Wiggly little fish

 At the end of August, at 12 weeks and 2 days we had our 12 week scan. The purpose of a 12 week ultrasound is routine screening to check the baby is developing normally. Together with a maternal trimester 1 blood screen, the scan is used to assess the risk of chromosomal abnormalities such as Down Syndrome (trisomy 21), trisomy 13, and trisomy 18. 

The sonographer had a little difficulty getting a clear view of the baby, saying it was quite deep in my abdomen. After positioning and re-positioning the probe, we managed to get a few grainy views where he was able to take some measurements including length (61mm), heart rate (150bpm) and checked the position of the placenta. During this time, the baby was very active - more so than I knew they could be at this age. They kept moving up and down like they were swimming, wiggling about like a little fish! They were also on a slight angle, which meant that the sonographer couldn't take one key measurement - the nuchal translucency. This a a measurement of a fluid pocket at the back of the baby's neck, and is one of the factors used to assess the risk of Down Syndrome. After asking me to repeatedly move positions and get up and walk around to try and move the baby (unsuccessfully) they rescheduled us for a follow up scan the next week.

The day before my next scan I had my next midwife appointment. They asked how I was doing, checked my blood pressure and we were able to hear the baby's heartbeat through a doppler (151bpm). They also conducted a urine test to make sure I wasn't passing an excess of protein or glucose, which can be indicative of health issues. Everything checked out as normal, and my next midwife appointment is to be at 17 weeks.

At the follow up ultrasound at 13 weeks and 3 days, the sonographer was able to find the baby more easily and images were much clearer - but this time the baby was upside down! After repositioning the probe a few times, they managed to get a clear view and were able to skillfully take the nuchal translucency measurements upside down. At 1.9mm the measurement was well within the normal range - anything less than 3mm is no cause for concern. Our next scan is to be at 20 weeks.

Stock image of 13 week old foetus. Ours looked more-or-less like an upside-down version of this.
From: https://www.sciencephoto.com/media/79609/view

When the risk assessment results came in from the scan and blood test, they reported that the chance of Down Syndrome is 1 in 4500; trisomy 13 1 in 100 000, and trisomy 18 1 in 100 000. The reference given for all of these was that the cutoff is 300 - so a chance of 1 in 300 or greater would indicate high risk. The analysis concluded that there is a low chance of our baby having any of these conditions. (the chance of Down Syndrome is only higher because it is a more common condition than the other two, these results are well within the range of normal and low-risk).

At 10 weeks, I was able to wean off both my Progynova and Utrogestan over 4 days. At 12 weeks, folic acid supplements are no longer necessary. The only thing I am currently taking is the daily iodine supplement. After consistently feeling pretty sick up until around 13 weeks, I am now mostly feeling a lot better, with the odd period of nausea becoming less frequent. I'm still generally exhausted, but I've had my busiest couple of months work/study wise, and should be able to get some more rest soon which will hopefully help. In the meantime, we will look forward to our next scan.

A Little Lizard Thing

It's been a busy couple of weeks! The week following my last post we met and signed up with a midwife, who sent me for my first antenatal blood test. While we will be in contact and I can get in touch if I need anything, we will not need another visit until after our 12 week scan.

Later that week we had a bit of a scare, as I discovered I was bleeding. I called Fertility Associates, and the nurse assured me that some spotting/light bleeding can be very normal at that stage of pregnancy, and for someone who has gone through the type of treatment cycle I have. Regardless, they ordered a blood test to recheck my hCG. It came back at 24300, so had still been at least doubling every 2-3 days, suggesting that everything was still ok. The bleeding also stopped after just a couple of hours, which was reassuring. I had been feeling a little nauseous, and that also hadn't changed, so it looked like we were still on track. Bleeding at this stage of pregnancy can be caused by the embryo implanting into the uterine lining, so hopefully it was just making itself at home.

Over the last couple of weeks I have found that instead of feeling hungry, I start to feel sick. While I haven't actually been sick yet, it's not a great feeling. I also find I get hungry a lot, so I'm basically feeling sick on and off most of the day at the moment. Nothing debilitating, but not fun either, especially as I'm also feeling tired most of the time. Also helpful is that I am experiencing the heightened sense of smell that often accompanies pregnancy, as well as food aversions. Some days I feel sick at the thought of certain foods, the next day it's one of the few things I can face eating. I can barely keep up! At least I can eat I suppose.

Today we had our 7 week scan. They advised me to go with a full bladder, but they couldn't get a very good view through the external probe so they asked me to empty my bladder so they could use the internal one. They were able to get a good look at our embryo, and take some measurements. We could see the embryo itself looking like a little lizard thing, and the yolk sac through which it receives its nutrients until the placenta forms. Normally, for non-IVF babies, the measurements from this scan are what they can use to calculate the estimated due date from. Today, known to be 7 weeks 3 days of age, it measured 13mm long and was calculated to be 7 weeks 4 days based on the length, so the measurements are pretty accurate. We could see its heart beating, and the ultrasound technician recorded it at 150 beats per minute, which they said was within the normal range for this stage. Since our appointment was late in the afternoon today, I expect Fertility Associates to call and discuss the scan with me tomorrow. If they're satisfied, they will discharge me into the care of my midwife.

Stock photo of an 8 week ultrasound. This is more or less what we saw (once again not posting our images out of respect for any potential future person).
From :https://www.itnonline.com/article/fetal-pictures-ultrasounds-gallery

While things are still very early, it was reassuring that things are looking ok so far. The appointment today helped things feel a bit more 'real', and it was nice to confirm that there really is something growing in there.

Player Two is Still in the Running

Today I had a blood test to measure my hCG (human chorionic gonadatropin), which is the hormone produced by the cells that surround a growing embryo. This is the hormone that is used in tests to confirm pregnancy. Ideally, I would have had this test over the weekend as this would have been 10 days following embryo transfer, but it was scheduled for today (Monday) so that we could get a same day report of our results. Just before 4pm today Fertility Associates called me, and after checking my identity details, gave me my results. Had the test occurred on Saturday, they would have been looking for an hCG ≥50, and the reference doubles each day, so by today they were looking for hCG ≥200. My level today was 410! So I am currently 4 weeks and 2 days pregnant, with very encouraging levels of hCG. 

We still have a long way to go!
From:https://www.healthline.com/health/pregnancy/pregnancy-week-4#your-body

I am to continue taking the Utrogestan and Progynova, and have a follow-up blood test on Wednesday to check my hCG is still climbing at an appropriate rate. If things are still looking good, I am to continue my medications until around 12 weeks, all going well. I am also to continue taking folic acid, and to start taking 150μg of iodine per day. I was also advised to contact a midwife, as although visits wouldn't start until around 7 weeks, they can book up really quickly. Pending a good blood test result on Wednesday, I will have an early scan at around 7 weeks (so in late July) to check how things are going. 

We are relieved and excited, but also mindful that things are very early (most people would not yet have announced) and we have a long way to go yet.

8/7/20 Update:

Today I had my next blood test, and a Fertility Associates nurse rang me early this afternoon to report my results. My hCG today was 1350, which is very encouraging given they said it should be doubling every 2-3 days at this point. They then checked the medications and supplements that I am taking, and organised to courier me some more Utrogestan. They sent through a referral to Pacific Radiology, and I have since arranged my 7-week scan for the end of the month. Until then, we're just crossing our fingers and taking it one day at a time.

Player Two Has Joined The Match

Last Thursday, my blood test results again came back showing that I was on schedule for embryo transfer. Yesterday we traveled to Christchurch in preparation for the appointment today. After finding that my bladder wasn't full enough last time to visualise everything properly on the ultrasound, I made sure I drank close to two litres of water over the course of the morning. By late morning when our appointment time arrived, I was very uncomfortable!

As before, on entering the clinic and being taken to a private room, I was asked to confirm my name, date of birth and address, before the nurse advised us that our remaining embryo had survived the thawing process and was ready to be transferred. They gave me all the paperwork and lab forms for aftercare and the next blood test I would need. I changed into a gown, and they led us back through to the theatre to the waiting nurse and specialist doctor. Dave was again seated on a chair just at my shoulder. This time, they had no trouble finding my bladder with the ultrasound, (if anything it was a little too big!), but they were able to visualise my cervix and uterus. Having a full bladder apparently helps move other organs such as your bowels out of the way, and flattens and straightens out your cervix and uterus into positions that are easier to see with the probe. They had no trouble inserting the speculum and threading the catheter through my cervix, and could see it on the ultrasound - the catheter shows up as a thin white line in the grey distortion. Again, this was a little uncomfortable, but not painful. When they were happy with the position, they indicated to a third nurse who handed them the embryo contained in a syringe from the lab. The embryo was then passed through the catheter and into my endometrium (uterine lining). The doctor waited a few moments before withdrawing the catheter, allowing the embryo time to 'settle'. The fluid from the syringe that contained the embryo could be seen as a small dark spot on the ultrasound. Once the embryologist double-checked the syringe to ensure the embryo had been transferred, we were set to go. We are hopeful that things going more smoothly this time is a good start.

Diagram showing ultrasound-guided embryo transfer.
From: https://www.youtube.com/watch?v=BSYkjZR4xmE

The next step is a blood test in just under a fortnight to see if this one takes. In the meantime, I am to continue taking the Progynova, Utrogestan, folic acid, and my probiotics. And on it goes.

Here we go again!

At the start of this week, I called Fertility Associates to notify them of day 1 of my cycle, and started taking the Progynova (estradiol) tablets again. After checking the usual details (Have I been consistently taking folic acid? Have I been well in myself? etc) the nurse entered my information into the system, and I waited for the embryologist to call me with a plan.

I'm back on the Progynova. Three times a day, every day.

The plan: the same as last time, more or less. I am to have a blood test late next week to check my body's response to the Progynova. This time they haven't requested a scan, most likely as last time they were happy that the results of my blood test were a good enough indicator of how thick my endometrium (uterine lining) is. All going well, two days later I'm to start the Utrogestan (progesterone) pessaries again. Then on the 25th of June we have an appointment in Christchurch to have the remaining embryo thawed and transferred into me. They have emailed me another set of consent forms (we must complete more for every cycle), a copy of the plan/timeline, and a request form for the blood test. Let's see how we go this time!

Maybe next time

At 8:00am this morning I had a blood test to check my levels of human chorionic gonadotrophin (hCG), which is the hormone produced by certain cells that surround a developing embryo. This is also what many home pregnancy test kits detect. At 4:20pm Fertility Associates called me (after I had already called and left a message since I hadn't yet heard anything) to say my hCG was less than 5mlU/ml, which is a negative result for pregnancy.

Table from Wikipedia showing reference ranges for hCG from last menstrual period (LMP)
https://en.wikipedia.org/wiki/Human_chorionic_gonadotropin#Testing

We are fine as we hadn't allowed ourselves to become particularly emotionally attached to anything yet. At this point, we're mostly feeling frustrated about the logistical side of things dragging out even further. The plus side is we still have one frozen unaffected embryo, and we can go back to Christchurch next cycle to try having that one implanted. In the meantime, I am to stop taking the Progynova and Utrogestan, and to call Fertility Associates on my next day 1. All going well, we could potentially have the remaining embryo implanted in a month or so. Onwards and upwards!

Implanted

Having travelled to Christchurch yesterday in preparation for our appointment, today we went to the Fertility Associates clinic. I was told to arrive with a full bladder, and was previously advised by the nurse that a good way to ensure this was to empty my bladder approximately one hour before my appointment, and then have two large glasses of water. A full bladder is easy to find via ultrasound, and helps position your uterus for viewing.

On arrival, the receptionist issued us each with a face mask (covid-19 level 2 precautions) and took us to the waiting area for the laboratory. After a couple of minutes the nurse called us through into a separate private room, went through the usual identity checks (full name, date of birth, address) and then gave us a run down on what we needed to know for the appointment, and for the days following. They said that of our two unaffected embryos, the five-day old one (the best one) had been thawed ready to be used. They also gave us a USB card with footage of the development of each of the two unaffected embryos from the TiMI (Time lapse Morphometry Imaging) incubator we used. They then gave us space for me to change into a gown, before we were taken through to the theatre whether another nurse and the specialist were waiting. One nurse was assisting the specialist, the other was on standby ready to pass the embryo from the lab, and Dave was seated next to me. They used an ultrasound probe (on my stomach this time) to try and visualise my bladder as a reference point, and then my uterus. Despite drinking water and feeling full, apparently my bladder was still so small it barely registered on the screen. They tried inserting the speculum, and tried threading the catheter through my cervix, which can sometimes help improve visibility and also help them 'feel' what they're doing. This felt a little uncomfortable, but not too bad. After a few minutes, the specialist decided they weren't confident enough they were in the right place, so they asked me to go back to the private room and drink some more water in the hope that a bigger bladder might improve visibility on the ultrasound.

The card given to us containing footage of our embryos. If you look closely, you can see embryonic development depicted on the card.

Around one litre of water and 10 minutes later, they took me back through to try again. My bladder was bigger, but my uterus still wasn't clearly visible, though the speculum and catheter showed up better on the ultrasound this time. The specialist explained that sometimes the position or the angle of the uterus can make it harder to see, or even some days it can be easier to see than others, depending on what your bowel and bladder are doing. They were satisfied that the catheter threaded through my cervix into the right place, and decided to implant the embryo 'by feel', which they explained was how they always used to do it before ultrasound technology was good enough to assist. They'd prefer to see via ultrasound as well, but it isn't imperative. The embryo was passed from the lab in a small (1ml) syringe that the specialist attached to the catheter, which was used to transfer and implant it into my endometrium (uterine lining). The nurse then double-checked the syringe to make sure the embryo had been transferred.

A stock photo of a blastocyst embyro similar to the one implanted in me today. For privacy reasons, we have decided not to post a picture of our actual embryos. You know, in case one of them is a person one day.

So now we wait. I am to have a blood test in approximately two weeks time to check to see if this implantation results in a pregnancy. In the meantime, I can go about my normal activities, though I will be making mindful choices about consuming pregnancy safe food and drink, just in case. Cautious optimism from here on.