Outlier

If you’ve been reading my blog for the past ten years, you‘ll appreciate my similarities to the bagel. 

When I concluded my last blog post, I was looking forward to finishing up treatment and finally moving towards a resolution of our fertility journey. When I finished the two weeks of Cipro and Flagyl together I felt like I won a gold medal. I was so relieved to be rid of those meds and braced myself to endure the repeat biopsy, it would all be worth it because the end was in sight. I just had to wait for the proper cycle timing for the biopsy appointment.

I asked my doctor’s opinion regarding my full time position working nights as I’ve been concerned about harm to a potential pregnancy. I’ve read limited research about night shifts (obviously) messing with your circadian rhythms and hormone regulation, potentially leading to an increased risk of miscarriage.  I wanted my doctor’s advice to navigate this. Clearly, many people work nights all the way through their pregnancy and have perfect outcomes. I just always feel like I’m the outlier. 

My doctor did not feel that it would be a major risk to a pregnancy to continue working nights despite my complicated history. It was a huge sigh of relief to hear I didn’t need to change my schedule, but the relief was short lived. I still felt worried about it. I know of at least 3 coworkers who have miscarried while at work during the night. It’s empirical evidence and probably not clinically significant, but my anxiety wins in this situation. I really feel the need to reduce the stress on my body. It’s no secret that working 12-13 hour shifts, 3-5 nights in a week, is hard on the body. 

Jack and Aidia are nearly out of school for the summer, and as I was trying to determine how to balance work and childcare, I decided it was best to reduce my hours to part time temporarily. While it reduces the cost of childcare, it’s still a leap of faith to drop to part time. I hope by the end of the summer we will be out of this period of uncertainty. By the fall, I imagine we’ll have a better understanding of our fertility situation and can make the best decision about work schedules. 

We are in the exhausting limbo phase. I feel restless and impatient. We haven’t even been trying to conceive yet, and I’m feeling the strain of 6 months of testing with the fertility clinic. I think it feels heavier more quickly because it’s compounded with the past decade. It just feels like this part is taking forever. I either want to be pregnant, or endure the worst and know that the door is closed for us. Trying to plan a life around “what ifs” is so mentally exhausting. My kids are soon headed into 8th grade and 2nd grade. I’m in a totally different phase of parenting and need to know if I’m going to be caring for a baby and a teenager simultaneously, plus one in the middle.

Thankfully, in the middle of all this cognitive dissonance and disequilibrium, Kevin and I were able to go away for a weekend as part of a work conference. It was absolutely the best thing and I needed the breath of fresh air. We jam packed as many activities as we could and it was a reminder of what it feels like to actually be alive; not so bogged down with daily responsibilities and parenting. We even did a zip line, which was scary but I finally crossed something off my bucket list!

The trip was a reminder to me that there is lots of joy to be found in life, whether we get a final miracle baby or not. All hope is not lost, and there is lots to live for and look forward to. We have some summer shows, concerts, and family reunions planned. We’re even taking the kids on a little vacation to Vegas. I’m happy to find what life looks like solidly into our 30s. It’s so much better than our 20s. Aging is fantastic. The “just in case” aspect of planning months in the future is still hard. I worry about “what if I’m going through a loss in x amounts of months.” But, it’s wonderful to feel like I’m actually living my life. I don’t want to wait on it anymore. 

Before the trip, I happened to see a job listing for a PRN position for a RN at Maternal Fetal Medicine. Immediately, I was excited about the prospect, but didn’t submit a resume because the stress of picking up another part time job seemed like too much. More so, I worried about my own personal triggers while trying to care of others. Some of the most traumatic and sensitive experiences of my life have taken place in clinics like an MFM office. But the job stayed in my mind the whole weekend away. Perhaps my experiences would truly serve me in the ability to be a compassionate and empathetic nurse. Since I couldn’t stop thinking about it, I applied when we returned home. Turns out they had already filled the position so I didn’t even interview, but it still felt like a win. Despite my mixed feelings of fear at the idea of working in a triggering environment, I was equally excited about the possibility of serving women in a population I’ve been a part of. I proved to myself that I can still put myself out there, in the speciality of my interest. I can keep progressing while carrying all my complicated feelings with me. 

The time came for the repeat biopsy. I wasn’t looking forward to the procedure but I was ready to move on from these tests. Doing the repeat biopsy was really just for my peace of mind, since the treatment I completed is so effective.

Thankfully the repeat biopsy was much more tolerable than the previous one. Maybe they didn’t remove a polyp in the process this time. I also thought if the endometritis had cleared up, maybe the tissue would be less sensitive. I was very hopeful. 

When my results came in, I was ready to tie a nice little bow on the testing phase of our fertility journey. I was so excited to move on and possibly conceive a healthy baby. The worst surprise. My biopsy came back positive again. The clinic was so sure treatment would work, they said I didn’t need to do a repeat biopsy. The studies clearly show that most cases of chronic endometritis are cured with antibiotics. Again, I’m the outlier. I’m so glad I listened to my gut about repeating the test. Still, I felt so shocked about the result and really sad.

Upon seeing the result, one of my first thoughts came with a jolt. I wondered, “does this mean I need ANOTHER biopsy?” That would be a grand total of 4, 3 of them being right in a row. It hurts my womb just to think about it. I really don’t want to go through it again. But could I risk NOT getting another biopsy after realizing how stubborn this infection is? Probably not. 

I’m wearing out. I could not even imagine doing more antibiotics. I’m so exhausted by all of this. But it’s not even like I can just say “ok we’re just going to be done, it’s too much,” because I can’t just walk around with a lingering infection forever. I started considering the idea of a D&C to try and cure this. Just scrape me out like a pumpkin. It’s fine. Here’s a link to a study published last year about using a surgical approach in the treatment of chronic endometritis.

However, my doctor decided on the treatment that I initially did in 2019: doxycycline twice a day for a month. I'm so overwhelmed. Another MONTH of antibiotic therapy is my nightmare right now. I wish I could just get these meds infused, I am not going to have a stomach left. Plus, fun fact about doxycycline, you are supposed to avoid the sun as side effects include photosensitivity; even a small/normal amount of sun exposure could potentially have pretty bad outcomes. Time to break out the hard core SPF.

The med bottle may as well have read, “Please do not enjoy spring while ingesting this poison.”

Perhaps unironically, this was the same day I started finding my first grey hairs while fixing my hair for work. How did so many pop up all at once?!

I reduced my vitamins for the time being and added more probiotics and lysine to counteract the mouth sores and tummy upset from the antibiotic. It’s still hella pills though.

Fortunately I have a depressing new Taylor Swift album to bask in this week, which is helping a lot. 

Shout out to my Swifties

Fortunately, I have a really great therapist and we’ve been doing a lot of work to help me get through these challenges in a healthy way. I think many people fail to realize that with recurrent loss, all these desperate feelings and disappointments are compounded with all your previous hardships experienced in years before. Small bits of bad news can sometimes feel crushing and you can slip back into horrific moments of loss that came before. 

We’ve been working on “radical acceptance” which is a concept I had somewhat been finding on my own, without the official name.  A lot of therapy principles we work with stem from Daoism and Buddhism. When you remove some of the spirituality, these Eastern concepts morph into very effective Western (clinically-proven) therapy techniques. I love the wisdom found in Eastern dogmas.   

Basically, radical acceptance is a way to prevent pain from turning into suffering. It’s recognizing that reality includes pain, and accepting it anyway. It’s understanding that some things will remain out of your control. It’s accepting emotions and circumstances that may not be changeable. Embrace (and don’t avoid/ignore) what you can’t change. 

In my mind, I go to the Beatles, who summed it up so beautifully. Let it be. 

“Parts work” has been extremely effective for me. I try to acknowledge each little “part” of me and appreciate its purpose and how an emotion may be trying to help or protect me. “No Bad Parts” is a great book if you are interested in learning more about this model.

I learned in therapy that confusion and clarity are two sides of the same coin. If we allow ourselves to sit with the uncomfortable, it can become clarity.

All of this is not to say that things are easy. They often feel heavy, depressing, and I get restless. Not to mention the physical effects from treatments. But therapy like this is getting me through. It helps. 

In what felt like that moment of clarity, I applied for my dream job. A full time NICU position at Primary Children’s Hospital. I was trying to build experience little by little before ever applying, and I thought, screw it, can’t hurt to go for the gold. I have spent the past couple years working in what is essentially a step-down NICU. I mean, I’m not pregnant and my uterus isn’t getting better. I could be months away from even trying to conceive. I don’t want to put off an opportunity for a “what if.” If we miraculously conceive a healthy baby, I will cross that bridge when I get there. 

It’s a big career goal of mine to get my neonatal intensive care certification. It takes a couple years of working in the NICU setting and then you can sit for the exam to get that beautiful RNC-NIC credential.

 

It’s a long shot at a competitive position. I’m sure it depends on what type of candidates apply, especially if there are potential internal hires. I don’t know how I would work out the full time with rotating days and nights, yet. But I would be stupid not to try. Opportunities come and go, and I’m proud of myself just for giving it my best shot.

All I Can Do Is Everything Humanly Possible

I was so thrilled when it came time to schedule my IUD removal. To think, either we’ll have a baby in the near future or we’ll decide we’re finished trying- which would mean a vasectomy for Kevin and I never have to worry about an IUD again 🙌🏻

For some reason the removal was extra painful and made me feel all emotional. It’s so easy to forget how intense pelvic pain can be, and for me it brings back a lot of bad memories from the past decade. I left with a bit of dread hanging over me; knowing I had an SSG and endometrial biopsy ahead of me still. The doc tried to encourage me saying, “You’ve had vaginal deliveries, you can handle it!” But is that really the pain threshold we want to set? Childbirth? Woof.

I had to wait five weeks after the IUD removal for the biopsy. Kevin and I got all our ducks in a row regarding all the supplements and meds we’re supposed to be taking starting now. It’s a lot. Definitely hard on the stomach. If I’m lucky, maybe my hair will get thicker🤞

I completed my initial full-time contract at work, which felt like a huge accomplishment. I’ve been at this hospital for about a year and a half and I didn’t sign a contract right away. I wasn’t sure how to work full time nights with kids at home, plus I was still in school for my BSN. But we needed the money that came with it. I signed the contract and was financially relieved, but pretty devastated emotionally knowing we would have to wait even longer to try for a baby. I already felt anxious to start the testing process after I graduated with my RN. I was nervous to put it off again for an entire year. In spite of the mixed emotions, it feels great to know what I’ve accomplished this year for my family. Both financially and career-wise. It was the right choice and I’m relieved that the pressure of fulfilling a contract is off. Though, I am still full time for the foreseeable future.

I met with my neurologist and my OB; they were both so supportive and hopeful for me, which was wonderful. My OB said I didn’t need to “draw a hard line” at 35 and thought I had a few good years left. Putting biology aside, I think I need to draw a line at some point for myself. After all we’ve been through, having started my reproductive efforts at 20 years old, it’s been a lot of my life dedicated to this. It’s not as if we’ve just been waiting on Mother Nature to do her thing, it’s always a long and expensive process. It’s a lot of collaborating with several doctors. 

It has to come to an end sometime soon. I remember the exact day the doctor confirmed my pregnancy with Jack, because it was 1/1/11. To think that was over 13 years ago. I don’t want us to put more of our lives on hold due to a “just in case.” Closing the door after a tenth pregnancy, no matter how it ends up, will open more doors for us in the long run. More experiences for our children, more financial planning, and more peace.That’s not to say I’m not scared of losing another baby. I worry about falling back into that dark place. I find myself already making a “Plan B” list of things to be hopeful or excited about if a baby doesn't work out. I’m discovering what other goals I could dedicate my efforts towards.

My OB approved my plan to stay on a couple meds during a pregnancy. Also, I can continue all my medications while trying to conceive, which is a huge sigh of relief. It eases the stress and pressure if it takes a long time to fall pregnant. At least I won’t be suffering with chronic pain sans meds.

Lots of notes from appointments on how to try to preserve a pregnancy

Looking at our plan can feel overwhelming and like a Hail Mary attempt. I keep telling myself: All I can do is everything humanly possible.

I will try to give life a chance to grow and accept the fact that I likely have very little influence over the outcome. Most factors are entirely out of my control. Maybe that's also a good thing? If all was healthy, I likely could do very little to accidentally hurt a little life growing.

I try to take courage in the fact that my body has always done everything it knows how, to the best of its ability, to protect new life. I’ve successfully produced a son and daughter, despite all the odds. I'm trying not to live in traumatic moments of the past. Who's to say the next pregnancy won't be perfectly normal and complication free? It's absolutely in the realm of possibility. I’m trying to have faith that “life finds a way” ;)

Appointment day was rough. I felt a little crazy. Why not stay up through the day, then work all night, then stay up into the next day to drop a grand on what feels like having a hole punch eat through your uterus? Why the hell not.

The biopsy was so much worse than I remembered; electricity was just shooting up my spine. Like literally are you sampling my vertebrae in there 😭 I had a harder time with the recovery too, it almost felt post op. I had to splint while walking or coughing and wasn’t allowed to take any hot baths which is my go to for pain management.

The SSG was more manageable and the NP said it was the most “perfect and beautiful uterus” she’s seen in a while. At least I have that going for me.

In 2019 when I was first diagnosed with endometritis, they gave me the choice of doing two weeks of antibiotics with a follow up biopsy, or doing a month of antibiotics with no follow up (because it was like 98% successful.) I couldn’t afford a second biopsy so I did the month of meds and it was just miserable. I know the protocol for treatment has changed in the last five years. We were never able to get pregnant after the antibiotic treatment before we took a long break from trying to conceive, so I was never totally sure if the endometritis cleared up. 

As horrible as the biopsy was, it would be completely worth it if the results came back negative! While waiting on results I put all the vibes out there- please please please be negative. Then the results came in.

And my reaction was somewhere around here:

I instantly felt dread just thinking of the constant nausea from the antibiotic treatment. I was prescribed Cipro and Flagyl and told to take both, twice a day, for two weeks. RIP my gut flora. I am taking a probiotic in between doses to minimize side effects, but I am just so freaking sick. It reminds me of morning sickness but worse, and my head is just spinning all the time. Work has been difficult because when I have 10 patients it’s hard to just run off sick and hide in the bathroom until the cold sweat stops. I will be taking antibiotics until the 10th of April, followed by another biopsy to confirm effective treatment. If I survive that long. The flu-like symptoms seem to get worse every single day of meds. 

My sweet friend just happened to stop by within 20 minutes of me getting the crummy news and brought flowers that she just happened to buy because they reminded her of me. Such an angel. She saved me from spending the afternoon crying.

Endometritis is caused by an infection in the uterus and can be due to several different types of bacteria. It is more likely to occur after a miscarriage or childbirth. It’s also more common after a long labors or a C-section. The incidence of chronic endometritis is very high in patients with unexplained infertility. 

From a scientific standpoint I think all of this advancement in understanding the endometrium at the cellular level is really exciting. Secondary infertility is more common than primary infertility and I wonder how frequently this is a contributing factor. Especially since the treatment is relatively conservative and easy with a high success rate- the data really speaks for itself.

Maybe I’ve had endometritis for a long time. I had 6 miscarriages in between Jack and Aidia. Jack was a long labor (like 28 hours) and a rough delivery. Maybe I developed it after giving birth to Aidia. Or after my miscarriage after her in 2019. I also had IUDs inserted and removed several times through all those years. I do have pelvic pain often, but with fibromyalgia it’s really hard to distinguish actual clinical symptoms when it comes to pain. A biopsy looks at the cellular level so it wouldn’t be surprising to me if chronic endometritis often flies under the radar with no symptoms. I imagine women who unknowingly have endometritis are often diagnosed with unexplained multiple losses or infertility. Even if I wasn't having any more children, I want to treat this to keep my own risks down.

Here’s a Link if you would like to read more about it.

Life will always throw curveballs and we just have to learn how to handle them. My hospital was just purchased by a new company and it really threw all my plans for taking a maternity leave out the window. Losing benefits randomly is scary and it just confirms that all we can expect is the unexpected. I really hope that also means unexpected joyful news. Thanks for all the love and support. Send me all your favorite foods to eat when you can’t eat anything without getting sick ;)

In the meantime, I’m going to do tough girl stuff. Like going to therapy.

Forced Perspective

    January is at least 49 days long and is just miserable, but on the bright side we’ve had several test results come in. Kevin’s first analysis came back normal, which was totally expected as this test has always been normal and I don’t usually struggle to conceive. But, he’s ✨35✨ now so I guess we’re getting old in fertility years. Every test that comes back with fantastic results is a huge sigh of relief. 

    Mostly, we were concerned about his DNA fragmentation results and oxidative stress. Just under a decade ago, his results in those areas were so bad that it gave us a “poor” chance of a live birth. These tests don’t show up on a normal analysis and have to be processed at a special lab across the country. I stayed pretty optimistic because a year after his surgery in 2015, his numbers did return to normal and were still great in 2019. But deep down, I just felt like the results would not be good news and all of this would be over. I was patient until it was time for results to come in. I tried not to compulsively check for results. Then we got a message saying the results were going to be delayed for up to two more weeks due to the storms on the East Coast 🙃. Frustrating, but at least it helped me relax while waiting. 

     In the meantime, I went in for my baseline ultrasound and blood draws. I did have a cyst on one side (shocking I know 😑) so they had to run an estradiol on my blood to make sure it wouldn’t affect any test results before sending blood off for my Ovarian Assessment. Luckily, it was not in a place that would affect results and the only inconvenience was the extra bill. 

    My ultrasound showed good news, I had ten little follicles waiting to mature on both sides! I felt so proud of the way my body was working properly, especially after all we’ve been through. My ovarian assessment results actually were sent off and returned while we were still waiting for Kevin’s results. My egg supply score was in the “excellent” category. My AMH was high: 88th percentile. I haven’t heard from my doctor regarding this specific test, and it’s not a diagnostic test on its own. But high AMH is often associated with PCOS. I dabble frequently with ovarian cysts, but my OB told me a few years ago she didn’t feel I had enough symptoms of PCOS to explore the idea further.

    At last, Kevin's DNA fragmentation/oxidative stress results came in. I took a deep breath before opening the file, knowing that if results had backslid, it would likely be the end of the journey.

    The relief and joy I felt seeing this! I was surprised, I really was prepared for a poor outcome. It has been 9 years since Kevin's surgery and I am thrilled that the results have held. The reproductive urologist wasn’t even sure if that surgery would accomplish anything. The only treatment for Kevin going forward is taking supplements to support healthy fertility and keep oxidative stress in check. I'm getting started on some of my supplements also. I need to take quite a few more than Kevin. A new one this time around is Selenium, which has been shown to possibly reduce Hashimoto's antibodies and thereby reduce the risk of miscarriage. My Vitamin D levels also came back at vampire level, so I've started on Vitamin D again too.  

    My IUD will be removed in a couple weeks, and after waiting 4-6 weeks for the inflammation to decrease, I'll have my repeat endometrial biopsy. If it comes back positive again for endometritis, I'll have to do treatment again. I really hope it's negative. The month of hard core antibiotics almost killed me last time. Absolutely brutal. 

    The last test to complete is the sonohysterography to make sure everything still looks good and there aren’t any physical issues with my womb that need addressing. After that, we should be able to make a decision about moving forward. I just need to save up another cool million dollars for these tests. Just kidding. But that's what it feels like. Especially since the discouraging news regarding a payroll error which has resulted in us owing hella taxes. Just one more frustrating setback. The good thing is, I feel sure that this is the last time. The last initial consult; the last battery of tests. Once it’s all paid for and plans are in place, it’s either going to work, or it’s not. And I think that will be the end of it. 

    I’m thankful we’ve overcome the impossible before, because even if it doesn’t work out again, I still get to glimpse the impossible watching my rainbow baby. You never know when something is going to bring up emotions, and a couple weeks ago it happened in one of the weirdest places. Aidia needed a renal ultrasound to double check her kidneys (everything’s fine). During the scan I was looking at all the little perfectly working structures in her kidneys and I almost started crying! It took me right back to my ultrasounds during my pregnancy with her; seeing her perfect heart and all her organs functioning like a beautiful machine with all their intricate parts. She is perfect and incredible and I still am in awe that she exists. 

 

    I also see the impossible while watching Jack, who was a miracle even before I knew that he was. He’s an exceptional person; talented, ambitious, and driven in a way that I didn’t know children could be. Maybe not in the traditional honor student way, but in perusing his passions (and everything else be damned). He reads long biographies of Einstein, Hamilton, Elon Musk, and Steve Jobbs. I see how he relates to people with dreams that most people weren’t ready to understand. I don’t always understand him, but I want to support him, and somehow still parent him in any way that I can (wish us luck).

    Therapy has been so helpful in unraveling all my different motivations and emotions that have mixed together through the years. It’s been very healing to do “parts work” (Look it up, it’s not as weird as it sounds). Therapy has helped me feel more settled regardless of the outcome and it’s brought more peace. I have a lot more grace for myself, specifically for my younger self. I was doing the best I could without knowing as much as I’ve worked out now. I’m starting to believe that a person can find peace even in painful circumstances when you do enough internal work. I am thankful to age because of the growth that has come with each year of life. I want to put in the work to change any circumstances that control over. Doing this fosters an environment of peace. I don’t think I ever really believed that before.

 

    I’ve been learning how to work through trauma in therapy. I came to my current therapist having previously been diagnosed with PTSD by two other therapists, and still felt guilt over the trauma label. Like I was being dramatic. My therapist explained that most of us automatically assume “real” trauma is rape or war, and that’s it. But in reality, trauma is not an “event.” If you want to read more about this, I highly recommend this Article I found online.

    This year is really the first time I’ve ever truly considered the risk to my own health and life. Especially considering the involvement of blood thinners, etc. Maternal mortality is a terrifying and awful thing. For the first time, I got scared. I realized I could never leave the two children that I have. Fortunately, no doctor has suggested that it’s too dangerous for me to try for another child. I just don’t want to push it too far.   

    I have a hard time with the idea of not wrapping up my family on my own terms with a nice little bow, but that’s rarely the way life works. It is hard not to know when it’s the “last time.” Last baby. It’s hard to imagine finding out my baby was, in fact, my last baby when she’s already 7 years old. But that’s part of being human, being mortal. We never know when something is the last time. As my anxiety so often reminds me, you never know when it might be the last time you see or speak to someone. We only have the moment! 

    I’m grateful I enjoyed Aidia’s babyhood, preschool years, and all the early “firsts” because I knew she was my miracle baby. I soaked it in and savored it as much as I constantly could. At least I didn’t take her for granted. My miscarriages started when Jack was only 13 months old, so I filled his baby and toddlerhood with everything I could, too. It may be a forced perspective but I’m thankful that I have loved each stage with my children. I’m going to do my best to continue that. It helps to remember that I have lots more to look forward to, even if I have to adjust my expectations about having any more children. 

 

    I continue to filter many conflicting thoughts. I’m 16 months into night shifts and I’m definitely feeling the shift work sleep disorder. I don’t dare start on a med for insomnia right now when I’m about to try to quit all my meds. I love my job and want to stay at my current hospital for now. But, I worry if progesterone supplementation would be enough to balance out any issues with hormone regulation and circadian rhythm problems. With fibromyalgia, I depend so much on medicine to make it through the day (and night) and wonder if I would really survive not taking anything. But would I survive never trying for a last baby? I don’t think so. 

    I probably need to take some of the responsibility off myself. If a pregnancy is healthy, it’s pretty hard to hurt the baby accidentally. If I lost one, it would probably be due to factors beyond my control. Most moms have to continue working through pregnancies and push themselves through hard shifts. I think I have to remove some of that guilt and anxiety that working would make me lose an otherwise healthy baby. All these thoughts reaffirm to me that this is what I want right now. More than travel, more than financial freedom. One way or another I’ll be able to close this chapter and focus on all the other exciting things life has to offer. No more living in limbo. Thank you everyone for your kind thoughts when reading this very personal journal I post on the internet, I will keep the updates coming. 😉

The Journey To Peace

Well, I’m back. It’s only been 4+ years since my last post! I went to nursing school and have been working as a nurse for a little over a year, and recently graduated with my BSN. I work at a hospital on the pediatric floor, mainly in long term acute care. Basically, I get to hang out with all the babies who are ventilator dependent, and I adore them. I’m significantly healthier than I was 4 years ago, when we decided to take a nice long break from anything fertility related. I’m also still playing with Skyward Symphony, so my music degree isn’t going to waste!

RN, BSN, summa cum laude 

My gorgeous family in 2023

Looking back, it was definitely the right choice to pause fertility treatments; we needed to focus on Jack’s needs for a while. He ended up being admitted to the state hospital in 2020 and stayed there for 7 months. He is now doing a million times better and just finished his first semester of 7^th grade. He fixes all of his teachers’ computers. I’m so proud of Jack! Aidia is the most wonderful ray of sunshine and is excelling in first grade. She just turned 7 years old! She is the biggest cat lady I’ve ever met in my life. I continue to feel lucky every day for my rainbow baby.

I’m sure from the outside it looks like we settled long ago on being content with the son and daughter we have. In a way, we were content enough to focus on other things. But ever since our 7th loss in early 2019, I’ve been swallowing down the ache for one last baby to complete our family. Please don’t mistake that feeling for one of ingratitude. I know I’m beyond lucky to have any children at all.

I imagine the relief of our family being complete but can’t seem to find that peace without at least exploring the possibility of one more. This phase of our lives has lasted a long time. I was pregnant with Jack at 20 years old and we've been trying to build our family since that time. I'm now 33. I’ve tried to lie to myself and say I’m content to be “done” with 2, but it’s just not what I actually want. I wish it was!  Maybe that sounds selfish, but you can’t say I haven’t put in the work over the years to deserve a chance. I don’t necessarily think it’s a bad thing to want a 3^rd child, obviously lots of people do, but for some reason since my chances are so poor- I get the vibe that I should “just be thankful” for what I have. Like, “Girl, sit down. You got your miracle.” Simultaneously, we STILL get asked when we will have another baby. I feel how I feel. I don't want to apologize for it on my own blog. I'm the one who will have to take the toll of all of it- regardless of how it turns out. My heart shatters for people who struggle with infertility of any kind; my personal hopes or wishes don’t negate that.

I can’t believe my baby just turned 7. Time is going too fast. The days are so long but the years are short. Like every other mother, I'm worried I'm missing it and not doing enough for my children- not teaching them enough.

I always told myself that age 35 would be my cut off from trying for any more babies because my risks are already so high. It just used to seem so much further away. It took 5 years to get Aidia, so it feels like it’s now or never.

I don’t know if this journey will be one that leads to another miracle, or if it is a journey to acceptance. I can only hope that it is a journey to peace and that my soul can rest with whatever is in store for this area of our lives. 

I went back to therapy nearly two years ago. I’ve been much more careful with myself as we’ve discussed the possibility of trying for a baby, as I now know how traumatic this tumultuous journey can be. I had specific goals to accomplish before I was willing to dive into anything fertility related again. Therapy has been a huge thing for me- I’ve tried to engage in a healing process, instead of crawling back to therapy after exposing myself to even more trauma. I’ve been slowly working through what I’ve experienced, and unraveling how it might affect the decisions I make now. 

 

I’m trying not to get too emotionally invested in this process or outcome either way. I just want to take baby steps and see what everything is looking like. See what our chances look like on paper. It’s too much emotional pressure otherwise. Right now, a baby is still a pipe dream. There have been many months where I’ve gone back and forth between “maybe, maybe not.”

 

It’s not the same economy that Jack was born into. I work full time nights as an RN. I would be lying if I said I didn’t grit my teeth and wonder how we would hypothetically manage. How would I go part-time? What about childcare, breastfeeding? Pumping at work?! How would I work overnight if I had a baby, or ever sleep during the day? Wouldn’t working dayshift be even harder due to childcare? Would I even survive working nights without caffeine? I now have one child in junior high and one in first grade. Their expenses and needs have expanded over the years. Do I want one child in high school and one in diapers? A 3^rd child would mean less room in a 3-bedroom house, and less of Mom to go around. It would mean less money for upgrades, first cars, college, or vacations. It might stretch us to our limits.

With my history, I have to entertain the possibility that I might be too sick or too high risk during a pregnancy to continue full time work. I take around 7 prescription meds to manage chronic conditions, and I would need to stop all but 1 or 2 if pregnant. That’s going to feel like it’s going to kill me all on its own. It is hard to imagine making it through a 12+ hour shift without at least an Aleve. I’m willing to push through the pain I go through fibromyalgia sans medications, but I am worried about how difficult it will be. This is less important, but I’ve spent over a year working hard to reach my goal weight. What if a pregnancy wrecks all of that work? My likelihood of gestational diabetes returning is also high. It’s a lot to consider.

Working at night affects your circadian rhythm, which regulates hormones. The research on working nights while pregnant being associated with miscarriage, pre-term labor, gestational diabetes, intrauterine growth restriction, etc is terrifying (though they haven’t proved causation). I remember when I first started nights my period was all over the place for a couple months as my circadian rhythm was adjusting. The risk scares me a lot. Rearranging my whole life to reduce the possible risk also feels terrifying. 

Babies must be on Aidia’s mind also. She asks me for a “roommate” at least twice a week. I explain that it’s not always easy for everyone’s body to have a baby and she tells me to pray harder! I love her sweet little spirit and optimism. She came bursting in my room the other morning and explained that she had solved the problem and we could just ADOPT a baby! Like it was as simple as driving down to the animal shelter. She told me she didn’t even care if was a boy instead of a girl. She would definitely be the world’s best big sister. 

Though we’ve been trying to focus on “baby steps,” our consultation with my RE cost a few hundred dollars and THEN it felt like “oh ok this is for real.” My doctor wanted to repeat a bunch of tests. I’ve been working with this same doctor since our 4th loss and trust him completely. He said I was brave after all we’ve been through to come back and even try for one more baby. I don’t know if I’m brave or actually just stupid. He emailed me a copy of his notes and I can’t believe the pages and pages of tests and procedures we’ve had in the past 13 years. I almost forgot what it took to get Aidia here. 

 

One of the hardest thing with fertility testing is figuring out billing. Usually insurance isn’t contracted so we opt for self pay prices. I call around with CPTs but companies get confused and you get bounced between representatives forever. Sometimes the nurses at the fertility clinic will get on the phone with 3rd party labs and try to figure out costs for me, which is amazing. At the end of the day, you usually have to decide to either take a gamble, or, pay the self pay price and know what you’ll pay. The first blood panel I needed cost $600 out of pocket to run. Insurance covers the CPTs but not the 3rd party lab. So you can bill insurance and hope they cover it, but if they deny it, you’ve lost your chance at the self pay price, and now that $600 would turn into $2000. I was a bit stressed about paying for the blood panel, but in the same week I was offered 3 extra partial shifts with call in pay which basically paid for it. That was kind of amazing timing.

The blood panel was a lupus/ antiphospholipid syndrome extended panel. Despite the autoimmune cesspool which is my family history, I actually tested negative for lupus and APS way back with a hematologist over ten years ago. I had read enough about APS to know it can be really brutal on pregnancies, but always felt relief that I had tested negative and ruled that issue out. I was fine redoing the test if that’s what the doc wanted. I decided to start with that test because I was confident it would be negative and I could mark that off the to do list easily. 

Then I learned that APS antibodies can be transient. 

I was completely shocked that I tested positive. Granted, looking at my history it makes a lot of sense. Not sure why these things still surprise me but this one really did. This one hurt my feelings because I was so sure it wasn’t going to be an issue. 

Just to be clear, I don’t have lupus, just the APS antibodies (which occur more commonly when you have lupus). This is the third condition found in my blood that increases the risk of blood clots. I sat in a stupor and wondered- how did I ever have children at all? How have I never had a blood clot? Should I be taking baby aspirin all the time, like starting yesterday?! How many dormant autoimmune issues do I have that are yet to be discovered? 

Basically, antibodies in my blood are mistakenly attacking cardiolipins (which are a fat important for blood clotting). These antibodies can lead to impaired blood exchange between mom and baby, cause placental insufficiency, possible impaired hCG release, and can lead to repeated miscarriages or stillbirth.

I just can’t believe we have another diagnosis working against us. It feels like we have all the top risks for miscarriage. Hashimoto's, endometritis, MTHFR, APS, and Factor V Leiden. Plus on Kevin’s side there is a history of high oxidative stress and DNA fragmentation. I look at that list and I feel deflated. But we’ve beaten the odds before. 

The treatment for APS is aspirin and Lovenox in pregnancy- which I did with Aidia anyway until I had a subchorionic hemorrhage with her. At that point I stopped the Lovenox injections and continued aspirin. Since I have other clotting issues here’s a good chance that I would be doing aspirin and Lovenox anyway. Especially with 7 previous losses. So this news doesn’t really change anything, it was just a bit triggering. Bad news never feels good. As far as the idea of going on more blood thinners in a pregnancy…I’m scared of having another hemorrhage and losing a baby to overcorrecting the risk of clots. Aidia survived a hemorrhage. It just feels like the worst game of “guess and check.” 

Though it may be brave to face the infertility world again, I also know it is equally brave (if not more) to know when to stop. I’m just not sure which hurdle I’m facing yet. 

I read an article online where a psychologist talked out the traditions we have around women, like bridal and baby showers, and how they celebrate the “beginning.” She said “It makes sense that that’s what we anticipate. When we’re done having kids, our perception of ourselves changes. We must navigate the expansion and contraction of ourselves in relation to who we thought we were, what we expected to become, and the reality of who we are…women who don’t firmly ‘close the door’ - be it mentally or physically- can be tormented for years, never letting themselves feel complete or enough.” 

I love working in pediatrics. My goal is to someday transfer to working in a NICU and get certified for critical care in that setting. Right now, it feels like there’s this big hole in my heart and I hope that I will be able to heal it to the point that I could work in a NICU without feeling triggered by my own traumatic experiences. The envy can be biting in some situations. I have more work to do before I’m ready to pursue that goal. I always thought that if I could settle my feelings and complete my family, I could be at rest with those emotions and give my all to help others. It probably all runs deeper than that, and tying things up with a nice little bow won’t solve everything. I don’t know what this year is going to look like, but I’m hopeful that I can face it with a little less fear, and a little more commitment to finding peace and satisfaction no matter the outcome.