Normal

I’m happy to report the 12 week appointment went well.  Baby’s heartbeat is 144bmp.  Normal.  Baby is measuring at 11w6d (a day behind as always!).  Normal.  The nuchal fold was 1mm.  Normal.  Baby’s head looks round, so no anencephaly.  The baby’s bones appear to be ossifying.  There are no signs of an omphalocele (or gastrocentesis).  The baby’s brain and spine looks normal (regular, no bulge) so there are no early indications of spina bifida.  There was nothing suspicious at all in the appointment.  Normal, normal, normal.

Of course, it’s too early to diagnose all structural issues.  We’re going to have another appointment at 15.5 weeks to look at the kidneys, the head in more detail, the face in more detail (looking for a cleft), the diaphragm, further signs of spina bifida, normal growth, etc.  But, as the doctor said, we’ll be doing it mostly to give me reassurance.  This was my first time meeting her—she’s at the high risk OB office, and this is my first time seeing a doctor there this time—and she was absolutely lovely.  Like the doctors at my OB’s office, she was like we’ll do anything you want to make you happy/comfortable.  All you have to do to get the four-star treatment from your OB is lose a whole bunch of pregnancies, including two in the second trimester due to catastrophic development issues.  (Not worth it.)

She also said that the 20 week appointment is the BIG one.  There, we can really take a look at the organs, including the heart.  She said if we survive the 20 week appointment without any lethal issues, we should be in the same boat as everyone else—terrible things can happen to anyone, but we would have a very good chance of success. 

Because of my age, she also said I would have weekly monitoring starting at 32 weeks.  (Again, assuming we make it that far.)

She said considering this good appointment, and taking into account on our history and age, she thinks we an 85% chance of having a healthy baby.  (I love a doctor that will actually give odds!)  Let’s see how that matches with my updated odds:

·        5% chance we have spina bifida (diagnosed via 15 week AFP test/ 15.5 week appt.).

·        10% chance we make it all the way to 20 weeks but have catastrophic issues diagnosed then.

·        2% chance something else terrible happens

83% chance I end up with a healthy-ish baby.  Okay, pretty much SPOT ON.  That’s pretty good, right? 

Here’s to hoping my little man continues to be normal!

Nerves of sugar

My big appointment is tomorrow.  How do I feel?  NERVOUS.  How am I handling it?  Oh, just eating my feelings.  I had 2 rice krispies treats and a dilly bar yesterday, and THREE dilly bars today.  What can I say, when I’m nervous I eat!  (Nom nom nom!)

What am I nervous about?  Well, obviously I’m nervous that we’re going to find some catastrophic structural issue, just like we did at our last 12 week appointment (omphalocele, poor spinal ossification, etc.) or just like we would have if we’d had a 12 week appointment for my pregnancy before that one that went that far (anencephaly, which would have been seen at 12 weeks, was not diagnosed until 15 weeks).  I’m also nervous that there will be something catastrophically wrong, but we WON’T see it at the 12 week appointment, and instead will see it at our 15/16 week appointment, or our 20 week appointment, or (worst of all) not until after baby is born.

I did some searching on a variety of topics.  One was just the general risk of miscarriage, particularly when age is factored in.  (I’m 39 now y’all!  Hubby’s turning 41!) http://onlinelibrary.wiley.com/doi/10.1046/j.1469-0705.1996.07030170.x/pdf  This article says what we all know—miscarriage risk increases with age, decreases the longer baby sticks around, and increases if you have bleeding (which fortunately I do not have this time).  However, it did not find an association with previous pregnancy loss and miscarriage rate.  (I don’t believe it, but I’ll take it!) The article also says that for losses between 8-15 weeks (the zone we’re in now), 45-70% of the cases are likely due to chromosomal abnormalities.  We do not appear to have those—at least any of the common ones.

Another topic was, what are the chances of miscarriage of a chromosomally normal baby after a normal 12 week scan?  Well, the internet has an answer!  It’s about 0.5%, which means 1/200.  That number sounds pretty low, or pretty high, depending on how you look at it.  http://onlinelibrary.wiley.com/doi/10.1002/uog.5138/pdf  “In singleton pregnancies with estimated risk of Down syndrome < 1:250 according to NT screening at 12-14 weeks, the spontaneous fetal loss rate before 25 weeks is likely to be around 0.5%. NT thickness up to 3 mm does not seem to affect the risk of miscarriage in such pregnancies. Instead, the risk seems to increase with number of previous miscarriages and deliveries, and possibly the risk is highest in the youngest and oldest women.”  Ugh again on the old mom shaming.

Okay, the topic that’s really got me stressing—how much does stress impact fertility/birth defects?  It turns out, probably some.  https://www.nature.com/articles/s41598-017-01792-3  This article looked at a variety of prior studies and suggests that stress does increase miscarriage risk: “Whilst chromosomal abnormalities underlie many cases of early pregnancy loss, the present results show that these psychological factors can increase the risk by approximately 42%.”  The article appears to accept that stress does not cause chromosomal abnormalities, but suggests that stress can increase miscarriage risk “from activation of the hypothalamic-pituitary-adrenal axis by recruitment of hypothalamic neurones which secrete corticotrophin-releasing hormone, increasing pituitary secretion of adrenocorticotrophic hormone secretion and hence of adrenal cortisol. This hormone has direct effects on decidual and placental metabolism but also interacts with progesterone signalling. Stress-related early pregnancy failure could also result from suppression of the hypothalamic-pituitary-gonadal axis…. These mechanisms are relevant because progesterone activity is crucial for the maintenance of pregnancy; low levels in early of gestation predicting miscarriage. Among its multiple effects, this hormone contributes to the suppression of maternal immune response to the conceptus.”  They also cite a study that “reported a live birth rate of 86% in women with recurrent (≥3) miscarriages who were enrolled into a program of emotional support, compared to 33% in similar women who had no formal supportive care.”  Maybe that’s why my OBs are pushing therapy on me!  I’m not sure what they would think of my rice krispies bar and dilly bar therapy plan….  (The article also cited an article I’ve seen before that says working out more than 7 hours a week increases miscarriage risk up to 18 weeks gestation.  http://onlinelibrary.wiley.com/doi/10.1111/j.1471-0528.2007.01496.x/abstract;jsessionid=549CA759D4EC7D5FF1256DE51DE4C1B5.f03t04)

Here's the one that really bums me out—the potential link between stress and birth defects. 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2094125/  Here, the researchers looked at the 2 months before conception through 2 months after conception and evaluated the mother’s stressful life events to see if there was a correlation with birth defects.  The mothers answered an 18-item inventory of stressful life events, such as:

whether she or her husband (or partner) had started a new job or lost a job;

whether she or anyone close to her had had a serious illness or injury, serious legal or financial problems, problems with drinking or drugs, or had problems with immigration;

whether she or anyone close to her had been a victim of violence or crime;

whether anyone close to her had died; whether she was separated or divorced or had had serious difficulties with her husband or partner;

whether she had moved;

whether she had had serious problems or disagreements with relatives, neighbors, or in-laws.

Most of the mothers of in the study were Hispanic, many had less than a high school education, and a majority took a folic acid-containing supplement during the periconceptional period.  The researchers found that birth defects tended to increase with the more stressful events the women had experienced.  The specific birth defects they say increased from stress were oral clefts, neural tube defects (ugh), and conotruncal heart defects.  They theorize that stress causes increased production of corticosteroids, which are teratogenic (ie bad).  They concluded, “more stressful life events experienced by the mother around the time of conception were associated with increased risks of orofacial clefts, NTDs, and conotruncal heart defects among offspring.”

Of course, if I were a participant in this study, I would have answered no to every single question they asked.  But going through fertility treatments—especially after a history of loss—is VERY stressful.  Plus, I have a demanding job that can be stressful at times.  How do I know if my life stresses—admittedly nothing to those faced by many other women—contributed to our birth defects?  I don’t.  And apparently stressing out about it is not going to make it any better.  So I’ll just have to wait and see what happens tomorrow....And maybe find something to eat.

My new mantra: And so we wait

I thought my appointment today was just a heartbeat check-up, but when I was in the examination room the doctor wheeled in a portable belly-ultrasound and I got to see my little man dance.  He was too active to get a heart rate measurement, but the doctor said it looked normal.  And the ultrasound machine they use is not good enough to get great pictures, but his little head looks round.  Obviously a relief, but the doctor was quick to point out that the fuzzy pictures on her machine were not like the crisp ones we’d get on Thursday at the high risk OB.  Nevertheless, she said she saw nothing that concerned her and would be surprised if he has anencephaly.  Of course, she acknowledged that our biggest challenge was going to be structural abnormalities, none of which (except perhaps anencephaly) could be seen at this point on this machine.  She said she would remain cautiously optimistic.

So we wait.

P.S. His movements seemed normal, which made me wonder if babies with anencephaly move normally.  The answer, apparently, is no.  https://www.ncbi.nlm.nih.gov/pubmed/3905349 (“In all [eight anencephalic] fetuses [studied] the movements were qualitatively abnormal: they were forceful, jerky in character and of large amplitude.”)

Hope springs eternal

What was left in Pandora’s box after everything else was lost?  Hope.

We got the results from our chromosome testing today.  (The testing looks at the common “compatible with life” trisomy chromosomal abnormalities—T13 (Patau syndrome), T18 (Edward syndrome), T21 (Down syndrome), and gender.  It does not test for all chromosomal abnormalities or look at whether there are broken chromosomes.)  Normal.  This is not a big surprise (although I’ll admit it was still a relief).  As far as we know, all of our last four pregnancies also had normal chromosomes.  And look how those turned out.

Today I am 10w4d pregnant.  We are waiting impatiently for that 12 week appointment, because that’s the one where we either found out or would have found out that our last two pregnancies were doomed. 

In the meantime, we’re doing exactly what we promised we wouldn’t do—getting excited and telling people.  This weekend, for example, we were at a very small family wedding.  At a winery.  Yea, it was a little conspicuous that I wasn’t drinking.  So we told a few family members.  And we ended up also telling a few very close friends because we were not going to see them in person again for a while.  Of course it’s impossible to keep people’s expectations in check—they’re immediately like “Miracle rainbow baby that magically sprung into being as soon as you stopped trying/being so stressed out/sold and gave away all your baby clothes/gear/furniture!!!  It happens all the time!!!”  Oh my G-, f- off!  (Of course I did not say, it, but I thought it repeatedly.)  This narrative of stop trying and it will happen is just so damaging to infertile people (and especially women, I think) because it places blame on the poor parents (wannabe mom).  I mean, it’s an odds game, right?  Someone somewhere will get pregnant the first time they ever have sex, and then never get pregnant again no matter how many times they try.  Most of the time, just because you’re infertile doesn’t mean it absolutely positively will never happen, it just means that your odds are lower.  Maybe far, far lower.  (I’ve actually read this is one reason it’s so hard to grieve/mourn/get over infertility—because there’s always that small chance it will happen.  So you can never have full closure.)  So instead of being normal and having a 1/6 (or whatever) chance of getting pregnant each month, maybe we’re like 1/100.  And instead of having a 1/10 chance of pregnancy loss/birth defects, maybe we’re 9/10.  But those odds do not add up to 0.  They just add up to probably not going to happen for you (again), sweetie.  (Actually, they add up to a 1/1000 chance of getting pregnant with a healthy baby each month.  I’m not saying these are actually our odds…. Although sometimes it sure feels that way.)  Regardless, I reject the notion that the only thing standing between me and a Dugger army of children was us trying too hard to get pregnant.  

But can I really blame people for their optimism?  I mean, I feel it too, as much as I really try to keep our expectations in check.  It’s hard to assume the worst.  What a terrible way to live.  But it’s also hard to allow yourself to hope, knowing that there’s still a good chance things will not work out.  I’ve been trying to take my OB’s advice and just not think about it.  Guess how well that’s going.

I will say, that early low heartbeat continues to really freak me out.  I mean, sure, it’s normal now, but it was still pretty slow.  I’ve read a number of medical journal articles that say an early slow heartbeat is a very, very bad sign (even if it’s normal later, although there are others that suggest the opposite) and is linked to an increased risk of miscarriage/birth defects:

•            http://www.fertstert.org/article/S0015-0282(04)00608-9/fulltext: For women with bleeding (threatened miscarriage) in the first trimester, those with a heartbeat of less than 120 were at increased risk for pregnancy loss.  It also said that most of the women who miscarried (85%) did so in the first trimester. 

•            http://egyptianjournal.net78.net/45_13.pdf: This article used a cut-off of 110 beats per minute, and also said most women who went on to miscarry did so by 12 weeks.  It also noted that “if the initial scan demonstrates a slow heartbeat, which indicates a high risk of subsequent demise, a normal heart rate on a follow-up scan obtained by 8.0 weeks lowers the risk somewhat but not entirely.” The study suggested that “first trimester pregnancy demise was 60.6% following a slow heart rate at 6.0/7.0 weeks, and this risk decreased to 25.4% if the heart rate was normal on a follow-up scan obtained by 8.0 weeks. This latter risk, however, was over three times as high as the risk in the control group of pregnancies with a normal heart rate at 6.0-7.0 weeks and a normal rate on a follow-up scan obtained by 8.0 weeks. The incidence of pregnancy demise was elevated regardless of the timing of the initial scan (6.0-6.0 or 6.3-7.0 weeks) or the severity of the slow heart rate (moderately or very slow).”  It cited another study, though, that found “A normal follow-up heart rate after a borderline slow rate, however, was fully reassuring in that it indicated that the risk of subsequent demise in the first trimester was no longer elevated.”  Their cut-off was slower than ours, so maybe I should not be too worried about the increased risk even if the later heartbeat is normal.

•            https://www.ncbi.nlm.nih.gov/pubmed/10447078: This article also found that for fetuses that had early slow heartbeats (< 100 bpm at < or = 6.2 weeks, < 120 bpm at 6.3 to 7.0 weeks) first trimester survival rate was 61.6% for the slow early heart rates versus 91.5% for the normal heartrates.  For those that survived the first trimester, most of the slow heartbeats were okay, but the slow heartbeats had twice the risk of having structural or chromosomal abnormalities: “Structural and chromosomal anomalies, however, occurred more than twice as frequently in cases with slow early heart rates: 5.4% (16 of 299) of the first trimester survivors with slow early heart rates proved to have anomalies, as compared to 2.4% (31 of 1281) of cases with normal early heart rates (p < 0.05, Fisher's exact test). In conclusion, a pregnancy in which the embryo has a slow heart rate at or before 7.0 weeks' gestation and which continues beyond the first trimester has a high likelihood (> 90%) of resulting in a liveborn neonate without congenital anomalies. Embryos with slow early heart rates do, however, have a greater risk of having anomalies than embryos with normal early heart rates.”  This one makes me nervous, because it suggests risks for abnormalities are increased with the slow heartbeat.  That’s obviously my biggest concern now—fetal abnormalities.  Our risks are already super high.  I hate that they’re likely even higher because of the slow heartbeat.

•            http://pubs.rsna.org/doi/abs/10.1148/radiol.2362040880: I think this is the article I cited before. Their cut-off was “slow if it was fewer than 90 beats per minute prior to 6.3 weeks or fewer than 110 beats/min at 6.3–7.0 weeks, normal if it was 100 or more beats/min at less than 6.3 weeks or 120 or more beats/min at 6.3–7.0 weeks, or borderline if it was 90–99 beats/min prior to 6.3 weeks or 110–119 beats/min at 6.3–7.0 weeks.”  They found “The rates of first-trimester demise were 60.6% for pregnancies with slow heart rates at 6.0–7.0 weeks (188 of 310), 17.4% for those with borderline heart rates (103 of 593), and 9.1% for those with normal heart rates (186 of 2034). There were 59 pregnancies with a slow heart rate at 6.0–7.0 weeks and a normal heart rate at follow-up US by 8.0 weeks; 15 (25.4%) resulted in first-trimester demise. This rate of demise was significantly higher than that of 7.2% (28 of 390) in pregnancies with a normal heart rate at 6.0–7.0 weeks and a normal heart rate by 8.0 weeks (P <.001, Fisher exact test). Pregnancies with a borderline heart rate early in pregnancy followed by a normal heart rate had a demise rate of 7.6% (nine of 118), which is similar to those with normal heart rates early in pregnancy followed by normal heart rates at follow-up (P = .84).”  This is the article giving me the most hope—it basically says that if the early heartbeat is “borderline” (which ours would be under their definition) and then normal later, there’s no significantly increased risk of fetal demise.  

•            http://www.ajronline.org/doi/abs/10.2214/AJR.10.4792: This one basically says a very, very early slow heartbeat might not be a bad sign if the baby is measuring behind (ie. the dating is off).  I actually think our dating is a few days off (but not 5, which is what they were looking at), so that gives me some hope too.

•            https://www.ncbi.nlm.nih.gov/pubmed/8029394: This one says very, very slow heartbeats (less than 70) are probably doomed, and most of the ones less than 90 bpm also will not make it.  (They described the outlook as “dismal.”)  In their study, of the fetuses that miscarried, none survived past 10.5 weeks.

•            https://www.ncbi.nlm.nih.gov/pubmed/19389900: This one just says a slow heartbeat before 7 weeks means there is an increased risk for chromosomal abnormalities.  Ya think?

It’s hard not to be completely freaked out about the early slow heartbeat.  Although I take comfort in the facts that (1) it was what’s considered “borderline” slow in some studies, (2) we have a normal heartrate now and (3) we do not appear to have any common chromosomal defects.

Oh, and we also found out gender today.  Back on the theme of hope, both my husband and I have been imagining it’s a girl.  I’m not sure why.  Probably because we have a son and would really like to have a daughter.  And probably also because our last four pregnancy losses were all girls and it would just feel like we haven’t lost as much if this were a girl.  (I know that logic is a bit twisted, but isn’t the idea of a rainbow baby already pretty sad?)  Of course, the peanut gallery (ie friends and family) have theories that we just can’t carry girls, and that’s why we kept having losses.  We had 2-3 losses before we started fertility treatments (ectopic, likely second ectopic, early undiagnosed miscarriage) and then 2 IVF losses after my son where we did not know the gender (blighted ovum and early miscarriage).  It is impossible to believe that those losses were ALL girls.  (Right?)  Now, we do know the four losses after that were all girls, including the two with catastrophic birth defects.  But, like I mentioned, the genetic counselor has said there is no scientific basis to believe we can’t carry girls or that our girls would have these genetic defects but boys would not.  (Of course his working theory is that we just can’t carry anything, and it’s my son that’s the unexplained miracle.)

Well, this one’s a boy too.  Let’s see if he makes it/reinforces the peanut gallery’s theory.

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!!

Don't phunk with my heart

This whole process has been a real whirlwind of emotion.  I’m pregnant!  I’ll probably miscarry!  There’s a fetus!  It has a slow heartbeat!  No it doesn’t!  I’ll probably find out there’s a birth defect!  I don’t know how much more of this whipsawing I can take.

I had my appointment today.  Based on my last menstrual period, I am 8w5d.  Fetus is still measuring behind that day (which is fine), at 8w2d.  Crown to rump is 17mm (hence the 8w2d measurement), gestational sac is 38mm, yolk sac is 4mm, heart rate is 170bpm.

Hold the phone, you say!  That all sounds normal.  Indeed it is.  Indeed it is.  From the information in my appointment today, I have absolutely nothing to worry about.  Except for my history (9 pregnancy losses, 2 after 12 weeks from severe and devastating birth defects) and my age (39).  And maybe the fact that I wasn’t trying to get pregnant and thus was not on any kind of prenatal vitamin, let alone high doses of folic acid in an attempt to avoid another NTD.  But other than that everything is roses!

I don’t know what to think.  I fully expected to go into this appointment hearing that there was no heartbeat, or that it remained catastrophically slow, or that the fetus was falling way behind on development.  And I was going to accept that because I felt confident it was just a matter of time that things went south.  I was not prepared to be told everything looks great!

So we continue to wait.  I’m starting to feel just the tiniest bit of optimism, which means, of course, that it will be all the more crushing when things go wrong.  But there’s nothing more I can do but wait, and try to keep my expectations in check.

In the meantime, I’ll have a lot of time to think about this when I’m running the Chicago marathon this weekend—a little slower than I was planning to.

P.S. I am in love with whoever created this miscarriage prediction website:https://datayze.com/miscarriage-chart.php  It give you chances of miscarriage by day depending on mom’s age, height, weight, previous live births, and previous miscarriages.  They even have a little thing “Nervous about miscarriage? Let us reassure you.” where they give you pep talk statistics.  For me, this week, based on my age (geriatric), history (abysmal), and height/weight (sexy as hell), it claims I have about a 5% chance of miscarriage.  (Obviously my concern is not miscarriage but birth defects, but still, that’s a nice statistic.)  It says, “At 8 weeks, 2 days the probability of not miscarrying is 94.7%.”  Still nervous? It tells you, “The probability of your pregnancy ending in miscarriage decreased 8.6% since yesterday, from 5.8% to 5.3%.”  Still nervous?  “Since becoming pregnant, your probability of miscarriage has decreased 87.3%, from 41.7% to 5.3%.”  How fun is that??

P.P.S. Am I nervous about running a marathon at 9+ weeks pregnant?  No.  Exercise during pregnancy is (generally) good!  See:

http://www.bbc.com/news/magazine-36402624; http://bjsm.bmj.com/content/50/10/571

P.P.P.S. Do not mistake my temporary surprise/increased optimism with confusion about how precarious our situation is.  I know our history and have not forgotten we had a slow heartbeat at the last appointment.  And a slow heartbeat at the beginning leads to increased changes of miscarriage even if a later normal heartrate: http://pubs.rsna.org/doi/full/10.1148/radiol.2362040880 (“When a slow embryonic heart rate is detected at 6.0–7.0 weeks, the likelihood of subsequent first-trimester demise remains elevated (approximately 25%) even if the heart rate is normal at follow-up. In such pregnancies, at least one follow-up scan in late first trimester is warranted.”)  There remains an increased risk of loss through the first trimester: http://www.fertstert.org/article/S0015-0282(04)00608-9/fulltext (“patients with slow fetal heart rate (<120 bpm) in first-trimester threatened abortion may eventually be at risk for pregnancy loss. If it survives the first trimester, the likelihood of subsequent death is low.”).