Selective attention

• Everywhere I go I see pregnant women and tiny babies and brothers and sisters clinging to each other. It's okay, it'll fade, it's just such an odd phenomenon.
  
  
• Her Indoors keeps dreaming that we lose Small Boy (literally, in  a crowd or something). Last night I dreamed that he was kidnapped, but I beat up a building full of thugs and got him back. He ran outside to my getaway car (and old Jeep. I'm not sure what that means) and I worried about the lack of an approved carseat, but threw up my hands and drove away anyway. So in the end, I guess it was an empowering dream.
  
  
• The bills from the D&C are rolling in and... I owe nothing! Turns out I hit my out-of-pocket maximum right before all that. It's surprising how soothing that discovery is.
  
  
• All quiet on the uterine front. Trying to get my medical records (fruitless so far), waiting for my appointment with Big Shiny Fertility Factory.
  
  
• Working up to a post on the subject of Ooops Pregnancies and the Infertile Blogger.
  
  
• My health insurance was actually real sweet when I called them. I was armed to the teeth in Sarcastic Mode and they instantly disarmed me. The person at the other end of the phone apologized twice, and said "I'm sorry for your loss." It is amazing just how good it is to hear those words from an outside party. I remember when going over my history with the nurse who was doing our non-stress tests, I had to mention the first miscarriage, and the nurse said "oh, I'm sorry". And I was so grateful to her for just stopping for two seconds to acknowledge that. It really does mean something.
  
  
• The last Saturday passed without notice. This is a good thing because it means I've stopped counting. I had to look at a calendar just now to confirm that yes, it would have been 9 weeks. But you know, it wouldn't have. That blast just didn't have what it needed to survive; there's no world where that particular embryo turned into our child. The aberration was that it implanted at all.
  
  I'm on one of those birth-month boards and at least 80% of the posters have a second child by now, or are in the process of building one.  Now I'm starting to see the posts from women who got pregnant at the same time I did, but with a happier ending. At first it was acutely painful, but as time goes on and our fates diverge, it starts to feel less personal. I was never on that road. I only thought I was.

Oh, FFS.

Dear Health Insurance,

I approve of your proactive focus on wellness. It's innovative and no doubt cost-effective to start supporting pregnant women's health from the very beginning of their pregnancy. It's efficient that you don't have to rely upon your members to inform you of their pregnancy. What do you do, wait for something to be billed to the "prenatal visit" billing code? Clever.

But before you send out the glossy welcome material, before you send the box full of pregnancy-friendly snacks and coupons, plastered all over with pictures of tiny multicultural hands and feet and scrumptious pictures of weensy newborn babes --

You might want to check your records a little more closely and see if the person who recently filed a claim for prenatal services has, even more recently, filed a claim for hospital services for a D&C. You could maybe save yourself a little money that way.

Sincerely,
A distinctly unpregnant member.

8 days past D&C: the next act.

I hesitated over the title of this post. When TTC, everything has an anchor: so many days since cycle day 1, so many days past ovulation, so many days post transfer. Now? I'm floating. Cycle day nothing, as Dr. Stewart once called it.

Thing're okay. I always underestimate how much of my pain and stress is due to being jacked up on hormones. The frisky hormones are nearly gone now; the line on my pee-sticks is almost invisible, a ghost of a line that only a crazy pee-stick-scryer could ever see. My estrogen and progesterone should have plunged, accordingly. I never had a hard bleed after the D&C, just a week or so of desultory spotting, and very little cramping. I've been lucky. I think Dr. Stewart did a very good job with the D&C, and got everything he needed to get.

I feel good about the medical care I got during the whole debacle. So good that I'm having second thoughts about switching clinics.

See, for the past few years, I've had insurance that only covered a very few practices, including Dr. Stewart's one-man show. We'll call it Dr. S's IVF Shack. I think Dr. Stewart is a very good doctor, and I personally like him immensely (as you can tell by the fact that his nickname is inspired by my beloved Jon Stewart). Dr. Stewart is smart, kind, funny, and listens to me. He treats Her Indoors well, and gives a very gentle pelvic. His practice is literally five minutes away from where we work and live. And Dr. Stewart got us Small Boy.

But. But. But. Dr. Stewart really is a one-man show. If Dr. Stewart is running late or has an emergency, then we wait, sometimes for more than an hour. Dr. Stewart's embryology lab is an unknown quantity, and seems to have uneven results. Sometimes they've done well by me, but then there was the time when it took seven vitrified embryos to get to two to transfer (most places have a 90% thaw success rate with vitrified).  Dr. Stewart's ultrasound machine is old and fuzzy. Dr. Stewart does not do ultrasound-guided embryo transfers. All IVF practices have to report success rates to the CDC/SART for public reporting. Dr Stewart's statistics stink. Now, I really believe that this is at least partially because Dr Stewart does not cherrypick patients; I can't imagine him turning anyone away, no matter how hopeless their case. A lot of programs have restrictions so as not to damage their stats; won't treat women over a certain age, weight, FSH... I can believe that Dr. Stewart doesn't care about any of that.

But. But.

About 20 minutes away from me is another practice, let's call it Big Shiny Fertility Factory. As of January 1, my insurance will be one that is accepted by Big Shiny Fertility Factory. Big Shiny Fertility Factory has very good stats. I am sure that Big Shiny Fertility Factory has all the latest equipment. Big Shiny Fertility Factory is a group practice, and a friend who goes there says that it's a smooth-running operation with little wait for appointments or scans.

We have an appointment for a consult at Big Shiny Fertility Factory on January 4. Big Shiny Fertility Factory sent me a big, shiny packet of glossy brochures and welcome information.   Big Shiny Fertility Factory has patient-appointment liaisons who reach out to you to guide you through the harrowing appointment-making process (I am not even kidding). 

I don't know how I feel about all of this.  Sorry to be thinking of leaving Dr. Stewart. Excited about trying something new.  I guess I don't mind  being sucked into the Big Shiny Fertility Factory Machine if I get spat out the other side with a baby.

A strong point in favor of Big Shiny Fertility Factory: I just called Dr. Stewart to make my post-op appointment. I was on hold for a while, and it was awful. The hold music at Dr. Stewart's makes me instantly shaky and nauseated; just thinking of it makes my eyes well up. I've just gotten too much bad news right after hearing that music. The thought of never ever hearing that music again is an uplifting one.

In which I catch a break

Pathology is back; it was an intrauterine pregnancy. This is very good news. This means it's over.

I resisted the D&C so hard, but now that it's over I'm glad I did it. I hated analyzing every pain and every dizzy spell. I don't live well under uncertainty, and once there were no good outcomes possible, the best outcome was for it to be done with. I alternate between fits of cheerfulness and near-euphoria -- it's over, it's over, it's over! -- and dips of extreme sadness. Staying home today, lounging on the bed, catching up on Season 6 of Doctor Who.

My poor little blastocyst. It tried so hard, and hung on so long. It just didn't know when to let go. I can relate.


ETA: Doctor just called to let me know that there wasn't enough tissue for chromosomal analysis. I'm both disappointed and relieved. It would have been kind of nice to have any more information, but I know I would have totally lost my shit if I'd had to find out whether the fetus was male or female. Probably for the best this way.

Well, there's one off my bucket list.

The D&C is over. It was far from horrible; the worst part was the endless wait. My surgery time was 11:30 and I was told to be there at 9:30. I was taken back at 1:30pm.  Four hours is a long time to wait, especially when for three hours of it you're not wearing pants.

Good things:

• My IV went in beautifully first try (I've had some traumatic IV insertions in the past). 
• I was afraid I'd start crying on the table, but I didn't. I was okay. 
• They didn't use general anesthesia after all; instead it was the same lovely, lovely IV sedation that I had for my egg retrievals. Apparently I take anesthesia fabulously well. According to the doctor I was in "fine form" and very talkative; I don't remember a single thing. I lay down on the table, and then it was over.
• Recovery from the anesthesia was easy, easy, easy. I woke up feeling extremely mellow.  Lay there, drank some juice, and went home. 

Only dark spot was that we were unable to get a cab (WTF??) and decided to walk home -- it's barely a mile, very close, not a big deal -- but I had such a strong urge to be safely home, home, home that it was a bit harrowing. But we made it.

Now I feel pretty wiped out, but cramps are minimal.

I wondered if I'd feel devastated when it was over, saying goodbye to the last little scraps of what I so desperately wanted to be our second child. I don't, thought, not right this second. Right now I'm just so glad it's over. Based on details that I do not know and do not want to know, my doctor feels optimistic that the pathology report will show that it was an intrauterine pregnancy. We'll get the report tomorrow. Then this'll be truly over.

Why the D&C

juliane2004 said...

I don't want to freak you out but I would NOT do a D&C if my betas were going up (Unless I saw an ectopic). What if it was a twin that didn't make it?

Hi Juliane!

Since I did IVF, we know exactly when I "ovulated", and I should be 7 weeks pregnant right now. At 7 weeks, with a beta of 800, and with nothing seen in the uterus (and you wouldn't expect there to be with the beta that low) there is zero chance that this is a healthy intrauterine pregnancy. Zero.  Average levels at this point are over 50,000. While there is a wide range of normal betas for any point in pregnancy, the range for 7 weeks is 36,000 to 72,000.

A 7 week pregnancy with a beta of 809 is either an unhealthy intrauterine pregnancy or ectopic. Unfortunately, there's no good way for us to tell since we can't see it on the screen. So I am doing the D&C solely so the tissue can be analyzed for the presence of placental cells, so we know whether or not it's ectopic. The fact that it will (hopefully) end this horror show is just a side benefit.

A lot of people would have just had the methotrexate shot weeks ago, just in case. I probably should have, but I just don't want to take a strong chemotherapy drug unless I absolutely have to. If the D&C shows no pregnancy there, the joke'll be on me and I'll have to have the shot anyway. But since chance favors it not being the case, I think it's worth it to try and avoid it.

You can get away with hoping after one bad doubling time, because the twin thing does happen. But after two bad doubling times, it's pretty clear what's going on.

P.S. Betabase.info does show six pregnancies that had a heartbeat and had day 30 betas of under 1000. But those are almost certainly data errors of one kind or another.

34dpo

Beta: 801. Progesterone 10.6.

Scheduled for the D&C at 11:30 am on Tuesday.

Gonna be a long weekend.

6w5d? 33dpo?

I don't know how to refer to myself. Thank goodness I haven't needed any unrelated medical contact, because I don't know how I'd answer the question "are you pregnant?"

Yes, but not usefully so?
No, in the sense that you should feel free irradiating me or giving me whatever teratogenic drugs you want, because the embryo no longer gets a vote?
Yes, in the sense that any test I'm given will instantly come up positive?

33dpo is good, I guess, because it's a reference to an event that definitely happened, rather than a state that implies something is going to happen.

No news. No spotting. Peesticks are mocking me. So, you wanted them nice and dark, huh? I get repeat bloodwork on Friday; if things haven't substantially improved, I'll have to book the D&C for Monday or Tuesday. I'm getting past the point where watchful waiting is prudent. If we could be certain it's in my uterus then waiting would be fine, but we're not. If I have the D&C we'll find out fairly quickly whether or not that's where my little zombie child has set up shop.

I called and ask a few questions, and I'm surprised? pleased? dismayed? to learn that they do D&Cs under general anesthetic. I didn't have a general for any of the egg retrievals, just a lovely, lovely IV twilight sleep. I had kind of thought and hoped it would be the same for this. I do like the idea of just really not being there for it. I've had friends who've had D&Cs under locals tell me in no uncertain terms that it is not a pleasant experience. OTOH, I've never had general; for my c-section it was a jacked-up epidural plus, I dunno, something else that made me super woozy but didn't actually knock me out. The general does make it seem like a bigger deal.

I've decided that I like the term pregnancy wastage. It sounds like what it is: a waste. A waste of time, effort, money, pain.

Things're okay. The last time I was in this position, in March of '08, it was pretty much "bottomless pit of despair". Now there's still some despair, but the pit has a bottom.  I am longing for this to be physically over, all of the phone calls and hold music and blood draws and small pains and indignities and reminders and hormones. I know I'll feel better then.

6w2d: Zombie embryo

Today's beta: 590, progesterone 18.

Poor little embryo. It doesn't know it's dead. Poor little thing just doesn't know when to quit.

I was offered a D&C tomorrow, but I just can't get myself organized mentally or physically for that. And there's still a hope that if I wait a bit longer my body will figure it out on its own. The danger is that, given the inconclusive ultrasound, we can't be 100% sure that it's not ectopic -- but it likely isn't.

I don't know what the right thing to do is. I'm scared of the D&C, but the idea of having this over with is very appealing. If (as is likely) Zombie Embryo is in my uterus, my hcg levels should go down pretty quickly afterwards. No more sore boobs, no more useless pregnancy symptoms. I could be good to try again in February or so.  It'd be over.

On the other hand, the logistics give me a headache. I'd have to figure out about getting Small Boy to and from preschool, I'd have to take time off of work, I guess I'd have to take cabs since Her Indoors doesn't drive, I know the whole thing would end up costing a mint which, although I am blessed to say is not my primary criterion, adds a special insult.  More, I think, the idea of lying there on a gurney in a hair-cover and gown is pretty awful. I'm afraid of it hurting. I don't know what kind of anesthesia they'd give me. I guess I could ask. I just want this whole thing to go away.
  
It's okay, little thing. Let it go. We'll try again, I promise.

Yep, nobody home.

Had a scan this morning. You know, I don't much think about the costs of scans on the other side of IVF. We socked away the money, whatever, when the bill comes we pay it. But I resented the hell out of every dollar this scan cost.

It was pretty useless, too. Not much of interest to be seen. A thinnish lining of 7mm, I guess I just get to wonder what that means. Was it my lining that borked this up, after all? Seems unlikely, though. Embryos are pretty robust where linings are concerned; otherwise extrauterine pregnancies wouldn't be half so common. A bit of fluid in the uterus, a smear of something that might have been a gestational sac with a fetal pole but clearly was never going to call me mama. A giant corpus luteum/cyst on my right ovary. No fluid in my abdomen, so that's good.

My pee-sticks are dark, dark, dark. I hope that things turn around during the weekend and start to lighten up. Otherwise I get to go back to "empty the uterus". I do not think that sounds like a particularly good time. Rechecking bloods on Monday.



Things are okay, I guess. I'm frankly sick of crying. Sick of tissues and snot. I've got a rotten cold, too, and I feel like I've been in an achy-headed stupor for a week now. Thick, sore, foggy.  I think I'll feel a lot better once this thing is actually out and my hormones can settle down. The moodiness, sore boobs, fatigue and intermittent nausea aren't half so fun when there's no prize at the end.

Today's beta

560. Progesterone, 23.

Since it's not going down in an orderly fashion, I'm going in tomorrow for a scan. Hopefully, we will get some reassurance that whatever cellular clusterfuck is happening in my pelvis is occurring in my uterus, not in my tubes.

I'm just so goddamned sad. I didn't really think that things would turn around with this beta. I mean, I may have had this very complicated scenario in my head involving a disappearing twin, but I didn't really believe it. I just. hoped.