Tuesday, June 9, 2015

The Elite 1%. Recurrent miscarriage.

According to UpToDate, which provides evidence based medical information, approximately 15 percent of pregnant women experience sporadic loss of a clinically recognized pregnancy. Just 2 percent of pregnant women experience two consecutive pregnancy losses and only 0.4 to 1 percent have three consecutive pregnancy losses. The observed frequency of three consecutive pregnancy losses is slightly higher than that expected by chance alone: if the frequency of miscarriage is 15 percent, then the probability of three consecutive miscarriages would be (0.15)(0.15)(0.15), or 0.003 (0.3 percent). By comparison, the observed frequency of two consecutive pregnancy losses is that which would be expected by chance alone (0.15)(0.15) = 0.0225 (2.25 percent).

Those odds are daunting, and I never thought that I would become a part of that elite 1%, especially after having a beautiful, healthy first child, Abby. We were barely even trying to have her, and it just happened so quickly, that I never assumed trying to have another one would prove to be the most difficult and exhausting experience of my life so far. 

Our experience began when I found out that I was pregnant for the first time late last August. I had begun feeling extremely tired, to the point where I thought that either I was 1. pregnant or 2. I had some horrible form of bone cancer, since no one should ever be that tired. Andrew had gone to Baltimore for the weekend and I decided to drag Abby with me to the store to pick up a pregnancy test. I still feel weird buying one of those, even having my wedding rings on and dragging a screaming toddler behind me. For some reason, I still don't feel "old enough" to buy one. I went home and took the test, 1 dark pink and 1 light pink line appeared. A light pink line, you can't trust that, so of course I took another digital one that gave me confirmation of "pregnant." I can't say that I was in shock, I expected it, because after all we had only been trying for 1 month and this was supposed to be easy. First estimated due date April 25th. I quickly went to the store to find a shirt for Abby so that I could write on it, "Big Sister" for when Andrew came home. She wore it to bed that night, since Andrew came home late. She woke up in the morning, and I could hear Andrew say to Abby, "what does that say on your shirt?" and then came and asked me what this was all about, a huge smile on his face. This pregnancy ended all too soon, 1 week later. I knew the second that I saw the spotting and since I had felt my pregnancy symptoms start to disappear 3 days earlier. The blood tests confirmed, I had lost my 1st child. I knew that it was early and that these things happen, but I knew I was carrying a life and it hurt. I still have that Big Sister shirt in her closet, even though she will never get to wear it since she has outgrown it.  

Life goes on, and I began to pick myself up from my loss. September was a difficult month, since every week I would find out that 1 or 2 people were now pregnant, all having estimated due dates in the spring. Every week I would break down and think that it's not fair, why am I the one being tested. It was really a grief reaction and the worst was the pain and guilt. Was this something that I deserved, was there something that I had done wrong? Not eaten the right things, didn't exercise enough. Was there actually something physically wrong? These were all questions, that had no answers, and I like answers. I finally found my upswing when we went to Tampa, Florida. I was finally able to relax, drink, have fun, and began to think positively about the future again.

We returned home after the trip, relaxed and ready. I found out that I was pregnant again at the end of October, estimated due date July 9th, 2015. I thought that this time would be different. I had all the pregnancy symptoms that I did with Abby, nausea, fatigue, and I couldn't touch my boobs with saying "ouch!" This one was going to be different and we were excited. Because after all, only about 2-5% of women have 2 miscarriages in a row. I called 2 weeks later to schedule my first OB appointment, 1 week later I was at the doctors because I had started spotting again. We went in for an ultrasound, and instead of seeing a heartbeat at 7 weeks, they only saw a gestational sac that measured at 5.5 weeks. They were optimistic and stated that this happens, and we really do not know when I ovulated, so they pushed my due date back 2 weeks. I had blood tests drawn which showed normal HCG levels (the pregnancy hormone) but a low progesterone (hormone that supports uterine growth and maintains the pregnancy until the placenta takes over at 7-9 weeks). I was put on progesterone supplements that night. I had hope but the bleeding had increased and I knew again. I had my levels drawn again which confirmed my 2nd pregnancy loss. It was Wisconsin's opening deer hunting and I told Andrew that he could go, but he took one look at me, gave me a hug and stayed with me on the couch. This one was tough, it was 5 days before Thanksgiving and my 30th birthday. I was supposed to be pregnant for my 30th and I wasn't. And to make this even harder, we were having both of our families up for Thanksgiving this year and no one had known about this pregnancy, since we were planning on telling over Thanksgiving. The first to come up was my family. My brother made a comment about Andrew having to work the weekend before and not being able to make it for the boy's hunting weekend. He didn't know, and I can't blame him one bit for making a comment that he knew nothing about, but this gave me my in and I told him that it was my fault that Andrew wasn't able to make it. My family was empathetic and we went on to have a great Thanksgiving together, and I was able to enjoy my whiskey. It wasn't until Christmas that I got a gift from my sister in law, of 2 angels. This was by far the most meaningful gift I've received and they will always be by my bedside.

The second loss was by far the most difficult. I called my doctor and asked what the next step was. I had no idea and once again I was blaming myself, the whole grief process was setting in. The depression and anger were starting to take over me. Facebook was extremely hard at this time, since there were always "new announcements," or statements/pictures of how easy or "hard" someones pregnancy was going. And all I wished for was to have A pregnancy that wouldn't end too soon. I ended up having some tests done. My anatomy was  normal, no fibroids, endometriosis, or scaring. My blood work came back showing that I have a blood clotting disorder, Factor V Leiden. I only have 1 allele to this, meaning that I only have 1 copy of the gene which gives me a 3 -5% overall increased risk over the general population of having a blood clot. I also learned that this is the most common blood clotting disorder in Caucasians of European descent. Well, I fit that bill perfectly. My doctor also suspected that I may have an increased of NK (natural killer) cells in my uterus, that may have developed after having my first child. NK cells attack foreign invaders, which when an embryo is implanting it is considered a foreign body, and if the right circumstances are not present you body can fight off the "foreign invader." We had a plan for the next time, and once again I felt hopeful. With the Factor V, I was going to be on Lovenox (an injection to prevent blood clots), progesterone (since my progesterone level was low with the last miscarriage), and prednisone (to try to lower my immunity so that my body doesn't reject the embryo). We were given the OK to start trying again at the end of January. 

I still had my ups and downs week to week, but Andrew became my rock and stability. People always give their opinion, but honestly if you have never been in this situation the best thing that you can do for someone going through this is not give your opinion, let the person talk, be empathetic and just given them a hug. I got lots of hugs and empathy from my sister in law, on our many talks on the porch at 3AM and I really hope that she knows how much that meant! Honestly, I really hate Facebook at times, and found myself deleting it off my phone every other week or so, because it became overwhelming with birth announcements. It was too much, considering that every month for me was filled with hope and then let down when my period started. Spring was supposed to by MY time and April 25th came and went with no baby. 

The 3rd time I found out I was pregnant was May 18th, just 3.5 weeks along. I was scared and could not get it out of my head that this was going to end differently than my last 2. I called my doctor the next day, and started on our plan, Lovenox, prednisone, and progesterone. This would work. We would never had told anyone that we were expecting, but it was Abby's birthday weekend, and I'm a connoisseur of delicious cocktails so someone was bound to notice. My brother and sister in law were the first to know, and were so excited for us, especially knowing our struggles. Abby's birthday was a blast, you can't go wrong with a Princess and Gun's Party. We though that we hid my new pregnancy pretty well, but my best friend, Jenny figured it out. Apparently we weren't as sneaky as we thought. Everything was going well, I felt tired, my boobs hurt, but in the back of my head I knew something was going to happen. May 29th, Abby's birthday it started. I called my Doctor and had labs drawn, I wouldn't know the results until Monday. I felt horrible, and seriously? Abby's birthday, hadn't I gone through enough already, dealing with this on my 30th birthday and now Abby's. I still can't answer that why. I had more bleeding over the weekend and I thought that was the end. I got my labs back on Monday. My labs looked great. Back to the clinic to have more blood drawn that day. These labs showed that my HCG was still OK, had gone up but my progesterone had gone down, still within exceptable range but had decreased by half. This meant more labs 2 days later. As I learned in early pregnancy you can expect you HCG levels to double by 48-72 hours or at least rise by 60%. There was 1 documented case of a viable pregnancy with a HCG rise of 53% in 48 hours.  My HCG level was barely going up and certainly not by 60%. Time for the ultrasound and here was the, excuse me, the kick in the dick. My doctor was most worried about an ectopic pregnancy, which thankfully it was not. The ultrasound showed a large bleed in my uterus and saw 2 gestational sacs. So not only was I not only pregnant but it was Twins, which also came with worse news. Now not only should my numbers be rising but they should be much higher with 2. The miscarriage was inevitable. I opted to wait and recheck my numbers again before scheduling the D&C surgery. My numbers didn't rise. I scheduled surgery for 6/8. 

Yesterday was tough, and I do not wish this pain on anyone. I cannot say enough good things about the support I was given by the nurses and my doctor's yesterday. All I can really say is that this sucks and it hurts soo much. I am lucky to have 1 beautiful daughter, who I look at every day and think, she really is a miracle! Even if she cries because the wind isn't drying her hair. I am also lucky to have my husband, who is my rock. We will get through this together. We plan to take the rest of the summer off to focus on: eating healthy, exercising, relaxing,  taking 2, week long vacations (Tampa and Wyoming), going up north to the cabin, going to the beach, winning El Norte's beer Olympics, golfing in the PTSD golf outing (where we will get last place this year :) ), and most of all to focus on our family and to just have fun. And maybe I'll update this blog with a little more happiness, expect a picture dump soon, I have 6 months of catching up.