The Devil is in the Details: Part 1 - Infertility
A professor during my masters once told a compelling story about the importance of details which I have adopted. Basically, I think that one needs the whole story. Here's ours.
My partner and I were struggling to conceive for years before attending the Ottawa Fertility Clinic. With some great luck and huge joy, I became pregnant on our first cycle of Intrauterine Insemination (IUI). I had a relatively uneventful pregnancy and our daughter was born in a by-the-book home water birth. Having enjoyed parenting and having put our concerns about pregnancy to rest we continued our dream of a big family. We began trying again when she was 15 months old.
For me/us, IUI is difficult. Certainly, emotions run high as we hope that IUI will be effective. The fact that I am doped up on hormones contributes to my own, sometimes over-the-top, emotional reactions. Logistically, we live about two hours away from the clinic, where I am required to attend appointments every other day. Add in parenting and full time work and I was struggling.
To our dismay, IUI did not work. We did four full cycles as well as one which was cancelled because I over-responded to the medications. As each cycle failed, my own hope for a family dwindled. I stopped buying pregnancy tests because my period would inevitably come. The emotional toll was fairly incredible. But, we survived it.
Eventually, we made the leap to In Vitro Fertilization (IVF). Practically speaking this meant, about 2.5 times the dose of hormones, new medications, a longer treatment cycle and far more invasive procedures. I responded well to the medications and they successfully withdrew 10 mature eggs, 7 of which fertilized. We thought this sounded positive: we would likely make it to day 5 for implantation and have a couple of little embryos to freeze. Day 5 arrived and dressed in a hospital gown, the doctor explained that while there were five remaining embryos, four were of 'poor quality' and one was of 'average quality'. The doctor advised that we implant two as the remaining embryos would be discarded.
The procedure of implantation required the monitoring of the uterus by ultrasound while the doctor sent an average and poor embryo down the tube. They advised us to watch the screen as we would see a flash with two white dots: our embryos. That day we were given an ultrasound picture with the two embryos before being sent home to hope that the fates took care of the rest. The picture, two embryos at 5 days after conception, would become either a very cool photo to have or a very upsetting one.
When we came home that day describing myself as negative would be an understatement. I told family we had 'crap' embryos. I did not have hope. Luckily, my husband always does.
The Devil Is in the Details: Part II - Pregnancy
I was lucky enough to have the summer off this year (less lucky that it was because I decided to leave an incredibly unhealthy work environment), so EllaGrace and I started spending all of our time together in the days after the IVF embryo transfer. In spending all that time together, EllaGrace noticed something that I was a little bit less aware of: I could not stop eating! After having a meal one day, we got in the car, and she said "Mummy is hungry AGAIN!". In retrospect, that was probably the first sign of pregnancy.
The fertility clinic controls and plans all details: no home pregnancy tests and attend the clinic for a pregnancy test. After all of the failed IUI cycles, I planned to follow their instructions. But, a friend of mine had mailed me one of her 'good luck' pregnancy tests. I had had it for months and never used it. For some reason, four days before my testing appointment, I woke up and decided to take the test. It was positive. I was happy, but by the end of the day, had convinced myself it was a false positive. Four days later, the clinic confirmed that I was pregnant and that my levels were a little bit high, possibly indicating a twin pregnancy. Despite any evidence leading up to the test results, when the nurse told me, I cried, ecstatic.
At 6 weeks and 6 days pregnant I returned to the clinic for my first ultrasound. Morning sickness had kicked in with full force the day I found out I was pregnant -so with peanut butter and crackers in hand, I sat and waited my turn. I was so afraid to allow my hopes to rise. By the time it was my turn, I had fully convinced myself that there would be no heartbeat and that I only felt sick because I was still carrying a missed miscarriage. The technician immediately noted that there appeared to be two gestational sacks, then, two heartbeats, strong and healthy. All signs pointed to a happy, healthy pregnancy and I finally let myself believe it and cried.
The Devil is in the Details: Part III - pPROM
At exactly 15 weeks pregnant, I was lying in bed at my aunt's cottage in the wee hours of the morning, and felt a gush of fluid. I had had spotting, with some gushes of blood in the previous weeks but no cause for concern had been noted. So, I assumed that the gush that morning was blood. It felt like more than usual and so I moved to the bathroom, where I continued to loose clear fluid. The reality of what was happening never crossed my mind. I went to a small town hospital where they explained that I appeared to have lost all the amniotic fluid around Baby A and that I could return home to await miscarriage. They recommended considering that I go to a larger city.
I immediately contacted my midwife on the phone who indicated that I should have been prescribed antibiotics and that it would be wise to attend a hospital in Ottawa or Toronto. Emotionally exhausted and terrified, I packed up my things with my daughter, aunt and uncle, heading to Ottawa via home where I would leave them and pick up my partner.
The wait in the Civic Hospital's emergency room was long. We eventually met with a gynecologist who indicated that if the ultrasound from earlier that day was correct, then my pregnancy was no longer viable. She arranged for us to meet with a High Risk OBGYN the following morning. The doctors there confirmed that although babies both had strong heartbeats, that Baby A had no visible fluid. They advised us that I would likely spontaneously miscarry in the next 48 hours and that if this was not the case, then I would be at high risk for infection. They recommended that I terminate the pregnancy as the odds of carrying to viability (24 week) were very unlikely. The lack of fluid was highlighted, as the baby is unable to have healthy lung development. They suggested I stay in Ottawa while I wait to miscarry as I would require antibiotics when it was complete.
I have not wept as often or as fiercely as in the days that followed this appointment. I was inconsolable. I was afraid of how a second trimester miscarriage would look and feel. I was devastated to lose a pregnancy for which I had fought so hard. I had so many unanswered questions. I was afraid of the impact of the loss, but also the impact if we managed to maintain the pregnancy to viability, on my family.
We have returned for two more ultrasound/specialist appointments since that day. They noted that the flow in Baby A's umbilical cord is not ideal and that there is fluid in the stomach and bladder. Despite this, they maintain that the baby is not producing amniotic fluid and that there is little to hope for. They have avoided answering our direct questions. They have denied any possible intervention in the case of a miscarriage in order to try to save Baby B. They provided antibiotics only because I questioned why they wait until 24 weeks. My impression is that they do not want to invest time and energy into a hopeless case. We have now asked for a second opinion and will meet a new specialist on Thursday, when I will be 19 weeks (fingers crossed).
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