Third Time’s a Charm?
March, April, May: Prep, Transfer, Test
I started this blog with the goal of sharing my story AS I walk through it. I failed at that on April 2nd 2021 when we went in for an embryo transfer. I feel the need to express why I did not share at that time. First off, I was scared. I was scared that it wouldn’t work and then I’d have to share another loss. I was scared that those I knew and saw on a regular basis would have questions for me or look at me differently. I was too afraid of judgment. It’s not “safe” to announce pregnancy until the 2nd trimester in many peoples’ eyes. Two months later, and after a 3 hour car ride with my husband reminding me of why I started this whole thing (and basically demanding me to post an update), I’ve sat down to write.
In February, I went to see a rheumatologist based on a test coming back positive for “antiocardiolipin antibody”. In order to see if I had this condition, I needed to see a specialist and have more bloodwork. After an extensive exam, questionnaire, and bloodwork panel, I received a phone call early March telling me that everything came back normal. Now obviously, I am very happy that there is nothing “wrong” with me, but on the other hand, it would have been really nice to have a reason for why I’ve been through multiple miscarriages. The Dr. told me that I could proceed with IVF, and that she’d recommend taking baby aspirin to help blood flow to the placenta.
I called the IVF clinic to tell them and they told me to call back when my next period started to go in for bloodwork (you can’t just start a cycle anytime). I kid you not, two days later I was back in their office. Thank you monthly cycle for being so efficient and for once working in my favor! They said it was very unlikely that my hormone levels had dropped enough to start a cycle since I had miscarried not too long ago, so they’d probably monitor me until they reached zero before moving forward, but that they would call me that afternoon to let me know. I received a phone call later that day and was told that my levels were back to normal, so we would start a transfer cycle this month and they would send medications to my pharmacy to start TONIGHT.
Now those who have been through infertility and IVF may know that things seem to move at the speed of molasses when you’re waiting. However, these two days in March felt like LIGHT SPEED. I went from waiting to hear that my miscarriage cycle was over to starting an IVF transfer cycle quicker than I could imagine!
After being on medications for a few weeks and going in for bloodwork every 4-5 days, I was told that my uterus would be ready for an embryo transfer on Friday April 2nd (which just so happened to be Good Friday). I started the progesterone in oil shots each night which last through most of the first trimester if things are successful. Dave and I took the day off work for this exciting event. We went to Greenwich Hospital which was a new setting for a transfer - very different from the homey feel of the previous fertility clinic we were at, but the people were great and we had lots of laughs throughout the experience.
Yes, Dave’s face looks confused - the nurse told us “say sexy” as we were smiling for the picture. Not the most appropriate phrase, but it made us laugh
The transfer itself was so quick - I don’t think I was gone for more than 10 minutes, if that. It felt very odd to get up off the table and walk back to the operating room knowing there was a potential little human trying to attach to my uterine lining! We reviewed discharge instructions and then headed home. Dave stopped at our favorite bakery and picked up a croissant and some iced buns for a snack. We spent the day relaxing.
The Monday afterwards, I went in for bloodwork and was told everything looked good. I continued shots and medications and had to wait 7 days before going back for a pregnancy test. Thankfully, working Monday-Friday kept my mind busy. We tried to continue as normally as possible until the day of the test.
Monday, April 12th, Dave was off work for April break, so he drove me to my bloodwork and back home. We patiently waited for the phone call to let me know if my HCG levels confirmed pregnancy. Now I have an app on my phone where test results get uploaded to, and so saying “patiently waited for the phone call” is a little far from the truth...we were not patient, and I checked the app multiple times that day! Finally, around 11am, I saw HCG results on my phone. It was 254mIU/mL, which I had no idea how to interpret. I texted one of my friends and she said “I’m no doctor, but looking at the reported level and the range, it looks like you’re pregnant!”
Like any (not) wise person, I opened google and started typing... HCG, IVF, pregnant, levels…I was 99% sure that we were one step closer to having a baby, but waiting on that phone call from the doctor to confirm. HOURS passed, and at 3pm, we received the call that we were officially pregnant! I was told to return that Thursday for more bloodwork as they needed to see that my HCG levels were doubling in order to have a successful pregnancy.
On Friday April 23rd, I went in for more bloodwork, and my first ultrasound, which I was unbelievably nervous about. My nerves were increased when I was told Dave couldn’t come in with me, so he sat in the car and waited for me. It was so early on, there wasn’t much to see, but there was a yolk sac which is a good sign. Turns out they stop testing for HCG once they’ve seen the yolk sac as that’s enough evidence that you’re pregnant.
After visiting the IVF clinic regularly 1-2 times a week, I was told that my next visit would be May 7th. Dave decided to drive me even though he probably wouldn't be allowed in. I was sitting in the waiting room as I saw a woman walk in with her husband and say “guys are allowed now, right?” And the receptionist said yes. I stood up and said so my husband can come in from the car?! They said sure. When I texted Dave, he asked if I really wanted him to come in his slippers, shorts and a tie dye t-shirt. I asked if he was going to let his attire prevent him from witnessing the ultrasound (nope!), and told him I'd warn people he wasn't prepared to come in. After I described his outfit to the other couple in the waiting room, they said “oh we definitely pulled up next to that guy”!
A friend texted me as we were sitting waiting saying she wished she got her daughter's first ultrasound on video and that she'd recommend recording if I felt comfortable with it. After discussing with Dave, and telling him I didn’t want to capture a sad moment on video, he said in the worst case scenario we just delete the video, so we went with it and here is what we saw:
*SOUND ON! It was such a relief to hear a heartbeat! And you can hear Dave is very happy with 168bpm!
Tuesday, May 18th I had my appointment with my regular OBGYN. I had seen a new doctor in February when I was miscarrying and she was the one I saw today. She walked in and said “boy am I happy to see you here today under these circumstances!” She asked a little about how it happened so quickly and I explained. She then started the ultrasound and immediately pointed out the baby’s beating heart on the monitor. It was amazing to physically see it. She said it was measuring about 9 weeks and 1 day (the IVF clinic had me at 9 weeks and 2 days, so it was pretty much right on track!).
I asked her if she minded if I took a quick video for Dave because it was so amazing, and she told me to go ahead. Now I don’t know if any of you have experienced the message “storage full”, but this really was THE MOST ANNOYING time for that note to pop up on my screen. Sitting on the ultrasound table with an ultrasound probe inside of you and a busy doctor standing there is not the time to delete videos to create more storage. The doctor suggested FaceTiming Dave so that he could see and she could say hello since she quite enjoyed him last time they met. Tech issue number two - FaceTime call didn’t register for Dave and we missed the chance.
Even still, this was the best experience I have ever had in an ultrasound room and I came away feeling joyful, and amazed at the miracle of life. I have the visual etched in my memory and don’t think I will easily forget it. Lesson learned: always check storage on your phone before important moments!
Now while I didn’t get to take a picture/video myself, I was sent home with an old fashioned photo of the little one which is a lot more human-shaped than the last ultrasound I had!
I had bloodwork at 10 weeks to determine if there were any chromosomal issues, which just came back this week - no concerns!
Graduation Day
On May 28th, the doctor decided that it was time for me to go down to shots every other day...woohoo! While this was exciting, I was still nervous as it meant that my body had to kick in to progesterone mode, keeping levels up without the help of medications. Friday June 4th I had more bloodwork to see how my body was doing without the daily shots. The doctor decided to take me completely off estradiol and progesterone shots. This made me really nervous as I dropped from around 45ng/mL of progesterone to 33 in that week when they decreased the shots. The nurse said that the doctor was not worried and that progesterone fluctuates so I did not need to worry. That’s easier said than done.
I prayed that my levels would improve and do what they were supposed to do. The doctors had me return on June 8th to check levels again. I assume this is to make sure that levels remain somewhat stable. And guess what...I “graduated”! They told me my levels looked great and that I should be seeing my regular OB very soon for an appointment. I have that scheduled for June 15th which makes for a one week wait.
I promise to update you more efficiently as things progress. Please pray with me/for me as going through pregnancy after losing 4 babies is not a smooth journey. By the grace of God, I have experienced more peace than I could imagine (thank you to everyone praying for me - I know there are lots of you!), but there are days when I worry and fear the worst. For those of you in that boat with me, my prayers are with you! All we can do is take things day by day (or hour by hour if it gets real tough).
I am still scared that I will have to go through and share another loss, and I recognize that sharing this news at this time comes with a risk, but I am being vulnerable in hopes that it will help someone else out there. I said I would share my story in the midst, not waiting until I had a happy ending. I don’t know how this story will end, but I know I am meant to share it even if it helps just one person.
13 Week Ultrasound Update
As promised, the update from Tuesday’s appointment:
We had a great ultrasound on the 15th where we saw a heartbeat of 163bpm, arms, legs, body, and a healthy looking neck. It was slightly painful as the sonographer pushed down hard to get a good view, but it was a huge relief and joy to experience such an ultrasound. We texted our family and close friends and showed them pictures of a more “baby looking” creature in the ultrasound. The doctor actually called me later that day to inform me that the baby was growing at a great rate and my due date was moved to December 16th (from the 19th), so I was 13 weeks and 5 days.
The next day after work, I went to use the bathroom and what I saw made me freak out (the toilet turned bright red). Thankfully, I was on the phone with my sister at the time (yes, while I was peeing. We both have significant others who work long hours, so tend to keep each other company and even in the mundane). She told me to breathe, put a pad in, and call my doctor.
It was 5:25pm, so they were closed - I left a message for the on call doctor and waited for my phone to ring. In the meantime, I called Dave to explain the situation. He asked for details and requested that I patch him in when the Dr. called back.
While we were still on the phone, the doctor called and asked a few questions. She asked if the bleeding was heavier than a period, how long it had been going on, and the color. She was kind and understanding of our history, but said that she was not worried since we had been in to the office yesterday and everything looked great. She said to monitor the bleeding and if I got through a pad in an hour to call back.
An hour later, I had filled a pad so called her back and updated her. She suggested trying to wait until the morning so that I didn’t have to wait in the ER to be seen, as long as the bleeding didn’t get worse. We had a trip scheduled that next day for Cape May with Dave’s family, so definitely wanted to make sure everything was ok before/if we left. We asked for prayer from our closest friends and family, and tried to sleep, although neither of us really could.
I knew that everything had looked fine yesterday, and the odds of my worst fears being reality had to be low, BUT it was still a very emotionally draining night. Both Dave and I struggled to remain positive.
Overnight, the bleeding slowed down. I woke up in the morning and it appeared to have tapered off. We went right to the doctor’s office and Dave was not allowed in because of “covid protocols”. The sonographer did an internal ultrasound, and about two seconds after inserting the probe said “baby’s ok”, which was a relief. However, I still had a sense of worry as to why I had bled so much and so suddenly, after everything had just appeared great on the ultrasound the previous day. She spent 15 minutes doing an external ultrasound, taking pictures, and shielding the screen from me so I had no idea what was going on. I asked if she could hear the heartbeat and what the rate was - 153bpm. That was another relief.
I got dressed and waited for the doctor to see me. She entered the room and showed sympathy to my situation. I asked if I could put Dave on speakerphone to hear what was going on, and explained: the reason for the bleeding was a subchorionic hematoma, in regular human talk: a bruised placenta. Dave asked what causes this and she said it still stumps doctors to this day. After a little more researching on our end, we found out that it is more common in IVF patients. While it can be very unnerving to experience, often the baby is ok despite the bleeding.
The doctor told me that I needed to take it very easy for the next two weeks - no lifting, no exercising, nothing strenuous. She said I needed to rest up. We explained that we had a beach vacation planned and she encouraged us to go and just relax - I couldn’t lift suitcases or walk for long periods of time.
Dave and I packed up for the long weekend and took the trip down to NJ for a restful time with his family. Thankfully the bleeding had stopped, and so I could focus on relaxing at the beach, or so I thought. That evening we walked down to the beach, which was not more than 500ft, and I sat in a beach chair while the nieces and nephew played in the ocean. We got back to our hotel room and I went to use the bathroom before bed. Again, I became alarmed at what I saw as the inside of the toilet turned bright red.
We called the on call phone number, left a message and waited for a call back. This time, it was less than 5 minutes before I received a call back from my regular doctor, who happened to be on call. She said that it’s possible for bleeding to come and go, and that we have a reason for the bleeding (the bruised placenta), but if I filled a pad in an hour then I’d need to go to the local ER. I went to bed with a towel underneath me, praying that things would quieten down overnight. Thankfully, they did. I did not need to go to the ER.
I made sure to take it very easy the preceding days. The bleeding has not resolved, but has decreased. Dave has just been amazing - he got me a special beach chair that was elevated higher off the ground so that I didn’t strain when getting up from it (this was a long walk each day to acquire it), he did everything he could so that I wouldn’t be bending/stretching/lifting/straining, and accompanied me back to the bathroom every few hours to make sure I wasn’t alone.
I am sharing this part of my journey hoping that it may help someone in a similar situation, somehow. If you feel pain during an ultrasound, speak up. If you are told that you need a pap smear during your pregnancy (and you are high risk), speak up. They can wait a few months to perform one. I had no idea what “subchorionic hematoma” was prior to this experience, but apparently it’s fairly common.
I ask for prayer for healing of this bruise, health of our little peach (that’s the size of the baby at the moment), and for peace. I will return in 2 weeks to see how things are looking.
Fireworks on July 4th, 2021
In brief, this entry summarizes another bleed that took place on July 4th. I have gone in to more detail than I usually would since I personally found it helpful reading others’ detailed stories, but if you’d like to skip ahead, then go ahead and scroll through this section to the very last paragraph which tells you where we’re at presently.
At 4am on July 4th (two days before my next scheduled appointment), I woke up to use the bathroom and saw more than I bargained for in the toilet - a lot of blood and clots. There was something large and I wasn’t sure what it was, but I feared the worst. I immediately called Dave (who thankfully was already awake, sadly because he’d had a nightmare). He came in, surprisingly Winston did too as he normally is not an early morning dog, and we decided this warranted reaching out to the on call doctor. The doctor said “odds are everything is ok” but it was best for us to head to the ER due to the amount of bleeding and the fact it was showing no signs of slowing down.
With a towel on the seat, we drove to the hospital and Dave ran to grab a wheelchair since walking just exasperated the bleeding. When I say I bled a TON, I mean through a huge pad, clothes, and towel in 15 minutes. They were very understanding and helpful in getting us entered in the system and seen. We had a baseline screening done - questions about why I was there, pregnancy history, blood pressure and vital signs. We had to wait for an OB to see us due to the fact that I was 16 weeks.
Dave was trying to play a game on his phone to keep his mind off things, while I was staring off in to the distance thinking the worst. As I was looking down the long hall, a woman started walking down it. I figured she was like one of many doctors using the hallway to get to a destination that was not our room, but sure enough, she came into our room and asked if I was Rebecca. She got a little more of our history, showed extreme empathy towards our situation, and explained what she wanted to do in an exam.
In order to perform her exam, we needed to be transported to a room suitable for this kind of situation - they only had 3, but thankfully one was available. Once we were in the room, the doctor’s first concern was to check that I was not hemorrhaging and didn’t need to go right to surgery - Thankfully, I was not hemorrhaging. Then her second check was to do an internal exam to check the source of the bleeding and make sure my cervix was closed - it was. I have to say I was a little surprised albeit happy to hear that news. It was another good sign. I kept telling myself that people can bleed a lot with subchorionic hematomas and everything can be fine, but it’s very hard to believe this when in the midst of things. Third was to do an ultrasound to see what was going on with the baby.
I’m writing this and it sounds like it was all so smooth and quick - it was not. The doctor would exit the room between each step and then come back in, and the ultrasound machine had to be located and transported to my room. When she finally put the probe on my belly, the ultrasound showed an active baby with moving legs, arms, and head. The heartbeat was solid at 153bpm. We breathed a sigh of relief.
At this point, due to the amount of bleeding I was experiencing, the doctor wanted to keep me under observation for a while until I was able to make it an hour without getting through a pad. At around 8am, we were given the all clear by the ER nurse, however, we had a few questions we wanted to ask before we left. (Should I be continuing on baby aspirin? What was the cause of the bleeding? How long can I expect this to continue? What are our next steps?)
They said to wait until I saw my regular OB before making a decision on the aspirin, the cause of bleeding was the hematoma, but their machine did not show how big it was, there is no knowing how long bleeding can continue, but it can be weeks, and the next step was to set up an appointment with a specialist to look at the hematoma. As long as I didn’t get through two pads in an hour, I could stay home and rest. They did not tell me that I should be on bed rest, since they said studies have shown that doesn’t decrease the risk of miscarriage. Even so, I still limited my activities and spent most of the day resting on the couch.
That Tuesday, I went in to see my regular Doctor H. Dave wasn’t allowed in. When she entered the room, she said “Oh my dear, it just doesn’t stop for you, does it?” She said I need to just take it really easy, no summer plane trips/big travels, no exercising, no lifting anything heavy. She performed an ultrasound and the baby was moving with a strong heartbeat. This was a relief. I also had some bloodwork done as they wanted to check my AFP levels. She said she wanted me to be seen by the maternal fetal specialist sooner rather than later, so that my hematoma could be assessed. She showed me a hint of a black area which looked small and said she could see there was still some bleeding/bruising in there.
Dave was on the phone and asked our list of questions including whether we needed to cancel our trip to North Carolina which we planned on taking with my family. She said as long as I stop every 1-2 hours on the journey, stay hydrated, and rest while I’m there, she’s ok if I’m comfortable going - there are hospitals in NC. Dave and I decided afterwards that due to her comment about no travel at the beginning, we’d see what the specialist said about traveling before making our decision.
Wednesday July 14th, we had a 2pm ultrasound scheduled with a maternal fetal specialist. At 9:45am, we received a call from my regular OB office - the doctor announced herself on the phone and I turned to Dave and gave him a thumbs down and ushered him to listen in as I put the phone on speaker - it’s rarely good news when a doctor calls you. Sure enough, my AFP levels came back elevated, indicating that our baby now had a high chance of a neural tube defect (spina bifida or anencephaly). The doctor explained with the elevated levels our chances of some type of defect were now 1 in 8 (before it was 1 in 580). She asked if we had an appointment set up with the specialist, which thankfully was that afternoon. 2pm never seemed so far away. It was the longest 4 hours we had endured in a while, as Dave googled and we updated our families.
Once we did arrive at the doctor’s office, we reviewed our history with the new sonographer, and she did both an internal and external ultrasound to check my cervix, the hematoma, and the baby. Going in, we were most concerned about the baby’s brain and spine. To our (pleasant) surprise, both of these looked good according to the ultrasound, and we could not contain our relief. We thanked God.
During the appointment, we saw the size of the hematoma. I don’t know why I had assumed it would be a small/medium sized one, but I believe the word the nurse used to describe it was “pretty huge”. We stared at the screen and looked at a large black area which seemed gigantic - comparable to the size of the baby, just hanging out the other side of the placenta. The sonographer immediately said she believed we would be told “no travel”, and “bedrest”. It was one of the biggest hematomas she’d seen in her 17 years of doing ultrasounds.
She said that the head nurse would be coming in to speak with us (who happened to be the wife of the doctor who runs the practice). About 5 minutes later, the nurse came in, Shirley. She walked in and had a calm, reassuring presence about her. Shirley started off by saying “you guys have been through A LOT”. It was nice to have that acknowledged. Then she said that I definitely needed to be on bed rest as this is a huge hematoma - they are concerned about the size of it. Due to the size, they wanted me to wait for Dr. V. to get out of surgery so that he could speak with us about our situation. They said I’d have a nice long chat with him. This led us to believe there was a little more going on.
They moved us to a room where I could start my “bedrest” while waiting for the doctor, and as I was getting ready to move, I dropped a sheet - I started to bend down to pick it up and with Dave behind me grabbing my body in opposition, the nurse said “DO NOT even think about it. No bending”. That’s when I realized that I really needed to take this seriously. They positioned me on a bed with my legs up and head reclined while we waited.
We sat in the room thinking we’d be waiting for an hour as they told us it would be a while since he was in surgery, but it was only 15 minutes. I walked very slowly down the hall to Dr. V’s office. He was an reassuring gentleman who immediately made us feel at ease, and his office had a huge bookshelf lined with scientific books, a black leather couch, a coffee table with my favorite sweets - Werther’s and more medical certificates than could fit on a wall (literally there were a bunch of certificates that were framed and leaning against the wall).
Dr. V led us over to his computer to see the size of the hematoma, then proceeded to explain his thoughts on our situation for the next almost 2 hours. I will try and condense the hour and 40 minutes that he spent with us into a brief paragraph (or four).
There were 4 problems he was concerned about:
A large hematoma. He did not get into the measurements, but this hematoma is one of the larger ones that he’s seen. He said in the past year, he’s had about 6 of them and literally today just came from delivering a healthy 7lb baby at 39 weeks for a mother who’d been on bedrest almost her entire pregnancy. This was encouraging. We explained that we’d had two major bleeds and my body was still getting rid of “old blood” actively.
A short cervix. Instead of the 35-45mm that they like to see at this time, my cervix was measuring between 21-25mm (he said he wanted to measure it more accurately himself when I returned). He said the cervix starts off about the length of 4 fingers, but at birth, it’s as thin as a piece of paper (WOW, the human body is amazing). Mine was shortening too quickly. Dave asked if there was a way to stop this, and he said yes, there are a few. The one he recommended was to put a stitch in, but I’d have to stop bleeding before this would be safe.
Multiple past D&C procedures. Due to the three miscarriages I’d had (and D&E at 14 weeks), my uterine lining was not acting as the fence that it usually is - he explained that usually the “fence” keeps things separate, but with the damage done to mine, there is a risk of things crossing that barrier that shouldn’t.
A history that’s too much to be coincidence. Dr. V had reviewed my history and said that having two known trisomy cases, 3 miscarriages, and the struggles that we’ve had, he suspects there could be more going on as there is too much for all of this to simply be considered a coincidence. He wanted to test both of us (since baby is part me, part Dave), and look at some extensive autoimmune indicators as well as others. He said it’s all a hypothesis, but that it’s possible I could have some kind of autoimmune thing going on combined with a clotting disorder which would mean this hematoma would not heal by itself.
I am sharing more details than I initially planned on because I have found personally to be encouraged by reading the stories of others going through similar situations. The biggest thing I wish I’d have known going into this appointment, was that AFP levels come back elevated if you have a SCH and are bleeding, so they are not accurate.
So, I have been upgraded from pelvic rest to bedrest. There are different types of bedrest, and this kind is the kind where I should be lying down as much as possible, only getting up to use the bathroom. The night we got home from the doctor’s, Dave started researching beds that reclined and was preparing to invest in quite a pricey bed since we figured this could be a long-haul journey. We called a friend to assist with moving furniture and he said “give me an hour - I’m going to make some calls as I know people in the medical field”. Twenty minutes later, he texted that a medical bed would be delivered the next day - we could rent it by month. What a blessing!
