The Next Strategy: Improving Sperm Morphology & Damage

On December 20th we had "THE TALK." I have been holding off for months because DH has been closed to the idea of TTC (trying to concieve again) after so much loss and frustration and I wasn't sure what approach to take after our sad news and multiple miscarriages. But on December 10th, which was Avery's due date, I visited the grave site and realized I still desperately wanted a baby, was feeling stronger again, and was even willing to go through more tragedy and loss just to try again...hoping against hope. I was also encouraged because several times I came across information that pine bark extract could actually improve sperm morphology, along with vitamins and minerals like C, E, B complex, zinc, grapeseed extract and iron. Antioxidants seem to be the key to correcting sperm damage.


I ordered DH an amazing multi-vitamin called Opti-Men (with an amino blend, excess amounts of vitamins A, C, E, D, B complex, and zinc, and Folic acid...much more than found in Fertile Aid or Fertile Blend for men), an iron supplement, and a supplement called Super OPC Plus. OPC has in each serving (2 capsules): Grape Seed Extract...500mg, Red Wine Extract.....200mg, and Pine Bark Extract....200mg. He began taking the supplements on December 21st and it takes sperm 72 days to be produced (from start to finish), so we should be seeing improvements some time after that. I realize now that we did not have enough time for his sperm to improve when he was off of his meds (~60 days) the last time we conceived and subsequently miscarried.


I was also given hope about pine bark extract after reading this study on Pycnogenol (200 mg of pine bark extract): http://circles.fertilityfriend.com/Circles/c.php?u=http://www.chiroonline.net/_fileCabinet/pycnog_pub.pdf .


I have just gone off of Birth Control pills and will begin basic charting, checking CM and using OPK's (not temping or obsessing however). The idea would be to prevent naturally for 2 months and then try again in earnest in March. The feeling that the biological clock is ticking for my eggs does engender feelings of panic within me, but I am trying to trust and pray for the future.


If I do get pregnant, I will have to take a different approach...I just cannot jump into doctor's appointments and ultrasounds, etc. until much later. They just bring me too much anxiety and ulimately false hope because my last two pregnancies looked so "good" up through week 8. I hope to wait till 12 weeks before I am seen. Easier said than done I know, but by then I would feel like we will have more accurate information (for us anyway) because the early "good" ultrasounds have meant nothing in the past and only made the heartbreak that much worse. I know there are still possibilities of birth defects beyond that of course, and we're never "out of the woods," not with what we're up against. But at this point I don't see any other options for us...DH is not open to adoption.


So...prayers now for healthy eggs and sperm and that they find each other at the right time. Feels like Russian Roulette but I'm willing to take the risk even given our odds, and I feel that it is worth it in case we get a miracle baby.

FSH and SA/SCSA Results

I am kicking myself for never recording the last of our tests with the RE, especially since I lost the hard copies during our move in October. I believe I remember correctly and found a few notes, so here's the best I can put together.

Results:

-Day 3 FSH (Follicle Stimulating Hormone): 8.75

That's mostly good news, as anything under 9 is considered 'normal' but it's worrisome because it's on the line, (9 - 11 is considered only "fair") and my estradiol was elevated slightly (I think it was 93). They prefer it to be under 80. This means that the estradiol could be falsely lowering my FSH.

The biggest problem was my husband's Sperm Analysis (SA).
-Count/Concentration: +50 million (good)
-Motility +60% motile (good)
-Morphology: Only 2% normal (devastating)

He also had "fair" DNA damage with the SCSA (Sperm Chromatin Structure Assay), which can be related to poor morphology. I believe it was 23% DFI. So, that's concerning though not as alarming as the morphology.

Regarding the SCSA:
Greater than 30% DFI (% sperm with damaged DNA) is viewed as a significant lack of fertility potential, 15-30% DFI as a reasonable potential and less than 15% DFI as high fertility potential.

And the new World Health Organization standards for SA's:

Concentration: the median was 73 million but anything over 15 million was considered normal
Motility: the median was 61%, anything over 40% being normal
Morphology: the median was 15%, anything over 3% was deemed normal

Hysteroscopy / Mock Transfer Today and Testing Underway

We called my RE at the beginning of July to see what type of testing we should be doing so that we can find answers related to our recurrent losses. We really can't afford IVF, but we want as much information as we can get and we know we need a lot of tests done.

Last February my OBGYN had me go in for a slew of blood tests that are standard for Recurrent Pregnancy Loss (RPL) and everything came back normal...no mutations or thrombophilias, etc. So that's good.

In June, after our third miscarriage, the OB had us get our karyotypes done, and everything came back chromosomally normal for us. Also very good.

After consulting the RE, he lined us up for a bunch of tests and had us do all the bloodwork for a "Fertility Panel." Everything came back fine...so again, very good.

Then today I had a hysteroscopy, ultrasound, and a mock transfer. I had no idea they were going to do a mock transfer, so that put me on edge, but in retrospect I'm glad they did it because I think it gave me the first glimmer of hope since we lost our twins in May.

I was also terribly nervous about possibly having Asherman's Syndrome (uterine scarring) following the last D & C to remove the placental tissue because I have had such scant periods since then (which is a symptom of Asherman's). I feared the worst, but thanks be to God my uterus looked fine. The RE saw no signs of scarring anywhere.

The RE removed the camera and did the mock transfer immediately afterward and it went very smoothly and quickly. I had some cramping right afterward and throughout the day, along with spotting, but it has been primarily uncomfortable, not painful. My understanding is that the mock transfer basically measures the uterus so that they know what tools to use and where to place the embryos in the future (should we ever get to that point).

They also did an ultrasound and measured my uterine lining and it looked "fine" for Cycle Day 12 at 9mm. My right ovary had 2 follicles measuring 16 & 17 mm, so I should be ovulating in the next few days. I'm very pleased that the lining looked good since he seemed to indicate that was essential.

The next test on my list is to get my Day 3 FSH and estradiol checked during my next cycle. My husband needs to get his sperm analyzed with a basic SA and have the DNA fragmentation checked with a SCSA. Our insurance covers basic diagnostics but nothing else fertility related, so it is adding up quickly, even in this preliminary phase of seeking answers.

All in all, everything has checked out great/ideal so far. We do not have any definite answers yet, but I think the next 2 tests will be telling. At least we are getting more information and ruling out possible causes for our losses, and that feels good. Knowledge is power.

The Burial

Since we lost twin babies, we went ahead and made a burial box for both of them, even though we only had the body of one of the twins to bury. Our other little one was too tiny to identify because he/she died so early on. My husband and I decided to do this ceremony by ourselves and picked a beautiful Maple tree in the canyon near our home for the burial site. We walked to site, dug a small hole, blessed it with prayers, laid the burial box inside, took some photos, and then prayed through a wonderful liturgy (miscarriage memorial) produced by the Episcopal Church. The text of that service can be found here: http://www.episcopalchicago.org/about/about-admin/documents/HannahsHopesRachelsTears.pdf .

Here's a prayer from it:
We commend to your mercy, O God, our child N., that death may be for her the gate of life and peace with you. At your heavenly banquet, may we rejoice with her and all your saints to see you face to face, one holy and undivided Trinity in glory everlasting. Amen.

We cried quite a lot and hugged. Finally we placed the soil over our little one's box and placed flowers and rocks (a Jewish tradition) on the burial site, one rock for each living family member (3). It gave me a sense of having honored my babies the best way that I could with a sacred rite.

Now I blow a kiss and remind my little ones how much I love and miss them every time I walk past that precious burial site. Tears often flow, bidden or unbidden.

D & C Following Misoprostol

By way of update, the Misoprostol failed to evacuate all of the fetal tissue after my miscarriage. This was discovered at my 12 day post-treatment ultrasound when most of the placenta was found. It is my OBGYN and RE's opinion that Misoprostol works well for very early miscarriages or chemical pregnancies, but for later or "bigger" pregnancies (6 weeks and over), it is not as effective. I should have been close to 9 weeks along by the time we discovered the fetal heart beat had stopped. Sadly, I had to schedule yet another D & C to evacuate my uterus because leaving the left over tissue could lead to a serious internal infection. In fact, I was still losing portions of the placenta several days after the D & C.

Unfortunately, I have been having symptoms of Asherman's Syndrome (scarring of the uterus) since the D & C and am very concerned that this last D & C has done damage which can impair fertility. This is more common than people realize after a D & C because the uterus is so fragile during and immediately after pregnancy. Often the scarring is caused by the tissue tearing away from the lining of the uterus and nothing more. My symptoms have included extremely scant bleeding/periods (especially in comparison to my normally very heavy periods) and uterine pain. I will be getting a hysteroscopy to have this checked into.

My Experience with Misoprostol (Cytotec)

This is graphic, so please don't read it if you're squeamish or young. It's really meant for women who are considering taking Misoprostol to induce labor for a missed miscarriage, which is what happened to me.

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My OB and RE wanted me to get another D & C but I just couldn't do it. Last time it was the right thing but this time I absolutely could not let anyone take my baby away from me to a lab to be disposed. I needed to see and hold my little one, tell her/him they are loved, and bury them on my own terms with prayers and a sense of a sacred ending. I also wanted to avoid any potential scarring of a second D & C.

I set up my room with candles, calming CD's, a heating pad, and plenty of disposable water proof sheets and Overnight pads in preparation for this. I do recommend those disposable water proof sheets (they can be found near the pads and Depends at the store). I waited until my husband was back from work and could be with me for the whole weekend in case anything went wrong and I needed to get to the hospital.

I prayed and then took four 200mg pills (800 mg) of Misoprostol vaginally at 1:30pm on Friday, hoping to miscarry that night. Preventively I took Advil and then later some Vicodin when some mild cramping started because I read it could get really intense. However, the cramping was light and I only started bleeding a few blood clots around 10:30pm after I took a walk to get things going. Then it stopped and nothing else happened. I slept the night and woke up to some bigger cramps and medium bleeding that again subsided in an hour. I realized the meds just weren't working and was stressed by this because I really wanted to avoid a D & C.

I had my husband get a second dose at the pharmacy and reinserted the same amount at 11am that morning (Saturday). NOTHING happened. I started to cry and get crazy by 7pm and decided to check my cervix. I felt in there and could feel all four of those pills completely intact, not having dissolved at all...no wonder they weren't working. I should have wet them first I guess, but instead I crushed them as much as I could with my fingers up inside me...very messy and unpleasant. I probably lost 1/2 a pill doing this.

However, by 7:30pm, the cramps started. I took Advil at 7:45pm. By 8pm the cramps were turning into contractions and I was bleeding and passing blood clots.

By 9:00pm the bleeding was out of control...I soaked through 6 HUGE overnight Always pads in an hour and was leaking all over the bed and my clothes with every contraction despite the pads. I took the Vicodin but it was too late. By 9:30pm I felt a very strong contraction, ran to the bathroom but pushed the gestational sac out on to my pad before I could make it to the toilet.

It was heart wrenching and amazing at the same time that I could clearly see our little 8 week baby in his/her amniotic sac floating inside the gestational sac/bag of waters....maybe just under an inch long. I cried and held him/her and placed everything in a container so that we could bury him/her.

After that I had one more large contraction and large blood clot came out and the cramps really susbisded. The heating pad was very helpful that night and I mostly felt relief that I had made it through the ordeal. I took a shower and cleaned up the bathroom because it honestly looked like a horror movie in there with all the blood. The Vicodin made me sleep and I went to bed. I passed some more clots at 4am with cramping and took more Vicodin.

Since then I've been bleeding with mild cramping but it was basically a short two hour labor once the meds worked. I have been extremely tired/fatigued since and crying a lot as I try to comprehend this tragic loss.

Tomorrow we hope to do the burial with flowers from the florist and a little black memory box I found. I personally would do the Misoprostol again with pain killers, but make sure they were dissolved/dissolving properly. This method is NOT for the faint hearted or those who are concerned about seeing a lot of blood...it is a VERY visceral experience.

I will go back for an ultrasound to see if everything passed...I am afraid of retained tissue which would mean a D & C, but hoping for the best.

Tragedy Strikes Again

After our last great ultrasound I was at peace for several days. And then...once again, I felt like I was feeling a little bit "too good." My nausea had decreased. On the other hand, all my other symptoms were in full swing...sore breasts, bloating, fatigue. But maybe that was due to the progesterone supplements.

On the morning of our ultrasound at 8 weeks 5 days, I had a terrible sinking feeling. I started crying and telling my husband that this felt "too familiar"...it was the same time, the middle of the 8th week, that we had lost Annabelle and discovered her heart had stopped. It was again a Wednesday too and I felt no assurance from my body that things were okay. I was a nervous wreck, but I also wondered if I was simply having some kind of anniversary depression/angst. I kept imagining, preparing myself, hearing the RE say, "I don't see a heartbeat."

I picked myself up and we went to the RE's office and waited. The news all seemed to be good that day at the office and that gave me a lift, plus I was peeing frequently, and that was a good sign. I got up on the table and the RE inserted the vaginal wand and I waited and watched his face as he looked at the screen. (I couldn't see anything.) His face grew intense and his eyes squinted while his brows wrinkled. That didn't seem good. Then he asked me if I had been spotting...I knew that was really not good. "No" I stuttered. Finally he said, "I'm just not seeing a heart beat. Why don't we look together?" We both looked at the screen then and we saw no movement...nothing, just my little one looking a little bigger than the last time, very still. My heart was pounding out of my chest desperately hoping for something miraculous, but I knew that was the end. He finally said that his machine was not top quality and he thought we should either come back again in a few days to "be sure" or go to a hospital for a more thorough scan now. I opted to go to my OBYN's office for a confirmation scan then. The scan and news was bleak: our little one had died and measured only 7w5d, almost to the milimeter/day what Annabelle did. Surely it was another trisomy and again, very likely due to my husband's meds.

After talking to the doctor on call, I opted out of a D & C, although both he and the RE recommended it strongly. I realize in retrospect that while the procedure was very easy physically for me for the most part, I really disliked being in a public place for that event and having someone take my baby away dismembered to a lab just causes me pain and regret. I never got to see or hold her. And now I just needed to hold and pray over my little one and give him/her a proper burial with some kind of sanctity and honor.

So, this afternoon, I will be taking misoprostol to induce labor. I'm scared about what it will be like and I know the risks are serious if anything goes wrong. But I hope emotionally this will be the better route for me. I'll update later and describe my experience. Oh, Lord have mercy.

Ultrasounds!

So I'm finally out of beta purgatory! But it has been a rather rocky road getting there. I had a very, very brief in & out type of ultrasound at the RE's office last Wednesday at 6 weeks 5 days along. Basically, he quickly slipped the transvaginal ultrasound in, made sure there was a fetal pole and heart beat and was done. He took no measurements and said he was only interested in whether anything was happening in there or not. I was happy about the heart beat but worried because he said it looked like I was not as far along as I knew I was. He also said the heartbeat looked "pretty slow" which is not what I wanted to hear. The husband and I left the office feeling ambivalent. Then they took my progesterone levels and it had DROPPED from 23.6 to 16.7. That's when I started freaking out. They put me on vaginal progesterone suppositories (eww...losts of white powder) and I think that has helped, but again, this was not a good sign in my eyes. (And don't even ask me how long it took me to figure out how to use the applicator to insert the dang things!)

And then I woke up the next morning and ALL of my terrible nausea and constipation was completely gone. So I completely lost my mind. I panicked and cried all the way to the office. I know that feeling "not pregnant" and "fine" at about 7 weeks is a very, very bad sign. When I went to see my spiritual director later that day I even told her point blank that I was miscarrying. I had no doubt whatsoever. I was sure of this fact for a 3 full days and I continued to feel completely normal and not pregnant. It was so depressing and I felt like I was postponing the inevitable.

And then suddenly on Sunday morning I felt nauseated again...terribly. I was elated!! I was so beyond thrilled to be sick and it gave me a tiny ounce of hope again. I called the OB after the weekend and she wanted to do yet another beta given my disappearing symptoms. The results came back on Tuesday and it was all the way up to 60,812. Wow. I was hoping for just over 30,000, so my hope continued to rise. (Apparently my numbers are the average for a 9 week, not 7 week pregnancy.)

But the true test would be the second ultrasound and I knew it. The OB had me come in today for a "viability scan" (don't you love that clinical term?) where they basically do all the measurements of everything imagineable of the uterus, ovaries, sac, and baby. It was not until that moment that I felt the shackles of beta purgatory start to loosen. As she focused on the gestational sac we saw right there our tiny little baby bean with a very clear heart just beating away beautifully!! I squeezed my husband's shoulder tightly. It was better than I had hoped.

She checked the heart rate and it was a very strong 159 beats per minute. Little one is measuring only 2 days behind now as 7 weeks 3 days (I think I'm 7 weeks 5 days) but that's okay. The Crown-Rump length (CRL) was nearly 12 millimeters and that's right about average for this week.

Afterwards we met with the OBGYN and she let me know that they found a second gestational sac. (I wondered what that was on the screen.) Sadly, it is most likely the result of a twin that didn't make it...so a fraternal twin since it had its' own sac, which is the result of 2 different eggs being fertilized. She said that probably explained my big jump in symptoms that was followed by the big decrease. "Vanishing twin" she called it.

I realize now that I really had miscarried, so it was not all in my mind. It's just that we had 2 in there and we didn't know it. I feel melancholy about this news, but then again I'm so thrilled that one of the little ones made it and is doing well right now. I am just going to count my blessings and thank God for the good news. Now, for the first time, I really -feel- emotionally pregnant, like there's truly 2 of us...and it feels so good for the time being. I know we're not out of the woods, but we have passed a major milestone today.

Beta Purgatory

Okay, this stage of pregnancy feels like purgatory to me. The image at the left is a painting of souls trapped in purgatory from Notre Dame. I'm pregnant at the moment, now just over 5 weeks along, so I'm certainly not in hell, but I'm far from being in heaven because I'm so fearful of another loss and I'm just waiting and hoping that all will be well.

I had my beta's done (blood work to check how much HCG-human chorionic gonadotropin or 'pregnancy hormone' is being produced). These numbers cannot guarantee any particular outcome, but they do provide a glimpse into the potential viability of the pregnancy. They are apart of my purgatory torture. My beta's with my last pregnancy started out quite low, and having researched this a lot since then, I now see that things were not going well from the beginning. However, my doubling time was excellent, so my low numbers at the beginning were overlooked.

Here are my beta's from my last pregnancy and miscarriage:

16 DPO: 63

18 DPO: 440

Here are my beta's from my current pregnancy:

12 DPO: 40

14 DPO: 122

17 DPO: 453

As you can see, my early beta's were are a lot higher this time around, and based on my doubling time, my day 16 beta would be about 300...quite a lot more than 63. This brings me some comfort, although I can't help wishing they were even higher just to give me some extra assurance. For now I can only hope and pray, because again, nothing is certain.

Here is a study I came across and saved the last time I was pregnant...it freaked me out at the time, and now I see it was predictive of my sad outcome.

16 DPO Beta Study...What your Beta may mean:

From: http://www.squidoo.com/16dpo

25 - 50 hCG at 16dpo -- Four women in this study had hCG levels below 50 at this stage. The researchers concluded that with these levels less than 25% would continue on with their pregnancy with more than 75% miscarrying.

50 - 100 hCG at 16dpo -- Of 16 women, 25% continued on with their pregnancies.

100 - 199 hCG at 16dpo -- Of 27 women with these levels, 73% continued on with their pregnancies.

200 - 299 hCG at 16dpo -- Of 48 women, 96% continued on with their pregnancies

Over 300 hCG -- All 105 women continued on with their pregnancies.

And another study I found from OBGYN News:

http://findarticles.com/p/articles/mi_m0CYD/is_11_40/ai_n16599521/

A quote:

"The investigators reviewed all IVF pregnancies at the New Jersey center from June 1998 to March 2004. A total of 53 patients did not have a fetal heartbeat at the end of the first trimester. Their mean [beta]-HCG levels were 56 mIU/mL on day 16, and 115 mIU/mL on day 18, with an average slope of 24 mIU/mL.

Levels and slopes were much higher for the remaining 269 women with viable pregnancies with mean levels of 216 mIU/mL on day 16 and 505 mIU/mL on day 18, with an average slope of 140 mIU/mL.

Most of the women, 180, had singleton pregnancies. Their average [beta]-HCG levels were 169 mIU/mL on day 16 and 401 mIU/mL on day 18. The researchers noted that the average slope of 111 mIU/mL was 4.62 times higher than in the pregnancies that were not viable."

I know women who have had great outcomes with low betas, but I was not one of them. I also know of women who had losses even with high betas. For now I will continue to place myself and my little one in God's hands, knowing anything may happen. And I am grateful that I am pregnant at this moment: thank you God. Of course, I don't know when I'll be out of this purgatory...perhaps not until (and unless) I deliver a healthy baby. Give me strength.

My Early Pregnancy Symptoms

Okay, so I managed to get another, much clearer positive pregnancy test again today (pictured above). I really do have to take it just one day at a time. In the mean time, since I spent so much time answering one woman's question on FF about early pregnancy symptoms, I thought I'd actually post them here, for posterity. Heh.

I am THE QUEEN of symptoms. Seriously, it is deeply embarrassing. I am either the most in-tune person with my body (in other words, crazy woman) or I actually just always have tons of hormonal things going on that I can't avoid noticing...PMS has always been severe for me.

Here are my early pregnancy symptoms, as of today, 11 DPO, in no particular order:

1. Enlarged/heavy breasts very soon after ovulation. They're always tender but not usually heavier until closer to my period. Bra feels uncomfortable.

2. Speaking of breasts, yesterday morning, before testing, I noticed in the mirror that my Montgomery Tubercles were really showing and more obvious/plentiful. And my nipples were itchy!

3. Shortness of breath during moderate activity. At times it feels like I can't quite take a deep enough breath. This was really noticeable on 9 DPO.

4. This symptom has happened w/every pregnancy: I just feel FAT...clothes don't fit right or look good. I always bloat w/PMS, but this comes on sooner and is a more general feeling.

5. Increased gas...for 4 days in a row now. Horrible! (TMI)

6. A few severe, very quick sharp pains, like round ligament pain, that feels like a charlie horse type cramp in the uterine area. That hit on 6 DPO and made me really wonder, since I only get that in pregnancy. It first hit on 9 DPO on my last BFP cycle.

7. Increased thirst started just yesterday at 10 DPO, which leads to drinking more fluids.

8. Increased fatigue, along w/feeling a bit feverish at times when I get tired.

9. A lot more cervical fluid starting at 4 DPO.

10. Irritable, everything is annoying...like severe PMS but this started at about 7/8 DPO.

11. Sleeplessness: I can't go to sleep at bedtime but then wake early even though I'm tired.

12. Let's talk cramps: At 3 DPO it felt like I was ovulating again through 5 DPO...basic ovulation pains again. At about 6 DPO the cramping felt like a dull, almost burning ache, but all on one side, that continued all day and radiated around the entire area/side. They subsided a bit, off and on, but continued to favor one side for the most part. Yesterday the only thing was a knot feeling just to the right of my belly button (but internally). Today it feels more like a lot of little knot sensations/cramps all over. '

13. More back pain, almost like I'm wondering if I injured it a tad. For a few days off and on, my legs felt achy, like I just worked out.

14. Bleeding gums when I brushed my teeth on 9 DPO. Apparently it's a symptom. I've read about it but my gums never bleed, so I took note.

15. Mild heartburn after almost each meal. I usually don't have this unless I REALLY over eat.

16. Seriously increased appetite, but it's more that I eat and get hungry sooner, like I'm famished.

17. Also strange and noticeable symptom related to eating: once I'm full, I feel like I'll hurl if I take another bite. I have to literally push the food away from me.

18. Craving and eating more protein. 2% milk started sounding super good, when I don't usually drink it and I ate through tons of soy veggie meat (I'm vegetarian).

19. Headaches almost every day for the past week.

20. Metallic or just "off" taste in my mouth that comes and goes...makes me want to chew more gum.

21. Stuffy nose every morning when I awake since about 3 DPO.

22. Not thinking as quickly/clearly, like a space cadet when I'm usually always so on top of things.

23. My intuition/brain told me "You ARE pregnant" quite a few times.

24. Diarrhea...oh joy!

Okay...it's insane I can name this many! Obsessive much?!?

A Very Faint BFP Today

BFP= Big Fat Positive (on a Pregnancy Test)

So, my husband and I were supposed to wait for 2 cycles before trying to concieve again. We really waited only one cycle because he had gone off of his meds in February and we felt we should not lose any time in case he had to go back on them again. (We believe and have been told that his anti-depressants are one of the potential causes for our miscarriages.) Our first cycle trying again was a major disappointment. I seriously thought I might be pregnant at one point and even had a very convincing evaporation line show up on one of the pregancy tests, but alas, it was not to be. I struggled with quite a bit of grief when it was clear I was not pregnant. Additionally, my husband became less sure how much he wanted to keep trying. He also realized (as did I), that he had to get back on his meds. This news spun me into a depression.

By the time we started my next cycle, I realized that this was our "last try" before my husband's meds took their full effect. He went back on them just a few days before I ovulated. We decided to give it a try, not expecting that we would fall pregnant. Additionally, I had started to do some serious soul work around the idea that I may never have another child. To say it has been painful and difficult would be an understatement, especially following our losses.

Sometime after I ovluated, I started having moments of a very strange sort of confidence that I was absolutely, without a doubt, pregnant again. And it was not just that I "felt" pregnant like I had before, but there was a deeper sense: it was simply a fact. I can't explain it, but I didn't like it, in case it was untrue. I also had a very vivid dream that first week after ovulating that I gave birth to a beautiful little boy. It was extremely vivid and wonderful. The only time I have had a dream like that was right before I found out I was pregnant with my daughter.

And then all kinds of "lucky" things seemed to be happening to me related to fertility: a child called me over to hand me a lady bug (they are considered very lucky for pregnancy). I was given 4 different gifts that were butterfly themed (symbol of new life). And while on a walk with my daughter, we found a baby bird's egg, very newly hatched and now empty, lying on the ground at our feet. We took it home. Plus, it's spring and everything seems to be shouting "fertility and new life" as we watch the flowers and leaves budding anew and as we prepare for Easter. It's all about moving out of death into new life and resurrection. Today itself is Holy Monday in the Church calendar and Easter is less than a week away now.

Of course, I had many more moments when I felt tortured by the idea that I could not be pregnant this quickly again, and this might be our last shot. In fact, by yesterday, I had convinced myself that I was simply a complete nut case with all kind of imagined pregnancy symptoms (of which I've had many)! Let's see, my symptoms include: heartburn, fatigue, tender breasts, gas, bloating, irritability, shortness of breath, itchy nipples, increased appetite and thirst, sleeplessness, vivid dreams, cramping and some very painful pulling sensations. The list goes on...seriously. And I kept thinking: what kind of insanity is behind my belief that I'm pregnant?! Of course you're not! Stop that!

So this morning, when I took my Wondfo internet cheapie pregnancy test, I was really and truly not expecting to see anything. But then I could have sworn there was a SUPER faint shadow tint on it...which even faded away when the test dried. Still, I reported the shadow to my Cycle Buddies on Fertility Friend and they were encouraging about it. I felt like I had gone truly mad, obsessing over this shadowy line. But I decided to test again with SMU (second morning urine) and again, another shadowy line, this time just a hair more visible. I took photos, tweaked, and posted them on our fertility discussion board to get opinions. Others could see it and encouraged me to "retest." By 1:30pm, I couldn't stand it. I retested and yet a third shadowy line, this time even more visible, appeared. I finally took my daughter to the store to get some higher quality tests and do some other shopping. We got home and I rushed to the bathroom, having "held it" for a full 5 hours so as not waste the costly tests and get the most accurate result.

I held the test in my hands, as I have so many other countless times, but this time it did not stare back at me stark white. No. It was like magic: a faint but clearly visible second line appeared. On both tests. (The test pictured above is one of them.)

So yes, I do have a very faint BFP only 10 days post ovulation. I have no idea if this pregnancy will last, if this little one will "stick," or if I need to prepare myself for yet another loss. I am less terrified in some ways because I feel prepared for the fact that we are high risk. No longer innocent, I know we could lose this pregnancy in a flash, and it would not be a shock.

We already have an appointment with an RE (Reproductive Endocrinologist) this week. It was to be our first consultation related to fertility, but now I hope it will also be to establish me as a patient who needs some extra attention and support for this pregnancy.

So, I am seeking to take it one day at a time. I don't want to get ahead of myself like I have in the past. I am trying to simply trust God that whatever will be, will be. Truly, the future is not ours! And for now, I'll enjoy those TWO little lines.

Diagnosing Infertility and the Causes of Miscarriage

There are many causes of infertility, miscarriage, or recurrent miscarriages, and there a variety of tests that can be performed to check for potential problems. If you've had 2-3 miscarriages, your doctor ought to begin doing recurrent loss testing. For those over 35 and unable to concieve after several months, don't hesitate to seek medical help. Below are some of the tests that can be performed as well as frequent causes of miscarriage and infertility that I have gathered from my own research. Please keep in mind that this list not exhaustive and I am not a doctor, but I hope it is helpful.

Category I: Immunological & Hemotalogical Causes
(blood clotting issues/thrombophilias)

Recurrent miscarriages can sometimes be traced to immunological problems or blood clotting disorders that cause a variety of complications in pregnancy. If you've had several losses, your doctor can (and should) order a blood test panel to check for these types of problems. The tests often include the following:

1. LA- Lupus Anticoagulant (related to the test called dRVVT: Dilute Russell Viper Venom Time)

2. ACA- Anti Cardiolipin Antibodies: molecules that attack cardiolipin causing clotting

3. ANA- Anti-Nuclear Antibodies

4. APA-Antiphospholipid -proteins that cause blood clotting/mc

5. PT and PTTT: Partial Thromboplastin and APTT: Activated Partial Thromboplastin

6. Factor V Leiden-mutation inherited thrombosis

7. Protein C and S levels and activated Protein C activity

8. Prothrombin gene mutation and/antithrombin deficiency - thrombophilia problems

9. Leukocyte Antibody Detection- abnormal attacking of the fetal cells

10. Coagulopathy-defect in clotting causing too much bleeding

11. MTHFR- a mutation that can create problems absorbing Folic Acid (usually treatable w/extra Folic Acid and Vitamin B)- single mutations are not considered problematic but double mutations can be and may elevate Homocystein levels

12. PAI-1 gene mutation: antigen in plasma -causes clotting

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Category II: Ovaries/Egg or Ovarian Reserve Problems

Another potential cause of infertility is a lack of quanity of eggs (low ovarian reserve) or poor quality egg(s) (which can also cause miscarriages), is often due to advanced maternal age. This can happen randomly to young women occasionally too. And as much as I hate the term "advanced maternal age," the risk really is much higher as a woman ages. Problems with a woman's eggs leading to infertility, miscarriage, or other complications rise after age 35. Below are some tests that may uncover any potential problems.

1. Day 3 FSH testing -Follicle stimulating hormone: this tests ovarian reserve (how many eggs are eft and potential egg quality) on Day 3 of a woman's menstrual cycle

2. Estradiol Level testing- similar to FSH, also tests ovarian reserve

3. Day 3 Inhibin- a follow up to low FSH in order to test egg quality

4. Clomiphene Challenge- another follow up to FSH after age 38 (more routine) to check egg quality. Requires taking clomiphene for 5 days.

5. AMH Testing: tests follicles for number of eggs to see if a woman is releasing eggs

6. AOA testing -tests for anti ovarian antibodies that interferes with ovarian funtion

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Category III: Male Sperm Factors

Problems with a man's sperm can certainly lead to infertility or miscarriage, although this is often overlooked and men are often only tested after a woman has been tested thoroughly.

1. Low Sperm count/motility/morphology- not having enough sperm or quality sperm is a rather common problem and can be diagnosed with a basic Sperm Analysis (SA)

2. Sperm DNA fragmentation- caused by environmental or substance damage (smoking, drugs, etc.) and other unknown causes. Of note is the negative impact that some antidepressants (SSRI's) have been shown to have on men's sperm. This type of damage is very problematic, causing infertility and miscarriages, particularly chromosomal problems, and is not diagnosed with a regular sperm analyis...one must get a sperm chromatin test or another test specifically on the DNA of the sperm.

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Category IV: Hormonal Causes

Low or abnormal levels of a number of hormones in women can cause miscarriages and infertility. Below are some of the more frequent hormonally related causes.

1. Hypothyroidism: This can cause problems with ovary function due to hormone stimulations. TSH or the Thyroid Stimulating Hormone test can diagnose this.

2. Low Progesterone: Progesterone is necessary to sustain the uterine lining during pregnancy. Progesterone levels can be checked during pregnancy and supplemented if low. The Day 21 progesterone test is given on Day 21 of a woman's menstrual cycle to ensure that ovulation has taken place (based on progesterone levels).

2. Luteinizing hormone (LH) - LH levels that are too low can prevent ovulation and level too high can indicate chromosomal problems. The LH Test is used to diagnose this.

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Category V: Infections/Viruses

Infections and viruses do not usually cause recurrent losses, but they can be a cause of miscarriage and so I've included them.

1. Toxomplasmosis -diagnosed by the Torch test

2. HIV-test to check for the presence of HIV

3. Hep B and C infections

4. CMV-endocervical infection

5. PARVO- virus (can cause fetal hydrops)

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Category VI: Anatomical Causes

If a woman's fallopian tubes are blocked or abnormal or if a woman's uternus is abnormally shaped or formed, this can cause infertility or miscarriages. Two ways to check a woman's uterus and/or fallopian tubes include:

1.HSG-Hysterosalpingogram (x-ray with dye) or Hysteroscopy (tiny camera): ensures that the fallopian tubes are open and the uterus is normal and no scarring or abnormalites are present

2. Uterine Ultrasound: checks for any uternine abnormalities via a thorough ultrasound

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Category VII: Chromosomal Causes

Sometimes a random accident occurs within either the egg or sperm during the early stages of development causing one extra gene (trisomy) or one less gene (monosomy) to develop in the embryo. Many are lethal to the developing embryo. These are not usually genetic in origin but are due to a random accident or to poor egg or sperm quality. Sometimes one or more parents may have an undiagnosed genetic translocation that causes more frequent chromosomal problems to develop and can be a cause for a small percentage of recurrent miscarriage.

1. Karyotype for genetic translocation: A test for the parents to see if there is a translocation causing recurrent chromosomal problems.

2. Other tests can performed during pregnancy, either in utero on placenta or umbilical (CVS), or amniotic fluid (amniocentesis) or after a miscarriage by collecting and testing the fetal tissue.

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My hope is that this list will not cause fear, because while many things can go wrong, most pregnancies will be succesful. However, if you're suffering from infertility or recurrent miscarriages, it's important to know that many tests are available to you so that you can be empowered to take the necessary steps to achieve a succesful pregnancy.

What to Do When Your Friend or Family Member Miscarries

I have heard from many women who end up being deeply wounded by the reactions of thier friends and family following a miscarriage. I know I was deeply pained by the responses or lack of responses from those I loved and who I thought cared about me. Most people just don't know what to do or say and end up doing something less than helpful. Silence can be the worst, further alienating the one who is suffering. Common experiences women report include avoidance by friends and family, a reluctance by others to talk about the loss, a down playing of the loss by others, or saying things that diminish the loss. For most women and men suffering from a miscarriage, the grief can be very deep and just as painful as losing a most beloved family member. For the mother, she is immediately connected to her baby both physically in a very literal way and emotionally, regardless of what stage she is at gestationally. For both parents, this little one was their baby and next child. It doesn't matter if they were just 4 weeks pregnant or much farther along. A loss is a loss. The loss can be even more traumatic later on, but the grief experienced with an early loss can be extremely acute and heart wrenching. Most mothers and many fathers will experience all the stages of grief after a miscarriage and this usually lasts for several months. Be assured that they will never forget the little one they lost and loved but never had the chance to hold.

Here are some very tangible things YOU can do to be a support to a women who has suffered a miscarriage:

1. DO call, visit, email or whatever is normal for your relationship to simply check in with her, especially during the first few weeks, but even for several months. She may or may not want to talk about the miscarriage, but just by calling to say, "I care about you and am here for you if you need anything" will help her tremendously to feel supported during a very painful time.

2. DO send sympathy cards or flowers, just as you would for the loss of any loved one. The baby was absolutely a loved one for the mother and father and acknowledging that fact in a tangible ways is a huge affirmation and comfort. Pretending the little one didn't exist is the worst thing you can do...that does not ease the pain but increases it. This was their unborn child and they had dreams and hopes for him or her, they were already in love with the little life they had created that died too soon. Give them your condolences.

3. DO talk about the topic if and when the parents bring it up. Don't change the topic or avoid it. It won't cause them more pain to talk about it, on the contrary, the pain is already there and not having a safe place to talk about it is much worse.

4. DO listen, say little, and don't give advice. Listening, nodding, and saying nothing more than, "I'm so sorry, I wish there was something I could do" or "This is so hard" is PLENTY! When we try to "fix" the problem with many words or advice, we usually say something stupid...it's a problem that cannot be fixed but simply needs to be expressed and grieved until emotional healing can be reached.

5. If you and the parents are open to prayer, then DO tell them they are in your prayers and then actually follow up with prayers on their behalf. They're going to need it and knowing that they're in people's prayers is a very comforting thing.

6. DO NOT tell them to look on the "bright side" or diminish their loss in any way. (By the way, this piece advice applies to all kinds of loss and grief. When you're grieving, this is NOT the time to look on the "bright side.") Healthy grief requires taking account the full measure of the loss and the all pain involved and then affirming that it was indeed, a very sad and significant loss. Do not tell people they are "lucky for x reason" or that "it was God's will" or that "it's a good thing for x reason." This only adds to their pain and sense of loss and alienates them further. People in grief need primarily to be acknowledged that thier grief is real and significant. Eventually, in time, they will heal, but that is not now, it is when they're ready. They will eventually see a bright side on the other side of grief, but you CAN'T short circuit the pain of grief to get them there, so don't try.

The gift of your presence and love is the most valuable thing...just being there is the most important thing you can offer. It can make a world of difference for someone in deep pain.

Healing After a Miscarriage

I began to heal, it seems, after the news about our baby girl's sad condition. Knowing there was a reason for the miscarriage truly helped, although I know many women never get any answers.

As I awoke from a dream about my baby the next day, my little girl's name came to me very clearly, almost audibly, while in that twilight stage between sleeping and waking: "Her name is Annabelle." I had never considered this name before (I have quite a few names on my list) but it was perfect and lovely and I instantly knew that was indeed her name. I doubted my husband would agree since we hardly ever agree on names. But when I told him, he really liked it, and so I looked up the name's meaning online: "lovable." Well, that was certainly true of our little girl! We deeply loved her and she was entirely lovable even at such an early stage of development (8 weeks in pregnancy terms and 6 weeks gestational age).

My healing since has included creating keepsake albums for our angel babies, Aidan and Annabelle. I included pictures taken when I was pregnant, the beloved "tokens" of the saved postive pregnancy test strips, and of course, the many ultrasound photos we have of Annabelle. My 4 year old daughter helped me put them together with stickers of hearts, flowers, butterflies, angels, "love" quotes and pictures of Jesus with the children.

I also purchased and decorated a wooden box with paint and jewels to place the little bit of fetal tissue I had left of Annabelle (after the D & C I still miscarried some fetal tissue and was told to freeze it just in case it was needed by the OBGYN). We are going to bury the little box at our church and have a private memorial liturgy to thank God for the lives and joy these little ones brought to us in their short existence on earth. They are our children in my eyes, regardless of their gestational age.

I also created a "plan" for healing and good health for a future pregnancy that includes having my husband totally wean off the SSRI's (he has since done this) and take fertility vitamins. For me it includes exercise, healthy eating, prenatal vitamins, increased folic acid, no caffeine or aspartame, and rather religious charting of my own bodily/fertility symptoms. So far so good.

Something else I found really helpful was to purchase a keepsake "baby bean" bracelet with Aidan and Annabelle's due date birth stones from http://myforeverchild.com/ (bracelet pictured above). I couldn't hold my babies, but I wear that bracelet and lovingly kiss and hold my little beans throughout the day alongside their emerald and peridot birth stone beads. I also like it because no one else knows what it means or asks intrusive questions about it.

Additionally, prayer and Scripture reading, which is something I've done daily for years, has taken a new level of priority in my life. This, more than anything, has been getting me through this time and bringing me healing. I record Scriptural promises and pray with more passion while praising God more frequently; this has kept my soul strong and even joyful in the midst of this terrible grief. "The joy of the Lord is my strength." If you have faith and are dealing with a loss: pray, pray, pray. I can't explain it, it's just a God-thing.

Trisomy 13

The OB called back in just a week, and I was surprised to hear from her so soon, but the lab results on the baby were already in after the D & C. She said, "it was an extra chromosome." I immediately wanted to know which chromosome and she explained that it was "number 13"...in other words, Trisomy 13. Trisomy 13 is a very serious chromosomal problem and is considered fatal to the baby she explained. Most babies do not make it to live birth and those that do usually live for only a few hours or days. One of the areas it impacts is the heart, and congenital heart failure is a problem, which explained (to my mind) why the heart beat may have stopped so suddenly. She also said they "weren't worried about it being genetic." Meaning, it was most likely not inherited from us as parents, but simply a random, fluke mistake that happened during conception due to damage in the sperm or egg. Once again...I immediately thought about those SSRI anti-depressants my husband was on and the way they damage sperm DNA. It certainly seems like a very possible cause. Of course, at my age of 37, my eggs aren't in tip top shape either, so between us, our risk is higher. Still....those awful SSRI's! (We resolved to get my husband off of them.)

Finally I asked the OB if they knew whether it was a boy or girl. My OB hesitated and asked, "Do you REALLY want to know?" "Yes" I said. "It was a little girl."

I hung up the phone and immediately called my husband to let him know. While it was sad news, I was also relieved on some level because it meant that we had been spared, in some sense, more heart break later down the road. While I still deeply, deeply wish I could have held my baby if even just once, I know that it would have been beyond heart breaking to go through an entire pregnancy and live birth with Trisomy 13. The pain I was experiencing was awful enough. I also realized, although I had been terribly angry at God, that this was an answer to my earlier prayers: "If something is terribly wrong, please take the little one home to you Lord."

I did a bunch of googling and saw all kinds of images and learned all about Trisomy 13. I also let my parents and best friends know the news. This was of some comfort, just to have answers to give others and not always wonder "why?" like I do with my first miscarriage. More information about Trisomy 13 can be found here: http://ghr.nlm.nih.gov/condition=trisomy13 and I found a very touching site for parents of Trisomy 13 children: http://www.livingwithtrisomy13.org/ .

The OB had me come back for a follow up appointment 2 weeks later and things looked fine. The lab drew 10 viles of blood to start testing me for possible causes of recurrent miscarriage. I was told the doc would put me on progesterone during my next pregnancy, not because she thought it was the cure, but because she would feel like she was doing everything she possibly could to give me and the baby the best chance. Low progesterone levels in women are known to correlate to higher miscarriage rates, but it is unclear and hotly debated whether it actually helps to take progesterone. I suppose many take the approach of, "We don't know but it can't hurt." I left the office feeling that this part chapter of the story was now over and I could begin healing.

The D & C

The morning after learning that my baby's heart had stopped, I knew I needed one more thing before the D & C (Dilation & Curettage): reassurance that my baby was really and truly dead. I called the OBGYN's office and asked, as nicely as I could, that while I knew it was "not logical," I needed "another ultrasound" before they did this irreversible procedure. Otherwise, there would always be the tiniest bit of doubt in my mind that maybe, just maybe, they had made a mistake. At first I was told that the ultrasound schedule was full. So I hung up and immediately made an appointment with a private company that specializes in doing 2D/3D images of (living) babies. I knew my request was odd and that if I hinted at the idea that they were somehow giving me a second opinion, they would probably deny me the scan. So I simply said I wanted some memorial ultrasound pictures of the baby I was miscarrying. They agreed to do it.

I arrived and realized how truly odd this was: it was a room with a large couch and places for a crowd to watch the baby on a big movie screen as the tech performed the ultrasound...obviously a moment of great celebration and fun under normal circumstances. I felt so strange and sad lying there by myself. But the tech did the scan and as the little baby bean's image was projected on to the big screen, it really sunk in that the heart was not beating. I asked her a lot of questions which helped me understand what I was seeing on the screen. I left that place ready to move on, so I don't regret it. (Surprisingly, the one picture I took home from the OB's office was detailed enough that we could see the head, face, body, limbs, and even the eyes and mouth of our little one...even at just 8 weeks.)

I called and scheduled the D & C for later that morning with my OB. My husband went with me and they even did a repeat scan just before the procedure, which was very compassionate of them since they were on a full schedule.

The term "D & C" is most frequently used in reference to the process of emptying the uterus after a miscarriage, but in the first trimester, what is almost always performed is actually a "Vacuum Aspiration." This is a much less risky procedure: often the cervix does not require dilation and no metal curettage is used. The process I experienced was this:

• The OB explained the entire process to me and my husband. He was then excused.
• The OB and nurse gave me a sedative through an IV. (I actually felt like I was very drunk and tired from it immediately.)
• They cleaned/sanitized the exterior of the cervix and inserted local anesthesia into the uterus (this hurt a bit), but the sedative kept me calm. I remember saying, "Ouch!" though.
• They then inserted a small tube into the cervix.
• When they turned on the machine it sounded like a loud vacuum and it aspirates (suctions) out the contents of the uterus in waves, which I found really rather painful. I gripped the table and did not open my eyes; I didn't want to see anything.
• It was over very quickly: just a few minutes of this and the machine was off. They made sure I was okay and then let me recover alone.
• My OB found my husband a little later and brought him back to my room. He had picked up 2 prescriptions: a strong antibiotic to prevent infection and a pill to help my uterus contract in case of heavy bleeding (with pitocin in it).
• The OB gave me some Advil and told me to continue to take it for any pain. I recovered for about half an hour and was told I could go home.

I was grateful that I didn't have general anesthesia because that makes me very nauseated and the sedative left me feeling very sleepy and calm instead. My husband escorted me out of the office once again through the sea of pregnant women and back to the car. We stopped for some noodle soup to go and went home. I spent the rest of the day in bed and my dear cat and dog cuddled up alongside me, as if they knew something was wrong and wanted to comfort me.

The bleeding was light and didn't last long. I had spotting off and on for a few days but over all my physical state was much better than expected. It was easier physically to deal with the D & C than the natural miscarriage which was traumatic because it is so sadly visceral. I cried a lot that week and just tried to be gentle with myself. There was a terrible feeling of emptiness though: I had been "two" and now I was just "one" again. I would reach for my tummy and have to re-remember that no little one was in there. We waited to hear back from the OB about the lab results on the baby. One advantage to a D & C over a natural miscarriage is that they can test the tissue and let you know what happened, if anything. Apparently they discover something about 50% of the time. Most miscarriages are mysteries as to "why" they happened however.

Conceiving Again

In October and November we tried to conceive, this time with the advantage that natural family planning with the sympto-thermal method and charting gave us. I knew the day I ovulated each month and we timed our intercourse just right, even with my husband's DE, I knew we had a shot. I took some early tests at the beginning of December and they were negative, so I took a short break, feeling defeated, then tested again two days after my period was due. Once again, the second line was super faint. What did this mean? I tested again with an early result test, and it was definitely a BFP (big fat positive), but faint. My first reaction was not joy but fear...the line looked too light, reminding me of my last miscarriage and the faint line. I started sobbing and waited for my husband to get home (he was dropping our daughter off at school), so that I could tell him, through my tears, that it was positive...we were pregnant but I was absolutley terrified. I didn't know I would react this way.

I called the OB and they wanted me to get my beta's drawn to check the HCG levels (an early predictor of the amount of hormone an embryo produces) that day. I went to the lab and the results that came back were a tad worrisome: the HCG was 63. I was pregnant but it was a bit too low for this date. I was 16 days post ovulation, and studying up on things, research had shown that late implantation and/or low HCG's levels by day 16 DPO carried higher rates of miscarriage. I would need to retest in 2 days to check the "doubling time." I was learning something new every day! Doubling time is the time it takes for the HCG hormone to double in one's bloodstream: in a healthy pregnancy, it should be somewhere between 24-72 hours, averaging in the 48 hour range. The next beta was drawn under 48 hours later and it was fantastic: HCG was now 440. My doubling time was better than average at 24 hours.

You might think I could relax, but I was far from it. There's sooooo many things to worry about with a new pregnancy, especially after a loss: What if it is an ectoptic? A molar pregnancy? A blighted ovum? A chromosomal defect? What if I miscarry again? I couldn't celebrate, I refused to get "too" happy. I was thrilled on one level, but fear was neck in neck with my joy, keeping my emotions at bay. We would wait to tell anyone, including our parents, until after the first ultrasound that the OB scheduled for 7 weeks. If the little one was growing on track and had a healthy heart beat, our chances of miscarriage would go down to 10%...this was key and I knew it. Christmas came and went: I was totally and completely focused on the pregnancy, nothing else much mattered. I prayed constantly, but also prayed that if anything was terribly wrong, that God would take him/her home to Jesus painlessly.

On December 28th we went in for our first ultrasound, we were holding hands with terrible nervousness. As soon as the tech had a picture of my uterus on the screen, I could see my little one's heart beat just racing away. We were ecstatic! It was going at 130 beats per minute, better than expected, and measuring on track. However, they did see a small "bleed" in my uterus called a subchorionic hematoma. My OB assured me it was nothing to worry about, but to take it easy and no sex for a few weeks. That very day we were scheduled to meet my family at Disneyland and we let them know the great news when we arrived. What a joyful celebration that was.

I could "let" myself start to bond with this little precious one growing inside me...finally, our second child was really and truly on the way! I kept telling my husband that we wouldn't be out of the forest until 12 weeks, but still, the statistics were "on our side" now.

As I started googling to get information on the uterine bleed, the SCH, fear overtook me once again as I realized that rates of miscarriage are much higher with a SCH than not. Our rate of miscarriage jumped from 10% to 25%. The first day I learned this I was paralyzed, but by the second day I was looking at it the other way around: we had a 75% chance of a healthy pregnancy. That was pretty great... and so I started to let myself celebrate. Quickly I was caught up in thinking about baby names and how I was going to tell our daughter and our wider circle of family and friends. I had joined the online "August due date birth clubs" by this time, and we were all bonding in our own way, going through this incredible experience together. Wow: I was due August 16th!

The day of my first regular prenatal exam was January 6th. They weren't even going to do another ultrasound, but I pleaded with the tech. She gave in and as she got a clear picture on the baby, I could clearly see that our little one was measuring right on track. Pure joy! I had been studying and writing down all the normative values and measurements for this date and the face/body, even limbs could be seen: I was in love with this perfect tiny baby! But then it hit me, with a sudden and strange force: I was not seeing a heart beat. I said it aloud, "I don't see a heart beat." I expected the tech to pause and say, "Oh, here it is." But instead she paused and said, "I'm so sorry." *blink* What? "How far along is the baby measuring?" I asked. "Right at 8 weeks" she said, "so the heart must have just stopped beating." I was dizzy, I was in disbelief, this could not be happening again. I reached for my husband's hands and the tears started to come...this was not possible. She quickly turned off the machine and gave us some privacy. I started to lose it. When the OB came in to say "sorry" and talk about a D & C (a procedure where they remove everything in the uterus by dilating and evacuating it), I was simply in shock. She wanted to know if I wanted to do the D & C right then. I couldn't even wrap my brain around this news! And I wasn't about to let them take this little one out of my body already! No...I would wait.

So, for the second time, my husand escorted me out of the OB's office with my red sobby eyes as we walked past all the other pregnant women in the waiting room. Our big day had turned into our big tragedy.

By the time we got outside to the parking lot, I told my husband I thought they were mistaken. They had simply made a mistake. I doubted my own eyes and the tech's analysis....we just hadn't looked hard enough, the baby was just in a bad position....it was a mistake. I knew rationally that wasn't likely, but my heart could not accept that my little one was dead. I was in the first stage of grief: denial.

Prozac, SSRI's, and Fertility

In my research to discover the possible causes of miscarriage, I started studying medication. I was not on my any meds, but my husband was. His meds were for depression and were making conceiving a bit difficult, causing what is called "delayed ejaculation." This meant that more frequently than not, he was unable to ejaculate during sex. We could make love for an hour or more, but he could not climax. I thought this was the extent of the trouble with Prozac and its' impact on fertility. But the more I learned about this class of drugs called "SSRI's" (Selective Serotonin Re-Uptake Inhibitors that includes Prozac, Paxil, Paroxetine, Zoloft, Fluoxetine, Celexa, etc.), the more concerned I became.

Most of us know that meds can impact a woman's fertility and ability to have a healthy pregnancy, but how many studies have been done on men and the impact on sperm? Sadly, not many. But early studies have shown quite convincingly that SSRI's impact a man's sperm in a very negative way. The majority of men on SSRI's in one study showed that their sperms' DNA actually became increasingly fragmented with usage. Men with healthy sperm showed a major increase in damaged sperm in just 4 weeks after taking these meds. Here's one summary of the studies:

http://www.womensmentalhealth.org/posts/paroxetine-paxil-may-affect-sperm-quality/

What is the result of fragmentation in the DNA of sperm? Well, not only does it impact the motility and morphology of the sperm (making it harder to concieve in the first place), but it can also cause more problems once the sperm fertilizes the egg: there is an increase in miscarriages and other problems with the embryo/fetus when an egg is fertilized by damaged sperm. Yikes.

When getting pregnant, you want the best egg and best sperm possible to get together, so anything that reduces their quality can make things more difficult and cause problems. I started to wonder if his SSRI usage might have contributed to our miscarriage. Still, I thought, I'm not getting any younger and it certainly couldn't "hurt" to try again since he had no intentions of getting off of Prozac any time soon. He was in the middle of a major career shift and we couldn't be tinkering with his meds. Wouldn't the best sperm make it to the egg anyway? (Well...maybe, that depends on a lot of things.)

So, we decided to start trying again. But a hint of worry lingered in the back of my mind.

Taking Charge

My response to grief is usually the same: cry and sob, but only for a few days, then dust myself off and do something about it, take action! Do something to start the healing, get stronger, and hopefully, find a way to somehow redeem the situation. But how do you redeem a miscarriage? I had to take 2 months (2 cycles) off from "trying" according to my OB, so I had to -do- something in the mean time.

My approach was to learn all about fertility, reproduction, and my body. I stormed my local library and book store and bought an excellent book called, "Taking Charge of Your Fertility" by Toni Weschler. It was an amazing read: I couldn't get enough. I learned everything I could, reading voraciously, taking notes, creating charts. Why had no one ever taught me this stuff before? The female body is incredible and there are so many things we can do to get to know our bodies and actually understand our fertility signs. God has made us "fearfully and wonderfully."

It was so empowering...and it helped me to feel a little more in control. I started charting my symptoms: basal body temperature upon waking, checking my cervical fluid every day, taking OPK's (ovulation predictors), making note of every bodily symptom I could think of (I even tried checking my cervix but haven't made that a regular thing due to it being so uncomfortable for me!). I did this throughout September and joined the online fertility charting community called "Fertility Friend." My obsession now had a place to go, and I could feed it throughout the day!

I read other women's stories and gained hope and strength. This knowledge would be the redemption. One miscarriage is very common, and it did not put us at risk for another. I would get it "right" this time and conceive again soon. I was "in charge"! Well...sort of. One thing you have to realize about pregnancy is that it requires surrender...to God and to the whole mysterious process.

An Early Miscarriage

Late on a Friday night it occurred to me that I was "late"....like a week late. How had that passed me by? I had been so busy. But then, it was only July and perhaps my body was still regulating itself after being off the Pill and my cycles were just off? But, come to think of it, my breasts were very tender and I was feeling overly tired, and that had been going on awhile. On Saturday I made the trip to the store for a test and took it...it was faint but it was there...2 pink lines. Did a faint line mean it was a positive?!? I didn't know. I called my best friend and she convinced me to go get some early tests and re-test to be sure, but, she assured me, "You're soooo knocked up!" As I drove to the store it hit me: I wanted to be pregnant so badly, and I was going to be completely crushed if the next test was negative. I saw 3, yes THREE pregnant women in the parking lot just parking my car. I smiled and winked up at God: it was a sign! I purchased the much-too-expensive tests while the clerk smiled and wished me "good luck!" I drove home like a maniac, heart pounding.

My body shook as I took 2 more tests: and both were very clearly positive! There was elation and celebration, I was so happy that I told my husband right away and we shared the news with our daughter as soon as she woke up from her nap. "Mommy has a baby in her tummy who is going to be your brother or sister!" We hugged and cried as she cheered. She had been asking for a sibling for months. We gave no thought to the possibility that this wasn't the beginning of a wonderful 9 months that would lead to our second child. We called our parents and the whole family and celebrated that night over dinner. My heart was full of joy and immediately I started making plans: baby names? the nursery? do we need a new car seat? should I see a midwife or an OB? when can I get in for my first prenatal exam? I signed up for all the online "May due date birth clubs" and pregnancy e-newsletters and jumped into pregnancy with both feet. I was 5 weeks pregnant and couldn't be happier.

That week, on Tuesday, I had to drive a long distance for a conference along with another colleague. As we talked, I confided my good news to him only to learn that his wife had the same news! We were absolutely giddy. Suddenly, a huge rock, actually a boulder, bounded down the hillside and headed straight for my car. Thank heavens it missed the windsheild and struck the left bumper. We were okay, surely the angels had protected us and my little baby! What a story we had to tell. The repairs were over $3000...but the boulder had hit in "just the right place." As I walked the dog that night, I was thanking God for his protection and for this wonderful little growing baby inside me. I felt great physically and mentally and I couldn't remember feeling this joyful in such a long time. Elation doesn't even describe it.

The next morning I woke up and hugged my daughter, but as we sat down, I suddenly noticed blood on on my pj's. Sheer panic ensued: what do I do? I had not even established myself with an OB and already I was in trouble! I needed a doctor to see me and to see me right now! I cried and elevated my feet, called the office to take a sick day and tried my best to get an OB to see me. I managed to get in to an office farther north of the city, but I would take whatever I could get because they promised to do an emergency ultrasound right then. The bleeding kept coming...I was seriously tortured and sobbing the whole way: I CANNOT lose this baby, I'm already in love with this little one! I called my husband and best friend..."pray!"

Before my husband could arrive, I was whisked back to the ultrasound room at the OBGYN's. As I looked at the screen I realized something was very wrong: there was no little baby bean with a beating heart...just a collapsed sac and blood everywhere. Could there still be hope? I knew it was unlikely. I met the OB for the first time that morning to get the grim news: I was indeed miscarrying. I was 5 weeks and 4 days along, not even to the 6 week mark. My husband arrived at the office in time to get the news and hold me while I cried and stumbled, blurry eyed, out of the office. We went home and held each other in bed, while I sobbed the rest of the day as the bleeding and cramping increased. This continued for several days and it was hell going back to work: I obsessed over everything happening with and in my body and my soul was truly tortured.

The next few weeks were dark and full of grief and tears for this little one that had been a part of our lives for such a short time. But what a time it was! The joy this little one had brought us was so intense and so blessed. If I had ever doubted wanting another child, those doubts were now gone forever.

We named the little one "Aidan" after a favorite Celtic saint known for his kindness and generosity (choosing a name was the advice of a very helpful miscarriage website to help women deal with their grief: http://pregnancyloss.info/). I had no idea the emotional pain and sense of loss would be so intense after an early miscarriage. I felt so naive, even foolish and wondered if I had done anything wrong to cause it. But since the day I lost my Aidan, it became my sole desire to have another baby. Life is not going to make sense and our family will not be whole until we have another baby. Maybe this is irrational, but it is a drive stronger than I have experienced before. I cannot explain it logically. I have asked God to take away the desire if it's not in God's will for us. Still it remains.

Back in the Beginning

I have a little girl. She's a preschooler now, but when she was conceived nearly 5 years ago, it was by accident while using birth control. Four months into the pregnancy, my husband left me for another woman, saying he did "not want to be a dad." I struggled mightily over that pregnancy, knowing it had cost me my marriage at a time when I was unsure I even wanted children. The labor went horribly and left me traumatized. I didn't think I would "ever do that again."

I was abandoned and the divorce made legal and I did the single mom thing...it was harder than I could have imagined, made more challenging by the fact that I was living thousands of miles away from my family. But, then an answer to my prayers: I met my soul mate, it was sudden and unexpected. We hit it off splendidly...and he hit it off with my daughter who was almost one year old. He proposed and we were married a year later...he even adopted my daughter... now our daughter. And I found that motherhood was a gift beyond measure when the joys and trials were shared with another.

Being a mother has completely changed me. While I find fulfillment in the wonderful work I do as a professional in helping others, motherhood has, over time, become the most meaningful part of my life. My daughter is sincerely the greatest gift from God.

Two years after our wedding, we were ready to grow our family. We wanted to give our daughter a sibling before she got too old and, oh yes, I was already 36, that "advanced maternal age" of post-35 that seems to magically spell difficulty for pregnancy. We were scared and ambivalent but excited. I didn't think it would be too difficult however...we're both in great health, eat well, exercise, do all the "right things" and we even appear younger than we are. I made plans to get off of the Pill and we started trying as we entered June of 2009. I suspected it would take us a few months, but we planned to be pregnant before summer's end, which would be good timing for maternity leave 9 months later during the slow time at work. Only, it didn't quite work out that way.