Tuesday, January 3, 2012

How we got pregnant

Beware, this is a really long post.

Our pregnancy journey didn't start on a beach, on our honeymoon, directly after our wedding.  Although, our honeymoon was involved.  We had talked about when the ideal time to get pregnant was.  We thought that we should start 6 months after we got married because it could take a while to get pregnant.

So, in March, I stopped my birth control, and I started doing basal body temperature (BBT) monitoring to find out when I would ovulate.  I had recently read Taking Charge of Your Fertility and for me, BBT monitoring was more about empowerment, knowing my body and exactly how things were working.  A nice benefit was predicting my fertile period and possibly attaining pregnancy.  It was pretty cool to see my temperature spike mid-April when I ovulated.  

My period was due the beginning of May, exactly when we had rescheduled our honeymoon to Japan due to the Tsunami in March.  I brought pregnancy tests with me to Japan, not expecting that we would get pregnant the first month but wanting to be prepared, just in case.  My period came on the flight to Japan.  I was not unhappy!  All the beer and raw fish and radiation exposure I could handle on my honeymoon!

About 10 days after arriving in Japan, five days after my period had stopped, I started spotting.  Just a little bit of blood here and there during the day when I went to the bathroom.  Honestly, at first, I thought that the travel had thrown my body off.  I most certainly wasn't keeping up with BBT well due to the time change and traveling.  When I traveled to Italy when I was 18 my period was late a week, so I knew travel could definitely throw a wrench in the works.  But the more I thought about it, the more I thought it was weird to have mid cycle spotting, something that has never happened before, with or without travel.  So, at four o'clock in the morning, with three days left in our trip, I lay stressing in bed about this bleeding.  I finally got out of bed to go to the bathroom to check for pregnancy, FULLY expecting not to be pregnant.  And as I watched the urine creep across the stick I began to see the most faint positive sign appear.  

I was pregnant?  I was... pregnant.  But, the period.  I had had a period.  And, god, I'd been drinking and eating fish and flying internationally and being exposed to radiation.  And the spotting.  None of it made sense.  Over the next three days, Lucas and I went over it and over it.  I told Lucas that there were no good signs for a real viable pregnancy.  I said, most likely it was an early miscarriage in process.  It could be an ectopic pregnancy, in the tubes.  Or, I guess, it could be a normal pregnancy.

When we landed in Chicago for our layover, I paged a doctor in my practice.  I explained the whole situation to him.  He was more convinced it was a normal pregnancy than not.  I had my doubts.  He met me the next morning on Labor and Delivery and did an ultrasound.  We couldn't see anything in my uterus.  But it was still very early.  I was about 5 weeks pregnant at this point.  I started getting my blood drawn for pregnancy hormone every two days to see if it was likely a normal pregnancy, ectopic or miscarriage.  By the next weekend there was still no pregnancy in my uterus, and an abnormal hormone level.  An official ultrasound showed a pregnancy in my tubes, still small.  

I received a dose of methotrexate, the medication used to dissolve pregnancies in the tube to try to preserve the tube for future fertility.  A week went by, continued blood draws, my hormones were dropping appropriately indicating that the pregnancy was dissolving.  

I had big plans to do a triathlon in August so I decided after all this mess to start training about a week after receiving methotrexate.  I ran for 15 minutes and started to feel the slightest twinge of pain on my left side (the side with the ectopic pregnancy), so I stopped and swam for another 15 minutes.  The next day I rode my bicycle for 40 minutes in the morning.  By that evening, at around 4:30 in the afternoon, I started getting cramps.  They were similar to the cramping I get before needing to use the bathroom.  They came in waves, about one every 10 minutes or so.  I didn't think much of it.  They continued through the evening and I told Lucas about them.  He thought we should go to the hospital.  I balked at the idea.  I spoke with the same doctor in my practice who had been following me throughout this whole ordeal.  We decided based on my description that it was GI related and to wait it out.  

By 10 pm that night, when I was trying to sleep, no position was comfortable for me due to the pain.  So, finally, I decided to go to the hospital.  Lucas drove me.  I walked in to see the triage nurse and said, "I have a known ectopic and severe abdominal pain." Code for I have a ruptured ectopic.

She put me in the waiting room.

They started an IV.  They had me pee in a cup to determine if I was pregnant (despite all my pregnancy hormone levels being in the computer system they used).  In the bathroom, I threw up in the trash due to the pain.  I told the tech that as I handed over my urine.

I was sent back to the waiting room.

As we sat there, the waves of pain would come, by now, closer in timing.  I would moan somewhat uncontrollably each time a pain came.  Eventually, this urge to lie down came over me and I asked Lucas to tell the guard I was going to pass out.  He asked, "Can I do that?" and I was like "YES!"  They rushed me back to the triage area.  I kept saying, "I'm going to pass out, all I want is to lie down."  They were rushing a gurney over to me but the triage nurse had me in a chair and she took my blood pressure.  It was 80/50.  My blood pressure is usually a robust 120/80.  I threw up again in the triage area due to the pain.  When I was finally lying down, the relief came.  I felt like a million bucks after I was able to lie down.  The waves of pain continued to come but the relief between them was better once I was lying down.

A resident came to see me.  I explained the whole story.  He asked what I thought should be done.  I said I should get an official ultrasound to determine if the ectopic had ruptured.  We were brought to the ultrasound, the tech confirmed I had a ruptured ectopic but she is not allowed to diagnose so she made me promise not to tell anyone she told me that.  I went back to the ER where they were still waiting for the report from ultrasound.  The attending MD in the ER came to assess me and after his assessment he decided that it was most likely not a ruptured ectopic but GI related.  He wanted me to go for a CT scan for which I would have to drink a liter of contrast.  I asked how drinking a liter of contrast would affect ectopic surgery if I did have a ruptured ectopic.  He said it wouldn't matter!  Ha!  (Here's what I've learned about the ER - it's not good to have a high pain tolerance.)

They soon got word it was an ectopic pregnancy and called for a GYN consult to come and see me.  I knew the residents who came down as they were residents who rotate through labor and delivery also.  There was a mixup with starting a new IV for surgery and due to its placement and the labs that were drawn, it was thought that my blood level had dropped significantly, indicating that I was bleeding out and could die.  I was rushed to the surgery unit.  There I had a short discussion with the attending GYN about whether I should have my whole tube removed and sealed off or if they could take the pregnancy and leave the damaged tube.  She recommended taking the whole tube, as a damaged tube is likely to have another ectopic in the future.  She also said my fertility shouldn't be greatly affected by taking the entire tube as my right tube would be able to catch ovulated eggs from either ovary.  

I had a left salpingectomy (removal of my tube) under general anesthesia.

I stayed in the hospital for four hours after surgery.  And then I went home.  

It was Friday when I went home.  I recovered easily and went back to work on Monday.  

I wasn't allowed to try to get pregnant for three months because I had received Methotrexate earlier in the month.  Methotrexate is a chemotherapeutic drug and can affect pregnancies over the next three months. During those three months I spent a lot of time pondering my future fertility, my ability to carry out the dreams Lucas and I shared for our future, wether or not I would be able to be happy if I never got pregnant.  Also during those three months I had a hysterosalpingogram, a special xray to look at the uterus and fallopian tubes.  It showed that my left tube was blocked (as it should be following the surgery) and my right tube was nice and open.

I had been doing BBT since June.  It was pretty cool to watch my temperature spike each month with ovulation.  In August we started trying again.  I even started taking pregnancy tests three days before my missed period even though I knew it wouldn't show yet.  On the day of my expected period I took a pregnancy test, hoping to see a pink line.  But to no avail.  I was pretty upset.  I expected my period for the next two days and it still didn't come.  Finally, while stocking up with more pregnancy tests for the next month at work, I decided to take another test to be sure I wasn't pregnant.  

And there, in the office bathroom, I saw my bright pink line!  Bright pink!  I was definitely pregnant!  I wanted to jump up and down and yell!  Instead, I blushed with excitement and tried to maintain a sense of decorum as I left the office for my dental appointment.  I called Lucas and my mother to excitedly share the news.  I was so excited I even told the dental hygienist!

And that is the long and complicated route that we took to get pregnant!

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