32 days later

I sort of got my period again on Sunday. It's so very, very light. Red when I wipe, otherwise nada. This is pretty much what my last one was like, and I thought it was just because it was the first one post-misoprostol. I guess not. It's not nice to have your heart sink every time you pull down your pants. I hope I'm not too broken.

Last night I dreamed that I was in a rowboat. There were lots of dogs swimming around, but I ignored them. Then a puppy¹ came paddling right up to my boat. I hauled him out of the water. He shook himself off and wriggled around and I thought "shit shit shit, I really wasn't ready to get another dog, but clearly I'm keeping this one."² I then noticed that the dog was female, not male, and was surprised.

My subconscious isn't too subtle, huh?

I am sort of conflicted about moving forward. If I try again, either I'll get pregnant or I won't. If I don't, it will hurt. If I do, then either I'll stay pregnant or I won't. If I don't, it will hurt. If I stay pregnant, either the baby will be okay or he or she won't. Etc. It's... just going to take me a little while to screw up my courage to go again.  





¹A swift google tells me that the puppy was probably a St. Bernard, possibly a Landseer Newfoundland.

²The last of our three dogs died not too long ago, and we've vowed to remain dogless for a while.

Year of the Wood Horse

I possibly, sort of got my period last week. I had outpatient surgery the week before that and the preop bloodwork went off without a hitch, so I'll assume that my hCG is down to zero (they tend to get tetchy about operating on pregnant women). Which means I could start again, right now.

I'm not. For the first time since starting TTC, I am taking a voluntary break. Since I began (both the first and second time) I've always felt like there was a drill sergeant barking "GO GO GO" -- just imagine one wearing a hat that says "FSH" on it.

Well, that drill sergeant is in the freezer next to my embryos and several pints of Ben & Jerry's. My eggs aren't getting any older. My ovaries will never be called upon again. No matter what happens, I'm not going to do another fresh IVF cycle.  I am lucky to have a generous batch of embryos. When I run those out, I'm done.

Any other haste would be driven by a desire to control the age-gap between Small Boy and Smaller Sibling. I wanted three years, didn't get that. Won't get four years either. Does a few more months really matter? I think not. I think if the sole consideration is temporal spacing, a few months' rest is not significant.

And I really want a few months off. I want to live on my own schedule, not buffeted by hormones and nerves. I want to do house projects and snuggle my child and future-wife (fiancee?). I want to plan our wedding.

Interestingly, I have experienced the exact same phenomenon all three times I have miscarried: while my HCG levels were declining, I felt a burning urgency to get pregnant again ASAP, and despair over how long the time gap would be until I could try again. And all three times, after my HCG had faded completely, so did the suffocating need to get pregnant immediately. *shrug*

I will, kinnehorah inshallah god-willin' and the crick don't rise, start again at either the end of April or the end of May. Until then, I'm just going to enjoy living.

Either of these dates would put any possible delivery in the Chinese year of the Wood Horse. I think that sounds like a really nice year to have a baby. Wood Horses are warm, stable, strong. I like it.

words are weak

There are no words to express the sorrow our community feels at the loss of Caemon.

T and I struggled to conceive together; she got pregnant a few weeks after I did. Caemon was born while we were still reeling from the shock of having Small Boy in our lives. T is a lively and eloquent blogger, and it has been a pleasure watching Caemon grow into a creative and precocious little boy, and watching his moms dote on every detail of his development. They reminded me of us, and of Small Boy, so very much.

This past August, Caemon was diagnosed with a rare form of childhood leukemia, JMML.  A bitter struggle followed with chemo, a bone marrow transplant, and relapse. He died on Tuesday.

It makes no sense. None of it makes sense. It doesn't make sense that I got to wake up this morning with my boy snuggled against my side, and J and T did not. It's not right, it's not fair, it doesn't make any sense at all. I am angry for them, and for all of us, and for Caemon, who didn't get a chance to do so many things.

I've had this post open for days. If it's so impossible for me to write, how do J and T even breathe?

What is there to do? Almost nothing. Send them money, send them love, and go back to trying to figure out how to carry the knowledge that we are all so close to the precipice.

It gets better.

Things are better. I'd have to look at a calendar to figure out where I'd be right now; it's fading, gently, covered with snow. Maybe not coincidentally, my hCG is falling, too. Two weeks ago it was 21. I have a recheck on Monday and expect it to be zero.

There have been a lot of babies around me lately. The lady in line in front of me at the thrift store had two huge baskets full of stuff. Checking her out took a while, so we had time to chat.

"How old are your kids?" I asked.
"One month, three, four, and five." She laughed and rolled her eyes. "How old are yours?"
"Three and a half."

I don't know. People don't get to choose the thing that's hard for them. This lady was, judging from her clothing and heavily accented English, a recent African immigrant. I'm willing to bet that the journey and adjustment hasn't been easy, even if she has had the best of circumstances. I don't know where I'm going with this. People don't get to choose the thing that's hard for them. A friend of mine, the thing that's hard for her is breathing. How is that fair?  I don't know.

But never mind, on to happier subjects. Her Indoors and I had been waffling about getting married until we knew the likely outcome of the pregnancy. I definitely wanted to be hitched before the baby was born, for the legal protection it'd give our family. That meant probably a small courthouse-type thing. But now that that is no longer an issue, the calendar opened wide up, and we could schedule it far enough in the future to give us time to plan the wedding we really want. So: next December! I am insanely excited.  I've been madly pinterest-ing and browsing for silk velvet and roses and sari fragments. I want this, and I can have this. I'm burying myself in wedding prep and it's really comforting.

I'm going to cycle again once I'm able, and maybe I will get pregnant and stay pregnant, and maybe I will be enormous and pregnant at our wedding. But you know what? I can't plan around it any more. I have to go ahead and live. If I get pregnant, we'll adapt.

Not 12 weeks

Today I'm not 12 weeks. 12 weeks, the last week of the first trimester, the time when most people start sharing the news. I'd be scheduling my nuchal screen.

I'll stop this self-pitying countdown eventually, I'm sure. I'll just forget one day, and not remember until Thursday or Friday or something. I'm not trying to be mopey about it. It's just Wednesdays are hard not to count.

My body is apparently remembering by offering a fresh bright red bleed. I guess it's good? I mean, action is good, right? And maybe it'll help my beta come down, in case there's a wee clump of trophoblastic tissue somewhere generating hCG.  My pee sticks aren't notably lighter, which makes me grumpy. Last Friday my beta was 467; recheck in two weeks.

Here is my riddle: how is a BFN different than a chemical pregnancy different from a 6 week miscarriage different from an 8 week miscarriage?  After all, they all end up in the same place: unpregnant.

I am not sentimental about embryos. With eyes focused on the bottom line (i.e. chances of success) I have always pushed for the production and cryopreservation of as many embryos as possible. If we have any left over, I will cheerfully donate them to Science.  If I am not sentimental about embryos suspended in cryoprotectant, then why be sentimental about embryos in my uterus, or no longer in my uterus?

There is a difference, and that difference is the difference between missing a bus by seconds, minutes, hours, days, weeks. How hard my heart was pounding, how much I thought I'd make it, how ferociously I clench my fists and dig my nails in frustration.

A BFN is missing the bus by weeks, I think. A pre-heartbeat loss is missing it by days, and a post-heartbeat loss is missing it by hours. I can only pray with all my heathen heart that I never experience missing this particular bus by minutes or seconds.

Not 11 weeks

Today I am officially precisely not 11 weeks pregnant. It's been two weeks since I took the misoprostol, three since the ultrasound where the RE said "I don't see a heartbeat".

Things are okay. I had a followup appointment two days after the misoprostol, and everything looked good and clear. That was the best I could've hoped for. My pee-sticks are still a lot darker than I'd like, but I guess it takes some women a really long time to clear out all the hCG. I can't start another cycle until my level is all the way down and I have another period, so I'm just spinnin' my wheels here. I have another followup on Friday. I imagine they'll start doing blood tests every week or two until I'm at zero.

Time floats by so aimlessly when you're unpregnant. Pregnant means that every day is an achievement, and is moving closer to Something Big. Unpregnant you're just waiting for something that may or may not happen. And if you can only conceive with fertility treatment, you're waiting to start waiting for something that may or may not happen.

I'm mostly back in the TTC mindframe (as opposed to the pregnant mindframe). I know how to do this; I've spent a lot more time trying to get pregnant than I have actually being pregnant.  But some part of me, maybe 10%, is still stunned and saying wtf happened here?  See, it all just seemed so right. The transfer was exactly on my birthday. The due date was exactly my mother's birthday. My BFF is pregnant right now, and we were going to be pregnant together. Some things are just meant to be, you know?

Some things, but apparently not this one.

A poem has been stuck in my mind: A Refusal to Mourn the Death, by Fire, of a Child in London. I don't know why. I have only a weak affinity for poetry, and almost none for Dylan Thomas; most of it just reads as word-salad to me. But this one has been drawing me back. I guess "unmourning water" is really a pretty good description of the resting place of those two tiny embryos, poor miniscule brine shrimp, released unto the municipal sewer system.

9 weeks: finding the reset button.

Today would've been 9 weeks. Last Wednesday I'd resolved to wait, zen-like, for my body to take care of this naturally, gently.

That decision lasted until the evening. I did a little research and found out that with misoprostol, it's frequently over within twelve hours. The old-fashioned way can take, literally, weeks. Weeks of bleeding, weeks of cramps, weeks of pregnancy symptoms.  I did the math (number of weeks multiplied by insanity factor) and by the next morning was super-keen to get the misoprostol.

Except it turns out that the misoprostol I was offered so lightly on Wednesday night was actually a pain in the butt to get. I called Thursday morning, with some idea that I could stop by the office on Thursday afternoon to get the prescription. Hahaha no.

I finally got a call back Thursday night telling me that someone would call me Friday morning. On Friday morning, the PA called and said she'd talk to the doctor and get back to me later in the day. At 5 pm she called me back and said "you'll have to come in for an appointment on Monday."  I'd dreamed that I'd be able get it all over with by the end of the weekend, and was bitterly disappointed to be denied.

Anyway, I dragged through the weekend -- I say "dragged" just because the pregnancy-fatigue was still going strong, along with the need to get up and eat a three-course meal at 2 am every night. Pregnancy symptoms are a lot of fun when you're going to have a baby. They're just an annoying inconvenience when you're not.

Monday morning I went in for my appointment. They'd mixed up the paperwork and had me down for an ultrasound even though I was only supposed to be there for a consultation. "What the heck," thought I. And maybe, just a little, maybe .05% of my brain thought what if it's all a mistake? What if it's a Christmas miracle? What if there's a little heart beating away in there?

There wasn't. There were two little embryos, measuring 6w2d and 7w4d, clearly sharing a placenta (i.e., identical). They looked like little packing peanuts curled up in there, two very quiet packing peanuts. I kind of wish I'd gotten a picture, but for some reason they don't offer you pictures of the dead ones. But in any case, I was still glad to have seen them again. Last week I hadn't gotten a measurement for Little Twin, so it was oddly satisfying to have that verified. 

The doctor's not a big fan of misoprostol. He gave a decent shot at trying to convince me to do a D&C. He assured me that they're "very gentle" and that they "only use suction" and "the chances of getting scars from a correctly-done D&C are almost nil". If I did a D&C it would all be over quickly. If I did a D&C I could have a chromosomal analysis done of the tissue. With misoprostol, 40% of women have to have a D&C anyway.

Unfortunately, I know that most of what he was telling me wasn't true. Don't get me wrong, I think this practice is very good at what they do, which is reproductive endocrinology. They don't know jack shit about Asherman's Syndrome. Yes, you can get adhesions from a properly-done D&C. No, using suction only doesn't prevent scarring.  No, a woman with Asherman's shouldn't get a D&C done unless there is absolutely no alternative. Misoprostol is more than 80% effective if you give it a whole week to do its work (this practice judges after three days).  I'm a walking dictionary of misoprostol trivia at this point. I spewed some figures and he sniffed and shrugged and said he'd go to get the consents.

He left, and then I cried. I wasn't really expecting there to be a living baby in there.  But seeing the pictures was still... hard. Little Twin was pretty indistinct, but Big Twin looked like such a perfect little fetus. Perfect, just dead.

I spent the next three hours getting my blood drawn (they require a hematocrit), waiting for the bloodwork to come back, waiting for this, waiting for that, waiting at the pharmacy. It was, apparently, lovely weather for a sleighride together with me. Also, I should have myself a merry little Christmas, and that's the Jingle Bell Rock. I did not stab anyone.

Four hours later I emerged with 8 200mg tablets of misoprostol, a strip of Zofran (anti-nausea), and a handful of Ativan, I guess in case the process made me edgy? I'd already filled a prescription for some painkillers.

I decided to wait until Wednesday morning. Misoprostol can be unpredictable, and if I were going to be doubled over/vomiting/yelling/cursing/hemorrhaging, I wanted it to happen when Small Boy was at preschool and not when the poor dude was trying to have himself a Merry Little Christmas.

So yeah. This morning I dropped him at preschool, went to the supermarket and picked up a party-sized pack of sanitary napkins. Went home, popped a Zofran and a Perc. Half an hour later I briefly dipped the misoprostol pills in 5% acetic acid, better known as white vinegar, and crammed four of them up the hatch (via my handy PreSeed applicator). I then waited for something to Happen.

An hour later I started cramping. Four hours later I felt like something was going to Happen. I shuffled over to the bathroom and then in a mighty rush, the entire universe fell out of my uterus.  In the space of five minutes I passed the gestational sac, the fetuses, and what Her Indoors was sure was at least some of the placenta (she's a biologist, so I have some faith in her identification).

Friends, that is some good stuff. I know everyone is not as lucky. Some women end up writhing and puking, and some women get no effect at all. But for me, it did exactly what it said on the tin. The cramping has been no worse than bad period cramps (admittedly, without the painkiller it probably would've been a whole lot worse). And holy god has it cleared a lot of underbrush out very quickly.

I've been bleeding briskly since this morning. The cramps have gotten better and worse, but the painkillers keep them bearable.  I won't know until Friday if the job's completely done. If it's not I'll likely have to fight not to have them "clean it up" with a D&C. But fight I will; if anything lingers, you bet I'd rather have another round of misoprostol.

Right now I feel wrung-out and crampy but so relieved, and grateful that the misoprostol seems to have worked for me. Fingers crossed that Friday finds that it truly is over.


¹The literature is a bit mixed on whether or not dipping the pills in acetic acid definitely speeds action/improves absorption. But I figured I'd try it on the grounds that at worst it would have no effect, and at best some studies have found it halving the time to completion (which otherwise averages about 12 hrs from administration). Since my uterus enthusiastically spewed four hours after inserting the tablets, I'm inclined to believe that it helped. It also makes a lot of intuitive sense to me. As soon as I dipped them they started to disintegrate. I was basically inserting a firm paste, not dry pills.  If any internet travelers stumble across this, I personally vote "yes" on dipping in 5% white vinegar.