The Next Stage

Once we arrived back from Australia, we began the next main lot of testing. I had a blood test done to confirm that my hCG levels had to returned to zero, and the next day went to have my thrombophilia panel blood work done. The following week my period arrived and on day two I went to have the Day 2 blood work done, which included a test for my egg reserves (the hormone, AMH). Over the next couple of weeks I had my pap and cultures done, as well as a saline hysterosonogram (SHG) to test that everything was as expected in my uterus i.e. with no septum etc.

We had our follow up consultation with Dr Sauer on Monday 10th August. Dr Sauer asked us what had been happening with over the last two months and I explained the remaining tissue after we'd seen him and the required MVA, and the differences in procedures from the one in January. He did say that it can be different with different doctors, but also could be a result of my cervix being in a different state. He asked how all of the testing had gone and then proceeded to explain to us our results. He told me that my thrombophilia panel, which tests for coagulation abnormalities possibly related to recurrent pregnancy loss or implantation failure, had come back positive for two of the tested genes. The main one, cardiolipin antibody IgG, was normal if it returned a result of less than 20, but mine had come back at 103, which Dr Sauer was surprised about. He said that if it had come back at, say, between 20-25 he would have me do the test again, but because it was so much higher than the normal range, it was definitely a true positive. This meant that going forward, if we were to fall pregnant, I would have the option of taking blood thinning medication. The other option would be to do nothing and hope for the best. I have decided that I want to take the medication option, despite the risks, which could be easy bruising or, worse, hemorrhaging and even miscarriage as a result. I feel like I want and really need to do as much as we can, now that we are armed with the test result information. How very lucky we are that Hunter was able to survive and that the conditions were just right for him.

It’s been another tough few months mentally. I stumbled across a web chat blog where Zita West had written of women who suffer miscarriages: “Many of the women I see in my miscarriage clinic have lost confidence and feel their lives are on hold. They are very anxious and need a lot of support.” I feel like that just perfectly sums me up right now. The impact on my confidence has been tremendous. I had someone try and offer support by saying, “That which doesn’t kill us makes us stronger”. It couldn’t be further from the truth for me. I feel like the last year has really battered me in that respect. It’s become all-consuming, which leads to the constant anxiety. I have been considering seeing a psychologist again. I think I’ll see how the next couple of weeks go and then decide. The psychologist I saw in February wasn’t someone who I felt I could really ‘break down’ to as she didn’t really show a lot of compassion, which is what I would have expected from someone in her position. I do know, though, that I do need to keep sight of what I have right in front of me, with Mark and Hunter and our little family.

3rd Time Unlucky

I wanted to believe that I wouldn't be writing this post about a third miscarriage; I wanted to believe that our next pregnancy would be third time lucky, but that wasn't meant to be. I found out on the last day of April that we were pregnant again. Mark told me that we had to be prepared for whatever came our way, but I didn't want to think about any negatives. I just wanted to focus on the hope that we had been given again.

We had our first viability sonogram on May 15th, which going by a normal cycle should have made me 8 weeks. The sonographer told us that I was closer to 5-6 weeks, which made sense given my long cycles and late ovulation (I'd had a front-to-back cycle the previous month and it had lasted 40 days). I was disappointed that we were so early yet again, but this time the thing that made up for it was that she was able to point out the embryo and also detect cardio activity i.e. a heartbeat, which we hadn't seen with the previous miscarriages. She told me to book in again to have another viability scan in 10-14 days.

The following week I went to see Dr Holden and he did a bedside ultrasound. I was so nervous that the heartbeat was not going to be there, but he was able to point it out to me on the screen, and I was so happy I cried. That weekend was the Memorial Day long weekend, and we went to the Catskills to stay with friends at their country house in the mountains. It was so nice to get out of the city, but all I could think about the whole weekend was the baby inside me and whether its heartbeat was going to be there at the next sonogram. I was so paranoid about whether or not I was still feeling pregnant, that it was all-consuming. 

It was a very long week until the next sonogram on Friday 29th May. The sonographer did a transabdominal ultrasound over my stomach first. I had told her that we had seen a heartbeat twice, but had to do a second viability scan because the pregnancy was so early. My heart sunk when I couldn't even make out a baby, let alone see a heartbeat. I asked the sonographer immediately, "Has it gone?". She said that she couldn't find the baby, but would do a transvaginal ultrasound next, as usual. I felt like I was going to start crying, because I knew that if she couldn't even find a baby, there was little hope. With the transvaginal ultrasound she said that she could see the baby, but there was no heartbeat. She had a Dr come and talk to us, as we had had with the previous miscarriages, telling us that unfortunately it was a miscarriage and that I shouldn't blame myself; that it was nothing I did and there was nothing I could have done differently that would have saved it. I was so devastated, I sat in the room with Mark after the Dr and sonographer had left crying for almost twenty minutes. I really had thought that it was going to be different and that it was third time lucky, because we had seen a heartbeat, twice. I realized that I was such a mess that I couldn't go to work, and called my boss to tell him what had happened. When I spoke with Dr Holden you could hear the sympathy in his voice. I told him that I wanted to book in for a D&C (as the MVA had been a little traumatic after the second mis), so did so with his secretary for the following Monday. He had also said that I could take the Misoprostol that I had leftover from the first miscarriage to see if they might work in helping to get the tissue out. Mark and I spent the day together, walking around the West Village with me drowning my sorrows. I inserted the Misoprostol that night and started bleeding heavily within an hour. The next morning I had a lot of tissue expel, and I hoped that that was it. When Dr Holden did the bedside ultrasound the following Monday, he said that the sac wasn't there anymore. There was still a bit of tissue, but that would come out naturally or I could try the Misoprostol again. He said that I didn't need to have the procedure, which I was happy with. We spoke about next steps. Now that we had had a third miscarriage, we would see the fertility specialists to talk about testing etc.. I went down to the 4th floor and made an appointment for the following Monday with Dr Mark Sauer, the Head Director of the Columbia University Medical Center's Center for Women's Reproductive Care. I took the Misoprostol again that night and some more tissue came out the next morning. I thought (and was hoping) that that was the last of the tissue. 

The following Monday, Mark and I met with Dr Sauer. It was such a refreshing consultation with Dr Sauer; truly amazing. He spent nearly two hours with us discussing everything in detail, our fertility history, statistics and the testing plan going forward. He made us feel reassured and positive, knowing that we still had so many parameters on our side; the fact that we already had a successful pregnancy, that we were still considered relatively young, and that we were now taking the next best steps seeing fertility specialists. I felt like I had reached a real mental hurdle having met with Dr Sauer. For him it wasn't just professional, but personal as well because his daughter had suffered 3 miscarriages and was about to give birth to a baby. He is also the pioneer of some fertility procedures, so is known worldwide. We knew we were in good hands.

We started some of the genetic blood work that day. Dr Sauer's nurse, Maria, called me to the next day as I was on my way to do the thrombophilia panel blood work to tell me that my hCG levels were still very elevated, and that I obviously had tissue still there so could not continue with the testing until my hCG was back to zero. I was told to come in for an ultrasound the next day to confirm the remaining tissue and potentially book in for a D&C. This was not music to my ears at all. I had been dreading the possibility of another procedure after my horrible experience back in January. The next day (Wednesday), I had the ultrasound and the Dr pointed out to me the large amount of tissue that was still remaining. Time was tight because we were flying to Australia the next day for Jonno's wedding. I rang Dr Holden, but he was not in the office and rang Dr Perera to confirm that she would be able to perform the MVA/D&C that day in the office at the hospital. I had it done that afternoon, and the experience could not have been more different than the previous MVA. While Dr Holden had prepared me for the pressure, which was excruciating pain, of each of the numbing syringes, Dr Perera only prepared me once and then said, "All done". I couldn't believe it; all 5 syringes had been given and I hadn't felt a thing. Dr Perera said that she couldn't take credit for the procedure being painless, because my cervix may have been more receptive this time, considering that I'd already been passing tissue. Whatever the reason, if (God forbid) I ever need another MVA, I'll be asking for Dr Perera.

 

A Tough Few Months

I'm not going to lie; the last few months have been tough, really tough. It took me quite some time to feel like I was beginning to move on from the second miscarriage. It didn't help that the expulsion lasted for weeks after the MVA procedure. Then the whole waiting game starts again; waiting for the next normal period, waiting to see what happens.

I think about wanting to have a second baby every day. This, together with the worry about having another miscarriage has led me to have really bad anxiety, and it became quite bad in the months following the second mis. I saw a therapist/psychologist a few times and it helped to talk to someone else. She helped me acknowledge that whatever happens down the track is out of my control; if another miscarriage does happen, then it is what it is but there's really no use worrying about it now. Much easier said than done, but I'm trying! I'm also trying to do more 'self-talk' to push the anxious thoughts out of my head when they come. I'm finding that listening to music more is helping too. I also did an acupuncture session, which I hadn't had for years since I used it to treat my sciatica when we lived in London, though I'm not sure how effective it was as I couldn't really feel it, though maybe that means it was good?  

I'm hoping that things start to happen again soon, and that we are given some hope that we will have another baby.

Burglary

We were broken into in early February, which didn't help with the bad anxiety I was dealing with at the time. He came in through the window that backs onto the communal apartment bins. We hadn't touched the window for months, and had obviously been far too lackadaisical about it, thinking that it would only be accessible to the tenants in our building. The CCTV footage shows him pressing apartment buttons and being buzzed into the building, perhaps someone thinking that he was a courier delivering a package to another tenant. He took my new MacBook Air, our iPads, sunglasses (including Hunter's Mickey Mouse pair!), Mark's watches, Mark's NorthFace jacket as well as my hard drive, which had photos on it from the last 8 years. Thankfully, the photos on my MacBook are on Hunter's blog, and the photos on the hard drive are on Shutterfly and FaceBook. He also took a bunch of fake diamonds that I had in a handbag, obviously thinking they were of some worth. It would be funny seeing him try to pawn those! A 15yo kid who bought Mark's iPad on the street in the Bronx for $80 the night of the burglary called the next day asking us to unlock it. After some back and forth between his mother and the police officer, he ended up with a juvenile record for admitting he knew it was stolen, though the record will be wiped when he's 18 if he stays clean. We now have an alarm system and renters' insurance, and just have to take solace in the fact that nothing else was taken and nothing worse happened.

Evening Primrose Oil late Jan & Vitex for luteal phase defect

After my second miscarriage, and in my continued angst to find out the causes of the miscarriages, I started reading blogs on the internet that discussed luteal phase defect as a possible cause of miscarriages. The luteal phase is the time between ovulation and when your period starts. It's also when the lining of the uterus becomes thicker to prepare for possible pregnancy. Luteal phase defect is when ovulation occurs later in the cycle and the luteal phase is shorter than normal, so the uterus doesn't become as thick as it should.

Thinking that luteal phase defect could potentially be the cause of my miscarriages, I started reading up on some natural remedies to treat luteal phase defect. One of these was Vitex, which is meant to assist in increasing progesterone levels to allow ovulation to occur normally, in turn increasing the luteal phase. A second remedy that I read about was evening primrose oil, in that it assists in normalising hormone levels that are important for fertility. I was also recommended evening primrose after discussing my miscarriages with a naturopath at a health food store.

I started taking Vitex and evening primrose oil towards the end of January 2015.

http://www.natural-health-for-fertility.com/vitex-for-luteal-phase-defect.html

http://www.livestrong.com/article/367180-how-to-use-evening-primrose-for-infertility/

2nd Time Unlucky

So it's happened again.. another 'mis'.  We found out we were pregnant several weeks ago.  I'd done a test 29 days after my last period on the 4th December and it had come up negative.  I'd then done tests on the 8th, 9th and 12th of December and they all returned very faint positive results.  I was booked in to have my first appointment and ultrasound with Dr Holden on Monday 22nd December, but I was also concerned that there was no increase in the boldness of the lines over the course of those days, so I had bloodwork done twice the following week.  My levels were increasing as expected by that stage and I was hopeful going to meet with Dr Holden on the 22nd. Going by a 'normal' cycle, which I know mine are not anyway, I should have been around 7 weeks. I knew that I wasn't going to be 7 weeks because of the results of the initial tests.  I knew that I must have ovulated very late in my cycle.  Dr Holden said that I was very early, about 4 weeks, and to have another ultrasound two weeks later.

It was a long two week wait, which crossed over Xmas and NYE.  A few days before Christmas I'd felt like my symptoms had weakened, and that I didn't feel as pregnant because I wasn't as nauseous or hungry.  We arrived at the 51st location of Columbia Medical for the sonogram on Monday 5th January.  I told the sonographer that I had previously had a miscarriage and to tell me if things didn't look right, as the last time the sonographer had kept telling me to speak with my Dr rather than giving me a conclusive answer.  As soon as the screen came up I knew it didn't look right.  We were expecting a foetus and heartbeat by this point, and there was only a small blurry mass of tissue, with nothing inside.  I knew it was another blighted ovum.  I think I had been expecting it, not only because of my lack of symptoms but because we know so many people who have had miscarriages in a row.  It's very sad and upsetting, but as Mark keeps reminding me, we must think ourselves lucky and move on quickly.  It was very early days, and we have a beautiful little boy who reminds us how lucky we are every day, and that is something very special.

I had the MVA (Manual Vacuum Aspiration) procedure on the Friday of that week.  It was much more painful than I was expecting.  The five injections in my cervix were extremely intense, especially the last two, after which I thought I was about to faint!  I felt fine and normal once it was over, and took the rest of the day off from work.  I barely had any bleeding following the procedure until the following week, when I started getting spotting and then heavy bleeding on the Thursday.  We went away to Mexico that Saturday, and unfortunately I was bleeding heavily and expelling large clots for the first half of the holiday, which wasn't conducive to a bikini break!  Thankfully, it subsided towards the end of the week.  Two and a half weeks after the procedure, the bleeding is only just tailing off, which is frustrating, but I know it's the process my body has to go through to ensure that it's ready to go through a cycle in 4-5 weeks and for us to be able to try again after that.

N.B. I found this paper on MVA, which goes into the detail of the injections etc. that I had during the MVA http://www.ipas.org/~/media/Files/Ipas%20Publications/MVAPAIN2E09.ashx

A Bump in the Road

Having not had a period whilst I had been breastfeeding, I wondered how long it would take my body to have a cycle. I'm not sure if I had been ovulating while I was breastfeeding, as I hadn't fallen pregnant in that time. I had gradually dropped feeds from our return to NYC, coming down to two feeds in the two weeks that I had in NYC prior to returning to work. Hunter was on formula for the two day feeds and still being breastfed morning and evening. In April, I dropped the evening feed to a formula feed and then finally in May I dropped the morning feed to formula. Two weeks later on 23rd May, I got my period. We were going on holiday to Turks and Caicos the next day, so I was a bit annoyed that I was going to have to deal with it on holiday as I'd heard from friends that the first period you have after pregnancy and breastfeeding is long and heavy. I needn't have worried, as it was a very light period and only lasted a couple of days. Looking back now, I wonder if that wasn't enough of a 'clean out' for my body to be prepared to carry another baby.

I did a pregnancy test twenty-nine days after the 23rd May, but it came back negative. I was a little disappointed, but thought that it would have been miraculous if we'd fallen pregnant first time around after one period again. A week and a half went by and on the Tuesday, I started to feel a little bloated and crampy. I also noticed that I wasn't able to run for as long at the gym, which was a similar symptom that I'd had with Hunter. I did a test that night and the test came back with a very confused blue screen; you couldn't make out any lines at all. I told Mark that night that I thought I was pregnant and he was very excited. I did another the next morning, and it came back very pale but positive. Mark was so excited that he started telling people we were pregnant. I thought it was too early to start telling people, but didn't see the harm in it given that we had had such a smooth ride with Hunter.

I rang Dr Holden's office and booked in to have an appointment with him on the 14th of July, which would be my 7 week mark and first ultrasound. That weekend was July 4th and we had been invited to go to Long Island to stay with friends. I still couldn't believe that I was pregnant, so I did another on the Saturday and it came back much bolder this time around. It was a long week's wait for the ultrasound appointment and when it finally came I was quite nervous. Up on the screen, Dr Holden pointed out the gestational sac but said that it looked like it may be too early to see a foetus. We had a quick chat about next steps, which he said would be to take blood that day and then again a few days later to see that my hCG levels were increasing appropriately. After that, I would have a viability scan the following week to make sure that everything was progressing as expected. I asked him if there was a chance that it could be a miscarriage and he said yes, but that we would see.

I had the blood results come back on the Friday. Dr Holden said that the hCG levels were increasing nicely and that the next step would be to book in for a viability scan. I was quite confident going in for the viability scan. I thought that everything must have been progressing as expected if the hCG levels were also. I knew straight away that something wasn't right when I saw a big blob on the screen with nothing inside. The sonographer was being very aloof when I asked her if it was a miscarriage, saying that I would need to speak to Dr Holden. It felt like she was treating me like idiot. I had more blood done and I remember crying to the nurse, Patti. She was trying to reassure me, saying that nothing was certain yet and that Dr Holden would be able to give me more information. I knew that it couldn't be good. I had been expecting to see a foetus and a heartbeat, but there was only an empty sac. I called Mark as soon as I was out and he didn't quite understand it at first. He just thought that I meant it was too early to see anything. I told him that it didn't look good and he started to realise the same. I hopped in a cab and went home, but ended up going back into work because I needed to take my mind off it until I spoke with Dr Holden. He called me in the afternoon and told me that it was "a mis". I felt numb. He was speaking in such a soothing tone that I thought he must have dealt with this many times before. I couldn't help but cry. We spoke again that evening and he explained in detail what my options were. He told me that I had three options; I could wait until the tissue expelled itself, which could take weeks, or I could take some meds to expel the tissue, which should happen 24-48 hours after taking them, or I could have a D&C, a surgical procedure that has some risks (though extremely rare), such as puncturing of the uterus. I decided to go with the meds. They didn't work the first time around, so I had to take them again a week later; apparently I was part of the 3% who they don't work for the first time. A week later, I only expelled for a day. I had a sonogram a couple of days later, which showed tissue still there, so Dr Holden gave me a prescription for different meds to expel the remainder. Nothing happened. We went away on holiday to Barbados to get our visas processed (I was changing jobs in the middle of all of this) and luckily nothing happened while we were on holiday. The day after we arrived back, it started again and I expelled blood and gross-looking tissue for two weeks straight, beginning my new job right in the middle. A couple of weeks past and I started bleeding again. I thought it was my period, but I've since learnt that there has to be around a four week gap (at least) for a proper hormonal cycle to occur. It went on for a week, and then almost a week later I started bleeding again. I got in touch with Dr Holden and he told me to book in for a sonogram to see what was going on. The sonographer told me that there was still a lot of tissue remaining and said that I would need to see my Dr as soon as possible, as the tissue may have been there so long that it could be difficult to remove. Dr Holden was busy the next day, so I was booked to see Dr Perera, another Dr in his team, at the hospital to have an MVA (manual vacuum aspiration). Dr Perera said that she wanted to have another look inside my uterus before she began anything to make sure that it was the correct procedure. She pointed to the remaining tissue on the screen, showing that it was taking up most of my uterus. She then said that she was going to bring in another Dr to get a second opinion about the procedure. The second Dr came in and they both agreed that it was best to do a D&C in the operating theatre and put me under a general anesthetic in case of excessive bleeding and also to make it more comfortable for me, in case the remaining tissue was difficult to extract. I was booked in to have the D&C the following week with Dr Holden.

Finally, the 8th of October arrived. I went through to the operating theatre after pre-op and was put under general shortly after. I woke up as if nothing had happened. I rested in the post-op room until Mark arrived, and was told to take it easy for the rest of the day. I didn't have any pain or cramping as I was told I might, so didn't need to take any painkillers at all. I couldn't believe how good I felt after the D&C and really wished I'd done it right at the beginning to save a lot of time and emotional energy. It was a huge relief to know that it was finally all over. I still feel the loss, but I am grateful that it did not progress to a foetus, as I think it would have been much more devastating to see the beginnings of a little baby itself. It was a bump in the road that went on for months and months, but hopefully we will have another little one with us soon enough.