Saturday, January 31, 2009


Well, I had my thyroid appointment and the doctor - a really thoughtful, helpful man with a great bedside manner - thought at first that I was four months postpartum. My bloodwork shows a classic case of postpartum thyroiditis.

I can understand the confusion. The numbers make sense for that diagnosis, and I wasn't wearing a tight shirt. Sitting down in a long floppy top, I could easily be a new mother. It took a while to sort it all out, partly because he had a lot of paperwork from my OB, so I assumed he had all the facts. Also, part of his exam turns out to be just talking for a bit and trying to see if he picks up on any overt lethargy or jitters. So, the conversation was a little weird.

"Any problems with breastfeeding?"

"Not that I remember..."

"Concerns about post-partum depression?"

"Not really - I haven't really gotten around to worrying about anything like that yet..."

"And when did you deliver?"


The look on his face was absolute confusion. And I'm sure I had the same look. When we started all over again, he was wonderful. He drew pictures to show how the thyroid worked, what happened to the T3 and T4 and how the TSH was regulated. He was very specific and scientific, which I always appreciate, but with a kindly sense of humor and a great vocabulary. At one point he said my numbers were "not too bad, but nothing to be sanguine about".

He decided to retest everything at a high-spectrum lab. My TSH is .43, with normal being >.5 - he felt this was not too worrisome since my actual hormone levels are fine. So, it's wait-and-see, and least until the lab results are back.

The one interesting thing he did say is that steroids can affect the thyroid. Since I was on dexamethasone for this IVF cycle maybe that has something to do with it. Although the dose is tiny compared to the amount used to treat chronically inflamed tissues, but who knows? I always turned a blind eye to the possibilities of long-term side effects from everything necessary for IVF - if I thought about it too much I would never have been able to go through with any of it.

Obviously, this is not a giant disaster. I feel like I'm in good hands and as long as the baby is fine I can cope with just about anything. But it is like another little message from my body, like it's saying "Listen, lady, wasn't it kinda obvious that I didn't want to get pregnant again? Then you go and do IVF and somehow it works. Great. Well, you can't say I didn't try to warn you."

I wish there was a way to argue reasonably with this grumpy body - but I guess if that were possible I wouldn't have had to go through IVF in the first place...

Wednesday, January 28, 2009

Just When I Thought It Was Safe...

I have never had a thyroid problem. I have been tested who knows how many times during these last years of bloodwork, and always the results are normal. My tests from September are completely normal. Sure, I have all kinds of other problems. My anti-trypsin numbers are too high and my hematocrit is too low. But thyroid has never been an issue.

Until now, of course. My very borderline, nothing-to-worry-about low TSH has been getting worse instead of better. Because my free T3 and T4 numbers were fine, the low TSH didn't really mean anything in the first trimester. Apparently the hCG can affect the thyroid hormone levels as it increases in the first months. But here I am in the second trimester and it's getting worse, so I'm off to the endocrinologist (a regular one, not a reproductive one.)

I keep thinking that clearing the hurdle of actually getting pregnant should be enough. All those years of trying to solve that problem have left me less prepared to handle new ones as they crop up. It should be the opposite - I know how to read journals and figure out what questions to ask - but instead I'm just useless. I googled "hypothyroidism + pregnancy" and there were just too many upsetting results so I quit. My medical-issue resolve has been exhausted. I have an appointment with the endocrinologist in two days, and until then I just want to think about something else.


The most interesting thing I can distract myself with now is the middle school search. It is fascinating to see what amazing opportunities there are at some of these schools. Kids on the debate team go downtown to argue their points before real judges. Science classes take four-day trips to the Channel Islands and the Mojave. For spring break there are (optional - and expensive) trips to Vietnam and Peru to build schools and bridges and clean up wetlands. Seniors are matched with internships in any field they choose. Even the lunches are amazing - one school is catered by one of our favorite restaurants!

My junior high was more like pre-teen jail. The halls smelled like grease and the bathrooms were always out of order. A lot of the boys were left back a few years on purpose, so they could be bigger for high school football. They would cut class and go across the street to get donuts, so there were always smears of jelly filling and whatever that yellow creamy stuff is all over the desks. Those guys would push girls against their lockers and grab their crotches - it was repulsive, but nothing ever happened to them because they were going to be football stars. In high school, one of them was in a bad accident (driving drunk) and his leg was crushed. He wouldn't be able to play football again and I remember being glad. I specifically remember thinking that it was kind of horrible of me to feel that way, but that I was glad anyway. He had grabbed me once, and I had never told anyone.

I know school is still school. Even if my daughter goes to the fanciest private school with the most exclusive everything, there will still be cliques and parties and mean girls and drugs and boy problems. Maybe worse, who knows? But these schools have "life skills" classes and advisory groups that encourage kids to talk about issues and rumors and problems. They have counselors and peer support councils and incredible small student-teacher ratios. If my friends and I had had anything like that, things might have been so much easier to deal with. If we had even thought there was a chance that somebody would really listen to us instead of just telling us what to do, things might not have been so out of control.

Even while I hope to be a new parent again, safe in those early years when conflicts are generally small even if they're noisy, I can't avoid the fact that I am also heading into the pre-teen years.

Sunday, January 25, 2009

Relief, Retrospect

I had an OB appointment on Friday, just in the nick of time. I was about to drive myself crazy with irrational anxiety. Even though my doctor is sweet enough to say that I can come in for a listen any time, I'm going to rent the doppler. If I went in as often as I wanted to there would surely be unflattering notes in my chart - plus the parking for her building is ridiculous.

That said, everything looks fine. I had to laugh when she looked so pleased that I had gained a perfect two pounds so far. Ha! She took my "baseline" weight after I was released from the RE, by which time I had already gained nine pounds. When she flipped back to my last yearly appointment weight she noticeably flinched. But I have to give her credit for regaining her composure so quickly and just telling me not to worry about it!

Other than that, I've been thinking a lot about how I actually got here. Since I never had a firm diagnosis of anything in particular in the first place, it's hard to know what the solution really was. Going to an aggressive clinic was definitely a big part of it - but even within everything they changed as far as my protocol and lab interventions, I wonder if there was one deciding factor that tipped the odds in our favor? Was this just a lucky month, just random chance that one of the few viable eggs in there was coaxed out this time? Were my eggs just "tough", so that they needed ICSI even though my husbands sperm assay was relatively normal? Or did the AH make all the difference? What if they hadn't let me transfer all three embryos? What if I hadn't done all that acupuncture? Would it really have made any difference if I had that glass of wine after all?

All the same questions that I had after my unsuccessful cycles are still there, even though I guess it doesn't matter so much if I get the answers. Still, after all those years of wondering, it's strange that I never really got to find out what the problem was. This cycle really did throw the whole kit and caboodle at me and hope something would work, and I suppose that's the best anyone can ask for... But the part of me that read through so many scientific journals and infertility publications still wishes I had an actual explanation for my seven years of disappointments.

It's not as if I can't just be happy and stop worrying about it - I am honestly thrilled to pieces now. But I can still remember the sting of a failed cycle, and the frustration of never knowing what might have made the difference. Now that I'm on the other side, I have only this to say: When it comes to unexplained infertility, you can either first try one thing, and then another, and then something else and try to pinpoint the exact problem. (I probably wasted years on the tentative possibilities of the "maybe this, maybe that" approach.) Or you can throw everything at it and hope something sticks. I may never know what made this cycle work, but I'll always be amazed an unbelievably grateful that somehow, it did.

Tuesday, January 20, 2009

Time Not Flying

It seems like it's been about a billion years since my last scan. It's peculiar that I myself was once a blissfully unaware pregnant lady, nonchalantly assuming that all would be well, and yet after seven years of infertility I am in need of regular reassurance.

Not that I have any particular reasons to worry. No unusual symptoms, no threatening conditions. It's just a tendency to believe that things aren't going to work out, because they so often haven't. And now that I'm really invested in this pregnancy - literally, in that I am having a wall built in my house to make an open room into something that might be able to be called a third bedroom - I am more anxious. The calm I feel after an appointment seems to wear off over time, and I am starting to think that I should rent one of those doppler devices after all. I hoped to be able to overcome the fear that years of disappointing treatment left me with, but it's harder to shake than I thought.


My daughter has gotten over the initial shock of finding out that I'm pregnant. She bought a baby name book with her own money and is busy crossing out the absolutely not acceptable names (Snowdrop, Horst) and highlighting the ones she likes (Jillian, Daniel). She says she is going to read Shakespeare to my stomach once she can feel the baby kicking, so she can tell if it likes the comedies or the tragedies. And she is excited about the idea of taking walks with the dog and the baby.

Our dog research continues. We met an adorable yorkshire-pekingese mix, which is supposed to be low-shedding and very friendly. And my daughter has been googling images of little maltese puppies almost every day. But poodles shed less than any other dog, so maybe a poodle rescue dog is our best bet. In any case, we have put the final decision off until the end of February, since we will be dealing with the construction and it just seems unfair to bring a new dog into a carpentry mess. I think the right dog will find us.

Private school interviews start next week! We got the test scores back and the information is actually fascinating - there are two scores each for verbal and mathematical abilities. The first measures comprehension and the second measures application. If there are wide discrepancies between the two it's a sign that there may be a problem - it could be just a concentration problem or a learning disability.

Luckily my daughter's scores came in exactly the same for each category - 9s for verbal and 7s for math (on a scale of 1-9 - with a true bell curve, anything above a 5 considered good.). Which I think is really accurate, given the flap about standardized testing. Even though her Wechsler IV scores put her in the top 99.9% across the board, IQ tests don't really measure practical abilities so much as cognitive agility. I think that in terms of school experience, the ISEE gives a better picture of her as a student than the IQ test does. Anyone who has taught her would say that her strengths are in the humanities, although she is certainly a perfectly good math and science student. So, that's my take on standardized testing - for this one particular girl, anyway.

Tuesday, January 13, 2009

So Far, So Good

I finally got the official results of the first round of testing - the nuchal translucency and the blood test for a specific protein - and the report is: "it's all fine." Huh?

It seems that most people get some kind of statistical probability report, some kind of one-in-however-many that allows them to make a decision about whether or not to do an amnio. I just got a sentence fragment, although it's a certainly a nice one. I'll call the nurse back, of course - I've had enough experience with lost charts and forgotten memos that I like to double-check whenever anything is vague. But for now, at least, all is well.

The real reason I'm not too worried is that the ultrasound tech showed me exactly what she was doing, what she was measuring and how the measurements related to the statistics. She said that anything over a 3.5 could signal a problem, and Little Whoever has a 1.3 lucency. She seemed very confident that there wouldn't be a problem - she did point out that this is only one test, etc., but she said this measurement was very thin, which is always good. She also said that if the measurement is thick she calls upstairs to the doctor, and they usually do CVS right then and there. Wow!

It's strange to be here. It's like all those years of trial and error just disappeared. It just feels normal, and right. I thought I would be overcome with gratitude and celebration, but the truth is, life goes on. My office has a new big amazing project, my husband may be going to of town for months, my daughter is getting ready for her interviews at new schools... The world is more or less the same place it always was, and I guess I wasn't prepared for that. After years of measuring each month in two week waits and injection schedules, I'm just dumped back here into normal everyday life. If my pants weren't all so gigantic, I might not be sure this is all happening...

Other than that, I am going to start a yoga-for-invalids class this week. It's really a class for people who are recovering from an injury or have some kind of chronic condition, but it's super-easy and I think I need that now. I have been so tentative about anything strenuous that I'm not sure I could survive in my old level 2 class. There are all kinds of prenatal yoga classes around, but I can't quite work up to that yet - I think you might need an actual bump for those sessions.

We are also going to figure out how to get a dog. Although I have never really been an animal person (allergies), my daughter has been asking for a dog for a long time. And it's not that I don't like dogs, I just never let myself get attached to the idea of having one. But the idea of a hypoallergenic dog is what really made me give in - although I'm not sure how hypo-allergenic they really are.

In any case, when we told her about the baby, the only thing she said (at first) was "Can we still get a dog?" To which there is really only one reply. So, off we go on the great hypoallergenic dog search. We all agree that we just want a sweet, easy-going dog - a good personality is definitely the most important thing. And it doesn't necessarily have to be a puppy. I keep hoping that you just know the right dog when you see it, kind of like husbands. Anyway, any advice?

Tuesday, January 6, 2009

Fat and Happy

Ah, 2009! Even the sound of it, with it's long-vowel and final ringing consonant, seems so much nicer than the sharp little noises of 2008. So nice to be in a brand-spanking new year, full of hope and waiting for it's history to be made.

I am entering this year with my own new hope, less anxious and not quite so nerve-wracked. I think the (almost) weekly ultrasounds have made it so much easier - I can't imagine going a month between scans! I think the fear of early miscarriage is so fraught for those of us who are afraid that's all we'll ever have that any possible concern about frequent ultrasounds is easily outweighed by the relief of knowing things are going well. I know that at a certain point I'll have to learn to live without them - but my OB is very understanding, says I can come in for a quick doppler any time. Maybe I can even get by without buying one of my own?

Of course, tomorrow's scan is the nuchal translucency test, and that has it's own set of fears and worries, but for some reason I'm not too wound up about it. It is what it is, and there's nothing I can do about it between now and tomorrow afternoon.

As for being a forty-year-old pregnant lady, I can only say that it is very different than being a twenty-nine-year-old one. While I know that a second pregnancy - okay, with infertility taken into account, it may not technically be the second actual pregnancy, but whatever - tends to "show" sooner, I am shocked at how pregnant I already look. When I was pregnant with my daughter I wore regular clothes until about five months. Then I wore floppy things and didn't even buy maternity clothes until seven months. Now all I can fit into are floppy things, although one of the advantages to being older is that I can afford nicer floppy things than I could have back then.

Although I don't have strong pregnancy symptoms (like nausea or sore boobs, although I think nursing for 14 months took so much out of my boobs nothing can really affect them any more) I seem to be starting in on the pregnancy-related consequences. The veins on one of my legs are snaking into prominence, and the skin on my stomach is insanely itchy. I am as burpy as a frat boy and as achy as a great-great-grandma. (Yep, my husband is one lucky guy!)

Of course, it's all nothing. I don't care, I'll wear the thick stockings or whatever. It's amazing to even think that I am twelve weeks (and one day!), that I am almost out of my first trimester already and that I feel pretty good most of the time. I thought I would be wracked with worry day in and out, but somehow things just feel right. Even though I know that anything can happen at any time, it just isn't something that haunts me. I think a lot of it has to do with getting past my own personal fertility disaster zone - the early weeks. I can only imagine that it would be harder if my losses had been later.

At this point, I think of those possibilities on the same level as the getting-hit-by-a-bus scenarios. Yes, terrible things can happen, can and do. But, somehow, the Abstract Terrible Thing That Probably Won't Happen just can't wreak as much emotional havoc as the Terrible Thing That Actually Happened and May Happen Again.

Of course, I'll let you know if I still feel that way after I get the results of the nuchal scan.