Tuesday, September 16, 2014

The beginning of the end of the beginning

I sit here at a little over 9 weeks along (9+2 maybe?).  I visited not one but two doctors yesterday, expecting both appointments to be filled with angst, and finding myself pleasantly surprised at the lack of angst-i-ness on display.

Dr #1 was Dr. K, the RE I had made an appointment to see way back in June before I found myself surprisingly knocked up.  This you may recall, was the Doc who treats high FSH-patients, many of whom are also kicked to the curb by the same IVF-clinic that unceremoniously kicked me to the curb.  Dr. K wanted me to keep my appointment, a) to offer me an ultrasound to calm my fears, and b)  because she too recognizes it's good to have a Plan B if this one doesn't make it.  An RE-in-training, Dr. W, sat in on our appointment (this clinic is affiliated with a large nationally recognized teaching hospital).

Dr. K, the warmest yet most competence-exuding RE I have ever had the pleasure of meeting (since the great Dr. Isaacson in Boston) gave me so many happy tinglies. She was an older woman, and one word that came to mind when talking with her was "gravitas."  Husband himself remarked that he felt like we would be in good hands with her if we needed her services (as opposed to Dr. H, aka "Dr. Cuddles," the scary woman who told him he should drop a few pounds).

I will cut to the chase:  Yesterday morning we saw a moving baby, this time a slightly larger blob, with a clearly defined head, torso, umbilical cord and a fast flickering heartbeat on the ultrasound monitor. Dr. K then looked at Dr. W, the baby RE in training, and said "Do not ever think that a woman with a FSH of 18 can't get pregnant." She then looked at me and added, "this is an important lesson for Dr. W to see.  I am happy to have you here today."

In fact, Dr. K explained to me that FSH is only indicative of egg reserve for IVF purposes.  High FSH would indicate that we wouldn't capture many eggs at retrieval, but offers no insight on to the quality of my eggs. And clearly I still have eggs in there.  "It's all a roll of the dice" as to whether any pregnancy of mine would succeed.  It was irresponsible for a previous doctor to suggest to me that I would never have a healthy baby with my own eggs, because that simply wasn't true.  In fact, I ever want to proceed with IVF at this fertiility clinic, they will absolutely treat me.... But for now, seeing a moving baby at this stage "precipitously drops" my risk of miscarriage.  And furthermore, in Dr. K's view, I am not a high-risk pregnancy.  My cervix should hold, though she wouldn't discourage early checks by my OB.  My MTHFR mutation does not warrant lovenox shots since my homocysteine levels are normal.  And so off she sent me, to see my OB next week, with a warm wish for me to never have to walk into her office again.

My next appointment was with a genetic counselor.  This one had me tied up in knots as well, because these are the people who say awful things about your age and statistical likelihood of having abnormal babies.  Well, again, yesterday was the day for pleasant surprises.  In fact, this nice young woman with two kids of her own did not hand me any stats. "I think you guys have had really sucky luck" she refreshingly said to Husband and I.  "I know it's been a really long road for you to get here, and I know you're nervous," she continued.  The long story short:  we have had three very random chromosomal losses but neither of us are carriers of anything.  So moved from a conversation about risk to a conversation about next steps.  Here's the plan:

At the end of the week I will take a blood screen, an amazing new tool in the genetics world that is offered to elderly mothers like myself.  The version of the screen I am taking is called the Panorama Test. It's kind of astounding really, because a lab is able to draw out the fetal cells in your blood and test them for downs, other trisomies and triploidies.  It has a 99% accuracy rate and will hopefully inform us that I am carrying a genetically healthy baby.  IF the test comes back with a positive (and there is still apparently a teeny-tiny chance that it could come back with a false positive) then I would have a CVS immediately afterwards.  If not, I could sit tight until 16 weeks, and top off my reassurance with an amnio if I choose (amnio is reportedly far safer than CVS, which does carry a small but real risk of miscarriage).  I will have the test performed around 9 weeks 4 days, and the results will come back 1-2 weeks later.  I have also scheduled a 12 week nuchal translucency scan to determine if there are any other potential defects we need to be aware of (e.g. heart defects).

The bottom line, is this:  assuming this baby continues to grow and thrive, I will know in about 3 weeks time, whether I need to start planning for maternity leave.  Whether we need to clear out our office to create a new bedroom.  Whether I can breathe again.

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