000 genes(to date) in your body, that is bound to happen), but its super confusing as well--- I've never tested progesterone since I got vitamin D replete, but a number of progesterone- related changes occured after I became replete- My luteal phages got significantly longer, my breast tenderness was very significantly increased overall, all of which you would assume was linked to higher progesterone blood levels. Instead,  the very first progesterone blood test I do (this one) shows the opposite of what one would assume, levels of this hormone are lower (!!). Oh, how I hate thee, biology.

About the beta- its not like my beta levels in the first 2 failed pregnacies were abnormally high, they were higher than around 80-90 % of all reported singleton pregnancies reported in betabase. And this fits with what other women who used my donor told me- thier early betas were very high too(and both of them went on to have perfect pregnancies)- I assumed its a donor related thing, maybe his gene set comes with an extremely strong promoter for the beta-HCG gene. I read somewhere that differences in gene promoter strength can account for the vast variation you see among different people. Either way, what I'm trying to say is, the high HCG's were not indicative of any issue, whatever the issue was in my 2 pregnancies, it was something that manifested much later (for example, pregnancy # 2, which had practically the same betas as pregnancy # 1, ended because of a genetic abnormaility). Both progressed perfectly till around the 7 week mark, and pregnancy # 2 looked textbook perfect till the 8.5 week mark.

So right now, I cannot help but look at my lowish, just above average beta and think that its an indication of something being wrong. The doubling should tell us something,I'm going in for a blood test tomorrow around 1-2 - which should be around 46-47 hours.

I can deal with things going wrong in any single instance. But, when it comes down to it, a) the question of what the hell is wrong with me and b) can it ever be fixed is what really messes up my equilibrium. But after reading around a 1000 stories of infertility and rainbows, intellectually, I know this: we may be in for a horribly long road, but somewhere, down the line, at some point, things actually go right.  You just need bucket loads of patience, and about a truckload worth of Kleenex.

And the fear is back (beta # 1)

I just heard from the nurse
Estrogen = 274
Beta = 71
Progesterone = 25.7

These are 13 DPO values. While both (progesterone and beta) both fall bang in the middle of the normal range, they are WAY lower than my other 2 pregnancies.

Last time: second pregnancy :15 DPO
beta = 457
Progesterone = 45

I also managed to dig up the values for my first pregnancy : 11 DPO
Beta = 50
Progesterone = 36

So, I'm not feeling good at all. All 3 pregnancies, based on when I got the first positive  pregnancy test (-ve in the morning of 10 DPO, positive by afternoon), implanted at the same time. Nonetheless, the beta values (and the progesterone too) for this round are significantly lower than the last 2 times. I'm going to ask for progesterone suppositories and pray that is not a terrible idea, because the last thing one wants to do, is encourage an ectopic or a pregnancy doomed by dragging it out.

If anybody feels like I'm being an idiot (I very well may be, given that these values are considered normal), feel free to point that out.

Chillin like a villian

First, thank you all for your wonderfully enthusiastic responses to the last post, It made me feel very, very good to see that level of enthusiasm and goodwill. I'm going to be going back and reading those for a while to come.

I have not gone in for any bloodwork yet. This is more out of sheer laziness (over the weekend, my only option is to show up between 7 and 9 am at my RE's clinic) and a lovely, lovely lack of fear that something is wrong  right at this moment.  I have symptoms of both high estrogen (in the CM) and high progesterone. My betas, by HPT are clearly rising (see picture). I think I can safely say, based on visual evidence, that it is doubling over a 48 hour period.

The main reason I'm going in for a  blood test now is to get the progesterone numbers, I'm really curious as to what they would be at, and to determine if I need additional supplementation. My first pregnancy ended around 2-3 weeks after I weaned myself off supplemental progesterone at around 7 weeks. I don;t think its because of that, because my blood levels  without supplementation were nice and high at around 40, but you never know. Incidentally, I was only put on progesterone because after getting my positive beta, my BBTs began falling to around pre-ovulatory values and stayed there, it had scared the crap out of me.  In retrospect, I maybe thought it was because of thyroid insufficiency. My second pregnancy, I was not on supplemental progesterone, and the development was going beautifully, right on track, till the heartbeat just stopped. And that can be attributed to the Turners (Monosomy 45 XO) with around 90 % probability.

My last pregnancies were conceived in cycle patterns with a luteal phase defect (11 days)- now my LP is almost always 15 days. One of the questions I continue to scratch my head about- what determines length of LP? Is it just the amount of progesterone being produced? Or is it dependent on the progesterone receptor and/or downstream pathways triggered by progesterone in the maintenance of the endometrium? In my last pregnancies, my progesterone  was always high enough (over 40 ng/ml), but this was a pregnant cycle, and your progesterone production is bolstered by the HCG in your system, its a positive feedback mechanism.

Now, I wonder if the progesterone would be higher in this pregnancy (than around 40 ng/ml). Time permitting, I'll go in for the test tomorrow afternoon.  I'll also be looking at TSH, T3, T4, estrogen, Beta levels. I'm also going to try to convince somebody to throw in a toxoplasmosis IgG/ IgM test. I have a cat, and though she is exclusively indoor, I'm still the one scooping out her poop.

Science aide, its wonderful that I'm not scared. If you had to ask me to come up with one adjective to describe how I feel about this pregnancy, its 'numb'. I'm overjoyed that I am pregnant, I think I have not left any bases uncovered, but I cannot bring myself to think that I'm getting a baby at the the end of this. I'm not saying I think I won't, its just that my brain (and my heart) is refusing to go there and imagine it. I'm like, it it goes well, great. If it doesn't, we'll figure out why to the best of our abilities, and probably move to IVF with PGD as a next step. And I think, all said and done, that is a very sensible place to be. I'm just glad my emotional side is allowing it, for now.  And its funny, despite this equanimity, I still talk to my uterus, making my developing baby the most extravagant promises if he/she decides to stick around. Yeah, I'm already bribing my unborn child.

10 DPO

Well, I have zero discipline.  But thankfully, in some areas, I manage to think ahead (In that I stockpiled on internet cheapies), and right now, I think the gods are smiling down on me. I can only fervently hope that they remain so benevolent for the next 9 months, and beyond.

I've been testing since 8 DPO. Yesterday (9 DPO), It still looked like a BFN, but if you stared at it for 3 minutes without blinking and held it an angle, you could see the faintest smudge of a shadow where the second line should be. That shadow which very well may have been a figment of my imagination kept me sane through yesterday. I'm glad I have a place to say this out loud without people thinking I'm nuts. Or, rather, I hope you won't.

Today, I had vowed to not test till evening, but my resolution cracked early, at around 7 am. Still a tantalizing hint of a shadow. At 2 pm today, I got that first, clear, yet super faint second line---can you see it? The test on top is actually supposed to be a more sensitive brand sold by earlypregnancytests.com , with a sensitivity of 10 mIU/ml, while the one at the bottom is thier regular one with a lower sensitivity of 20 mIU/ml, and their regular brand is actually better, IMO.

So right now, at this moment, I am pregnant. Today, I'm afraid of a chemical pregnancy. A week from now, if things continue to go well, I'll be afraid of an empty sac at at 6.5 weeks. Or twins. Twins mean I can't go back to India, because I can't chance a high risk pregnancy, with all the stuff that can go wrong there. After that, I'll be afraid of the heartbeat stopping before embryogenesis is complete. Then, comes the fear of improper development and a 5 month termination. Then, come all the multitude of the2nd and 3rd trimester fears.After birth, I'm sure there is a brand new set you inherit.

The innocence is gone. But thankfully,despite the fear, I still have the ability to truly enjoy this moment. This is a beautiful day, no matter what tomorrow brings. And I hope (and feel optimistic even) that it will bring good things. I'm so grateful that I've been given this chance.

Btw...I hope this post goes some way towards exploding the myth of FMU (first morning urine) being the most optimal to test in. I had a BFN in my FMU. But this early, beta production (and excretion in the urine) is mainly a function of time. The test at 10 pm is more likely to be darker than the test at 2 pm , which is more likely to have more beta HCG thnt the FMU collected when you just wake up