Period from hell update

Man, I am not fond of methotrexate. Turns out that it didn’t do a good enough job for me so I got a second shot. And for the last couple of days, the expected bleeding started and I’ve had period from hell – major cramping, aching, soreness, tiredness and generally, not feeling-good-ness. I really hope this second shot does the trick. Who knows – maybe this means that my embryos are actually strong and bodes well for the future? At any rate, I’m hanging on to that as hope.

Also, in completely TMI news, no one told me that it wasn’t just blood that comes out! (Also apologies for the graphic-ness of the description) Actually, I have no idea what the discharge was but it was emphatically not blood or a clot or anything. And then I flipped out because my first guess was that it was the gestational sac (not that I know what it looks like). Then called the emergency helpline at the clinic and the doctor said it was likely the mucus plug or some tissue (but that’s what I was scared of — that it was tissue!). Anyways, I still don’t know what it was but the doctor seemed to think it was lining that was so old that it got leeched of all its blood and hence was flesh-colored. Literally, this has been a recurring nightmare of mine so that whole ordeal didn’t help.

Sigh, I just want this to be over. At least I’m in a flexible job where I can effectively work from home/not work for a few days without any repercussions.

#MicroblogMondays : Playing with babies

I spent a good chunk of the weekend with one of my friends and her family – just hanging out, going to the zoo with her and her kid, cooking dinner and then movie night. One thing I’ve found strange is that with some friends and their kids, I’m perfectly happy to play and laugh with their babies. With others, just the thought of seeing them fills me with dread. I don’t actually know why but I have a few theories.

Some friends got pregnant before we started trying or in the early days of process for us. That feels.. justified. They started earlier so of course they reach the goal earlier. It’s the ones who started well after us (and now have had their babies) who are painful to watch. With others, the fact that they’re a few years older makes it easier to spend time with them — it feels like I have more time to ‘catch up’ and I’m not behind in life. With some others, their less than sensitive comments essentially made me cut off contact to whatever degree possible. We’re ‘out’ to most of our friends so ignorance isn’t really an excuse. And with some, there’s no logic really.

At any rate, in spite of all the blood tests and cramping, I actually had an enjoyable weekend with a baby who has finally deigned to accept me as a friend! 🙂

When will I stop tearing up?

Before starting the TTC journey, I never expected it to be so emotional. I’ve known for years about my PCOS so I knew that I might have to go through the whole fertility treatment process. But somehow I was not at all prepared for the emotional rollercoaster I’m on. The few friends who had talked a bit about it made it seem very matter of fact (went to doctor, took meds, have baby). Perhaps it is that simple for some people. For me, the lack of control and the uncertainty associated with the process has made me slightly crazy.

Today, I went to get a pedicure. I haven’t gotten one for ages and it’s spring and might as well celebrate life in some form. It turns out that random customer next to me is preggers and starts talking about it and I immediately start tearing. I never used to be quite this emotional. The ectopic pregnancy has made it even more painful. I was almost there. Almost done with the process and on the road to being ‘normal’. Almost able to hear a heartbeat and start doing all the things ‘normal’ pregnant women do. Now, I think this is yet another emotional scar that I’ll carry with me for a long time.

I realize now that when I was first diagnosed, I was incredibly naive. I wasn’t even dating my husband then so as much as I always knew I wanted to be a mother, it was still very far in the future. Plus, we have modern medicine so how bad could it be?

I never even thought about the emotional toll. I’ve gone through months of seeing the spotting that heralds my period and still holding onto the hope that it’s implantation bleeding (even though the timing totally doesn’t make sense). Months of missing periods and hoping against hope that this time was it only to realize, that PCOS strikes yet again. The treatment cycles at the fertility clinic actually restored some semblance of calm. At least I was doing something productive and I was ovulating! Now.. I’m not too sure. I’m actually glad for the enforced break in trying after the ectopic resolves. I’m not sure about my husband but I definitely feel the need to recenter.

The thought of resuming the constant poking and prodding and tracking just feels so exhausting. Again, something I didn’t expect – effectively this is almost like a second job. There’s the RE doctor visits and blood tests and checkups. Then there’s the more regular than usual annual checkups (gotta get my flu shots) and gynec appointments. Then there are the endocrinologist appointments. And then there’s the planning involved with figuring out who to go to when and making the appointments. And this is the bare basics. Other things that take time: worrying about diet (do carbs really make that much of a difference? god knows I’ve tried going low-carb and still no sign of a baby), worrying about travel coinciding with the various appointments (I still go to school in my old city and go back once a month to meet my advisor), googling about every symptom, agonizing through the 2ww, wondering about finances, dealing with the insurance companies, cursing the insurance companies (actually to be fair our insurance is pretty good, it’s our HSA company that kinda sucks), googling organic X (where X is makeup/perfume/food/what have you), googling success rates of various procedures. Some of this can be avoid, sure. But even just the appointments, scheduling and insurance is time and energy consuming.

Anyways, the upshot of all this is I’m tired. Just tired. I still have sore boobs because, of course, that was the first sign of pregnancy that I had. I took so much comfort in that. Every morning I’d get up, still feel sore and be at peace that the baby was still there and doing ok. Some use that was. And now its just mocking me. I’m achy and crampy and bloated from the methotrexate. I’m super anxious about blood test results for whether it’s working or not. At least, I’m no longer have panic attacks about surgery (I’ve never had surgery in my life. Or anesthesia). I’m also physically not in great shape. I was on enforced relaxing schedule during the 2ww. Then the couple of weeks after that, told to rest a lot during early pregnancy (I did slowly start working out then). And once the ectopic was diagnosed, strongly told to not do much in order to avoid a rapture. So now, I’m also really out of shape.

Maybe things will be different, maybe I’ll be pregnant again by then but I have a feeling Thanksgiving will be bittersweet. Of all things I was excited to have the best excuse to not host Thanksgiving (which I usually love) – I’d be due around then! But now.. well, maybe now is not a good predictor for how I’d feel.

PS – After reading this, I realize that I’m not giving my husband enough credit. To give him his due, he comes with me for every single blood test, appointment and ultrasound. I also told him early on that I refuse to give him any sympathy for his tasks in the process. He deals with some of the scheduling but usually the nurses call me with the results so its easier for me to handle it. I deal with most of the insurance stuff mostly because I handle the money in the family. As for all my googling/trying to educate myself — well, some of that is me needing to be in control and knowing what to expect and some is that only I really know what I’m feeling.

I spoke too soon…

The methotrexate is rather a roller coaster ride. First a pretty bad backache from the injections but bearable (especially with hot compresses). And then, right on time, on day 3, massive cramping started. Then nothing for a couple of days. And now then cramping, aching and bleeding again. Apparently its all par for course. Hopefully tomorrow’s blood test will be show that it’s working. Would rather not go through another round of this thing.

Data Science-ing my life

In case it hasn’t been obvious, in my non-baby-related life, I’m quite technical. A huge component of my work is data analysis and building computational tools. Enough years of this and it completely colors the way I look at the world. I like knowing the numbers behind each measurement and treatment.

One consequence is that I’ve started keeping better track at some of my vitals. And by vitals, I really mean hormones because those are the most useful measures for me.

Some caveats: I have no training in medicine. I might like data but my interpretation below could very well be faulty.

One struggle I faced during this process was getting my TSH levels under control. I went through several dose levels and sometimes it looked like it was responding and then it would go back up. The image is a plot of my TSH levels over the last year or so along with my synthroid doses.

tsh_overtime_2016on_nostress

A few things that I’ve observed over time:

  • Both my endocrinologist and RE told me that TSH is a very slow moving hormone. Hence the 6 week wait after starting synthroid to see if it worked properly. But.. that’s not what I saw. During a 2 week period in November it doubled.
  • Lab and/or time of day makes a huge difference. Aforementioned doubling seemed so bizarre that I insisted on getting it retested because it looked like a lab error. Within 24 hours, I got measures of 5.44, 4.9 and 4.8 (each from a different lab). The 4.x measures were taken in the afternoon, 5.44 was from the morning. Does it really change by 20% within that short a time period??
  • I’m not convinced that synthroid is doing much for me. Even after starting, my levels have been fluctuating quite a bit and they were super stable in the year before starting these treatments.

Honestly, after writing this, it feels like this is a useless post. So far I haven’t learnt much from this other than TSH levels are much more unstable than I’ve read/doctors have said. I suppose that in and of itself is a useful observation. And perhaps I’m not correlating it well enough to life events. The last increase could have been due to the pregnancy. The doubling could have been due to major stress (had a bunch of deadlines in super quick succession in Oct/Nov) though my endocrinologist assures me otherwise.

Still, I find it interesting to track this. I’m doing something similar with my HCG levels to see how it fluctuates/decreases with the ectopic pregnancy. Does it have an exponential decrease? Linear? Plateaus and then linear decrease?

Shots

Very evocative title, I know.

Got the shot of methotrexate. Two of them. This process is just so undignified. On top of the endless poking and prodding of your vagina and uterus, there’s all the shots to .. well .. not the arms. So far it’s been ok. The injection site is rather sore. And I’m definitely tired. Apparently that gets worse over the next week.

In comforting to me news, I finally figured out how to get decent medical information. Through this fertility treatment process, I’ve struggled with finding information as granular as I want it. For instance, I know that IUI has a success rate of ~20% per cycle. But what are those probabilities for someone of my weight? my TSH level? my gynecological history? It’s been almost impossible to figure out this level of information. And I’m a data person — I need the stats and the numbers to be comfortable with the processes.

In this case, I was trying to gauge what the probability of this treatment working and not having to resort to surgery. Offhand that probability is ~80%. BUT there are indications for better rates (http://www.medscape.com/viewarticle/576935). In case of HCG levels <1000 (check) and gestational sac < 3.5 cm (check. well, i’m not positive what this means but presumably the round thingy in the ultrasound?), the success rate is ~ 98.5%. HUGE difference. I wish the nurses would have led with that instead of dire warnings about tubal rapture.

That being said, I know probabilities aren’t everything. Apparently only 10-15% of ectopic pregnancies are in women with no previous pregnancy (http://www.obgyn.net/tags/ectopic-pregnancy). I’m assuming a chemical doesn’t count? So not only did I fall into the 2% of ectopic pregnancies, I fell into the minority of that. Plus, I had zero prior indication. Nothing to be done about it but it really does suck.

Also for anyone reading the blog, any input about other questions for which I still don’t know the answers would be useful! What are:

  1. E[time to resolution of ectopic]?
  2. P(successful pregnancy | previous ectopic)?
  3. P(successful pregnancy via IUI | previous ectopic)? E(number of cycles for successful pregnancy via IUI | previous ectopic)?
  4. P(successful pregnancy via IVF | previous ectopic)? E(number of cycles for successful pregnancy via IVF | previous ectopic)?
  5. Correlation between TSH/thyroid and ectopic?
  6. P(ectopic due to bad eggs/chromosomal issues)?
  7. Correlation between weight and .. anything really

Life goes on..

People tell me I’m a positive person. I don’t often feel like it but I’d like to think that infertility has not totally pulled me down. Over the last several years, I’ve found many things to take comfort in – I have a husband who is a gem, family who are incredibly supportive, wonderful friends, a job I enjoy. And even on the fertility front – my case is.. standard run of the mill PCOS. No other issues, so theoretically should be a relatively straightforward resolution. So I’ve been keeping faith, trying to maintain the optimism.

This time, it’s a bit harder. Yet another several friends are pregnant with no issues whatsoever.  While I keep getting one hit after another. Finally, even when I thought I was pregnant, it turns out to be unviable. How shitty is that? And how weird? I have none of the risk factors for an ectopic pregnancy.

Still, there are silver linings which I’m trying to draw comfort in. Egg quality and sperm quality seem ok. Clearly I have ovulatory issues but clomid seems enough to resolve them. Fertilization seems ok. Embryo health seems (ironically) ok. Lining thickness was good. So.. there’s hope that things will succeed in time. My husband’s new mantra is ‘2018 is our year.’

And there are other things that are going well. After many (many) years, I’m finally finishing up my PhD in a few months. I got my dream job which I’ll start this summer (which even allows us to not be long-distance!). It’s exciting and social relevant while still being technically challenging. I don’t have to worry about going on maternity leave almost as soon as I start. I’ll likely have the protections of FMLA by the our little one finally decides to arrive in our life.

So, inspite of all this, I am grateful for all that’s going well in my life. And trying to keep the faith that it’s just a matter of time for us.

At this point, all I want is for things to resolve fast (and hopefully without surgery). And then I’m building new aims for the next several months. Build stamina. Build core strength. Lose some of that tummy weight (and hopefully that will help sugar levels). Enjoy the summer for once – go to those outdoor concerts and explore the city. Eat good food. Go swimming. Read a lot so I don’t start my new job completely blind. Read more non-fiction. And life goes on.

“Relax, it’ll happen”

So.. that’s stupid advice. I’m all for reducing the stress in life. But trying to say that the reason you’re not pregnant is because you’re too stressed? Bull*$#!.

My data point – of all the months, the one time I have a positive pregnancy test is one of my craziest months. During the week of my IUI and the couple after, I was in crazy interview mode with something like 3 interviews a day!

It’s happening!

So.. apparently it worked! I know this sounds weird, given that I’m going treatments but I actually didn’t expect a positive outcome. I think after several years of counting days and trying to time it, only to start my period or not get it because of PCOS issues, I just.. expected it to take a while and see more negative results.

It took a while to confirm – HCG levels were low at first and had to go back every couple of days to get tested to see if they were rising. Last check, they were at 120 which is definitely pregnant! We’re scheduled for an ultrasound soon to make sure everything is ok. And then I get handed off to OB? How exciting – I’ll be a normal person again!

For now we’re cautiously optimistic. It’s obviously still early but this is further than we’ve come before so regardless of what happens, there’s progress.

I have to say, I’m definitely feeling different. I’ve been feeling on and off bloat-y in my lower abdomen (presumably this is my uterus doing..things?). And I’m taking comfort in the weird feelings – it feels like proof that things are progressing and doing ok.

Funnily enough, this is pretty much the worst timing career-wise for me. All these years we’ve figured that when it happens, it happens and we’ll work it out. So.. we’re working it out. I’m finishing up grad school and hopefully starting a new job in a couple of months. But FMLA benefits definitely don’t kick in until you’ve been there a year. And even short term disability kicks in only at 6 months of working so it’s a bit of a race for me to finish and start somewhere early enough. Have I mentioned how stupid this country’s maternity policies are? Isn’t it better for everyone if there’s time to recover from the birth and time for both parents to develop a bond with the baby? And don’t get me started on the ‘mommy-penalty’ in jobs.

For now we’re taking it a day at a time and seeing what happens. *crossing fingers* for ultrasound.