The Middle Chapters

It's been a good week. Acupunture, even with the students, good. Work retreat, even though I'm not working, good. Camping with husband, dog and friends, good. Chinese herbal medicine - what did I get myself into?

So my acupunturist recommended Chinese herbal medicine. I figure while I'm going the alternative route, I might as well listen to recommendation. I'm still going to the teaching clinic. My lead student was great - easy to talk to and funny, although she said no more soccer. My other student, well, she said no sex during pregnancy, at all. Apparently there are three ways that you can consume Chinese herbal medicine - or at least there are at this clinic. Boiling the things that look like twigs and bark and drinking the liquid; mixing a powder with water and drinking it; or capsuls. The first is the most effective. I thought I could drink anything so I opted for #1. Again, if I'm going to do this stuff, I need to give it my best effort. I'm rethinking this decision. The flavor - bad. Not horrible bad, but still bad enough that I'm trying to find a way to rationalize not drinking more. But, I only have to continue for the rest of the week, then I can go for one of the easier methods of consumption. (The balance between best effort and just getting the stuff down.)

Dr. Chicago and I have been trading voice mail. I did speak to a nurse who said that all of the blood work results seem normal. The calls continue tomorrow.

Yesterday I went to yoga for the first time. About a month ago, I started playing co-rec soccer again (and have the bruised shins to prove it). As already mentioned, I'm taking supplements and drinking lots of water.

So, what's my point?

Ever since the first miscarriage, my body has seemed like something foreign and dangerous. I stopped moving too quickly, just in case I disturbed something. I stopped playing soccer in case I got pregnant and moved too quickly and disturbed something. Already a big fan of the sofa, we became even closer. Rough day at work - find the sofa. Positive beta - where is my sofa? What was that twinge - I'll be on the sofa.

Truthfully, I went from generally ignoring my body, in large part because it always did what I wanted it to, to trying to interprete the white noise (what was that twinge?), to simple overload. I basically left my body alone and did what the doctor told me with a lot of lounging thrown in for good measure.

Comfort and safety in my own skin seemed like one of the many losses that happened with miscarriage.

When I went to the naturopath a few weeks ago, they talked to me about nuturing myself. I realized that I don't really know what that means. At first, I told myself that doing what I wanted to do -- including sofa-time and a bag of chips -- was nuturing. And while I do think it is in some measure, so is doing the sport I used to enjoy, finding new challenges (I'm not very bendy, so yoga is challenging for me), and drinking 8 times the water I would normally drink.

I'd like to get to the point that me and my body are a team. Where we both do what we can to accomplish our goals. That concept seems relatively easy at the moment - my stamina is increasing so running around on a soccer field is getting easier, beginning yoga was actually fun, I have coverage for 12 acupuncture visits, I'm not working, and I just started the ever popular 2ww. But I'm haunted by the memory of past failures and worried that the difficult times will bring back my now familiar relationship -- me and the sofa rather than me and my body.

Briefly, I took a leave of absence from work, the second IUI was successful, but third beta fell and miscarriage followed shortly after stopping the progesterone. I returned to my doctor who agreed that IVF with PGD was a reasonable next step, but the nurse also mentioned a doctor who is actually a specialist is recurrent miscarriage in Chicago. (I'm really starting to appreciate nurses.) I started plans to undergo IVF but also set up a referral with the Chicago doctor in Chicago. (While Chicago seems a far place to go for a simple doctor's appointment, we have no insurance coverage for IVF, so plane tickets, a hotel room and our co-pay seemed very reasonable in comparison with the high price of IVF.)

Dr. Chicago met with us and reviewed our history and discussed where to go from here. She was strongely against IVF with PGD on the basis of two recent Belgian studies published in the December 2004 volume of Human Reproduction and the March 2005 volume of Fertility Sterility (I haven't actually read them) which did not show any increased likelihood of successful pregnancies for women with unexplained recurrent miscarriage who underwent IVF with PGD. Instead, she recommended additional auto-immune testing and an endometrial biopsy with endometrial function test. The endometrial function test is apparently something new performed at Yale. I can have the endometrial biopsy performed locally. The tissue sample is then sent to Yale. Dr. Chicago has worked with the doctor heading this up at Yale and believes that his work is aiding in the identification of uterine lining issues not discoverable through the endometrial biopsy alone. We've decided to take Dr. Chicago's recommendations (although I haven't have the endometrial biopsy).

Dr. Chicago was very big on the role that stress plays in early recurrent miscarriage. I appreciate, but hate this fact. The chance of me staying calm during any future pregnancy seem virtually nill. But, I've started my first foray into alternative medicine. I started at our local naturopathic teaching clinic. I'm on supplements, am eating more often and have hugely increased the amount of water I drink a day. I also started acupuncture. I'm going to a yoga class tonight. I have roughly a month and a half before I return to work.

I had the auto-immune blood work done two weeks ago. I just spoke to a nurse who said that all of the results look normal, but that Dr. Chicago will be calling to discuss them with me in the next few days.

One of the hardest parts of this has been the unexplained nature of the miscarriages. Because its unexplained, there is nothing we can fix. There is nothing we can work on or work toward. My local doctor has repeated the statistic that 55-70% of women with recurrent miscarriage do have a successful pregnancy. (I understand this statistic covered both primary and secondary recurrent miscarriage with more of the secondarys - those who already have a child - having more success. But statistics apply to populations, not an individual. This statistic doesn't affect my likelihood of success. There's also the other statistic about recurrent miscarriage - that it affects less than 1% of the US population. Since I already missed out in being one of the 99% that doesn't have this problem, it doesn't seem unlikely that I would fall into the 30-45% who never have a successful pregnancy.

While that's sad, its not really the hardest part. The hardest part is knowing when to stop trying. When do you stop paying money, taking drugs, being a basket case, hurting your marriage, your friendships and your job? If you stop too early, how do you live with the thought, "if only .... (we had done one more test, undergone one more cycle, took more drugs, changed doctors, I had left my job.)"

For now, we're in the middle part. Its been a lot, but not too much. We have an also (not instead) plan of starting on adoption when I turn 39. The point of this all being to bring a child into our family.

I remember talking with a friend at work and saying that I didn't know what I would do if the third pregnancy failed. But, when it came down to it, there weren't many options -- I went on.

I worked and spent a few months going through tests and was told that I now suffered from unexplained recurrent miscarriage. I felt like such a failure. The unexplained part made it worse. It meant that there was nothing that could be fixed.

It was three month after the third loss, a month or so after the testing, and coming up on my 38th birthday that I felt the worst. My husband still was (and is) confident that everything would work out. I felt lost and alone. I didn't want to drag him down with me, but I felt so sad and separate.

After the testing, we tried two unsucessful medicated cycles. I spoke with the doctors and we decided to move to IUIs. (The hope being that the medication would help with egg quality and lining issues, progesterone would address any undetected luteal phase problems, and the IUI would speed up the getting pregnant again part.) DH didn't understand the need to get so invasive. I broke down and started talking about my sadness and fears. He hadn't known how I felt. Given the strength of my concerns, he agreed and we started IUI.

After another six months passed, I went back to my OB. I actually spoke to a nurse practitioner. She asked if I knew if I had been ovulating each month -- well no, I assumed so. (Okay, I admit I was very naive, but the doctor hadn't mentioned anything and obviously I'd gotten pregnant once.) At age 37, she thought I should hop to it -- make sure I'm ovulating and come back after a few months. At this point, I wasn't so happy with Dr. McLightly, but glad that Nurse Straight-forward wasn't trying to talk sunshine and bunnies to me.

So I bought the ovulation indicators. Lo and behold, I was ovulating. Lo and behold, I got pregnant again that month. But it was short lived -- low beta followed by a miscarriage at less than six weeks. The office forgot to order blood work; then ordered the wrong blood work (or the lab screwed up.)

I was seriously less happy with Dr. McLightly. I think he picked up on this. (Perhaps it was my less than happy response to his suggestion that I shouldn't have come in for blood work on a day that he is out of the office when I had no alternative or his suggestion that I obviously hadn't given the lab the right paper work.)

He referred me to an RE who got me in right away. Shortly after my first visit, I found out I was pregnant again. I had a reasonable beta with nice doubling. They started me on progesterone.

The first ultrasound at 7 1/2 weeks showed no heartbeat and an undersized embryo with none of the proper bits. A D&C followed.

A few months after my first miscarriage, we entered the time of trying again. I was so sad about the loss of our child and the loss of my family. I was desparate to put the pieces back together (get pregnant again). Many of my pregnancy symptoms lingered for months. I warned my boss that I may want to take time off or work part time. (Not such a good idea.) But, I wanted everything ready for the next pregnancy and whatever I had to do to protect it.

After six months of trying and finding out that my regular doctor no longer provided pregnancy care, I went to see the doctor who treated me in the emergency room. (Not the crier.) I was a month away from turning 37. He saw no reason for concern -- in fact, his wife was 39 when they had their child. I went home with advice on "timing" our attempts.

That first six months was the hardest -- I was still so very sure that if I got pregnant again soon the hole in my soul from the miscarriage would go away. During this time, it was comforting to hear about so many co-workers' wives and friends who had dealt with miscarriage. But, it had a strange double-edge. Because it was "so common," people expected me to be fine. My duties at work remained seriously high. Although the clients were very happy, my hours lagged and I was reprimanded for my lack of commitment to my job. My dear husband (DH) was so confident that everything would work out that I didn't want to burden him with my sadness and sense of loss.

Do you remember the days when you first met your love? For me, ever the pessimist, it started with doubt and a dash of hope -- Wow, he's not only cute but he can string together sentences too. Maybe this is something. Hey, I really want to see him and he wants to see me too. What do you know about that?

I remember the days following those days -- heady, wonderful days when I felt like every part of me was happy. When the inane stuff from work wasn't making me crazy because life was just too good.

Then it got better -- I got to be with the man I love and the news that we were going to have a baby. These were the days that childhood dreams are made of. It's true, I hadn't fulfilled my plan as a 12-year-old to go to college, fall in love, get married, have kids, then have my career. (At 36, I was at the point where staying home alone beat a bad date out every time.) But, late in the game, I got it -- everything I wanted.

I remember the bliss. I was ten weeks pregnant. One of my girlfriends had just had two miscarriages at nine weeks. In my mind, I was home free. I started to tell people about the pregnancy and started to plan our future. Then the cramping started. A call to the doctor sent me to the emergency room on the weekend. After several hours and the cramps actually decreasing, the doctors suggested I go home. While they could do an ultrasound, it would cost extra to have the radiologist come in on the weekend. After a while more, someone realized that the radiologist was already at the hospital for another case, so sent us up for the ultrasound.

After having "good" ultrasounds -- the ones where the technician is happy to point bits out to you -- this one was clearly different. The heartbeat that we have seen just a few weeks before was simply not there. After confirmation by the radiologist and the news that the baby had stopped developing a few weeks ago, we were sent back down to the emergency room. The resident, a woman in her thirties, came in and shared the fact that she and her husband were trying to conceive and started crying. The doctor came in and explained our options from here.

After an incomplete miscarriage, a D&C, and a heavy course of antibiotics, I just wanted it all back. I wanted the bliss; the unthinking certainty that life is good. I still had this wonderful man, but it was as if someone had taken scissors to a photo of my life. I wanted the other part back. It was the part that held my future with my child and my bliss.

After my third miscarriage and after trying to ignore the fact that it happened (so I could continue to function), I went on-line to see what I find out about miscarriage and the things that the doctors didn't seem to be able to tell me. Through my searches I came upon "A Little Pregnant" and through that blog many, many others that have helped me get through the days since then. These blogs, written by women with issues related to infertility and recurrent miscarriage, have become part of my day. They let me know that someone else is feeling what I'm feeling - the lack of control, the sadness, the anger, the pessimism, and the hope that comes with these issues. Over the past week, several women that I read on a regular basis have decided to stop writing their blogs (for either a short or long time). So, in an attempt to give back some of what I've gotten from this community and help myself I'm going to try to keep a blog.

As the name reflects, this is the middle part of the story -- after school, work, marrying a wonderful husband, and four miscarriages. This is the part that comes next.