one foot in front of the other

I finally received the MTX injection on Thursday (July 28).

I was originally scheduled to receive the MTX injection on Wednesday (July 27) but when I went to my appointment I learned that the b/w from the previous day indicated that my platelet count was a bit low.  I had a platelet count of 104,000 and the normal range is between 140,000 and 250,000.  My hcg level had also increased to 255 (23dpiui).  My RE was not comfortable with proceeding with the MTX injection because of my low platelet count.  It was decided that additional b/w would be done.  My RE indicated that she would review the b/w results in the morning and then make a decision with how to proceed.  So I had to get more b/w done.  Again.  And to think that when I started this process I was terrified of getting b/w.  Now I don't even blink an eye.  I could probably do my own b/w at this point in the process.  Just give me the needle.  I know where to find the good veins.  My arms were looking quite hideous by the end of the week.  I received a call bright and early on Thursday (July 28) and I was told that the RE reviewed my b/w results and it was okay to proceed with the MTX injection.  I did not bother to ask for the details of the b/w.  To be honest I did not care.  I just wanted to move forward with the entire process.

The actual injection was not too bad.  I was surprised at the amount of medication that got injected.  It was a significant amount (and bright yellow).  The nurse indicated that the dosage is based on your body mass index and most of the time a patient has to receive two injections.  So this was one of those times that I was actually thrilled to be fairly petite.  The injection was an inter-muscular injection (that means it goes in my butt) so thankfully I could not see what was going on!  It did take about a minute though for all the medication to get injected.  And it burned a bit.  Otherwise, the injection was no different than the trigger shots I receive to induce ovulation.  My instructions are to stay away from foods containing folic acid (including all vitamins) and alcohol.  I personally think it is a crime that I cannot drink during this entire process!

I have not had too many side effects from the drug.  The first night I felt like I had been hit by a truck.  I was exhausted.  I actually feel asleep around 6:30pm and slept through my alarm clock the next morning.  I was extremely nauseous the first night.  However, when I finally woke up the next morning I felt completely fine.  And up until this point I have not had too many additional side effects.  Though I do get really bloated anytime I eat.  It could either be from the medication or it could be because my eating habits suck at the moment.  If I'm not allowed to drink alcohol, then you better believe that my diet is going to consist of a lot if ice cream at the moment.  Plus I was told to eat unhealthy!  I am crossing my fingers that the minimal side effects continue.

I am scheduled to go back for additional b/w next Wednesday.  My hcg level should be dropping at this point in time.

Mary

some updates

I have an hcg level of 182 as of Monday.  I had an appointment with the RE yesterday to discuss the current situation.  I was a bundle of nerves.  But thankfully Kara was able to go the the appointment with me.  She did a good job making sure I spent most of the time laughing. The alternative is crying!  The RE began the conversation by making certain that I understood that this pregnancy was not viable despite the fact that my hcg level continues to increase.  This I know.  And I have accepted this over the last week.  She also wanted to reassure me that there was nothing that I did to cause this miscarriage.  I didn't exercise too much.  And it wasn't because I didn't eat enough broccoli.  I appreciated that she took the time to say these words.  It showed me that she could understand the emotions that I was feeling at the moment.  And it made me laugh.  Because my hcg level continues to increase at an abnormal rate, there are a few concerns that needed to be addressed.  It is a possible that I have a normal uterine pregnancy and for some reason or another the pregnancy has failed to progress at the proper rate.  At some point my body would recognize the problem and my hcg level would begin to decrease.  I would then have a natural miscarriage.  However, there is no way to determine how long it would take for my body to recognize the fact that the pregnancy is not viable.  It clearly has not done that over the course of the last week.  The other concern is that I have an ectopic pregnancy.  An ectopic pregnancy occurs when an embryo implants itself somewhere other than inside the uterus.  It is most common for the embryo to implant itself in one of the tubes.  The major indication of an early ectopic pregnancy is an abnormal rise in the hcg level.  The abnormal rise in hcg level occurs because while the embryo is continuing to develop it is doing so at an abnormal rate because the embryo is not getting sufficient nutrients.  An ectopic pregnancy, if not addressed early in the pregnancy, can become a life or death issue.  Eventually the embryo would grow to a size not supported by the size of the tubes.  The tube could then potentially rupture.  Unfortunately, because my hcg level is still low, it was unlikely that the RE would be able to determine via u/s if the embryo implanted in my uterus or if the embryo implanted outside of my uterus.  And this ended up being the case yesterday.  The RE did an u/s and could not determine where the pregnancy was located.  Therefore, unless proven otherwise, because of the abnormal rise in my hcg level, we need to move forward with the assumption that I do in fact have an ectopic pregnancy.  We have decided to use the drug Methotrexate (MTX) to end the pregnancy.  This drug, commonly used as a chemotherapy drug, will attack the pregnancy tissue.  This should cause the cells in the tissue to stop multiplying and essentially end the pregnancy.  The drug is fairly potent but because I am receiving such a low dose of it the side effects should be minimal.  I am scheduled to go back to the RE today to receive the injection.  The RE will continue to monitor my hcg level over the next several weeks to make certain it decreases.  The drug should cause my levels to start to decrease in the next seven days.

Today will be the hardest day for me.  The shot will be the hardest moment.  Today I will end this pregnancy.  Today I am 5 weeks and 3 days pregnant.  I know that there is absolutely nothing that I could have done to have prevented this from happening.  But it doesn't make it any easier.  And I know that I need to move forward.  And I am ready to do this.  I will always think of what could have been.  However, I know there is a greater plan for us and I know that we will someday get to hold our baby in our arms.  It's just not today.  It's just not tomorrow.  It's just not nine months from now.

Mary        

wrong direction

Not a lot to report.  I went for more b/w today and my hcg level is now 85.  Yep.  That would be the wrong direction.  I will go back at the beginning of next week for more b/w.  My arms are starting to look like those of an IV drug user.  Lovely.  I have been doing fairly well from an emotional standpoint.  I have my moments.  There are times when I feel very alone.  Those are my worst moments.  I'm trying not to think of myself as being pregnant.  But that is not always possible.  I also get really down when I think about moving forward and how long it might take for me to get pregnant again.  I'm also still dreading the whole bleeding that will eventually happen.  I wish I could just snap my fingers and get a "do over".  But that is not going to happen.  So it is one foot in front of the other at the moment.  We will see what next week brings.

Mary

and it's over

That didn't last long.

I went for more b/w today and my hcg level only increased to 73.  It is officially a chemical pregnancy (or an early miscarriage).  The most ironic part ... I stopped spotting.  I have to continue to go back to the RE for b/w every couple of days to make certain that my hcg level drops.

The phone call was really difficult.  I thankfully got to talk to my favorite nurse.  It would have been harder had it been someone else.  I knew the moment that I picked-up the phone that the news was bad.  You can always tell by the tone of voice.  Plus they waited until the very end of the day to call me.  Then I just kind of zoned out while she was talking to me because the tears were already flowing down my cheeks.  I had been holding in a lot of emotions over the last two weeks.  I managed to ask a few questions.  But honestly I didn't even process some of the responses.  I just knew that I had to ask questions or I was going to freak out.  And then I ended the conversation as fast as possible so that I didn't become a blubbering mess on the phone.  The nurse indicated that it can take up to two weeks for my body to recognize the miscarriage.  I'm not looking forward to this at all.  And I'm especially not looking forward to the whole bleeding aspect.  I know that is going to be fun.

My emotions are all over the place.  I'm sad.  I'm angry.  I'm at peace.  I'm ready to get back onto the horse.  I want to crawl under the covers and hide.  I'm resentful.  I'm tired.  I'm numb.  I honestly don't know what to feel at the moment.  I am thankful for my wonderful lady and all the support she has given to me during this entire journey.  I am also thankful for my "inner circle" of family and friends who have supported me through the last several days.  I'm just going to do my best to get through the next couple of weeks.  Kara and I need to decide what we do next.  And when we do it.  I now know that I can get pregnant.  I guess that is something.

Mary

today I am pregnant

I must keep telling myself that over and over again.

I continue to have regular spotting.  I called the RE office as soon as it opened this morning.  This is how the conversation went ...

me: "This is Mary ***.  I had an IUI on July 3rd and I am calling to let you know that I am getting positive tests at home."
front desk lady: "Yay!! That is so exciting."
me: "But I have also been spotting since Saturday."
front desk lady: "Oh."

I quickly put a damper on that conversation.  I am such a Debbie Downer.  I immediately left work to go to the office to get some b/w done (to test both my hcg level and my progesterone level).

I was originally planning to work today but I only managed to get a half-day in at the office.  I simply did not want to be in that office with the nurse called back with my results this afternoon.

My hcg level (15dpiui) is 66.  This means I am pregnant.  There is so much variation in hcg levels that I have been told to not focus on the actual number itself.  Instead, it is important that the hcg level doubles approximately every 48 hours.  Therefore, I am scheduled to go back to the RE office for more b/w on Wednesday. My progesterone level also came back at 45.6.  This is actually a really good number.  And does not give us an explanation for the spotting.  However, the RE has still requested that I start on progesterone supplements to keep that number as high as possible.  I believe that any follicle that releases an egg continues to produce progesterone in order to continue a pregnancy.  I believe my progesterone level may be a bit high because I potentially had two follicles that released eggs.  Then again I could have that all wrong.

All I know is I am terrified of losing this pregnancy.  I know I must believe that all will be okay in the end.  But it is difficult to do that.  I have not let myself get even the least bit excited because I have so many fears at the moment.  I am hoping with every bone in my body that things continue to go just fine.

Mary

a roller coaster of emotions

The last several days have been filled with every emotion in the book.  I am pregnant.

I decided to test out my trigger shot again this month.  However, unlike previous months I never really got a negative test.  I also was fairly symptom free except for the residual effects from the trigger shot.  I will try to break down the last several days

8dpiui - This was the first day that I noticed anything.  I had some fairly significant cramping during the afternoon.  I actually got a bit nervous as I assumed it was the normal cramping I get the days leading up to my period.  I was still getting a BFP on the test strips.  This was still residual HCG from the trigger shot.

9dpiui - No symptoms.  The cramps disappeared.  This is not normal.  I typically have cramping several days leading up to my period.  I was still getting a BFP on the test strips.  This was still residual HCG from the tigger shot.

10piui - No symptoms.  I also still had no cramps and I noticed that I was not getting any of the other symptoms that I normally get prior to my period.  The line on the test strip this morning was very faint.  However, there was still a line.

11dpui - No symptoms.  There was a line on the test strip this morning but it was again very faint.  I asked Kara to look at the test and she said she could see a very, very faint line.  I actually started to get concerned at this point thinking that the batch of tests strips that I purchased were faulty.  

12dpiui - There was a definite line on the test strip today.  I also started to get cramps.  The cramps were not severe but there lasted the majority of the day.  Kara and I made a decision that we would purchase a digital test and I would take that test in the morning.  I also made Kara pee on one of the test strips to make certain the tests were not faulty.  This was not one of my finer moments but it did prove that the tests were not faulty.  I woke up in the middle of the night (between day 12 and day 13) extremely nauseous.

I do want to share one story from this day.  I need to remember it.  I always lock myself in the bathroom when I am taking a test.  The moment the line popped up I just had a feeling (for the first time ever) that this was the real deal.  I was pregnant.  I bolted out of the bathroom and ran into Kara in the hallway.  I think I said, "There is definitely a second line today."  And I will never ever forget the look on Kara's face.  Her eyes got as big as saucers.  And she got a nervous smile on her face.  It was a wonderful moment.  

13dpiui - The digital test said "Yes".  I of course ran and jumped on the bed only to get a half groggy response from Kara.  That's what I get for testing at 4am and waking my lady out of a deep sleep.  The cramping continued all day.  I also used another test strip and while there was a line I think it was lighter than the line from the day before.  We allowed ourselves to be thrilled for a couple of hours.  We had a day trip planned to Erie, PA to visit with Kara's family.  We stopped to use the restroom a couple of hours into the trip and I noticed that I was spotting.  Oh the cuss words that came out of my mouth.  The spotting was minimal but noticeable.  At this point it was all old blood.  I called my really good friend and she managed to talk me off the ledge.  However, by the time we got to Erie, PA the spotting had increased and it included some pinkish blood.  The rest of the day was an emotional blur.  We actually ended up leaving early because I was once again dealing with being nauseous.  The spotting slowed down significantly by the time we got home.  I also seem to have an increased sense of smell.    

14dpiui - I spent the entire night being nauseous.  I took another digital test this morning and it said "Yes".  However, I am still spotting but it only appears to be old blood at the moment.  It is not enough for a tampon.  I am also still cramping and I am extremely tired but cannot seem to sleep.    

Here is the proof from 13dpiui and 14dpiui.

I will call my RE in the morning to report the positive pregnancy test that I got 14dpiui.  I am extremely nervous because the spotting continues.  I know that it is often completely normal to spot early in a pregnancy but it is not doing anything to help reassure me that this pregnancy will continue.  I also know that there is nothing I can do at this point.  I am trying to take it easy.  I must remember that today I am pregnant.  

Mary  

"they should give out frequent buyer cards"

Those were the words out of Kara's mouth as we waited to get called back for IUI #4 this morning.  I could not agree more.  We think a buy 6 IUIs and get the 7th IUI for free sounds like a great plan.  This conversation made me laugh.  We have gotten to that point.  Grrr.

The IUI went just fine.  The office was super quiet this morning.  I guess because it is a holiday weekend.  We even beat our RE to the office.  It was also sad because when I went to sign-in this morning I signed-in right below my name from yesterday's appointment.  Yep.  I was the last patient on Saturday morning and the first patient on Sunday morning.  I also discovered reason # 99 that I love my RE.  She wore flip-flops with her scrubs this morning!  She rocks in my book.  I mentioned it as soon as she walked into the room and she said she was afraid some patients would be upset.  I thought it was great!!  So onto the IUI ... Captain America was a bit disappointing this morning.  We had a total motile sperm count of 15.5 million.  These numbers are still good for a frozen sample but they happen to be the lowest numbers we have had up to this point.  That was a bit of a bummer.  Otherwise the IUI went according to plan.  No issues.  Though near the end of the IUI the RE went "Whoops" and then I heard a laugh from Kara.  Of course I cannot see a thing from my end and when you are messing with both an expensive vial of sperm and my lady parts I do not want to hear those words come out of your mouth.  I was like, "Huh? What happened?" The RE started laughing and said those were probably not the best choice of words.  It was funny.  She had actually just dropped the catheter on the floor but she was done with it anyhow.  Just another funny moment along this grand adventure.

Now we wait.

UPDATE:  I had an "oh s#&$" moment on Sunday evening.  I suddenly realized that we NEVER confirmed that we were receiving the right DS before our RE proceeded with the IUI.  Usually I am required to verify that the vial has both my SS # and the ID of our donor on it.  Yep.  We did not do that this time around.  What happens if I get pregnant and deliver a baby that looks nothing like our donor?!?  We could have a problem!!!  I can just see it now.  I'm sure all is okay.  I also think we were the only IUI that morning so I do not believe there could have been a mix-up.  But it still made me a bit nervous.  I mean Captain America's numbers were much lower this time around.  Coincidence?  I hope so!!  I just read too many news stories.

Mary

just another date with the RE

I had another u/s this morning.  It was fairly uneventful.  I only have two follicles that continued to grow after my last u/s.  I have a 19mm and a 20mm (one on each side).  The other follicle remained at 15mm.  My lining had also grown to 8mm.  This seems like a pretty standard number for me.  The nurse went ahead and did the hcg trigger shot because the other two follicles are considered to be mature and I am going in for the IUI tomorrow morning.  There is not a whole lot of other information to report.

Mary

slow and steady wins the race

I had my mid-cycle u/s yesterday.  I typically go for my mid-cycle u/s on cd 11.  However, this time I actually pushed the appointment up to cd 12 because of the events of last month.  The u/s determined that I was no way near ready to do the IUI.  My lining was at 6.3mm.  It looks like I have three follicles that are currently maturing.  Each follicle is about 15mm.  I was not totally surprised by the results of the u/s.  I am very in tune to other signs of impending ovulation and unlike previous months I have had none of those signs.  So I get to spend my holiday weekend with the RE.  Joy!  I go back for another u/s tomorrow morning.  I should hopefully be ready for the IUI on Sunday morning.  I am really nervous for some reason.  So send any positive vibes in my direction.

Mary