10 days of eughhh

It’s been 10 days since I started to miscarry and I am just exhausted from all the emotions and the physical madness that is going on with my body.

My 7 day post-methotrexate injection hCG blood test went very well today.  My levels have almost exactly halved since monday, from 2696 to 1358, and dropped 58% overall since the injection was administered.  This bodes well for successful treatment. I am even allowed to travel to Stockholm – as long as I am not having any pain.  I am not going to hide it, I have been suffering with pain for past two evenings now (weird how it is mostly in the evening).  Last night I struggled to sleep because of it.  The 500mg extra strength acetaminophen doesn’t seem to cut the mustard, but the acetaminophen with codeine #3 I was prescribed for pain relief after my egg retrieval seems to work a bit better.

My favourite nurse drew my blood today, she asked how I was doing.  I just replied ‘eughhh’.  She understood and nothing more was said.

Here are two photos of my cat Diesel….sympathising with my ‘eughhh’ feeling.  Chris managed to take these beauties yesterday evening in an impromptu photo shoot…..

Chris captured Diesel in  beautiful way yesterday evening

Chris captured Diesel in beautiful way yesterday evening

Chris captured Diesel in  beautiful way yesterday evening

Chris captured Diesel in beautiful way yesterday evening

What would we do without our fur babies to keep us sane?

Methotrexate Side Effects

I am just over 72hrs past my first methotrexate injection.  I have definitely noticed the side effects, but so far they have not been as bad as I thought.

Over the first 24hrs I felt nauseous and had a very dry mouth despite drinking lots – apparently this is very normal.  My bleeding also stopped – not what I was expecting.  Since those first 24 hrs, the nausea has continued 😦  I have spotted on and off (no more need for a pad, just a thin panty liner).  I have been super tired, but have been sleeping deeply – a silver lining I guess.  Last night I had weird pin-point pupils, Chris noticed them and so I looked in the mirror and absolutely freaked out.  With a quick google, it looks like it could be the painkillers that did that, so I am not keen on taking those anymore!  Pain has been bearable with pain killers – acetaminophen extra strong (NSAIDs like Ibuprofren are not good with the methotrexate), but the pain has been different to when I first started miscarrying where it felt like the worst period cramps, the pain I am experiencing now is short sharp bursts around my ovaries, but not constant.  Each time I get a short sharp burst of pain I hold my breathe (not literally) as I hope there is nothing crazy going on down there with a burst tube.

Apparently with methotrexate, the deed starts to kick in after 72 hrs, so I am hoping that tomorrow morning my hCG levels have begun to drop.

Emotionally, I have only broken down in tears three times – an average of once per day I believe is not bad going.  The things that upset the most is thinking about how for particular very short moments I actually believed this was a viable pregnancy and talked about the ‘may be’ and ‘what ifs’.  It makes me sick to my stomach just thinking like that.  Having said all that, I don’t think those thoughts are going to go away anytime soon.  So we have been focusing on our road trip out West, it helps a lot to re-focus the mind.  I think I am ready to go back to work tomorrow – I hope so, I’ve got a meeting in Stockholm to prepare for!  (that is if my doctor lets me fly :-s )

PS.  I have got to the point that I am not sure what category to post this under – ectopic pregnancy, suspected ectopic pregnancy, miscarriage, part of IVF vol I???? I just hate not knowing if this was actually ectopic or not, they had no visible proof of where the pregnancy was and it frustrates the hell out of me – I think I will put it under feelings for now and figure it out later.  I wonder what the doctors call this?

Just when you thought it was safe

If you have read my earlier post from today, you will know I was waiting for my hCG results, my doctor was expecting to see a drop or at least a similar level because I have bled so much since Monday.

I got the call at 2.15pm, my doctor said ‘Your levels have increased again to 3200 (from 2600 yesterday), I want you to take the methotrexate.  There has to be something growing somewhere other than your uterus.  When can you come in?’.

Fortunately Chris was with me because he was working from home, so we were out of the house and on the road to the fertility clinic.  We had to stop by the pharmacy to pick up the methotrexate.  The pharmacy was in a children’s hospital.  I joke with you not.  The pharmacy was having problems processing my insurance details, so we waited about 45 minutes.  Babies and children EVERYWHERE.  It was a very cruel joke.  Then to top it all off, it turns out my insurance wasn’t going to cover it.  Well – using methotrexate to effectively abort a pregnancy is an off label use of the drug.  Duh.  Of course my insurance wasn’t going to cover it.  Fortunately, the pharmacist used a coupon and it only cost us $23.

Finally we arrive at our clinic, drug in hand.  When 5 doctors are telling you to take the methotrexate, it’s time to listen.  If my hCG levels got any higher I would not have been eligible to take the drug and surgery would have been my only alternative option.  We are not completely out of the clear…the drug is effective only 90% of the time.  In 7 days time we find out if it actually worked – and of course I’m still on ‘ectopic rupture watch’ until then.

One of the doctors injected the drug into my buttock muscle…honestly, all I was thinking was – can’t a nurse do it?  Only because he asked where I would like it to be injected arm muscle or butt muscle (nice to have the choice!), we decided on butt muscle – he then turned to my doc to ask where would be a good place on the butt!  This was the point I was nervous!! But I think it had to be the doctor injecting it – I don’t really know.  It was painless compared to progesterone butt injections, the needle was a lot smaller though.

Methotrexate comes with a long list of side effects…I am already experiencing two of them (though these should only last about 24 hours and are relatively normal) – tiredness and nausea – they hit me about 3 hours after I was given the injection.  I won’t list the things I have to watch out for as a side effect, they can easily be found by googling ‘methoretexate ectopic pregnancy’.

We are truly gutted this had to be our course of action, but it seems to be the safest considering the large unknown growing inside me 😦

When you see your doctor’s number appear on your phone….

When you see your doctor’s phone number appear on your screen….in that instant your brain racks in an instant through all the possible reasons she is calling…you pause, take a breath and answer nervously.

This is what happened this morning at 9AM. My doctor tells me she is reconsidering her position, she wanted me to come in sooner for a beta blood test, in fact right this instant if I could make it. Luckily, I’ve taken the day off work and I decided to get up and get ready with Chris rather than laze around in my PJs. So I was out of the house in less than 3 minutes, making the 25 minute car journey to my clinic. All I could think is what if my hCG levels aren’t falling? What will this mean? Am in danger? Have I made the wrong decision.

I have lost so much blood now, probably about 3 times the amount of my heaviest period…let’s not even count the number of vials of blood I’ve given to the nurse for various tests!

My doctor popped her head in whilst my nurse was drawing my blood. She just wanted to check on me and assure me she thinks this is a miscarriage but she wants to do her due diligence and be certain. I understand her worry and appreciate their observation of me. But what a roller coaster.

I’m going to mention now just how much I dislike forums and some facebook groups. I joined a couple last week relating to ectopic pregnancy, one was for those who were misdiagnosed and one for those who were suffering/suffered ectopic. In this latter group there was a lady who was going through almost exactly the same as me, except one week behind. I commented with my story because everyone who had commented thus far was singing doom and gloom. I explained what my doc had said yesterday, and then one women replied to my comment “that’s what happened to me, I too was passing huge clots, they thought I was miscarrying, but actually it was ectopic”. Oh for craps sake, way to freak out a girl!!!

So now I wait….please….please hCG be lowering. I’m tired of this 😒

The saddest thing

The saddest thing about today is that we feel a relief with our miscarriage.  It’s a bit of an oxymoron really.  I am sure it is going to hit me soon, but for now I am feeling a huge weight of my shoulder, I feel 5 times lighter.

I had my blood drawn this morning by a super nice nurse, and I returned to my clinic this afternoon for the results and ultrasound.  It didn’t start off great.  My doctor said my hCG had risen again to 2600 from 1300 4 days ago.  Yikes.  I told her about my bleeding the past two days and how at 2AM I was up passing clots the size of golf balls and had been bleeding for the rest of today.

The two doctors spent an age checking every inch of my tubes, ovaries and uterus.  The ‘junior’ doctor kept pointing to something and saying that she thought it was ectopic, they even switched on the colour flow on the ultrasound to see my blood pumping around, looking for the signs of the tell-tale ‘ectopic donut’ where blood flows around the pregnancy.  But my doctor said no, that was definitely not ectopic, and she has seen lots of ectopics in her career (she this out loud!!).  Especially now my hCG levels are much higher they really would expect to see something by now.  I am very appreciative of the amount of time they took to look,  particularly in comparison to the on-call doctor and other senior doctor at the weekend who spent 1/8 of the time hunting.  My doctor said with an ectopic pregnancy I wouldn’t get bleeding with such large clots so she thinks it is very unlikely I am ectopic.  I am SO GLAD I listened to my gut instinct and said NO to taking the methotrexate.

So the conclusion?  It takes a few days for hCG levels to drop after a miscarriage begins therefore I will return on Monday next week for another blood test to check they are dropping and this is in fact a miscarriage.  I have got a sick note for the rest of the week off work, so now for a bit of chilling out and eating lots of chocolate (seriously I have eaten a lot of chocolate already today).

I’m not completely in the clear just yet, we need to see my hCG levels drop and I need to pass whatever it is that has been growing in me causing my hCG levels to rise (prob. the placenta).  The ‘junior’ doctor is on call this weekend, she said ‘don’t call me!!!’  she really meant “I hope you don’t need to call me!!!”…bless, she is lovely in her very quiet way.

My doctor reckons 6-8 weeks before I get a normal period returning, then we wait a natural cycle, start the Birth Control Pills and then can start a new round of IVF again or do a Frozen Embryo Transfer (FET) – whatever we want 🙂  This will put us at Christmas time :-s

Miscarriage is a terrible, sad, painful and hurtful experience.  At 2AM last night when the big clots were passing I felt lonely and slightly terrified, I tried to sleep through the waves of pain but it was impossible, I finally fell asleep again at 5.30AM.  I don’t know how long the physical pain will last, but I know that the psychological pain will last a whole lot longer.

For anyone who is reading this and currently experiencing a miscarriage right now, my heart truly breaks with you too – may be you have found this web page already, but I thought it was very useful: Coping with Miscarriage  http://carikay11.hubpages.com/hub/miscarriagerecovery .  Knowing that miscarriage is so common (1 in 4 pregnancies end in miscarriage) makes this even harder, because I think about how many of my friends and family have silently been affected.  I am so sorry you had to go through this – because this truly sucks X

Tomorrow is M-Day (Methotrexate Day) Ummmm NOT!

Yesterday I started to properly bleed, but it was on and off and only about a regular pad’s worth of blood.  Today I woke up with spotting. Damn it I thought.  But then at lunch time it came – the bleeding got heavier and has continued today.  I think my body is going to deal with this naturally.  I am starting to feel more positive about me saying no on Sunday to the methotrexate injection.

Today I rang up my clinic and explained what happened over the weekend.  After multiple calls from various nurses and doctors, this evening we eventually decided upon a plan of attack.  Tomorrow morning I go for a beta blood test, then in the afternoon I will return for an ultrasound.  By that time my doctor will be free out of surgery so she can see me personally, and she will have my blood test results.  So fingers crossed my hCG levels are in fact going down – surely they must be if I am bleeding this much? Otherwise if they are still increasing she wants me to take the methotrexate.

My liver function blood test results all came back normal, but my Blood Cell differential results didn’t come back exactly all normal.  But they are not too far from the normal limits i.e. pointing towards anemia. It will be interesting to see what the doc says.  I know what is normal for me because my work makes me take an annual medical which includes a full blood cell count – I’ve always had quite low numbers and is why I take multi-vits to top me up – perhaps it is just the IVF treatment, or perhaps it is normal for a pregnant lady.  But we shall find out tomorrow!!!

I said NO…am I crazy?

The on-call doctor called me first thing this morning and apologised she had not called yesterday with my results (she did have them yesterday after all and gave no reason).  She said my beta hCG levels have risen again and she wanted me to come in today to take the methotrexate shot.  I asked her if she had spoken to my doctor (- no she hadn’t) because my doctor had said she would keep monitoring me up to 7 weeks for a visible confirmation of ectopic before administering the methotrexate.  7 weeks was her cut off point.  The on-call doctor said it was ultimately my decision, but it would be against their recommendation not to take the methotrexate today.  She also checked with the other senior doctor who was there with her, and he said it was OK for me to wait – despite it being against their recommendation.  I said OK and asked when can I come in for another ultrasound, she said it was up to me.  My doctor isn’t back in the office until after the holiday weekend, Tuesday.  This is when my doctor said her cut off point was.  So I told the on-call doctor that I will wait for my doctor to come back.  I also asked what was my actual hCG level because she hadn’t told me up to then – it was 1300 (up from 1066 48 hours ago).  That was a lot less than I expected.  I have a feeling it’s tailing off.  Here is my chart:

Normal hCG levels compared to my hCG levels

Normal hCG levels compared to my hCG levels (Note this is on a Log scale)

The on-call doctor told me to call her anytime I wanted to change my mind, and please look out for any pain.  After I got off the phone, I panicked.  Chris was still asleep in bed at the time of the phone call so I woke him and basically cried at him.  He says he supports my decision, but wants me to take the methotrexate.  Ultimately I feel like crap right now.  I have had SO MANY unknowns from encounters with doctors and I am sick and tired of it:

  • When I was 18 I went to ER because I had a random massive vaginal bleed.  They couldn’t tell me why.
  • When I was 19 I spent a year in and out of doctors trying to diagnose my abdominal pains.  I was eventually diagnosed with Irritable Bowel Syndrome (IBS), but there is no test to confirm this, it was their last thing in the box (I know I do have IBS, but really we don’t know why – and no one really knows what causes IBS).  I could have endometriosis too, but IBS explains the pains too.  They couldn’t tell me why.
  • When I was 20 I ended up in an ambulance being taken to ER because I passed out from abdominal pains.  I freaked out a lot of people.  They suspected that it was IBS related after eating 3 days of ration pack food in the field whilst on Army Exercise.  But really – they couldn’t tell me why.
  • We can’t have a baby without medical intervention.  We have unexplained infertility.  They can’t tell me why.
  • I’m pregnant, but they can’t see anything on the ultrasound at 6W4D and hCG level of 1300.  THEY CAN’T TELL ME WHY.

What is wrong with my body?  It’s like I have a black box body of unknown-ness.  Am I actually an alien??!

Honestly, I think I might be going crazy for not taking the methotrexate, but there is something that just doesn’t feel quite right about it.  Why don’t I want to take this drug? Because I’m very afraid of the side effects and being put through this unnecessarily if the abnormal pregnancy is in fact just growing slowly in my uterus and not one of my tubes.  Methotrexate can really mess with your gut, and my gut really is bad enough as it is.  I am not even bothered by the fact that we have to wait 3 months before trying again – I will WELCOME this after everything we have experienced the last 2 weeks.  Chris thinks I should take the shot so we can end this right now, mostly for the psychological pain, plus of course he is worried I will end up in hospital. Aghhh.  This truly sucks.

Compared to this, the 2 week wait will feel like a breeze

Warning – grumpy Dani on the loose!!!

  1.  We turn up to my ‘monitoring’ appointment this morning, sign my waiver which only has a beta blood test and no ultrasound listed.  I point this out to the receptionist…she checks my notes, apparently in my notes my doctor said only for a beta because it was too early to see anything on the ultrasound.  Hmmmm, this is not what my doctor said on the phone on Thursday!!  She said now that my hCG levels were over a 1000 perhaps we would find Waldo this time!  Receptionist talks to doctor and adds the ultrasound to the waiver form.
  2. A nurse I have never met before takes my blood…after making me almost pass out.  She jabbed hard with the needle, Chris was watching, I wasn’t but it was REALLY painful.  He was pulling faces at me from across the room because he could see that the nurse did not have control over the needle – even with a butterfly clip the needle apparently flipped 180 degrees.  She was not apologetic and had not appreciation for the pain on my face or that she had even done anything wrong.  The other day when a nurse hit a valve she was so apologetic, but it barely hurt so I told her not to worry.  The nurse today – I give her a big fat Freddie F for FAIL.
  3. We waited an hour after my blood draw for the ultrasound.
  4. Once we are in the ultrasound room, lucky me – I get two different doctors again, one I have never met before – my doctor was not working Saturday.  Fair enough, everyone needs a break!!! No Waldo found today.  BUT both Chris and I noticed that my uterus looked different from the previous 2 ultrasounds, I think this is one of the downsides of having different doctors monitoring me.  Basically, the doctor sent me to have more blood drawn in preparation to take the methotrexate if my beta hCG levels are still rising.  They even discussed whether the labs would be able to get the results today stat and could get a prescription in at the campus hospital for them to administer tomorrow (Sunday).  They thought it would be possible.  We sat there nodding our heads.
  5. Chris asked if a different nurse could draw my blood as he explained the ineptitude of the earlier nurse.  I will admit that I was annoyed that Chris asked this because I would have preferred not to have caused a fuss, and being a reserved Brit, probably would have told the nurse that she had really hurt me earlier and shown her the bruises she left – then at least get an apology from her.  Anyway, the doctor kindly arranged for me to have a different nurse draw my blood from the other arm.   Blood drawn – nurse hits a valve – may be my body is telling the nurses it is done with blood draws.
  6. We wait for results all day.  It is now 9PM and I have not had a phone call today.  In the UK, if the doctor doesn’t call it’s a good thing.  I’m not sure that’s how it works here?  Chris thinks it’s a good thing.  I think the tests were not done ‘stat’ and there were simply no results today – usually the nurse would call to update me, but because it is a Saturday and we seemed to have got one nurse into trouble, no one has updated us.
  7. I am still pregnant unknown location (PUL) – i.e. rising hCG levels and no visible sign of pregnancy on ultrasound.

I have been concerned today that the on-call doctor wanted me to take the methotrexate tomorrow – but I realised after the appointment that my doctor had said she thought that as long as I have no symptoms and there is no pregnancy on the ultrasound she would keep monitoring me until I am 7 weeks pregnant (3 days time).  So I wondered how that would work – if the on-call doctor had a different opinion to my doctor, would my doctor be pissed.  I was planning on talking to the on-call doctor about this when I got my results, but this seems to be a moot point now she hasn’t called today.

I’ve done a bit of research into my situation of possible ectopic pregnancy and there is quite a bit about misdiagnosis of ectopic pregnancy.  Basically, doctors prefer to diagnose ectopic early to avoid rupture of the fallopian tube.  This makes a lot of sense….except there are many cases where doctors have been too early in their diagnosis and effectively terminated a healthy uterine pregnancy mistaking it for ectopic.  The most up to date information I found on PUL, ectopic pregnancies and methotrexate was discovered from an article: “Tragically Wrong: When Good Early Pregnancies Are Misdiagnosed As Bad“.  The author of the article is interviewing a Dr Peter Doubilet, one of the authors of a well written research paper: “Diagnostic criteria for nonviable pregnancy early in the first trimester

I am literally copying the introduction to the article, written by Carey Goldberg, because I thought it was worth sharing, but the full article can be found here:  http://commonhealth.wbur.org/2013/10/ectopic-pregnancy-misdiagnosed-methotrexate

A beautiful, supremely talented young friend of our family recently fell victim to a terrible medical mistake. Newly married, she was having some pelvic pain and bleeding, and the doctor who saw her diagnosed a probable ectopic pregnancy — an embryo that develops outside the womb. Concerned that such pregnancies can turn life-threatening, the doctor prescribed the standard treatment: methotrexate, a drug used for chemotherapy and to help induce abortions.

When our friend returned to be checked a few days later, the imaging revealed that in fact, the pregnancy had not been ectopic; it was in place, in her uterus. But because she had taken the methotrexate, a known cause of birth defects, her pregnancy was doomed.  She soon miscarried. What may have been a perfectly healthy pregnancy had been ended by well-meant medical treatment.

I assumed her horrifying case was an exceedingly rare medical fluke — until now. A paper just out in the prestigious New England Journal of Medicine shows that such misdiagnosed pregnancies are part of a pattern — a pattern that needs to be changed. “Considerable evidence suggests that mistakes such as these are far from rare,” it says.

When I told our friend’s story to the paper’s lead author, Dr. Peter Doubilet, he responded that he knows of “dozens and dozens and dozens of similar cases that have come to lawsuits, and that’s probably the tip of the iceberg.” There is even a Facebook group, Misdiagnosed Ectopic, Given Methotrexate, run by a mother given methotrexate whose daughter was born with major birth defects.

The New England Journal of Medicine paper stems from a panel of international experts who resolved to change medical practice to stop such misdiagnoses.

When I read the research paper the most interesting take away for me was:

  • Women with a pregnancy of unknown location (PUL) and hCG levels of 2000 to 3000, the likelihood of ectopic pregnancy is 32.7%, the likelihood of nonviable intrauterine pregnancy is 65.5% and 1.7% for a viable intrauterine pregnancy.
  • Women with a PUL and hCG levels of 3000 or more, the likelihood of ectopic pregnancy is 33.2%, the likelihood of nonviable intrauterine pregnancy is 66.4% and 0.5% for a viable intrauterine pregnancy.

The authors recognise that these likelihoods are not highly precise, and there are some limitations to their data, but they argue that this does not matter, it purely demonstrates that ectopic pregnancy is not the likely outcome in PUL.  However, they point out that this is only true of the woman is hemodynamically stable and not presenting with abdominal pain. The one thing that was comforting to see was that there is limited risk in taking a few extra days to make a definitive diagnosis in a woman with PUL.

There is also one other interesting thing I discovered after looking up the facebook group  “Misdiagnosed Ectopic,Given Methotrexate”.  PUL is very common in women with a tipped (retroverted) uterus.  Why?  Because it can be harder to see an early intrauterine pregnancy on transvaginal ultrasound and may not be seen up to week 8.  A lady who created the website misdiagnosed miscarriage says that no research has been done on the relationship with retroverted uterus and misdiganosis of miscarriage.

What is my conclusion?  Keep going to the monitoring appointments, if I have pain – take myself to ER straight away, wait until my hCG levels rise enough to see something on the ultrasound- then we can make an informed decision on which drug to take to aid my miscarriage. – Or best of all situations, I just miscarry naturally.  Really, the next 2 week wait is going to seem like a breeze compared to this.

Sad, but starting to feel mad

This afternoon I had my mobile (cell) phone with me on loud so I could hear the doctor ring with my results.  I get a lot of notifications and pings every 5 minutes so I am sure my colleagues were getting annoyed with me.  But anyway, I received three pings all at once, which I thought was odd, so I checked my email to find a notification from my clinic for a new appointment, with my doctor tomorrow morning (The three pings were from my email and app that tracks my appointments).  Well isn’t that just nice?  My eyes started to well up because I knew this had to be bad news – what a crappy way to find out?  After 20 minutes of consoling myself, I finally received the call from my doctor.  My hCG levels have continued to rise again to 686 (Tues) from 345 (Fri).  Not good news.  So my doctor starts talking more about this potentially being a tubal (ectopic) pregnancy…she didn’t really tell me anything new from yesterday, she stressed again that there is zero chance that I have a viable pregnancy (OK so I got that from yesterday when there was nothing on the ultrasound).

Tomorrow morning I will have another ultrasound to double check my uterus for a (non-viable) pregnancy and some blood tests to see if I am suitable candidate for the drug methotrexate.  I have done a bit more research into this drug, and I really want the doctor to explain all tomorrow – I will be using my 3 point guide to help me feel better informed!  The best guide I found is from the NHS:

“The use of methotrexate to treat pregnancy of unknown location and ectopic pregnancy” available here.

I have been having some random (but not sharp) short pains today, including pain on the left side.  I have also not passed any blood today.  The problem is with Irritable Bowel Syndrome for me is that stress causes pain, so I am having a hard time distinguishing between the two – I don’t feel stressed per se, but this rollercoaster surely can’t be good for my gut.

In the meantime I’m looking forward to tomorrow’s appointment as I move from feeling sad to feeling mad – mad that this feels really unfair and crappy.  I’m taking bets on how many med students/doctors/fellows/nurses they can squeeze this time in the room for my ultrasound tomorrow…..I have a feeling there will be some interest 😐


There was nothing there on the ultrasound screen, just my beautiful uterus – empty.  There was the teeniest tiniest black spot that may have been the beginning of a sac, but it was so small my Doctor was not certain.  She didn’t need to say anything for me to quickly realise that I was not one of the lucky 1%.  My doctor checked my ovaries: my right one is still hyperstimulated from the IVF and I had some VERY big follicles/cysts (but this is normal for after IVF and of no concern, but may explain any pain I may have here), my left ovary too was swollen, but not as bad as my right one.

What does this mean?  It was difficult for my doctor to say without knowing what my beta test results are.  If my hCG levels are continuing to rise, it is likely that I have a tubal pregnancy (ectopic pregnancy – a pregnancy that grows outside of the uterus).  If my hCG levels are falling, then it will be safe to assume that I have a chemical pregnancy* and the little black spot on the screen was indeed huckleberry.

My symptoms have been spotting dark brown blood since Friday, general abdominal pains all day Monday, my spotting surprisingly stopped today (Tuesday).  I have had some pains specifically on my left side, although not overly sharp pains, and I pointed out to the doctor (doctors – there were 2 others in the room with her) where this was….yeh, about where my ovary/fallopian tubes are.

If this is a chemical pregnancy then the doctor will prescribe me some medication (a vaginal pessary, I cannot remember the name of it) to help my body along with expelling the uterine pregnancy.  If this medication doesn’t work, or my hCG levels come back higher with a likelihood of a tubal pregnancy, then I will be prescribed Methotrexate (an intramuscular injection – YEY another injection, of course!!!).  I want to avoid taking this drug because it will mean we are not allowed to conceive for at least another 3 months because the chemical can stay in the body and harm a developing embryo.  But at the same time, we don’t want to wait and see for too long because there is a chance my tube could rupture and I would lose a fallopian tube.  I have read that even after being given the shot their tube still ruptured because it was left too late.

So I was asking you to hope with me that I didn’t bleed, but now I want to bleed….please, please body, just bleed!!!  I think this will be one of those times when I cry tears of happiness when I start to bleed full flow!  I know it will also be sad at the same time….choo choo, all aboard the emotional train wreck!!!

I mentioned that there were two other doctors in the room, one was ‘shadowing’, the other was a fellow (no not a chappie you silly Brits!!!).  The fellow interjected and answered some of our questions, he was clearly very knowledgeable, but there was a lot of bouncing around between them.  Chris was getting frustrated with the information we were receiving, they were talking to us as if we were medical professionals.  It took 5 minutes of Chris’s continued questioning to get the doctors to say that despite the miscarriage being bad (and sad), what we were seeing was ‘normal’ or ‘common’.  What they really needed to start out with was – don’t worry, there is nothing seriously wrong with you, chemical pregnancies happen frequently with IVF (because they are transferring 2 embryos).  I think I had a bit more knowledge than Chris and didn’t feel quite as frustrated because I had googled a lot on miscarriage, chemical pregnancy, blighted ovum and have read forums/blogs etc.  So my lesson here is to share more of my ‘google expert medical opinion’ knowledge with Chris before these types of appointments.

We also discussed my hCG levels (49, 110 and 345) and my doctor did admit that my first hCG result of 49 was borderline low- to non viable.  So why, oh why, did the other doctor (who did my IUIs) seem so happy and chirpy on the phone, proceed to tell me my progesterone and estrogen levels were excellent but fail to tell me my hCG level.  All it required was this:  “Congratulations Ms Dani, you are pregnant, but your levels were a little lower than average, we would like to see you again in 5 days just to make sure you levels are doubling nicely.  Your estrogen & progesterone levels are excellent, so this is a good thing.”  Expectation management is not a bad thing.

So – we have one big question answered, I feel a relief, albeit a sad relief – there is no viable pregnancy.  The next big question we wait for an answer is – is this a chemical pregnancy or a tubal pregnancy?

*A chemical pregnancy is a clinical term for a very early miscarriage. It happens before an ultrasound could even detect a heartbeat (before the 5th week of gestation). This occurs when an egg is fertilized but it does not implant on the uterine wall. Chemical pregnancies are actually quite common, occurring in 50 – 60% of first pregnancies.  There are many possible causes of chemical pregnancy – inadequate uterine lining, low hormone levels, luteal phase defect, infection, or other unknown reasons. The most common assumption is that they are due to chromosomal problems in the developing foetus. This can result from poor sperm or egg quality, genetic abnormalities from either mother or father, or abnormal cell division of the foetus.