Cautiously optimistic

10 week appointment went well.  Baby is measuring 9w6d, which is fine.  (S/he’s been measuring behind from the beginning.)  Baby’s head looks round (but who knows for sure) with a heartbeat of 189.  All good.

The ultrasound tech did not see anything to be worried about – not even a subchorionic hematoma.  She acknowledged my prominent vascular system, but suggested it just might be because I’ve been pregnant so many times.  Who knows?

The doctor noted that the neural tube is closed or its not by now (obviously), but suggested I should stay on the high dose of folic acid until at least my 12 week appointment, when we should be able to confirm no anencephaly.  The doctor also suggested that, while 10 weeks is very early to be diagnosing anencephaly (I don’t think baby is even 32mm now, although I forgot to ask about exact measurements), the fact that the head looks round is a good sign.  The heartbeat was normal for the last two appointments, and she said she had absolutely no cause for concern that it was slow at the first appointment. 

One thing she and I discussed at great length was all of the testing options.  She said that the standard tests that do not pose any risk to the baby (the Harmony test that looks for the common chromosomal defects, the 12 week “NT” ultrasound, the AFP test at 15 weeks, and the level 2 ultrasound at 20 weeks) will catch 99% of the diagnosable issues.  She acknowledged that a CVS/amnio will catch that last 1%, but questioned whether the risk was worth it.  She suggested that a risk of pregnancy loss from either of those tests hovers around 1/500, and said that for someone who would do absolutely anything to avoid a child with a defect, those risks might be worth it.  But she basically said, in not so many words, that this is our miracle baby and we’re unlikely to have another shot and unless we saw something that concerned us on those other tests she personally would not take that chance.  She also told me a story about one patient—the only patient she could think of that did lose a pregnancy from one of these tests—and how hard it was.  Apparently this patient was miraculously pregnant in her mid-40s, but understandably scared because of her age, so she opted for one of those tests and then lost the (genetically normal) baby.  The doctor said it was absolutely devastating and not something she would ever want another patient to go through. She also suggested that because these other diagnostic tests are so good, they are seeing less and less patients even agreeing to CVS or amnio. 

She was the second doctor I’ve seen in the past month that suggested I might want to see a therapist.  I said, “yea, you’re not the first to suggest that, so maybe my responses are not normal?”  She said something along the lines of, “no, you’re being very logical and scientific about it, which is totally understandable, but I’ve seen a number of patients in your position and it can be hard to have a normal pregnancy.”  Fair enough.

I didn’t ask her about our exact odds of success, but did ask for her general thoughts.  She said they were “pretty good.”  Hey, I’ll take that.

Here’s my thinking on the updated odds (keeping in mind that I’ve had 3 other pregnancies that went this far, and only one that turned into a healthy baby):

Up to 12 weeks [After yesterday I have to admit—I’ve started to invest emotional energy.  Lord help me.]

·        10% chance something else goes wrong between the 10 week appointment and the 12 week appointment.

·        5% chance we have an abnormal chromosome test result after our 10 week screening.

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

·        15% 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.]

·        10% 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

43% chance I end up with a healthy-ish baby.  The odds get better every day.  And if we come out of that 12 week appointment unscathed, I think we have a much better than 50% chance of success.  Our last two pregnancies to make it past 12 weeks had issues that were or would have been diagnosed then, so it will be a really, really scary appointment.  I want the next 2 weeks to move as fast as possible!!