Mommy and Mamita

Very Sad

2010-04-14T14:20:00.002-04:00

We found out this morning my sister lost both babies. Doctors don't know why yet. She was 15 weeks along and having girls. She needs to have a D&E because she is too far along for a D&C. They are in Singapore now and will have the surgery in the morning. We are very sad -- such a tough thing to go through and so far away from home without family.

Identical Twins

2010-03-13T15:18:00.003-05:00

Now that I have your attention, no I'm not pregnant. Those days are past -- this uterus is closed for business. I found out about 2 weeks ago that my sister is pregnant and then last week that she is pregnant with identical twins. My sister and her husband are a bit shocked and overwhelmed. I think the odds of having identical twins are something like 1 in 300. For them, the situation is even more complicated because they are living in India. She will come back to the US to deliver. My sister had a very routine pregnancy with no complications for her first child and was expecting/hoping for the same this go around -- so much for planning.

I did a lot of research about twins when I started fertility treatments, since I knew that was a risk and we were so concerned about having twins given by prior history. It is coming in handy now, so I can give helpful advice. I'm definitely struck by the irony of the situation, though. I took fertility drugs and end with one wonderful baby and my sister gets pregnant the "old fashion way" and ends up with twins. Keep your fingers crossed that it all works out well.

Back to Work

2009-11-10T10:03:00.007-05:00

It has been so long since I posted I don't even really know where to start. JB really is a pleasure and a very easy baby, which has been great because two kids are definitely exponentially harder to manage than one. T has been very high maintenance for a while now, so we really lucked out with JB being Mr. Easygoing.

Yesterday was my first day back at work. I had 12 wonderful weeks to devote to JB and care for him. I really enjoyed it, but now it is over. I only work 30 hours a week and half of that is telecommuting, so I will still get to see the boys a lot. I go into Manhattan 2 days a week and those 2 days are hard. Yesterday, I left at 7am and did not get back home until 8pm.

I have been breastfeeding JB pretty much exclusively. At work, that means pumping 3 times a day. Unfortunately, there is no great location to pump, so I have to use the handicap bathroom, which at least is clean and is seldom used by anyone else.

I really missed JB and thought about him the whole day. I had forgotten how hard it is to be separated from the baby when first going back to work. Today at least, I'm happy to be working here next to my little guy while he sleeps. Tomorrow, it is back to NYC again.

Here are a couple photos. The first one is a few weeks old, but the 2nd is from last week.

1 Week Old

2009-08-23T12:20:00.000-04:00

Our little guy is one week old today. It is hard to believe how much he has changed just in one week.

This will be the last infancy for the last child I will ever have, so I'm really trying to enjoy every minute. I hold him and cuddle him as much as possible. Y and I actually found the hospital visit pretty relaxing, despite the pain of recovering from a c-section. My Mom stayed with T at our house, so Y was able to stay over with me at the hospital and we could spend a lot of time focusing on the new baby. It is such a different experience having a baby delivered full term and being able to be with him in the hospital. We really didn't have to worry much about the little guy and could just enjoy him. Our hospital room happened to be located right next to the NICU, so I would walk by there several times a day and it was a constant reminder about how different this pregnancy worked out, although I'm really grateful to have what appear to be two perfectly healthy boys.

We came home from the hospital on Thursday and are settling in with our boys. T is doing really well with the baby. Y has been spending a lot of time with him and that seems to be helping. The hard part is he doesn't understand why I can't carry him and why he can't hold the baby by himself.

We are doing very well with the breastfeeding. I had to supplement him for a few feedings in the hospital while waiting for my milk to come in, but now we are back to exclusive breastfeeding. He gave us a bit of a scare the first night home when he refused to eat for about 6 hours, but he has been doing great ever since.

JB has been a really easy baby so far (I know it is still early). The only problem we are having with him is that he manages to pee through about 4 out of 5 diapers, so we went through all his newborn clothes in just 2 days. The same thing would happen when the nurses would diaper him in the hospital, so I don't think the there is a problem with how we are putting on the diaper. We tried switching diaper brands, but it does not help. I think we are just going to have to live with it until the cord falls out and then we can put the diaper higher or move up a size. We think the leaking is coming from the top. We also think we are going to have some clothing challenges beyond the leaking. Because T was born in the dead of winter, I kept him in footie PJs most of the time. JB has extra long feet, so we are having trouble using T's old PJs because the feet just don't fit.

Here are photos from the hospital I promised. I will post the birth story when I find some time to write it up.

Welcome JB

2009-08-17T23:15:00.002-04:00

Sorry this is such a quick post. I did end up going into labor yesterday and had an unscheduled c-section last night. JB was born last night at 9:20 PM. He weighed 7 pound 5 ounces and was 19 inches long. More details and photos to follow later.

Contractions - Labor or Not?

2009-08-16T14:46:00.004-04:00

I have been having contractions since this morning. Initially, they were pretty irregular in terms of timing, but now they are a few minutes apart. I wouldn't say they are painless, but they are not so excruciating that I can't keep doing whatever I was doing through them. I have been taking it easy and lying in bed, but I'm not sure that helps that much. So technically, now, I should call the doctor's office and they will tell me to go to the hospital, but I'm reluctant to go unless I'm sure I'm in labor. My concern is that since I'm past 39 weeks (the magic number from an insurance perspective for a doctor not to get sued for doing an elective c-section), if I go to the hospital, the doctor will deliver the baby regardless if I am in labor or not.

So how do you know if you are in labor? The baby seems a little lower, but not too much. Contractions are 4-5 minutes apart but don't last for more than 20 seconds. Contractions are localized to the lower abdomen and back. I have a history of having contractions close together without going into labor. I have not lost my mucous plug as far as I can tell and I'm not having any unusual discharge (bloody show or the like). I just finished eating, so it would be at least another 5 hours before I could have surgery. We are going to wait it out a bit before doing anything. I like the doctor who is on call this weekend, but I would be catching her at the end of over a 48 hour on-call shift where she has been covering for 4 practices, so who knows how much sleep she has gotten the last 2 days and I'd prefer to have surgery done by a doctor who may be fresher.

Last Day of Work and Last Doctor's Appointment

2009-08-15T20:54:00.008-04:00

I had my last day of work on Friday. I only work for 2 hours on Friday and telecommute, so Thursday felt like my last real day. A few of the guys I work with took me out for lunch, which was great, but a bit of a long walk for me at 39 weeks pregnant. I have been managing the commute okay, but the last 2 weeks it has gotten pretty hard to move around much.

Tuesday was my last appointment with the high risk practice. I concerned initially because the baby's growth seemed to have fallen off a bit. He was in the 49h percentile and had been in the 65th percentile 6 weeks before. The doctor did not seem concerned. He said this was in the margin of error for normal growth and that ultrasounds in late pregnancy are not very accurate in terms of size assessment. I could see what the problem was in my case at last. The baby's head was pretty low and was being partially blocked by the pelvic bone, so he had some difficulty getting head measurements, which make up 2 or the 5 measurements used to estimate size. The little guy is supposedly currently 6lbs. 13oz., but this could be off by a pound either way and he will still likely have one more week to grow (from the appointment last Tuesday) before delivery.

I was discharged from the practice at the end of the visit. Since the high-risk practice and my fertility share the same floor on that wing of the hospital and they take up almost the whole floor between the two, it was strange to think I would likely never visit that part of the hospital again, particularly since between the two practices, I would have probably had almost a 100 doctor appointments.

I'm still hanging in there. I get tired very easily, so I'm trying to prioritize what little time I have left the best possible. Y and I have finally be able to locate and go through most of the baby paraphernalia we had in the attic. I'm still missing a few critical items that I used to have and must have given away or gotten rid of for various reasons after T stopped using them, so we may take a shopping trip tomorrow or leave a list for my Mom to get while I'm in the hospital.

Final Appointments and Keeping It Boring

2009-08-10T15:28:00.006-04:00

I had my final regular OB appointment today. My doctor was back from vacation, so I was able to see her. The appointment was again really uneventful. She didn't even do an internal, which I thought was strange for a 38 week appointment, so I asked her about it. She she said it is because I'm having a scheduled c-section, she'd rather not disturb the baby and potentially bring on labor. She thinks she should be able to cut through the same incision used last time, at least externally, so I won't end up with multiple scars. My weight has been flat for the last few weeks, which I think is fine at this stage in pregnancy. I have gained 15 lbs. overall, which I am also satisfied with, particularly since this may be a big baby. Friday is my last day of work and I was able to get my disability paperwork filled out while I was in the office, which was very convenient.

I have an appointment tomorrow at the high risk practice for a growth ultrasound. I'm really curious to see how much the baby has grown in the last 6 weeks. I'll be bringing a bag for the hospital to that appointment, because I'm sure if anything looks off they will just send me to be delivered right away. The good news is my doctor is on call tomorrow, so she would still deliver the baby. I got the on call schedule for the week and it looked pretty good. Dr. Husband is on vacation this week, so, no matter what, he won't be delivering my baby, which is good news.

It has been strange for me to end up with this non-drama pregnancy after all the excitement last go around. Of course that could all change tomorrow or if there are birth complications, but I'm really hoping that everything continues to be utterly boring with nothing unanticipated occurring, even though it does not really make for interesting blogging.

Crazy Weekend and the Kissing Doctor

2009-08-03T16:25:00.003-04:00

I have been scolded by a few of you for not updating the blog in while, so sorry about that. Hard to believe that my last post was almost 4 weeks ago -- that is bad. For part of the time, I have a good excuse at least. This Saturday, I officially turned 37 weeks and reached full term, but it was a totally crazy weekend, so no time to dwell on that milestone.

We are scrambling now, trying to make up for not doing what is needed to get ready for the baby ahead of time. This weekend, we moved the office down from what will become T's bedroom to our Sunroom on the first floor. Y did the bulk of the moving physical work along with her sister and brother-in-law, but I still overdid it a bit in terms of packing and organizing and was a bit wiped out by the end of the weekend. We ended up losing Internet connectivity for a for a few days because the electricians that we hired to rewire data/coax among other work necessary for the move did not do the wiring properly. I'm pretty annoyed about this because the work was rather expensive and it is the type of thing where if I was not pregnant I would have done the bulk of it myself. This is my first day working in the new office and I'm still adjusting. It is only about 7'x10' and both Y and I need to work in the space. I work from home about half the time and Y works from home all but one day a week. T is home during the day with a Nanny and his main play area is just outside our door, so we will see how that goes. He is already "visiting" a lot, which can be nice or disruptive depending on how busy we are.

The old office is almost cleared out. Once that is done, we can finally bring down all the baby stuff from the attic and I can see what I have and what I'm missing. Out of the two of us, I'm the one that keeps track of all the baby paraphernalia and clothing needs, so I can't really depend on Y to deal with this and it has been too hard for me to go work in the attic at this late stage of pregnancy. I'm hoping the baby holds out until the scheduled delivery because we still need more time to get ready.

Speaking of the scheduled delivery, the delivery date was moved back from August 14th to August 18th due to some scheduling issue with my doctor. I was initially a bit annoyed, but I have gotten over it. The 18th is actually my correct due date. The OB still insists on dating the pregnancy inaccurately, using LMP instead of the IUI timing, so they have me as being 40 weeks on the 22nd. Looks like it will be a Leo baby one way or another. I have been having some pelvic pressure, cramping, and occasional Braxton Hicks, but the baby still seems very high to me, so I doubt labor is anywhere in my immediate future, but who knows.

I have had a few doctor appointments since I last posted. I have regular OB appointments every week now. Since my doctor was on vacation two weeks ago, I saw Dr. Honey, who was pleasant enough, but then at the end of the appointment he gave me a kiss on the cheek, which I thought was mighty odd. Between getting and being pregnant twice, I think I have had hundreds of doctor appointment and this was the first time I remember getting a friendly kiss from the doctor. The closest think to that was that our RE gave Y and I a hug after we finally got pregnant, but that seemed appropriate in context and this did not. My OB was on vacation again this week and I saw the same doctor, but this time no kiss.

I did actually get to see my own OB last week in between her busy vacation schedule. It was good to be able to go over at least a few details and some of my questions regarding the delivery. She was a bit flustered because she just got back from the hospital, which was a bit cute because normally my doctor does not get that ruffled over much. One of the her patients has walked in hospital already 10 cm. dilated and ready to delivery immediately. She had to walk right out of the office with several patients already in exam rooms. I'm guessing this does not happen very much and usually there is more advance warning.

I'll try to be better about posting more from now until the baby comes. I have a regular OB appointment next Monday and then my last appointment with the high risk practice on Tuesday. I will be bringing a suitcase to the Tuesday appointment, because if there are any problems, I'm sure they will send me right to L&D.

The End is in Sight

2009-07-09T09:38:00.004-04:00

I have been scheduled for delivery via c-section on August 14th, "if I make it that long," as my doctor says. The should put me just 1 day shy of 39 weeks, which is the earliest my doctor will do scheduled deliveries with singleton pregnancies. If I don't make it to the scheduled delivery, I think it is unlikely the baby will be delivered by my doctor, since she is on vacation the week before I will be delivered and then also another week 2 weeks earlier. This doctor sure take a lot of vacations.

My appointment on Tuesday was pretty routine. I had not had any contractions since the weekend before (although I had some yesterday again), but she did a cervix check anyway. My cervix is still closed and posterior. My doctor thinks it is unlikely I will go into labor in the next few days and after that they would not do anything to stop labor anyway -- they would just delivery the baby--so she was less concerned about the contractions than Dr. Careful was from the high risk practice.

I got a copy of the ultrasound report from the week before and it looks like the baby is actually in the 65th percentile, not the 60th as I had been told. I'm happy with that since that puts him in a range where growth problems are unlikely, but I have been letting him know that 65th is high enough -- no need for additional over achievement. I was also surprised to see that the head circumference is in the 85th percentile, since that was not mentioned during my appointment. This makes me feel a bit better about not having changed doctors so I could attempt a VBAC delivery. T, on the other hand, has a tiny head. Even though he is average height now, he has never gotten above the 25th percentile for head circumference. He must get that tiny head from the donor, because my family all has very large heads.

Overall, I'm doing fine, but not really feeling wonderful. I get tired very easily and I'm not sleeping well, both from discomfort and because this little guy likes to pound me all night long. I've been feeling nauseous again rather frequently, which is a bit odd. It was bad enough yesterday that I felt like I would throw up, but I didn't. I suspect I will make it through 2 pregnancies without vomiting even once -- how often does that happen?

I did confront my doctor about her partner making reference to my husband. She seemed pretty uncomfortable with the discussion and looked like she wanted to flee the room. I thought my RE handled the situation better when I had a similar problem with Dr. Clueless during one of my monitoring appointments. My OB said all my information is in the computerized system now and this doctor is having trouble adjusting. Incompetence as an accuse for ignorance -- not very confidence inspiring. She recommended I see her other partner for appointments when she is on vacation. Now, if you will recall, I have not had a great experience with that doctor either. He is the one that called me "honey" during an internal exam and also thought it was okay to not access the computer to pull up my records. So given the choice between Dr. Honey or Dr. Husband, I went with Dr. Honey for the 2 appointments I needed to schedule while my doctor is away. Dr. Honey has the better reputation of the 2 doctors anyway, even though my experience with him has been less that great. Y says I should cut these doctors a break, that we get treated pretty well overall, and I'm just a difficult, over demanding patient. What do you think?

Bad News, Good News

2009-06-30T15:09:00.002-04:00

The weekend was a bit rough. On Saturday, I started having some contractions. I lay down and that helped a bit, although it took a while before they went away. Now, the contractions are really just standard Braxton Hicks. In general, they would be nothing to worry about except they occur every few minutes, so I should really call my doctor who I know would tell me to go to the hospital. Now, I have been through this drill before, so I know how it works. They will monitor me and assess the risk of preterm labor. If they think there is a risk of preterm labor, they will administer Terbutaline, which is pretty awful, and potentially poses some risk to the baby. I was hoping too keep myself out of the way of unnecessary drug intervention, so I did my own assessment. I checked my cervix and it was closed. I have been carrying very high for the past few weeks and the baby had not dropped down at all, so that was reassuring. The baby was moving arround a good bit -- in fact, he would kick after pretty much every contraction. Everything seemed okay, so I decided to just put myself on bedrest and drink a lot.

On Sunday, I started having the same contractions. Unfortunately, we were out and it took a few hours before we could get back home, so I just drank a lot in the interim. I got back in bed when I got home, but the contractions still continued for a few more hours. I probably would have gone to the hospital, but I had an 8am appointment at the high risk practice on Monday, so I decided to try to wait until then. Everything was fine by the morning when I left for my appointment. Unfortunately, this translated to another non-productive weekend in terms of getting ready for out rapidly approaching new arrival. Y had to watch T while I was out of commission.

The high risk practice had just gotten new ultrasound machines and, unfortunately, patient monitors were not hooked up, so I did not get to see the baby much, although Y was able to watch the full scan. I was told everything looks great, though -- no growth problems so far, which is a huge relief. The baby is an estimated 4lbs 11oz., in the 60th percentile, and dated at 33w6d (I was 32w2d at the time). Since T was only 4lbs. 1oz. at birth, I'm entering into uncharted territory for me now, carrying a baby that is larger than what I have carried before.

I saw Dr. Careful and when I told him about the contractions over the weekend, I was scolded for not calling my OB -- I knew that was coming. He wanted to do an internal exam and run a fetal fibronectin test, which helps assess my immediate risk for going into labor. My cervix was closed and very far back, so he had a hard time reaching it, which he said was a good sign. The fibronection test came back negative, so it looks like there was no harm done in my skipping a trip to the ER.

My next visit to the high risk practice is not for another 6 weeks and that is pretty close to when I could be scheduled for delivery. Dr. Careful says he doesn't think there is likely to be any growth problems this pregnancy -- 60th percentile at this stage is a good sign. I think T was down to the 35th percentile by this time. Hopefully, there will be no more unusual contractions and I can have an uneventful 2nd half of the 3rd trimester.

Danger Zone

2009-06-27T12:04:00.004-04:00

I have now entered into what I have been referring to as the pregnancy danger zone. I'm 32 weeks now and this is when I started having complications my last pregnancy. I failed a non-stress test at my 32 week appointment with the high risk practice and took my first trip to the PET unit. It was all downhill from there and T ended up being delivered 1 1/2 weeks later. Luckily, it is not an overly dangerous danger zone. As long as I can make it at least another 1-2 weeks, the risk of long term complications is fairly low. A lot of children born at 33 1/2 weeks like T was will have some lingering respiratory problems, but T has not and he has really been the epitome of perfect health, despite remaining pretty small until recently. I go for a scan at the high risk practice on Monday where I will get to see my favorite doctor, who I have yet to see this pregnancy. Keep your fingers crossed that the little guy is still growing well.

I had an appointment last Tuesday at the regular OB's office. I was supposed to see my OB the Friday before, but the appointment was canceled because she was sick and she was on vacation last week, so I had to see one of the other doctors. My doctor seems to be on vacation very frequently and is often sick, which sort of sucks because, while I like her, I don't care for either of her partners and the one I saw on Tuesday I like even less now. He acted like he had never met me before even though I had just had an appointment with him a few weeks ago. During the course of the exam, he referred to something "my husband" would need to help me with. Really, I don't understand why some doctors are such ignorant fools. I mean if you are not going to bother to read a patient's chart, why, in this day and age, would you assume that just because you have a pregnant woman in front of you that there is a husband in the picture? Now, I will need to complain to my doctor about her partner, which is a bit tedious.

One thing I did learn is the my uterus is now up to my sternum, which probably explains why I have been having some trouble breathing. I'm carrying very high at the moment. At some point, this baby will need to move forward and carve out some new territory. I can't see how there is much other room left -- I keep saying that, but then the little guy just finds some other organ to displace. The stealth pregnancy continues. I'm sure if I make it to term, I will likely look more pregnant, but it has not happened yet.

Another Busy Weekend

2009-06-16T09:51:00.006-04:00

My Mom's surgery went fine. She was bad for the first day, but by the 2nd, she was able to get out of bed and even do a little cooking. By Saturday, the third day, I was able to leave. My 93 year old grandmother would come over to "help," so I would get to take care of both of them and listen to them bicker, but overall, it all went well.

I had another grueling weekend. I worked all Friday night and did not leave the office until 1am on Saturday. Everything went well, though, and there should not be a lot more crazy weekend work between now and when baby comes, since the project that was driving all the weekend work is now complete. Of course, now that I typed that I just received an email that I need me to work 3 Friday nights in July :(

So I finished up at 1am on Saturday and my sister, her husband, and my niece arrived on a flight from India at 5am. Luckily, my Mom was the lucky one who went to pick them up and took them back to the hotel. My niece is spending a lot of time at our house with T while my sister and her husband are working in Manhattan. It has been interesting so far and a nice experience for T to spend time with his cousin who he barely sees since she lives so far away. She is about 6 months younger than him. They are such different kids. T is really high energy with a big personality and always wanting lots of attention. She is much more subdued and able to self-entertain. It has not been as much work as we thought it would be having her around because she is so easy going. Regardless, it is still good practice for Y and I to take care of 2 kids at once. We really love T and all his crazy antics, but we definitely won't mind if #2 is a bit more mellow.

My sister leaves on Friday, so Y are I are going to start getting ready in earnest for the baby this weekend. We really need to get moving. Delivery, if I make it to the scheduled delivery, will be 7-8 weeks from now.

Changes

2009-06-09T19:10:00.004-04:00

I passed my glucose test. I was close to the upper limit, but passing is passing, right?

I feel like I have been going through a lot of changes in the last few weeks. If I dress in maternity clothes, I actually look a bit pregnant now. I'm starting to feel pretty constant pelvic pressure and some shortness of breath, like the baby and my lungs are competing for space.

I worked again this past weekend, but it was not so bad/stressful and did not interfere with sleep. I'm actually taking a day off this week. I wish I was able to take a break or make progress on getting ready for the new arrival, but I'll be going to Baltimore to help my Mom for a few days -- she is having minor surgery. Not sure how much help she will need, but I wanted to be there for her.

30 Hours

2009-06-01T21:58:00.002-04:00

Work continues to be very time consuming for both Y and I and we are not making the progress need to get ready for the new arrival. To give you an example -- this weekend I worked for 30 hours, almost straight through with only a few hours of sleep in there. Nice, right? I think I may have a few more weekends like this one ahead of me too.

I saw the cardiologist last week and was finally given my walking papers. The doctor said, "I don't see any point in my continuing to scan a healthy heart." I was there already a while ago, but at least now we finally agree.

Today, I had a regular OB appointment. I had my glucose test this morning -- yummy. Results back on Wednesday. I asked the doctor what she thought about my working 30 hours straight and she wasn't thrilled about it but said it did not pose any risk to the baby as long as I continued to have no complications of any kind. If I start to have any trouble, she does not want me working those kinds of hours. At my last scan, the baby was in the 64th percentile, so the growth problems I had last pregnancy are not an issue so far and I have no other complaints at the moment.

I'm on a 2 week schedule now for regular OB appointments. I went to schedule my next appointment and was told my doctor was "booked" for that week and I would need to see another doctor. I said no and made them find me an appointment. It is a Friday appointment and I don't have childcare on Fridays, so I will need to take T with me, which could be interesting.

I'm still continuing to not really look very pregnant even through I'm 28 weeks now. People at work don't know I'm pregnant unless someone else tells them or they overhear me talking about it. I actually think I lost a little weight between this OB appointment and last, which is a bit odd for this stage in pregnancy. However, I have reached the point where I'm going to need to move into maternity pants full time -- that means venturing into the attic and actually finding my old maternity clothes, which could be a challenge.

Cruising Along

2009-05-18T16:14:00.004-04:00

My break from doctors appointments ended last week. I had an appointment with the high risk practice today and my regular OB last week. Both were pretty uneventful. For today's appointment, I made it in and out in 30 minutes, which never happens because they run so late. The baby looks great. He is 2 1/2 lbs. now and is measuring 27 weeks. This is a few days ahead of schedule, but really only because they insist on dating the pregnancy inaccurately, which I know I keep mentioning. I saw Dr. Jolly again. I used to be a fan of his, but not so much lately, because feel like he has been on autopilot during my last few appointments. According to him, the anatomy looks great, fluid levels are good, placenta looks good, heart has no problems. I'm still supposed to keep going to the cardiologist because .... I really have no clue why. My regular OB said once you get referred out to the cardiologist, they will always want to scan in the 3rd trimester even if there is no real problem. Ah, well, at least insurance is paying for it.

I don't go back for another scan for 6 weeks. At first, I was happy about that, since I'm a bit tired of all these doctors appointments, but I have been thinking now that maybe is a bit too casual. I'll be 32 weeks then, which puts me a bit later then when the baby started having growth problems my last pregnancy. I was able to get an appointment with Dr. Careful, at least, who I have yet to see this pregnancy because our schedules never match up. He is always so meticulous and detail oriented, so I will be able to feel like everything is being looked at closely. I see the cardiologist next week and then the week after that I'm back to the regular OB for my 1 hour glucose test.

Home Alone

2009-05-11T13:32:00.003-04:00

I have really been terrible with keeping up with my blog, so I apologize to my readers, if I still have any, out there. The "no blogging" has been part of my "vacation from pregnancy" program, which I think is likely to be coming to an end pretty soon, since the 3rd trimester is just around the corner for me. Everything has been going smoothly with the pregnancy, with no problems or complaints to report. I have not had a doctor's appointment in 4 weeks, which I think is probably some kind of personal record for me. I do have an appointment tomorrow with my regular OB and then an appointment the following Monday with the high risk doctor.

I am continuing to work really long hours at my job and Y is working a lot too, so that has left almost no time to get ready for the new arrival. I was working until 5am on Saturday because I had some scheduled changes for Friday night that went badly. I am building up some comp time, so that should be helpful later, so I can at least take a few days off in July or August before I officially go on leave. My company only gives comp time for weekend work, so it does not really cover all the extra hours I am putting in, but I'm grateful just to have a job in this climate and I am happy to have pretty decent benefits when I'm out on maternity leave, although it still won't be full pay.

I'm still not really looking pregnant, "just fat" as some less than generous family members like to say. I have only gained about 6 lbs so far, but I'm carrying pretty much the same way I did last pregnancy, which is low and not very far forward -- this creates a barrel effect, so, yeah, it just looks like I'm getting fatter. My running joke is that my babies figure why carve out new territory for themselves when then can just take over this space occupied by my internal organs. Even though I'm 25 weeks now, no one knows I'm pregnant without my telling them. Stealth pregnancy has some advantages, though. I never have to deal with random strangers making stupid comments or putting their hand on my belly. The funny part is that just because I don't look pregnant does not mean that I feel any less pregnant and I'm getting to the point where I'm always aware that my body is now a "shared space" and an increasing percentage of the overall resources are going to the "visitor."

Yesterday was my second Mother's Day as a mother, but this year Y and I split the kids. I stayed with the baby in progress (not like there was a choice there anyway), but Y took T to South America to visit her family. I did not go for reasons that are sort of complicated and would take too much time to get into. Y and T left on Thursday and Thursday was the first night that I had not slept in the same house as T since he came home from the NICU at 11 days old, so the past few days have been so strange without him. Y does call at least once a day and I did get to see T and talk to him on Skype yesterday, so I know he is having fun. He also told me that he loves me, which he does not do very often, so that was a great Mother's Day gift.

For Mother's Day, we would normally go to Rehoboth Beach, but a family friend had a birthday party on Saturday, so the plan was to go to Baltimore and spend Mother's Day there with my Mom and grandmothers. Unfortunately, one of my grandmothers was rushed to the hospital on Friday night and ended up having emergency surgery on Saturday morning. She is doing fine and was discharged yesterday, but we ended up spending Mother's Day in the hospital for the most part. So it was pretty far from the dream Mother's Day for me, but I'm still happy that all the mothers in my family are doing fine and that I have my two boys to cherish (hopefully) for Mother's Days to come.

Vacation from Pregnancy

2009-04-15T04:10:00.003-04:00

I had a regular OB appointment yesterday and somehow managed to get mixed up about the time. I had a 10:30am appointment, but I thought it was at 2pm for some reason and showed up at the wrong time. The doctor's office managed to squeeze me in, but I needed to see a different doctor and not my regular OB. I thought this was pretty decent of them, since while I was there they needed to cancel/reschedule 3 other patients who were waiting for their appointments with one of the other doctors in the practice who had "gone missing." Sometimes it pays to be an OB patient -- so I was able to have an unscheduled appointment and these other women with valid gynecological appointments were sent away. I was almost proud of myself for having screwed up the appointment. It is so unlike me to me less than obsessive about my medical care, at least as far as fertility and pregnancy goes, so being casual enough to miss an OB appointment is a bit of an accomplishment. Having a pregnancy with so much medical intervention already on top of all the medical intervention it took to get pregnant to begin with has taken its toll on me. I think I'm at the point now where I need a little vacation from pregnancy. I know that is not really possible, but if it were, 21 weeks seems like the optimal time to try.

The doctor I saw is the 3rd OB in the practice -- I have not had any contact with him yet this pregnancy and I had very little to do with him last pregnancy either. So obviously given the scheduling mix up, he had my massive chart dumped on him at the last minute and had to try to make sense of it. He was actually trying to read my chart and I guess I have come to have such low expectations for doctors at this point that was enough to make me happy. He asked if I had any questions about my conceiving through IUI, hypothyroidism, Rh negative status, or prior delivery through c-section. Lucky for this guy, this was actually the one doctor's appointment ever that I really had no questions. Since I did not have any questions, he kept going with his. How old was I? Had I conceived using donor eggs? Donor eggs + IUI ... hmmm.. that would be a neat trick. I guess I will add him to the list of OB's that I have met during my pregnancies that don't know much about how fertility treatment works. Luckily, there is not much going on at the moment as far as the pregnancy goes, so there really was nothing to talk about. I got a copy of my ultrasound report from last week at the high risk practice and left.

I had my 20 week scan at the high risk practice last week. This is a very long scan because all the anatomy is examined very closely. My little guy was very active and really hamming it up for the audience. Everything is fine. The baby was measuring 5 days ahead at 21w1d, which makes sense, since they still insist on dating the pregnancy inaccurately. There are no visible problems with the heart. After the technician scanned me, Dr. Jolly came in to take a look. Now, I normally like Dr. Jolly, but he seemed in a big rush for this visit, which I really, really don't like. Even Y, who is much less picky when it comes to doctors than I am, complained that he flipped through the screen captures that the tech had taken during the ultrasound so quickly that she seriously doubted if he would have been able to see anything wrong. I asked for permission to stop seeing the cardiologist, but that was a non-starter. I may take it upon myself to stop going -- I can't see why I need to see a cardiologist when the baby does not have a diagnosed cardiac condition. I don't need to go back for another growth scan for 6 weeks. I'm pretty psyched to actually be able to go more than a month without another ultrasound. I know a lot of women look forward to the ultrasounds, but after having 12 of them so far and only being halfway through pregnancy, I'm a bit over it.

Halfway There

2009-04-03T20:52:00.002-04:00

Tomorrow I will officially be 20 weeks pregnant. If I make it to full term this time, that means I'm halfway through this pregnancy, although I find it hard to count that first 4 weeks before pregnancy is even confirmed. I have my 20 week anatomy scan scheduled for this Tuesday.

I finally got my remaining Amnio results on Thursday. The remaining micro array panel also showed no chromosomal anomalies. I also went back to the cardiologist the week before last and he is still seeing no problems with the baby's heart. Despite that, he still wants me to come back at 26 weeks for another scan. When I see the high risk practice, I'm going to ask if I can skip this if they are also not seeing any problems. I already need to go in for growth scans every 4 weeks, so that really should be sufficient. It is astonishing to me how much the cardiologist charges my insurance company every time I go there. So far, they have paid the claims, but I'm really not up to getting stuck with the bill if they decide not to cover it because the baby doesn't have a diagnosed heart condition.

Outside of the doctor-induced stress, I have been doing really well. I feel the baby moving and kicking a lot now. I think Y should also be able to feel it soon too. I'm not having a lot of success getting T excited at the prospects of having a baby brother, but when I ask him to give his brother a kiss, he will kiss my belly, which is pretty cute.

100% Baby Boy

2009-03-17T18:03:00.002-04:00

I had a regular OB appointment today and it was vastly different than my last two appointments. I saw my OB and she was much more like I remembered her from my last pregnancy -- great bedside manner, smart, on top of all of the details surrounding my care, and patient about going through all my questions. We started by going over all the recent developments from latest week. She had received nothing back from the high risk practice (no amnio results, no ultrasound report, no blood test results) and nothing from the cardiologist, so she sent someone to call the high risk practice right away to see what info she could get for me before my appointment was over.

After answering all my questions, she checked the baby's heartbeat with the Doppler. No ultrasound today -- not that I needed one, since I have had 9 already this pregnancy and that is not even counting all the preconception scans at the RE. I'm still having watery discharge, so she wanted to do an internal exam and left the room, so I could change. When she came back, she said she was able to get my amnio results -- everything is normal and it is a 100% certain we are having a baby boy now. Yippee!!! These are just the regular amnio results. I'm still waiting on the micro array panel that tests for various less common genetic disorders -- their main concern is DiGeorge syndrome since that can correlate with the potential heart problem detected last week.

Overly Eventful Amnio Appointment

2009-03-09T15:13:00.004-04:00

Before I alarm anyone with my blog posting title, let me just say off the bat that the amnio itself went fine, was almost completely painless, and was totally uneventful. I hadn't really been stressed out about the procedure in advance either --hadn't done any research about the procedure, which is very unusual for me. I was surprised that the needle was inserted so high, above the belly button. It really did not hurt much at all. I remember my CVS last pregnancy also being no big deal, but this needle was even less painful. The doctor withdrew 2 large syringes of fluid. I made sure to look away when the needle was inserted, but I was inadvertently looking in the wrong direction at the end and I saw the doctor remove the needle -- that sucker was really long.

Since I had the amnio done at the high risk practice that I see regularly, they also do an anatomy scan. The technician said she should be able to identify the sex of the baby and asked if we wanted to know -- of course we did. Unfortunately, this was easier said than done. She had a rough time getting a decent view because the umbilical cord was right between the little one's legs. She said normally it would move at some point during the scan, but there was no such luck in our case. She thought it was probably a boy, but could not be sure because the view was so obstructed. The doctor tried again when he scanned me later and had a similar problem. He said he was 98% sure he could guess the sex but could not be certain. There was a nurse in the room at the time that was encouraging us to wait for the amnio results so we could be certain. She left later and we asked the doctor what he thought the sex was. He agreed that we would be having another boy. When we got home, I asked T if he wanted to have a little brother and he sang out very loudly, "NO!" I asked if he wanted a little sister and got the same answer, so someone is going to be likely facing some disappointment. As for Y and I, we are just hoping for a healthy baby -- on that front, read on.

When the technician did the anatomy scan, I was surprised that she spent an inordinate amount of time looking at the heart. She told us the heart looked great, which we found out a few minutes later was not entirely true. After the technician does the preliminary scan, the doctor comes in and usually rechecks certain things. We we got to the heart, he showed us there was what looked to be a small gap in the wall of the heart where I take it there is not supposed to be one. He said that was a potential problem, although it was too early in the pregnancy to be able to fully confirm if there is a hole in our son's heart. Even if there is, it is unlikely to be anything serious and sometimes these holes close on their own. Nevertheless, he wanted me to go see a pediatric cardiologist and he arranged for me to have an appointment later that morning.

I had mentioned that I was feeling pressure on the cervix, which can be a symptom of an incompetent cervix. Since I had experienced this pressure during my prior pregnancy, I suspected the doctor would want to check cervix length, which I know requires a vaginal ultrasound. The technician asked me if I had had one before and it was hard not to laugh, since I have had so many that I have lost track. My cervix was locked up tight like Fort Knox and was over 6cm long, which is great -- nothing is coming out of there anytime soon.

By then, my head was spinning, but the good times were not over yet. I was told I needed a blood draw in preparation to get a Rhogam shot. Now, I probably should have anticipated the Rhogam problem a little better. I'm Rh negative, so I know already from my prior pregnancy that I will have Rhogam pushed on me at various occasions. I don't need it though, because my donor and I have the same blood type (O negative), so there is no risk I will develop antibodies. Unfortunately, I didn't have any paperwork to prove this -- when this had come up before, I would just decline the Rhogam and that would be it, but this nurse wanted proof of the donor's blood type. Well, there are some advantages to having your RE located next door to your OB, so I sent her down the hall to get the necessary paperwork. So, I was able to escape the Rhogam shot, but still needed to go through the blood draw because I was missing a blood test that my regular OB should have run and had apparently missed. Unfortunately, the blood draw required 2 attempts by 2 different nurses -- I hate it when that happens.

I had an 8:30am appointment for the amnio, but by then, all we had was a time for was a quick bite before running off to the pediatric cardiologist at 11am. I'm not really sure what the big rush was to get to the cardiologist right away because he said at 16 weeks the heart is so small that only major structural problems can be confirmed. The cardiologist said that in general our son's heart looked normal, but he could see why my doctor thought there might be hole in the heart wall. However, he we would need to wait a few weeks before he could be definitive one way or another. There was only one ultrasound monitor at the cardiologist's office so I couldn't really see anything, but Y said that the picture quality was much better at the high risk practice, so if they could not tell anything for certain, she doesn't see how the cardiologist would do any better. I need to go back to the cardiologist in 2 weeks when the heart will be more developed. Until then, we wait.

Hello 41

2009-03-07T22:05:00.003-05:00

I turned 41 earlier this week. Everything appears to be going well with the pregnancy so far, so I'm on track to give birth at the ripe old age of 41. The passing birthday reminded me again to be grateful that I was able to get pregnant at 40 -- I know the odds were against me at that age and I'm glad I was able to end up on the other side of them.

Birthdays for the last few years have had special significance for me as far as TTC/pregnancy goes. When I turned 38, I had my minor meltdown where I realized if I wanted to have children I had better get started before it was too late. In retrospect, it would have been smarter to have that meltdown earlier, particularly since I knew I might want two children. I'm lucky it still worked out for me. My 39th birthday was T's due date, although he arrived much earlier than expected. For the past two years, the difference in time between T's birthday and mine always seems so long. Sometimes I have trouble getting my brain wrapped around the idea that I could have been pregnant for that much longer than I was -- 6 1/2 weeks in addition. Hopefully, I will be this go around. On my 40th birthday, I had my first appointment with the RE that helped me with TTC #2. I know it is a bit perverse to schedule an appointment with a fertility specialist on your 40th birthday, but that is just how it worked out, since I was trying to get in to see her after I had a preconception appointment with my peri and before I had to leave on vacation. Unlike the few years prior, nothing momentous happened or was supposed to happen on my 41st birthday. I'm 16 weeks pregnant, so let's just call that my birthday present to myself.

I've been doing a bit better in the last 2 weeks as I have moved into the 2nd trimester. The nausea is not as bad, although not completely gone, and I'm no longer completely exhausted at all times. One thing that has gotten worse, though, is the constipation, which has really been a mess for me the last two weeks. I take collace, drink prune juice, eat dried prunes, and take Metamucil and I still have trouble. Y says it makes her want to run to the bathroom just watching me eat all that stuff. I feel like the baby is really bearing down on the colon, so that makes it hard for me. I know it will get better it a few weeks because everything will shift up a bit. I've been feeling some slight pelvic pressure as well because the baby is low at this stage in pregnancy, but it is not nearly as bad as when I was pregnant with T where, at the this stage in pregnancy, anytime I would stand up I would feel like the baby was going to fall out.

I have an appointment on Monday at the high risk practice for an anatomy scan and to have amnio performed. I know we will find out the sex of the baby from the amnio, but I'm sure that takes a while and I'm not sure if they will be able to determine the sex from the ultrasound at this stage. This is all uncharted territory for me. Since I had CVS when pregnant with T, I found out the sex of the baby at 13 weeks. It feels strange to me not to know yet, although I know it is the norm not to find out until 20 weeks or even later.

Still Employed

2009-03-03T16:14:00.002-05:00

My company had layoffs today -- their first ever. Miraculously, I'm still employed. I'm not sure how I managed to escape the ax, for now at least. I met with our HR coordinator last week and she made a point of mentioning, even though I did not ask, that I could still be layed off while pregnant or on leave after birth. My boss had told me a few weeks ago when I did ask that there would likely be layoffs, but I wasn't at risk -- I didn't believe him at the time, but I guess he was telling the truth.

2nd OB Appointment

2009-02-17T14:13:00.002-05:00

Sorry about the radio silence as of late. I have been going through a lot of turmoil at work for the last few weeks and I'm feeling like I'm at some risk of losing my job in the next few months. I've been too bummed out to blog about it or really about anything.

I had my 2nd appointment today with my regular OB or, at least, what I thought was going to be an appointment with my regular OB. I was initially supposed to have an appointment in the afternoon and the office called on Friday to see if I could could switch to a morning appointment. I said that was fine, but when I checked at reception for my appointment, I found out my doctor was not even going to be there today and I would need to see another doctor. Nice -- thanks for letting me know ahead of time.

I was promptly escorted back to see Dr. R, who I take it was a very busy guy today since he needed to see both his own patients and all of my OB's as well. I was left waiting in the exam room for almost 30 minutes before the doctor showed up. He then spent several minutes trying to find my chart in my big stack of medical records. He eventually figured out that I didn't have a chart because my chart was in the computer. I assumed he would need to step out to retrieve my chart from the computer to review before examining me, but no, he just kept going. I still don't really understand the whole transition process that my doctor's office is going through as they move to a computerized record system. If their records are going to be totally computerized with no printouts, then don't they need computer terminals in each exam room?

I had been expecting to have ultrasound this appointment, but I had been put in a room without an ultrasound machine, which Dr. R said was done by his staff to "torment him" and he was not sure he would be able to pick up a heartbeat on the Doppler because it was so early. It took him a while, but he did eventually find the baby's heartbeat. I was actually okay with not having an ultrasound. I have not really been feeling anxious about the baby lately other than how all this work stress is impacting him/her. I'm actually pretty sure I have been feeling the baby kicking for the last week when I'm lying quitely in bed, although Dr. R says it is really highly unlikely that I could feeling kicking this early.

My only "complaint" worth sharing with the doctor as far as pregnancy symptoms go is that I have been having a lot of clear discharge on and off for about 2 weeks now. This makes me concerned that I could be leaking amniotic fluid, so Dr. R did an internal exam to check the fluid. Even though I have had regular appointments with the speculum and more vaginal wandings than I can count in the last year, this was the first internal exam that I have had performed by a male doctor since my last pregnancy (my RE's office is all female doctors and my OB is also a women), so that was a bit strange already, but the worst part is Dr. R referred to me as "Sweetie" while doing the exam -- so much for sensitivity training. The fluid looked like normal discharge to him.

So, as you can imagine, I'm still looking to switch OBs. I had given myself permission to not deal with this issue for a while because I have been stressed out enough from work and I did not want to give myself more things to worry about. I have the choice for a new OB narrowed down to 3 practices, but I'm having trouble picking which one to go with since none of the 3 really seems perfect. I need to figure out what is most important to me in terms of prenatal care other than just basic competency, which I'm growing concerned may be lacking with my current care.

Nuchal Scan X2

2009-02-03T20:15:00.000-05:00

I had an appointment on Friday for my first visit with the MFM practice and to get the nuchal fold measured for the bean as part of the ultrascreen test. The MFM practice I go to is one of those group practices where you don't get assigned a primary doctor, but you can request a specific doctor when you make an appointment. I have two doctors there that I like -- the first, who I will call Dr. Jolly, has a good bedside manner and is very patient with all my questions. The second, Dr. Careful, is totally not the usual type of doctor that I like -- he tends to be a patronizing and has no bedside manner. The reason why I love him is that he is incredibly careful and meticulous when he does ultrasounds. This is the doctor that detected that something was going to go wrong with my pregnancy last time, even though the ultrasound, for the most part, really looked fine.

My appointment on Friday was with Dr. Jolly. He went through my questions, although there was one he refused to answer. The funny part was that after all my questions, he complained that I was being a little difficult. I laughed and told him he could go next door and compare notes with my RE -- I know they are friends. I got a list of other OBs he recommended, which was a bit awkward, because I know he is friends with my OB as well. He didn't see any reason that I could not attempt VBAC if I wanted to try. Now, the weird part of the visit is that they were not able to do the nuchal scan because the baby was 1mm too short for the minimum length required to do the test. I was told to come back the following week, so I scheduled an appointment for Monday, since my CVS was scheduled for Tuesday.

The baby was supposedly almost 1cm longer this morning. Unfortunately, the LO was not being cooperative and it took a long time for the technician to be able to get the needed measurements. Once she did, though, the measurements were quite good and the nuchal fold was 1.3mm. Anything under 3mm is okay, so 1.3 is very good. After the scan, I had to see the genetic counselor again to discuss my results and it was another one of those conversations why pregnancy at 40 is never a harbinger for good news.

The Ultrascreen has 3 parts to it - hCG bloodwork, PAPP-A bloodwork, and nuchal fold measurement. My nuchal fold measurement was great and my hCG levels were normal (50th percentile), but my PAPP-A was on the low side (20th percentile). Now, this was still a good number for me, since my PAPP-A had been in the 1st percentile last time and 20th percentile is high enough that it is not predictive of any future placenta problems. However, it is still low enough that it can indicate some increased risk for Downs Syndrome. My risk factor for Downs Syndrome after the test is 1:282 and the cutoff for not being at increased risk is 1:298, so we just barely missed being in the clear. Now, based on age alone, my risk factor for Downs is 1:61, so the positive test results do reduce my risk levels, just not enough -- due to my old geezer reproductive status. The genetic counselor said that at my age the test results really need to be perfect to indicate reduced Downs risks and my results were actually pretty good.

We opted not to do the CVS today. It was going to be a logistical mess for us anyway because we would have needed to take T with us - T in the room with a doctor and a big needle does not sound like my idea of a good time. I am still going to do the amnio. I really wanted to have it done by Dr. Careful, but he is out that week. Dr. Jolly was also unavailable, so I'll be seeing the head of the practice instead.

Bills and Bloodwork

2009-01-28T20:27:00.000-05:00

When I arrived home from vacation on Monday night, I was greeted by a very think letter from the billing department of my fertility clinic. I had a bit of a panic attack opening the letter, but it ended up being just a bill for $30. The reason why the letter was so big is that it had 6 pages of "pending" payments from my insurance company. I started going through the bill and it looks like about half the items that they consider pending were already paid by my insurance company with some items paid many months ago. The other items are claims that for some reason my insurance company just chose to reject, even though most of these claims are identical to other claims my insurance company has paid. I think insurance company claims systems are programmed to just reject a certain percentage of all claims regardless of merit.

I'm trying to figure what to do about these "pending" claims. No one is asking me for money yet, but based on past experience, when a provider thinks the insurance company owes them money, if they don't get the money, I eventually get the bill. I have $10,000 per year in infertility coverage and I think I should have enough left to cover all claims, although it may be close. It all gets very complicated very quickly because every visit to the RE generates about 6 different billable items and I had a lot of visits during my 8 total cycles, so it ends up being hundreds of charges that I need to review and potentially negotiate with the finance office later. I was happy to see at least that my visits after the first positive beta do seem to have been coded correctly as OB visits, so they should not count against my fertility coverage.

Yesterday, I called my OB's office to find out my blood results from last week's appointment. I ended up having to call twice because the first time I was told a nurse would call me back, but no one did. I had the results faxed to me. It looks like I'm still blood type O negative just like the 6 times I was tested last pregnancy. I'm also still not a Cystic Fibrosis carrier just as I was not the 2 times I was tested last pregnancy. So, although they managed to run a bunch of unnecessary tests, they did not run the two tests I had actually requested -- my progesterone and thyroid levels. I called the doctor's office and left a message for my doctor asking that she call me and explain why the bloodwork we had agreed upon was not ordered. I got a call back, from a nurse, an hour later explaining that the lab screwed up and that my doctor has submitted the paperwork for my progesterone and thyroid levels to be checked, but for some reason, Quest had not run these tests. I suppose this is an honest mistake and not my doctor's fault, but what I don't understand it why I'm the one that figures out that bloodwork is missing and not her. Again, that makes me feel, as I did during my initial appointment, that she is not being very attentive.

Not checking my thyroid levels is actually a problem. I have had a thyroid condition for 25 years and have been on the same dosage of medication for all that time except when I was pregnant with T and my dosage needed to be increased. Keeping normal thyroid levels is important both for the health of the pregnancy and for appropriate fetal development. I know when I see the high risk doctor on Friday he is not going to be happy that I have not had my levels tested yet. I will need to stop at the OB's office on Friday to get another blood draw.

Ski Trip

2009-01-27T17:30:00.001-05:00

I'm not sure if I have mentioned it previously, but we had a ski trip planned for the end of January and just got back yesterday. My Mom has a house in Deer Valley, Utah that is a rental/investment property, which she is most likely going to need to sell at the end of the ski season. She had wanted us to come skiing with her at the end of January and the beginning of March. I had originally thought I would likely be doing IVF in March, so I had agreed to go in January. When I ended up getting unexpectedly pregnant in December that threw a wrench in my plans. However, I asked my RE and she said it was fine to go skiing in the first trimester -- that she had skied when she was pregnant too. My OB, unfortunately, did not agree. When I saw her last Monday, she said I should not be skiing or doing any other high impact sports. Well, the tickets had already been purchased and this might be the last time I could go to my Mom's house, so I decided to go anyway and just take it easy.

Skiing ended up being more difficult than I expected. The weather was uncharacteristically bad. We planned on skiing three days. The first two days there was freezing rain and fog on the mountain. I'm always a bit nauseous the first day of skiing due to altitude sickness, but altitude sickness + morning sickness + fog was not a good combination for me and I ended up being really nauseous. I still ended up skiing some, but I took a long break after lunch and just sat by the fire with a hot cider, which was also really nice.

The second day, the weather was even worse -- more rain and ice. When we got up to mid-mountain and were already really drenched, my Mom and I decided to have a sit-down breakfast. Y went out and braved the elements, but after an hour, she had really had it. We ended up doing a few runs, but decided it was too miserable and just bailed.

Now, if I had done a little contingency planning or really looked for alternatives to skiing like a should have after my OB told me no skiing, I would have realized that the Sundance Film Festival coincided with our trip. Our course, we figured this out once we got there, but we didn't have tickets on hand or really know how to go about purchasing last minute tickets. After we quit skiing the 2nd day, we checked it out and found out that all showings for the rest of the afternoon were sold out. I wasn't up for waiting 2 hours in the rain to "maybe" get a ticket off the wait list, so we decide to go to a regular movie. We went to see "Revolution Road," which I knew very little about in advance and suffice it to say was a very strange movie to see when you are 10 week pregnant. Still, since we had T, I almost never get to see a movie in the movie theater, so it was fun to be able to see a good movie on the big screen and eat popcorn, even if the subject matter was not really pregnancy friendly.

Now, we thought it might rain again the next day, so we wanted to be better prepared. Sunday was the last day of Sundance and most of the screenings are festival award winners. My Mom and I bought tickets for 3 movies -- Y was still looking to ski even if the weather was not good. Of course, as luck would have it, it snowed over night and was still snowing when we woke up. We decided to go skiing it the morning and then still see the last movie after lunch. We saw "Push: Based on the Novel by Sapphire," which won both the Jury and Audience Prizes for US Dramatic Films. This was a really amazing film and we got to see it in the Eccles Theatre, which seats over 1200 and is sort an experience just in itself.

T was in daycare for 3 days while we were skiing and going to movies. T is normally with a Nanny and only goes to daycare occasionally, maybe a few times a year, at Y's work. He would really lay it on think when I would drop him off in the morning -- crying, refusing to walk, and hugging me in the death grip, but by the time we went to pick him up in the afternoon, he would be happy as a clam.

Anyway, overall the trip was a success. My Mom was so happy and appreciative that we came and kept trying to prevent us from paying for anything, which was very sweet. Airplane travel with young children can always be a bit of a challenge, but we did fairly well. T just missed the under 2 year cutoff where the child can travel on your lap and so we had to buy him his own seat, which was more expensive but a lot less painful. It is hard to believe that the next time we go on an airplane we will likely be travelling with 2 kids -- that should be interesting.

1st OB Appointment

2009-01-21T13:05:00.000-05:00

I had my 1st OB appointment Monday. While everything is looking good with the baby, I was not happy how the appointment went overall. Well, first the good parts. The bean is measuring 9W4D and had a heartbeat of 186 beats per minutes. We could not hear the heart since the ultrasound machine lacked that capability, but we could see if very clearly. He/she has visible arms and legs and was really dancing around and showing off. My OB, pretty much unsolicited, told me that she has very few patients my age that get pregnant with their own eggs and that I'm very lucky. Don't I know it.

Now, for the bad parts. When I showed up at the office, I was given a printout with most of my personal details preprinted. Over 50% of the info was wrong and I had to correct it. I learned later that the office had just switched over to a computerized record system and from the looks of things, they were in complete chaos. I was escorted back to the exam room and my OB performed the ultrasound. She calculated my due date as 8/22 and asked me if I had made an appointment with the high risk practice ( I had).

At that point, I think as far as she was concerned, I just needed to have some blood drawn and the appointment was over, which is sort of amazing for the 1st visit for new pregnancy. I told her that I had a number of questions for her (no doctor escapes from me that easily) and she agreed that I should get dressed and meet her in her office. She did take the time to answer my questions, but I felt really rushed, which was strange, because I have always found her to be very patient and careful in the the past. I was surprised that my questions were really the sole focus of our conversation. I would have expected her to want to review what had happened my last pregnancy and to discuss how she would want to manage my care for this pregnancy, but there was none of that.

The most disturbing part of the conversation is that I asked her what were my delivery options and she actually had to look in my chart to see that I had delivered previously by c-section. That really set me on edge -- whatever issues I had with my RE, at least she always knew who I was and what was my personal history. I found out that I would be delivered by a scheduled c-section at 39 weeks -- they won't schedule before 39 weeks because the lungs are not fully mature, which seems not right to me since 37 weeks is viewed as full term. Also, the pregnancy will be dated by LMP even though that is not accurate, so 39 weeks is really 39 1/2 weeks for me. The due date she is calculating falls on a Saturday, so I may not actually get scheduled until the following week, so another words, they will do a scheduled c-section if the baby makes it to full term -- I'd be surprised if I make it that far. Now, I don't really think delivering early is a good idea unless there is a specific medical reason, but the problem is that if I end up with an unscheduled delivery I get thrown into my doctor's delivery rotation schedule, which is a real nightmare. My doctor is in a practice with 3 other doctors but on weekends, they rotate coverage with 3 other practices, so potentially my baby could be delivered by 1 of 12 doctors, most of whom I will have no opportunity to meet prior. During the week, it is a little better, but not much. Daytime coverage rotates between the 4 doctors in the practice but at night they share coverage with one of the other practices. The net result of this setup and the scheduling of my delivery is that the likelihood of my doctor actually delivering my baby is pretty small.

I wanted a list of the doctors that could potentially delivery my baby and my OB said they could give me that at front desk, but mainly what I got when I asked at the front desk was a whole lot of attitude and confusion -- they gave me a partial list, but I think counting all the way up to 12 was beyond their capabilities.

I was interested in having the option of attempting a VBAC, but my doctor says that her insurance does not allow it. They require $100,000 per year per doctor in additional premiums to allow for VBAC deliveries. I really don't think the $100K is just for VBACs -- that probably also covers the right not to be forced to deliver multiples by c-section. I found this really amazing site with VBAC and c-section stats broken out by hospitals in NJ:

http://romancathanachronism.typepad.com/ican_somerset/2008/04/nj-hospitals-vb.html

My hospital has almost a 50% c-section rate, which is quite awful and you don't really get up to those levels if a meanful numbers of VBAC deliveries are performed. For countries with advanced medicine, c-section is usually medically warranted in about 15% of deliveries. In 2007, 2.5% of deliveries at my hospital were VBAC, so there appears to be at least a few doctors who will do them.

I had no real choice last pregnancy regarding delivery. T was breach and my amniotic fluid was low, so rotating was not an option and c-section was the only thing that made sense. My initial recovery was fine, but I had pain for 18 months afterwards. It also took a week before my milk came in -- I ended up breastfeeding T for over a year anyway, but another baby might not transition so easily from the bottle to the breast.

I'm not really sure how important VBAC is to me -- I just like to have the option. If my pregnancy goes well, I would be interested in trying a vaginal delivery. If I end up having complications like last time, I think I will just be more focused on the health of the baby and won't really care how he/she makes his/her way into this world.

Anyway, my real dilemma at the moment is whether or not to switch doctors. I don't know if my doctor was having an off day due to being disoriented about the computer system change, but she was really just dialin' it in and I'm not going to want to tolerate that for my whole pregnancy. I also hate the way her practice handle deliveries and since a lot my predelivery care is really managed by the high risk practice, I feel like it would be good to leave just so I can have a delivery group that is smaller than a Softball team.

My Big Boy

2009-01-16T19:07:00.003-05:00

I took T to the pediatrician today for his 2 year well visit. When you have a preemie, doctors will tell you that by 2 years the child should have caught up with babies that are born at full term. Previously, T had never had any of the catch-up growth that preemies usually have. His weight has usually been in the 5-10th percentile and his height has gotten up to the 25th percentile, but has often been lower. He has hit all his developmental milestone on time, but really at the very tail end up what is viewed as normal.

Today my boy hit the 5oth percentile for height and is in the 20th percentile for weight. I actually think he was heavier before, but he has lost some weight in the last 2 months from one of those rare times he has been sick. I'm not really concerned about his weight. He is really quite the big eater, so we are lucky that he is not a bit of a chubster. He has also hit all his developmental milestones. I feel like physically, he is pretty much on par with other kids his age. I think his language skills are still a bit delayed, but that is more from being bilingual than from being a preemie. He is getting a lot of exposure to Spanish, which I think is great and he seems to understand Spanish a little better than English.

The only real downer about the appointment is that Y thinks his legs flail out when he walks and the doctor agreed that his walking is a bit odd, but that the problem is very subtle, so she thinks we should wait a bit to see if he self corrects instead of going to physical therapy right away. I'm fine with that approach for now.

I had thought he would get the controversial MMR vaccine or part of it today, but I have chosen to delay a little longer. My doctor can only get 2 of the 3 parts of the vaccine broken out separately and she is not sure if she will be able to get the 3rd part. If she can't get that 3rd part by the summer, I will need to move ahead with giving him the combined vaccine. He will need to be fully vaccinated before starting preschool in the fall.

T is generally pretty much a complete nightmare to take to the doctor. He will cry through the whole appointment and fight the doctor when she tries to touch him. His hatred of doctors and doctors' offices is part of the reason that we have tried to never take him to the RE's office except when totally unavoidable. Today, though, he was a little different. I had to take off all his clothes at the beginning of the appointment, so he could be weighed and measured. As always, he was very anxious to leave, but for some reason, he understood that he could not leave without clothes. He kept trying to put his clothes and his shoes on, which is something he has never done before and is not capable or doing yet, or to convince me that I should dress him. It was really funny. The doctor was very entertained.

T turns 2 on Sunday. We are just having a small party with family. We have a party with kids planned for a few weeks from now. We couldn't get it together enough to get the kids party organized in time for his birthday. Oh well. Luckily, he is still too young to really notice that his party will be a little late.

Yesterday and Today

2009-01-12T18:28:00.006-05:00

There are some perks that come with pregnancy and I definitely benefited today. Since I have not been feeling so great lately, Y has been pampering me. Today was enrollment for the preschool that I had selected for T to attend next fall. The enrollment started at 7:30am, but there were only few spots open, so I was planning on getting there early. Y volunteered to get there at 6am and get a place in line, so she was out there huddled in the freezing cold while I was still warm and toasty in bed. I showed up a little before 7:30am and we were able to get T enrolled for 3 days a week from 9am to 1pm, which is what we wanted.

I had spent the better part of the last three months researching daycare and preschool facilities in my area. I have probably visited 15 places and spoke on the phone to another 25. I only found 2 places that I really liked and were reasonably close to my house and the school I enrolled T in was one of those 2, so we are pretty excited. The poor woman in front of us in line was pregnant with twins, had come in from Manhattan for the enrollment (her family will be moving), and was unable to get her child into the class she needed -- that really sucks. I can't believe how much competition there is just for preschool.

This afternoon, I went to the dentist. I think most women would have figured this out beforehand, but having a cleaning at 9 weeks pregnant is not a great idea. Luckily, I was not very nauseous at the time, so I got through it okay, but it was a lot more painful than normal. It was just amazing to me to see the amount of blood pouring out of my mouth. My dentist said that elevated estrogen levels during pregnancy increase capillary flow, so the additional bleeding is normal. I know I had a cleaning while I was pregnant last time, but I think it was during the 2nd trimester and I don't remember is being such an ordeal.

Yesterday, we had our monthly NYC TTC-Meetup. It was great to see everyone as usual. I was able to pass along most of my leftover meds to other members of our group, which was a great feeling. It is crazy how much some of these injectable medications cost, so I'm happy others can make use of them, instead of just having them take up space in my refrigerator. It was pretty funny to do the handoff in the middle of the restaurant. I still have some Crinone and Prometrium that I will probably pass along at some point. I'm just waiting to discuss my progesterone levels with my OB. I did end up emailing my RE about my descending progesterone levels, but she said my levels are fine and they don't need to be monitored further. I'll will probably ask my OB to do one more check anyway.

Feeling Pregnant

2009-01-10T14:04:00.003-05:00

The nausea and exhaustion has really kicked in full force in the last week. I have been feeling a little queasy the last few weeks, but it was mild enough that I could ignore it. This last week, though, I have gotten to the point where it can be difficult to eat anything other than fruit and cornflakes -- not exactly a balanced diet. Sometimes, I can manage a normal lunch, but almost never anything significant for dinner. I can't really eat any red meat and often even chicken can be problematic. Y has been making me these protein shakes, so I will have some protein in my diet. I hate those things even when not pregnant, but I have still been managing to get them down.

I get pretty tired around mid afternoon. I work at home a lot of the time, so it is tempting to go lie down, which I really need to not do from an employment perspective. Before T goes to bed, we usually let him watch Sesame Street for a half hour, so I have been having him watch on the TV in mine and Y's bedroom. I keep failing asleep during the show, so Y tends to find the 2 of us together passed out in the bed. Now, when I tell T it is time to go to bed, he walks to our bed instead of his crib -- not good.

My sense of smell has also really increased. Walking around the streets of NYC or even just walking through the Mall can be a real sensory assault. I have also noticed the T's poopy diapers, which never smelled good to begin with, seem really awful to me, so that is not helping in the nausea department either.

I'm also feeling the reality of the pregnancy setting in because I have gone ahead and scheduled my various 1st trimester appointments and testing. My first OB appointment is a week from Monday, which is great, because it is MLK day and I'm off already, so I won't need to schedule extra time off.

I am going to do the Ultra-Screen diagnostic test for 2 reasons. The Ultra-Screen is primarily a diagnostic test used to assess if the baby is at elevated risk for Down's Syndrome, Trisomy 18, and other genetic disorders. One of the components of the Ultra-Screen is a blood test for PAPP-A and this was the blood test that I had when pregnant with T that came back abnormally low, which, in addition to increasing risk for Down's Syndrome, correlates with placenta problems later in pregnancy. If my PAPP-A comes back low, this would be the first indication that I may be likely to have placenta issues again this pregnancy. If the Ultra-Screen shows elevated risk for a genetic disorder, I will go ahead and have CVS done. If there is not an elevated risk, then I will likely wait and do amniocentesis instead. I had a very good experience doing CVS my last pregnancy. The procedure was not very painful and it was great to know I was having a genetically normal boy at only 13 weeks. However, CVS does involve removing tissue from the placenta and, given my history, I don't want to needlessly disturb the placenta.

Scheduling the CVS after the nuchal scan that is part of the Ultra-Screen was a bit of a challenge. The Ultra-Screen needs to be done no earlier than 11W1D and it is best if I can get the CVS performed before 12W0D. To further complicate issues, if you will recall, my RE and I don't really agree on the dating of my pregnancy, so there is a potential difference of 2 days. Risk of miscarriage from CVS depends very heavily on the experience of the doctor doing the procedure. There is a practice in NYC where women come from around the world to have CVS done -- that is where I had my CVS done last pregnancy and really the only place where I would consider repeating the procedure.

What I worked out was that on January 30th, I will have my nuchal scan and, at the same time, my 1st appointment with my perinatologist. Unfortunately, they are also forcing me to have an appointment with a genetic counselor even though I had multiple genetic counseling appointments during my first pregnancy and I know all the potential issues associated with diagnostic and more invasive genetic testing. I'll be 11W3D by my dating and 11W1D by my RE's dating of the pregnancy.

Then, on February 3rd, I have a tentative appointment setup for CVS. This is at another hospital, so, unfortunately, I am being forced to have yet another genetic counseling appointment before the procedure. CVS can be done either vaginally or abdominally, but these doctors will only do CVS vaginally if the fetus measures less than 12W0D by ultrasound. I'll be 12W0D by my dating of the pregnancy and 11W5D according to my RE. The timing is a little tighter than I would like, but it was the best I could do.

Graduation

2009-01-07T17:15:00.003-05:00

Today was my last appointment at the clinic, so I have officially graduated. I was expecting the clinic to be packed because I think the lab is reopening soon, but it was totally empty. I was called in for blood work before I had even taken my coat off. Unfortunately, my scan was done by Dr. Clueless, who was in her fake nice mode. We got into a little disagreement because she didn't want to call me with blood results because they are "irrelevant" given the ultrasound tracking. Well, if they are irrelevant, then why do they still do them? I won and my nurse called with the results. My hCG levels are 63,981 and my progesterone is 12. I'm still a bit concerned because my progesterone seems to be trending down.

Everything looked great from the scan itself. The baby is measuring 8W0D, so that is 9 days growth in 7 days. The heartbeat was much stronger and measured 150 beats per minute, so that was reassuring after last weeks slower heart rate.

I picked up my records, said goodbye to few people, and left. Unfortunately, my doctor was not in her office, so I didn't get to say goodbye to her. Oh well, maybe I will run into her in the elevator.

And the Beat Goes On

2008-12-31T17:50:00.000-05:00

Everything went fine during today's doctor appointment. We saw Dr. Mini, who I have not seen for a while now. The bean still has a beating heart and we actually got to hear it beating 109 beats a minute. The doctor said everything looked excellent and that the heartbeat was nice and strong. Google tells me that fetal heart rate should be over 120 beats per minute, but I guess 109 is close enough. The baby is measuring 6W5D, which is 7 days growth in exactly 7 days, so that sounds good to me. My hCG level is now 29,393 and my progesterone is down again slightly to 13.

I have one more scan at the RE's office and then they will cut me loose. I have my first OB appointment on January 19th.

So just one quick, funny story. Like last week, we went to the appointment on our way our of town. I arrived about 5 minutes after monitoring hours officially ended, so I guess to punish me, they made wait forever even though the office was relatively empty because the IVF lab is closed. T got very impatient during the wait and started playing with the elevator buttons. The elevator opened and my RE stepped out. I guess T decided he had enough of waiting, so he made a dash into the elevator and I snatched him just before the doors closed. My doctor had sort of a shocked expression and said, "One almost got away." Hehehe. I always seem to run into my doctor in the elevator. It is a bit weird. It could still continue to happen even after I graduate from the clinic, since I need to take the same elevator up to my perinatologist's office.

Thanks everyone for your supportive comments. I'm happy to be ending 2008 on a high note with everything looking good so far with my pregnancy. I'm sure in a few days I will be a bundle of nerves again, but, for now at least, I'm feeling good.

More Number Crunching

2008-12-30T08:08:00.007-05:00

I had meant to write the post several days ago, but with the holidays, time got away from me. When I had the heartbeat scan last last Wednesday, my doctor said the baby was measuring 5W5D, which see said was only 1 day off from her calculation that I was 5W6D and 1 day difference was not significant. We did discuss pregnancy dating and she is dating by conception, but she is defining conception as occurring 2 days after the 2nd IUI. This is almost physically impossible given that I was using donor sperm and the trigger shot would force ovulation to occur earlier, but by that point, we had been back and forth on the issue a number of times, so I just let it go. I mean why schedule IUIs at 12 hours and 36 hours post-trigger if conception occurs so late? I think really the latest that conception could occur would be the day after the 2nd insemination and the day of the 2nd insemination is more likely. If I use my dating, that would mean the baby is measuring 2-3 days behind. This concerns me some, since that seems like a significant amount of time so early in pregnancy. I'm trying not to worry too much.

I did ask my doctor as well about the bleeding that I had experienced. She saw no evidence of bleeding on the ultrasound and she felt that the bleeding was probably from cervical trauma from the IUI. I'm not buying that explanation either. I had bleeding as late as 16 days past the last IUI and I think cervical bleeding would show up a lot earlier plus there would be less blood than what I had. I had 2 bleeding episodes overall -- one at 8-10 days past the IUI and one at 14-16 days. I'm pretty sure the one at 8-10 days was an Estrogen withdraw bleed that I normally get during injectable cycles and that would precipitate an early arrival of AF. My doctor said this withdraw bleed would not occur if I was pregnant, but I don't think that is true. I have no idea what caused the later bleed. In general, I know my clinic does not really view bleeding in early pregnancy as indicative of any underlying problem, so I'm trying not stress about it. I haven't had a bleeding episode in 2 1/2 weeks, but I have been having fairly persistent cramping for the last few days. It isn't painful or really comparable to AF cramps, so I'm hoping it is just the uterus stretching.

I did ask to be called with bloodwork results and my old nurse, who I really love and who has since been promoted, called to give me the numbers. My hCG levels were up to 10,708 and my progesterone had fallen slightly to 14. That puts me at a doubling time of about 62 hours since my prior Beta. I was expecting levels to be a bit higher, but I think that is still fine. That still puts me at only 10% off the median for 29DPO according to the Betabase site. If my doctor is right and I ovulated later, then I would actually be above the median.

I go back to the doctor tomorrow for another scan and more bloodwork, so I will have more numbers to share then and, hopefully, more good news. If all is well, we should be able to hear the heartbeat, which will be very exciting.

The Best Christmas Gift Ever

2008-12-25T08:00:00.000-05:00

Sorry I did not have time to post yesterday. Y's family and mine are together for the holidays and it has been hard to find a spare moment. I only have time for quick update now.

Despite freezing rain yesterday morning that made for treacherous road conditions, I did make it into the clinic for the heartbeart check. We were on our way our of town, so I went to the appointment with the whole gang in tow, including T.

My doctor did the scan and almost right away she said, "I see a heartbeat." I could see it too -- it just looked like a little flutter. She said it was great that we could see the heartbeat because this is a day earlier when they would normally check for the heartbeat. She turned the sound up on the ultrasound and tried to let us hear the heartbeat, but it was too early. Next week, if everything continues developing as expected, we should be able to hear the heartbeat and measure how fast it is beating.

We are very excited that we got to see the heartbeat. I took a gamble on going in early and I'm glad it paid off. Now, we can enjoy the holiday feeling more confident that the pregnancy is going to make it. Thanks Santa for the best Christmas gift ever.

The Dating Debate

2008-12-23T16:49:00.004-05:00

Of course, willpower failed me again. I emailed my doctor and asked if I could come in for the heartbeat check tomorrow instead of Monday and she said yes, but then we got into a debate regarding how far along my pregnancy is. I told her I will be 6W1D tomorrow based on when I had my IUI. She says I will be 5W6D. I have no clue how she is getting this date.

There are generally 2 ways to date a pregnancy -- using last menstrual period or estimated conception. Using LMP, the day AF arrives, CD1, would be viewed as day 1 of the pregnancy. For pregnancies conceived using ART, doctors will generally prefer to date based on conception because that is more accurate. One would be considered 2 weeks pregnant on the day of the last IUI (if more than one was done) or on the day of retrieval for an IVF cycle. For me, the injectable medication caused me to ovulate very early, so tomorrow I will be 6W1D using conception-based dating (I had my second IUI on 11/25) and I will be 5W5D using LMP dating (AF started on 11/15).

For those of you who are or have been pregnant before using IUI or IVF, I'd be curious what method your doctor used to date your pregnancy, so drop me a line and let me know.

I would imagine that my doctor continues to marvel at how I can remain a PIA to the very end. I ask tons of questions, I second guess everything she tells me, and I sometimes don't follow instructions. Not a formula for a patient popularity, but I'm pregnant now using a protocol that was pretty much of my design, so I feel justified in my approach. Ah well, hopefully everything will go well tomorrow and I will get to graduate from the clinic in a few weeks.

More Beta Data

2008-12-19T21:55:00.000-05:00

When I had my scan with Dr. Clueless yesterday, she said they would only call with bloodwork results if there was a problem, since the bloodwork is not that meaningful once the pregnancy is visible on ultrasound. I figured I would try to give it a go with that approach, but it just isn't me. If there is information out there in the world about my pregnancy, I want to know it. Besides, they really made me work for that blood draw yesterday. They had to stick me three times before getting a successful draw and the phlebotomist was having so much trouble that she asked someone else to do the draw. I have had trouble in the satellite office before, but never in the main office where they are doing up to 80 blood draws a day. Today both my arms are black and blue.

No call about my blood results came during the celebratory shopping yesterday, so I figured all was good, but I still wanted to know the actual numbers, so I called the clinic this morning. My hCG was up to 2140 and my progesterone is now 15. The Beta level was higher than I was expecting. I have been browsing around on the Betabase.info site. My intial Betas of 45@14DPO and 105@16DPO were definitely well below the median for a singleton pregnancy. The median according to Betabase at 23DPO is 2350 and I'm still below that level but not by much, because my Beta levels are doubling slightly faster than the median. My doubling time since my last Beta was 38.63 hours and the Betabase median doubling time for my hCG level is 45.16 hours.

I'm actual pretty happy with my Beta levels at this point. Because the initial levels were on the low end, I did not worry much about the possibility of multiples, even though I had used injectable medication that would increase my chances of getting pregnant with more than one. Elevated hCG levels can also cause the placenta to develop quickly at the beginning. While this may seem like a good thing, it is not. The placenta has a limited life span and is only intended to last for the length of the pregnancy, but if it ages too quickly, it may not be viable for as long as the baby needs it, which is what happened when I was pregnant with T. I'm hoping the lower hCG levels this pregnancy help create a better environment for a healthy placenta.

I had been a bit concerned about my progesterone levels as well. I had had a few significantly lower temperatures this week and had been worried that my progesterone levels were falling, which can be a precursor to miscarriage. It looks like my progesterone levels are actually rising, so I've gone ahead and retired my thermometer. I'm also happy that my levels have made it up to 15. I know my RE thinks anything over 10 is fine, but I had been reading elsewhere that other doctors think that over 15 should be the minimum for pregnancy. I was considering starting to take supplements, but I thought I would have a hard time explaining to my doctor why I don't take the supplements when she tells me I should and why I do take them when she tells me I should not. Luckily the numbers went up on their own, so I can at least pretend to be an obedient patient now.

We Have a Sack

2008-12-18T09:10:00.003-05:00

Thanks everyone for all your good wishes. It must have worked because there was a gestational sack and a yolk sack in the uterus visible on today's ultrasound. Yippeeeee!!!! There was also only one bean, which is what we were hoping for and expecting given my Beta levels.

Y came with me for the ultrasound and she hasn't been to the clinic for a while. Of course, as my luck would have it, Dr. Clueless was the one to do the scan. She was pleasant enough. We ran into my doctor on the way out of the clinic--she was sweet as ever and gave me a big hug. I showed her the ultrasound printout and she said everything looked perfect for this stage of pregnancy and that they would not expect to see a heartbeat until next week. She would be the one to scan me next week, but they wanted me to come in on the 26th and we will be out of town , so I don't think the heartbeat scan will happen until the following week when another doctor will be on rotation. I could probably negotiate to get a scan on the 24th, but I don't think I want to -- I think it is better to wait to be more certain the heartbeat will be visible.

When I was misdiagnosed as miscarrying when pregnant with T, I was 5W1D pregnant and the ultrasound looked pretty much the same as the one from today. It is just so amazing to me how doctors can see the same thing and draw the exact opposite conclusion. It is so much more comforting to be under the care of an RE at this stage in pregnancy.

Wish Me Luck

2008-12-17T20:54:00.002-05:00

Wish me luck. Tomorrow is the big day -- I have my first ultrasound. I still can't believe my clinic does an ultrasound so early. I will be only 4W6D. I know my clinic calculates based on the insemination date, so that would 5W2D. Even if my hCG levels continue to double every 48 hours, they would still be just barely at a level where you would expect to see a sack. I had been pretty calm for most the week, but have gotten anxious in the last day.

It will all be over in less than 12 hours one way or another. I took the day off tomorrow, so if it is good news I'll be able to do some celebratory holiday shopping -- I'm really behind this year purchasing gifts. If it is bad news, then at least I will have the day to myself.

Cycle Summary

2008-12-16T21:20:00.004-05:00

I prepared a summary sheet of all my cycles for when I was supposed to meet with the new doctor at the Big Fancy Clinic. Since I never made it there, due to the funeral I needed to attend, and I don't want it to go to waste, I thought I would share it with all of you. I updated it with numbers from my BFP too. I'm a really detail oriented person and I always love to hear all the specifics about other TTCers' cycles, so here is more info about my cycles than you probably ever wanted to know. Enjoy!

Pre TTC #1 Testing
4/7/06 CD3 FSH 8.0 E2 72
4/25/06 7DPO P4 14.4

TTC #1, Try #1 – Unmedicated, Unmonitored IUI
Outcome – Not Pregnant

TTC #1, Try #2 – Unmedicated, Unmonitored IUI
Outcome – Pregnant with Live Birth
6/22/06 11DPO +HPT – I’m pregnant
6/26/06 15DPO 4W1D hCG 314.5 P4 21.7
6/29/06 18 DPO 4W4D hCG 917
7/3/06 23DPO 5W1D hCG 6768 U/S – yolk sac, no fetal pole, no HB – misdiagnosed as miscarrying by ER
7/5/06 25DPO 5W3D hCG 11048 U/S – yolk sac, no fetal pole, no HB – miscarriage “confirmed” by OB
7/3/06 6W4D U/S – HB of 126
1/18/07 – DS born at 33 ½ weeks

TTC #2, Try #1 – Unmedicated, Monitored IUI
Outcome – Not Pregnant
3/23/08 CD2 FSH 7.4 LH 8.1 E2 44 P4 .76
4/2/08 CD 12 E2 63 P4 .39 LH 7.5
U/S RT 16mm, Endo 6mm (type 3)
4/3/08 CD13 E2 87 P4 .52 LH 6.2
U/S RT 17mm, Endo 7mm (type 3)
4/4/08 CD14 E2 128 P4 .4 LH 7.6
U/S RT 17mm, Endo 5mm (type 1)
4/6/08 CD16 E2 268 P4 .99 LH 65
U/S RT 22mm, Endo 6mm (type1)
4/7/08 CD17 IUI
4/10 3DPO P4 4.01 – start Progesterone supplementation
4/21/08 14DPO E2 32 P4 7.8 hCG <1

TTC #2, Try #2 – Unmedicated, Unmonitored IUI
Outcome - Chemical
5/5/08 CD13 IUI
5/6/08 CD14 IUI
5/9/08 3DPO P4 8.8 – start Progesterone supplementation
5/20/08 14DPO hCG 9.8
5/22/08 16DPO hCG 20 P4 12.4
5/27/08 23DPO hCG 53
5/29/08 25DPO hCG 93 P4 7.06 U/S Endo 11mm (type 3) – nothing in tubes or uterus
5/30/08 26DPO hCG 109
6/2/08 29DPO hCG 93
6/6/08 33DPO hCG 12
6/20/08 47DPO hCG 1.0

TTC #2, Try #3 – Unmedicated, Unmonitored IUI
Outcome – Not Pregnant
7/11/08 CD14 IUI
7/12/08 CD 15 IUI
7/15/08 3DPO P4 6.91 – start Progesterone supplementation
7/26/08 14DPO hCG 1 P4 9.5 E2 46

TTC #2, Try #4 – IUI with Gonal-f 150iu
Outcome – Not Pregnant
8/1/08 CD3 E2 51 P4 .57 LH 7 FSH 9
U/S RT 4<11 LF 6<11 Endo 4 (Type 3)
Start Gonal-f 150iu
8/4/08 CD6 E2 295 P4 .49
U/S RT 16mm, 14mm, 12mm, 6<11mm
LF 14mm, 12mm, 6<11mm
Endo 7mm (type 1)
8/5/08 CD7 E2 522 P4 .77 LH 3.2
U/S RT 2@15mm, 14mm
LF 14mm, 12mm, 4<11mm
Endo 6mm (type 1)
8/6/08 CD8 E2 689 P4 .56 LH 7.1
U/S RT 17mm, 16mm, 15mm
LF 15mm, 3@13mm
Endo 5mm (type1)
8/7/08 CD9 E2 1077 P4 .88 LH 9.2
U/S RT 2@19mm, 15mm, 11mm
LF 17mm, 15mm, 3@14mm, 13mm, 11mm, 3<11mm
Endo 6mm (Type 1)
Stop Gonal-f, add Ovidrel 250mcg trigger
8/8/08 CD10 IUI
8/9/08 CD11 IUI
8/12/08 3DPO P4 17
8/20/08 11DPO Bleeding
8/22/08 13DPO hCG<1 E2 37 P4 .25
U/S RT 54mm cyst, LF 30mm cyst

TTC #2, Try #5 – Unmedicated, Partially Monitored IUI
Outcome – Not Pregnant
9/3/08 CD15 E2 237 P4 .48 LH 17
U/S RT 19mm, 5<11mm
LF 20mm, 13mm, 7<11mm
Endo 7mm (type 1)
9/4/08 CD16 IUI
9/5/08 CD17 IUI
9/8/08 3DPO P4 6.7 – start Progesterone supplementation
9/19/08 14DPO hCG 1.0 E2 44 P4 7.0

TTC #2, Try #6 – IUI with Gonal-f 150iu
Outcome – Not Pregnant
9/24/08 CD3 FSH 9 LH 7 E2 54 P4 .48
U/S RT 11mm, 6<11mm
LF 4<11mm
Endo 5mm (type 3)
Start Gonal-f 150iu
9/27/08 CD6 E2 206 P4 .36 LH 2.6
U/S RT 14mm, 12mm, 6<11mm
LF 12mm, 4<11mm
Endo 5 mm(type 1)
9/29/09 CD8 E2 626 P4.37 LH 5.9
U/S RT 14mm, 2@12mm, 11mm
LF 15mm, 13mm, 12mm, 4<11mm
Endo 5mm (type 1)
9/30/09 CD9 E2 692 P4 .26 LH 9.4
U/S RT 17mm, 2@12mm, 11mm
LF 13mm, 10mm View of ovary blocked by bowel
Endo 5mm (type 1)
10/1/08 CD10 E2 1102 P4 .79 LH 30
U/S RT 17mm, 3@15mm, 11mm, 10mm
LF 18mm, 16mm, 14mm, 4<11mm
Endo 6mm (type 1)
Stop Gonal-f, add Ovidrel 250mcg trigger
10/2/08 CD11 IUI
10/3/08 CD 12 IUI
10/6/08 3DPO P4 25
10/20/08 14DPO hCG 1.0

TTC #2, Try #7 – Unmedicated, Unmonitored IUI
Outcome – Not Pregnant
10/29/08 CD16 IUI
10/30/08 CD17 IUI
11/2/08 3DPO P4 7.2 – start Progesterone supplementation
11/14/08 15DPO hCG negative

TTC #2, Try #8 – IUI with Gonal-f 150iu
Outcome – Pregnant
11/17/08 CD3 E2 72 P4 .97
U/S RT 14mm, 2<11mm
LF 5<11mm
Endo 7 (type 1)
Start Gonal-f 150iu
11/20/08 CD6 E2 169 P4 .27 LH 1.0
U/S RT 16mm, 12mm, 3<11mm
LF 7<11mm
Endo 5 (type 3)
Start Ganirelex 250ui
11/22/08 CD8 E2 514 P4 .66 LH 2.6
U/S RT 20mm, 17mm, 4<11mm
LF 14mm, 6<11mm
Endo 6 (type 1)
11/23/08 CD9 E2 756 P4 .66 LH 2.6
U/S RT 25mm, 19mm, 3<11mm
LF 16mm, 13mm, 3@11mm, 3<11mm
Endo 8 (type 1)
Stop Gonal-f and Ganirelex , add Ovidrel 250mcg
11/24/08 CD10 IUI
11/25/08 CD11 IUI
Missed Progesterone check and instructed to start supplementation, which I don’t
12/6/08 11DPO +HPT - I’m Pregnant!!!!
12/9/08 14DPO hCG 45 E2 172 P4 11
12/11/08 16DPO hCG 105 E2 202 P4 13

Bare-Knuckle Beta

2008-12-13T14:30:00.002-05:00

I had forgotten how excruciating it can be waiting for Beta results when it is not a forgone conclusion that the test will be negative. I have had the pleasure of undergoing many beta tests. I had 4 tests when pregnant with DS. My clinic is a bit cruel in that they force you to come in for beta test even when it is not necessary to determine you are not pregnant, so I have had a test each BFN cycle - 6 total. The cycle when I was being monitored for a suspected ectopic I had 8 (yes 8!!) Betas drawn and this cycle I have had 2 so far, so that is a grand total of 20 Beta tests.

The wait Thursday was one of the harder ones. I was not overly stressed about the first Beta because I knew it would be positive and I was not expecting a blow out number. 45 was actually higher than I was expecting. I even let the call with the first Beta results go to voicemail, so I could call back and speak to my doctor directly. By noon Thursday, I was really on edge and by 1pm the conversation in my head was going something like this:

My nurse normally calls between 2 and 3pm, but on Tuesday she called me at 1:20pm, so she must call the "good news" people soon. If she doesn't call soon then that means the news is bad. In fact, the clinic was empty today, so the list of people to call should be shorter and so she should have called already. Why haven't I heard from her? I got the call at 1:50pm. It was a very long 50 minutes.

I have also been tormenting myself with HPTs. I know that these tests are really just meant to indicate if you are pregnant -- not to help quantify HCG levels. Comparing lines between tests taken 24 hours apart (or less) has been stressing me out and making me feel like my Beta numbers are bouncing all over the place when, most likely, there are just variations in the amount of dye in each test or urine is more diluted at some times than other. After I got the results on Thursday, I handed over my HPTs to Y and told her not to give them back to me until Saturday night, so I could test Sunday morning. She has threatened to take away my cash, bank card, and credit cards if she suspects me of sneaking off to the drug store to buy more. I know it would be better if I quite cold turkey, but it is hard when you are a POAS junkie.

I guess what I'm looking for is a way to know for sure and have validated on a daily basis if the pregnancy is going to make it. I know that is not possible. HCG levels only mean so much anyway and a high, normally doubling beta can still often result in miscarriage.

I know I should be celebrating now. I'm finally pregnant now after 8 IUI cycles, 6 BFNs, a suspected ectopic that ended up being chemical, many injections and blood draws, regular vaginal probings, extensive fertility testing, and numerous doctor visits. This is the end game, right? The thing I have been working for all these months.

Early pregnancy is really a lot like TTC -- what is going to happen is mostly out of my control. I'm at the mercy of my body and those few cells growing inside it that will hopefully become our baby. If I can make it over the initial miscarriage hurdle, I still have a high risk pregnancy ahead of me due to my prior history.

I don't mean to sound ungrateful, because I'm not. I know how lucky I am. I have one beautiful child already and a good chance of bringing home a second. Getting pregnant at 40 is not easy and to do so without IVF on my 8th IUI no less is really beating the odds. This month, too, has been so hard with the passing of my friend and my being pretty burnt out from a TTC perspective, having done 8 cycles over a nine month period. It is just so amazing to me that I could actually be pregnant given these circumstances -- it really has just started to feel real to me in the last day or so, even though I got a positive HPT a week ago.

So I'm working on surrendering myself to the process and trying to accept my lack of control. The spotting has stopped. I am having various pregnancy systems. I am pregnant and hoping for the best.

Still in the Game

2008-12-11T14:05:00.002-05:00

I just got the call and the results are:

Beta 105
Progesterone 13
Estradiol 202

My nurse says everything looks good. That puts my doubling time for my beta at 39 hours, which is good. I think 105 for 16DPO puts me on the low side of normal, but I think it is fine.

I don't go back to the doctor again until next Thursday and I will have an ultrasound at that time.

I'm so relieved. I have been a bundle of nerves all day waiting. I will try to write more about that later, but I have a ton of work to do today and, as you can imagine, I've been completely worthless up until now.

Things Are Looking Up

2008-12-10T21:00:00.007-05:00

Things are looking up today. The spotting, although it is not totally gone, is very light now. I continue to be a POAS addict and the line from this morning's test was much darker today than it was on yesterday's test as you can see here:

Of course, me being me, I have been researching the impact of bleeding on early pregnancy. It seems like there is bleeding of some type in about 25% of pregnancies and about 50% of pregnancies where there is bleeding will result in miscarriage. The risk of miscarriage goes down significantly after seeing a heartbeat. Those odds don't sound great, but I will certainly take 'em. After so many failed cycles, a 1 in 2 chance of bringing a baby home still seems pretty good to me.

Thanks everyone for your very kind comments and congratulations. I will post again tomorrow after I get the 2nd beta results.

Good News and Bad News

2008-12-09T14:22:00.005-05:00

The good news is I just got the call from my nurse and it looks like my Beta is a 45, which she says is a good number, although I remember my initial beta when I was pregnant with T was 314 -- that was at 15DPO and this test is at 14DPO.

The bad news is I started spotting again yesterday and today it is a bit heavier. It is brown spotting.

I'm waiting for a call back from my doctor so I can confess that I never took the progesterone she prescribed and so I call tell her about the spotting. I'm sure she will think I am a complete nut job if she doesn't think that already. My clinic normally will test progesterone and estrogen on Beta day but, for some reason, they did not test mine today.

I had been using 1-2 HPTs per day and had only been getting faint positives, but this morning the line was somewhat darker, although still pretty light. I just used one of those digital tests and it came back PREGNANT -- cool.

At the moment, I'm feeling cautiously optimistic. If the spotting were to stop I would feel at bit better about the whole thing. For now, at least, it looks like I'm pregnant.

UPDATE: Just got a call back from the doctor. They did actually test my Estrogen and Progesterone. P4 was 11 and E2 was 172. She did not seem fazed because I did not take the supplements and she said that I should not start now because they only supplement if levels are below 10. As for the spotting, she said spotting is common in IVF and medicated IUI cycles even if the pregnancy is viable -- that I just need to wait and see what happens.

I still can't believe it. I'm in shock. I'm actually pregnant.

Limbo

2008-12-07T09:58:00.002-05:00

I'm still out of town and I did not bring any pregnancy tests with me, so I ran to Target last night and got a 2-pack of FRER. I had wanted to wait until morning to test, but lack of willpower prevailed and I tested last night. I got a faint, but visible positive, which I think is the same as what I had on 11DPO when I got pregnant with T. Of course, I could not sleep last night, so I got up at 3am to POAS. I still got a positive, but lighter than before -- one of those you have to look real hard under a bright light to see anything and then you are not sure if the line is really there. I was out of tests, so I had to run back to the store again the morning. I just tested again and it looks negative to me. I'm thinking it is likely another chemical, but we will see. It is still a bit early. I have had no more bleeding or spotting, so that is good. My beta is on Tuesday.

Avoiding Hope

2008-12-06T11:11:00.003-05:00

I'm 11DPO today. I have been having a lot of cramping, particularly overnight, and I woke up this morning and expected to be greeted by AF and there was nothing. I stopped spotting about 24 hours ago. The spotting overall was pretty light. On both of my prior injectables cycles I have gotten AF on 11DPO with spotting for 1-3 days in advance.

I'm trying to fight it, but it is hard not to be hopeful. I know that hope in general is a good thing and without being hopeful it would be hard to keep going with the very difficult TTC process, but I find that whole cycle of hope and then disappointment each cycle to be difficult. I have been so focused on other things this TWW and had very low expectations given that the stimulation part of this cycle did not go well, so I would not be overly disappointed if the cycle was not successful. However, if AF shows up tomorrow or the next day, I will find it hard to keep avoiding hope in the interim. I will probably test tomorrow unless AF arrives beforehand.

Drip, Drip

2008-12-04T16:23:00.003-05:00

I'm spotting today and cramping has gotten worse. My temps are still elevated, so the end is not here yet, but I'm quite certain it is on its way. I'm guessing AF will arrive either tomorrow or the next day. Looks like IVF here I come.

Y and I have agreed that if I get pregnant and if we have a girl we will name her after my friend that passed away. Of course, that is a lot of ifs, so we will see what happens. I told my Mom and she was very touched.

Not the Usual TWW

2008-12-03T22:37:00.004-05:00

I'm 8DPO today and these last 8 days have been rough. I never made it to my progesterone check. A close family friend with end stage lung cancer took a turn for the worse and I needed to leave for Baltimore earlier than expected to see her before it was too late. It was very sad and difficult, but I was glad that I got to see her before the end. We returned home on Sunday night only to have to return to Baltimore again on Monday as my friend passed away in the early morning. The funeral was yesterday, which is the same day I was supposed to have my consult with the new doctor at the big fancy clinic. I was forced to cancel my appointment and it will be another 2 months before I can get a new appointment, which means if IVF is in my future, I will probably be cycling with my current clinic.

I don't have a lot of physical side effects from gonal-f, but it makes me very emotional, particularly during the TWW. This is really the last thing I needed. I have been crying so much for the last week, which is confusing because I don't know how much of that is my grieving and how much is just the gonal-f talking.

Since I was not able to get my progesterone levels tested, my doctor prescribed Crinone. I filled the prescription, but then decided not to take the progesterone. I just was feeling so awful by that point that I did not feel like I could take on anything else that would make me feel even worse and I always find the progesterone a misery.

I had spotting starting 8DPO my last injectables cycle. So far today no blood, although I am having some cramping, so it may be coming tomorrow. We will see.

Farewell to IUIs

2008-11-25T10:25:00.005-05:00

It is hard to believe, but I had my last IUI ever today. I wish I could say that the sperm count was amazing and the doctor was fabulous, but that is not how it went down -- all and all it was a very average, inauspicious IUI.

Dr. Clueless was there again today to do the deed, although she was much friendlier than yesterday. She inquired about my son and asked if I was using the same donor as I did for him (I am). She decided to work again with the metal speculum and the Wallace catheter. She seemed to struggle a bit more that yesterday, but was able to complete the IUI without any excessive drama.

I was using one of the "old" vials that I purchased when TTC #1 that was IUI prep, but I did not get the great numbers that I had from the vial from last month. This time we had 11.25 million TMC for the post-wash. Anything over 10 million TMC is fine, so that number is good enough.

I'm waiting for a call back from my nurse now. I'm supposed to go in for a progesterone check on Friday, but I will be out of town on Friday, so unavailable for blood letting. I knew this was going to be problem before I started the cycle, but I figure better to ask for forgiveness than permission.

Next stop on this TTC train -- pregnancy or IVF. Let's hope for the former.

The Silent IUI

2008-11-24T09:05:00.003-05:00

I had my first of 2 IUIs this morning. My friend Dr. Clueless was there and she barely said 2 words to me. She runs so hot and cold, it is always hard to know what to expect when she is on rotation. I requested the metal speculum, which she did use, but for some reason she also decided to use the Wallace instead of the Tomcat catheter. She usually starts with the Tomcat and then switches to the Wallace if she has trouble. I guess she was feeling lazy today, so she just started out with the Wallace. It went fine, as far as I could tell, since she said nothing.

So after I spent the obligatory 5 minutes lying down after the IUI, I noticed that the catheter was sitting on top of the garbage, so I decided to take a look at it. It looks more flexible and a bit larger than the usual catheter. The nurse walked in while I was looking at the catheter and told me I could get up and then I felt rather foolish. This is what this process has reduced me to -- trash diving while half naked.

Post-wash sperm counts were fine, but nothing worth celebrating:

48 million/ml
71% motility
3 Progression
10.22 million TMC

Well, back tomorrow for more fun with Clueless and Company for what, one way or another, will be my last IUI.

Uncooperative Follies

2008-11-23T15:14:00.005-05:00

I slept late this morning and almost managed to miss the clinic's monitoring hours. The extra day of meds has not produced the desired results. My dominant follicle, the big troublemaker in this cycle, grew from 20mm to a whopping 25mm in just 24 hours -- ouch!!! My doctor is unsure if there is a viable egg in there. The 17mm is now 19mm and the 14mm is now 16mm. Dr. Sweetness says because of the big guy, it is too risky to wait longer and I need to trigger tonight. The 19mm is the only "sure thing" for this cycle. The 25mm may be over mature and the 16mm will not necessarily release. I have 10 other follicles, but all significantly smaller. The only silver lining is that for once my lining is not on the thin side. I probably would have been better off without the Ganirelix and then I would have had 2 viable follicles for certain. Ah, the benefits of hindsight.

My other two injectables cycles were so different. By point of comparison, on trigger day for injectables cycle #1, my follicles were 2@19mm, 17mm, 2@15mm, and 3@14mm. On injectables cycle #2, I had 18mm, 17mm, 16mm, 3@15mm, and 14mm. Well, even though both those cycles looked great, they ended in BFN. Sometimes it is the cycle where nothing seems to go right that actual works, so we'll see what happens.

My doctor still recommended I do 2 IUIs this month. I didn't really get into it with her why. I don't really know what impact on ovulation that large follicle will have, so I'd rather just have the extra "coverage" that 2 IUIs provide. I'll be back at the clinic tomorrow and the next day for my back-to-back IUIs.

On a happier note, we had the 5th NYC TTC Meetup today. Thanks to Gia for continuing to organize this event. As always, it was great to be able to spend time with other lesbians going through the TTC odyssey.

Almost There

2008-11-22T16:39:00.003-05:00

I ended up using the Ganirelix last night. I had some EWCM and was worried that I would surge on my own before the ultrasound this morning. I did use an OPK beforehand to be sure that I had not surged on my own already -- I had not.

This morning ultrasound results:

Lining 6mm, Type 1
Right Side 20mm, 17mm, 4<11mm
Left Side 14mm, 6<11mm

Dr. Sweetness wants to wait one more day to give the 14mm a chance to be viable and so I can likely release 3 eggs. I'm sure if not for the Ganirelix I would be surging on my own today. I now have tons of EWCM -- rather gross.

Overall, this cycle is not looking nearly as pretty as my last 2 injectables cycles, where the follicles were much closer together in size and I had more measurable follicles. I'm still feeling okay about the cycle, though. At this point, after 7 failed cycles, anything different seems good to me.

So I got to thinking (always a dangerous thing) that since I'm using the Ganirelix, I am really on a similar protocol now to what I would use for IVF. For IVF, my clinic does retrieval 35 hours post trigger. For IUIs with frozen sperm, they do IUIs 12 and 36 hours post trigger. I'm having doubts about the value of the IUI at 12 hours post trigger, since I think the Ganirelix would keep me from ovulating early and frozen sperm only survives for 12 hours. If the sperm is only viable until 24 hours post trigger and the eggs would still normally be available for retrieval 35 hours after retrieval, I can't see how the first IUI would be helpful. I have emailed my doctor, so I'll see what she has to say.

I'll Take that IUI with a Shot of Ganirelix

2008-11-21T19:33:00.001-05:00

I emailed my doctor last night and asked her if they ever use Ganirelix during IUI cycles and if that would help with my dominant follicle problem. She said they do use it and she is not sure that it would help, but it won't hurt, so I can take it if I want. I have the medication now, but have not made up my mind yet whether or not to take it. Ganirelix is normally used during IVF cycles to prevent premature LH surge and ovulation prior to retrieval. The purpose in my using it would be to prevent my dominant follicle from causing me to surge before any other eggs were mature. My concern would be if I take the Ganirelix I could end up potentially releasing more eggs and increase my risk of multiples.

Dominant Follicle

2008-11-20T11:02:00.004-05:00

I went back to the clinic today for ultrasound and bloodwork after 3 days of meds. I'm definitely having a dominate follicle problem. I had a follicle at 16mm and another at 12mm plus 11<11mm. I've had a 16mm follicle at this stage in the injectable cycle before, but there have been other follicles not far behind, whereas this cycle, everything else is pretty small. I'll still probably go ahead even if there is only one follicle. I go back again on Saturday.

I asked Dr. Sweetness about the impact the dominant follicle would have on an IVF cycle and she said the different protocol using Ganirilex would prevent it from being a problem. That doesn't sound totally right to me. During my IVF orientation I was told they start Ganirilex when the lead follicle hits 14mm, so I would have needed to start stims and Ganirilex at pretty much the same time, which is not the way the protocol is supposed to work. I know that estrogen priming protocol is the solution to this problem, so I just need to be sure that if I end up doing IVF, I work with a doctor who will let me do an EPP protocol. I'm not totally sure how that will work, since EPP is usually used for poor responders and I'm not a poor responder, or at least have not been up to this point. Who knows with AMA? Things can always go downhill fast.

The Cycle That Almost Wasn't

2008-11-17T16:12:00.008-05:00

AF arrived on Saturday -- a full two days before her usual expected arrival given when I stopped the progesterone. I was planning on doing a natural cycle this month, but the timing would put me needing an insemination when I would almost certainly be away for Thanksgiving weekend. My options were take a break or do an injectable IUI cycle that will (hopefully) allow for IUIs to occur before we need to leave.

I spent much of the weekend agonizing over what to do. I have done 5 straight cycles and could really use a break. Plus, I would really like to do IVF as soon as possible after January 1 when I have another $10K of insurance coverage at my disposal. On the other side, I still have 2 vials of sperm left at my RE's office and given how clueless they generally are when it comes to anything related to donor sperm, I'm not anxious to try to work with them to figure out how to get the sperm transferred to the new clinic. Also, if I don't cycle this month, I'm basically committing to do IVF, since cycling in December is not an option for me. I solicited input from Y and from 2girlsandtheirfamily with whom we coincidentally had lunch on Sunday. In the end, I decided to go for the one last injectables cycle.

On the way into the clinic this morning, I ran into my doctor in the elevator at the clinic and then she actually ended up doing my ultrasound, which was strange since I seem to never see her during monitoring. I ended up having a 14mm follicle on CD 3, which is not good. I also had fewer total antral follicles that I have had on earlier CD3 scans -- also not good. Dr. Sweetness said given the size of my lead follicle she would cancel me if my estrogen level was too high, but my E2 levels came back at "only" 72, so I have been cleared to start my Gonal-f 150 tonight. I asked the nurse at what level they would have canceled me and she said over 100. I need to go back in on Thursday.

I'm glad once again that I did not move forward with IVF this month. My feeling is that I need to be on a protocol that will prevent dominant follicle development and the protocol that Dr. Sweetness has proposed does not have a precycle suppression phase, so I don't think this is the right protocol for me. I'll be curious to see what the new doctor proposes. My guess is probably the same antagonist protocol my current doctor has recommended plus estrogen priming protocol.

No Beta Love

2008-11-14T21:45:00.003-05:00

My beta was supposed to be yesterday, but I rescheduled it for today because that worked better with my schedule and I was in no rush to get final confirmation of the bad news -- yet another BFN.

I'm still not certain what to do next cycle. I'm not going to do IVF. I'm too close to my annual fertility insurance cap for the year and I'm afraid I would end up paying mostly out of pocket. We would also need to cancel our travel plans for Thanksgiving, since retrieval would almost certainly fall over the holiday weekend. What sealed the deal for me is that I found out my friend Dr. Clueless is covering for Thanksgiving weekend and I'm not anxious to sample her surgical skills on top of having to see her for monitoring the whole week.

I might be able to squeeze in another injectable IUI cycle before the holiday, but I'm concerned that could end up delaying my ability to do IVF in January. I have an appointment with another doctor in a few weeks. I'm not sure what protocol he will want to use. I know this doctor likes patients to be med free before starting an IVF cycle, so if I did injectables this cycle and he wanted to put me on the long lupron or estrogen priming protocol, I'd probably be looking at more like a late February retrieval and I don't want to wait that long. I was leaning toward just doing another natural cycle since I thought I would not need to inseminate until after Thanksgiving weekend and a non-medicated cycle would give me the most flexibility to move forward with IVF in January. However, I was spotting today even though I took my last progeterone pill yesterday and it normally takes me 4 days after going off progesterone until AF arrives. I think I will just need to wait until the red devil is here and figure out what to do then. If I need to go on break this month and decide to switch doctors I have another problem because I still have 2 vials of sperm left at the old RE.

5 out of 5

2008-11-02T21:31:00.004-05:00

I went for a progesterone check Sunday and it came back low. That is 5 for 5 natural cycles where my progesterone has been low. When I was TTC#1 and pregnant with T, I had excellent progesterone levels, so I guess this is one of those things that deteriorates with age -- I will add it to the long list. I'm on Prometrium, which I debated not taking since it extends my cycle and will cause me scheduling problems next cycle with Thanksgiving. Oh well, I guess I will cross that bridge when I come to it. As always, this would be a great cycle to actually get pregnant.

Picking a Doctor - TTC #2

2008-11-01T22:21:00.008-04:00

By the time we were ready to start TTC#2, I was much better educated about how this whole making a baby lesbian style works. I knew these three things:

1. I was very lucky when TTC#1 to get pregnant at 38 on my second cycle, particularly without the use of medication.
2. Getting pregnant at 40 was likely to be significantly harder than getting pregnant at 38, even under the best of circumstances.
3. I never would have been misdiagnosed as miscarrying if I had been working with a fertility doctor instead of an obgyn.

Given this, I knew that I wanted to work with a RE.

There were some geographic challenges to deal with in terms of picking what RE to use. I was working 30 hours week - 2 days in Manhattan and then the rest from my home in NJ. Theoretically, I could have used either a northern NJ or NYC doctor, but since I was only in Manhattan 2 days a week and in NJ 5, it seemed to make sense to pick an NJ doctor, even though NYC offered more choices.

I knew that I would want to start out doing IUIs and I view IUIs as a pretty "low-tech" process that pretty much any fertility specialist should be able to do properly. I looked at most of the doctors that were close to my house. There were a few standalone practitioners very close to where I live, but I was worried there could be scheduling problems depending on only one doctor. I also wanted to use a clinic where the doctors do the monitoring and I think that is difficult for standalone practitioners. The clinic in my area with the best success rates had a satellite office near me, but the primary doctor there was supposed to be awful and the main office, which was the only office open on weekends, was a bit of a trek for me and prone to long waits. I ended up going with clinic that coincidentally has their offices right next to the MFM practice that I went to when pregnant with T. How weird is that? I mainly picked this practice because the doctors have a reputation for all being very nice and the practice for being relatively well run. Both these things have been true for the most part, but I have found that I have very high expectations for my doctors and have still run into situations where I have found both bedside manner and competency to be less that what I would like. Coincidentally, my clinic has only female doctors (and nurses). This was not really an important selection criteria for me, but I don't mind. Here are the cast of characters at my clinic:

Dr. Sweetness - This is my doctor and she is always super nice, so she gets the most "generous" nickname of all the doctors.

Dr. Clueless - This is the doctor I like least at my clinic and, as luck would have it, I see her far more often the all the other doctors combined. I have had 13 IUIs now done at my clinic and Dr. Clueless has done 10 of them. She was dubbed with this less than generous nickname during my first injectables cycle when she told me my "husband" would likely need to come in to provide a sperm sample 2 days later. At the time, she had already done 4 IUIs on me, all with Y in the room and most with T there as well.

Dr. Mini - I used to call this doctor Dr. Mean, since I had a horrible experience with her when she did an ultrasound to evaluate me for a suspected ectopic last summer. However, since I had a great IUI with her last cycle and generally positive experiences with her on other occasions, I decided she was not living up to her nickname and stuck with the "M" theme but renamed her.

Dr. Teenager - This is the newest doctor in the practice, fresh out of school and very young looking. I like her so far.

I'm seriously considering switching doctors now because I'm likely moving onto IVF. While my clinic's IVF stats are good, there are other clinics in the area with better success rates and, if I'm going to go through the hardship of IVF, I would like to have the best shot of getting pregnant.

Picking a Doctor - TTC #1

2008-10-31T07:40:00.010-04:00

I sure I'm not alone in feeling this way, but I hate going to the doctor, particularly the gynecologist. When I started TTC #1, I had not even had an annual pap exam in several years. I used to get paps done my regular GP, but then we moved and I changed to a GP that did not do pap smears and then I never bothered to find a real gynecologist. When we decided to start the TTC process, we knew that we would need some support from a doctor, but we really had no clue where to start. Y is also not good about keeping up with her doctor appointments, but we called the office of a gynecologist who she had seen a few years before and found out that they did would do inseminations. I made an appointment to get a pap and then scheduled another appointment to meet with the nurse practitioner who did the inseminations. There was no doctor even involved in the process.

The NP wanted me to take a month to do some basic testing (just bloodwork) and then I could start right away the next month with the inseminations as long as the bloodwork did not uncover any potential problems, which it did not. The main problem with doing inseminations with an regular OB/GYN office is that it is hard to know when an IUI will actually occur. It may need to be done on the weekend, and most doctor offices are only open M-F. My nurse had an arrangement with a local sperm bank who would do inseminations on Saturday/Sunday as needed for her patients. This created some logistical problems in terms of sperm delivery since it was impossible to know what location the insemination would need to be done. We had the sperm delivered to our house. The first month we ended up with Monday/Tuesday inseminations performed by our nurse, but the second month I needed my IUI on Saturday/Sunday, so we ended up at the sperm bank.

I got a BFP on a HPT at 11DPO on my second cycle, so I called my nurse so I could come in for a blood test. She said no, though, they don't do blood tests (weird, right?) and if I had a positive urine test, then I was pregnant and should schedule an OB appointment at 8 weeks. I knew I was not going to make it to 8 weeks knowing nothing about the pregnancy status, so I begged the sperm bank where I had the IUIs done to let me come in for a beta test. I had 2 betas done with very good numbers and was told I had the "progesterone levels of a 20 year old." Everything looked good.

I started having some spotting at 5 weeks and some pain on my right side. I tried to reach my doctor's office on July 3rd - the office was closed, but due to some snafu with their answering service there was also no emergency contact mechanism, which is very bad for an OB. I ended up in the emergency room. I was told that I had miscarried. My hCG levels were 6768. They could see a yolk sac, but no fetal pole or hearbeat and once levels hit 5,000 the hearbeat should be visible. We were devastated. I spent all of July 4th in bed crying. I went into the OB's office on July 5th and the doctor could not see a heartbeat either and confirmed I had miscarried. The doctor gave me a prescription for medication to help "expell" the non-viable pregnancy. I refused the prescription and said I wanted to wait, so she gave me a different prescription to go see a radiologist in a week and get another ultrasound with better equipment. I called the office a few days later and found out my hcg levels were 11,048. I was told this confirmed that I had miscarried because a fetal pole/heartbeat should be visible at those levels. Keep in mind that this dx of miscarriage was done also with a very high beta for a singleton pregnancy still doubling at a rate of almost 48 hours. I was only 5 1/2 weeks pregnant and it is not uncommon to not see a heartbeat at this stage in pregnancy.

I went to the radiologist a week later and he saw a perfectly normal hearbeat with the baby measuring 6w3d, just where it should be. I was both elated and angry. It was a reasonable error on the part of the ER. I'm sure the bulk of the patients they see in early pregnancy don't know exactly when they conceived, so I'm sure they dated the pregnancy as further along than it really was based on hcg levels. The doctor from my OB's office should have been able to date the pregnancy exactly based on my IUIs and she should have know that a heartbeat might no necessarily have been visible at 5 1/2 weeks. If I was the type of patient to blindly follow doctor's instructions, I would have taken the prescribed medication and ended up terminating a perfectly viable pregnancy.

I stuck with that OB's office for a while longer, but I never really got over it and I had trouble again with the same doctor when she did not want to refer me out to a MFM specialist due to the low PAPP-A. "Maybe the baby has Down's Syndrome and that's why your PAPP-A is low." Nice. Y got a recommendation from a colleague at work for a perinatologist and he referred me to a local OB. I changed doctors and never looked back.

Lucky #7

2008-10-30T21:52:00.007-04:00

I had an IUI yesterday and then another one today. My clinic believes in doing 2 IUIs a month for patients using donor sperm and I support that approach since that is the recipe that produced our wonderful T.

My IUI was scheduled for 7:15am yesterday. I usually take about 45 minutes to an hour between when I get there and when the IUI is done, since the lab needs time to thaw and wash the sperm, but yesterday, they were running late. I actually think it is totally understandable that there may be long wait times at fertility clinics. My clinic does not batch cycle IVF patients and they always schedule monitoring visits and IUIs when it makes sense based on your cycle and not when it is necessarily convenient for them. This means they pretty much have zero control over patient traffic flow and some days, like yesterday, it may just be packed. However, yesterday morning my IUI was not until 9:20am, but the sperm was finished being prepped at 8:05am. That is not good. The doctor's staff need to do a better job coordinating with Andrology to make sure the sperm can be inseminated as quickly as possible after prep. I emailed my doc to express my concern, but she sent me back some nonsense answer about the culturing and prep that they do to the sperm allows it to be fine for many hours, so I should not be concerned.

Yesterday's IUI itself did not go smoothly. I had the new doctor at my clinic who is fresh out of school and looks about 20. She had to switch speculums in the middle, which is not fun, but I think far better than changing catheters, which is what the doctor who has done most of my prior IUIs usually does after 30 seconds of not being able to get through my cervix. Once she switched to the new speculum it was smooth sailing and everything was done in a snap.

The sperm sample was the best yet that I've had. Post-wash counts were:

115 million/ml
64% motility
3 Progression
22.08 million TMC

This was one of the old vials that I had back from TTC#1 and it was an IUI prep vial that was rewashed.

My 2nd IUI this morning went very well. The waiting room was just as packed as yesterday, but my IUI occurred almost a full hour earlier, so either something went wrong yesterday or they were motivated to adjust the timing is response to my email to my doctor. I had the only doctor left in the practice who has not performed an IUI on me. I had a bad experience with this doctor when she did an ultrasound on me when I was being evaluated for a suspected ectopic last June, but she has been nice to me ever since and today she was great. I gave her some tips on what she could do to better navigate my sometimes tricky cervix and she was very appreciative. She used the metal speculum, which is what the doctor yesterday had to switch to after having trouble with the plastic. She explained that my cervix sits off to the left some, so the metal speculum can be opened wider than the plastic one for better access. She had no trouble with the insemination and put a note in my chart for any future IUIs to been done with a metal speculum. So I'm happy that the IUI went well, but again I'm annoyed with the doctor who kept switching catheters during a number of my prior IUIs when all she needed to do was use a different speculum.

The sperm sample today was fine, but not the amazing number from yesterday -- more typical of what my guy usually provides:

52 million/ml
71% motility
3 Progression
11.08 million TMC

I'm wondering if the issue is that the IUI (what I used yesterday) samples are better than the ICI (what I used today) or that my donor used to be better than he is now. The vial I used yesterday was from 2005 whereas the one I used today from from 2007.

I'm feeling strangely optimistic for this cycle, which is unusual for me. I'm so not normally one to have the PUPO (pregnant until proven otherwise) attitude. I just usually hope for the best and expect the worst. For me at least, I find if I count on success, it becomes difficult to plan ahead for what to do next. Maybe lucky #7 will be the one for me. I sure hope so.

Starting at the End

2008-10-26T16:30:00.005-04:00

I'm not new at this. Y and I first joined the many lesbians trying to get pregnant over 2 1/2 years ago. I turned 38 in March 2006 and had a bit of a crisis. I felt like, given my age, it was now or never, so we took the plunge and decided to move forward as quickly as possible with the TTC process. We decided to work with a nurse practitioner at a lesbian friendly OBGYN office who was willing to do unmedicated IUIs. We did some basic testing in April and our first cycle in May, which was unsuccessful, and then our second cycle in June, which, miraculously, worked!!! Nothing like a quick start out of the gate to make up for lost time.

My pregnancy was not an easy one. I was misdiagnosed as having miscarried at 5 weeks. Then later in my first trimester, my Ultrascreen diagnostic test showed elevated risk that the baby would have Downs Syndrome. We elected to do CVS and found out that we were having a chromosomally normal baby boy. The elevated risk for Downs Syndrome was from a relatively new blood test for PAPP-A, which I had tested abnormally low -- in the 1st percentile. The results of this blood test also indicated that I was at risk for 3rd trimester complications related to placenta failure. Given this, I decided it would be best to work with a perinatologist. I had regular ultrasounds every 4-8 weeks and everything was looking great until I went in for an appointment at 31 weeks and the doctor was concerned about one of the baby's measurements. I came back 2 weeks later and the baby had not grown at all the 2 weeks prior. My doctors felt that my placenta was failing and recommended I be given steriod shots and that the baby be delivered in 48 hours. T's due date was supposed to be my 39th birthday, but he ended up joining us much earlier than expected. On January 18, 2007 our wonderful baby T was delivered by c-section, since he was breach. He was only 4 lbs 1.2 oz., but otherwise healthy except for some mild jaundice that was probably unrelated to the preterm delivery. He spent 12 days in the NICU before we brought him home. While is a small guy and has hit some of his milestones late, T will have no long term issues from being delivered 6 1/2 weeks before his due date.

I had always wanted to have children, but until T was born, I never realized how much I would love being a mother. Y initially only wanted to have the one child, but I eventually won her over and she agreed we could TTC #2. We did not start back up right away, since I wanted to breastfeed T for at least a year. I felt like my body had failed him while I was pregnant and I wanted to do what I could to make up for it after he was born. I had a preconception appointment with my peri and he said there was up to a 20% risk of the placenta failing again in a singleton pregnancy. The risk would be higher if I got pregnant with more than one baby, which he did not recommend.

I decided for the second go around that it would be best to work with a fertility doctor, since I knew that at 40 I might have trouble getting pregnant. I never took it for granted that getting pregnant on the 2nd try at 38 was a real stroke of luck and I did not necessarily expect it to go as smoothly this time, which it has not. I had my intial appointment with my RE in March, coincidentally on my 40th birthday and one year from T's estimated due date. My RE gave us the usual depressing speech about how fertility declines with age, which, of course, I already knew. We agreed to start out with natural cycles, since that is what worked for me before.

As you can imagine, my RE wanted to run a lot of tests. We were anxious to get started, so we did all the required testing in March. In April, I did my first cycle - BFN. In May, we tried again and I got a positive beta, but, unfortunately, it did not stick. I had a series of low, non-doubling betas for about 2 weeks and my doctor was worried that I might have an ectopic pregnancy. Eventually, though, I got my period and the beta went down, so the cycle ended up being a chemical pregnancy. I needed to sit June out waiting for my beta to zero out. In July, I did another natural cycle - BFN. By this time, we were ready to get more aggressive. My RE does not recommend using clomid on patients older than 34, particularly if the patient ovulates on her own, which I do. We did an injectables IUI for cycle #4 in August. I responded very well to the medication and was told by one of the nurses that my cycle looked "perfect." Unfortunately, that ended in another BFN. I was prepared to roll right into another injectables cycle, but on my CD3 workup I had 2 cysts leftover and was told to take a rest cycle. My RE agreed to let me go ahead with another natural cycle, though, which also ended in a BFN. By that time, I was ready to at least consider IVF. Unfortunately, though, the lab was closed for what would have been my next cycle and I thought I would end up with a scheduling conflict on the following month. For attempt #6 in early October we decided to go ahead with another injectable IUI cycle. This cycle was very similar to my first injectables cycle -- looked great on paper, but ended with a BFN. For cycle #7, I'm doing another natural cycle. I expect to inseminate sometime this week.

I feel like I'm at a crossroads. At this point, I'm ready to move onto IVF. I feel that is what is necessary for me to get pregnant. Y is opposed to moving onto IVF for various reasons, but mostly because of the fear of multiples, a concern that I also share. This is a big issue for us -- I'll elaborate later in future posts. I've gotten Y to agree to let me do IVF, but it required serious arm twisting and it would be her preference not to go that route. If I'm going to do IVF before the end of the year, I need to do it next cycle as the IVF lab for my clinic closes in December. I'm lucky to have infertility insurance coverage, but the insurance has an annual cap of $10,000 a calendar year and don't think I have enough left to fully cover an IVF cycle this year. In January, I will get another $10,000 to use for the year. I'm also considering getting a second opinion or changing clinics for IVF. These various circumstances are all pushing me to delaying IVF until 2009. On the other hand, when Y and I started the TTC #2 process we agreed to sent boundaries on the process and not to try for more than a year. After that, we would move on and pursue adoption or enjoy life with only one child, which we are already so lucky to have. March 2009 is when the year runs out and also when I turn 41 -- that seems a good place to stop if we have not achieved success. With such limited time left before we reach our stop point, I would like to maximize success by moving onto IVF as soon as possible, potentially allowing for multiple IVF cycles if needed.

Since I have been TTC for quite some time now and plan on stopping one way or another a few months for now, this might be considered a strange time to start blogging. But then again, there is nothing that says you can start at the end. As we move forward together over the next few months, I will try to fill you in on what has come before. Welcome and thanks for listening.