Pregnancy

That’s what I write on my calendar each time: Cycle One , Day One.  Then, the next month, I write Cycle Two, Day One, and so on.

This one, Take Four, began on Saturday.  I’m feeling pretty excited – again.  I don’t know how on earth I can be excited about something that has caused me so much pain, but I do seem to emotionally reboot myself each time.  Damn, I’m really proud of that.

On Sunday I had my FSH test blood draw, and I should have the results tomorrow.  They’re testing a few other things, too, but frankly, I didn’t pay much attention to those.  There are only so many brain cells I can dedicate to this project.  But if I have high FSH levels, then it could mean that I have a higher-than-normal-for-my-age egg-quality problem.  This is the biggest outstanding question.

Next week I get to have a hysterosonogram to test for any abnormalities in my uterus.  Fun!  My history indicates this is highly unlikely, but it is an easy test and the problems it can detect are relatively common.

If both tests are normal, we can start trying to conceive again right away.  If not, we’ll reassess.

I also found out today that no determination could be made for the cause of my last miscarriage.  The tissue was too “necrotic.”  I wish I had opted for the D&C right away – then maybe we’d have more information – but I also hope that I’ll never have to put that “lesson learned” to use.

Adam and I had our first appointment at the new fertility clinic a couple of weeks ago and we were very pleased with the entire organization, and especially with our doctor.  Of course, I often seem to like each doctor I try early on, only to discover the problems later, but a good first impression is at least a good start.

We met with our Reproductive Endocrinologist for about an hour, and he explained the results of the testing we did with the previous doctor.  We needed this review because the old R.E.’s entire explanation of the results so far was, “You are homozygous for C677T and need to take folic acid.”  Everything else that I wrote here on the blog came from my research on the Internet.  My research was generally correct, except that I had an inflated idea of how relevant my MTHFR issue is.  Our new doctor (Dr. U.) said he would not even test for this gene except that it comes automatically with the battery of genetic tests.  He claims that the science does not show any correlation between the mutation and pregnancy loss.  He does look at homocystiene levels, which can cause clotting problems, and mine are normal.  Even if he is wrong on this issue, the folic acid would still be the only treatment.  I am doing that, and there are no side effects, so the whole thing is just a non-issue.  I was close to that same conclusion based on my research, but I had some lingering doubts until I heard his explanation.

Dr. U. then explained what had been ruled out, which the previous doctor never did.  I won’t bore you with the details, but any identifiable genetic issues that could be the problem have been ruled out, and that was my main concern.  Just about every other common issue has been ruled out as well, but we have two more easy, safe tests that we can do.  I have to wait for my next cycle to perform the tests, and this time we are being more careful!

However, before Dr. U. explained the additional testing, he gave us a lecture about accepting the unknown.  He didn’t realize that he was preaching to the choir!  Using statistics and citing results of controlled studies, he told us that, especially after the testing we have already done, we will probably never know why I have had recurrent miscarriages, beyond the guess that it is an egg-quality problem (which is normal at my age).  He talked about how there are dozens of “treatments” for this or that, but that most of the things people try either have no evidence for improved outcomes, or have positive evidence for worse outcomes.  He was obviously warning us against something I’m sure he sees all the time:  people’s desperate grasping for some action to take – something that they can do and control.  I’m sure you can imagine the wacky things people will try in order to make a baby, and the thing is, sometimes they are actually making it harder on themselves.

(This is an issue that I’ve been thinking about a lot lately:  the seeming human need to eliminate the unknowns and deal with uncertainty.  Personally, I have great trouble with uncertainty, but I tend not to cling to fantasies to solve the problem, and instead build up psychological defense-mechanisms that cause me great anxiety. That’s a mistake that I’m working on.) 

After we agreed on the tests, Dr. U. told us that based on my history so far, I still have a 60-65% chance of having a successful next pregnancy.  I asked him about IVF with PGD and he said (despite the fact that he himself is a pioneer in this area) that PGD will not give us better odds than that, and it might even worsen the odds.  If you know anything about genetics, the reasons are, 1) mosaicism (in PGD, they test only one of less than ten existing cells), and, 2) the limited number of problems they can test for in the short time available before they have to implant the embryo.  Dr. U. said there have been at least seven controlled studies on this and that they show a slightly worse outcome for PGD patients in circumstances similar to mine.  (The best uses of PGD are for weeding out known genetic problems or for gender selection.)  The doctors might be able to somewhat increase the likelihood of a healthy embryo with the testing, but that is outweighed by the problems inherent in harvesting the eggs, fertilizing them outside the womb, and then reimplanting them.  Since we have no trouble conceiving, we’d be lowering our odds overall.

One of the additional tests we are doing will tell us if I have a bigger egg-quality problem than would be expected for my age.  If that is the case, then we will reconsider our options, but otherwise, we’re going forward naturally. 

So, believe it or not, it looks like three miscarriages at my age really is quite normal – maybe a little unlucky, but not unbelievably, shockingly, devastatingly unlucky.  I want to scream to all my young friends to start trying NOW, but I think it’s a bit tacky so I’ll just do it here on my blog instead of in person.  Did you hear me, young friends?

I ended up going in for the D&C last week. 

I did a lot of serious thinking about my Reproductive Endocrinologist (the fertility doctor) after receiving some comments here on the blog, talking with some friends, and especially after listening to Leonard Peikoff’s podcast #111.  Peikoff mentions in passing (in a question about consulting experts) that he knows at least one cancer patient who tried many different doctors before finding one that he trusted and who cured him, while he would have been dead if he had stuck with the earlier ones. 

This all made me re-evaluate my attitude towards finding doctors.  I had assumed that I was doing something wrong, since I’ve seen so many doctors and had almost nothing good come of it.  I’ve seen about 7 different practitioners for pregnancy, 2 dermatologists (and I need to find a new one), and at at least 7 or 8 doctors for my undiagnosed pain.  Partially because we’ve moved around, I’ve had at least 9 “primary care” doctors in the past 10 years.  Since people don’t tend to talk about health issues much, I had no idea that this was anything other than insane.  I thought most people saw one doctor, and maybe a specialist if something came up. 

If I look at it another way – that there is just as much incompetence in medicine as there is in any other field, and maybe more because of government intervention in health care – then it actually makes perfect sense.  I interviewed about 7 companies to install my windows, so why wouldn’t I do the same with doctors?  This also means that it is possible to find a doctor who can actually help me improve my health if I keep looking and judging with my own mind.  Maybe they’re not all hopeless, after all! 

So, I fired my R.E.  I took a recommendation from a friend for a new infertility clinic and we have an appointment next week.  The amount of work in making the switch is daunting, but I’ve come to terms with the idea that this is just what you have to do.  And I might have to do it again.

In the meantime, I have no ob-gyn.  I hated the practice I used in September, so when I got pregnant in January, I decided to investigate home birth.  I did a mammoth amount of research and work on that, interviewing 3 midwives and finally settling on a birth center, and then I had the second miscarriage, which is probably going to preclude midwives and home birth.  So then I went to the R.E., who was going to refer me to a high-risk OB when the time came, but with the third miscarriage, that never happened.  The new fertility clinic would not take over my care from this miscarriage, but said I should just find an OB.  So, I had to find yet another doctor.

So far, I like this guy.  I chose to have the D&C after talking to him for a variety of reasons, but mostly because I could not stand the waiting anymore. 

The wonderful part is that I had the procedure on Thursday, and on Saturday, my energy came back.  Until then, my body still thought it was pregnant, so I had to take a nap almost every day and I was hyper-emotional and grieving all at the same time.  I couldn’t tell what were my real emotions and what was the pregnancy.  It was pretty awful.  Now I feel like myself again, my head is clear, and I have enough energy to handle my day-to-day activities.

The other big thing is that, unlike my previous R.E., my new OB agrees with me that there is a 98% chance that our pregnancy troubles are caused by my age, and nothing more.  He agrees that more testing is probably a waste of time.  I’m going to get the new R.E.’s take on this too, but it was nice to hear something other than, “the next step is genetic counseling,” which made no sense to me at all. 

This is not the best diagnosis.  There is only one treatment, which is the one that we said we’d never do: IVF.  The alternative is exactly what we identified on our own: play the numbers game and live with the miscarriages.  My previous R.E. did not talk to me at all about IVF so I was very ignorant.  After I realized that she was useless, I did my own research and found that there is a much higher chance of success than I thought, especially when the IVF is done along with PGD, or preimplantation genetic diagnosis.  They fertilize the eggs, wait a few days, then take out one cell from each embryo and check selected chromosomes for anomalies.  If there are any viable embryos, then they can be implanted.  The technology is amazing!  This is the same method used for gender-selection.  Did you know that you can pay about twelve grand to select the gender of your baby as a fairly routine matter?  I had no idea. 

We never could have considered this but for the money Adam inherited from his grandmother.  Our entire baby making journey, which started six years ago, consists of one reversal after another.  First, we’d have no kids, then we’d have one.  I never would have had a baby outside a hospital, but then I had one underwater in a birth center.  Then, well, one kid is great so wouldn’t two be even better?  If it doesn’t work out, then so be it – we’d never go through the trouble of high-technology pregnancy, and we could never afford it anyway.  Well, now we’re here, and we’ve changed our minds again.  People ask us about whether we’d consider adoption and I say, “No, I really don’t think so.  We’re happy enough with our one child.”  But then Adam reminds me that, when it comes to children, trying to predict the future is futile.

Well, it has happened again.  Miscarriage number three.  Only one baby in five pregnancies.  Shit.

At the time I wrote about number two, about a month ago, I was already pregnant and didn’t know it.  Adam and I had been under doctor’s orders not to try to conceive again until we got some answers on what might be the problem, but we figured that we’d start using protection after my first cycle.  Ooops, we never got that far!  I must say, it’s quite exciting to get pregnant without really trying.  No ovulation predictor kits or loose underwear or basal body temperatures – it seemed miraculous!  And maybe because of the surprise and new experience, I somehow convinced myself that this was the one – this one was different.  I was sure of it.

To add to my certainty, we had an ultrasound and saw a heartbeat at 7 weeks.  Everything looked perfect.  The fertility doctor told us to come back in a week for one more ultrasound, just to be sure, before she would refer us to a regular ob-gyn.  So at 8 weeks, once again, we found out there was no heartbeat.  After my pregnancy in the fall when I went to the 8 week ultrasound alone only to get the bad news with no support, I decided I would never have an ultrasound again without Adam present.  I’m glad for that, because I was devastated this time.  Although it was still nowhere near as bad as my first pregnancy experience, it was the worst shock of these recent three.

I still didn’t completely believe it until we got a second ultrasound that day.  And even then, I had moments of disbelief.  I mean, mistakes are made sometimes, right?  But I’ve since had a third ultrasound with the same results.  I’m now waiting for the inevitable passing.  I decided not to get another D&C because, although it would provide certainty and possibly more information about what went wrong, the procedure was more traumatic, mentally and physically, than I had anticipated when I decided to go that route the first time.  It also requires Adam and I to be totally useless for at least two days, if not three.  And I passed the second miscarriage naturally with no pain or fuss (I didn’t know ahead of time with that one) so I’m less frightened of what will happen.  Still, the waiting is very difficult.

After number two, when she instructed us to use protection for the time being, the fertility doctor explained, “because the last thing you want is to have another miscarriage.”  Well, she was wrong.  I’m actually glad it happened this way – or maybe I should just say that I have no regrets.  We had another shot at a baby.  We lost, but we had a shot.

Barring any evidence of a treatable condition, both Adam and I see this as a numbers game.  There are still avenues to pursue in diagnosing our troubles, but we’ve covered all the common things.  There are only two things that look suspicious at this point: the MTHFR issue, which is now being treated (but wasn’t in time for this pregnancy), and some kind of genetic defect in one of us.  If the problem is the former – we’re covered.  If it’s the latter, well, we know we can produce a healthy child because we have one, so it’s logical to assume we just need to get lucky.  That doesn’t mean that there is nothing more we can do.  What we are trying to find out (and I haven’t been able to pry this information out of the doctor yet) is whether, if it is a recognizable genetic issue, what the treatment options would be.  I only know of one, which is IVF and then genetic testing of the embryo before implantation (which is just a numbers game minus the miscarriages).  We’ve already decided that we won’t do that.  It’s too expensive, too stressful, and the success rate is too low.  So why bother with further testing if we would take no action on it?  I’ve tried to address this with my doctor twice, and she has intimidated me out of pressing for an answer both times.  (I really need to work on my assertiveness skills.)  Adam is going to call her next to see what he can find out, and if that doesn’t work, it’s “Hello, Internet.”

Right now, Adam and I agree that we will disregard the doctor’s instructions and keep trying immediately, even if we continue on to genetic counseling and whatever might follow that.  It’s amazing to me that the doctor refuses to discuss this issue with us to understand our values and priorities.  (She had the same attitude towards the D&C issue – she recommended that I wait, but as soon as I started asking questions she got defensive and said, “Fine, then have the D&C,” but would not directly answer my questions.)

Anyway, the worst of it is over.  I only knew I was pregnant for ten days, but they were ten days of joy and it may sound silly, but nothing can take that away.  We got pregnant again, and that’s something.  So many people can’t get that far, and having a child already makes a big difference in how I feel about it.  Sure, I suffered terribly for the loss, but it is a temporary thing.  In fact, this one was particularly difficult, but one week later, I’m practically recovered and ready to move on.  To paraphrase Ayn Rand, my focus is not on avoiding pain, but on achieving life.  I don’t mean the life of the baby we hope to have, but my own life and my own values.  This does not mean that I will do anything to have a baby – our position on IVF makes that clear.  It doesn’t mean that I evade the fact that we might fail.  I am perfectly aware of that.  It doesn’t mean that the pain of miscarriage is repressed or even irrelevant.  I fully experienced the pain.  I barely got out of bed for five days.  On Monday, at my lowest point, I started to wonder when and if this repeated trauma would do permanent damage to my psyche.  But by the next day, that feeling had disappeared and I have felt better each day since.  I think these experiences are showing me the real meaning of a pain that “only goes down to a certain point.” (Ayn Rand, again.)  I can’t say that I have that level of self-esteem in all areas of my life, but I have it here, and it gives me more confidence in all those other areas.  I know that I can and will act to achieve my values.

But I will never again look forward to an ultrasound.

I had to go to the fertility clinic this morning for another blood test so I asked the nurse my questions mentioned in the last post.  It looks like my MTHFR issue is not likely to have caused the skeletal dysplasia in my first pregnancy, nor the trisomy 16 in the the third.  Since the problem with the fourth pregnancy was indeterminate, my mutation may or may not have been a factor.  The fact that my homocysteine levels are normal is a very good thing and I probably don’t need any further tests, although the nurse said she’d have the doctor call me on that one.

I’m starting to fall back to my earlier position that we’ve probably just had a run of bad luck with this baby-making business.

The funniest thing I found out from the nurse is that, amongst labor and delivery nurses, mutations of the MTHFR gene like mine are called, “the motherfucker gene.”  MTHFR actually stands for methylenetetrahydrofolate reductase, but I like the oh-so-appropriate nickname much better!

The “little thing” that turned up in my bloodwork sounds scary, but it’s really not too bad.  I’m a mutant!  I have two copies the mutation C677T on the MTHFR gene.

From what I can glean from reliable Internet sites, this is not uncommon.  5-10% of Caucasians may be homozygous for this mutant gene (have 2 copies of it).

The effect is that my body can not metabolize folate properly.  Folic acid!  Vitamin B9!  The one and only supplement that is prescribed for all pregnant women, because a lack of folic acid is one of the very few things for which they’ve found a real correlation with miscarriage, stillbirth, and birth defects.  A lack of folic acid is associated with neural tube defects, especially spina bifida.  Of all the garbage you hear about what to do to maintain a healthy pregnancy, taking folic acid is one of the few that has a basis in science, and isn’t just fear-mongering or a fad of the moment.

It is entirely possible that all of my failed pregnancies were caused by this problem, or it could have nothing to do with it.  The doctor didn’t order a test of my folic acid levels, but I see there is such a thing, so I’ll ask for it the next time I see her.  My body can metabolize some folic acid, so taking large supplements is the way to fix the problem.  (I’ve already started a supplement called NeevoDHA.)  This also means that if I’ve been getting enough of this vitamin in my diet plus the prenatal vitamins that I’ve been taking for years, I may have had plenty in my system all along.

So, as far as pregnancy goes, this is not any kind of conclusion – just one negative factor to eliminate with the easy fix of taking a different vitamin.

As for my own health, this condition means that I am at higher risk for heart attack, stroke, or anything else that involves blood clotting.  However, I am not clear (and I’m not sure doctors are either) on the causality chain here.  I think that the inability to turn folic acid into MTHFR properly causes hyperhomocysteinemia (elevated levels of homocystein in the blood), and that hyperhomocysteinemia causes the clotting problems as well as the problems in pregnancy.  My bloodwork included a homocystein test, and my levels were normal.  This may mean that I’ve been managing to get enough folate to overcome my body’s substandard production of the MTHFR enzyme, in which case, there would be no ill effects (unless I got the causality chain wrong).  But other things I’ve read indicate that it is not entirely clear whether homocystein levels are a reliable test in assessing these risks.

This web site has a brief but clear explanation of some of the issues, if you’re interested.

(I really wish I could find a link between hyperhomocysteinemia or low folate levels in the blood, and any kind of pain.  If this could explain my mystery pain, and if taking a vitamin could fix it, how happy I would be!  I did see one, less reliable web site that mentioned pain and fatigue as symptoms of hyperhomocysteinemia, but since I don’t actually have elevated homocystein levels, I think this would be grasping at straws.  Still, I’ll bring this up with my new doctor when I see him.)

Hopefully I can clarify these questions at my next appointment with the fertility doc.  In the meantime, she wants Adam and me to get genetic counseling.  We did this after our first pregnancy loss, and they didn’t find enough in our family histories to even order any tests.  Unfortunately, I can’t seem to get my hands on those medical records, and my new doctor doesn’t trust my memory.  She recommended a genetic counselor in Bethesda, which means that we’d both have to spend an entire day on that project and hire a babysitter.  Also, this geneticist does not take insurance, so we’d be paying out of pocket.  We’ve decided to put that off for the time being.

And that’s all for now, folks.

Wednesday marked the one year anniversary of our decision to try to have another child.  One year, two miscarriages.

We’re now one for four.

I had my second consecutive miscarriage in March.  I didn’t write about the pregnancy this time because I knew it was all wrong from the beginning.  I won’t bore you with the details, but I was in hell for a month.  I was actually relieved when the pregnancy was over, since I was pretty sure it had to end that way anyway.  We don’t know exactly what went wrong this time because I didn’t have to go through the D&C, but after three failed pregnancies, I decided that there might be something more going on than just “advanced maternal age.”

Seeing even more doctors is just about the last thing I want to do right now, but I’ve started going to a fertility specialist.  I thought fertility doctors were for people who couldn’t get pregnant, but apparently they can help people like us, too.  They’re doing karyotypes on both me and Adam, and I’m having just about every conceivable blood test.  We’re waiting on the results of the bloodwork, and I know they’ve found something because I got a message on my voicemail the other day saying, “there were a couple of things that were just a little bit off.”  My appointment to find out what those things are is this Thursday.

The thing is, even if we find some particular problem, I’m not so sure we’d get any kind of treatment for it.  Most of the common, easy problems are not likely in our case.  There are things that can be done for certain genetic issues, but they are very expensive and have a low success rate.

We really want another child, but I don’t think we want one that badly.  I mean, it’s hard to say at this point, but we’re pretty happy with our family of three.  Neither Adam nor I have the kind of burning, relentless desire that I’ve seen other couples have when trying for subsequent children.  But who knows – maybe there is something reasonable that we would do to improve our odds.  What I really want from this is to find out if we should even bother trying any more.  I want to know that I explored all the options, and I want to know that, if we’re going to keep trying, that we have a reasonable chance at success.  And if we are going to keep trying, I want to have every bit of data available to me to try to make it happen, instead of just taking my chances.

So we’ve been banned from trying to conceive until the doctor has more information.  I haven’t had a regular cycle yet anyway, but we might have to wait an extra month or so to get started again, if we choose to do so.

So, one year and counting.  But you know what?  It took two years and one month to produce Sam, from decision to birth.  We can still beat that record!

I went to the doctor today for my follow-up from the miscarriage.  It was all good news.  There was no indication of any problem with my body or the way I carried the pregnancy.  This is good because those problems might have meant higher risk for the future. 

The chromosomal analysis showed that the fetus had Trisomy 16.  This means that instead of a pair of chromosome 16, the fetus had 3 copies.  Trisomy 16 is the most common chromosomal cause of miscarriage.  This problem alone doesn’t indicate any higher risk of problems in future pregnancies.  If you’ve never heard the word “trisomy,” you might be interested to know that Down Syndrome is also known as Trisomy 21.  People with this condition have 3 copies of chromosome 21.  All trisomies are major problems but only trisomies 18 and 21 generally appear in living humans (although there are rare cases of live births withother trisomies).  The rest involve defects so severe that the babies die before birth.

Another good thing is that Trisomy 16 is in no way related to what happened with my first pregnancy.  The two problems that I have had are most likely totally unconnected.  This means that I’ve had some bad luck, and bad luck is much better than an underlying problem!

I still have to wait until Monday for blood test results to make sure that my hormone levels have gone down.  If they have not, that would indicate that some tissue remains and my body still thinks it is pregnant.  But once I clear that hurdle, we’ve been given the green light to try to get pregnant again during my next cycle, which means we have to wait just about a month.  I don’t think we’re going to try to avoid pregnancy this month, though; we’ll just see how it goes.

It’s been a week since my miscarriage and I’m feeling like I’m pretty much over it.  I did a lot less grieving than I thought I would.  The procedure on Friday went smoothly and I felt fine by Friday night.  I just moped around the house over the weekend and, although it was probably good to have some time to reflect, I was very happy to get back to my normal routine on Monday.

I guess I was right when I said that there wasn’t much of a context to disintegrate with this loss.  Usually, that disintegration is the work of grief.  (I got that from Leonard Peikoff, but the specific source eludes me.) When you love someone, you integrate him or her into your life.  You share values.  In my case, I hadn’t integrated a person into my life, but a pregnancy.  I had to do things like unsubscribe from a pregnancy newsletter, cancel ob-gyn appointments, cancel my prenatal yoga class, rethink next summer’s travel plans, set aside the plans for preparing the baby’s room, and even cancel a prenatal massage.  Those things were a disappointment.  I had valued all of it as part of the pregnancy experience.  But I had no connection with the life growing inside me yet.  I do indeed feel like this is just a setback.  We’re still going to have a second child and all the values that come from that – we’re just not going to have them as soon.

I don’t mean to diminish this experience.  It really is a horrible thing to go through.  I think when it happens in a first pregnancy it is much more difficult.  But it’s been a week and I’m over it.  Sure, there is a little residual sadness, but it is in the background.  There is a little bit of new doubt about whether we will be able to have a second child, but I’m fighting that by focusing on the fact that it is metaphysically given whether or not we will succeed.  We will take all the action we can to make it happen, but worrying about it will not change anything.

We did decide to get the chromosomal analysis of the fetus.  We should have the results in a few weeks.  If there is anything to learn from this that can help our future efforts, we’ll learn it.  Most likely, though, we won’t learn anything at all.  I’m ok with that too.

There are other things I’ve learned from this experience.  I’m working on a bad premise I have about accepting help and support from other people.  And I’ve been vindicated in my practice of being totally honest with my daughter about sensitive issues like this.  We told her everything from the day I took the pregnancy test to the miscarriage, and she’s handled it just fine.  I’ll write more about both of these subjects in the days to come.

So tomorrow I go to the hospital for a procedure called “dilation and curettage,” which is a type of abortion.  This is my second unwanted abortion, and I’m not happy about that.  Since it makes me feel better to write about all of this, I’ll tell you what I know about this process.  (And thank you all for your kind comments.)

In a case like this, where it is discovered that the fetus is not developing before there are any symptoms of miscarriage, there are two choices:  have the D&C, or let things happen naturally.  Eventually, my pregnancy hormones would adjust and my body would naturally expel the contents of my uterus.  The problem with that option is that you don’t know exactly when it will happen, it can be very painful, and it is very bloody.  The doctor emphasized, “a lot of blood.”  The risks of a D&C these days are minimal, the most common major problem being infection, which could lead to perforation of the uterus and infertility.  But I trust the doctor who advised me yesterday that this risk is very small.  I will be on prophylactic antibiotics anyway, and I’ve never been prone to infection.  Many times, even if you let things happen naturally, you need the D&C anyway to be sure all the tissue has been expelled.  The other benefit of the D&C is that a genetic analysis can be performed to possibly find out what went wrong.  I’m not sure if my insurance will cover this, so I’m not sure we’ll have it done, but it would be nice to know if possible, especially given my history.

The biggest cause of miscarriage is genetic defect.  If the problem is bad enough, the fetus can’t get beyond a certain state of growth.  When we are amazed at how well DNA builds such perfect human beings even with all the problems we see in living people, we shouldn’t forget that there are a lot of errors – these are the miscarriages.  I read last night that up to 75% of a 40 year old woman’s eggs may contain genetic defects.  Unfortunately, the book I have does not include footnotes and this figure sounds ridiculously high.  (The book is also one of those types where pregnant women are encouraged to take no risks whatsoever so I don’t completely trust it.  Another source put the percentage of defective eggs at 50, with the caveat that this figure was arrived at by studying only infertile women, so it is probably still high.)  But one hard fact is that the miscarriage rate for 40 year old women is about 1 in 3 and it goes up dramatically as you move towards 45. 

These figures can be depressing, and it is certainly possible that we’ll never have another child.  (Here is an interesting personal anecdote from a woman who tried to have a second child in her mid-forties – she eventually did fail.)  But I look at these figures as a way to understand and cope with this miscarriage.  As I said before, it can be seen as “normal” at my age of 39.  And I have to be prepared for it to happen again.  But for now, this is no deterrent.

Tomorrow is going to be a terrible day, and from what I gather, I’m going to be in pain through the weekend at a minimum.  But I want to get it over with.  I’ve spent the past 24 hours worried sick that things would start happening on their own.  I hope I make it through the next 24.

I had an ultrasound today.  There is no heartbeat.  The fetus stopped developing a couple of weeks ago.  I had a miscarriage.  On Friday I’ll have a D&C.  I’ll write more about that later.

It’s ok.  I mean, it’s horrible, but I’ll be ok.  This is nothing like losing a 24 week pregnancy.  When that happened, I really resented people who equated my experience with a miscarriage, but I wasn’t sure if my feelings were just, because I had never experienced a miscarriage.  Well, I was right.  This is hard, but I don’t feel like I’ve lost a baby.  We didn’t know the sex yet, we had never heard the heartbeat or seen the baby on ultrasound, and we hadn’t bought anything for the baby.  My belly hadn’t grown.  I hadn’t felt the baby move.  We hadn’t bonded with it.  We don’t have a huge context to disintegrate.  We just have to start over.

I do have one similar feeling:  the feeling that I have lost time.  When our first child was stillborn, I felt like I had lost a year of my life.  We had spent 4 months getting pregnant, 5+ months being pregnant, and then we had to wait 3 more months before we could try again.  I’m sure I’ll be told that we should wait 3 months again, but I might not heed that advice.  I started planning and thinking about it within 10 minutes of finding out, and Adam agrees: We’re getting right back on that horse!

I’m also thinking about the things that will be easier.  We have some travel plans that will be much easier now.  Next time, I’ll be better prepared with the right drugs for my psoriasis, which has gotten totally out of control since I had to suddenly stop my medication.  Well, that’s about all the positive stuff I can think of right now.  As for the negative, I think the thing that bothers me the most is that when we do have SS, there will be that much more of a gap between our children’s ages.  That, and the fact that, the older I get, the less likely we are to successfully have a child at all.  But, at least right now, I’m not feeling as stressed out about that as I was when we first decided to try for another child.  For some reason, I was really afraid that we wouldn’t be able to conceive at all.  A miscarriage is almost par for the course at my age, so I don’t feel like this doesn’t bode well for the future.  We might have another miscarriage, but we’re still fertile, and we’ve had one healthy child, so there is no reason to leap to worries about ultimate failure.

And that is one of the reasons I decided to announce my pregnancy to the whole world immediately.  I knew this could happen, and if it did, I wanted people to know.  I can’t tell you how shocked I was after our first, failed pregnancy, to find out how common miscarriages, infertility, stillbirths, and other problems really are.  Once you are a part of “the club,” the stories come out of the woodwork.  Miscarriage is common enough that I would call it normal.  If you don’t know how common it is and you have one, you will not have the right perspective, and you might become afraid.  It might seem like there is something wrong with you, or that you did something wrong like eating the wrong food or exercising too much.  Many women even feel ashamed, since it is just never, ever talked about (except in those internet chat rooms, and you should not go there–trust me).  I don’t want women to have to go through that.  I mean, I hate thinking about all the pity people will feel for me, and even the sympathy.  I hate to cause other people those negative feelings and I hate to be the object of them.  I could have spared all of us that by just keeping my mouth shut.  But now that this has happened, I can confirm what my gut told me in the first place:  We need to stop hiding early pregnancy and miscarriages.  It’s one thing to learn the miscarriage rate as an abstraction.  It’s another to know that 5 out of your 6 best friends have had miscarriages, fertility problems, or a stillbirth. 

I’ve only known that I miscarried for about 8 hours now, and I’ve had to tell 5 people.  Telling people is difficult and painful (although writing this blog post is cathartic).  I understand the desire not to have to go through that.  But I think that telling people is an important part of facing up to what happened.  I can’t imagine having been pregnant this whole time, losing the baby, and having the whole thing be invisible to all of my friends and family.  I think it would prolong the pain.  I don’t mean that I want to ”share” the pain, like spreading it out would lessen it or something.  I just don’t like keeping secrets from people who are close to me.  (And once you tell those people, the cat is out of the bag and you might as well tell everyone.)  It’s important to note that I absolutely do not think that it is dishonest to keep an early pregnancy a secret–it is nobody’s business but the parents’ and there are plenty of situations where it is rational to keep it hidden.  What I’m saying is that this default practice of waiting 3 months to announce a pregnancy does not do anybody any good.  Ignorance is not bliss.

I’ll write more about this in the days to come, but now I have to go have a good cry.

I finally got started taking photos of my pregnant self.  Here I am at 7 weeks pregnant.  (For the uninitiated, being “7 weeks pregnant” means that you conceived 5 weeks ago.  A pregnancy is dated based on the first day of your last period.  Your due date is 40 weeks from that date.)

That belly you see is just my usual fat self, but I have gained 5 pounds and my clothes are too tight.  I’m determined not to buy any maternity clothes until I absolutely have to.  This is not because I don’t like maternity clothes.  As a matter of fact, I love maternity clothes!  The only time I get to wear a lot of new things is when I’m pregnant because I’m the kind of person who normally spends about $100 a year on clothes.  Maybe $200 if you include shoes.  $250 if you include jewelry.  Seriously, my budget is $20/month.

So anyway, the reason I don’t want to buy anything much in advance is that last time around, I grew out of clothes before I had a chance to wear them.  I was due in September, so in March I went out and bought a lot of summer things.   That year in Michigan the warm weather didn’t come until June, and by that time I was too big for some of the stuff I bought.  You’re supposed to just buy size ”small,” “medium,” “large,” etc. based on your pre-pregnancy size and, just to be safe, I bought a size up from that.  Still, I had to keep buying new things cotinuously.  By August I had grown out of every single thing I owned and had to buy a whole new wardrobe (ok, that just means a few pairs of pants, really) for one month of wear.  I had to shop in the fat womens’ maternity section, and I’ll tell you, it was really hard to find anything at all that fit me.  I went from an original size of 6 to bigger than 14.  That’s not about the belly – that’s just the hips and thighs and the rest.

Even with all of that, I really loved the big belly.  I never felt “fat.”  Well, there was that one photo that clearly showed all the cellulite on my thighs (shudder).  But really, I loved the whole thing, including the maternity clothes.  Yesterday, I went into my closet and looked at all those jeans that feel so tight, and I thought, “I’m going shopping!”  The thought of buying stretch pants was a thrill.  (I know, I’m sick in the head.)  But I came to my senses.  In the meantime, I’m going to go shopping in those boxes of maternity clothes that have been in storage for 3 years.  Yipee!

I just completed a nightmarish 4 day saga of deciding which prenatal diagnostic tests to have.  I got no real help from my doctors or the support nurses in the Future Moms program I am participating in.  I finally decided to stick with the Nuchal Translucency screening, which was what I did in both of my previous pregnancies.  It involves an ultrasound and a blood test and it looks for markers that indicate a higher likelihood of genetic problems such as Down Syndrome.  It does not test directly for these conditions, but just gives you an indication that you might want to take a definitive test such as an amniocentesis.  There is a pretty high rate of “false positives” – results that indicate higher risk when there is no actual abnormality present.  So you have to be prepared to get a scary result, take another test, and then wait about 10 days for definitive results.  I can live with that.  The NT screening also tests for neural tube defects and congenital heart defects, which CVS and amniocentesis do not, unless they are part of an identified genetic condition.  (I can’t find anything that tells me exactly what is tested for, just these broad outlines.) 

Because the problems with my first baby were detected through ultrasound, I like the idea of this direct “looking” at the fetus.  The 20 week ultrasound will be the most important one, but the NT screen will give me a measure of comfort if the results come back negative.  I also like that the test is more comprehensive, even if less definitive.  My situation does not lend itself to looking for any specific problem since the cause of my first baby’s problems is a total mystery.  I want the most comprehensive testing possible.

All of that was the easy part of the analysis.  The hard part was trying to compare the costs of each procedure.  Health insurance co-pays are supposed to signal costs to the consumer – something that has been lost in our insane collectivized health system. (Of course, the current proposed “reforms” of health care would make this problem worse, but I’m not going to get into that issue on my blog.)  My insurance company, however, makes it impossible to figure out what something will cost me ahead of time.  I spent 4 days making phone calls trying to figure out my portion of the costs of these tests, and ended up knowing nothing at all.  Finally, I gave up.  I’m going to rely on the fact that there is a yearly maximum out-of-pocket expense that I can pay.  I’m going to budget that full amount and be prepared to spend it.  I still have to be careful, though, because if I neglect to get a pre-authorization for a procedure that requires one, I’ll have to pay all the costs and my maximum won’t apply.  How do I know what requires pre-authorization?  I have to guess, and then call the insurance company for every single thing that I suspect might require it.  What clues do I have to go on?  Nothing.  Wish me luck!

The next thing that I decided to do was to get a flu shot.  That took over a week of work.  First, I had to figure out where I could get one under my insurance.  That took a few phone calls and hours in front of their web site.  Once I figured that out, I found that all of the places giving the shots would get a small supply, use it up, and then have nothing for weeks.  I had to keep calling different clinics and pharmacies every day to see if they had any shots and how long the wait was.  One time, I raced out to a CVS in the next town over, only to find that there was a wait of over 2 hours!  I got lucky last night and got my shot at my local supermarket pharmacy.  By just showing up and asking, I think I cut in front of dozens of people on the waiting list (they were waiting for a phone call from the pharmacy), but I could care less.  I’m supposed to have some kind of priority because I’m pregnant anyway, but I don’t know how I was supposed to exercise that priority.  

I’m still debating about whether I’ll get the H1N1 vaccine when it comes out in a month.  It is recommended for pregnant women, but I’m nervous that it is a new vaccine and that it was “rushed.”  I’ll think about that next month.

The bureaucracy of health care is one of the biggest stressors in my life.  Every single time I consider going to a doctor, I become confused, angry, and sometimes I just shut down.  I don’t trust the doctors, who are more concerned with liability and getting ripped off by regulations than in my health, my insurance company is my enemy, and I can’t stand the arbitrary rules, paperwork, and processes.  None of this bothered me at all with my pregnancy with Sammy.  The birth center I used was not part of the medical establishment and I didn’t use insurance, but just paid for it out-of-pocket.  I need to find some way to deal with the medical world this time, or else it’s going to suck all the joy out of this pregnancy.  Honestly, I don’t know how I’m going to do that.

I had my first prenatal doctor’s appointment last week.  I was pretty excited about it, and had hoped that it would kick-start the feeling that this pregnancy is for real, and that there actually is a baby coming.  I guess I still have mental scars from my first pregnancy, because I’m having a hard time getting excited.  Unfortunately, the appointment was nothing at all like my prenatal visits at the birth center where I gave birth to Sammy.  It was just another doctor’s visit.  They took my blood to confirm the pregnancy, which is totally unnecessary.  They didn’t even do a urine test (because, I suppose, they don’t really believe that I’m pregnant yet.)  The doctor was completely unhelpful in discussing the first trimester diagnostic tests that I should have.  Since I have an unusual history, I was hoping for some advice on whether to do the standard NT/blood test screening, or go straight to CVS or amniocentesis.  The doctor didn’t even give me any statistics on accuracy or risk, and basically said, “It’s up to you.”  Gee, thanks.  She didn’t even calculate my due date.  Sure, I’ve already done this myself, but isn’t that one of the fun parts? (Officially, my due date is May 16, but I’m holding out hope that this baby will come just a bit early like Sammy did, so I’m saying early May.)

I’ve met 2 of the 3 doctors in this practice now, and I didn’t particularly like either of them.  They have 2 midwives in the practice, though, which is why I chose this place.  I’m holding out hope that I’ll like one of them better.  I can pick my preferred doctor/midwife for the birth of my baby, but there are no guarantees – the person could not be on-call or could be on vacation and another would have to cover for her.  Apparently, it’s standard practice to induce labor just so you can get the doctor you want.  This is absolute insanity, in my opinion.  Inducing labor increases the risk of needing a C-section.  Once you have that pitocin, it kicks off the chain reaction of medical interventions that cause so many problems.  The two best ways to avoid a C-section are to let labor come when it comes, and to stay out of the hospital for as long as possible.  I think I’ll take my chances with whatever doctor is available and let nature take its course, thank you very much.

I did learn something new about pregnancy, although it wasn’t from the doctor, it was from this “Future Moms” program I’m eligible for through my health insurance.  The idea is that the insurance company can help keep costs lower if they provide education and incentives to pregnant women to take care of themselves.  So if I participate, I don’t have to pay the hospital co-pay when I deliver.  That saves me a few hundred bucks!  Plus, I can talk to a nurse on the phone 24 hours a day, during the pregnancy and for postpartum support.  I suspect the nurses will be more helpful than the doctors, so this is a nice perk.  (I’m going to call them regarding the diagnostic tests this week.)  What do I have to do in exchange?  I had to enroll and give a health history (so they could assess my risk), and I have to have a dental cleaning before 24 weeks.  A dental cleaning?  Yes, you see, preterm deliveries are the biggest maternal health cost to insurers.  (Think of the amazing things they are doing for preemies in the NICU.)  And many preterm deliveries are caused by infections.  And many of these infections are apparently caused by, of all things, poor dental health.  Interesting!

Everything seems to be going fine with the pregnancy.  I’ve had no nausea, and just a little bit of fatigue and emotionalism so far, all of which is normal for me.  I enjoy pregnancy.  It’s the post-partum problems that get me.  Don’t worry, I’m sure I’ll share all the disgusting and horrifying details with you when the time comes.