One Heartbeat, Two Sacs, and an Emergency

In my last blog, I talked about driving back to Houston with Abi to get a second opinion on my pregnancy. To continue ...

My doctor in Lafayette had seemed very unsure of what was going on with my pregnancy. I needed to talk to a doctor I knew and trusted, and I trusted the doctor that delivered Abigail with my life and the life of my children. So the morning after I got to Houston, I left Abi with a dear friend for the day, and I went to work in my old office.

My doctor's appointment was in the afternoon, and another friend of mine came with me to the doctor's appointment in case the news wasn't the positive news I was hoping for. My hope was that the doctor would do an ultrasound and find the baby immediately, and that all would be fine. I was actually quite optimistic all morning, and in turn I was very productive at work.

When I saw my wonderful doctor that afternoon, I was a bit surprised that, after hearing how my numbers were increasing slowly, she immediately said that it sounded like an ectopic (tubal) pregnancy. I hadn't even told her about the pain in my left side, and she hadn't even done an ultrasound, but she was pretty sure already. So she was not at all surprised when she did an ultrasound that she didn't couldn't find anything in my uterus. She scanned the tubes, but with the bedside ultrasound machine, she didn't see anything. She began explaining what would happen next ...

She would send me for an ultrasound in radiology so they could identify where in my body the baby had implanted. If they found a baby in a location other than my uterus, we would have to treat for an ectopic. There were two directions this could go: 1) If a gestational sac was found outside of the uterus, but no heartbeat, they would give me a chemotherapy drug that would destroy any fast-growing tissue in my body. That basically meant that the drug would kill my baby. It would also make me very very sick, and I would not be able to travel for a few days. 2)  If they found a fetus with a heartbeat anywhere outside of my uterus, I would have to have emergency surgery within a day or two. The surgery would remove the baby, and any part of my reproductive system that was damaged by the growth of the baby in the wrong place. The surgery would also end the  life of my baby.

But I kept thinking that there would be a third possible outcome: 3) They would find a set of twins who were just too small to be visible on a bedside US. I would be 4 or 5 weeks pregnant instead of 6 or 7, and I would get to go home with no issues.

A couple of hours later, I was laying on the table in the radiology department with an ultrasound wand inside of me. This was the first ultrasound I had ever had where they turned off the monitor on the wall so I couldn't see what was going on. It seemed to be taking forever. I must have been laying there for about 30 minutes before the ultrasound tech turned some nobs, and I started hearing a very familiar sound. It sounded like a very rapid heart beat, and I started to get very excited. I asked her what it was, and she hesitantly said, "That is just your blood pumping into your ovary." That's what she said, but I could tell she was not telling me everything. Soon after, the technician left, but told me not to get dressed in case the radiologist wanted to take a second look. And then I was alone with my friend, and I was very afraid.

The radiologist came in and explained to me that he had spoken to my doctor already, and that I would need to speak with her before leaving the medical center. He explained that they had found the pregnancy in or on my left fallopian tube, and that one of the babies had a heart beat.

One of the babies .....

One of the babies? How many were there? What did this mean?

He could see the shock on my face and quickly informed me that it was a twin pregnancy, but that one of the gestational sacs did not have a heartbeat that could be found.

And then I cried. I had held myself together all day, and I had been strong and optimistic. But this was too much. I had prayed for twins for years, and God was giving them to me and immediately taking them away. I was really confused, shocked ....devastated.

The radiology team excused themselves and told me I could get dressed, and to take my time. My friend held me and prayed for me while I wept.

And then I realized that I would have to explain this to my husband...that our babies didn't have a chance, and that I had to make the decision to go into surgery, knowing that it would end their lives. I was terrified that he would tell me to wait and that the pregnancy would kill me, leaving Abi without a mommy. I didn't want him to think I would make a decision to end the lives of our babies just to save my own. I was afraid he would think I was being selfish by listening to the doctor.

Two gestational sacs. The one on the left had a heartbeat.

He would want to see the babies, right? We had no evidence that they were ever conceived or even alive. I needed a picture. And so, I found the ultrasound tech and asked her for a picture, which is apparently not a common request from a mother who was about to say goodbye to her babies.

My friend and I walked out to her car while I waited for the doctor to call with next steps. And the whole way to the car, I told her how afraid I was of telling anyone. I felt responsible, and I was afraid to make the decision to have surgery because I was scared that I was murdering my babies. I didn't want people to think I had aborted the babies I wanted so very badly. Maybe I would have a couple of days to make the decision ...

And then the doctor called, and she told me that I needed to go straight to St. Lukes ER. My surgery would begin as soon as her associate could make it to the hospital. This was considered an emergency because with two babies growing rapidly, my fallopian tube could rupture, and I could bleed to death at any moment. They wanted me to be monitored in the ER until the surgery began so that if i started bleeding internally, they could save my life. She was apologetic that she couldn't do the surgery, and she was sorry about the outcome. I asked her if there were any other options to save the lives of by babies. And she said no.

It was time to start making phone calls. I was so afraid to tell anyone.

Pregnancy #3

In my last blog, I talked about trying to get pregnant again even though my uterine septum had partially grown back. To continue...

Finding out we were pregnant again the day of our move from our home in Texas to our temporary apartment in Lafayette was so awesome (April 2011). I was overjoyed! Before we ever found out we were pregnant, I began praying that God would cause the baby to implant in the perfect spot. The location of implantation was so important because I still had that portion of septum that could interfere with the pregnancy. I prayed every day before and after we found out we were pregnant.

Moving pregnant also presented us with the interesting challenge of finding another wonderful OBGYN while pregnant in a new city. We already knew that the Houston area was saturated with excellent health care and that we were moving to an area that has good doctors, but that was not saturated like Houston was. Our first Monday there, I started calling OBGYNs with good online recommendations, and I found several. Unfortunately, almost all of the doctors that I called were either not taking new patients, or they wouldn't take high risk patients. So I finally found a doctor that would see me before the second trimester, and he happened to be a Maternal Fetal Medicine specialist, which is a high-risk doctor. I scheduled an appointment for the following week at 5 and a half weeks pregnant. I was delighted they were willing to see me so early.

Later that night, I started spotting bright red blood. Abigail was already sleeping, so I left her and my husband at the apartment to sleep while I drove myself to the emergency room. I was scared, but I also had a peace about the pregnancy. I knew that the ER was the right decision, but I was also sure that things were going to be ok. The ER staff at 11PM were very busy. I was there until about 2AM before they took me up to have an ultrasound, which of course showed nothing but a thickened uterine lining at 4 weeks. They did mention that my beta HCG (the pregnancy hormone) was so low, they were surprised I could have gotten a positive on Saturday. They sent me home with instructions not to have sex and to take it easy.

The next morning I called my new doctor, and they told me to come in the next morning for my first appointment. They saw me, did a complete exam, and then scheduled me for not only another beta HCG test, but also a 1-hour glucose tolerance test ....at 4 weeks pregnant. They didn't have their own lab in the office, so I had to drive to a hospital to get the labs done. At this point, it was almost lunch time, and Abi was livid about the whole process. So when I found out that I would be there for over 2 hours for the 1-hr glucose, I wasn't exactly thrilled. We used all of Abi's snacks and watched a lot of PBS while in the lab that day.

The results were not stellar. I failed the glucose test, and was scheduled for a 3-hr glucose test. And my HCG had not quite doubled. For a healthy pregnancy, it should double every 48 hours, and mine was calculating to be almost 80 hours. I still had peace.

I went back to the lab for another HCG and the 3-hour glucose on Monday. Then on Tuesday, I went back to the doctor's office to get results and talk to them about what was next. I passed the glucose, but my HCG was still only doubling about ever 75-80 hours. The doctor and the ultrasound tech were out of the office, but the nurse practitioner explained to me that it might be a "chemical pregnancy" which would result in a miscarriage or would require another D&C. I still had peace, but I was starting to get a little nervous.

I was also starting to have a recurring sharp pain on the left side of my abdomen, which was not very bad. I assumed it was related to the pregnancy, but since it was not bad, I also assumed it was nothing to worry about.

The following week, I went back to the office to have an ultrasound. My HCG was about 2000 at that point, and a gestational sac should be visible when a woman's HCG is 1000. The ultrasound revealed nothing ....literally nothing. No sac .... nothing. I asked about the pain on my left, and the ultrasound tech and the nurse practitioner assured me that it was probably just the left ovary since it was enlarged from producing an egg. She also said that it was probably not a viable pregnancy and that I would get a call from the doctor.

At that point, I got scared. I held it together until I got to the car and got Abi buckled in. But once I called my husband, I lost control and started crying so hard I had to pull over the car. I decided that I really needed a second opinion. The ultrasound machine at that doctor's office seemed really old to me, and I had also experienced some staff incompetence at that office, so I had no confidence in what they were telling me. I scheduled an appointment for the following week with another doctor in the area so I could get another opinion. That afternoon, the doctor called me to review my ultrasound results, and he explained to me that it could just be an early twin pregnancy. He was not concerned, and he said we would repeat the ultrasound the following week.

I had work scheduled for the next few days in Houston, and I almost cancelled the trip in light of the news. But then it occurred to me that I could possibly stop in and see my amazing, wonderful OB in Houston to get that second opinion. I trust her completely, and I knew she would get to the bottom of what was going on. Their office was happy to oblige, and so I packed Abi into the car and drove to Houston.

I was feeling afraid and concerned about what I would find out, but I was also still upbeat and positive about how this pregnancy would turn out. I was sure that not only would God take care of my baby, he would take care of me.

We were going to be ok ....weren't we?

Moving Day

In my last post, I talked about having surgery to correct my septate uterus, finding out we were moving again, and finding out that the surgery was not 100% successful. To continue ...

So after taking a little over three months break from trying to get pregnant again so I could have surgery on my uterus, I found out that the surgery did not completely correct the problem. When I saw the HSG (dye test to see the shape of the inside of the uterus), it looked SOOOO much better than the pre-surgery HSG. The day of that test, I got excited about trying again and began planning. Then, about a week later, my doctor called me into her office and told me that she recommended having the surgery again. Apparently there was still a significant portion of the septum that had grown back together.

But I was already so excited about trying again .... She was changing my plans again, and I was not ready to hear what she had to say.

When she saw my spirit collapse in front of her, she backed off of her news and began explaining the risks of not doing the surgery again:
1. Miscarriage if the baby implanted on the portion of the septum that had regrown.
2. Preterm labor.
3. Continued difficulty getting pregnant.
She also explained that the risk of each of these possibilities had already been dramatically decreased by the first surgery. And then she left it completely up to me.

I took the information home to my husband, and we discussed the risks and benefits. We talked about the fact that we would be moving in April, which would be about a week after the earliest date I could schedule the surgery. We talked about how traumatic it could be to have another miscarriage, and how difficult it would be to have another baby go through an extended NICU stay with a toddler at home. And we prayed.

In the end, we decided that we would do one cycle of fertility meds with the fertility specialist before moving. If we got pregnant, we would pray A LOT for a healthy pregnancy and trust that God would not possibly let us go through another loss. If we didn't get pregnant, we would find a fertility specialist in Lafayette, and discuss it with the new doctor. We also decided that if we had another pregnancy loss, we were definitely having the surgery before trying again.

I started Clomid again with the March cycle, and we hoped for the best. We were not totally focused on getting pregnant because we were preparing for a move in just a few weeks. My husband had to start his new job on April 18, and his last day with the old job was April 15. We had one weekend to move. And we weren't moving from one house to another. We were moving into a temporary, furnished apartment until our house in Texas sold, which we were certain would take no more than a month or two. We packed up all of our necessities, some toys for Abi, and got ready to move into a furnished, non-child-proofed, 3rd story apartment that was about a third the square footage we were used to.

For about 3 days before our move, I took pregnancy tests every morning. (I use dollar store tests, so I wasn't blowing too much money on pregnancy tests.) The move was scheduled for the 11th day after injecting myself to make my body ovulate. Technically, it is possible to get a positive on day 10 after ovulation, so when I got a negative on day 10, I decided I was probably not pregnant.

The morning of April 16, when I woke up to start preparing for moving day, I decided to take another pregnancy test. To my surprise, it was a big fat positive. I was so excited, I woke my sleepy husband up before 7AM on a Saturday, which is generally a bad idea. So we were pregnant again for a move! Yay!

And then the panic set it. What if we had made a mistake? What if the baby implanted on the septum and we lost it? I had to make a very fast decision to trust that God would not let us go through another loss.

And we started our move ...pregnant.

Surgery and a plan to move

In my last post, I discussed my new correct diagnosis of Septate Uterus. To continue...

A new diagnosis ...It was actually a difficult challenge believing this new doctor we had just met.  I really wanted her to be right and to get the problom corrected. But the challenge came from 7 years of living with a wrong diagnosis. It was hard to get it in my mind that my uterine problem was correctable, and that I would be able to schedule surgery.

Because I was having a hard time accepting that the new diagnosis was correct, I was afraid of the surgery. The way the surgery would work is that the doctor would enter my uterus with a camera, called a hysteroscope, and an instrument that would cauterize the extra tissue inside the uterus that was dividing it in two. In a septate uterus, that tissue gets no bloodflow, in most cases, so the surgery wouldn't cause much blood loss at all ....unless the new diagnosis was not correct, in which case, I could end up with a ruptured uterine wall or a hysterectomy. The doctor was confident though, and she also planned to do a laparoscopy as well, to make sure the top of my uterus was flat, thus verifying her diagnosis.

Most women with a uterine septum as large as mine suffered multiple miscarriages before diagnosis, and for that reason, I decided it was worth the risk. And, although there is no proof, there are a lot of people who have connected infertility with uterine septums. In truth, there is a good possibility we have had several eggs fertilized that never implanted because the septum made it impossible.

So, now came time for scheduling ... My doctor told me she could schedule me for some time in February or March, but I told her I would talk to my husband and call the office to schedule. We decided to definitely do the surgery, so I called the nurse, and practically begged for her to schedule the surgery as quickly as possible. She was SO wonderful! She actually got me scheduled for just over 2 weeks later in late January 2011.

My mother was gracious enough to come down from Pennsylvania to take care of Abi and me during my recovery from surgery, and actually missed spending her anniversary with my dad. I was so glad she was there, because I was so afraid the day of surgery ....not for my life, but for my reproductive ability. Having her there really helped me stay calmer.

I don't remember waking up from that surgery, but I do remember my husband telling me that everything went really well, and that we could start trying after a couple of months and a good HSG confirming that my uterus was in much better condition. I was so grateful, hopeful, and anxious to get started trying again.

In February, my husband accepted a new position with a new company in the Lafayette, Louisiana area, and we were starting to plan another move. My hope was that we would have enough time to do one fertility cycle before moving to Louisiana and that we would move pregnant (again).

Then in March, I had an HSG, which showed that a small part of the septum had grown back ...sigh. My doctor recommended that we do a repeat of the surgery, but left it entirely up to me. She was willing to do a fertility cycle with me if we decided not to have the surgery again.

Decision time ...

Misdiagnosed

In my last blog, I talked about having to see a fertility specialist while trying for another child after Abigail. To continue...

From my first meeting with the new doctor, we discussed the possibility that I had been misdiagnosed with bicornuate uterus, and that the doctor suspected it may really be a septum, or septate uterus. The major differences were that Septate  is reparable, and can cause miscarriage and other complications, while bicornuate is irreparable, and only causes preterm labor. On my first visit with the new doctor, she recommended an investigative ultrasound to see if she could identify which condition I had.

Within 30 seconds of the start of the ultrasound, she told me that she was positive that it was indeed not bicornuate. It was actually a complete septum that split my uterus into two halves. This should be good news, right? It was a reparable issue. A reparable problem that causes miscarriage, preterm labor, and can contribute to pre-eclampsia...

Miscarriage - check
Preterm labor - check
pre-eclampsia - check

So basically, I had been misdiagnosed years ago, long before I started trying to have babies. It took me a couple of days to realize that if I had been correctly diagnosed from the start, my uterus could have been repaired, and I may not have lost Angel. I may not have had Abigail at 33 weeks, and we may not have had to spend 37 days in the NICU. I was beyond livid. I mean, I know doctors make mistakes too, but this one affected 4 lives, my entire family. And I had insisted multiple times that they double check to see if there was any possibility that I really had a septate uterus rather than bicornuate.

I remember exactly where Angel had implanted in my uterus, and it was right on the septum. The difference between a septum and the lowered fundus of a bicornuate uterus is that in the bicornuate uterus, there is blood flow. So, even though we saw a heartbeat at 6 weeks with Angel, my poor baby hadn't received the appropriate level of blood flow to stay alive in my uterus.

Besides anger, there were a lot of other feelings I had:

1. Regret - I should have gotten a 2nd, 3rd, or even 4th opinion when I was originally diagnosed. I should have been more vigilant until I felt confident in the diagnosis myself. Maybe Angel would have survived.
2. Guilt - My body was deformed in a way that killed my child. My baby didn't survive because he or she didn't get enough bloodflow to support life. And I had even more guilt that Abi had to struggle so much early on, also probably because of my deformed uterus.
3. Frustration - Now I would have to have surgery ...Yet another delay. I knew God had a plan, but it was so far from my plan! Sometimes I think God allowed these delays just to show us how much better His plan is.
   
   
4. Gratefulness - This is what I felt with the greatest intensity. Once I saw how little space there was in my uterus, I was again reminded of what a miracle Abigail is. We were so fortunate that she made it until 33 weeks gestation. It was a miracle any baby could have survived my uterus. But God knows the plans He has laid out for Abigail, and He brought her into this world miraculously. Since that realization, I have had several doctors remind me just how much of a miracle she is when they see my HSG from December 2010 and realize that she was born BEFORE my uterus was fixed.

I can rest in the knowledge that God has big plans for my little girl. She is special, and she will always be a beautiful reminder that God can still do miracles in our lives today.

Reproductive Endocrinologist (RE)

In previous posts, I described our battle with infertility, our subsequent 2 pregnancies and birth of Abigail, and our struggle to get pregnant again. To continue...

So after trying to get pregnant again with my OBGYN'S and Clomid's help for almost 6 months, I was referred to a Reproductive Endocrinologist (RE), otherwise known as a fertility specialist. I really struggled with the decision to go to the RE. I really believed that we shouldn't have to seek the help of a specialist because we had been pregnant two times already.

It was more though... I didn't want to acknowledge that our infertility was as much of a problem as it was. There are so many other women out there who are dealing with infertility far worse than ours. We were not so bad off that we required a specialist. Were we?
I had to let go of my pride.

My doctor had just gone on maternity leave though, and since I was not excited about seeing her partners, I decided to go ahead and see the RE. They had recommended one of the best-known REs in the Houston area, and I called to get an appointment. The earliest they could see me would be late March. That was almost FIVE months! I was also just not terribly comfortable with the doctor in question, and I am not sure why. I just didn't feel settled.

So I went to a wonderful RE that a good friend recommended. It took us a month to get in to see her, and we had our 1st appointment in December 2010. I talked to her about my previous diagnoses of Polycystic Ovarian Syndrome (PCOS) and Bicornuate Uterus and about our miscarriage and preterm birth with Abigail. I also told her that I had initially suspected that my Bicornate uterus diagnosis may not have been correct, but that it had been confirmed during my D&C after we lost Angel. When I told her that, she looked at me like I was a little crazy and told me that the doctor performing my D&C should not have been able to confirm a diagnosis like that during a D&C. She also told me that she would like to take a look to confirm that diagnosis herself.

After ordering a battery of tests, including labs and a HSG (which is a dye test and Xray of the uterus to determine how open my uterus and tubes are), she asked if I would like for her to take a look at my uterus via ultrasound to see if she could determine anything about the deformation (more on that later). She also offered to do some labs on my husband, but we declined the semen analysis. It just didn't seem necessary. He had managed to get me pregnant pretty successfully considering I was barely ever ovulating.

And so our journey with a fertility specialist began. I was excited, a little nervous, and definitely annoyed at the delay this was all causing. I had no idea what was in store for us over the next few months.

Here we go again

In previous posts, I described our infertility and pregnancy loss before having Abigail. To continue...

When Abi was 6 months old, I stopped breastfeeding so that I could start taking Clomid again in hopes of having another child close in age. My body had already returned to normal operation for a women, and in fact, was actually closer to normal operation than before giving birth ...at least for the first few months. I was also considering that I was 33, and it took about 4 years to bring Abi into our lives. That was in July 2010.

The doctor who delivered Abi started me on 50mg of Clomid. She was very cautious and monitored me through each cycle by doing several ultrasounds to determine if I was going to ovulate. The first Clomid cycle was very disappointing. No follicles matured, which means I wouldn't ovulate and there were not going to be any eggs to get fertilized. Then, since I didn't ovulate, I didn't start a period. So, in my mind, no period means that I could be pregnant! I began to have hope that God had done another miracle, and we would be welcoming another child to our family soon.

Every month for a women trying to conceive is like a dramatic ride. It is kind of like those swinging ship rides at an amusement park. You know... the ones that start slowly swinging and build up to the point where your hanging upside down for a few seconds? Well, that's what a cycle (or month) of trying to conceive is like. At first, you start getting hopeful, but you tell yourself not to get too emotionally involved. But as the month goes on, you have moments of confidence that you're pregnant and then moments when you are convinced that you aren't. And by the end of that two week wait between ovulation and expected period start date, you have days where you feel like you are hanging upside down.

So I took pregnancy tests ....lots and lots of them. Thank goodness for Dollar Tree tests, or we'd have spent hundreds each month on tests. Seven days and probably 10 hpts after my period should have started, my doctor started me on progesterone for 10 days to jump start my next cycle. A few days after I finished the prescription, my period started. I was so disappointed, but excited to get started on the next cycle.

The second cycle was slightly more optimistic because there was a follicle that had grown to about 15mm. Ideally, they want them to be between 17 and 23 for a good healthy egg to develop, so the doc gave it a few more days to grow and then triggered ovulation with an hcg injection. But again, there was no positive, and along came my period two weeks after the injection.

The third cycle was similar to the 1st and was also long and drawn out. Then the 4th cycle was similar to the 2nd despite using 100mg of Clomid.

So  after 5 months and 4 cycles, my OBGYN gave up and referred me to specialist.