Reflecting

Wow. That last post was a difficult one to write. I haven't really written about my first pregnancy ever, and I haven't spoken about it in detail for almost a year. Writing about it brought a lot of emotion back. Remembering how I told my husband about the pregnancy made my heart ache, because seeing that excitement in his eyes and then watching it fade away was really sad. I asked him the other night why he wasn't so brokenhearted about loosing that baby and his response surprised me. He said, "I was angry with that baby. That baby tried to hurt and could of killed you. I was so grateful you were ok."
Apparently the doctor was more honest with him than me about the seriousness of the situation. I leared that he was told before I went into surgery that I could loose a fallopian tube, an ovary, or both, and it really scared him.
Its weird what I do remember in detail to this day. I remember the uniform I was wearing the day I lost the baby. It was a bright cheery green scrub set. I don't wear it to this day because it brings me back to that horrible lunch hour when everything began to fall apart. I should get rid of it, but instead it hangs in my closet, a reminder of what once was.
I remember the song that played in the car when my friend and I left the doctors office after that dreadful ultrasound. After I learned it was over. It was "Do I" by Luke Bryan. That song makes me shiver to this day.
The first two weeks after surgery were filled with constant blood draws waiting for the pregnancy hormone (HCG) to fall out of my system, confirming that the pregnancy was over. Finally on January 2nd my level was 2, which is considered not pregnant. And, on January 4th I had my final appointment with my doctor.  I remember looking at crazy pictures of my reproductive organs and my doctor saying to me, “this was a fluke, I expect great things from you.” I cried in his office. I cried about the baby I lost, and about the nagging fear that either this would happen to me again, or I would never conceive again. I wanted to start trying right away. Looking back, I know it was because deep down I knew the grieving I was about to feel, and I thought filling the emptiness with a new baby would make it dissipate. That didn’t happen.

            My doctor told me that I had to wait three cycles to start trying again. Because of hormone changes and recovering from surgery my body needed time to heal. I was so upset about this, what the heck was going to do for three whole months? I get it now, he wanted me to grieve. My husband later told me that the doctor had told him that I also needed the time to heal emotionally. Because, if for some reason I had another loss, I needed to be able to deal with that. So we waited.

            There were days I didn’t get out of bed. There were days I didn’t care whether I ever talked with anyone I loved ever again. I’m not proud to say that, but it’s the truth. The few people that did reach out to me could not say anything right. I was angry at people for trying to console me, but not saying what I thought they should of. I don’t really even know what I wanted from them. I wanted people to sit with me and let me cry and just stay quiet. I did not want to hear any of the following statements:

1. “it’ll be ok, you’ll have a baby when it’s the right time.”
2. “everything happens for a reason.”
3. “obviously something was wrong, so the baby wasn’t healthy.”

But, I heard these things over and over again. Why? Because my friends and family are human and they didn’t know what else to say. They didn’t know, just like I didn’t know, how to let this go. I wanted time to stop for my grief, and anyone who has gone through grieving can relate to this, I know they can.

      Loosing my baby was one of the hardest things I have gone through to date. Even though that little one was the size of a pea, or smaller for that matter, it was mine. From the minute that digital test read “pregnant.” I became a mother. My job was crystal clear. Protect and nourish my baby so that in 40 weeks I could hold him or her in my arms.

Grief and loss is always a touchy subject. Always.  I could go on, but one of my favorite blogs "The Pregnant Chicken" recently did a post on Loss and I couldn't say it as well, and with as much humor and pure honesty as she did. Please read: http://pregnantchicken.squarespace.com/pregnant-chicken-blog/2011/1/2/loss-and-miscarriage.html

And Then It Was Over...

I was eight weeks to the day on Saturday December 12^th. By this point I figured that things had to of stabilized. A baby’s heart started beating around 6 weeks and 5 days. I was passed that point. My little bean was there, heart beating. And I was going to see my family for Christmas in just a couple weeks. Things were starting to get really exciting.

            I was at work eating lunch and I got a sharp cramp. Gas pain is what I thought. I got up to go to the restroom and investigate, and to my horror, there was blood. I was shocked. This was not happening. But it was happening. The bleeding didn’t stop an hour later. I left work, and my obstetrician agreed to see me in his office that Saturday afternoon. I went to my friend’s house and she took me to the appointment. It was the beginning of the end and I knew it. When I met my doctor for the first time he had concern in his eyes, which lead to tears in mine. The abdominal ultrasound showed nothing. He told me he would do a vaginal ultrasound, and that at 8 weeks we should see a “little person” in there along with a heartbeat.

            As the ultrasound began I was sort of lost. I had never had babies or been pregnant before, so I wasn’t sure what I was looking at. But my friend had been pregnant, had a healthy baby, and she stared at the ultrasound screen with such horror, her eyes trying to find something that wasn’t there.

            Dr. said my uterus was “text book.” There was nothing living there. Especially not for 8 weeks. I remember telling him that I definitely had a positive pregnancy test, and my blood work was positive, and I hadn’t had a period since October. He said miscarriage was possible, and that another possibility was an ectopic pregnancy. I was in shock. I left his office with the heaviest heart I have ever felt. This pregnancy was not viable, and furthermore, could be costly to my reproductive organs. If an ectopic pregnancy was present, and it was in my fallopian tube, the tube could burst costing me almost ½ of my fertility.

            The drive home is a distant memory. All I remember thinking was: how am I going to tell my husband? He has been reading “Pregnancy Sucks for Him” faithfully each night.. I was going to drop the biggest bomb on him, and it wasn’t fair; not to him or me. I don’t honestly remember the rest of that night. Shock I guess.

            I woke up early the next morning with a sharp pressure in my life side. This was it, I worried I was going to loose my tube. My husband hustled me to the hospital and before I knew it, I was in the emergency room. It’s a whole different world to enter a hospital as a patient, when you are a nurse. People were sticking me with needles, catheters, and I was just laying there. No one said anything. How could they? What do you say to a young woman who’s dreams are shattering before your eyes. My doctor met me in the emergency room, and told me that he would accompany me to an ultrasound, and depending on that ultrasound I would likely have surgery.

            The ultrasound showed little. Possibly a mass near my right ovary, but nothing to be sure, and my pregnancy hormone level had dropped from the day before. So everyone was kind of stumped. It was decided by my doctor that I would have exploratory surgery that afternoon. The goal: laparoscopic surgery to remove the pregnancy, the worst case scenario: an open abdominal surgery involving the removal of one of my tubes, one of my ovaries, or both. I was terrified.

            You know where they put you before this type of surgery? Obstetrics. That’s right. To add insult to injury they put me in the post partum ward to await my surgery. As I layed in my bed, and pretended to listen to my pre operative teaching (which ironically is the virtually the same teaching I give to my patients on a daily basis.) I heard babies crying. I wanted to get up, pull out my IV, and go home. I wanted to hold onto this baby somehow, but knew that I couldn’t. This little person growing inside of me would not survive. I would never hold this baby in my arms. Thats all I thought of that day, empty arms.

            It took hours for them to get me to surgery. I kept getting bumped because it was, after all, a Sunday afternoon. The anesthesiologist kept having to leave and start epidurals for women in labor, my doctor had to deliver babies before he could start my case. I would have given my left leg to trade places with one of women laboring. There is no way labor pains could have been worse than the heartache I felt.

            They rolled me into surgery about 4:30pm that day, and as they put me out, tears rolled down my cheeks. God get me out of here, this isn’t my life, I don’t deserve this.

          I woke up shivering. I was scared. I moaned for my husband, and he was there right beside me. This was special, I knew, because families were usually not allowed in the recovery room. “Did he take my tube?” I asked concerned. “No baby, everything went fine, he said he would talk with you when you woke up.” Knowing that all my parts were still intact I drifted back off to sleep.

            Later the doctor came and told me that “the products of conception” were in my pelvis. The inflammation being caused by blood and tissue in the pelvis was likely the culprit of the pain and pressure. I still cannot believe that term: products of conception. You mean to say, my blueberry sized embryo was in my pelvis. The doctor told me that I was very lucky, because my body “took care” of the pregnancy on its own. That made me feel like a horrible mother. My body rid itself of my own baby before it killed me? Great. How will ever carry a child if my body chooses to harm it?

            The next few days were a blur. I had to have blood drawn every 48 hours to make sure my pregnancy levels were consistently decreasing, and five days after surgery (with my Dr.'s OK) I got on a plane to go visit my family for Christmas.

November 2009

On November 20^th 2009 I took a pregnancy test. It was a Friday and I was deathly ill with what I thought was the swine flu. My whole body hurt and I had a fever of 102.0 that developed this day. It was crap and I was certain that I may die (yes I am a nurse who is also a hypochondriac).

            Back to the pregnancy test: it had a faint line. My husband looked at me and said “you’re pregnant.” I told him he was wrong, that faint lines meant nothing. I was so naïve (because now if I got a faint line I'd be ecstatic, we'll get into this later).  I went to bed all weekend, but deprived myself of robitussin, because my period was due any day and I was hoping she wouldn’t show and I’d be pregnant.

            On November 23^rd I was finally up and around. I still didn’t feel great, but had planned a shopping trip with my friend to do some early Christmas shopping. I never miss a shopping trip. I woke up, drank my morning cup of coffee and immediately felt nauseated. Weird. Well, I thought I must still be getting over the flu. We shopped most of the day, and on our way home stopped at a coffee shop for a chai latte and a brownie. But I couldn’t eat the brownie. The chocolate didn’t even sound good. Anyone who knows anything about me knows I love chocolate. Love it, never turn it down. I could eat chocolate three meals a day and still crave more. At this point my friend got involved and we ended up stopping at Target to buy pregnancy tests. This time I went for the digital.

            You know what comes next don’t you? I got home, peed on my clear blue easy, and up popped the happiest, most fulfilling word in the English language at that moment: Pregnant. Oh my God! Heart pounding, jumping up and down, I called my friend on her cell to tell her. More importantly, I only had an hour before my husband got home from work, and had to think of something creative to do to tell him. We squealed with excitement and pretty much planned my entire pregnancy in about five minutes and also devised a great plan for telling my husband.

            When he got home and I handed him a box. I said to him that I had bought this present for him today, and yes it was kind of expensive, but I knew he would love it. In the box was the test. I have never seen him examine something so closely. He looked at me and said, “is this real?” It was real, and we were so excited! That night, against everything we had said before, we told our parents, grandparents, my brother-in-law, and two of my close friends.

            For the next twelve hours I was ecstatic, but the following day things became more complicated and I realized that this pregnancy was not going to last.

         The following day I went to my gynecologist’s office to pick up a lab slip. They called it “pregnancy confirmation.” They would draw my blood and see if I was in fact pregnant. The result came back at 26. I had no idea what this meant, and while waiting for the doctor to call me, I called my friend who had been taking the steps to become a surrogate mom for a childless couple. She told me that the number 26 was low, and that I needed to remain guarded because something could be wrong. I was terrified.

            Later that evening my doctor called and said that the number was low, but that numbers varied in early pregnancy and I shouldn’t be worried. Too late! I looked up HCG levels in my nursing lab book and scanned over what could be the result of a low level. Among the list of things was “ectopic pregnancy.” I remembered learning about that in nursing school and recalled the risk factors: STD’s, endometriosis, and others. None of these had I been diagnosed with. So that was out.

            Over the next few weeks I was scared but tried to remain calm and positive. The obstetrician I chose didn’t see patients until 10 weeks. So I had nothing to do but wait, and pray. I never really felt typically “pregnant.” My boobs hurt, and I was a bit tired. But, when I hit 7 weeks pregnant and had minimal morning sickness I began to wonder. Was I just the lucky woman who didn’t get sick? Or was something wrong?

            We spent our nights tossing around names we liked, talking to our little one, finding out how big the baby was already. It was a dream come true and we couldn’t wait to meet him or her in July. July 24^th was our given due date, and it couldn’t come soon enough.

Misconceptions....

Again, there is an idea that this whole process of making a baby is easy. I mean, when I was on birth control it was drilled into my head that if I missed one pill I would get knocked up. And I was not alone. A few weeks ago I was having dinner with some great girlfriends. None of them have decided to start the journey to having a baby yet. So, as we sat around the dinner table we began to discuss exactly what happens to a woman each month in order to conceive a baby. I think I frightened them. The truth is that each couple only has a 20-25% chance of conception each month. When I heard that number I thought "holy crap, I wouldn't bet on that."

So what is it that makes this so difficult?

I'll tell you. When a woman starts her cycle (aka her period) she begins a recruitment phase called the "follicular phase." Even in the first few days follicles begin to develop in both ovaries. There can be many follicles developing at once. During the first couple weeks these follicles grow and then as we near ovulation (when the egg releases) one follicle, the largest follicle, becomes dominent. At this point the other follicles stop growing and reabsorb into the ovary. There ends up being one egg on one ovary that will be released for the possibility of conception. Of course there are some instances where two eggs are released resulting in twins.

So, around CD 14, which is crap because every women is a little different, some women ovulate on day 12 and others on day 22, that mature follicle or egg is released from the ovary. These little finger type cells coax the egg into the fallopian tube. The 10cm-11cm of the fallopian tube is the road to the uterus, and the place where conception happens.

Once the egg is released from the ovary (ovulation) it is only viable for 24 hours. In that time it must be fertilized by waiting sperm. If sperm is not available, there is not conception. Other limiting factors include poor quality sperm or poor quality egg. If the genetics are off in either, or the match is not a strong one, conception will not occur. Then sometimes, conception does occur, the chemical reactions happen, but the actual embryo (future baby) is never created (chemical pregnancy).

The last hurdle is that the now fertilized egg must implant into the uterus. This means that a womans uterus must have blood and nutrient rich lining that can house the embryo. She must have a long enough luteal phase. The luteal phase is the part of the menstrual cycle that occurs after ovulation. In this phase a hormone called progesterone is secreted which creates and maintains this plentiful enviornment in the uterus for the embryo. You must have adequate progesterone to sustain pregnancy. You must not have an imbalance of progesterone that causes early "spotting" or shedding of the lining after ovulation so that an embryo cannot implant.

Lastly, your partner must have enough good quality sperm to fertilize the egg. There are many, many factors in the female body that limit the sperm once they are introduced. I hate to say it but the sperm really enter a war zone once they enter the womans body. I recently watched a film about this journey and it was really eye opening. It is called "The Great Sperm Race." You can find in on YouTube, and its a six part series, the entire thing is about an hour long. It explains this journey using human beings as the sperm, so you really can get an good idea of the amount of sperm that die on their way to meet the egg.

Link to part 1: http://www.youtube.com/watch?v=gAnMymnJiLM

Its really not that easy! This is why doctors say that a healthy couple where the woman is under age 35 and man under 40 should give themselves a full year to conceive. If either partner is above these ages the timeline goes to 6 months, as advanced age limits your time alottment to be able to conceive and carry a baby.

Whew....there is your conception lesson of the day.
Getting pregnant is not easy, people think it is, but thats just a misconception.

Where do I start?

Its taken me a while to make the decision to start a blog. I have wanted to talk about this subject for a long time, but both fear and embarrassment have kept me from sharing our story. It is our story, because of course there is me and my husband, but I will be the primary author of this blog.

Our story begins in July 2009 when we finally decided we were ready to start a family, I never thought I would be sitting her writing almost two years later, or in fertility land 19 cycles later, childless. Sigh.

The blog will start like this: I will catch you up on all the events leading up to this point. This will take a while. So bear with me. I hope our story not only gives commrodary to the fellow infertile, but makes you laugh, cry, and have hope when there is none in sight.

Happy reading.