Tuesday, August 23, 2011

A Different Kind Of Limbo

Out of everything in this infertility journey, the thing that I hate the most is the waiting. Especially if you are waiting and the chances of the end of your wait revealing something good are pretty slim. We are perpetually stuck in limbo--these last two and a half weeks have been shifting from happy to sad, but always with this in-between uncertainty looming over us. I think I finally feel like I would feel better if there was just an end--either a typical pregnancy for the timeframe or an end to the pregnancy that is mercifully swift and allows us to move on. At some point.

Yesterday's ultrasound did not go well at all. We were all ready to see something, anything--a little dark splotch that was clearly implantation would be ok with me. A yolk sac would be awesome, and a heartbeat out of this world, but we knew better than to hope for that. Just a splotch would be fine. But, after what felt like 10 minutes of searching, my doctor couldn't find a thing except a nice thickened lining in my apparently empty uterus. Because my numbers are climbing, although at an abnormal rate and level, the current theory is that there is something there. It just isn't where it's supposed to be. It is still possible that the development is so far behind that it was too early to see anything with the numbers that we have, but in that case it's likely we are so abnormally behind schedule that viability of this pregnancy is a snowball's chance in hell. We have to go back on Thursday for another ultrasound at the ob/fetal clinic across the hall because they have more sensitive equipment for detecting early pregnancy. Their fancypants machines can apparently detect the splotch more easily, or definitively confirm that there is nothing in my uterus and I am looking at an ectopic. It's even on my script for the appointment there, that this appointment is to diagnose an ectopic. What the hell?

Before I wax pedantic on what ectopic pregnancy means for me, I just have to address a couple of things. First, I think that going to this appointment is going to be a special kind of torture. This is a waiting room that is full of giant pregnant bellies and people with babies. This is a waiting room that rubs in my face the loss that I am inevitably discovering. It's pretty much just a question of which way the loss will go. I think the wait before won't be as bad, since I am still holding tight to that nearly invisible filament of hope that it's a late bloomer and a miracle story and everything will be ok and all these tears are for nothing. It's when we come out, after we've either seen something abnormal in my uterine cavity or nothing in my uterine cavity and I know I am dealing with an ectopic pregnancy, that those bellies will really all be giving me the finger. I would like to think that I could still look at them with hope and the thought that one day, that will be me!, but I don't think that will be possible. It's likely to just make me feel the unfairness of this whole awful situation so much sharper.

Back in the doctor's consultation room, our wonderful RE explained what was likely happening. Everyone was full of "I'm sorrys." I refused to accept that. I kept saying, "It's not over yet..." But as my doctor kept explaining the likelihoods (and in my head I calculated that we are probably looking at 60% ectopic, 39% abnormal gestation, and 1% miracle healthy but slow baby), and he looked so sad as he was explaining this, I lost it a little. "But it's not zero, right? Our chances of just having a late bloomer are not zero, right?" A pause, a sigh. Nope, not zero, but pretty darn close. And...waterworks. My husband swears my doctor had tears in his eyes. We are so lucky to have such a great, talented, and compassionate doctor. So, he continued to explain what was likely going on. There was a disproportionate amount of time spent on ectopic, both by our doctor and by the IVF nurse that came in later to explain Thursday's appointment and what would happen if it confirmed ectopic.

Here is the lowdown on the ectopic scenario. In this scenario, it's possible we have a perfectly viable embryo/almost-fetus that grew and hatched and attached and is developing normally with one huge exception. It picked a crappy location. Our little nugget needs geography lessons. Instead of picking the plush, cozy, and appropriate location of my welcoming uterus, it took a detour and traveled up a tube. Where there is insufficient space for it to grow. Where it will continue to develop until it runs out of space and the tube distends to attempt to accommodate and then ruptures when it can't, causing bleeding and a generally not-good situation for Mom. But, they will treat it well before that rupture occurs. And by treat, I mean I get to have a double shot of low-dose chemo medication, methyltrexate, injected into my hips with that lovely intramuscular needle. The ectopic pregnancy is basically like any tumor--a multiplying mass of cells in the wrong place. It just happens to look like a developing baby. That's the thing that sucks--this could be a perfectly viable pregnancy had it not taken a wrong turn. This is some seriously shitty luck. Oh, and the other thing about the injection is that it means we have to wait three months to try again, because of the poison. And, it means more waiting--after the injections you have another beta (oooh, my 7th potentially) to make sure that the numbers are going down. If they aren't you may have to have another shot and/or surgery to remove the "mass."

The other scenario is that my embryo is super slow because it's abnormal--it's missing stuff. It could be a step behind the blighted ovum (when you have a pregnancy sac but nothing inside it--so the sac was sending out the HCG and making you feel pregnant but there is no developing embryo inside). In this case we don't have a sac yet but we do have the trophoblastic material that sends out the HCG and would become the sac, we just don't have the part that becomes baby. And it just isn't visible as that yet. In that case we can either wait to miscarry naturally or take a pill that will speed things along and hopefully insure a more complete evacuation. Because an incomplete evacuation is bad. Because it's so early and this likely dysfunctional nugget is so tiny, I will probably be spared the D&C.

So there we have it--waiting with bated breath to see which horrible scenario we are facing. I'm not sure which is worse--an abnormal pregnancy in the right place (indicating good implantation but questionable genetics) or a normal pregnancy in the wrong place (indicating a possible tubal factor that didn't show up on previous scans--at the least an absence of the current that normally goes from ovary to uterus, helping the egg go in the right direction and discouraging an embryo from going up the tube). A normal pregnancy in the wrong place would at least mean we don't have a genetic issue. I read somewhere that after 35 you have a 50% miscarriage rate, mostly super early and mostly due to faulty genetics in the embryo. So I don't think I have to worry that we have mutant genes. But it sure does suck bigtime that we are stuck in this place, not knowing again, but definitely in "I'm so sorry" territory. I have the tiniest amount of hope left in me, because I can't give up until it's definitely over. But I am completely beaten down. I sure hope the next two days go by quickly, so at least the waiting for the why can be over. Then it will just be the waiting for the end to come. And then the waiting to be able to start up again, once we have recovered sufficiently in every possible way. And then waiting to see if our next attempt can be our jackpot win. Waiting is nothing short of exhausting.

1 comment:

  1. I hate that it's being drawn out like this, but for now, while it is, I'll be holding onto hope with you for a late-blooming miracle. Ahh, why can't any of this ever be easy? Why's it so hard to get some frigging unmitigated good news?! Thinking of you as you wait.