My Story - The Second One

After the experience with the first doctor I decided to find a new physician. I wanted to find a doctor who would see me when the need arose and who I felt would hear and meet my needs. I also needed to make sure that the doctor's staff would help, not hinder, the process. I soon scheduled an appointment with another OB/GYN who came highly recommended. When I met with this doctor, I thought he was great but unfortunately his nurse didn’t call me back about lab results, forgot what labs had been ordered and seemed slow to respond to phone calls in general. Call me unfair, but after my last experience with poor follow-up, I wasn’t up for any more of the same. That office struck out too. 

During this time I had a recurring prompting that I needed start working with the physicians at University Hospital. University Hospital is known for excellent medical care and advanced research and treatments. It is a huge medical facility with many different associated clinics. However I wasn't sure what doctor or group of doctors I should be working with and I didn't know where to start. I just knew that I felt guided to be there. I started looking up information regarding doctors that treated miscarriage. I found one in the Maternal Fetal Medicine Department and I called and scheduled a consultation.

At that time I had no idea why I had miscarried. I was told that it was most likely a once in a life time event. In spite of this reassurance, something inside of me just didn't feel settled. It had been almost five months since the miscarriage and I had felt really off ever since. I had been experiencing hormonal mood swings, foggy thinking, forgetfulness, constant fatigue, water weight retention, hormonal migraines, irregular cycles and to top it all off, I had not been able to get pregnant. It was miserable.

The day of my consultation came and I went in and met with the doctor. Even though I wasn't fond of this doctor's bedside manner (it was actually pretty atrocious) my visit yielded some very helpful information. He recommended that I see a Reproductive Endocrinologist (RE) for what he termed sub-fertility. After leaving the consultation, I looked over the list of REs and one name seemed to stand out to me in particular. I called the RE clinic. Much to my surprise and delight, they had an opening in two weeks. I scheduled the appointment and felt an excited anticipation.

The first time we met with our RE, Dr. J, she elicited hope and confidence in me. I knew from her online bio that she had been educated at some of the best schools in the country. During my appointment she reviewed my history and was convinced there was hope for me. It was the first time in five months that I felt hope and I was grateful for such a gift. Before my appointment ended I had a follow-up plan and instructions. Even better, I had a way to contact Dr. J directly with questions (through a secure web portal). No more having to go through the office staff! I knew after meeting her that she wasn't just good, she was GREAT. I felt confident that we were finally working with the right doctor. I had more hope and peace in my heart than I had felt for five months.

The first step in my new treatment plan involved a trip to the lab for several blood tests. I can’t remember how many tubes of blood were drawn that day, but it is a good thing I don’t get sick at the sight of blood. Dr. J checked everything that could be causing a problem - thyroid, adrenals, pituitary gland, kidneys and a basic metabolic panel. I was impressed at how thorough she was.

My next appointment with Dr. J occurred on day two of the following cycle. More blood was drawn and an ultrasound was conducted. When all the results came back normal, I was given the green light to begin Clomid. I was nervous about starting Clomid for several reasons. I had heard horror stories about it and the pharmacist who consulted with me dryly stated that this drug was "not pleasant" (never a good sign). Much to my surprise, my body responded very well to the Clomid. I didn’t feel so hormonal, the foggy brain was gone as was the moodiness. I even lost ten pounds as my body finally shed the water weight it had been hanging on to for months. For the first time in a long time I felt like myself. Clomid was my new best friend! Don’t get me wrong, I had some side effects but compared to the benefits, they were minimal. In addition to the Clomid, I was put on a strict regimen of Progesterone. I was instructed to begin the Progesterone three days after I had a positive ovulation test and either continue it on into pregnancy, if that occurred, or stop if pregnancy didn't occur. I remained on this regimen for three months.

A little note on using Progesterone. Progesterone makes you feel pregnant, even when you're not. This is because it is increasing your natural progesterone level which is one of the first hormones to increase in pregnancy. It has been my experience that when I am actually pregnant the symptoms are much stronger than they are with just the Progesterone. I term how I feel on Progesterone as “faux” pregnancy symptoms. Because of these "faux" pregnancy symptoms, it is an emotional roller coaster. I had to mentally prepare myself each month and somehow find a balance between having hope the Clomid/Progesterone combination would work and not letting myself get too discouraged when it didn’t. This is easier said than done. Every month I had to fight these emotions and would shed some tears when the result was negative. During this time I came up with a mantra that helped me manage these feelings. I would tell myself over and over again, "It's not never, it's just not right now."

A little note on Clomid that I learned from Dr. J. If you are ovulating on Clomid then it is doing its job. Clomid is only an infertility drug in the sense that it helps the woman ovulate more regularly. Since abnormal ovulation is a very common source of infertility for women, regulating ovulation can be very beneficial. However if something else is going on, in addition to irregular ovulation, Clomid won’t necessarily help conception. I also learned that with Clomid, the lowest possible dose that achieves ovulation, should be used. Using higher doses can actually be quite dangerous as problems such as hyper-stimulation of the ovaries can occur.

On the third round of the Clomid/Progesterone regimen, I began to experience stronger symptoms of pregnancy. Although my home pregnancy test (HPT) was negative I was suspicious that I was actually pregnant. At this point I had been trying to conceive (TTC) for nine months after the first miscarriage. I wanted to see a positive pregnancy test more than just about anything. Right around this time I had my three month follow-up appointment scheduled with Dr. J. I decided to discuss my stronger pregnancy symptoms with her then.

At my appointment, Dr. J and I went over my treatment plan and discussed how things had been going. Dr. J recommended if I hadn’t conceived by February (five months after beginning the Clomid) that we move on to a more advanced form of infertility care. I was grateful to hear this. I had heard stories of women who were on Clomid for extended periods of time and I didn't want to use it long term if it wasn't helping me get pregnant. While visiting with Dr. J, I also told her about the stronger pregnancy symptoms. We decided that I would go ahead and have a quantitative human chorionic gonadotropin (HCG) test to see if I was pregnant. The HCG test is more sensitive than HPTs. I went to the lab and had my blood drawn. As I went home I felt hopeful but uncertain. 

The next morning I received a phone call from Dr. J. She told me that based on my HCG results I was technically pregnant, but my numbers were very low and she wasn’t hopeful. Her directness might seem a bit harsh, but one of the things I have come to really appreciate about Dr. J is that she is very honest with me, even when it is hard. Because of the low numbers, I had to go and have a second blood draw in 48 hours to see if the HCG level would increase. I hung up and prayed and cried. I called my husband and then my Mom. We all prayed that if this was right, the numbers would grow. I had waited for such a long time. All I wanted was to know was that I was pregnant again and everything was okay.

I went to the lab 48 hours later and had my blood drawn. The following day I heard from Dr. J again. She told me that unfortunately the numbers had fallen, not risen. She instructed me to go off of the Progesterone and told me that my cycle would follow in a couple of days. I was devastated. It was December 20^th and we were scheduled to fly out for Christmas the next day. I was terrified to go through another miscarriage, especially away from home. My first one had been so traumatic and painful, physically, that I wasn’t sure what I would do if the same thing happened when we were away. I expressed these concerns to Dr. J and she reassured me that it would be more like a heavier menstrual cycle and less like the miscarriage I had experienced previously. 

Even though this second pregnancy was what is technically known as a biochemical pregnancy, it was real to me. That is the thing that still amazes me about miscarriage. I have lost babies at several different gestational ages in the first trimester. No matter how long or how little time I knew about the pregnancy, I have grieved each one. They were and are my babies. I have loved and wanted each baby. I had hopes and dreams for each baby. Was the second pregnancy loss easier than the first because I knew about it for such a short period of time? Perhaps in some ways it was, but it was still a loss of something and someone I dearly wanted.

After the biochemical pregnancy, Dr. J instructed me to schedule an appointment for a sonohysterogram. The sonohysterogram is a test that looks at the condition of the uterus to ensure there aren't any abnormalities that would prevent a successful pregnancy. It had to be performed somewhere between days 6 and 12 of the cycle. With Christmas, our being out of town and Dr. J's office being closed for the holidays, the only time we could schedule the test was on the morning of New Year's Eve.

On the morning of New Year's Eve, I went to Dr. J’s office. I was nervous and still hurting emotionally. I had been told the test was uncomfortable and would cause cramping. The procedure was actually better than I had expected. Dr. J is very gentle and has a calming manner about her. I was given very good news that day, everything was in tip top shape. I felt like I had been greatly blessed. I dried my tears and looked forward to better news in the future.