Monday, August 4, 2014

A long absence...for a good reason

Oh, goodness, it's been a long time since I posted. I swear it's for a very good reason, though. I have a story to tell, and I'm going to tell it because it was thanks to hearing stories like this that I was able to get through my own experience. This is not a unique story -- plenty of people out there have been through their own version of it -- but it is a story that is often swept under the rug. Because of the almost taboo nature of the subject, I think a lot of people suffer rather unnecessarily. My hope, in telling my tale, is that anyone else out there who is struggling with this same problem will realize that they are not alone, and that a glimmer of hope is not always beyond reach. The story goes a little something like this:

Several years ago, I approached my sister-in-law, then a resident in Obstetrics and Gynecology, about the terrible time I had been having with my periods. This is something that I have suffered with my entire post-pubescent life. I have had dreadful irregularity, which has included having a period for weeks at a time, having a week off, then starting up again, as well as being in so much pain that I couldn't get out of bed. (I should mention that I am not generally much of a wuss about discomfort. I was back doing archaeological fieldwork less than a month after major abdominal surgery, just as an example.) I had been to doctors about this problem before, and most had patted me on the head and told me to take a Midol. My fabulous sister-in-law, however, said "That just isn't right," and arranged for me to see one of the doctors she studied under at the local University hospital. This doctor asked me loads of questions, ran some tests, and listened to my concerns over the fact that nothing had happened after 2 years of trying to conceive. She concluded that endometriosis was the likely culprit, and that a simple surgery would probably correct a lot of these problems, so I went ahead and scheduled the procedure.

Surgery day came, and I was wheeled off to the operating room in the hopes of waking up to a whole new comfortable world, and to the possibility of being able to get pregnant. When I woke up, however, I was given some slightly disheartening news. Years ago, I had lost an ovary and fallopian tube as the result of a cyst that caused ovarian torsion. Because of the fact that I was starting at a slight disadvantage when it comes to conceiving, the surgeons decided to check out my remaining parts in order to ensure that everything was in good working order. What they discovered was that my remaining fallopian tube was blocked. It appeared to be a blockage at the end where it enters the uterus, and so I was given a very positive prognosis. A simple procedure should have been able to open up the tube for me.

I was sent off to a reproductive endocrinology (RE) specialist who told me that, if the blockage was where the other doctors had thought it was, it would be an easy (although not permanent) fix. She said that, once the tube was opened up, I would have a good 6 months or so to try to get pregnant before it likely would close up again. In an effort to make sure that everything else was functioning before we tried opening the tube, my RE doctor put me through a battery of tests to make sure my hormones were working properly and that I had a good egg supply left to work with. Long story short: they were not, and I did not. Based on the results of my test, I was looking at an early onset of menopause. My egg quality had diminished substantially, and I did not seem to be producing eggs reliably. Any hope of becoming pregnant was beginning to fade, but was not entirely lost.

The option to open the tube was still a viable one -- there was, after all, a chance that a good egg would make it through -- so I scheduled the HSG procedure (hysterosalpingogram). This procedure involves injecting a dye (contrast material) into the uterus and then observing the path of the dye with a steady X-ray beam. (Incidentally, this procedure is NOT comfortable, no matter how much Advil they tell you to take! But it's not a long-lasting pain.) I watched the procedure on the X-ray monitor. My doctor showed me where the various structures were, and explained to me what she was seeing. In my case, there was only the very faintest trace of dye in the fallopian tube. It looked like fine, hair-like smudges in a couple of spots along the tube. This indicated that the blockage was not just at the proximal end. Instead, the tube was almost completely blocked along its entire length, making it un-fixable. My heart dropped at this news.

My doctor presented me with one last option: I could try injectable fertility drugs (hCG), which force the ovary to produce many eggs per cycle, in the hopes that one might find its way through the tube. After my first cycle, my RE performed an ultrasound and discovered that I had produced a small handful of eggs -- about four, if I remember correctly. This was not terribly encouraging. When women are injected during IVF cycles, doctors like to see more on the order of ten eggs. We had no luck with that first cycle of injections, so we tried again the next month, with a much higher dosage of the hormone. At the end of this second cycle, despite my dosage having been increased to the maximum, I produced even fewer eggs. This was not good news. My ovary appeared to be shutting down. My doctor sat down with us to discuss our options. Because of my lack of response to the fertility drugs, I was not a good candidate for IVF, nor was there much point in continuing the injections in the hopes of conceiving the "good ol' fashioned way." I was given a less-than-2% chance of ever being able to conceive naturally and the doctor said that, if I ever did manage it, the blockage in the fallopian tube would almost certainly cause an ectopic pregnancy that would have to be terminated. Our remaining options: embryo adoption, egg donation, or traditional adoption. Being a starving student, all of these options were, at least for the moment, out of our reach.

My husband and I grieved for a time, and then decided that we had done all we could do. We began to study adoption procedures, and we looked into taking classes so that, if we were eventually in a financial position to do so, we could pursue adoption. This was at the end of 2012.

In mid-February, 2013, friends of ours asked us out to dinner to announce their pregnancy. I was very happy for them, but our sad news from a few months before was still a bit raw, so the evening was rather bittersweet. I mentioned to the mommy-to-be that I was excited to eat some real food again, as I had been feeling really nauseated for about a week-and-a-half. I had no appetite, and nothing was sitting right. Perhaps I was just overly aware after news of our friends' pregnancy, but I started to think: I had been nauseated for most of two weeks, and I had been feeling very tired. I decided, on a whim, to take a pregnancy test....

...and there was a line! I was in complete shock, so I called my sister-in-law (the OBGYN). She told me to call my RE right away. If I was, in fact, pregnant, I would have to be checked out immediately, in case the pregnancy was ectopic. After what seemed like an interminable wait, my doctor called me with the results: I was pregnant! Based on the date of my last period, I was just barely pregnant -- around 4 weeks or so. My hCG levels were very high, though, for being so early in the pregnancy, so either my calculations were off, or I was pregnant with twins. (Spoiler alert: it was not twins. Phew!)

I went in for an ultrasound, to see if the embryo was in the right place, and it was. This little "bean" had made it through the tube, and had attached itself perfectly. I was measuring at 6 weeks, which was odd, considering that the date of my last period meant that I should be 4 weeks along. Regardless, I was PREGNANT!!! My elation was short-lived, though, as the doctor became concerned that she saw no movement or heartbeat. It turned out that my last "period" was actually the scary kind of bleeding that indicates a problem with the pregnancy. I was actually 8 weeks along, and had lost the pregnancy at 6 weeks. People who hear this story are always very sympathetic and sad over the loss of this pregnancy. I remind them, though, that, while it was a little heartbreaking in the moment, it was actually really good news. Contrary to all the medical opinions I had received, it was possible for me to get pregnant. And now that we knew that, my RE could help us with our baby-making schedule, and could provide the appropriate hormonal support.

So, after having to take Misoprostol to deal with the missed miscarriage, we started trying to conceive, with the help of my fabulous doctor. I'll skip past all the remaining gory details and just tell you that, on June 19, 2013, this happened:

and then, over time, this happened:

with a little of this along the way:

 and then, finally, THIS happened:

We welcomed our beautiful, healthy little boy on February 27 of this year. He is now a beautiful, healthy, active, sweet, and hilarious little boy of 5 months. I was sick as a dog the whole pregnancy, gave them a couple of scares at the end, and had a long and somewhat difficult delivery...and I would do it all over again to get to meet this little fellow! I am still completely stunned by how things worked out. I thank my lucky stars every day, and I thank that first little "bean" who didn't make it. Whoever he or she was did a wonderful thing, I think, and got my "oven" all ready to bake an amazing little boy.

I am so grateful for the help and support of my doctors, family, and friends throughout this whole ordeal. It has been a definite test of my mettle, and of mine and my husband's strength as a couple. I couldn't have survived the last several years without my husband's constant love and support. Even when things were at their darkest, he was able to lift me up, and to remind me that not all was lost and that things have a way of working out.

So, to any of you out there who are struggling with similar issues, I encourage you not to give up. I know this same story won't happen for everyone, but if you can manage to cling to a little glimmer of hope, you never know what might happen. I think, for me, relaxing after accepting that pregnancy was not in the cards, as well as the effects of what we thought was an unsuccessful medical procedure, were the keys to our success. To all you ladies who are struggling, I wish you all the best of luck and encourage you to remember that you're not alone. We're all cheering for you (including Baby O)!