Flotsam

Friday was a trying day. You know you are not quite yourself when you sob brokenly at an Amanda Bynes movie. Actually, the fact that I watched the movie in the first place was probably just as telling, but it seemed like a good idea at the time.
First, a word about pregnancy symptoms: as of last Monday, at six weeks and two days, I didn’t have any. I felt terribly unpregnant, and it worried me, as everything is wont to these days. I have been pregnant before, after all, and in my longest previous pregnancy I threw up for the first time at four weeks.
I am telling you all of this in case one of you got here by googling “six weeks pregnant no symptoms miscarriage” or “six weeks pregnant no nausea doomed.” I like to help wherever I can, so let me assure you, neurotic pregnant women of the world (NPWW, Unite!), that you can have no symptoms at six weeks, two days, and feel perfectly awful only twenty-four hours later. Give it a whole week, and you too could be shivering on the couch, wearing a pair of oh-so-stylish Sea Bands and swallowing your own bile! I know! I am a beacon of hope.
So. Yes, I am ill. Last Monday I was fine, and then Tuesday I started feeling nauseated in the afternoons and evenings. I didn’t say anything about it here, in case it was a fluke and I went to my Thursday ultrasound and saw only static, but on Friday, the vertigo began. I am assuming this is pregnancy related, and not the result of a head injury I do not remember sustaining, but when I move my head too quickly (read: at all) or do something strenuous like walk or shift my eyes, I have the alarming sensation of being in a funhouse. A funhouse located on a boat. The nausea is worsening as well, and my list of acceptable foods has dwindled alarmingly in the last two days. Curiously, mornings are my least nauseated time.

I was at work when the vertigo started on Friday, causing me to walk crookedly down the halls from meeting to meeting, and then my OBs office called to say that while my pap smear was normal, I seemed to have a yeast infection. That afternoon, Fedex didn’t deliver my progesterone and syringes, and I was forced into a rather embarrassing altercation at Walgreen’s when I tried to buy a syringe “just to get me through tonight,” which in retrospect was probably not the ideal choice of wording. I topped off the evening with a bit of light googling of “small gestational sac” and “twins measuring behind” before proceeding to the bathroom where I noticed pink spotting. It was around this time that the Amanda Bynes movie seemed like a good idea, and, well, you know the rest. As I said, it was a trying day.
As of yesterday the spotting has stopped, I am still feeling like a reluctant sailor, and thanks to my Sea Bands I have “Physical” running through my head on a continuous loop. I am seven weeks and one day, making this officially the longest I have been pregnant, and I am very, very grateful.

Thank you all for your encouraging comments on my last post. I am not so much worried about the sacs measuring behind (this study was a bit reassuring on that point) as I am about the lack of growth (3 and 4 days in a week). But I have an other OB ultrasound Wednesday and my RE ultrasound Friday, so I don’t have terribly long to wait for more information.

I spent this weekend catching up on my Tivoesque, and wow, Private Practice was HORRIBLE, and I will not be watching that again. The Addison of Private Practice bore almost no resemblance to the Addison of Grey’s, and the only explanation I have come up with for this phenomenon is that in Shondaland, only peripheral female characters (like Addison in Grey’s) may be smart, strong, likable, and nuanced. Primary female characters, on the other hand, are required to be neurotic, whiny, and “kooky.” Bonus points if they are wishy-washy and excessively focused on the bemused Primary Male character, and TRIPLE bonus points if they undercut any show of power or initiative with a concurrent display of the aforementioned kookiness. Pratfalls are encouraged.
On the other hand, Dirty Sexy Money wasn’t half bad, the season premiere of House was so funny I watched it twice, and Friday Night Lights starts soon, so I think I will manage without Ms. Rhimes. Also, the finale of Top Chef is coming up, and while we’re on the subject, I wish people wouldn’t be so mean to Hung. I understand finding him unpleasant in many ways, but come now. Surely he is better than the execrable Dale?

Yesterday I discovered Minute Maid Soft Frozen Limeade, in the Limonada flavor, which is a sort of scrumptious push-up Italian ice stick that I cannot recommend highly enough, especially if you aren’t feeling particularly…fresh. This weekend was the perfect time for this discovery, as it coincided with my realization that we live in a very smelly world (honestly, it is revolting—sing about that, Louis Armstrong) and placing one’s nose close to a cold citrusy thing helps tremendously. So consider that recommendation my gift to you, and feel free to return the favor:
I think I need a book to read, something easy and absorbing. Any ideas? I do not have the energy for anything excessively literary, so no suggestions that I read Anna Karenina in the original Russian, please. I have already reread my old feeling ill standby, my Sarah Caudwell collection (why did she have to go and die after writing only four books? WHY?), and I am in the market for something new. I liked A Girl Named Zippy and I dislike Hemingway. Trashy is fine. Funny is good. No dialect, poetry, or war stories. Nothing on a boat or in a funhouse. I will also accept suggestions for a TV series available on DVD, as I am entirely tapped in that area as well (like: Veronica Mars, Gilmore Girls, The West Wing; dislike: science fiction).
Go!

For the newly pregnant, the world must have been a rather bleak place before blogging came along. How frustrating to have such news and be unable to share it—after the ultrasound I wanted to tell everyone from the parking attendant to the woman who poured me an Italian soda, that I was maybe, possibly, really pregnant after all, but of course it is still a fragile secret, so all I could do was burble at my meetings with more enthusiasm than warranted by the subject of print production schedules. And then I hurried back to my desk to read the kind, jubilant comments that were rolling in from all of you, and I cannot tell you how good it felt to have people with whom to celebrate. I was overwhelmed and touched and I feel very, very lucky.

So! The tedious recounting (with ultrasound pictures, so be warned):

My modus operandi when faced with a difficult doctor’s appointment, one that will require me to be more assertive than usual, is to listen to Biggie on the way there. I am sure other people have methods that work for them—deep breathing, say, or affirmations—but for me nothing is more effective at banishing my overly deferential people-pleasing compulsion that twenty minutes of Life After Death. By the time I pulled into the parking ramp I almost felt a little sorry for my OB, sorry for the whirlwind of hardcore that would be unleashed upon him if he refused my request for an ultrasound. I would make it hot, like a kettle get.

Or I would have, if he hadn’t responded to my initial “I think we should do an ultrasound” with “That’s just what I was thinking!”
He left to secure an ultrasound room, leaving me gaping at the door, my heart flapping frantically against my chest wall. I had a sudden impulse to leave before the ultrasound, in order to preserve for as long as possible the illusion that I was still pregnant, but of course I didn’t, opting instead to stay and sweat and rend my garments.
An exceedingly perky Nurse Practitioner appeared and led me down a hallway to a shockingly posh exam room. This is how the other, fertile, half lives: the space was comfortably dim, soothingly appointed, and contained an ultrasound machine with an auxiliary screen mounted near the head of the exam table for easy viewing by the patient. I undressed and assumed the position, and promptly started to cry. The crying was silent, but the trembling of my legs rattled the stirrups, and I must have been quite the picture when the NP returned to begin the exam.
She inserted the probe, and for one sickening moment I saw only static, and started to shake harder, and then I saw this:

“Oh my god!” squealed my new favorite nurse, “Two little sacs!”
“Oh! Oh!” I said eloquently, gazing at the screen and wiping my streaming eyes.
She pointed out the obvious yolk sacs, and measured the two gestational sacs at five weeks, three days each.

“They are just so cute,” she said, and I have to agree:

Here is a close-up of A, (the one on the bottom), in which you can see its yolk sac and cunning fetal pole (the white line in the middle):

And here is B (with yolk sac, but no fetal pole yet—though at one point she thought she saw one):

Not pictured is my left ovary, which is still roughly the size of a Buick, probably explaining why I am so…rotund.

The nurse printed off some pictures for me and I followed her back to my original exam room, grinning like a fool.
While I waited for Dr. Schrodinger to return, I tried to prepare myself to demand a repeat ultrasound in ten days or so by humming a few bars of Kick in the Door and rehearsing my speech about supportive care and recurrent pregnancy loss. Dr. Schrodinger came in beaming, announced that he was just thrilled for me, and that he would like to see me for another ultrasound in a week. This is when I cleared the desk with one arm and flung him upon it, proceeding to make sweet, sweet love to the best obstetrician the world has ever known.

He reminded me that it was too early to tell whether this would be a twin pregnancy or a singleton pregnancy (I managed to refrain from adding “Or no pregnancy at all,” which should show you what an excellent mood I was in) and said that we would remain on pins and needles until eleven weeks or so, given my history. Which made me laugh, because I have a hard time imagining any point in a pregnancy when I would not be “on pins and needles.” Or, more accurately, “prodded by the sharp swords of fear and desperation.”

I return Thursday (one of the only days Dr. Schrodinger sees patients at my location), which means I am rescheduling my RE ultrasound. No point in wasting a perfectly good sonogram on a day when I will already have had one. This way I know I have at least two ultrasounds coming to me in the next two weeks, which soothes me. Especially as I had some light spotting last night, putting a significant damper on my post-ultrasound bliss.

Still, we are pretty blissful around here. I was six weeks yesterday. Scott is beside himself, and I feel much more relaxed knowing there are two sacs in there, my rate of embryo attrition being what it is. Two takes the pressure off, just a little, though of course we are greedily hoping that both will have heartbeats this week. It seems too much to ask, and I half expect the hand of god to reach down and smite me for typing such a thing—so let me hasten to add that I will be delighted with one: one fast, strong, thumping heartbeat, one that intends to keep beating for, oh, forever.

Unless Dr. Schrödinger, OB discovers differently at my appointment, I am now five weeks and four days pregnant. Of course my hCG could have dropped like a stone after my last beta, the inevitable bleeding quelled only by the vast quantity of hormone I am injecting into my musculature each evening, but I am valiantly attempting to ignore that possibility. I still have no symptoms that can’t be attributed to progesterone, and the crippling nausea that haunted my longest pregnancy is notably (and probably visably, due to my increased cheese consumption) absent. I could not feel less pregnant, and in fact have felt more pregnant on cycles that turned out to be negative. But in less than twenty-four hours, I will have an ultrasound, and the infernal speculation will finally cease.

You notice I say will have an ultrasound. I have decided not to take no for an answer, and if Dr. Schrödinger wants to live to probe another cervix he is damn well going to attempt to visualize Science Baby/ies via sonography. They always have little glass jars of cotton balls in OB offices, and if necessary I will break the top off one and hold the jagged edge against his throat. Scott won’t be at the appointment, so I can be as shameless as necessary, and also he can’t be charged as an accessory.
Speaking of which: the lovely Amanda continues to clamor for news of Scott’s reaction, and I can report that he is much more confident than I about the current state of my uterus—as he put it:
“I think you’re definitely pregnant, because you’ve been really mean lately.” Awww.

When I first started getting positive pregnancy tests Scott did not believe them, and would brook no discussion of the matter until after the beta. We have had very different anxiety trajectories—from positive pregnancy test to beta I was nearly levitating with joy, while he gritted his teeth and worried about something going terribly wrong. When we got the beta results we were both giddy. And since then he has remained on an even, optimistic keel, while I have descended further and further into madness, surfacing only occasionally for handfuls of goldfish crackers. He has put up with my progesterone-induced mood swings [see: screaming (well, that was only me) fight about, of all things, Christianity and the early Roman empire (neither of us are Christian); broken-hearted sobbing after latest episode of Meekat Manor; petulant flinging about of self after discovering we were out of carbonara ingredients] and he hasn’t said a word about my truly revolting night sweats. He even administers the progesterone-in-oil shots, which have become a bit of an ordeal. Originally I did my own PIO, simply because I found it easier that way. I’m not afraid of needles and the shots weren’t particularly painful, 1 1/2 inch 22 gauge notwithstanding. Sometime around my beta the shots became excruciating, and I started playing a tense game of chicken with myself before each one. So with the exception of Fridays, Scott now handles the nightly shot, leaving me free to take deep breaths and then whimper obscenities. We started using a numbing cream, which helps a bit, but there is simply no unbruised territory left. And Scott swears the skin on my hips has become thicker and harder to pierce over the weeks (and just a little reminder for any partners out there: comparing your hormonal wife’s ass to rhinoceros hide is never, ever a good idea). Eventually Scott will have to shoot the progesterone at my backside via dart gun.

Anyway, the point being he is handling all this like a champ, buying me macaroni, doing the laundry, and constantly telling me what a good job I’m doing, even as I am sniveling like a whiny, whiny baby and pondering a trip to urgent care with faux “ectopic” symptoms to snag an early ultrasound. His reaction is no surprise really; I am a very lucky girl.
What was a surprise was him telling me, a few days after transfer, in front of his parents, that he is “kind of hoping for twins.” Yes, Mr. How-About-a-Single-Embryo-Transfer has changed his tune. I think it comes from having seen the embryos under the microscope—it is hard not to hope both of them are still alive, as they were both so charming and attractive. I even find myself wanting to see two on the ultrasound, though for a rather morbid reason: part of me feels that seeing two living embryos at six weeks gives me a better chance of seeing at least one embryo emerge unscathed from the first trimester. Not a very nice way to think, perhaps, but there you are. Of course all I really ask (over and over all day, and probably in my sleep as well) is one gestational and yolk sac set, appropriately sized, in the uterus where they belong. A fetal pole would be appreciated as well, but I don’t want to be greedy.
To be honest, it all feels rather academic as I have been blankly unable to envision any ultrasound scenario besides the one I experienced almost three years ago. I try to picture myself on the table tomorrow while Dr. Schrödinger peers at the screen, but in my mind he opens his mouth and what comes out is the voice of the female ultrasound technician whose blond, sprayed coif I can still see clearly before me: “I’m sorry, but…”

I am woefully behind on my email correspondence, so if you have written and haven’t heard back, please forgive me. My appointment is at 8 am CST tomorrow, after which I have a long drive back to work and a flurry of meetings. I will try to post the results as soon as I get to the office, but will not have time for the detailed, tedious recap until later in the day. Although if the news is unambiguously bad, I may not go back to work at all, which would give me more time for posting. Of course in that case I will probably be drunk by noon, so an update might take a while either way.

17 hours and 19 minutes until the moment of truth.

Edited to clarify: I will still have my official RE ultrasound next week, and am not expecting to see a heartbeat until then. Gestational sac and yolk sac, appropriately sized; gestational sac and yolk sac, appropriately sized…a little long for a mantra, but it works for me.

Friday afternoon I developed a wicked lower backache, and my cramping ramped up from “twinges” to “uterine vice grip.” Sitting in my desk chair became increasingly unpleasant, and I was forced to flee work early in order to spend an evening on the couch watching Meerkat Manor. There was no spotting, however, and I didn’t want to bother the clinic over what was probably nothing.
Saturday morning was better, but by afternoon I felt awful. Curiously, it was similar to post-retrieval pain. Or last-day-of-stims pain, even. I was bloated, and my undercarriage felt stabby. I started to wonder whether it was my ovaries that felt so unpleasant, and to my shame, found I just couldn’t tell. It could have been my ovaries, or it could have been my uterus, killing my embryos. Maybe I didn’t spend enough time with my hand-mirror as a youth, but I find it difficult to distinguish various undercarriage-related sensations. When I had my last kidney stone in February, I was at first convinced the pain was some kind of cramping related to my then-recent miscarriage. Kidney, ovary, uterus, cervix—it’s all the same to me.
Sunday followed what was becoming a familiar pattern: fine in the morning, late afternoon spent entertaining my own less-charming seven dwarves: Whiny, Shaky, Crampy, Bloaty, Weepy, Cranky, and Stabby.

It may seem bizarre that I didn’t call the clinic through all of this, but you should see the instruction sheet specifying that the weekend on-call number is FOR! EMERGENCIES! ONLY!!! Besides, I figured there was nothing they could do, and I have a pathological fear of over-reacting or inconveniencing someone (Er…see this post). Also, I was feeling so happy to be pregnant, so grateful and sunny and optimistic, that some strange, hitherto unknown part of me didn’t want to spoil my mood with more information.

Yesterday, however, the clinic was open and the pain was back and I managed to get in to see a nurse that afternoon, right at the time of day (2:00) that the discomfort starts to increase to unpleasant levels.
And, as I was beginning to suspect, I seem to have developed a mild case of OHSS.

It is quite unpleasant, I must say. The backache makes it very difficult to sit at my desk at work, and if I overdo it at all, I pay a heavy price. And by “overdo it” I mean “run two errands.” Last night we went to the bookstore and then to Target, and I went from moderately uncomfortable to almost unable to walk with astonishing speed. The other casualty of the OHSS has been the relative calm I had managed to maintain through Sunday: though I tell myself that any unpleasant undercarriage sensations are merely my over-stimulated ovaries, it is hard not to panic at back and pelvic pain in pregnancy after three previous miscarriages. After all, they didn’t do an ultrasound, relying only upon their years of clinical experience to make the diagnosis. Who’s to say the pain isn’t the result of tiny devious gnomes that hopped aboard the transfer catheter and are even now gnawing on my cervix and plotting the demise of Science Baby/ies?
The nurse suggested I take a few days off from work, but I have no vacation time left and just finished using FMLA to cover my myriad IVF appointments, retrieval, and transfer. I am terrified of asking my boss for more time.
“Well,” the nurse suggested, “Maybe you could lay on your left side during your lunch hour!”

Again, I must ask: what do these people think we do for a living? For one thing, lunch “HOUR?” Ha. Ha, ha, ha. And for another, what am I supposed to do, recline on the floor of my cubicle?
“Hi Alexa, I was just bringing you…Oh. Are you ok?”
“Oh yes, I’m fine! I’m just taking some Me Time. Or…I lost an earring.”

The upside to yesterday’s impromptu clinic visit was that I managed to score another beta. I asked the lab tech to draw an extra vial of blood, assuring her that I would convince the nurse to run the test. Which I did, and I’m not too proud to admit that I begged, all Oliver Twist-like. But the results are in, and my beta at 13dp3dt was 426. The doubling time was just over 44 hours, which is perfectly fine, but didn’t stop me from googling “increasing doubling time hcg miscarriage” for an hour and a half last night. I certainly know how to have a good time!

Just as there is no crying in baseball, there is no logic in early pregnancy—when you are in pain, you worry. When you are not in pain, you worry, because what if the pain went away because the embryos are dead?
I keep reminding myself that people stay pregnant all the time, and I am doing everything I can, and there is no reason yet to think this won’t work out. I am taking progesterone injections, progesterone suppositories, baby aspirin, 2000 mg of Metformin, twice daily Folgard, and Prednisone. I am eating plenty of pasta, which early studies show is very popular with embryos.
I am still pregnant.

384 hours and 50 minutes until the ultrasound.

Spotting. Brown, not red, which I suppose I should be grateful for, in the way that you might be grateful after having your car stolen that at least you still have your bicycle. I am 9dp3dt, and it seems too late for implantation, and this is the time in a regular cycle that I generally start spotting. I have some cramping as well, though I have been cramping on and off since transfer, so that could mean anything. I am sitting here listening to “Please, Please, Please” by James Brown and thinking I know exactly how he feels.

But this morning’s test line was not faint. It was obvious, strutting into view almost immediately. Brash, bold, all “Say it loud! I’M PINK AND PROUD!” while the horns blare saucily in the background.
A blind man can see how pregnant you are, it whispered at me whenever I opened my purse to check on it (yes, I did take it to work, WHAT’S YOUR POINT?).

And then I went to the bathroom this afternoon and saw what I saw. I left work and called my clinic to pry yesterday’s progesterone level out of them, in case I need to increase my supplementation. But my progesterone was 33, which is apparently sufficient. (Or IS it?)

Oh, I don’t know what to think. The line is dark, so I’m happy. But I’m spotting, so I’m scared. I’m scappy.
I want my happy back.

Saturday morning, as we were rushing around getting ready for my in-laws to arrive, I had a bit of a pant crisis. Namely, I didn’t fit into any. Though I have gained less than five pounds during this IVF cycle, they seem to congregate around my midsection in an alarmingly protuberant fashion. I have been wearing forgiving dresses for the past week or so, but alas, in our zeal to clear our bedroom floor before the guests descended all of my dresses and skirts were gathered up and pitched into the washing machine.

I give you this expository information in an attempt, though probably insufficient, to explain this:

Yes, that is duct tape.
When it became clear that no amount of huffing and puffing and kneading of flesh was going to induce my jeans to button, I remembered The Rubber Band Trick. This is one of those small pieces of pregnancy lore you hear and store away for when you, yourself are with child—I had been storing that tidbit for almost three years, and I was damn well going to get some use out of it, barren or not. For those of you who don’t know, The Rubber Band Trick is to extend the life of your non-maternity pants by looping a rubber band through the button hole and around the button. Hooray! Problem solved!
Except we didn’t have any rubber bands.

At this point my voice began increasing in pitch until Scott grabbed a roll of duct tape. At first I thought he was going to use it to cover my mouth, and then I thought he was going to attempt to brutishly lash the pants to my body, but instead he devised the above clever little stratagem, and I greeted my in-laws with my pants held together by a rudimentary duct-tape belt. Thank heavens for tunic-length tops.

The rest of the weekend went much more smoothly, and having my in-laws around was actually a welcome distraction from what might or might not have been going on in my undercarriage.

To give you a little more information about the none-to-freeze situation, as it turns out “quite a few” (embryologist’s words—I was too disoriented to demand much detail) of our embryos made it to blast, but none were suitable for freezing, and so were discarded. One of them was very close, a 4BB I think, but the others were all lower quality, some missing one of the two cell sections entirely. I asked about the quality of our embryos on day three, to try to ascertain whether we had definitely transfered the ones most likely to implant, and was told that the two we transfered were our only grade 2s. We had no grade 1s (the highest grade at my clinic) and the other fifteen were grades 3 and 4, most of them only four or five cells. We had “a couple” eight-celled embryos on day three, but they were grade 3, so it does look like the seven- and nine-celled embryos were our best bet, and the embryologist assured me that the fact that they had an odd number of cells is not significant (no idea if this is true or if she was merely trying to stop my infernal sniffling).

Friday night was hard. Having nothing frozen for Plan B was a shock. Hearing that most of my embryos were such poor quality on day three was a shock. I don’t know if it was a protocol issue (too much LH) or whether my eggs are just prematurely rotten. I am petrified of what will happen if this doesn’t work. I wasn’t being dramatic when I said we can’t afford another fresh cycle—we really can’t. Scott keeps declaring that he will get three jobs and we will have the money saved within six months, but he is still in the middle of a brutal search to find a primary job that pays well enough for us to do more than barely scrape by, and now we have debt from this cycle as well. I don’t see how we could possibly raise the money in less than a year, assuming he finds a better job, um, tomorrow. And the thought of waiting to try again, after all of the waiting we have done, makes me physically sick to my stomach.

As of this morning, pregnancy tests are negative. I know it’s too early, but I also know that won’t stop me from dry heaving in terror if tomorrow’s test is negative as well.
This should be an interesting week.