Sunday, June 1, 2014

Moving forwards

After the miscarriage and D&C, it took a little while for the results of the pathology and genetic testing to come back, but eventually we got the results: everything was normal. We've joined the unhappy club of people who have a miscarriage and never know why. People tell me "There's a reason for everything" and I shrug, grit my teeth, and say something along the lines of "That's what I hear" while trying not to say "FYI, I don't find that remotely comforting or helpful, especially since we'll never KNOW the reason...". This was good news, it means there's no need to worry about getting an egg donor.

Once I started my period (about 5 weeks after the D&C), I was scheduled for a hysteroscopy there at the clinic in Los Angeles. Hysteroscopy is a procedure that can be used for different things. In my case, it was just a matter of applying a local anesthetic to my cervix, dilating my cervix slightly, and inserting a scope so the doctor could see the inside of my uterus, in full color, in real time (and very magnified) on a screen (as opposed to using an ultrasound to look around from outside my uterus). Since Dr. Ringler was out of the office that week, Dr. March did the procedure. I'd never met him before but he quickly set me at ease with his cheerful and friendly manner.

I have to say, it was REALLY cool to get to see the inside of my uterus via camera. I even got to see where my fallopian tubes enter my uterus. How awesome is that? Anyways, Dr. March said he was looking for 3 things:
1. Anything that could have caused the miscarriage (not a huge concern, but take a look and see just to make sure).
2. Retained tissue
3. Scarring or any other signs of problems caused by the miscarriage and/or D&C
He didn't see anything for #1. There was a TINY bit of retained tissue still attached to my lining but he was able to quickly cut it out with no issues. He said it was extremely microscopic and that an ultrasound would never see it, and that it's actually probably pretty common but just not known and not problematic. The one I was most anxious about, #3, was all clear. He said my uterus still looks absolutely perfect and ready to go for another round. I'm pretty sure my sigh of relief was audible.

The next round will be a frozen transfer again, since they don't want to start me on meds before getting PGD and knowing we have good embryos (dropped cycles sucks, nobody likes them). IM is supposed to be going for ER (Egg retrieval) at the end of the month and with any luck, we'll be able to transfer again at the end of July. That works out nicely for me since I'm taking a couple of summer classes and the semester ends July 25. :P

So, that's where we're at right now. I'm still taking my prenatals and just waiting to get word that I can start meds again. I have a love hate relationship with that PIO... lol

Monday, May 19, 2014

Hello and Goodbye

It's been a while since I last blogged. It's been a roller coaster of emotions. Trigger warning: miscarriage, D&C.

On January 30, the two remaining embryos my IP's had frozen were thawed and transferred to my uterus. It was an exciting day.

4 1/2 days later (4.5dp5dt), I took a home pregnancy test. There was a VERY faint line. 12 hours later, the line was darker and no squinting was necessary. I emailed IM to tell her the good news. She was thrilled. Over the next few days, my tests continued to get darker and I got more and more antsy for my beta (blood test that measures the exact level of hCG that's present in (of course) your blood).

6.5dp5dt BFP (Test: First Response Early Results)

On February 10, I went to the lab and had my blood drawn. The results were good, my beta was 415! A week later, I went for a repeat beta (they do two to make sure your hCG level is rising properly indicating a viable pregnancy) and the result was 5906. Again, a very good result.

On February 27, at 6w5d pregnant,I went for an ultrasound at the clinic here in town that was being used as my monitoring clinic (since my doctor is a good ways away, most of my appointments for ultrasounds are done at this clinic and the doctor there sends the reports/results to my doctor).

Ultrasound pictures from 6w5d. Fraternal twins!

We were able to see that both embryos had stuck around and were able to see and hear both of their heartbeats. When the picture came up on the screen, I think I said something brilliant like "Is that two? So that means it's twins, right?". It was amazing and incredible and super cool. In all honesty, it also felt a bit overwhelming at first. Even though I had known that transferring two embryos meant chances were good I'd carry twins, and even though I'd had a gut feeling since early on in the home pregnancy tests that it was twins, it was still this slap of reality that "HOLY CRAP! There's TWO in there!!!". I think I actually told a friend "I know how to be pregnant. I'm good at being pregnant. I have no clue how to be pregnant with twins.". I was scared, but also excited, and my IP's were over the moon. I was even more excited that evening when I found out that I only had to do one more shot of Delestrogen and would then only be taking progesterone via injection and via vaginal suppository.

On March 13, 8w5d pregnant, I went back to the monitoring clinic for another ultrasound. Both babies still looked good, were actually recognizable, and had great heartbeats. One twin was still measuring a few days behind the other, but everything looked picture perfect. I was told to go ahead and schedule an appointment with my OB  for 3-4 weeks later.

Ultrasound pictures from 8w5d. 

On March 28, I had a blood test to measure my progesterone levels. My progesterone levels were sufficiently high, and I was far enough along in pregnancy, that I was able to stop doing the injections. I was to continue the vaginal suppositories for a few more days and take my final suppository the evening of March 31. March 31 was also my first OB appointment, so it was a Big Day that I was counting down to.

March 31 rolled around. It was a Monday, and the first day of Spring Break. I was 11w2d pregnant. I was excited to see my OB (she was also the one who was present when I delivered my youngest son and she's an absolute doll). I was excited to get to see the twins and have more ultrasound pictures and video to send to my IP's (Besides emailing them u/s pictures, I'd been able to use my phone to record parts of the u/s and send it to them, so they could see movement and see and hear the heartbeats). Since my OB is herself the mother of twins, I was looking forwards to her input on carrying and delivering twins. I also wanted to find out whether she usually sees twins born before 40 weeks, what the latest is that she'd permit me to travel for an uncomplicated twin pregnancy, and other such questions.

I went back to the room. My OB came in the room, hugged me, and we exchanged greetings. I told her, quite excitedly, the story, and she asked a few questions to make sure the details in my chart were correct. She then had me lie down on the exam table for a quick check of my uterus size. Then, it was time for The Ultrasound.

In the space of seconds, the world came crashing down around me. She asked if I knew which twin had been measuring smaller and said that the first one she was looking at didn't have a heartbeat and was behind in . I wasn't totally shocked since one twin had measured a few days behind from the first ultrasound and I had known this was a possibility. She moved the u/s wand around to look at the other twin and... nothing. Two babies in two sacs, no heartbeat, no movement. Nada. They were just floating there, motionless; it was as though time had stopped inside my womb.

Upon measurement, the twins measured at 9w2d and 9w5d, indicating that they had died about a week after my last ultrasound at the monitoring clinic, they had been gone approximately 2 weeks by the time of this OB appointment. I don't have a very clear memory of everything the doctor said, aside from "I'm so sorry. I wasn't expecting this at all". She told me that she'd do another u/s, or be happy to give me a referral to a different OB or back to the monitoring clinic if we wanted someone different to take a look. She talked with me about the options moving forwards (wait for my body to miscarry on it's own or various methods to manage it medically), genetic testing, etc. I told her I'd call her back as soon as I'd had a chance to talk to my IP's, the fertility doctor, and the agency to see what needed to happen.

I headed home with my husband driving (he'd been in the waiting room with our kids). I dropped them off at home and headed out: partly to get some time to myself to think and process, partly to get a cell signal so I could make some calls. I remember it was raining. I had a phone call with a wonderful young woman from my church; at the end of the phone call (which left me both in tears and feeling a slight measure of comfort), a huge and beautiful rainbow appeared. I remember thinking that both the rain/dreary weather and the rainbow were appropriate.

The decision was rather quickly made to have my OB do another u/s to confirm that we had a missed miscarriage on our hands and, barring a literal divine miracle, schedule a D&C. They wanted a D&C so they could be sure of having all the tissue collected to send for genetic testing to make sure that there weren't any genetic abnormalities at fault. I wanted to just get it over with and to NOT have to remember the process of miscarrying. It was also convenient since I was on Spring Break. I wasn't particularly keen on the idea of waiting it out, going around uncertain when it would happen, worrying about miscarrying in the middle of a math exam, speech in class, at church, or out to dinner with my family. I just wanted it done and over with. I thought multiple times that this had to be some type of horrible April Fool's Joke. It wasn't.

On April 2, I went back to the OB for the follow-up ultrasound. I had been told earlier that the doctor had a patient in labor so there was potential that my appointment could wind up rescheduled if a delivery was taking a while. I got to the office and sat there in the waiting room. I had brought my iPad fully charged with a couple of new books loaded on my Kindle app. I always expect to wait at an OB/GYN's office because babies, like honey badgers, just don't give a flip. During the course of my wait, I was treated to  quite a performance by another patient and her mother (both fully grown "adult" women), who stormed out yelling about having to wait for the doctor and how dare they, and slamming the doors so hard the walls rattled (literally. The walls rattled. That's not an exaggeration). The other patient in the waiting room and I exchanged The Look, raised eyebrows and everything, and discussed how ridiculous it is to be upset at having to wait for a doctor who delivers babies, and how much we like that an OB/GYN who takes her time with her patients, including in office visits, rather than rushing you and ignoring questions. I do remember thinking "Those women should STFU. For all they know, the doctor could be running behind because a patient ended up with an unexpected missed miscarriage showing up on the ultrasound".

Eventually, it was my turn. As I had expected, there had been no Heavenly AED, no angel Gabriel who did fetal CPR, no miraculous divine intervention. The doctor scheduled me to go to the hospital for a D&C on April 4. I had wanted to go in the next morning but she explained that it would be better for me to come to her office the next morning and have a laminaria inserted into my cervix, to allow me to dilate more slowly over time, thus lessening the risk of damage to my cervix that could occur by just forcing it to dilate suddenly.

April 4 came. I took a Valium the night before to help me sleep and to have me a little less high strung the next morning. It also needed to be the night before because the hospital didn't want me to eat or drink anything after midnight since I would be going under general anesthesia. Anyways. I had to be at the hospital by 6:30 to get pre-op stuff done. I arrived, filled out the last of the paperwork (most of it had been done the day before with admissions), and got dressed in the lovely hospital gown, socks, hair net hat thingy, and whatever else they had me put on. There were those little wrap thingies that go on your calves to hook up to a machine that massages you, I think, to keep circulation going or whatever. I was eventually whelled into the pre-op area, where I read my chart out of boredom and tried not to cry. I was given a dose of... erm... some IV drug that was to help me relax and to get me started on the path of anesthesia. Shortly thereafter, I was wheeled into the OR where I was greeted by the anesthesiologist and my OB. My last clear memory was of the doctor telling me hello. The anesthesiologist was very good at his job because I don't even remember getting sleepy. I think I remember being asked to breathe something through a mask but t's very hazy and I can't swear that it actually happened vs. being a figment of my imagination.

I closed my eyes to blink.

I opened my eyes and I was lying on my back, staring groggily up at the ceiling, with someone saying "There you are." and the OB telling me "It's all over, it went fine.". My throat stung a little from the tube that had been in it while I was under anesthesia. I immediately started to cry and someone got me another dose of medication to help me calm down. I was wheeled back to recovery, and then wheeled back to my room. Eventually, I was able to go to the bathroom to get dressed. I sat down on the toilet, passed a very large clot, freaked out, and pulled the emergency call button thinking I had just passed some retained placenta or something. Nope, clots are normal. Oops.

I was discharged. I declined any pain medication, having been told I would experience "cramps". My friend took me home. When I left that morning, I had set up the couch downstairs with blankets, pillows, etc. so that I could just go to sleep there and not have to worry about navigating the stairs. After I got home, I decided it had been a very smart idea. About this time, I decided that "cramps" was a piss-poor description and informed the cat that I was pretty sure my uterus was trying to claw it's way out of my body through my belly button. I took 800mg of Motrin and curled up, moaning and groaning and pretty much cursing Eve for eating that damn apple. The cats were very attentive to me all day and were obliging enough to curl up against my abdomen and purr, which actually did help my cramps (vibrating heating pads are the bomb for cramps, btw). Another friend brought supper by that evening.

And that's the story of my first surrogate pregnancy.

It was one of the most emotionally difficult things I've ever gone through. Just recounting the events is difficult, even without getting too much into the emotions and recovery. It seemed most appropriate that the evening I found out the twins were gone and the next day were rainy and dismal and dreary. It was as though heaven and nature wept with me.

I can't really describe adequately what it felt like, to lose someone else's babies. To lose something that is in me but not mine, but entrusted to my care. Grief, anguish, anger, confusion, guilt (lots of guilt, even though I knew it wasn't my fault), sorrow... so much pain, and being upset for my IP's, grieving for and with them and for their loss. My heart breaks for them, for everything that they've been through, and now this, just when it seemed like everything was perfect and it was meant to be. I have felt so much pain, but it's not a pain that I can describe, or that anyone can understand unless they have themselves been in that situation.

I'm doing a lot better now, and my IP's and I are moving forwards to try again. I'm going down to LA this week for a hysteroscopy to make sure my uterine lining is still in good shape. I'm hoping we can start cycling again soon and transfer again before too much longer. The next round will be a fresh transfer since the twins were the last two embryos my IP's had frozen.

I had planned to focus this post more on emotional aspects of what it's been like in the emotional aftermath, but I think I needed to just write down What Happened, to process the timeline. I may write more later about the topic, I may not. I don't know.

Dearest little twins,
You were so loved by many people.
You were wanted more than words could truly describe. 
If there were anything I could do to bring you back, I would.
I would move heaven and earth if it meant I could deliver you safely into your parents arms, full of life.
But I am not God, and I can not.
So all that I can do is to carry your memories with me through life, 
to honor your memories as best I can.
I promise that you will never be forgotten and will always be loved.
You were in our lives for such a short time, but you made an impact.
I will speak only for myself and say that you changed my life.
Like little butterflies, you came and went, fragile but beautiful, not there for long, but most certainly There.
For you I sing:

"Said goodbye, turned around
And you were gone, gone, gone
Faded into the setting sun,
Slipped away
But I won’t cry
Cause I know I’ll never be lonely
For you are the stars to me,
You are the light I follow

I will see you again, whoa
This is not where it ends
I will carry you with me, oh
'Til I see you again"
-See You Again, by Carrie Underwood

Tuesday, January 14, 2014

2 shots down, lots more to go

I am officially cycling now. My period started on 1/9, as expected, so I went on 1/10 for my labs to measure my Estradiol (E2) and Progesterone (P4) levels. Both numbers were good and indicated that ovulation had been suppressed. I was a little worried because after I got back from Texas, I got sick with sinus and respiratory crap (thank you pollen) and had to take antibiotics towards the end of the BCP-taking. Anyways, my lab results were fine so I did my first self-injection that night (the 10th): .1 cc (aka 2 mg) of  Delestrogen (a brand name of estradiol valerate). The reason I say .1 cc is because I have  a 1 cc syringe and when I draw my meds, I pull the plunger to the .1 line.

I've now done two shots of the Delestrogen. I take it every 3rd night. I go back to the lab tomorrow (1/15) to get bloodwork done to recheck my E2 levels and see if my dose needs to change. On 1/22, I have an appointment at an IVF clinic here in town to repeat my E2 and P4 labs and (most important) to do an ultrasound to check my lining. We want to see that lining be nice and fluffy!

The Delestrogen injection hasn't hurt too bad so far. Actually, it hasn't really hurt at all beyond the initial pinch when the needle pierces my skin. I feel this weird combination of relief that it doesn't hurt and worrying about "What if that means I'm doing it wrong?". LOL! Silly Esther.

For those of you who are interested in the specifics and fascinated at the thought of me stabbing a needle in my own butt (hi Kelli!), I'll ramble on about that for a few minutes.

Earlier in the afternoon on 1/10, I started crowd sourcing the surrogacy groups I'm in on Facebook, asking for the videos that they watched and found the most helpful in learning how to give themselves shots. There were a couple that, while detailed, I didn't find too helpful because they were videos of a nurse giving someone else an IM injection. It was helpful to hear the description and specifics, but not so much on how to do it while watching the needle for blood, finding the right spot on yourself, etc. (For anyone who's interested, the links to the videos of the nurse demonstrating IM injections are here and here). The video that I personally found most helpful is this video by a surrogate.

I think I follow Becca's instructions pretty much exactly, with one exception. She recommends using a rice heating pad to warm the meds in the syringe after you draw them. I didn't have any kind of heating pad so I came up with my own method: to warm the meds in the syringe, I just tuck them under my breast and keep it there for a minute while I have an ice pack on my butt. I like that my method requires no extra supplies and prep. And after nursing 3 babies, my boobs are floppy enough for that to work. So, that's a little trick you can try.

Here's a picture of my supplies:

I made the mistake of not unwrapping the syringe and needles before I got started. I only made that mistake the first time, it made the process so much more clumsy. For shot #2, I unwrapped everything before I got started and it all went much faster.

The syringe is a 1 cc syringe. It comes without a needle so I have to attach the 18 gauge needle (pink top) first. That's the needle I use to draw the medication from the vial. Since the Delestrogen is a medication in oil, it's thick and comes out super slow so you want the larger needle for that. After drawing the Delestrogen, I switch to a 22 gauge needle (gray top) which is smaller, to do the actual injection.

For switching the needles, the Nurse Coordinator gave me a hint that I had either missed or nobody else had told me: draw a big air bubble BEFORE taking the 18 off and putting on the 22. I'm super glad she included that in her voicemail telling me the labs were good and to start injections.

That's about all I can think of to say about sticking myself in the butt, aside from reiterating that if you're doing these injections, MAKE SURE you switch the 18 gauge needle for a smaller one between drawing the meds and doing the shot. That thing is HUGE and would hurt like the dickens if you forgot and tried to use it to inject. Dear sweet 8 b. 5 oz. Baby Jesus wrapped in a swaddling cloth and lying in a manger, pleeeeeeeeeease don't ever let me forget to swap my needles.

I'll close with a little joke I came up with, all on my own. Ahem. *taps mic* Ready?

Some ladies do shots of tequila. I do shots of hormones.

HA! I crack myself up.

Thursday, January 2, 2014

Legally cleared and on the calendar

Sorry I'm behind in updating, December was a crazy month, between Final Exams and the holidays (and, of course, surrogacy stuff). I hope y'all had a great holiday! I went back home with my husband and kids to spend Christmas with my family. It was really nice to be back with everyone for about a week. I'm now on break from school for the month of January until the Spring Semester starts at the beginning of February.

On to what you're really interested in, surrogacy updates! The contract portion of the process went really fast. After my attorney sent my requests back to my IP's attorney, they responded with another draft with some of my requests accepted, some changed, and some turned down. Compromise FTW. :D I was happy with how it all read so we were able to get the contract signed at both ends and had legal clearance before Christmas.

It was just in time, since I started my period on December 21. My Nurse Coordinator called in a prescription of birth control pills to a pharmacy near my parents house and I got started on those. I've learned pretty fast that unless I want to spend the morning nauseated, I have to take the BCP with a full meal, and eat my meals at regular intervals, as well as snacks.

My last BCP will be on January 5th. When my period starts (projected to be ~1/9), I'll go early morning the next day (CD - aka Cycle Day - 2) to a lab here in town to get my Progesterone and Estradiol levels checked, and that's also the day that I'll start doing Delestrogen injections.

Speaking of Delestrogen and injections, I got my box of meds today!!! It came via FedEx and was SO exciting.

The contents of the box:
-1 Sharps shuttle
-Vials of Delestrogen and PIO (Progesterone In Oil), I'll take these via Intramuscular injection
-Boxes of Endometrin (Progesterone supplements that will be administered vaginally)
-Prenatal vitamins
-Various syringes and needles for the Delestrogen and PIO injections
-Valium to take prior to the transfer
-Doxycyclene and Methylprednisolone, both to be taken orally (there are 5 each of both, I think one is to prevent infection from the transfer and one is to reduce the risk of my body rejecting the embryo).

-Various supplies for the injections, like a LOT of wipes for the site and the top of the Delestrogen and PIO bottles

If we were doing a fresh transfer, I'd also have to do Lupron injections. Some doctors still do Lupron for frozen transfers, mine does not. I'm cool with that. I'm not scared of needles but I'm also cool with not having to do any more meds and injections than necessary. :D

Like I said, I'll start Delestrogen injections on CD 2. That's projected to be 1/10. As long as my mid-cycle monitoring appointment on the 22 goes well (they have to check my hormone levels again and do an ultrasound to verify that my uterine lining is at the thickness they need it to be at that point), transfer is scheduled for January 30. I'm so excited!!!!!!!!!!!!