Getting Pregnant with POF / DOR / Low FSH

Supplements anyone? I recently got rid of these and gave away my remaining OPKs, which felt really, really good.

I'll never forget the moment when I found out I have premature ovarian failure / diminished ovarian reserve. My OB ran a few "routine" blood tests after I told her I was having short cycles after coming off of birth control (24-25 days).  I didn't even know for what she was checking, but I was sitting at my desk at work when she said "Your AMH level was undetectable and your FSH very high.  You may have a very narrow window in which you can have your own children.  But don't worry, you can always use donor eggs."  Those three sentences completely upturned my world and everything I thought about building a family (not to mention that I had no idea what AMH was and what, exactly, she meant by donor eggs.

After the initial shock wore off and I scheduled an appointment with CCRM, I fell down the rabbit hole that is Google and started to learn everything I could about high FSH, low AMH, DOR, POF, etc.  In a situation where I felt like I had no control, I wanted to arm myself with any information I could and to do whatever was in my control to become pregnant.  I scoured the internet for success stories, read every book available on the subject, and had consults with three Denver fertility clinics, including CCRM (where I was handed a packet of information on donor eggs and told I wasn't really a candidate for IVF).  

I found great hope in posts I read online from women who beat the odds and got pregnant despite depressing statistics and seemingly insurmountable odds (see My Bum Ovaries and Torthúil as examples) and I promised myself that if I had success, I would share my story and what I learned with others.  I've been wanting to write this post for ages, but I knew I couldn't do it until Baby C was safely in my arms.   

I live in Colorado, so I've included local resources that I utilized and liked.

Background

• Diagnosed at age 32 with DOR/POF. AMH less than 0.15 (undetectable) and day 3 FSH of 17.3
• My FSH has since been as low as 7 and as high as 59 (immediately following my first miscarriage).  My AMH has been as high as 0.23.
• I have mild hypothyroidism and low Vitamin D
• Day 3 ultrasound shows only two follicles on one ovary and one follicle on the other
• I have been pregnant 5 times:
• Spontaneous (unassisted) pregnancy 8/2013, which ended in the stillbirth of our daughter at 26 weeks (unrelated to fertility)
• Spontaneous (unassisted) pregnancy 5/2014, which ended in the birth of Baby B
• Spontaneous (unassisted) pregnancy 3/2016, which ended in miscarriage at 6 weeks
• Pregnancy while taking Clomid 12/2016, which ended in miscarriage at 6 weeks
• Spontaneous (unassisted) pregnancy 8/2017, which ended in the birth of Baby C
• I have tried IUI once and have tried 2 cycles on Clomid.  I have planned to do IVF cycles 3 times but had a spontaneous pregnancy before each planned IVF cycle.
• My husband has no issues with sperm count or quality.
• I am otherwise quite healthy, eat well, exercise regularly (marathon runner and triathlete), drink only in moderation, don't do drugs, and have never smoked.  

Books I Read

• It Starts with the Egg by Rebecca Fett (I can't recommend this one enough)
• Taking Charge of Your Fertility
• Real Food for Mother and Baby: The Fertility Diet, Eatingfor Two, and Baby's First Foods by Nina Planck
• The Hormone Cure by Sara Gottfried
• The Fertile Female

What I tried

• Acupuncture (Jane at Acupuncture Denver and Gina at Insight Acupuncture)
• Hypnotherapy (Eastburn Hypnotherapy Center)
• Mayan Uterine Massage (Artemisia & Rue - Shelley is incredible)
• OPKs
• Less exercise
• Eliminating BPA and phthalates
• Changes in diet, restricting caffeine, and eliminating alcohol 
• Charting / AVA Fertility Monitor
• Supplements & Vitamins
• Vitamin D 2,000 IU D2 (2/day)
• Prenatal Vitamin (1/day)
• Fish Oil EPA/DHA - 2,000 mg/day with food
• COQ10 (300 mg, 2x day) - taken in the a.m. with protein (purchased from a compound pharmacy with a prescription)
• Inositol (2 scoops, 2x day) - 4g day total
• OPCs (1 capsule daily) (http://umm.edu/health/medical/altmed/herb/grape-seed) 
• DHEA - 75 mg (taken in 2 half doses and purchased from a compound pharmacy with a prescription)
• Amazing Grass Green Super Food (650 mg x 5)
• Amazing Grass Organic Wheat Grass (1000 mg x 5) 
• Life Extension PQQ (Pyrroloquinoline Quinone) (10 mg)
• Therapy
• Regulating Thyroid 
• Regulating Vitamin D
• Baby Aspirin
• Tracking cervical mucus
• Tracking fertility (I like the Ovia app)

What I think worked

• OPKs - While I found that tracking my cervical mucus was the best indicator of ovulation, I heavily relied on OPKs to confirm ovulation and to identify potentially fertile days in otherwise wacky cycles (for example, when I'd have egg white cervical mucus (EWCM) but not other signs of ovulation, or EWCM was oddly early or late in a cycle).  I purchased the Clearblue Fertility Monitor at some point, but far preferred the basic Clearblue Digital Ovulation Tests and the Clearblue Advanced Ovulation Tests.  In some cycles, I used both (can you sense my desperation?).  For me, it was critical to have confirmation of peak fertility or to identify that my cervical mucus might otherwise be off. 
• Tracking cervical mucus - This was the easiest way for me to tell when I was ovulating.  There are many primers online and I found this to be an extremely accurate way of knowing when I was ovulating.
• Acupuncture - Acupuncture helped me to regulate my cycles and generally to improve my mental health throughout the challenges of the last 5 years.  I can't say whether it directly impacted fertility because I did acupuncture in conjunction with taking supplements, etc., but it made me feel better emotionally and my cycles did regulate.  When I was having perimenopausal symptoms, it helped to diminish those as well. 
• Trying to stay positive / mental health / exercise / therapy - This isn't specific, but for me trying to stay positive, even in the depths of overwhelming sadness after losing Baby L, was really what kept me going.  Hand in hand with keeping a positive attitude for me exercising, not eating a super restrictive diet, having a drink here and there, and finding things to do that I still enjoyed that were unrelated to baby-making.  Vague, I know, but it is all too easy to become completely engulfed in the world of infertility and to lose sight of everything else going on around you.  I saw a therapist after Baby L died and throughout my pregnancy with Baby B, which helped immensely.  
• Supplements & Vitamins - Generally speaking, I felt that taking supplements absolutely helped me feel better.  The two that the research shows help the most are DHEA and COQ10.  At various times, I took all of the supplements listed above, but sometimes the sheer number was overwhelming so I dropped to just taking the DHEA and COQ10. 
• Regulating Thyroid and Vitamin D - Research shows that having a TSH level (thyroid function) in a normal range, as well as normal Vitamin D levels both have an impact on fertility.  Both can be checked with a simple blood test and easily regulated if they are out of whack.  These are simple and inexpensive areas to "fix" if there is an issue.
• Tracking Fertility - I used the Ovia app to track my cycles, cervical mucus, intercourse, OPKs, etc.  You could certainly do this on a calendar, but the app makes it easy and offers insights regarding your cycle. I have found it helpful to be able to scroll back through the past few years to see what my cycles looked like when I did get pregnant, etc.

What may have helped and that I didn't mind doing

• Eliminating BPA and phthalates from our home - I got rid of plastic, checked all of my toiletries, changed up household cleaners to a certain extent, etc. I go into more specifics here if you want to know more.  I have no idea whether this impacted my fertility, but it seemed like something I ought to be doing regardless.
• Mayan Uterine Massage - I had only had one session when I found out I was pregnant with Baby C, so I have no idea whether this helped, but I continued working with the same masseuse through my pregnancy and found it helped with stress, anxiety, mental health, and preventing back pain and soreness in pregnancy.  
• Eliminating Caffeine - I periodically have eliminated caffeine entirely and generally drink decaffeinated coffee or a half caf (which is what we make at home).  I like the taste of coffee and I don't mind drinking decaf, so this wasn't a big deal for me to do.
• Baby Aspirin - Because I have a history of clotting in pregnancy, I take a baby aspirin when pregnant.  There is some evidence that taking a baby aspirin can assist with getting pregnant, so I have taken one when we were trying.  

What didn't work for me

• Restricting food, exercise, and alcohol  - I tried removing gluten from my diet, giving up running, only drinking decaffeinated beverages, and entirely giving up alcohol, but it turns out I am someone who prefers to moderate than to abstain.  I am a very healthy eater, and do not drink excessively.  My evidence is anecdotal, but I was not eating or drinking in any sort of limited way when I became pregnant and I find it is a huge drain on me emotionally.  Exercise was the hardest of these for me because I find running to be therapeutic and essential for my mental health.  Again, for each of my pregnancies that didn't end in early miscarriage, I was running quite a bit and feeling strong and fit.  One caveat to this is that I would have strictly adhered to it leading up to and during an IVF cycle, which is recommended.
• Hypnotherapy - I was glad I tried this once, but I didn't feel compelled to go back. Interestingly, the woman who ran the session told me I'd have two living children, a girl and a boy.
• Charting / Basal Body Temperature - Call me lazy, but I could never get the hang of taking my BBT each morning.  The thermometers always beep (which my husband hated), I often forgot to take my temperature before I got out of bed, etc.  I even bought the Ava bracelet, which is supposed to do this for you, but it always fell off and didn't seem to be all that accurate.  I found that monitoring cervical mucus and using OPKs were more effective for me.

Sugar & Spice

I am thrilled to share that we welcomed a healthy, screaming, beautiful baby girl on Monday, April 16th at 8:41 AM.  She weighed 7 pounds, 11 ounces and is perfect.  She has a head full of dark hair like her sister and as I type this, she is resting on my chest and I am pausing to kiss her head every 30 seconds or so.

Is it just me or do newborns smell divine?  There may not be a better scent than that of a newborn baby.

Despite big sister B's requests to call her Latte Shop, Coffee, Stop Sign, and Canopy, we have named her Claire.

My c-section was mercifully uneventful. Unlike when B was born, I walked myself into the OR, got a spinal/epidural combo, had some moments of feeling absolutely terrible and like I was about to pass out, which were fixed by some sort of concoction the anesthesiologist gave me by IV, and then we started.  I was prepared with a Spotify mix called C-Section Tunes that will most certainly go viral (ha), and Claire was born to the song "Show me love" by Robyn, which seems fitting.

Our journey to have babies started almost exactly five years ago.   Since then, I've had five pregnancies, two miscarriages, one stillborn daughter, and two incredible blessings in Baby B and Baby C.  I've been staring out the window at the spring blossoms on the trees remembering spring of 2013 when I thought I'd never have a child... and remembering spring of 2014 when Q had just died and I couldn't fathom feeling happy again... and spring of 2015 when I had B in my arms and was so filled with joy... and spring of 2016 after my first miscarriage when I realized how much I wanted to have another child... and spring of 2017 when we were in Japan and I'd had yet another miscarriage and was doing my best to stay positive, get healthy, and enjoy our travels amidst sadness, disappointment, and even some anger.

And here we are.  Thanks for following along on our journey.

(By the way, it was so fun to be surprised by the gender.  I was convinced we were having a boy and I'll never forget Rob's voice saying "It's a girl!"  More on the actual birth in my next post.)

Déjà vu

I had my NST this morning and the baby looked great - movements were as expected and no signs of contractions.  When I met with my OB following the NST, I mentioned that I have been having a lot of shortness of breath in the last week (more than previously), and not when I was doing anything.  At night when I try to read in bed, I cannot find a position (other than sitting up, criss-cross-applesauce) where I can get a "full" breath.

(I won't bury the lead - everything is fine)

Because of my history of blood clots in pregnancy, her concern was that, despite being on therapeutic anticoagulation (blood thinners - Lovenoax), I might have a pulmonary embolism (PE - a blood clot in my lungs).  Shortness of breath is completely normal in pregnancy, but you can't really be sure without getting a more thorough evaluation.  So, off to the ER I went.

I was initially pretty calm and felt certain that I didn't have a PE, but my EKG came back abnormal (which may be my normal, apparently EKGs are somewhat like fingerprints and each are different) and so the ER doctor felt that the abnormal EKG coupled with the shortness of breath meant I ought to have a CT scan.  I haven't had one before and when they ran through the litany of risks, I started to panic a bit (radiation exposure being the key risk for both Mom and baby).  

Mostly, the entire situation felt so similar to when I went to the ER with Q when I did have a clot and it went from being a normal day when I was pregnant to everything crashing down in a matter of moments.  I tried to stay calm, but I was alone and everything started to feel totally overwhelming.

In any event, my CT scan came back normal (no clots), the doctor recommended I have a follow-up EKG 2 months post-pregnancy to see if my EKG is still abnormal, and I went about my day, but the whole thing really shook me.  I am 12 days from meeting this baby and even being so very close, I know how many things can go wrong and yesterday just reminded me of that.

Needless to say, I'm looking forward to wrapping up work this week (Friday is my last day), and spending a week getting some rest -- and hopefully the week will be uneventful.

************************

One upside to spending 5 hours in the ER is that I finished the book I was reading, Everything Happens for a Reason by Kate Bowler.  I can't recall where I first heard about it, but Kate is in her 30s, a professor at the Duke Divinity School, a mother and wife, and battling Stage IV colon cancer.  The book interweaves her experience with cancer and motherhood with her religious background and I really enjoyed it (in the way one "enjoys" sad books).  There were a few passages that resonated with me that I wanted to share:

• The book is dedicated to her son, Zach: "Zach, my darling.  I can see now how my beautiful life was always for you."  I sometimes feel so completely overwhelmed by how much I love B (and Q of course) and that love has just shifted my perspective about so many aspects of my life.  I thought she expressed that sentiment so succinctly and perfectly.
• Kate describes the moment she learned she had cancer: "There was a before, and now there was an after.  Time slowed to a pulse.  Am I breathing? I wondered.  Do I want to?"  This reminded me of how I felt when I found out Q's heart was no longer beating.  My world stopped.  And for a long time, I wasn't sure I cared.
• Finally, these words: "I have had two perfect moments in my life.  The first was running down the aisle with Toban [her husband] on our wedding day, and we burst through the church doors and stood, breathless, alone as husband and wife, gazing at each other like complete idiots.  And the other was when they put Zach in my arms for the first time and we looked at each other like it was a conspiracy of mutual adoration.  These are my Impossible Thoughts.  These are my Can't-Live-Withouts.  I cannot picture a world where I am not theirs.  Where I am simply gone."  These words prompted me to think of the "perfect moments" in my life.

I highly recommend Everything Happens for a Reason and if you'd like to read something similar that may be the best book I've read in the past two years, I recommend The Bright Hour, another memoir written by a mother dying of cancer.  Both books really shook me to my core.

The Final Countdown

I'm 36 weeks pregnant today and have 2 weeks until my scheduled c-section.  After much deliberation, we pushed the date back to exactly 38 weeks so this baby will have a bit more time to grow.  There is the added benefit that, if all goes as planned, I will have all of next week off of work to relax, set up the room, and prepare for baby's arrival, plus spend some quality time with B.  This past weekend we picked up a crib from a friend who kindly offered hers to us (I sold B's crib and dresser last summer), borrowed a Halo bassinet and Dock-a-Tot friend a different friend, and moved everything out of the office so that it could officially become baby's room.  I have yet to go through any of B's clothes, but I have ordered diapers and wipes and will take the time next week to sort through B's newborn gear for gender-neutral clothes.

All things considered, I feel relatively calm about delivery and the next two weeks. I had a non-stress test last week and have another tomorrow morning.  As always, they begin with more stress since inevitably it takes a while to find the baby's heartbeat (every single time).  Even when I felt a kick moments prior, panic begins to set in.  

I can't tell if I have completely forgotten how I felt with B, but I FEEL very pregnant these days. I'm having shortness of breath, lightheadedness, and generally am completely exhausted.  I'm still getting to pilates a few times each week, but my energy levels are really low and I feel like I am letting B down in my lack of enthusiasm for running playing, climbing, etc. I truly don't recall feeling this way with B, but then I wasn't chasing a toddler, making meals, doing bedtime, etc.  I suspect I just came home from work and laid down? 

My OB again raised the possibility of tying my tubes and while R seemed ready to sign on the dotted line, I am not.  Do I think we will have a fourth child?  No.  Do I like even considering this before giving birth to a third baby? Absolutely not.  But do I like the finality of making this decision now?  No, thank you.  

B has suggested some classic names for this baby: Hot Sauce, Latte Shop, Stop Sign, Coffee, and Blythe.  We joked that if we had the baby on April Fool's Day, we'd send out an announcement saying we named it Latte Shop Levy because it has a nice ring. 

I am having trouble wrapping my head around the fact that it is April and that on the morning of 4/16, I will have a c-section and hopefully deliver a healthy baby into this world.  My due date with Q was 4/9 and it is ironic to me that this baby will be due so close to that date and that B was born 2 days shy of the anniversary of Q's death.  It is wonderful to have important dates to celebrate during times that would otherwise be marked solely by sadness.

So, that's the report from here.  T-minus 2 weeks. Two doctor's appointments remaining (and two more NSTs).  No more ultrasounds unless something unexpected happens.   We are crossing fingers and toes around here that nothing happens in the interim and that this baby arrives safe and sound.

I have been trying to take time to do little random acts of kindness for R and B and to pamper myself a bit.  Last week a friend and I went to see Hamilton, which was fantastic, and exceeded my expectations in so many ways.  I've been getting regular massages and have 2 more scheduled before baby arrives.  I'm letting myself enjoy my pilates class or a night out with friends rather than feeling guilty about it as I often do (this was a resolution for 2018).   I'm both so very excited to meet this baby and aware that our world is going to change and want to be sure B (and R) know how much I love them.  I hear over and over that loves multiples rather than divides, but I am nervous about making sure everyone knows and feels loved, especially B.

Oh, one final observation from this pregnancy.  Two things have happened that didn't happen with B that have totally weirded me out:

• I have been leaking milk for the last few weeks.  Not much at all, but it is there.  I hope this bodes well for breastfeeding again.
• My belly button has been "out" for weeks (months, really).  This didn't happen with B and I find it so creepy.  

I'll leave you on that happy note... 

Reminiscing

One of my New Year's Resolutions is to finish all of our photo books from our travels. I was pretty good about keeping up with them while we were on the road, but I'm determined to be completely caught up before this baby arrives in mid-April.  I ordered two last week, so progress is being made.

I was sorting through photos and came across two that I took in our cabin in the Archipelago of Sweden (this place, seriously one of the best airbnbs of our entire trip).  The cabin was full of charming details, but I was most struck by two pieces of art that made me think so much of being pregnant -- so much so that I took photos of each in an optimistic gesture that perhaps I'd get pregnant while we were there.  That didn't happen, but I did shortly thereafter.

I was struck by how the woman in the top picture looks quite pregnant and the one in the bottom appears to be holding a baby.  The translation of the bottom cross-stitch is "she comes down the fields."  There isn't a real point in sharing this, but in stumbling upon these, I was reminded how even in the midst of feeling pretty despondent about our situation and still grieving over the two miscarriages, I had hope that I might get pregnant again.  

I still feel great disbelief about the size of my growing belly, the wonderful movements I'm feeling, and the fact that my c-section will be scheduled for 10 weeks from now.  TEN WEEKS.  It doesn't seem possible.

Next week I'll be in my third trimester, I'll have another ultrasound and my glucose screen and I'll post another update.  For now, I'm embracing the positivity, am thrilled to be past 26 weeks, which is when we lost Quinn, and generally trying to just stay calm. 

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2018

As I type this post, I'm feeling this baby kick around in my abdomen and am thrilled to finally be feeling little pops and flutters on and off throughout the day and night.  What a difference a few weeks makes in terms of feeling less unsettled now that I can feel movement.

We took down our Christmas tree yesterday and B went back to school today (she was jumping up and down with excitement about seeing her teachers and being back in the classroom).  This past month was both magical and exhausting -- emotionally and physically.  Christmas and the New Year will always make me think of Q and I can't help but replay Christmas 2013 when I was in incredible pain and ultimately Q died on December 28th.  I spent New Year's Eve in the ICU awaiting another surgery and finally delivered Q on January 3rd.  B brings so much joy this time of year and it is truly such a gift to watch and help her enjoy the holidays so much, but I do think a lot about the what could have been and worry about this baby growing inside of me.

I'm 23 weeks pregnant now and officially have less than 4 months until this little one arrives.  I'll have my next check up in a week, including an ultrasound, and I'm so excited to see how this baby is growing.  We also celebrated B's birthday on the 28th, which was so much fun.  I threw a small party at home with two of her friends, my parents, and her former nanny, who she adores and happens to share her birthday.  It was actually fun and the perfect size and I could tell that B just felt so special having a party just for her.  This pregnancy has absolutely kicked my butt in terms of exhaustion, but I'm glad I rallied and made a cake, decorated the house, and really celebrated B's birthday, which admittedly was hard for me to do on the heels of hosting Christmas.

I feel as though I should have more profound thoughts to share on this 4th anniversary of losing our beloved Quinn, but they are escaping me. It's not for a lack of her being in my thoughts, but more that I can't seem to capture what I'm feeling in the midst of the holidays, B's birthday, and this pregnancy. I think of her most often in the rare quiet moments I have alone - when I awake in the pre-dawn hours and let my mind wander, when I'm driving somewhere alone, or at night when I should be asleep and find myself thinking of her and imaging what she would be like at 4.  Four.  How is that possible?

Separately, the NYT had a piece two weeks ago entitled When a Grieving Mother Talks, Listen that I highly recommend.

Do you set New Year's Resolutions?  I'm a huge fan and have set them for as long as I can remember. This year, in addition to setting resolutions, I'm declaring "positivity" as my word for 2018.  This idea came from one of my class instructors at Fierce45 and it really resonated with how I'm feeling these days.  This will be my last pregnancy and I can't wait to meet this baby.  I don't want to spend the next 4 months worrying so while I know I will worry, I'm going to try my best to generally be positive.  The word applies to every aspect of my life, but I need the most work in the pregnancy/baby department.  Does anyone else do this?  Apparently My One Word is a thing!

Happy New Year. 

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Meet Me Halfway

19 weeks!

Technically, I won't be 20 weeks until next Monday, but for me 19 weeks marks halfway through this pregnancy as my high-risk OB informed me at our mid-pregnancy anatomy scan that she wants to schedule a c-section for sometime between 37 and 38 weeks.  So there you have it, friends.  Fingers and legs (and toes and everything else) crossed, we'll meet this baby, boy or girl, in mid-April.

Suddenly, this pregnancy feels very real.  Somewhere around week 18 I popped and now it is quite tricky to hide the bump.  I finally told the head fo my new law firm and while I haven't told my other co-workers, I'm no longer avoiding maternity clothes and fitted tops at work.  The best thing is that I am feeling this baby move!  Despite having an anterior placenta, which makes it more difficult to detect movement, I'm definitely feeling it, especially when I lay down at night to read.  I'm excited for a few weeks from now when the movements are strong enough that R and B will be able to feel them as well.

Telling my boss was interesting and went about as well as I could expect.  Keep in mind that I have only been at this job for 6 weeks, so obviously I was pregnant when I accepted and started.  I decided to be direct: "I'm pregnant.  I wanted to tell you when I joined (which is true), but this is actually my fifth pregnancy and given the fact that pregnancy has often not ended well for us, I wasn't ready to tell you or anyone else when I accepted the job."  It went something like that.  He was wonderful about it -- he has five (!) daughters and was just so happy that we were having another kid and was just great about it.  The whole conversation was a huge relief and I felt so much better about everything at work afterward.

Oh, and our mid-pregnancy anatomy scan looked great.  Baby was moving around like crazy, everything was measuring on track, and he or she has all of the organs you'd expect to see.  We breathed a big sigh of relief.

This little girl's happiness related to all things Christmas is infectious

And here we are in December.  The tricky thing is that everything about this pregnancy reminds me of being pregnant with Q (Baby L - it's confusing, her name starts with Q, but L, which stands for Lemon, was her nickname throughout my pregnancy).  Q was due in early April.  She died on December 30th.  And going into the holidays, I felt great... until I didn't.  Christmas of that year was awful, including a Christmas Eve phone call to the emergency line at my doctor's office, no sleep, and being so uncomfortable I couldn't even walk a hundred yards.  Whenever I think about that Christmas, I get furious at myself for not trusting my instincts, knowing something was wrong, and driving myself to the ER.  So even though I am being closely monitored and I'm taking tons of Lovenox so getting a blood clot is virtually impossible, I'm just anxious about letting my guard down and letting myself get excited -- even know I rationally know this a different pregnancy.   Don't get me wrong - I am just thrilled about this baby and I have moments of being incredibly optimistic and imagining Rob putting this baby in my arms in April and telling me whether it is a boy or girl... but those moments are always tempered by thoughts of cord accidents and blood clots and unexplained late term losses.  Every time a pregnant woman tells me she feels great now that she is 26 weeks along and the baby will be fine no matter what, I have to bite my tongue not to tell them that isn't true.   I know these feelings are exacerbated because we are fast-approaching B's 3rd birthday, which is followed 2 days later by the anniversary of Q's death.  She would be 4.  FOUR.  How is that possible?  What would she be like?  I so desperately wish that I knew.

What is keeping me from a downward spiral of sadness and introspection on this topic is the fact that B is giddy about Christmas and her impending birthday.  Each morning we go downstairs and check the advent calendar for a little treat for her.  We've talked about the cupcakes she'll take to school for her birthday and I mailed invitations to her (very small) party yesterday.  Her joy for this season is contagious and I'm trying to stay present in that feeling instead of the others, although I will make space for the sadness this month, too. I always do.

I'm thinking of all of you who have lost babies this month and sending lots of love.  And I'm giving B extra snuggles and kisses and love because I am able to --- and how lucky am I for that?

16 Weeks

Earlier this week, I had a quick heartbeat check with my OB.  Baby's heartbeat was beating away at 143 bpm and today I'm 16 weeks and three days along.  Last week I went in for a blood draw and the sonographer, who is a friend and the sweetest lady, saw me in the hall and asked if I wanted to take a peek at baby.  Umm, yes please!  I never turn down an opportunity to see him or her wiggling around.

All looked good in the ultrasound and we checked out the brain and the spine, looked for fingers and toes, and just watched baby move around a bit. I'm anxious to feel those first movements.  Sometimes I think I've felt something, but it is just too early to be sure and I have an anterior placenta again, which makes movements even more subtle at this early stage.

I've been feeling quite calm thus far, but this week I've had thoughts creeping in about all of the issues that can arise in the remainder of this pregnancy. I know this isn't healthy and I try to push them out of my mind, but as I creep closer to the time when we lost Baby L, I am reminded of what can happen.  The urge to relax and enjoy the pregnancy is there, but so is the underlying knowledge of how quickly everything can go awry.

Otherwise, I'm feeling good, sleeping well, and really just still feeling utterly exhausted but otherwise fine.  I swam for the first time in months earlier this week and it felt incredible. I need to get back into a swimming routine, especially as I get bigger.  The Lovenox is going well.  We check my AntiXA level once each month and so far it has been right in range and I've avoided bumping up (at this point in my pregnancy with Baby B I had already bumped up a dose).  I'm so used to giving myself shots twice each day that I give it relatively little thought at this point.

I'm wrapping up my third week of work at my new job. So far, it is as promised and I've been working from home two days each week and arriving into the office at 9:30 AM and departing by 3:45 or 4 PM the other three days.  It's been manageable and, frankly, enjoyable and I feel like it strikes the right balance between engaging and still allowing me to have time at home, with B and R, etc.  I still haven't told them that I'm pregnant - I've been wearing regular clothes and if something is fitted at the waist, I just wear a vest over it (the office is cold anyway) and I don't think you can tell.  I have another appointment after Thanksgiving and plan to tell them if all goes well.

Happy Thanksgiving, everyone.  This may be the most boring update I've ever written.  I'll close by noting that I have a lot to be thankful for this year.

The Second Trimester

I'm just days away... I'll be 14 weeks at the beginning of next week, which means the arrival of the second trimester.  If it means that I'll stop feeling so fatigued, I'll take it -- my new job starts on Monday and I could use some extra energy.

Our MaterniT21 test results came back this week and everything looks good.  This combined with our 12-week ultrasound makes me feel slightly reassured, although I am still weighing the pros and cons of an amnio in the back of my head (I have a few weeks to decide).  We agreed to be surprised about the gender and I'm feeling really excited about waiting.  It's fun to ponder whether B will have a sister or a brother.  Driving home from school the other day she was telling me about her classmates who have babies (younger siblings).  She mentioned a few and then said "We should get a baby at the story."  This was completely unprompted by me.  I asked whether she wanted a sister or a brother and she answered "a brother."  When I asked what his name should be, she suggested we ask Forest (our cat).  Obviously he has all of the answers.  B will have a baby brother named "Meow".

According to "The Bump", this baby is a lemon this week, which makes me nostalgic for my pregnancy with Baby L / Quinn.  We called her "Lemon" throughout my pregnancy (we called Baby B "meatball").  Somehow that fruit just stuck and since our last name begins with "L", it had nice alliteration.  I remember how joyful R and I were just to be pregnant and how much fun I had reading about the baby's development each week.  I wonder if we'll ever get to a place in this pregnancy where we feel that way -- I know I could get there, but I think I need R to lead the way and I just don't see that happening.

I was just thinking that, like Lemon and Meatball, this baby needs a nickname, but I realized B already took care of that - Meow!

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On a completely separate note, this article in the NY Times this week was fascinating.  For those of you with POF/POI and/or low AMH, I recommend reading it.  Essentially, the article concludes that "AMH doesn't dictate a woman's reproductive potential," although it is one marker used to assess overall fertility.  What this study concludes is that "Among women attempting to conceive naturally, diminished ovarian reserve was not associated with infertility; women should be cautioned against using AMH levels to assess their current fertility."  These findings are certainly in line with my experience, which is that while I've been pregnant five times, I do have an issue with egg quality (hence two miscarriages) and I don't always ovulate regularly.  Plus, a friend who endured numerous IVF cycles while living abroad in various places mentioned to me that doctors outside the United States place a much lower value on AMH as a predictor for getting pregnant than they do on follicle count and FSH.  

Homeland

We've finally settled into our home enough to find time in the evening to watch a show and Homeland Season 6 is the show of choice.  Peter Quinn returns in this season as a central character and it made me think about how I can trace so much of what has happened in the past 4 years to which seasons of Homeland we were watching (I know, it is ridiculous).

We were watching Season 1 while I was pregnant with Q and it's where we first heard the name Quinn, which ultimately became our first daughter's name.  It's a character's last name, but we fell in love with it and thought it would be perfect for our little girl, which it is.  After Quinn died, we returned home in a cloud of grief and I recall binge watching Seasons 2 and 3 when it was easier to lose myself in a TV show than to allow myself to obsess over everything going terribly wrong in our life.  We watched Season 4 in the weeks leading up to B's birth and in her first days at home (I was so worried about watching it while she slept on my chest because it's so violent - I'm pretty sure she couldn't even make out my face at that point).

I am, miraculously, still pregnant and here we are watching Season 6.  It's a wonderful distraction from obsessing over miscarriage rates (I have visited this site more times than I'd like to admit), possible chromosomal abnormalities, blood clots, and the myriad ways in which a pregnancy can go awry.  I haven't allowed myself to worry too much thus far, mostly because I've been trying to pretend this isn't happening in an effort to protect myself.  We all know that never works.  I'm hugely invested in this pregnancy and the swell of joy I feel at each ultrasound when I see those little arms and legs moving and listen to the baby's heartbeat is truly incredible.  Today was no exception.  I am officially a patient of my regular OB now instead of my RE and today I got to see this tiny person bopping around in my belly and measuring 10 weeks with a heartbeat of 170 bpm.

R and I have literally exchanged 10 words on the topic and he hasn't been to an appointment yet (I felt superstitious and wanted to go alone), but he'll join me next week (my regular OB wants to see me weekly through the first trimester).  I've been feeling okay - definitely strong aversions to certain foods, some nausea, and exhaustion.  I caught strep throat last week, which hit me like a ton of bricks.  Thankfully, you can take penicillin when pregnant and I'm already feeling much better.

I'm also likely to commit to a new job this week and since I feel so uncertain about this pregnancy, I'm trying to not let myself ponder what it would mean to start a new job at 12 weeks pregnant.  Instead, I'm focusing on making B's Halloween costume, enjoying this luxurious period where I have childcare and no job, seeing friends, and relaxing.... and trying to take this all one day at a time.

P.M.A.

Enjoying the beach in Okinawa

My Dad was my high school soccer coach, which had some perks but also a great many downsides, mostly relating to accusations of favoritism and him being particularly hard on me (because he wanted me to be the best I could be, but still).  In any event, one of his favorite acronyms was P.M.A., for "positive mental attitude."  Having a positive outlook on life is not something I've had trouble with until the last few years.  And a few weeks ago, I made a decision to make a change.

As those of you who have been reading know, I've been feeling terrible about my body lady, I'm been having perimenopausal symptoms, and my mood has been all over the place.  I hate feeling this way, but I wasn't doing much to fix it and I realized I was being whiny and downtrodden and not appreciating what I have.

There was a triggering event for this wake up call that came out of nowhere.  I receive the GOOP newsletter, and while I normally delete it straight away, last week something caught my eye.  There was an article whose subtitle mentioned hormone imbalance and is on the GOOP site here.  Hormone imbalance!  That's me!  I immediately clicked through, read the article, downloaded the Dr. Sara Gottfried's book The Hormone Cure, and read it in one night.  It reminded me of when I read It Starts with the Egg a few years ago and immediately overhauled our house (no BPA, glass containers), my toiletries and cosmetics, and my supplement and vitamin protocol.  I just had this feeling like, "Hey! I want to feel better. I know I'm not doing everything in my power to feel better right now and how lame is that? Just do it."  When I wanted to improve egg quality, I did EVERYTHING I could.  And why am I not doing that now?

In any event, I ordered $350 of supplements and vitamins that will hopefully be waiting for me at the Westin in Tokyo next week before we fly to Amsterdam.  I've signed up for a marathon and started running regularly and using this app I love called SWORKIT (it has workouts that will make you sweat that require no equipment, including yoga and pilates), plus I created an Instagram account where I'm posting about my running, which helps me stay motivated (@rundarcyedenrun if you are interested).  We've been making a point of being in bed at 9:30 PM and lights out at 10:00 PM, which means I feel rested in the morning no matter what time B wakes up.  I'll resume regular acupuncture and massage once we are home (that's tough to do on the road).  I've started keeping a gratitude log in my Bullet Journal.  I've stopped drinking and am reducing carbs/gluten and treats/dessert. I find that on the road it is easy to see all of this travel as "vacation," which means have a drink at night! Have dessert!  Have a mid-afternoon ice cream! The trouble is, that vacation is many months long and not two weeks so it has taken its toll.

I'm two weeks in to making these changes and I feel so much better.  I had this realization that I have been singularly focused on trying to get pregnant, grieving Q, being pregnant and thus anxious, or dealing with a miscarriage for almost FIVE YEARS (it will be five years in October from when we first started trying to have babies).  FIVE YEARS.  I've lost myself in so many ways during this time and I'm ready to get myself back.  I feel like a better Mom, wife, and happier person and I'm so excited to keep this up.

Okay, so I think I sound a little crazy and possibly a little manic, but I really do just feel better.  P.M.A.!

I'll leave you with two things that happened in the last week.

Jizo Statues in Kyoto

First, I found my Jizo for Baby L / Q!  I read this NYT article "The Japanese Art of Grieving a Miscarriage" and knew that when we were in Japan, I wanted to find one of my own to have at home.  In Japan, these small figurines honor the souls of babies who were never born.  I'd been looking since we arrived, but hadn't seen any (I am positive I was just not looking in the right place).  Last week, we finished a lovely day of biking and rode by a shop with lots of figurines on display outside.  We pulled over on our bikes and there in front of the shop next to a fountain were all of these little Jizo statues.  I picked one out and have it carefully wrapped to bring home.

Second, I bought ovulation predictor tests.  This required a great deal of Googling, searching many drug stores, and ultimately showing photos of what I wanted to employees and asking for help.  I finally found them and actually purchasing them requires taking an empty box to the front of the store, someone going to a back room to get them, and then several layers of bags and packaging being wrapped around them (this is standard in Japan and not specific to the OPKs, but still amusing).  I haven't tried to use them yet, but hopefully I can interpret the lines on the tests (they don't have the smily faces like at home).  It was a funny thing to search for in a country where nothing is written in English.  I do very much miss the convenience and anonymity of Amazon Prime.