Tuesday, February 15, 2011

Miscarriage April 2009 at 5 1/2 weeks
Miscarriage December 2009 at 6 weeks
Missed Miscarriage December 2010 at 10 1/2 weeks
Melbourne, Australia

I am 33 years old and my husband and I have been trying to conceive our first child since January 2009. For a long time I thought I would never be married.  I have mild cerebral palsy which affects my left side and I was always aware that this might put some guys off.  But my biggest obstacle to meeting someone was myself - I didn't have much confidence.  
That all changed when I met my husband via the internet.  From the beginning he loved and accepted me for who I was (as clich├ęd as it sounds).  We met in October 2006, were engaged in November 2007 (on my 30th birthday) and got married on 2 November 2008.

We didn't see any point in waiting to start a family; buying a house could wait but my biological clock could not.  In late 2008 I saw the doctor to get various pre-conception blood tests and other checks done.   I'd had a history of serious episodes of depression and had been on Zoloft for a number of years.  Previous attempts to stop it had not gone well.  Despite this, and despite not looking into my psychiatric history, the Doctor recommended I wean myself off the meds.  Since I thought it would be better for my future child I agreed.

In January 2009 we started trying.  It felt like ages, but our first pregnancy in April 2009 was achieved after 4 cycles.   My due date was Christmas Eve.  We were cautiously excited and told our close family straight away.  Almost immediately, however, I started having trouble sleeping and eating and suffering severe anxiety.

About 2 weeks later I started having some minor spotting.  The Dr sent me for blood tests and at the same time started me back on the Zoloft.  As a result of being off my meds, the stress about the pregnancy and a busy time at work, I had an anxiety attack at the office.

Tests showed my HCG levels weren't doubling as they should have been and the Dr was worried the pregnancy might be ectopic, so sent me for a scan.  The scan showed a sac and yolk sac and no foetal pole (unsurprisingly as I was only about 5 1/2 weeks).  They told me to come back in a week or so but not to worry unless the bleeding turned bright red. 

A few days later I woke up with bright red bleeding and got DH to take me to hospital.  A further scan was still inconclusive, but the blood test indicated the pregnancy was not going well.  I had already booked into a private hospital and OB.  That day I found  myself at the OB, but not for my first check-up but to tell me that there was no chance this pregnancy would be successful.  He gave me the choice of a natural miscarriage or D&C and, as I was barely coping as it was, I opted for a D&C.

I had a few days off after that.  Unfortunately I couldn't seem to get myself on an even keel.  I was still unable to sleep and this was just lowering my threshold for everything that was going on.  I had a meltdown, became suicidal and had to be hospitalised. 

What followed was several months of trying to get my mental health sorted out.  I went back home to my folks for about 3 weeks and had about 6 weeks off work.  When I came back to Melbourne I found a specialist peri natal psychiatrist who would help me deal with what had happened and advise on my medication for future pregnancies.

We started trying again in about October or November 2009.  In December 2009 I got my second BFP.  A few days later I was at my Dr (I had changed practices by then) having the pregnancy confirmed when I again had some spotting.  The Dr wasn't too worried, telling me it was probably just some implantation spotting.  I told her I'd also been having some mild left-sided pelvic pains.  As I was only about 4 weeks she said it was too early to be from an ectopic and was probably just a luteal cyst.

A couple of days before Christmas I was still having spotting.  I was also still having the pain but it was mild.  The Dr sent me off for a scan that day.  Again they saw a sac and yolk sac but no embryo.  They deemed it 'inconclusive' and told me to wait a couple of weeks.  The next day I had a feeling AF was about to arrive and sure enough I had started bleeding.  I miscarried at home over the Christmas break.

After the 2nd miscarriage I didn't get depressed; I got angry.  I started doing lots of internet research on why I couldn't seem to get past 6 weeks.  I remembered that in early 2009 I had been for a pelvic ultrasound to rule out ovarian cancer because I was getting a lot of vague abdominal symptoms and I'd read that they could be an early warning sign.  The scan had revealed no issues with my ovaries but had shown 2 small fibroids in my uterus.  I started reading up on the link between fibroids (especially submucosal ones) and miscarriage.  My Dr didn't dismiss the idea and said I should keep my appointment with my OB when I should have been 8 weeks.

I told my OB I was not prepared to try again until I'd had some investigations done; that in fact I'd told DH to use condoms until we'd had some testing.  The OB gave me the old line about not generally testing until 3 miscarriages.  I didn't see why I should have go through another one just to satisfy some statistical threshold.  Two had been more than enough for me and I was prepared to pay for the testing myself if necessary.  The one thing I wasn't prepared to do was to plunge back in to trying without at least satisfying myself I had done all I could to find out if there was an underlying reason.

The OB reluctantly agreed to refer me to a fertility specialist, telling me he didn't think my fibroids were a problem and the tests were "unlikely to show anything".

A couple of months later I saw the FS.  She too told me I didn't qualify as a recurrent miscarrier, but she agreed to refer me for tests.  Nine vials of blood and another encounter with "dildo-cam" aka internal ultrasound later (plus 1 vial from DH) the only abnormality detected was what the FS thought was a polyp.  She scheduled me in to have it removed and said she'd do a hysteroscopy and D&C at the same time.  When I woke up she said that she'd found a 3 cm fibroid, not a polyp, and that she'd have to refer me to a different OB to remove it.

A couple more months passed until I could see this OB.  He said that it was quite possible this fibroid had caused my miscarriages and that he could remove it no problem.  I remember his words: "don't worry - we'll get you your baby."  On 1 September 2010 he performed a hysteroscopic myomectomy.  The surgery went well and the OB said we could start trying again straight away.

November 2010 and our 2nd wedding anniversary came around.  We went away for the weekend to celebrate.  I was feeling really 'off' and just felt I was pregnant.  The following Tuesday I got my 3rd BFP.  This was it, we thought.  My squatter (aka fibroid) was gone, and I had the FS monitoring me.  Surely we couldn't be that unlucky 3 times?!

The pregnancy was monitored with serial bHCG and progesterone tests. I had 3 blood tests - the first at around 17DPO, the second at around 19DPO. The third blood test (at approximately 6 weeks) showed a falling progesterone level but appropriate HCG so the FS started me on progesterone pessaries once a day.   I had a tiny bit of brown spotting a few times but tried not to worry as it was not getting any worse.

At what should have been 9 weeks gestation I went for a scan.  I waited to see a little heartbeat on the screen.  The sonographer was silent for a while, and I knew it was too long, but couldn't bear to ask if everything was alright.  The sonographer said, "I'm sorry, I'm having a lot of trouble finding a heartbeat."  She told us the scan showed a sac and yolk sac of approximately 6 weeks size but no foetal activity.  The sonographer questioned whether we might be wrong about the dates but, since I was tracking my cycle we hadn't had sex since my BFP, I knew it was mathematically impossible for me to be only 6 weeks along.  I just felt empty.  I had tried not to let myself become emotionally attached to this pregnancy to protect myself.  Still, I had worked out when my due date was (only a few weeks after my sister-in-law's and that of one of my best friends) and started thinking about when I would go on maternity leave. 

I got up from the examination table and went over to DH, who was sitting next to me.  I saw that he had tears in his eyes.  That was it for me.  In the four years we'd been together I'd only seen him cry one other time.  We walked back to the car speechless.  DH called my parents from the car to tell them.  When we found out about this one it was the most awful feeling. I wasn't even really surprised...more just resigned to this happening over and over to me, and starting to feel like I'm just not destined to get to be a mother.

We were house hunting at the time and had a number of inspections booked for the day after the scan.  I told DH to keep them, hoping that keeping busy would keep me from succumbing to despair.

Five days later after the miscarriage I had a D&C as I had not started bleeding and was not prepared to wait it out. I also hoped that genetic testing might be able to be done on the embryo, however the FS warned that this might not be possible, since the pregnancy had apparently stopped progressing 3 weeks before the scan.  I was desperate for some kind of explanation.

The Dr gave me Misoprostol to take 3 hours before surgery. Unfortunately I was only taken in to surgery after 10 by which time the Misoprostol was working really well and I was having the worst period cramps I've ever had.  If I had known I wouldn't be going in to surgery until 10 I would have taken the Misoprostol at 7. Of course because I hadn't had the surgery yet they couldn't give me any painkillers.

The Dr sent off some samples to pathology but wasn't sure it would be capable of being tested.   Luckily they managed to do a karyotype test.  A few weeks ago we got the result: trisomy of chromosome 16 - incompatible with life.

At the moment I am waiting for the results of a coeliac antibody test to explain those same gastrointestinal symptoms from 2 years ago.  My research has indicated that this can also be related to recurrent miscarriage.  When I speak to the FS we will talk about the plan for trying again. In the meantime I just have to figure out how to pick myself up off the floor and get the courage to try again.   At the moment it seems like everyone around me is either pregnant or has just had a baby.  I struggle with seeing my pregnant friends and the mixed emotions of being happy for them and my own pain, jealousy and anxiety that it will never happen for us.  It wears me out emotionally.  Spending time with your friends shouldn't leave you feeling like you've done 9 rounds with Mike Tyson.

I know that statistically we still have a good chance of having a healthy baby.  But I'm not a statistic…I'm just me.

Adrienne blogs at http//tryingtimes-au.blogspot.com 
You can contact her at adijoe.rsvp@gmail.com


Loni said...

I'm so sorry for your losses...I understand your anger, grief, and frustration. I too have 3 losses and am currently awaiting my 2nd myomectomy. It seems I grow fibroids like grass unfortunately. I hope to share my story with Faces of Loss soon when I can build the courage. Good luck in your journey and hopefully one day we shall both make it to the finish line :)

Cher said...

I'm sorry for your losses as well. I too have had three- mine in the last year and all missed. I love your last line. I am not a statistic either. I don't like to hear that studies show blah, blah, blah. If something might help (extra folic acid, b6, b12) and can't hurt why not let me try it? Basically my chances of having a successful pregnancy next time are either 0% or 100% so lets do all we can to aim for the high one. I hope you get that next time.

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