Mentally preparing myself

I often sit back and think about everything that I have gone through til this point and it still amazes me. I am at the point where I don't really know where to go from here if God forbid this doesn't work and I suffer through yet another loss. I want to be strong for myself and my husband...but I have taken my lashings and I just want to be done. I understand the reality that the possibility of losing another is very high. So I have to mentally prepare myself.

   I don't want to be a "debbie downer" and I know having a positive mental attitude is very important. And believe me, I am trying. But I am also the type of person that kinda goes by the "hope for the best but expect the worst" kind of attitude. Many don't like this rational....but it's the way I am programmed. It's how I deal. Maybe it's a bit negative. But it's just how I think.

  Anyway, we try again next month. In like 3 weeks I have to go back to the doctor for an ultrasound to make sure I am going to ovulate next month. It's important to time this ovulation precisely because I have to take these injections literally right after. So I can't be off on my days. Timing is everything with this one.

  It makes me a bit sad. It's all so calculated. The fun has been stripped away. The excitement is gone. It's very scientific now more than anything. I feel like a guinea pig. I will always remember the excitement I had with the first positive. I will always miss that feeling. Now I am just petrified, curious, anxious and angry that it has even come to this. But as my nurse said - if this all works out - every single thing I did to get there will all be worth it. I hold on to that very hard. Every time I will have to prick myself with daily injections...I will think of that.

  If this doesn't work out...and I do miscarry again. They will test the embryo and find out what is going on. I read a blog where the woman who was literally going through the same thing. She had another miscarriage after everything. 4 losses, same medications, I literally could have written her blog. But she went on to have her "rainbow baby" as they call it. Her blog gave me hope. That even if God forbid my long road isn't over...that one day it will be. Hopefully with a happy ending as well. But regardless the outcome, I just hope someone who is going through what I am going through will stumble upon this blog and find some inspiration...or at the very least, someone to relate to.

The Gameplan

Looks like I am all caught up now! I started this blog after all of this had happened, and wanted to move forward sharing my experiences as they come from here on out. So this is the most recent and up to date entry. Last week, Sept 22. we had our followup with the doctor to go over the gameplan. My doctor believes that the issues are stemming from my blood clotting disorders, so she is going to put me on a cocktail of medications for the next time (which will be after this cycle).

  Basically, the recipe is going to consist of:

- Daily Lovenox (a blood thinner) injections. Yes I have to take a needle and inject this medication into my stomach for the next God willing 36 weeks. If I make it that far, after 36 weeks I will switch to Heparin (another blood thinner) and will up the dosage to 2 shots in the belly a day until the baby is born. Then I will be put back on Lovenox for a good 6 weeks post labor. This will help prevent and/or breakdown any clots from forming while pregnant. I will get started on this medication on day 3 after ovulation (even before I even get a positive pregnancy test) to be sure no clots form during implantation.

- Baby Aspirin. Another blood thinner. Lovenox basically protects me from blood clots - baby aspirin protects the baby. Lovenox does not cross the placenta...baby aspirin does. That's the difference between the two. With my conditions, I will have to take baby aspirin every day for the rest of my life.

- Metanx - it's a non synthetic form of Folic Acid since my body has a hard time breaking it down due to the MTHFR. It also contains B6 and B12.

- Progesterone - Have to take this the entire 1st trimester to help keep my uterine lining nice and thick for baby.

- Calcium - Lovenox really takes a toll on your bones so I have to keep them strong with calcium tablets

- MultiVitamins - to go along with the Metanx

- Prenatal DHA - to help avoid neural defects

- Vitamin D3 - since I was low and it plays an important roll in pregnancy

And there you have it. Blah.

Give it to me straight, doc

Well, the results are in. And from what it seems...the issue lies solely within me. My husbands results came back perfect! More than perfect actually! I knew his results would. I mean, he's batted home runs 4 times in a row now! He's a champ! Me on the other hand.. well for starters, my HSG results came back great! Uterus showed no abnormalities and fallopian tubes are wide open! No blockages! So that was refreshing to hear! Also my FSH and AMH results came back, which basically gives you an idea of how your ovarian reserve (eggs) are....and my numbers looked great! Lots of little eggs left so definitely not going through menopause anytime soon! Yay! Now for the bigger issues. 

Here are my results: 
 - Heterozygous for 1 copy of the MTHFR C677T Mutation
 - Homozygous for 2 copies of the PAI-1 Serpine 4G/4G Variant 
 - Chromosome 9 inversion. 

 And there ya have it. Here is a brief rundown of what each one is:

What is MTHFR? 

MTHFR - (Methylene-tetra-hydro-folate-reductase) is an enzyme found in the cells of our body. It is needed to metabolize (break down) homocysteine, an amino acid found in the proteins you eat. Elevated homocysteine levels have been associated with fetal neural tube defects (i.e., spinal Bifida) and miscarriage. An elevated homocysteine level can also indicate a increased risk factor for blood clots, arteriosclerosis (hardening of arteries) and strokes in both men and women. The metabolism of homocysteine depends on several enzymes, one of which is MTHFR, along with B vitamins and folic acid. In other words, B vitamins, folic acid and MTHFR are necessary to keep homocysteine levels within normal limits.

Sometimes your MTHFR has a genetic defect. These defects are fairly common and its estimated by some studies that up to 60% of the population have one MTHFR mutation or another.

There are two common genetic MTHFR mutations. If you have one mutation only, you are heterozygous. It is reported that nearly half the population is MTHFR heterozygous. - it is nothing abnormal. If you have two copies of the same mutation, you are homozygous. Homozygotes can have elevated homocysteine levels in maternal blood and amniotic fluid. If you have one copy each of the two different mutations, you are compound heterozygotes. Compound heterozygotes have the same treatment and risk level as homozygotes. If you have neither mutation, you are negative and don't need to worry about MTHFR.

There is NO CURE for MTHFR mutation. If you have the mutation, that's the way your body is made. You can, however, lessen any risk factors you have by taking B vitamins, Folic acid and baby aspirin in doses prescribed by your doctor. By taking these agents, you can lower your homocysteine levels and therefor your risk for the conditions above.

MTHFR mutations are hereditary. Families with significant early cardiovascular disease or recurrent pregnancy loss might benefit from clinical investigation.

PAI-1 4G/4G

      PAI-1 4G/4G has to do with the blood clotting system. Everyone has a plasminogen activator inhibitor that is responsible for helping to breakdown blood clots. A person can have PAI-1 5G/5G, PAI-1 4G/5G, or PAI-1 4G/4G mutation (4G/4G being the worst- the one I have). When the PAI is “broken” or “mutated” blood clots that form are not broken down as they should. With pregnant women, this can cause clots in the placenta, cord, or uterine wall, inhibiting effective implantation. MTHFR and PAI 1 4G/4G are a bad combo. MTHFR can be responsible for forming clots - and the PAI 1 4/G/4/G cannot break them down once they are formed. 

Pericentric Chromosome 9 Inversion

Pericentric inversion in heterochromatic region of chromosome 9 (inv[9]) is a common (1–3%) heteromorphism in the general population. Chromosome inversions are a relatively common structural alteration. There are 2 types of inversions. If both breakpoints are on the same side of the centromere, the inversion is paracentric; if they are on both sides of the centromere, then it is pericentric inversion. Pericentric inversion in the heterochromatic region of chromosome 9 has been recognized as a normal variant, generally without phenotypic effect. 




Pretty overwhelming stuff. My doctors and the lab tech, both agreed that they do not think the Chromosome 9 Inversion plays any issue in this. The lab tech stated that they are so common, he see's at least several a day. He also said it's considered a normal variant because the genetic codes are all there and the break point is in the center which leads to no issues. So I am just going to take their word on that and focus more on the blood clotting issues. Man oh man. Now time to figure out a gameplan...

Testing, Testing..1..2..

And so it begins. The insanity of the tests! I had to get roughly 20 viles of blood taken for my RPL (Repeated Pregnancy Loss) testing. Yeah...they are giving me the works! Everything from Thyroid issues, to Chromosomes, to blood clotting, to immunities...all of it! My husband wasn't off the hook either! He had to go in to get his sperm tested, as well as his chromosomes. On top of that I had to go in for an HSG exam where they basically stick a tube in your cervix, inject a contrast dye and take a look at your uterus and fallopian tubes to see if there are any abnormalities there. But since I recently suffered another loss, she had me reschedule that for the following month to allow my uterine lining to return to normal.

   So much stuff to check for, it's amazing! My doctor said there was a 60% chance they would find something - and a 40% chance that they won't. She said don't get discouraged if you are in the 40%....that means there is nothing really wrong and everything has just been really bad luck. But the chances of having a healthy baby are great! Part of me wanted to fall in that 40%....but another part of me wanted answers!! How could it just be realllllly bad luck 4 times in a row? I mean, I know I walk around sometimes with a gray cloud over my head...but my luck hasn't been THAT terrible! Guess we will see...

D&C Nightmare

After I completed the D&C procedure...I went home to rest. My husband was amazing. I couldn't have asked for a better caregiver. He made me breakfast, lunch and dinner, bought be pads, went and got my prescriptions, did everything for me. I seriously don't know how I got so lucky. I had the procedure on a friday and was back at work by monday. 

All seemed well until thursday rolled around. I was at work when I just felt something down there. I hurried to the bathroom and without getting too descriptive - noticed I was bleeding A LOT. I guess there is no way around not getting too descriptive here. There was literally golf ball sized blood clots coming out. I obviously panicked and called my doctor immediately. They told me to come in asap for an ultrasound. I had the most severe cramping I've ever experienced as well! 

My coworker drove me to the doctor since I was in far too much pain to drive. I went in to get an ultrasound and they had to put towels on the floor while I undressed because I was bleeding that bad. They looked at my uterus and it was just FILLED with blood! They couldn't see anything! They brought me in the examination room where my doctor looked inside. She took samples of a blood clot and sent it to the lab for testing. They gave me a heavy prescription of motrin and I started feeling better. The bleeding was becoming less as well. 

They had no explanation other than perhaps there was some "products of conception" left behind and my body was trying to get rid of it. I hate that word btw. They sent me home and I rested in bed for the remainder of the night. They gave me the 3 pills to take that was option number 2 when I was deciding what to do about my baby. If there was products of conception left behind - those pills would take care of it. I took them that evening and they made me so sick. I threw up all night. It was awful. After 3 months of on and off bleeding...my body FINALLY regulated itself and it stopped. WHAT.A.NIGHTMARE. I will NEVER get another D&C again if Heaven forbid I have to cross that bridge again. Never.

Trying again

After the green light to go again for round 2...I wasted no time to get back into my temping habits and opk's. Around the first of January, I felt a little dizzy. I would get dizzy when I stood up, and it lasted all morning. I also was going to the restroom every 5 minutes! I decided, well...let me just try to test and see. After going through the first loss, my excitement to test every 5 seconds wore down and I just wasn't that crazy about the whole thing anymore. Moreso just a little scared now. The excitement was gone. Those feelings had all been stripped away. Now all I had was nerves and the anxiety of it happening again. But most of the time - the 1st is just a fluke and your odds go way down of miscarrying again. So I did have that easing my worries.

 I went ahead and retested that evening and there it was...another BFP!(Big fat positive for those who aren't down with the pregnancy lingo) haha! Again, I didn't jump up and down and cry with excitement this time around...it was more of a "ok...here we go...I hope this sticks!" type of feeling. This pregnancy felt different. The first one I was having a lot of cramps very early on...it just didn't feel right. This one however, felt great! I was experiencing all of the normal signs you would feel when you're pregnant all except the morning sickness. But that doesn't usually kick in until the 6th week anyway so I wasn't worried about that. The best part was...I passed the 4 week "chemical pregnancy" mark! So I knew then that this one was going to stick around! I started finally getting excited! 

 Around 5 1/2 weeks, I started feeling very strong pains in my right ovary. It was so severe that it woke me from my sleep and felt much like menstrual cramps - but only limited to one side. I took motrin and called my dr. in the morning. She wanted me to come in for an ultrasound since localized pain in early pregnancy could be signs of an eptopic pregnancy. (Where the baby starts growing in your Fallopian tubes instead of your uterus). That was a very scary thought and I went in that afternoon. At the ultrasound - they saw a gestational sac and nothing in my tubes...so that was good...kinda. But they didn't see anything in my gestational sac either. It wasn't tooooo alarming, however since I was only 5 1/2 weeks and sometimes it's just too early to tell. The pain I was experience actually ended up being my Corpus Luteum cyst (also known as the pregnancy cyst) that appeared on my ovary. It's actually a good thing because it provides progesterone to help keep that uterine lining nice and thick and helps nourish the baby. So that was relieving to hear. 

 Finally - it came. My 8 week appt! This was the one where we get to hear the heartbeat! My husband came along and we were both very excited! It was just a cool thing that we were going to get to do together. One that would kind of change our lives! We arrived at the appt and went in the ultrasound room. Then it appeared on the screen! There was our tiny little bean!! I was so excited - only for it to be short lived. I saw a little flickering heart on the screen...but it was so slow. No more than 47BPM. A babies heartrate will start at around 160BPM...so clearly this was concerning. I saw the look on my ultrasound techs face and it wasn't good. She told me the heartrate is really slow and that the baby was only measuring 6 weeks. I felt maybe I had ovulated a little later than I thought and that is why the baby was measuring small. But she wasn't convinced. She left the room with a "sorry guys". And I was left feeling gutted. Then my husband who always looks at life with the half glass full mentality said "We saw a heartbeat! Everything is going to be fine!!" But I knew deep down it wasn't. 

 We reset a followup appt for 2 weeks. They wanted me to come back the following week - but I wanted to give the baby time to grow. I didn't want to go in the next week for them to tell me that there hasn't been much change. So I patiently (well as patient as I could be) waited the 2 weeks. My husband couldn't go in with me this time as he had to work. So I went in alone. As I laid there waiting for the image to appear on the screen, I saw my baby again. Only this time..no heartbeat. It still measured at 6 weeks so not even any growth either. It probably passed shortly after the 1st visit. I stared at the screen and then the tech left me alone to get the doctor. During those moments I just felt numb. Why is this happening again?! What did I do wrong?! I immediately called my husband when it all hit me. I could only mutter the words. "No heartbeat". I could hear in his voice he was crushed. I was crushed. I just cried. And he was too far away to hold me. 

 They took me into a small room while I waited for the doctor. Finally, the doctor came in and went over my options. I knew immediately I wanted a D&C (Dilation and Curettage). I just wanted it to be over with and that was the fastest way it would be. The other option was to take 3 pills and go home to pass it naturally. The 3rd option was just to wait for your body to take care of business....whenever that would be. So we arranged for the D&C procedure the following day. That evening, I went home and my sister went into labor. She delivered a beautiful healthy little boy. That news was very bittersweet. I was so happy for her, but there I was...about to say goodbye to mine. The world can be very cruel sometimes.