The Middle Chapters

Today has been beautiful. I walked to lunch - great, cheap Chinese food - and met one of my neighbors. He, Walt, and his dog, Piper, were walking back from the grocery store. They live about a block and a half away. He told me where his house is. I know the one. Walt looks to be in his 80s. He told me the story of the man who lived on my corner - Sam, an 85 year old WWII vet, who recently had a stroke in the grocery store and passed away. I'd never met Sam, but I had seen him walking his dog several times. I used to visit his dog in his front yard and I took my dog for a walk. Sam's house sold about two months ago and is currently being remodeled.

My neighborhood is, in theory, up and coming. Likely, because every neighborhood in the city is. The houses are mostly small. They are owned by a mixture of elderly, young couples and a few families. I bought this house before meeting my husband. He has called the neighborhood sketchy. It is true that we have more taverns than any other type of business in our small downtown area and that people in various stages of inebriation have a tendency to roam the streets. But, I would walk the streets at any time of day and feel safe. And I get to meet people like Walt.

Walt made me think of my grandmother who died nine years ago. Like Walt, my grandmother had a blind eye. She'd been in a terrible car accident in the 1950s and had to have significant facial reconstructive surgery. They couldn't do anything about the injury to her eye. It wasn't until after she died that I saw photos of her from before the accident. She looked a lot like my mother and a lot like me. She rocked.

Tomorrow is another ultrasound. Today I find myself thinking about this pregnancy, whether we will get to keep this one, and thoughts of the possible child we may have. I hope I get to name this one in memory of my grandmother like I've always wanted to.

Thanks so much for listening yesterday. Just getting all the worry and whatnot off of my chest helped a lot. I'm still worried, but there's at least a shred of hope in there.

Today I went to Chinese Herbal Medicine. I'm used to having two students. Today I had five. It felt a lot like giving a speech to an audience. Except they all were very interested in what I had to say. Based on the change of quarters and schedules, I saw a new doctor and new group of students. Like all my trips, I felt unrushed and cared for.

I admitted right away that I have been less than stellar in drinking my bark juice. The nausea is getting in the way. No judgments - they gave me a new formula of granuals. No more boiling and straining.

The doctor recommends very cautious living - like bed rest through the fifth month. No lifting over five pounds. (I think my purse weights more than that.) No stress. She does not recommend going back to work next month.

I've been laying around lately like I'm sick. It's nice to have a reason for it. Today I'm laying around to create a nurturing environment for my fetus.

When I left work in March, I packed up a box of random stuff from my drawers. Digging for a nail file that I knew was in the box, I came across the only ultrasound picture from my first pregnancy. I knew this was in the box as well.

The picture is from 4/28/03 when I was 6 1/2 weeks pregnant. My estimated due date was 12/18/03. I remember my husband was there for the ultrasound. I know that I had spotting during that pregnancy; I think this ultrasound was scheduled in response. I remember the hearbeat - it was an amazing sight.

I can't remember if there was spotting after the first patch. I remember having nausea and sore breasts. I also remember a feeling that I needed to lay down. It hit about 3:30 every afternoon. On the one day, when I was about 10 weeks pregnant, I didn't respond to the feeling and it didn't go away. It led to mild cramping. I took the next day off of work. I woke up very early the following morning with rolling cramps. Still no bleeding, but serious pain.

I've described the rest of it already.

According to my last ultrasound, I'm 6w4d today. We've seen the heartbeat. We have an estimated due date. I want this one to go well, but my experience hasn't supported that outcome. I want to have hope, but I just can't get there.

For me, it's so much easier to hope for a pregnancy. The feeling of having a positive beta is so triumphant. There's at least a moment of bliss. (For this most recent pregnancy, the moment was very short - but it was there.) Being pregnant is waiting for the other shoe to drop. And it's a big ugly painful shoe.

Besides a coma, is there a way to get through this while staying remotely sane?

Another good ultrasound. The fetus measured 6w1d and the heartbeat was still going. They still didn't measure it. The doctor/technician - a person I don't know - estimated that it was about 100 beats per minute and seemed happy with that. I'll take it.

I asked if the heartbeat is any indicator of successful pregnancies. She said that they really want to see a strong heartbeat and fetal movement at 8 or 9 weeks to make any predictions. That seems like a very long way away.

I just can't imagine feeling secure with this pregnancy. Absolutely nothing has gone wrong. But still. . .

I'm trying to figure out when to go back to work. Regardless, I'm planning on sometime during July. The advantages to sooner are: (a) the distraction and (b) the income. But, if I have another miscarriage I know I'll need time to deal with it.

I keep thinking about it and coming back to the exact same points. I think if I just commit to a date and tell the office, it will help.

I'm not good at hoping. I'm much better at anticipating the worst and getting ready for it. I really don't want to do it, but I can't seem to stop myself. I do it at work (when I'm working). In fact, I tell myself that it helps me be good at work. By anticipating problems and explaining them to my clients, they are never disappointed in our work. Yeah, it typically works, but boy, do I spend a lot of time visiting failure.

I think the problem with hope for me is the fall afterward (or the kick). It feels both like a fall and a kick. An internal "I told you so."

The upside of hope is not living with the failure. I love the idea. Now if I can only put it in practice.

My counselor talks about it as being able to accept the fact that I can take the loss/failure if it happens when it happens, rather than anticipating it along the way. I think she has a good point. Part of me thinks my life will implode if I have another loss. The other part knows I can deal with it. Just like I've dealt with the past losses.

I keep thinking that I just need to get past a certain point, then I can breathe easier. That's not really working for me. There's a lot of moments between now and whenever that mythical point is. I think instead I need to learn to live with hope.

Everything is good so far. Some cramping, but no spotting. High betas and an early heartbeat sound like good signs. Thank goodness I have an ultrasound again tomorrow. Maybe I can wean myself from them eventually. Maybe when hope stays longer than a driveby.

Hooray! Today's ultrasound showed a heartbeat. I asked about the rate, but the doctor said that this early, the rate doesn't matter. Everything was so tiny. It's measuring 5w5d which the doctor says is on track with last week. (Will week five never end?)

I'm having another ultrasound on - Friday. That's right, Friday. The doctor asked when I wanted to come in and Friday is the answer. True to his word, he said fine and got me scheduled for Friday.

After cramping on Sunday and a bit on Monday, I was actually pretty confident that things would go okay today based on my worsening pregnancy symptoms. Yeah, I want to throw up! Yippee, I wish I wore a sports bra to bed.

By Friday, we should be in week six. Then just two more week and I'll breath much easier.

During my first pregnancy (the most successful to date if there is such a thing as relative success when it comes to miscarriages), I had the full array of pregnancy symptoms - sore breasts, serious morning sickness, and desparate fatigue. The other three, not so much. For the third pregnancy, a virtually symptom-free seven weeks, my best friend was also pregnancy and had no symptoms. I told myself that every pregnancy is different and that because L was having no symptoms, it was perfectly okay if I didn't.

That wasn't the case. Instead it was a missed miscarriage.

This time around, so far, I have some of the symptoms - and they appear and disappear. Tender breasts, sometimes. Food aversions and nausea, sometimes. No tiredness to speak of, but of course, I'm not doing so much these days.

Also, there's the lack of spotting. (I know I thought I may have had a tiny bit of spotting a few days ago, but I'm now convinced that that was a combination of the pink Progesterone and the yeast infection. Yes, pleasant, I know.) And lack of miscarriage since I'd already lost two by now.

I keep trying to tell myself that this appears to be a perfectly normal pregnancy, but I can't get away from my history. With all this being said, I actually am pretty upbeat about things. Of course, I check regularly for spotting and grab myself throughout the day, but I do think that this could possibly work.

I'm so glad to have the ultrasound on Tuesday. While I know that Tuesday will be hard, knowing that I don't have to wait longer to get information is very comforting.

Today's ultrasound went good-ish. After discussing when my last cycle started and the whole birth control pill thing/negative home pregnancy test, they saw a yolk sac. Officially, I'm 6w3d. My doctor said that the embryo is measuring 5 1/2 weeks. This puts me on the early side of where I was calculating things. (This is good because it makes my betas look better. This is bad because it means that dreaded week 5 continues.) The doctor complimented the yolk sac, so I'm thinking this is good.

I've been relatively un-freaked out so far. The worst have been during my last post (posting actually helped calm me down) and right before the ultrasound. I started sobbing when the ultrasound was done. I think it was part relief and part residual anxiety. I need the next ultrasound to see if there has been growth since this one.

I had planned on asking about a beta. I didn't. I wanted to ask about implantation. I didn't. But the doctor did say I can come in as often as I want - once; even twice a week. (This was during the crying part.) We scheduled my next ultrasound for next Tuesday. We'll be looking for a fetal pole or maybe even a heart beat.

I'm trying to live in the moment - but I suck at it. It's hard to simply be happy that I'm pregnant when I've been through this so many times.

If you have any extra good thoughts hanging around, please send them my way.

I can't believe that I forgot how hard it gets after the betas are done. Without the every other day reassurance that things are okay, the fear and worry start taking over. Although the betas were good (assuming I'm somewhere in the 5th week), I'm not having the same symptoms that I did with the first pregnancy (that continued the longest). I'm trying not to obsess, but I'm really not having any luck.

I was just reading Jen's story of her pregnancy at http://oneof100.blogspot.com/. I admire her ability early on to think that no news means continued pregnancy. With two "missed" miscarriages, I keep thinking the worst.

I now have a yeast infection (I hate Progesterone) and thought I might have had a hint of spotting yesterday. Yes, I am driving myself crazy.

Using the betas and the negative FRED on 6/4 as my evidence, I calculate that I am in the range of 5wd3-5wd5. (Based on LMP, I should be 6w1d. But that only works if the 6/4 FRED was a false negative.) This puts me in the range of where I lost three out of four pregnancies.

Yes, I'm totally overthinking this. I have acupuncture is a few hours. Hopefully that will help take my mind off of this.

I just need to get to Friday's ultrasound. I'll ask about a beta too.

This is a very good number. I just wish I knew what day I was so that I could confirm that it's a good number for today. I just scheduled an ultrasound for Friday. Based on my previous research, that should be too early to see a heartbeat, but late enough to see a yolk sack. More importantly, it will give me something to do before the following Wednesday, when they originally wanted me to come in for the ultrasound.

I have seen different people write about hope in the context of infertility and recurrent miscarriage. At the time, I didn't really understand the concept. After the second miscarriage and until the last several weeks, I didn't hope - I did the opposite - I worried. I didn't hope things would go well; I worried that they wouldn't. Last year, a friend described herself as "living through many disasters that never happened." I could totally relate. My thought was that if I braced myself for the worst possible results, I would somehow be protected from them. Instead, like my friend, I ended up living through many disasters that did and did not occur.

That being said, being told to "not worry" is incredibly annoying. Wouldn't everyone "not worry" if they could? If you always worry, how do you break the habit?

For my last pregnancy only about two and a half months ago, I didn't move much at all and worried almost non-stop. I stayed on the sofa between betas and after getting the news that my numbers were going down and the pregnancy was failing.

This time I'm off the sofa (at least part of the day) and trying to stay busy. Not only am I worrying significantly less, but I actually have hope that this one might work. I'm not very familiar with hope. It makes me a bit uncomfortable when I think about it. So, I'm trying not to think of it. I have acupuncture on Wednesday and the ultrasound on Friday. These will help me get through the week. Hope and acupuncture - a good combination.

Actually Dr. Google seems to say that hcg has to be around 10,000 to see a heartbeat. That sounds like too much waiting. I think a good yolk sack may have to be good enough.

I got a nice second beta of 633. In the past I haven't really paid much attention to the betas because I usually don't start having trouble until just after I'm through with getting the betas. But, for two out of four of my miscarriages, I started with low numbers. For the last one, I started with a low number and then delayed getting additional information. My third beta was a week after my first. By then, the number was already going down. Dr. Google suggests a low starting number indicates a lower likelihood of a successful pregnancy.

For three out of four miscarriages, my trouble has come mid week five. Since I have no idea when I ovulated this month, I have no idea what day I am post-ovulation. For the purpose of driving my early numbers up, I'm pretending that I ovulated late. For the purpose of getting through week five, I'm pretending that I ovulated on schedule (although I'm having a bit of trouble because FRED came out negative on 6/4).

On Thursday, I spent a few hours on-line trying to figure out how soon I could have an ultrasound that would show a heartbeat, if there is one. (For miscarriage 3, the pregnancy has stopped about a week and a half before my ultrasound and D&C - which may have caused the doctor's inability to gather any information from the karyotyping.) Dr. Google seems to say that a heartbeat is typically visible when your hcg is over 6500. I'd like to get the good or bad news as soon as possible. If things keep going as they have, my numbers won't be quite high enough on Friday.

633. Now I'm going on-line to see what Dr. Google has to say about my doubling time.

After hearing about the book from many sources, including Dr. Chicago (who's in it), I finally read "Coming to Term" by Jon Cohen. I started it yesterday and finished this morning. I was a bit hesitant to read it -- I was primarily concerned that it would include a lot of grief stuff -- I'm not quite sure what that would look like, but it would be a lot of "it's okay that you're sad" and whatnot. That's not this book at all.

The book was a mixture of science, including the studies that have proven or disproven a variety of things related to miscarriage, theory and conjecture, including some of the treatments out there that are currently unproven, and personal stories. The combination helps make it very readable.

A point that is repeated many times over, including on the back of the book jacket, is that women with three or more miscarriages in a row have a successful pregnancy nearly 70% of the time without any treatment. While that still leaves 30% (and the general problem that I have with applying statistics to an individual), I'll still take the hope that it provides.

Two studies were also discussed that measured the impact of "tender-loving care" on recurrent miscarriers. While the study groups were relatively small (36/24 and 42/10), both studies came to the exact same results -- that the women who received "formal supportive care" versus "standard care" had successful pregnancies at a rate of 86% versus 33%. That's huge. Some of the things included in TLC were weekly exams and psychological support. (These TLC studies also may confound the results of other treatments that also provide TLC -- any good results may be from the treatment or the TLC and since there's a 70% success rate without any treatment, the success rate has to be above 70% to show any improvement over nature.)

The book also explains why IVF with PGD isn't necessarily a good answer for recurrent miscarriage. While I had heard all of this before, from my local doctor who was in favor of doing it, and Dr. Chicago who was opposed, it was easier to take in by reading it.

Being diagnosed as unexplained, I love the idea that something as simple as TLC can improve my chances of success. I have no idea if the alternative medicine that I've been doing has helped or will help, but it does make me feel cared for. (The book does not address any alternative medicine.) But, under the TLC theory, it very well may help.

Recurrent miscarriage has been so hard to take. As discussed by someone in the book, a first miscarriage brings flowers and condolences - by the fourth one, there was very little recognition (except from Pam - thanks Pam! - who had gone through 2 herself). I keep trying to treat this like any other hurdle - throw more effort into it; don't give up until I've done everything possible regardless of cost. Dr. Chicago and "Coming to Term" both focused on the point that is hard to listen to - more intervention doesn't necessarily mean more success, but keep trying. There may be more miscarriages, but the odds for success are in your favor.

My beta was in the 220s and my progesterone was 19. Both good starts.

I just took a home pregnancy test and its positive. But I seemed to have skipped the happy part and gone straight to the sad part. I'm shaking and crying. I know this is supposed to be good. I know that this is what I've been working toward and I can't have a successful pregnancy without the pregnancy. But I've gotten to hate this part.

Could someone just wake me up when I'm through the first trimester - or after the miscarriage?

I realize that I have no idea what it does or how. Sometimes it hurts. Today it included massage.

I think part of it has to do with wanting to do something to help things. When we were trying medicated IUIs, I was very busy. When we planned to do IVF, I knew I would be very busy. Now that we're back to trying naturally, I find I need something to do. Along that line, I'm still taking my supplements, drinking tons of water, and drinking my bark juice (Chinese herbal medicine). I thought the bark juice would be difficult, but I've gotten used to it. These things help too. But, its the acupuncture that's the best.

It's comforting and, in a strange way, relaxing. I feel cared for when I leave the acupuncturist. Its not that different from any other of the practitioners at the teaching clinic I go to. (But, perhaps the difference is the lack of expressed guarantees from the acupuncturist as opposed to the students discussed below.)

I also think its different from the regular doctor or the RE based on the time spent together. Every visit lasts an hour. At the regular doctor or RE's office, there's typically a wait because they're running behind. Then the rush to get in and out in a very short time. That rush doesn't exist at my clinic. The people seem kind. No one is rushing. I like that.

Today I got a reading assignment. My acupuncturist suggested that I read "The Web that has No Weaver;" specifically the sections on (1) blood deficiency, (2) spleen qi deficiency, and (3) liver qi stagnation. Sounds interesting.

Typically the fourth week of my cycle or the second week of the 2ww are the worst for me. The Progesterone is making me constipated and cranky. I wildly try to pay attention to every possible sign that I might be pregnant only to have my hopes dashed (or if I'm pregnant, have a joyful 15 minutes followed by serious fear and worry.) With the addition of Progesterone to the mix, I actually have a 2ww plus four days. I get the usual two weeks followed by four days of waiting for my period to show up.

This month, because I started BCPs in anticipation of IVF, then stopped them when Dr. Chicago suggested I forgo IVF, I have an unknown cycle. I actually bought the ovulation prediction kit recommended by Dr. Chicago. But, couldn't use it this cycle. I typically have mid-cycle pain that I attribute to ovulation. This month, I got it about three days later than expected which I chalked up to the BCP use. I started using the Progesterone based on that ovulation day. But, then I had the same mid-cyle pain a week later.

FRED said no pregnancy on day 16 after ovulation, so I stopped the Progesterone. I'm now on day four, so I should get my period today. But, I keep wondering if there's any chance that the second "pain" was ovulation or whether it was some other time altogether and if there's any chance I might be pregnant. I also wonder if I was working whether I would have this much time to wonder about all of this.

So, this month the worst days have been the second week of the the 2ww and the bonus four days.

The upside is that once my next cycle starts, I'll use the ovulation monitor and will know when things happen. In theory, my next cycle will contain less unknown and less bad days.

This week I've seen my counselor, my acupuncturist, my naturopath student, and my Chinese herbal medicine student. The students are graduating, so it was my last visit with each. I congratulated them, and they told me how sure they were that everything was going to work out for me; that most people have trouble conceiving and that's obviously not my problem; that lots of people have "my problem" and go on to have successful pregnancies; and other things that, at this point, I can't remember because I really wasn't listening. They are both kind people and I tried to listen to the kindness and not the words themselves. That still didn't stop me from waking up the other night wondering if I should have responded differently. Should I have pointed out the difference between one miscarriage and multiples? Should I have told them that actually less than 1-2% of the US population actually has this problem? Should I have mentioned how kind words of guarantee don't really help when you've been down this path?

All that being said, I'm not pregnant this month, but the coating on my tongue is thinner.

After my third miscarriage and the start of medicated cycles, I about lost it. Do you know that feeling that you're juggling at least one more ball (or orange or piano) more than you can handle and you're desparately trying not to drop anything? Well, I got and stayed there for several months. Finally, after a close friend took a leave of absence from her job and then a co-worker of mine also took a leave of absence from work, I saw a light. Hey, maybe I could take some time off and try to get a hold of things. Yes, this would cut our income by half. Yes, I had no idea what I would do with my days never having not worked or gone to school.

I came from a "pick-yourself-up-by-your-bootstraps" kind of family. It didn't matter whether it was famine or flood, we were supposed to dig in and make things work. (Perhaps this is why we're all competent but unhappy people.) Quitting work outright seemed undoable. But, asking for time off to deal with this recurring problem seemed reasonable -- acceptable even.

My time off started in March -- just in time for my second medicated IUI and my fourth miscarriage. We have savings and my husband has a good job, so we're doing fine financially. I am amazed at how little I can do in a day and be satisfied. I've been in counseling (which started well before this) and to lots of doctors/practitioners. I'm feeling good - a ton less anxiety, stress, and worry.

I'm at CD 30 today. I typically have 31 day cycles, so usually start feeling pregnant around now if I actually am. I don't feel pregnant. I haven't been tempted to use a home pregnancy test. On the slight chance that I am pregnant, I don't want to know yet. On the bigger possibility that I'm not -- I don't want to know that yet either.

I'm planning to return to work in July. I'm more than half way through my time off. This leaves me with one more cycle before I return to start a pregnancy before I return to work. If I don't get pregnant next month, I feel like I have to return to the work. Since I left, my employer has taken over more space and my office has been moved. They also hired someone to help on my work load while I'm gone. (This is the second person hired to help out in less than six months -- it is a big work load.) But, I'm afraid that these changes won't be significant for my stress and anxiety levels. I'm afraid that I'm going right back into a situation that I found unbearable a short while ago.

I don't know any women who aren't staying home with their children who don't work. I recall reading other women's blogs who have decided to stay home while dealing with infertility issues, but I don't recall any discussion about the topic. If anyone has dealt with the issue of whether to work or not under these circumstances, I'd love to hear about it.