Genetics

I met with the genetic counselor the other day. He remembered me from the last time I was there (after my anencephaly pregnancy, before my omphalocele pregnancy was diagnosed).  He was (obviously) very sad to see me again. His expertise is genetics and, unsurprisingly, based on our history, age, and the low heart rate, was of the mind that the question was not if this pregnancy is doomed, but when we diagnose what the issue is.  Gotta love a realist.  We talked through our plan for finding the issue.

The next step is my 9 week appointment next week.  Assuming there is still a heartbeat the next step is….

A blood test.  The high-risk OB runs a free cell DNA test through Natera that can be done as early as 9 weeks.  It tests for the fetal fraction of DNA in mom’s blood—it cannot be done before 9 weeks because there’s not enough DNA there.  Even at 9 weeks, they might not be able to get a result, especially if mom is heavy (over 200lbs).  Fortunately I’m a skinny-minny (although less skinny by the day) so we are going to give it a try right at 9 weeks.  That test looks for common chromosomal issues, including Down syndrome, Trisomy 18, etc.  It also tells us gender.  (If we did it through the regular OB’s office, we couldn’t do it until 10 weeks.  Their testing lab is Harmony.)  We should get the results in about a week, although we are not expecting a bad result from that—my genetic problems have not been chromosomal, and the risk even at my age (39) for a bad result is only like 3%.

After that, the next step is the 12 week appointment at the high risk OB. They will do what’s called a level 2 ultrasound, which will look at growth, heart rate, and nuchal cord measurement, and should be able to diagnose anencephaly (which we’ve had in the past) and omphalocele (also something we had in the past).  It is not usually able to detect spina bifida or other minor structural issues. 

After that, the next step would be another scan at 15/16 weeks, again at the high risk OB.  Once again, we’d be looking for major structural defects, including those of the heart.  It should also be able to catch a severe case of spina bifuda.

If we have reason to think there’s a chromosomal issue that was not picked up by the free cell DNA test, we could do an amnio sometime around 15 weeks.  That test look for all chromosomal issues, not just the common ones.  But if we don’t have some reason to think that’s an issue, we likely will not do an amnio.

Also at 15 weeks, we could do an AFP test—which looks for anencephaly / spina bifida.  Not sure if we will do that, because anencephaly should be picked up at the 12 week scan, and spina bifida should be picked up at the 15/16 week scan.  The AFP test can miss minor cases of spina bifida that would be more likely to get picked up on a scan, so there’s no obvious reason to do it if you’re having those scans and looking for the problem.

The next step would be the 20 week appointment.  That’s the big one that would catch most structural issues.

So that’s it. We’re approaching this pregnancy like there’s something wrong, we just want to find it as soon as possible.  That’s pretty depressing.

We also talked about what the likely cause is.  The geneticist says there’s nothing obviously jumping out at him because we have a living child, so whatever the issue is, it’s not 100% fatal.  At the same time, we have had so, so many losses, and they do not appear to be the same thing each time.  It’s confounding!

Thinking out loud, here were some of his thoughts:

·        It could be a recessive genetic condition.  He thinks that’s unlikely because recessive genetic conditions should only have a 25% recurrence, and we have had 9 pregnancy losses (soon to be 10?) and only one live born child.

·        It could be a dominant genetic condition.  For the same reason, that’s unlikely because there should only be a 50% recurrence, and we are far beyond that.

·        It could relate to mitochondrial genetics, which have a unique inheritance pattern and are passed on from mother.  (I do not understand this one.)  He said this was unlikely because it is not generally related to the issues we see.

·        It could be one or more mutations on the MTHFR gene.  MTHFR is a common mutation: ½ of the population has 1 mutation, 10% have 2, etc.  He acknowledged that nothing was proven, but there is a theory that the more mutations there are the increased risk there is for pregnancy loss and particularly NTDs.  The mutations can affect the way you metabolize folic acid.

o   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3385168/ (“Methylenetetrahydrofolate reductase mutations, a genetic cause for familial recurrent neural tube defects”)

·        It could be a defect in some other way I metabolize folic acid or something else.  I wasn’t surprised to hear that because I’d previously read a theory that some NTDs could be caused because mom wasn’t properly metabolizing folic acid.  For example, obese women and women with diabetes are more likely to have pregnancies with NTDs.

o   https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3982189/  (“Intersection of complex genetic traits affecting maternal metabolism, fetal metabolism, and neural tube defect risk: Looking for needles in multiple haystacks”)

·        It could be a germline mosaicism.  A mosaicism is when some cells differ in their genetic component from other cells, caused by a mutation early in development. When the mosaicism is germline, that means it affects the eggs or sperm. So, it might be that one or both of my/hubby have some defective/fatal genes we are passing on, but they are combined with normal cells so there is some development, and sometimes they are not fatal (see my kid).  The fatal cells do cause problems, if there are enough of them.  (To be clear, this means the baby is a mutant.)  I read a number of articles on this, it’s very complex. 

o   https://www.ncbi.nlm.nih.gov/pubmed/3033033 (“Lethal genes surviving by mosaicism: a possible explanation for sporadic birth defects involving the skin.”)

o   http://www.nature.com/nrg/journal/v14/n5/full/nrg3424.html?foxtrotcallback=true (“A genomic view of mosaicism and human disease”)

His theory is that it’s likely some genetic alteration of an in important gene in fetal development, either from me or hubby.  That would explain the recurrent pregnancy loss with different problems, and would also explain why it does not mean we have 100% loss.  He also thought it could be the way I metabolize folic acid or some other metabolic issue.  Let’s be honest, it’s probably multifactorial.

We talked again about exome sequencing.  He thought it was unlikely to yield results.  It generally only provides a potential answer 30% of time, and he thinks our likelihood might be less because we are not seeing the same thing over and over again suggesting there’s a “simple” answer.  He told me that in the past year he saw a couple who had a situation eerily similar to our own.  They had a living child, but had a number of miscarriages and two pregnancies with severe issues—one with a NTD (spina bifida) and another with severe birth defects.  They chose to do exome sequencing and did not get a result.

That made me really sad for this couple I'll never know. Because they're like us. 

Wait and see

I had my appointment today.  The ultrasound lasted forever.  At one point, I thought, this woman would not be torturing me if there were no heartbeat, so I’m just going to ask.

Me: Is there a sac with no embryo?

Ultrasound tech: No, there’s an embryo.

Me: Is there no heartbeat?

UT: No, there’s a heartbeat.

Me: It is slow?

UT: It’s not as fast as we would like.

Yea, of course it’s not.

I’ve already done a post on fetal heartbeat, so I won’t repeat it.  (http://3yearwait.blogspot.com/2016/03/hoping-my-embryos-heart-is-beating-like.html)  But here’s the gist: slow is bad, fast is good.  The faster the better, the slower the worse(r).  

I am “dated” (per my last menstrual period) to be 7w1d.  Based on my sac measurement last week, I should be around 6w5d.  (But I was told sac measurement is not that predictable.)  Fetus was measuring at 6w 6d.  (I completely forgot to ask for my fetal or yolk or sac measurements.  D’Oh!)  So I’m right around 7 weeks.

A common threshold at this point (late 6 weeks/early 7 weeks) is 120 and above is “normal,” 110 and below is “slow,” and between that is “borderline.”  If you’re in slow, you’re looking at a likely pregnancy loss.  Borderline is also at risk.  

Heartbeat today was 114.  That doesn’t sound too low when you say that 120 is “normal,” but then you have to remember that below 110 is likely to end in miscarriage.  So 114 is no good.

If you follow one of the links in my fetal heartbeat post (https://fetalmedicine.com/synced/fmf/2010_27.pdf), it gives you precise measurements based on date.  At 49 days (7 weeks) gestation, a heartbeat of 117 is in the 5^th percentile.

Yea, when you put it like that, 114 does not sound so good.

Oh, and the reason the ultrasound took so long is because the tech was completely taken aback by the “prominent blood vessels” in my uterus.  She was basically like, “in the five years I’ve been doing this, I think I’ve seen another patient with blood vessels this prominent.”  We already knew I had a wonky vascular system, so that wasn’t the surprise she might have thought it would be.  She also mentioned a “small” subchorionic bleed.  Again, that comes as absolutely no surprise.  I had issues with at least two pregnancies.  (My little man—they resolved—and the gushing one with my omphalocele pregnancy.)

The doctor I met with (someone I have not met before) was super nice.  When I pressed her on my chances of success, she said, “I’m an optimist, so I’m going to say 60%.”  I appreciated her optimism and honesty, because there is no way there’s a 60% chance of success.  But she didn’t lie and tell me to just be hopeful—she gave me a pretty low number (relative to what I’m guessing she would usually say).  I asked if I could come back for another check before my marathon—I’d like to know when I’m running if I’m pregnant or not—and she said absolutely.  In fact, she told me I could come in every week.  Anyway, I have another appointment in just under two weeks.

So, where does this leave us?  Well, I’m not going to lie friends, it’s not good.  Obviously no fetus/no heartbeat/super low heartbeat would be worse, but it’s not good.  I have to update my odds because I did have a heartbeat today, but this still looks like it might be on track to end.  For those of you placing money on this pregnancy, here are the current odds:

Up to 12 weeks [Before which I invest only a teeny tiny amount of emotional energy.]

·        30% chance something else goes wrong between now and the ~9 week appointment.

·        20% chance something else goes wrong between the ~9 week appointment and the 12 week appointment.

·        4% chance we have an abnormal chromosome test result after our 10 week screening.

·        20% chance we have another neural tube defect (diagnosed either at the 12wk appt if anencephaly or 15 week AFP test if spina bifida).

·        6% chance some other catastrophic issue is diagnosed at the 12 week appointment.

Up to 20 weeks [At which time I have allowed myself to hope and will be devastated.]

·        6% chance we make it all the way to 20 weeks but have catastrophic issues diagnosed then.

Beyond 20 weeks [Devastated.]

·        2% chance something else terrible happens.

10% chance I end up with a healthy-ish baby.

Again, those odds are not great.  But they’re better than 0.

Sick & tired

One of the worst things about infertility—and the process of creating/growing a person—is the blame and guilt.  When I had trouble getting pregnant, and when I miscarried, I blamed myself for anything that I possibly did that could have caused it, and felt tremendous guilt over so many choices.  (Did I wait too long to try having children?  Did I exercise too much or, later, not enough?  Was I eating healthy enough?  Was I taking the right vitamins/supplements, or too much? Did I do too much acupuncture, or not enough?  Was I too stressed out?  Was it that cold I got that I should have avoided by never seeing people / going into public?  Was it because I stood in front of the microwave?  Etc.) 

In some ways, getting pregnant on accident just makes that worse, because it’s going to prove to people that I was, in fact, to blame for all of those years of infertility/losses.  Assuming this actually goes on long enough that we tell people (and I am not assuming that), I’m sure someone will say something along the lines of, “see, you just had to relax and it all worked out.”  Yea, stress caused my baby’s organs to grow on the outside of her body and her bones not to harden.  Stress also, separately, caused another pregnancy to fail after my baby’s neural tube didn’t close.  Stress, obviously, caused at least one and probably two pregnancies to implant into my fallopian tube.  It was definitely all about the stress.

Likewise, assuming I end up having a baby with a birth defect again (either born alive or, more likely, passing away/terminated), there’s that voice (either my own or that really shitty friend/family member I tell) that thinks/says something like “too bad you were not on vitamins/not taking folic acid/drinking in the first week/ran that marathon.”  Yea, after at least three other pregnancies failed due to genetic issues (and let’s be honest, probably many more), it’s my actions THIS time that caused issues.  UGH.

And yet, knowing all of this, and being aware that it’s just not my fucking fault that any of this happened, I still can’t shake the guilt/blame.  Nothing has happened yet, so I’m just pre-gaming the blame/guilt, but I know it’s there.  If I end up with a pregnancy with a NTD, I’m going to blame myself for not being on folic acid.  If I have a heartbeat this Friday, but something else goes wrong after I run my marathon, I’m going to hear those little “what if…” whispers in my head.  I have a small cold right now (did I mention my germ factory—I mean little guy—started kindergarten 2 weeks ago?  He brought some a cute little art project and a cold his first week).  I am already running through my head what I read after one of my last pregnancies—colds in the first trimester increase the chances of birth defects.  Dammit!

Okay, so this post is getting away from me.  I am literally sick (cold) and tired (pregnant, for now).  I am also, figuratively, sick and tired of the guilt and the blame.  So I absolve myself right now—whatever happens, it’s not your fault.  You did everything right for almost a decade, and you couldn’t get pregnant/lost a bunch of pregnancies.  The fact that you may not have been perfect now (and who even knows what perfect is??) is not your fault and does not have final bearing on whatever the outcome of this process ends up being.

Just don’t stand in front of the microwave for the next few weeks.

When things went south

I can’t help but reflect on when things started going badly in my last pregnancies.  For most of them, it was right away.  For the four that made it past 5 weeks, my blighted ovum went south at my 6 week appointment—when we saw a sac but no embryo.  My pregnancy with my son seemed like it might go south at my 6w6d appointment, when we saw that blood clot/active bleed.  It ended up resolving at the end of my first trimester—thank God!  My omphalocele pregnancy started going south at 5w3d when I started having heavy bleeding.  Of course, we thought it had resolved later in the pregnancy and then found out that we had much bigger problems at my 12w appointment.  My anencephaly pregnancy went south at 16 weeks, when we got the bad results from our AFP test.

I wonder when… I mean if… things will go south here.

Here are my predictions:

Up to 7 weeks [Before which I invest 0 emotional energy into this situation.]

·        50% chance there’s no heartbeat at my ~6w5d appointment next Friday, or I start to miscarry before the appointment.* 

Up to 12 weeks [Before which I invest only a teeny tiny amount of emotional energy.]

·        2% chance we have an abnormal chromosome test result after our 10 week screening.**

·        25% chance something else goes wrong between the ~6w5d appointment and the 12 week appointment.*

·        10% chance we have another neural tube defect (diagnosed either at the 12wk appt if anencephaly or 15 week AFP test if spina bifida).***

·        3% chance some other catastrophic issue is diagnosed at the 12 week appointment.****

Up to 20 weeks [At which time I have allowed myself to hope and will be devastated.]

·        3% chance we make it all the way to 20 weeks but have catastrophic issues diagnosed then.****

Beyond 20 weeks [Devastated.]

·        1% chance something else terrible happens.*****

5% chance I end up with a healthy-ish baby.  Those odds are a million times better than I would have guessed last month.

*Based on the fact that so many of my pregnancies ended early, and general risk of early/prior to 12-week miscarriage.

**We are OLD now.  I’m 39, hubby’s turning 41.

***The published risk for recurrent neural tube defects after one pregnancy with one is about 5%.  Because I was on folic acid and apparently had a folic-acid resistant neural tube defect, and because I’ve had so many miscarriages/other pregnancies with issues, and because I wasn’t on folic acid until part-way through week 5, I think I’m at least double that.

****I’ve read the recurrence rate of omphalocele is less than 1%.  Of course ½ of all omphaloceles are associated with abnormal chromosomes, and we did not have that, and we’ve lost so many pregnancies / had other pregnancies with birth defects.  So I imagine our “birth defect rate” in general, and risk of omphalocele specifically, is much higher.

*****Always a risk.  In at least this one way, I am just like everyone else.

¯\_(ツ)_/¯

Today was very surreal.  We’ll see where this journey takes us, but in the short term I think I might have to leave a note for myself on my nightstand so I don’t get confused when I wake up and assume I just dreamt all of this: “This is not a dream.  You really did get pregnant naturally at 39, after 10 years of infertility and more than half a dozen failed fertility treatments.”

I went in for an ultrasound today to make sure this is not another ectopic pregnancy.  (The only availability my doc’s office had was in one of its exurb-ian clinics, so I had to drive my ass into the middle of nowhere.  Uuuunnnggggghhhh I forgot how annoying this whole process is.)  The ultrasound tech was NOT friendly, and was not amused by my adorable shot-gun style of questioning.  But I did manage to jot down a few things I saw on the screen/squeezed out of her:

1)      The embryo is almost certainly not in my tube or anywhere else it shouldn’t be.  We saw it right there on the monitor.  (Apparently there’s still a small risk it’s in the wrong place?)

2)      We saw a gestational sac (7mm) and yolk sac (2mm).  We did not see an embryo but apparently that’s to be expected at this early stage.

3)      They have me dated as 5w2d pregnant, based on those measurements.  I was told that the embryo size is a far better predictor of gestational age than gestational/yolk sac, so that could be adjusted if/when we see an embryo.  (Based on my last period, I think I technically am closer to 5w5d.)  Obviously I would have previously freaked out about my dating being off, but now I’m like, whatever!

4)      The ultrasound tech was not impressed that I am not taking folic acid, considering my history.  She has a child with a neural tube defect (spina bifida, he’s 24).  What can I do?!—I was drinking craft cocktails less than 48 hours ago!  I think folic acid is the least of my worries.

Then, later that afternoon, I hauled my ass over to my OBGYN’s office.  After an extensive wait in the lobby (uuunnnggggghhhh) and examining room (uuunnnggggghhhh), I finally saw my doctor.  Here are her thoughts:

1)      Based on my history, there are reasons to be concerned.  (No shit.)  But she would be “cautiously optimistic.”  I was like, “that’s nice, now let’s talk reality.”  But she was slippery and wouldn’t let me pin her down on my chances of success, other than to say she wishes we could just fast forward through the first trimester.  And through the 20 week ultrasound that shows structural abnormalities.  Nice.

2)      There is a grape-sized cyst on my ovary.  It’s not “normal,” but not entirely abnormal for “pre-menopausal women.”  That was the one comment that threw me—“I’m pre-menopausal!??!!?”  Her response, “yes, because you haven’t gone through menopause.”  Oh!  Whooh!  Maybe that needs to be called something else.  Anyway,old me would have spent the next 16 hours becoming one of the world’s most well-read amateur scholars on ovarian cysts.  New me?  Ate three mint Milano cookies and read some YA.

3)      The doc’s biggest short-term worry was my risk for neural tube defects and lack of folic acid supplementation.  She was like, “walk, don’t run, to fill this prescription for a high dose of folic acid.”  I didn’t have a chance to fill the Rx, so I sent my hubs to the pharmacy to buy a jug of folic acid tablets and have now taken a large handful of them.  (If I overdose and die, this blog post is the evidence that it was not an intentional suicide.)

4)      Final observation, being under the care of a regular old OB instead of a fertility doctor is amazing!  

a.      I told her I was planning to run a marathon in 3 weeks.  She was like, “cool, have fun!”  I cannot stop laughing thinking how my fertility doctor would react if I told him, just after confirming my pregnancy, that I planned on going out for an easy nbd 26.2 mile run.  He would have FREAKED OUT.  Bigly.

b.      I am most certainly not under a microscope. I requested a follow-up HCG test tomorrow (to see if it was doubling) and she was like, “no.  I have what I need on the ultrasound.  It won’t tell us anything more than this.  We just have to wait.  No need to get stressed out.”  Ok then.

c.      …but I am still a super duper high-risk patient.  So I’m going to do a follow-up ultrasound in a week and a half (there should be an embryo and a heartbeat).  Assuming that’s okay, I’m going to do a Harmony test (tests for normal chromosome count) at 10 weeks.  Then a level 2 ultrasound at 12 weeks.  Then an AFP test (neural tube) at 15 weeks.  Then a second level 2 ultrasound at around 20 weeks.  Good times.

So, what do I think?  I think the chances are better than not that this does not work out.  But I’m not saying that from any sense of “mother’s intuition” or anything I’m feeling.  We have just had so many things go wrong.  The odds are definitely against us.  And while I don’t doubt I’ll be sad if it doesn’t work out, I’ll be okay.  Better than okay.  But the longer this goes and the more emotionally invested I get, the harder it’s going to be.  SO, at least until the AFP test at 15 weeks, I am not putting any emotional energy into it.  I mean, I’ll take my vitamins/super dose of folic acid, and I won’t drink or do any heavy drugs (such a sacrifice!), but I am not going to give up my life hoping this works.  I mean, I’m running a marathon in 3 ½ weeks!

Infertility and unplanned pregnancies

Approximately half of all pregnancies in the U.S. are unplanned. That can seem unbelievable to an infertile couple—how can it be so easy for everyone else and so hard for us??  Of course many of those pregnancies are because of youth—i.e., a super fertile and irresponsible (no BC) couple of kids.  Many infertile couples have great life experience, maturity, etc., but crusty old eggs and sperm. Ah, youth (and youthful eggs/sperm) is wasted on the young!

But unplanned pregnancies can even happen to people who have suffered with infertility.  A friend of mine had two planned pregnancies after years of infertility—her son, after IUI, and her daughter, after IVF.  And then a few years later, BAM! pregnant with her miracle baby.  Pretty much everyone I know has a friend (or a friend of a friend) with a story like this—the one that keeps the dream alive.  The one that justifies that tiny, the quiet voice in the back of the mind of those of us trying and failing to have a child: maybe it will happen naturally.

Obviously that can’t happen to me.  

Occasionally a well-meaning friend/family member will say something like, “maybe it will still happen.”  “No,” I firmly but kindly tell them, “not for us.”  Understanding it comes from a nice place, I don’t react the way I think many people (including myself, from time to time) might be tempted to respond: IT’S NEVER GOING TO HAPPEN AND IT’S LIKE A KNIFE IN MY HEART THAT YOU EVEN SUGGEST IT.

About a month ago I was catching up with a friend I hadn’t seen in many, many years.  After sharing our adult life stories (my middle name should be TMI), she ended up writing me an email asking, “Are you still allowing yourself the chance to get pregnant naturally?” I responded (and this is less than 3 weeks ago, mind you):

“On the getting pregnant naturally front….  I mean, it’s not like we’re doing anything to stop it, but I’m pretty confident there’s no chance.  After my 1 (and likely 2) ectopic pregnancies, one of my tubes is so scarred the doc told me if I ever got pregnant naturally there’s a 50% chance it would be ectopic.  And it looks like my body naturally releases eggs really late, making a natural pregnancy highly unlikely.  And our last 2 pregnancies (from chromosomally normal embryos via IVF) both had catastrophic birth defects.  So if I found myself pregnant naturally, I would be terrified, not excited or happy.   :/  But I suppose anything is possible.”

After another couple emails, I told her:

“If I thought we had a good chance of getting pregnant naturally, I think I would probably make the decision to medically do something to make it impossible, because I am pretty nervous about what would happen.  Infertility is the lazy person’s birth control!”

So, that pretty much sums up my thinking on getting pregnant naturally.

And we are really in a good place now.  I feel like myself again.  I have taken back my body!  I’m currently training for the Chicago marathon.  This summer, I did a number of road races and a couple triathlons.  (And I even PLACED in some of them!!)  We have no intention of having another child.  We sold our crib and gave away all of our baby stuff/baby clothes/maternity clothes.  Our little guy just started KINDERGARDEN.  We redecorated our living room and got really nice furniture because we don’t have a destructive little kid anymore.  We planned some awesome vacations—including in tropical locations where Zika is running wild.  We are DONE.  Sure, we wanted a second child, but it didn’t work out.  We’d moved on.  We were happy.

And then…. You want to make God laugh?  Tell him your plans.

Last weekend I went out for my longest marathon training run of the season—21 miles.  I had an amazing 17 mile run, but then I just hit a wall.  I couldn’t run anymore.  I had to walk.  It was bizarre.  And I was so exhausted for the next few days, I skipped two more runs.  I might occasionally miss a run here and there, but never two, and certainly not in my top training week.  I chalked it up to overtraining, rested a few days, and did a couple shorter runs to get back into my training plan. And then my boobs really started to hurt.  I didn’t think anything of it, because that’s been happening lately right before I get my period.  So I assumed that meant any day I’d be getting auntie flow.  But I didn’t.  And I’d been waiting for my period because I was hoping it wouldn’t be right in the middle of my marathon—which is now less than a month away.  So then I started wondering, when was the last time I had my period?  It seemed somewhat recent, but overdue.  (One bad thing about not being on birth control—periods sneak up on you.)  THEN I had another long run this Sunday.  Before my run, I weighed myself.  I always weigh myself before and after a long run because I’m trying to dial in my race nutrition, and I want to figure out how dehydrated I get.  And from the many times I’ve weighed myself before my long runs, I know that I have been basically the exact same weight for months.  BUT that day I was randomly three pounds heavier.  Bizarre.  So I started my 18 mile run, and I just my mind just kept going over all of the weird things that had been happening over the last week—tiredness, sore boobs, weight gain, missing period….  And suddenly, I had to pee like I’d never had to pee before.  I stopped to pee three times during my run.  I was like, “no…. it’s not possible.”  I couldn’t shake the feeling that I was pregnant.  I cut my run short, went home, and told my husband.  He was like, “nah, I think you had your period right around a month ago.”  I’m like, “yea, you’re right. I didn’t randomly gain 3lbs in a week from being pregnant.  It’s water retention right before my period.  And my boobs are always sore before my period.  And I had to pee so much because I’m psyching myself out.” 

Except, I wasn’t so sure.  

I couldn’t get it out of my head, and I was having an impossible time concentrating at work today, so after lunch I popped over to a pharmacy and bought a cheap-o home pregnancy test, which I took in my work bathroom.  (The exact same work bathroom I took a HPT in almost 10 years ago when I discovered my first pregnancy—ectopic.)  I felt like it would be quick negative, I’d get my period tomorrow, and it would just be a silly thing I’d laugh about later.  (“Remember the time I thought I was pregnant?  Ha!”)

But the test didn’t give me a quick negative.  I was so confused I couldn’t read the test.  (I should’ve gotten one of the digital ones that just say “pregnant” or “not pregnant”.)  I’m looking at it, thinking, “I see a dark horizontal line, and a light vertical line, and another light horizontal line. Is that a plus sign, or just the outline of what I would see if I were pregnant?”  My hands were shaking so hard, but I managed to sneak the test to my office, take a picture of it, send it to my husband, and call him.  He answered and immediately asked, “are you alright?”  I could barely talk.  I wasn’t laughing or crying.  I wasn’t happy or sad.  I was confused.  VERY confused.  He looked at the picture and then he was confused too.  We boththought it was a plus, but we were not sure.  So I called my OB’s office and demanded/begged/cajoled my way into a blood test.

And then I spent the rest of the day freaking out.  This was not the plan.  This was officially NOT the plan.  We’d made the decision to stop trying because we are super scared that even if we were lucky enough to carry a pregnancy to term, our histories make it super likely we’d have a child with potentially profound medical issues.  And, of course, I could totally die from an ectopic pregnancy.  I literally kept having phantom feelings of discharge, like this was the sticky beginning of me bleeding to death in my office.  Fortunately, I survived the afternoon.

I got my result tonight.  HCG 4119.  Pregnant.  Holy shit.  I cannot believe this.  I cannot believe that after trying, and failing, to get pregnant for almost a decade I find myself here. 

Of course, I have absolutely no idea when I ovulated, or even when I last had my period, so don’t know if this is a good result or not.  My husband and I think I started my last period on August 3.  So that would make me… 39 days post-LMP?  A rule of thumb is ovulation 14-16 days after your LMP, so I’m probably around 23-25dpo?  If that’s right, this measurement is significantly lower than my other 3 pregnancies to make it out of the gate (my son was 7519 at 5 weeks and 1 day pregnant, my anencephaly pregnancy was 4167 at 21dpo, and my omphalocele pregnancy was 10693 at 24dpo.  My blighted ovum, which was diagnosed at 6 weeks, was 453 at 18dpo, so we’re past that….).  I will say this—it’s already much higher than any natural pregnancy I’ve ever had.  I have gotten pregnant naturally exactly three times.  The first with my ectopic pregnancy, diagnosed at about 6 weeks.  My highest HCG measured then was 682.  The second time I got pregnant I had a very early miscarriage, probably also ectopic due to additional scarring in my fallopian tube.  My HCG never got above 64 that time.  The third was never even confirmed, I just knew.  But before I could even take a HPT I got my period.  That was the last time I even arguably had a natural pregnancy.  That was over seven years ago.  So, at THIRTY NINE years old, I have my highest HCG measurement from a natural pregnancy.  And my lowest HCG of any pregnancy that made it beyond 5 weeks.

Oh, and I keep forgetting I might die!  My doctor’s note said, “we should schedule you for an ultrasound promptly to determine the location of this pregnancy.”  She gets it—I could totally die right now!!!  Although that HCG measurement is pretty high—even high HCG levels can be ectopic.  (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1247706/)  It’s high enough that the doctor should be able to see a sac on the ultrasound, so if she can’t, we’ll know it’s ectopic.  I’m going to get an appointment tomorrow, asap, and confirm this is not growing in my tube/about to kill me.

And what if it’s not ectopic?  Let’s not even get started on my “baby health.”  Am I on a prenatal vitamin?  No, unless you’re counting margaritas as prenatal vitamins. Was I on any kind of rest?  No, unless you count cutting off a 21-mile run off at 20 miles.  Have I been avoiding things like gardening, lifting heavy objects, sex, and anything else fun?  Why no, I have not.  HOW IS THIS POSSIBLE??  My husband and I couldn’t find a healthy egg and sperm to rub together when I was 29.  What are the changes we got it right now that I’m 39?  

I haven’t given myself the luxury of thinking, “how do I feel about this, assuming it’s not ectopic.  Do I even hope that it works out?”  I mean, I honestly can’t believe how it could, considering our history.  But it’s already a miracle I’m pregnant at all.  Is it too much to hope for another miracle—a healthy baby?

I was wrong, my initials shouldn’t be TMI.  They should be WTF.