Early Pregnancy

My husband and I were very cautiously excited in the beginning. I told myself that I would not really believe it until I at least heard a heartbeat.

The doctor's office wanted me to repeat the blood test two days after the original to make sure it was rising appropriately. Then they wanted to do an ultrasound a week later, and another one two weeks after that. I told them I could come in a week later, but I would be away for three weeks after that because I had to fly overseas to attend my brother's wedding. In that case, they said, I should come in for an ultrasound and meet the doctor before flying out.

My HCG level rose nicely, it went to 935 in two days. A week later I went in for the ultrasound. It was the day before I had to fly out. I knew it could still be too early to hear a heartbeat, but I was still hoping that I would hear it. I was just over five weeks pregnant at this point.

The ultrasound technician was one I was familiar with, one who had done a lot of scans of my ovaries and measured my follicles. It was a little comforting to be with someone familiar at a time when I was so nervous. As she moved the ultrasound probe, she said, "Here's what we're seeing. Just the gestational sac for now." I felt like I was in a bad dream. The first thought that came to my mind was that it was probably another early miscarriage or a blighted ovum or something like that. I didn't know what to say or ask or think. She finished up with her measurements and led me back into the waiting room.

The doctor called me soon after that. She explained to me that, at about five weeks, they didn't usually see a fetus but they saw something called a yolk sac inside the gestational sac. But it was not very unusual to not see the yolk sac at this stage. She said that it would have been great if they could have seen the yolk sac, but maybe it was just too small and they didn't see it or that it was just a little too early to see it. She said it was perfectly normal to not be able to see anything until six weeks or so.

She told me that I would need to go in for an ultrasound in two weeks while I was traveling and communicate the results back to them. She said that once we were able to hear a heartbeat on an ultrasound, the odds of a miscarriage would go down drastically. Normally, I knew, the chances of a miscarriage are pretty high during early pregnancy. She also mentioned that it was a good thing that I had not had any bleeding so far. If I did have any bleeding, I should go straight to a hospital.

The nurse reassured me that it was very likely that it was just too early to see much more on the ultrasound, and that I should stay positive. She gave me her email address since I was traveling internationally, across time zones, and it would be difficult for me to speak to them on the phone during their normal business hours.

When I shared all of this with my online support group, one of the women said that the same thing had happened to her with her first child, they had seen only a gestational sac at five weeks. They went back a week later and heard a heartbeat. It was reassuring to know that it had actually happened to someone in real life. Hearing that kind of story holds much more weight than being told by a doctor that similar things happen to other people too.

Anyway, I realized that there was not much I could do at that point, other than wait for two weeks and go in for another ultrasound. I would have to find a hospital and make an appointment as soon as possible. I had not been to my home country in more than two and a half years and had never been to an obstetrician's office over there, so I would have to look for one.

For the moment, I decided to focus on the fact that I would be seeing my parents and my brother after so long and on how exciting it was that my little brother was getting married. I was very emotional when my flight landed, because I had not slept through the entire seventeen or so hours of flight time and the pregnancy hormones were messing with my emotions. My husband and I had not yet told anyone, not even our parents, about the pregnancy. I wanted to wait at least until we heard a heartbeat. So my mother was a little taken aback when I hugged her and started crying as soon as I saw her.

My brother and soon-to-be sister in law also came to the airport to receive me. It was the first time I was meeting her, but I liked her almost immediately. It felt good to be surrounded by family and to have so many people to talk to. I was glad that I would have enough festivities over the next couple of weeks to keep me occupied and to keep me from worrying about my pregnancy. I just had to make sure that I ate healthy and got enough rest. The rest part was a little difficult because I would usually wake up between 4 and 5 AM the first few days while I was jet lagged. The food part was easier, since my mother had not seen me in so long and wanted to make all my favorite dishes for me and was always asking me what I wanted to eat. The only problem was making up excuses to avoid cough syrup with alcohol in it. I had to just put up with the somewhat sore throat I had because of dust allergies, pretty much as soon as I landed.

Once I was actually there, back in my own country, I got preoccupied with everything that was going on around me and did not obsess over what was going on inside my belly. I had fun, enjoyed the festivities, ate food cooked by my mother and danced at my brother's wedding. I scheduled an ultrasound for two days after the wedding.

On the morning of my appointment, my husband drove me to the hospital. The radiologist performing the ultrasound came across to me as a rather strange person. She did not want my husband to be in the examination room. She said that he should stay on the other side of the curtain because she needed to scan me trans vaginally. She said she would call him in later. I did object once but I did not have the energy to argue with her. But I have serious doubts about the mental stability of a person who does not want a husband to be with his wife during an ultrasound where they would probably hear their baby's heartbeat for the first time. And she appeared to be uncomfortable about the idea of him being in the room when I was not fully clothed. Exactly how did she imagine babies being conceived?

While she was scanning me, she started asking questions about whether I had had any bleeding or spotting or if I had seen any brownish discharge. I told her I had not, but the way she was asking the questions was a little worrisome to me.

Anyway, the woman did call him in towards the end, after covering me up with a sheet and showed both of us the tiny little baby and we were able to hear the heartbeat. I barely had the opportunity to feel happy and excited about the life growing inside me when she said, "Look, here's that baby, growing as expected, heartbeat is fine, but here I see an irregular collection of blood."

"What does that mean? Is that a problem?" I asked her.
"I don't know, it may be. I will write out my report and then you should take it to a doctor and seek their advice."

She started explaining things to her assistant and telling her what to write in the report as I was getting dressed, right there in the same room. I asked her to explain a couple of terms to me as she was talking to her assistant and she, without so much as a glance in my direction, said, "It's a medical term."

That was a very different experience from what I had had with doctors in the States until then. Just about all the doctors, nurses and ultrasound technicians I had met would, at the very least, be polite and willing to explain the details of your case as best as they could. This woman was just plain horrid. Making a confusing and worrisome situation even worse.

The assistant, as she led us out, told us not to worry too much. She said she had seen a lot of women experience a lot of bleeding during pregnancy and still have perfectly healthy babies. It was a good sign that I had not had any bleeding so far.

My husband took me to the OB-GYN who had delivered him when he was born. She was much older than any doctor I had even been to before. She had gray hair tied back in a bun. She looked over the report that the radiologist had written out. She asked me why I had even traveled overseas when I knew I was pregnant. I told her that I had consulted with my doctor in the States and she had expressed no reason whatsoever why it would be inadvisable to travel. This doctor said that I should not have traveled, especially since I was being treated for PCOD. This was another thing that made me rather uncomfortable. Both this doctor and the radiologist used the outdated, less accurate and more terrifying term "Poly cystic ovarian disease" instead of "Poly cystic ovarian syndrome." I was also to learn later that they were using a more terrifying term for the blood collection by calling it "sub chorionic hemorrhage" instead of "sub chorionic hematoma."

I mentioned to her that I had had the other ultrasound 18 days earlier, and the doctor had advised me to have another one in about two weeks. Like a school teacher reprimanding a student who had not handed in her homework on time, she demanded to know why I had not had that ultrasound in two weeks after the first one.

This doctor insisted that I had brought on this hemorrhage by taking on undue stress by traveling, shopping for the wedding, dancing at the wedding and so on. I took a strong dislike to her right then. I had read enough medical literature in recent times to know that air travel during early pregnancy was not dangerous, and the only reason why a doctor would advise against it would be if the destination did not have adequate health care facilities, because problems are more likely to occur during very early pregnancy, irrespective of travel or anything else, and dealing with them becomes more difficult while traveling.

I had also read enough to know that modern doctors advocate being active and doing light to moderate exercise during pregnancy. They recommend continuing with a similar level of activity to what you were doing before you got pregnant.

This doctor was evidently stuck with the same outdated knowledge and beliefs that she had acquired in medical school when she originally became a doctor.

She advised me to be on complete bed rest for the next two weeks, take progesterone and HCG supplements, cancel my return flight, and come back in two weeks for another ultrasound.

I do not know what she learnt in medical school or if she had any basic human instincts, but I do know that, even years ago, most medical professionals and most sane human beings acknowledged that all attempts should be made to minimize stress during pregnancy. Even a normal, healthy pregnancy. An already complicated pregnancy can be further worsened by undue stress. This woman, on the other hand, was trying everything in her power to freak me out and make me feel as worried and stressed out as I possibly could. I have to say that I hated her for that.

We still had about four days to go before our return flight. We wanted to consult another doctor who was my mother-in-law's distant cousin but based in another city. I read out the report to her over the phone and she said that she didn't see a need for complete bed rest, but would definitely recommend taking it easy, avoiding moderate or heavy exercise and abstaining from intercourse. That sounded much more reasonable. She recommended postponing the return flight not because it was unsafe to travel, but because if I stayed, I would be surrounded by family who would be willing to do the household chores and so I would be able to get more rest. I did see her point, but I was not sure I agreed completely.

I knew that, even if I was able to get additional time off on medical grounds, my husband would not be able to get extra time off. So postponing the flight would mean that I would have to travel alone. I was not too happy about that prospect. Plus, I would have to deal with doctors who made me rather uncomfortable. And I can't say that I would be too comfortable staying for too long with at my husband's parents' house in his absence. I had spent maybe a total of ten days at that house during that trip and during the first few days after our wedding, before flying out to the States. I would want to stay with my own parents and my husband and his parents would probably be offended by that. Even so, I knew I would definitely be most comfortable in my own house and seeing my own doctors during a stressful time like this.

I also sent a copy of the report to my RE's nurse via email and asked for their thoughts. She said that my doctor and her colleagues did not recommend the course of treatment that was prescribed. They do not suggest any of the medication and did not feel a need for complete bed rest. All they wanted me to do was to keep taking my prenatal multivitamins and avoid sex and strenuous exercise.

My husband and I arrived at a decision after considering everyone's viewpoints. We decided that I would fly back with him as planned. I would take the medications with me and take them for two weeks. I knew that they would not be harmful during pregnancy, so I thought they were worth giving a try. I would keep my first appointment with the OB's medical assistant, which was only two days after I was supposed to arrive back home. I was also supposed to meet the OB about a week after her assistant had done the initial evaluation and preliminary blood work.

Getting Pregnant

My husband had been reading about a medication called Femara which, it seemed, was also beginning to be used for ovulation induction. Originally a breast cancer treatment drug, it was in the experimental stages as a fertility medication. He wanted me to ask the RE about it. I did ask her, and she said that it was at a very experimental stage and she was not keen on giving it to me. I had inferred the same thing based on all the literature that I had read, but my husband was keen on exploring the possibility so I asked the doctor about it, mostly just to satisfy him.

For the next cycle, the doctor increased my dose of clomiphene to twice what it had originally been and asked again if we wanted to do an IUI or just timed intercourse. After what had happened the previous cycle, I was getting anxious and impatient and wanted to give it the best shot we could. So I said that we should do an IUI. My husband went with it. At that time, we did not know that our health insurance company had a $15,000 limit on coverage for infertility treatments. If we had known, I would probably have suggested saving that limited amount of money for IUIs with the injectible drugs that were more effective at inducing ovulation. But we found out about that only after we had done two cycles of IUIs with clomiphene.

So anyway, this time round, the clomiphene did lead to the development of a mature follicle. I had been hoping for more than one, because that would give us better odds, but the doctor was pleased that there was only one follicle, so that there was only a minimal risk of having more than one baby. She said that having more than one baby is always risky, it leads to a lot of possible problems for both the mother and the babies. I had to trust her judgement, because obviously I could not cause another follicle to mature in my ovaries. The nurse gave me a specific time of night to inject myself with the trigger shot. I would go to their office thirty six hours later for the IUI. My husband would have to go in an hour and a half earlier on the same morning.

I was rather nervous about injecting myself with the trigger shot. I had never done anything of that sort before. I knew that lots of people did that kind of thing, like diabetics who had to inject themselves with insulin every day. The nurse had showed me the technique using a dummy and had told me to watch a particular video online. The woman in the video seemed to be injecting herself so easily and effortlessly. The needle that was on the syringe that I had received from the pharmacy seemed to be rather small. But I was still nervous. While I was watching the videos, my husband volunteered to do it for me. That thought had not crossed my mind before. I very thankfully accepted his offer. I figured, if nothing else, his hand would be steadier than mine would be if I did feel a lot of pain from the needle. So I had him sit down with me and watch the videos. And then he followed the instructions in the video step by step. As it turned out, I did not feel anything as that needle went in and as my husband pressed on the plunger. I was very relieved that it was over.

Thirty six hours after the trigger shot, I had to go in for the IUI. Usually one of the registered nurses at the doctor's office performed that procedure. Since it was the first time for me, I was rather nervous and I was a little relieved to see that the nurse doing the procedure for me would be the one whom I had been communicating with all through and I was familiar with her and she was familiar with me.

As the nurse led me into the room where she would do the procedure, she asked me if I was nervous. I told her I was. She talked me through the entire procedure and was gentle while working through it. It turned out to be a little uncomfortable but not painful. I had some mild cramping during and for a few hours after the procedure, but not much else.

They asked me to stay where I was for about fifteen minutes after the procedure was done. They gave me some instructions to follow for the next two weeks. I was supposed to stay well hydrated and not do any heavy exercise that would cause my heartbeat to exceed 140. I was not supposed to take pain medication other than acetaminophen. And I was supposed to call the doctor's office and ask for a pregnancy test if I did not get a period for fourteen days after the IUI.

I took all the instructions very seriously. I monitored my heartbeat on the treadmill at the gym whenever I stepped on it. I kept track of how much water I was drinking. I never took any medication other than the metformin.

But, of course, all of that helps ensure that if you do get pregnant, then the pregnancy is healthy. It does not help ensure that you actually do get pregnant. And I did not. That was not my cycle.

I got my period exactly fourteen days after the IUI. I was very disappointed. But I tried to see the faint bright side of things, which was that I had a luteal phase of exactly fourteen days. At least something about my cycle was normal. This was the first time in my life that I had known exactly when I had ovulated, so it was the first time that I had been able to see how long my luteal phase was.

I called the doctor's office to set up the preliminary testing for another cycle with clomipehne. They wanted to see me in the office on cycle day 3 for a baseline ultrasound to see where the follicles were at the beginning of the cycle, so that they could track the growth and development of the follicles.

When I went in for that ultrasound, the ultrasound technician took all the measurements like she normally would and then asked me to wait in the waiting room while she checked if the nurses wanted to do some blood work. Now I had always had blood work planned out at least a day in advance, and I asked her why they would want to do something like that. I had a feeling that she had seen something very wrong with my ovaries and I was a little scared at that point. She said that when the thickness of the lining of the uterus was "above a certain millimeter," then the nurses usually took blood. I was still confused but no longer scared after this explanation.

I got dressed and went to the waiting room to wait for a nurse to tell me if they wanted to draw my blood. One of the nurses came up to me shortly and led me to the room where they usually drew blood. She told me that since the lining of my uterus was thicker than they usually saw on day 3, they wanted to make sure I was not pregnant. Not pregnant? I had got a period exactly when I had expected to get it, the blood flow had been completely normal so far, and they wanted to make sure I was not pregnant? This was very confusing to me, but they said that sometimes women do have period like bleeding during early pregnancy.

I did not actually expect the pregnancy test to come back positive, but I had to wait for them to call me in the afternoon and give me the result before I could begin taking clomiphene. It came back negative, as I had expected, and they asked me to begin the clomiphene that evening.

Around this time, I found a support group on the Weight Watchers website for women who were trying to conceive. The women there were a great source of moral support and information about fertility treatments and related subjects. The friendship and support of these women eventually turned out to be the most important thing that Weight Watchers gave me, much more important than the fact that I was able to lose weight and get into the healthy weight range for my height.

One of the women in that group said that she had had period like bleeding around the time of her expected period when she got pregnant with her first child. It lasted for only two days and she took a home pregnancy test after it stopped. The test came back positive. Her son was two years old at the time and she and her husband were trying to conceive their second child. I had never before heard of such a thing, but I did some online research and saw that it was possible but that it was the exception, not the rule.

Anyway, since I was not the exception to that rule, I moved on and focused on the next cycle. I went through the routine of taking the medication every evening for five days and then going in for monitoring at the doctor's office. My husband did the trigger shot for me again. I was and still am a little scared of needles, even when I know that they will not hurt. I find it difficult to insert a needle into my own thigh in one quick, dart like motion. I would do it slowly and steadily. That would be counterproductive, since it is the quick motion that minimizes the pain and discomfort.

One of the hardest things about fertility treatments, or even trying to conceive in general, is to wait out the two weeks from ovulation until the time you get your period or see a positive pregnancy test. Anyone who has had to spend even a little bit of time trying to conceive a baby will know what I am talking about. I always tried to keep myself busy and not obsess about whether or not I have pregnancy like symptoms, but there was inevitably some time spent in observing possible symptoms and looking them up online and discussing them with the ladies in my online support group. But of course, there was no way to be sure that I was pregnant until that two week window had passed. I could not take early pregnancy tests because the trigger shot is chemically similar to the pregnancy hormone and can possibly linger in the body for up to fourteen days.

On day fourteen after the second IUI, I was seeing no bleeding or spotting. I was cautiously excited at this point. I called the doctor's office and set up a blood draw for the next morning. Once I went in for the blood draw in the morning, waiting for the nurse to call me with the results was even harder than the last two weeks had been. I was restless and jumpy and constantly checking my phone all day. When I finally got the call, I answered it with my heart pounding in my chest. The nurse said that she was calling about my test results. She said it was very slightly positive. I asked her exactly how positive it was. She said that my HCG level was 7. Normally, they expect it to be around a hundred when they first test it. She said it was likely to be what is known as a chemical pregnancy. That was also the first thought that has popped into my head, since I had already had a chemical pregnancy about a year earlier and had read enough about chemical pregnancies since then to know that it was likely to be the case.

The nurse said that they would want me to come in for another blood draw two days later to see if the levels were rising or falling and then take it from there.

The next day, I started seeing some very light bleeding. I called the nurse again to tell her that I was bleeding, and that it was good enough for me to believe that I was experiencing a chemical pregnancy. I requested her to order my medications for the next cycle, because we had done three cycles with clomiphene and were ready to move on to injectible ovulation stimulating drugs. She went ahead and put in the order, although she said that they would need to see a negative blood test before giving me the go-ahead to start injections.

The day after that, I saw what I expected to see - normal period like bleeding. But I had to go in for the test anyway, since they wanted to see a negative test. It went down to 3 and they said they still wanted to see it go down further. I asked them if I could do treatment as planned for the next cycle. They said that the doctor was okay with that, she wanted us to go ahead with treatment right away. I asked them if the first day of bleeding counted as cycle day 1 even though the HCG level was 3 on that day. They said yes. That meant that I had to go in for another blood test and the regular cycle day 3 testing two days later.

Now the hospital was a bit of a drive from my house, and we were expecting a big snowstorm the next day. That would mean that I or my husband would have to drive about twenty five miles one way, early in the morning, after a bad storm. It was only late October, and the leaves were still on the trees, so the weather folks were saying that a lot of trees and branches could potentially fall from being weighed down by the leaves, the snow, and the snow on the leaves. That would mean there would be trees blocking the roads, falling electric poles causing power outages, and live wires to watch out for. To add to it all, the town did not always clear out snow from the streets early in the morning on weekends, and this was going to be a Sunday.

We did see a pretty bad storm on Saturday and lost power that evening. With the bad weather and power outage, we were pretty cold that evening, but not too bad because we had kept the heat running almost all day and our house was well insulated. We could see that the winds were strong outside and a lot of branches were weighed down, but we did not step outdoors in that kind of weather to actually see how many trees had fallen.

On the bright side, the town did clear the snow early the next morning and we did not find any fallen trees blocking the roads completely at any point. There was snow at least eight inches deep on our driveway. There were fallen trees everywhere, but they were blocking the roads only partially. Given the weather and the fact that it was Sunday morning, there was not a lot of traffic, so we were able to get to the hospital much earlier than we had planned and without much difficulty.

The nurse took my blood and the ultrasound technician did the ultrasound, and then the nurse demonstrated to my husband and me the injection technique for the injectibles that we would be doing for the first time that cycle.

I got the call from the nurse that afternoon asking me to begin injections and saying that my HCG level had gone down to less than 2, which is what they treat as a negative test result.

That evening we faced another added challenge with the injections. This new injection was a little more complicated than the trigger shot and you had to accurately measure out the correct dosage. My husband was doing it for the first time, and he had to do it by candlelight. But he managed to do it just fine, and this particular injection, in spite of appearing more scary to me, did not really hurt either.

This time, I had to go in for more frequent monitoring, about every three or four days. They would look at the size of the follicle and tell me whether to stay at the same dose or increase it. I was once again a little disappointed to see that I had only one follicle, but I had to stay positive and keep reminding myself that I needed only one follicle to have one baby, and that I wanted only one baby at a time.

The last dose of the injection was unexpectedly painful for me. It was this intense burning, stinging sensation in my left thigh that I had not expected and I cried out in pain. I was thankful that I had asked my husband to do the injections, because I wouldn't have been able to do it without hurting myself if I had been distracted by that kind of pain. I was glad it was the last one, and that I only needed the trigger shot the next day and no other injections for at least a couple of weeks.

But suddenly, later that evening, my husband said that he had been distracted by my expression of the pain and was not sure if he had actually injected it. I told him I was pretty sure that I had felt the needle go in, but he was not convinced. I had to call the doctor's office the next morning and ask them what to do. The nurse was very calm and said that it was not that big a deal, since they had already seen a fairly mature follicle before that particular dose. She said that there was no way to accurately determine whether or not I had actually got the shot, but even if I hadn't, they wouldn't have me take another one because the follicle was already pretty mature. I was a little more relaxed after that conversation, but, somewhere at the back of my mind, beginning to wonder if this cycle was just not meant to be the one. We had had a difficult beginning to the cycle, and a confusing last day of the follicle stimulating hormone injection. I had no idea how large a follicle needed to be before it could release a viable egg.

But anyway, I went in for the IUI at the scheduled time, because I did not want to just give up and the nurses were fairly confident that things were going okay. The nurse who did the IUI that day was a little older and a little friendlier than most of the others in the practice. I mean, all of the nurses there were warm and friendly, but this one stood out a little bit. This was also the first time we were doing the actual IUI on a weekend, so my husband was able to stay for the entire duration of the procedure. The nurse encouraged him to be in the room where she would be performing the procedure and talked him through it. He mentioned to her that he had lost his father a few months ago, and she expressed her sympathy and said that that was the circle of life, one life ends, and hopefully, another begins here today. There was something about the way she was talking to both of us that made me feel more positive and cheerful, even though I had worse cramps than usual on that day. It was also the first IUI when I kept feeling the cramps for a few hours after the procedure, and also had a bit of spotting afterwards. The nurses always told me to expect these things, but they had never happened to me before.

Around the same time, a friend from my online support group did an unsuccessful IUI with the same kind of medications as I had been using. She was experiencing a very heavy menstrual flow at the end of that cycle. I had heard before that these medications made the lining of the uterus thicker, and I feared that kind of outcome for myself if the IUI did not work. I did not know that I was in for something much worse.

The rest of that cycle, I was unusually tired and often in no mood to do anything other than plop on to the couch in front of the TV. I figured it was because of all the hormonal injections. I had a craving for a sandwich made with a hot pepper spread that I had recently bought, and some peach jam. I knew it was a weird craving, but it was still only a week past the IUI, so too early to say if it was a symptom of pregnancy or just another side effect of the shots.

As the time when I would get my period drew closer, I did notice that I was not experiencing the kind of cramping that I usually had right before I got a period. I tried to stay firmly grounded but I could not help feeling more than just a little hopeful. As it happened, I did not get a period and I went in for a blood draw during Thanksgiving weekend. And then waited for the rest of the day for them to call me back. And when the nurse did call me back, she said, "Your HCG is 353. Congratulations, you're pregnant!"

I was in a bit of a daze and did not quite know how to respond and whether or not to believe her. I managed to say, "Oh. okay, so what do we do next?"