Visit to the Fertility Clinic and A New Plan!

This trip to the fertility clinic came a little earlier than we had planned, but as I wrote around mother's day, I felt strongly that it was time to look into testing, because sometimes testing itself can take months and months.  We don't feel ready to try pregnancy again quite yet, but we are ready to find some answers for the future.

I'm so glad I listened to this feeling, because as soon as we were talking with our doctor (who is amazing, brilliant, has probably a dozen degrees, and is a recipient of the "Most Compassionate Doctor" award) I felt like I was in the exact right place at the right time, doing what I should be doing.  It was a great comfort to me.

To start out with, after we had discussed my very LONG and detailed history, I was thrilled to hear him say basically "They've been focusing way too much on blood clotting factors, it might not have anything to do with that."  THANK YOU.  I have never actually had a blood clot, and with all the anti-clotting therapies I've done, I was feeling really discouraged and thinking there must be more to the puzzle.  He said they haven't even done the "normal tests" to determine what caused the miscarriage.  Granted, because of the blood clotting disorder he does want me to begin on a baby aspirin when we start trying to conceive as a precaution. Which is what I did with Jack and what I feel like is safest for me and a growing baby.  But I don't think it's going to fix any problems.

He said although it's possible that thrombophilia may cause problems with miscarriages, and he can't rule it out for me, he believes MOST of the time, Leiden Factor V does not affect the outcome of a pregnancy.  (Once again, thank you!  I think 11% of the population has this factor and many don't ever know they have it).  This is a very conterversial topic in the medical field, but when it comes down to it, I don't know what else we can possibly do with this issue.  I've done any treatment that would be used if this was the actual issue.  He said about the same thing for the low Protein C and S (although he wants to repeat that bloodwork and see if any activity has changed since my last two tests).

This brings us to the second blood issue, MTHFR (once again, this is not a naughty abbreviation but an actual diagnosis).  I told him "Well they ruled that out as causation because there were no clots and my homocystiene was not elevated when I lost the pregnancy"  He kind of shook his head and said while that might make sense from a hematologist's point of view, the problem with MTHFR is broader than that.  In a nutshell, this disorder is like an enzyme deficiency.  So when I take folic acid, my body can't really convert it into a usable form (which he called metafolin).

My other doctors compensated for this difference by having me take a ton of folic acid, but if I still couldn't convert it into a useable form, what was the point?  Everyone knows how important folic acid is for the start of pregnancy- without it the baby can have severe neural tube defects that can end the pregnancy very early.  My eyes widened as he was explaining this- could it really be that simple?  And then the real kicker- he told me that there is a prescription prenatal that contained 1 mg of Metfolin.  Meaning instead of taking crazy amounts of folic acid and trying to convert it, I can actually just take the active form.  HELLO?!  DID NO ONE ELSE IN THE MEDICAL FIELD KNOW ABOUT THIS?!  Did you know you can BUY METAFOLIN ON AMAZON?!  I feel somewhat annoyed that I didn't understand this concept (since I work in the vitamin field) and also that no one else explained this to me!  So he wrote me a prescription and told me to start on this prenatal right away, he wants me on it for several months (and even through my entire reproductive life).

Also, after reviewing my history, he has decided that I should continue with Progesterone supplementation in future pregnancies, but he will be prescribing double the amount that I used with my last pregnancy (thank you that's what I wanted before!).  My progesterone levels from previous reads during pregnancy were lower than he was comfortable with.  Thankfully, it looks like I will be allowed to use vaginal suppositories/pills instead of injections!  Yay!!

As far as my thyroid, it is being managed well for the most part, so I just have to stay on my daily medication.

So now we move on to all the other testing that they want to do to find problems and causes.
Unfortunately, before they can do any more testing, I have to have the Implanon removed from my arm (ACKKKK).  I expected as much because that form of birth control messes with all your hormones, etc.  I am dreading getting it out because it was so awful getting it in...but I knew it was going to have to come out at some point.  I need to have it removed, and then will have to wait at least 2 months (2 regular cycles) and then they can start the other testing.  I am looking forward to having the Implanon out though, it hasn't been the easiest on my body.  I have really felt the hormones affecting me.  I've gained weight on it and have felt more run down (and have had horrible unpredictable bleeding).  All of those things should get better once it's out.  I would love to lose some weight!  It does make me nervous to go off of hormonal birth control (just call me fertile myrtle) but I'm sure everything will be ok.

One of the first things he wants to look at is my egg quality.  Normally having poor egg quality is a problem with older women, but you never know, so we need to check it.  The same goes on Kevin's side, so the doctor wants to do a semen analysis to make sure there aren't sperm that have "bad DNA." Motility and those other kinds of problems with sperm aren't on our list because we don't struggle to conceive, just the DNA side of it.  Hopefully we can hold off on this test because it is more expensive, and there isn't too much you can do about it.  This test is further down on the list to be done if they rule everything else out.  If this turns out to be an issue, there are two options.  The first is using a sperm donor (we're not interested in that option) or you can just try to improve the overall health of the sperm hoping that they will provide good DNA packages.  So the Dr is putting Kevin on a special vitamin/amino acid supplement starting now, to basically make sure the sperm is as healthy as possible.  He needs to be on it for several months also.

Probably one of the first tests we'll do after the two month wait period is to rule out any problems with the anatomy of the uterus using a saline ultrasound, which they will use to evaluate the cavity and such.  This makes so much sense to me and I've wanted to do something like it for a while.  They will check for fibroids or any type of damage.  I always wondered about this because my first baby was over 9 pounds and the birth was really hard on me, and then I've lost all babies since then, could there be some type of internal trauma or damage?  I'm excited to get the results back from this test, because either way it will put lots of my questions to rest.  Not as excited to have the procedure done however...it's one of those they tell you is just "uncomfortable" but then offer you Valium if you want it.  Riiiight.

Then, of course, lots of blood work is required.  They want to redo some of my large blood panels to check them against previous results (like my antiphosphilipid one, protein c and s, etc).  They also want to do blood work to check certain hormones like Prolactin at certain points in my cycle. And they will check my blood for immunity to diseases I've had immunizations against.  If immunity doesn't seem strong, they may re-vaccinate me (unlikely, I've had all my shots and boosters).

The Dr mentioned that because none of my doctors did an ultrasound during the last four pregnancies, he can't confirm that they were actually in the uterus, and could have in fact been ectopic pregnancies that ended on their own.  That is scary to think about.  If that was the case, I'm thankful that I never had any rupture!  He explained to me that because of my history with recurrent miscarriage that my risk for ectopic pregnancy is much greater and I always need to be aware of that possibility.  Once I become pregnant, the clinic will do a transvaginal ultrasound at 5 weeks and 2 days, because at that point they can see a sac and confirm that the pregnancy is in the uterus where it should be.

Testing that makes sense for us to have (but I'm hoping we won't end up doing) is the karotyping.  It's not genetic screening in this case (we're not looking for genetic diseases) but rather it checks to see if Kevin or I have what's called "Chromosomal Balanced Translocation."  In a nutshell this means that we turned out ok, but part of our chromosomes are off (but somehow balanced each other out to make it act normal so we turned out normal).  This is fine for the person with the balanced chromosomes, but it becomes tricky when the chromosomes try to mix and it can create problems.  Once in a while, it can somehow work though, which would explain Jack being perfectly healthy.  I would love to do these tests just to know, but we are going to wait on them unless we aren't getting answers from the other tests, because it's about $500 a person at the cash cost.  And who knows about insurance helping at all these days...  So the karotyping will probably have to wait a while (if it's necessary at all).

A test (that I have to do for sure) is freaking me out just a little bit- A CLOMID TEST. ahhhh!  Run for your lives!  My cousin is pregnant with triplets right now from this miracle-making medication...so I'm just a little anxious about the idea of needing to take a high dose for 5 days straight.  This is not to help me conceive, it's so they can see how my body responds to ovulation and makes sure that everything responds properly to make a nurturing environment.  But just knowing how easily I get pregnant, I told Kevin he has to live in a different house while I'm taking Clomid.  I'm pretty sure if we shake hands while I'm on Clomid I will have quintuplets.  

I am a little concerned about the scheduling of all these tests, since they have to be at an exact time on my cycle (so can only be scheduled a day or two in advance) and the clinic is 45 minutes from my house.  Also, I can't take Jack to these appointments for obvious reasons.  Also, Kevin is in full time doctoral school and I work from afternoon to night.  So I am wondering even logistically how we are going to make this happen... but I'm praying something will somehow work out.

We walked out of the clinic seeing dollar signs...that part is a little crazy.  The good news is we have a few months before we can start testing, and our loans finally came in to help with the normal bills, so with me working some extra hours we should be able to save up for at least a couple tests at a time.  If it's God's will for us to take this journey, it will work out somehow.

Occasionally my hope turns to sudden fear and I think, "What if it really is my blood and they really can't do anything for it?"  But we just have to take this one day at a time and have faith.  Fear like that doesn't help anything.

I felt so overwhelmed walking into the clinic and seeing pictures of all these miracle babies on the wall.  I know it's possible for us, even though it might be a lot of work, money, time, patience, stress, and "uncomfortable procedures" (just say painful already).  The doctor was very happy to see we have a son and it gave him confidence that it's possible again.  Sometimes I feel a little mad at the world that we have to go through this process and I wonder why it can't just be simple.  But I try to get rid of that attitude pretty fast.  It is what it is and I'm just thankful there is so much help and hope available.  Kevin told me he can't wait to hold another newborn of his own and tell them "You were hard, you caused a lot of problems." haha- wouldn't that be the most wonderful thing in the world? I'm sure he wouldn't even be able to fake scold them because he wouldn't be able to wipe the smile off his face.  

We are dreaming of you baby.  We hope this leads us to you. <3

What To Expect When You're Expecting

What a crazy and wonderful two weeks it has been.  We moved into our new apartment (which we love), and got a huge surprise three days after we moved in- Kevin got a phone call that told him that he had been accepted to the Doctoral Program for Physical Therapy, at the school we just moved 4 minutes away from.  We were floored.  The rest of the class had been accepted in February and tuition was already past due.  Someone had paid the deposit and then dropped out- and Kevin was the very next name on the list.  It was nothing short of a miracle!  Obviously we have been scattered and trying to quickly figure out how we are going to deal with finances- but things have started to work themselves out.  Hopefully our loans will come in quickly (since they take a month to process) and I have been looking for part time work.  I had a good interview yesterday, so I’m hoping that I will be able to start a job within the next week or so.  We have unpacked our house, and though it’s not totally clean yet, it’s comfortable and peaceful and I feel very happy to be in our new place.  Kevin is starting his Doctorate program tomorrow- dreams are coming true.  I really expected that as we settled into our new life, my baby aching would settle too, and I would be distracted with everything else and be consumed with all new things.  That’s not quite how it has worked out.  Maybe it’s because we’re back in our own place; maybe it’s mother’s day, but the aching has been difficult since we moved and that hole I feel in my heart has seemed to be getting bigger.

As usual, I’ve found myself diving into the world of self-improvement to fill the void and make me feel like I’m doing something worthwhile with my time.  Time that would otherwise be spent just at home, which sometimes eats away at me and makes it easier for me to slip into depression.  I’ve tried harder to keep up with the housework.  I’ve rededicated myself to school and figuring out how on Earth I’m going to finish this program (which is way more difficult to do with a child than I anticipated.)  I’m starting piano lessons this week to improve my abilities in that area of music. I’m starting a part time job (if everything works out) with more hours than I’ve had since Jack was born- so I’ll be a first time working mother.  Kevin will be in an intense school program during the day, which I’m sure will be a great experience, but a new stress for both of us.  Also, I just joined the rec center and have set a goal to work out in some form at least 4 times a week.  Basically, I am keeping myself busy with good things.   

I’m not sure what started the hurt again- it is more pronounced in my life than it was a month ago.  Maybe it’s because I got really upset a few weeks ago because I had encountered several things consecutively that made me feel that the sanctity of life is just not respected in this country.  I feel like there is not enough respect for those babies who lost their lives because of purposeful procedures initiated by their mothers- a concept I seriously can’t even stomach.  I would bury every one of those babies with respect and dignity instead of their resting place being in a “toxic waste” bag to be burned with the rest of the “medical waste and tissue.” I've become much more sensitive to the issue of abortion through my experiences.  I don't think that being upset about it brought the pain on, but I think it amplifies it.

The hurt that I’m describing has been changing, not to be less painful, but just morphing back into readiness to try again.  I have felt this "switch" happen before, where all the sudden my grief feels less present than my hope and I feel ready to be pregnant again.  It turns from "waiting for the right time" to "nothing is going to happen if I don't try and fix the problem somehow."  It really makes no sense timing-wise right now to look back into this.  Money is the first issue- we are now going to be living on loans and a part time job.  I'll be doing everything I mentioned before (along with the normal mom/running the household stuff) all while Kevin is doing his doctorate.  It is literally insane.  But so was having Jack half way through college- and he came at the perfect time and everything worked out.  I've always been one of the attitude "If you want something, make it happen." and I'm not necessarily patient about it either... so what happens when you don't have the power to make something happen?  It makes you dependent on God for one thing, but it also drives me to want to at least be working on my goal in someway, or else how will it ever happen?  

This week has been so heavy with the baby ache that I've decided to make somewhat of a compromise. We decided to wait a year before we tried again- and I'm six months in.  I'm impressed I made it this long without the ache and impatience feeling overwhelming.  So I thought "Maybe I can do consultations, appointments, tests for six months or occasionally until next year."  I think what it comes down to is that I'm not in control and it breaks my heart- so I have to feel like I'm taking charge of something.  If I do tests and research (if those things count for anything, or make a difference at all) at least I'm showing God that I'm trying everything I know how to do on my end.  I know I’m not ready to be pregnant again, but if I’m feeling this ache again, perhaps I can start seeing doctors.  That’s a start.  I'll be doing something more than just sitting by and crying and wishing and aching for my lost babies. 

Maybe it's being in our own place, maybe it's mothers day, I'm not sure what is motivating this sudden pain and urgency to get back in the game.  I try to be very prayerful.  If I know something is a prompting from God and not my own impatience, then I know things will work out the way they are supposed to.  If I need to do tests for 6 months, so be it.  At least I'm working towards our goal.  I just don't feel like I can sit around for another 6 months only waiting in this pain.  I just feel that someone is missing from our family.  Jack keeps talking about turning 3, which is still 4 months away, but it's something I really can't seem to comprehend either.  Children really only keep getting bigger don't they?  At least I know I will appreciate it more if we are ever blessed with another.  My prayers have changed and I am learning to accept God's will and trusting that it really is best in the end.  If I realize all that I'm feeling is impatience, I will change my plans.  I have been praying to find a job that will make enough that we can afford to maybe look into a fertility clinic.  We will see what God's will is.  When I look into fertility clinics, I feel discouraged all over again.  Because I see the tests they offer, and common reasons for pregnancy loss, and it looks like everything else we've tried.  What more can they do for us? But I wrote a message to a fertility clinic near us anyway, just to see what they had to say on the matter.  If it's only 50 dollars to go in for a consultation and talk about what they could do for us or ideas they have that we haven't tried- totally worth it.

I would say that "some days are easier than others" but it is more accurate to say "some days are less crazy super hard than others."  As I was unpacking I pulled out my book "What to Expect When You’re Expecting" and almost burst into tears right there- I don't expect a live baby anymore.  What to expect when you're expecting--for me it's a loss.  I expect a miscarriage. I find it hard to be realistic and not get my hopes "too high" if that's possible, but also have faith that I will have another living child.  The idea of a positive pregnancy test just starts my mind on the course of "this child will die before they are born, probably within the first two months, and I will never meet them."  Yet somehow, my heart aches to try again.  This is why I got the implant in my arm- so I couldn't have a hard week and change my mind so suddenly to be ready to go through it again.  But the idea of trying pregnancy again has been on my mind constantly even though it makes no logical sense with what is going on in our life right now.  That's why I think a new doctor might be a good start; the waiting can sometimes get pretty tough.  This always seems to happen right as I've settled into the life of being a mother with one child and actually feeling happy.  Something triggers it and once again I get desperately sad and lonely for another baby and feel somewhat disgusted in myself to watch so many women around me do something that I can't do- even though I have tried four times to have a second child.  I can't understand why this won't work for me. 

A study done in 2002 by researchers JB Ritsher and R. Neugebauer “evaluated the Perinatal Bereavement Grief Scale (PBGS)—the first scale designed to measure grief following reproductive loss in terms of yearning for the lost pregnancy and lost baby.” The study compared “measures of attachment and investment in the child and divergent validity against measures of social desirability and depressive symptoms.” Not that we should need a study to evaluate the true grief many feel after a miscarriage, but it does help to show that the feelings that are present afterwards certainly prove that a miscarriage was a “real baby,” worthy of a grieving process.

Some days you just have to have it out all day and cry and think, so that you can go back to normal life the next day.  I worry sometimes that I'm fooling myself- that these losses were a start of a pregnancy that didn't take, more so than a "loss of life" and that concept terrifies me because I have felt so much grief and mourning.  I told Kevin "I can't think of it as something other than life, because I remember when we were at that stage with Jack, and I loved him then like I love him now, and he is very much alive, so how can it not be a loss when they don't make it to birth?"  He just replied simply "It is life."  Maybe it would seem more real if we had ultrasound pictures from 8 weeks or something like that, but does it even make a difference?  Death perhaps is more difficult to understand when it happens so early.  How do your mourn someone you never met but loved so much?  My heart hurts for them the same.  To be pregnant and then to suddenly not be, that is a loss.  And I suppose in the end, the exact science doesn't matter as much as the big picture, and the emotions we go through, and the children we yearn for to join us.  To have a positive test turn negative, that is a loss and it's just the adversary whispering "You're fooling yourself, mourning nothing, there was no baby, and there is no hope for the future."  

Something that I have been, I won't say "angry" but, "upset" about is the loss of excitement surrounding pregnancy.  Before I was pregnant with Jack, or after he was born but before we experienced any losses, pregnancy was the most exciting happy thing in the world to me- for a friend, family member, acquaintance, didn't matter.  I felt like throwing them a party. Ultrasounds, seeing a new baby blessed, meeting a friend's newborn, were all thrilling and joyful experiences.  Now, no matter how positive my attitude, or how strong my self-control, all these things are accompanied with sadness and loneliness and painful memories.  Why are all these things tarnished for me, and how do I get that joy back?  I know that we all have painful areas in our lives and different things will trigger that pain.  I just wish it was something less thrilling (and less frequent to be honest...I don't like to be brave about it so often).  I know that no pregnancy is "care-free" but I think for the most part, moms expect their babies to live and be born when they see that positive test.  For me, that now brings stress, and what feels like unrealistic hope at the same time.  After a loss, I scold myself for ever thinking things could change.  What did I think was going to happen?  Why did I do this to myself?  I can't imagine ever having a pregnancy where I don't feel nearly consumed with worry that everything is ok and somehow working. I imagine that even in a successful pregnancy I will have to choke down fear until the very delivery day.  But then again, it never stops does it? Moms worry about their children and their wellbeing their whole lives- it doesn't end with birth!  So I will learn to be brave and let go the things out of my control and try to be happy and focus.  I wish just one time though, I could look at a friend's ultrasound and feel that joy and excitement without the side of painful memories and grief.  I feel like I've lost a great treasure because of these mixed emotions.  I tell myself perhaps if we have another miracle baby someday- at that point I will know it's possible and I won't feel the same amount of sorrow or grief.  Maybe it will shrink with time and miracles, and that joy will return as I accept my plan in life.  Maybe.  

I remember the joy with my second pregnancy.  I was smiling everywhere I went for those few weeks.  I wrapped up the beautiful white dress I wore for my own baby blessing and gave it to Kevin to announce to him that we were expecting.  I had a whole list planned out for how I wanted to do things with the second baby.  We were touring hospitals when I was just short of six weeks, beaming the whole time.  The excitement was so different than with my first because I knew what being a mother meant.  I had my hand on my belly constantly.  When I lost that baby, I felt like the whole world buckled and fell down on top of me.  

We were actually watching "What to Expect When You're Expecting" a movie which I loved, and in the part of the movie where the girl finds out she's lost the baby I started to cry thinking how awful it would be.  When the movie was over, Kevin and I were sitting on the couch and I remember telling him "Can you imagine how horrible it would be to wake up in the night and find you're bleeding like that poor girl?  I feel so bad for people who that happens to."  I remember rubbing my belly and standing up to go use the bathroom as Kevin was still sitting on the couch.  I went into the bathroom, and found I was bleeding.  The irony alone almost killed me.  For that first night I tried to tell myself I was just freaked out because of the movie (we had called the doctor and he assured us it was fine).  But by the time the cramping started I knew.   I struggled so much to process how this could happen, and that inexplicable joy that I had been feeling was gone, along with a bit of my ignorance.  I was just a little less naive.  When I lost my third pregnancy- my shock and horror that I felt lasted even longer.  It was like I was living a nightmare.  How could this happen twice in a row?  I had finally started to heal from the first loss, how could God take this baby from me too?  This was no longer a "fluke."  This was a problem.  Then with the fourth pregnancy, and the fifth...each time I became more hardened, less hopeful, less naive to the possibilities.  I lost that glow and joy I felt with my second pregnancy.  Now it's just what I expect.  What I expect when I'm expecting.  Yet in the back corner of my mind, I know that our next baby has a 70% chance of surviving and being born healthy and alive with no medical intervention at all.  And perhaps that's why every 6 months or so I feel ready to give it a chance.  But in the end it's not about the statistics, it's about God's will.  I hope that the spirit will somehow help me to feel that maternal joy again and take all the dark and depressing feelings away.

It's true that things are in fact, less complicated and easier with one child.  I just wish I could settle into that life and appreciate it without having so much pain because of the lack of more children.  It seems ungrateful.  But at the same time, I feel that having children is one of the most important things God gave me time for, and so it is difficult to tell myself I shouldn't have these feelings and be glad I can do other things instead- because it is still just second best.  But if it's what God wants me to do right now- I try my best to be thankful and appreciate everything that comes in life with having an only child.  I really do celebrate my wonderful child.

 

Saturday night I told myself “I have to be brave enough to go to church tomorrow.”    Because I am a mother and I do have a child who is alive and healthy and incredible.  I need to focus mother's day on that, instead of this deep sadness that seems to spill over on certain days.  For some reason it’s hard to go to church and listen to all the wonderful things about babies and mothers.  I keep telling myself to adjust my attitude and to stop ruining wonderful things- like mother's day and how I could use it to be a celebration of my wonderful gift- my son Jack.  But instead, somehow in the frustration of not finding the shirt that matched the skirt I was already wearing for church- I collapse in my closet crying and I am forced to admit it's not actually about the shirt.  Mother's day is hard.  I really looked forward to church today- I knew that there would be uplifting messages for me and comfort- even if there were some painful moments.  But after not being able to get dressed or put my make up on without several little breakdowns, Kevin suggested that we just stay home today.  It makes me feel a little more like a failure, but I guess at some point you have to admit you're only human.  I lit four little candles to burn in the kitchen for a little while for my heart's sake.  I went into the office and picked up the guitar I've had since my 16th birthday and pretended I understood how to figure out chords for a little while.  Then I fumbled through some hymns on the piano for a little while.  I miss music in my life, and all the ensembles I got to participate in through college.  I’m glad I start lessons again this week.  It will be healing for me.   

As every mother does, I have definitely had some experiences I never anticipated and that I felt were too much for me to handle- but as mothers, we rise to the trials that God gives us and we keep going.  The love for our children is stronger than the trials they come with. 

Overall, I know I am so blessed and I am so especially grateful to be a mother to the most wonderful boy.  I'm blessed beyond measure to have such a loving and dedicated partner to navigate this life with and for caring, understanding, and considerate family and friends.  

Happy Mother's Day.  To my own mom, to my friends, sisters, extended family, in-laws, and every nurturing woman with a mother's heart.  I love you all!