It Was Only A Matter of Time

It's probably never a good thing when your OB calls at 7:00 at night to talk to you about your test results. Good results are calls from a nurse and can even be left as a message. The doctor only calls when something is obviously going to involve lots of questions and medical decisions and unfortunate consequences.

My screening test results came back positive for Down's, Trisomy 18 and Smith-Lemli-Opitz Syndrome. While I'm sure most people have heard that the testing for Down's carries a high false positive rate, the SLOS has an almost non-existent false positive history. SLOS is a combination of severe mental retardation and congenital malformations. Basically, it sucks. So does Trisomy 18, with less than 10% of babies who manage to be born surviving to their first birthdays.

The fact is, I'm old. My eggs are old. My husband is old. This baby was old even before conception. And the thing is, old is not good in the world of reproduction. I thought I just had to actually get pregnant, that if I could just manage to have an ultrasound with a normal heartbeat everything would be fine. But at forty years old it's just a fact that things are likely to go awry. I thought I was lucky to get one embryo that made it, but the odds are the others tanked because of chromosomal issues, and this one just happened to have the kind of anomalies that don't cause immediate demise.

We'll do the amnio Wednesday. I don't even know how long it takes to get results after that, but I suspect it will be longer than I would like. Meanwhile, constipation seems like the least of my problems.

ETA - Thank goodness for bloggers like Amber, who has been through this and tried to sort out all of the info about these various results for those of us who are desperately googling "SLOS screen positive" and reading nothing but dire pub med articles. Basically, she had almost the same kind of quad screen results I have, and her amnio was normal. I may not end up with the good news she got, but at least I have a little bit of hope now!

Movement? Or Bowel Movement?

I can definitely feel some kind of flickery something going on, especially when I lie down. It's usually a little bit to one side or the other, a skittery fluttery something that almost tickles. I've tried to coordinate the feeling with the doppler, but it's not as easy as it seems - it takes me too long to get the doppler going and the little scrambly feeling doesn't last very long.

I have to admit that it's more likely to be related to the odd digestive side effects of Repliva, the iron supplement. I have had either diarrhea or constipation every day since starting these. The crampiness just pisses me off now because I still run for the doppler just to reassure myself even though I know it's bad digestion. Plus, I hate to have digestive problems at work. I know it's some kind of uptight prissy thing that I should try to overcome so I can Be Comfortable With The Human Body or whatever, but I think solid waste is really a home-based activity.

I know, I know - the body should be allowed to function freely as it needs, blah, blah, blah. But personally my own body is somehow adjusted to a daily rhythm that pretty much avoids ever crapping in a public toilet. For one thing, the bathroom at my office is just not the best place for anything discreet. The building is a 1929 art deco tower, and the bathrooms are wedged into little spaces between stairways. The walls are thin, there is no ventilation and some guy's office is right across the hall. There is a window, but it opens onto the fire escape, and usually the across-the-hall guy is out there smoking. Basically, it's fine if you have to pee. Kind of.

So, as much as I would love to think that little bubbling feeling is the tiny whoever* in there, I also kind of dread a day at the office with too much abdominal activity. Luckily I'll be out at some new sites tomorrow, so I may be able to pop home if need be and at least avoid smoker-guy.


* Ultrasound Friday - and we are definitely finder-outers. I can't decide if I even wish for one or the other - I so desperately wanted a girl the first time I was pregnant. I thought that this time I would either really want another since my daughter and I have such a close relationship, or that I would really want to have a boy so I could experience that instead. But I can honestly say I will be thrilled with either and it's all about seeing a healthy little somebody in there. It's just another difference between a naive easy pregnancy and one that was such a long time coming.

Hmmm...

It's just a hunch, but something does not ring true with this octuplet story. Until someone can explain how an unemployed woman on disability can afford to do IVF six times (at least) I am not buying it.

I haven't seen the interviews (and won't) but the LA Times seems to be covering the whole thing to death. All I can say is that even if six embryos were transferred and two split to become two sets of identical twins, I am still skeptical. I mean, really?

Bad Blood

It's always something in this fight my body and I have about pregnancy. I can imagine my body in a one-woman (what else?) show, played by an unknown red-head with her best "My Cousin Vinny" accent, chewing gum and wearing too much mascara.



"Look, it's not like a big surprise or anything. I toldja all along that this pregnancy thing just itn't for me, right? Didn't I? Didn't I tell ya like a hundred different freakin' times? So don't go cryin' now that it itn't a bed a roses or somethin'.

"Oh, ya think so? Ya think it's easy to keep this rickety skeleton togetha, to make sure all those organs are workin' in a basically kinda normal way? To get that hair to keep growing? It's a full time job already and now ya I gotta buildja a whole otha human bein' ? Are you kiddin' me?"



I'm pretty sure my body's persona is basically a pain in the ass. No matter how much blackstrap molasses and spinach I eat, plus whatever is in the prenatals, I am severely anemic. I do tend to be mildly anemic sometimes anyway, but this time it's a dramatic drop. So, onto the giant iron supplements.

I keep reminding myself that I am perfectly happy to deal with a jillion little problems along the way as long as I can avoid any major ones in the long run. I just hope my body can stop complaining so much - it's not like I don't try to be good to this rickety skeleton and all of it's various bits.

Tomorrow, a massage - just to show that I do still care.

Thyroid

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?"

"Ummm....1998."

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...

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.

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.