Early Pregnancy Loss
I'm back! March brought about some technical difficulties with the blog, but I've got it figured out and I'm glad to be back. Ironically, March's blog entry was not one that I was eager to write anyway. The month of March will probably always be bittersweet for me. It was in March of 2022 (just a short year ago) that I found out I was pregnant for the very first time, after countless surgeries and fertility procedures. It was also the month that I had a pregnancy threat and feared losing my baby. In April it was confirmed that my fetus had stopped growing and no longer had a heartbeat. Let me back up and explain.
On February 23rd I had a frozen embryo transfer (FET). I used my last viable embryo; a mosaic embryo. There was a chance that it could possibly not implant, and if it did, it may not become a full-term pregnancy. Mosaic embryos are those which have some normal cells and some abnormal cells. The thing is that it cannot be determined if the "bad" cells recognized in the biopsy are from the actual embryo or the placenta, which surrounds the embryo. I was very skeptical about using this last embryo, especially after already using two Grade A embryos that did not implant. But I also did not want to live a life of "What Ifs". I wanted to be able to say that I had tried everything I knew. Not only could the embryo have not implanted or resulted in a miscarriage, but it could have also resulted in pre-term labor or a baby with birth defects. 
Bee Harris for NPR
After wrapping my head around all of that, I moved forward with my last embryo; hopeful, but not expectant. So imagine my surprise and delight when I got the call and my doctor said "I have some good news for you." I was completely and genuinely shocked. I hadn't fully expected for the FET to work. Remember, I had been through this twice before with what was considered my best embryos. After my first blood test results, there were 2 more blood draws scheduled a few days apart, to confirm the pregnancy. After 3 positive lab tests, the pregnancy was solid.
Upon implantation, the embryo was already 2 weeks and 6 days old. So I was a little over 5 weeks pregnant when I had some bleeding and cramping. I believe it was the day I received the final lab results. Go figure. Late that night I was bleeding and in pain. It was more bleeding than I knew was okay, but not like a period. I called the after-hours answering service for my doctor and when he called back, he told me to give myself a shot of progesterone and stay off my feet. I was told to come into his office the next day.
At the appointment, the doctor did a sonogram (earlier than was originally planned) to see what was going on. I just knew I had miscarried. He was able to see the gestational sac and yolk sac, but it was too soon to see the fetal pole. (I didn't know what any of this meant, so I did some research when I got home). What I DID know was that there was a heartbeat. I was relieved but still worried.
At the time, I was on my spring break and was told to remain on bed rest until my next appointment, the following week. The nurse said it was okay to return to work after my break, but to take it easy. When I went back to work the following week, I sat and taught from a stool. When I returned for the second sonogram, there was a pregnancy sac and yolk sac, and the bleed spot had gotten smaller. There was a fetal pole visible, but there was no heartbeat. My HCG numbers were still growing, which signified a pregnancy. I told myself that maybe there were twins and one died, but there was still another growing. It just didn't make sense. The doctor told me that day that the embryo was behind in size and that he was "not encouraged". He said we would have another look the following week.
By the end of March, I was 7 weeks, 4 days along. However, the embryo was only measuring at 6 weeks, 1 day. The heartbeat was slow, at about 75 BPM (beats per minute), but it should have been greater than 100. Again, I went home sad and confused. At the same time, I was still hopeful. The doctor had said he didn't think it was a good pregnancy, but it was "still going". So guess what...we would look again the following week.
On April 4 it was confirmed. The embryo had not survived. There was no heartbeat. No words that I type can express my muddled feelings. Sad. Relieved. Crushed. Devastated. Optimistic. Confused. Disappointed. Deflated. Angry. Lonely. Afraid. I was given the option to receive a prescription for a medicine that would cause the embryo to pass, or just wait for it to pass on its own. I chose to wait it out, still in denial and hoping that the well- experienced doctor may be wrong and that God would perform a miracle for me.
After I was given my options I was sent home. If the embryo didn't pass by a certain day I was to schedule a procedure to return and have it removed. The nurse didn't even stick around and wait outside my door to see if I had questions (which was usually protocol). I walked out to silence and no nurse in sight. I had to leave my question ("What should I expect when the fetus passes? Bleeding? Cramping?") on a sticky note with the lady at the front desk who takes my payments. How humiliating and heart wrenching.
Believe it or not, I went back to work the next day (Tuesday), and for a couple of days following. I had researched how long it may take a fetus to pass and it was several days. I couldn't just stay home. So I went on. I took off that Friday, not knowing when it might happen. I even went to class that Saturday (I was in grad school at the time.) AND I had an exam. Imagine the stress!! Of course I hadn't studied like I needed to. I was a mess. But nobody knew. Thank GOD it didn't happen on campus that day, because I had no idea what I was in for!
The next day, Palm Sunday, April 10, 2022, the fetus passed. It was late in the evening when the cramping started; maybe around 7 or 8. It was a long, painful and lonely few hours and then I was finally able to rest. Because I didn't know how long the process would last, I didn't know if it was worth calling someone to come sit with me. I thought it was a one and done, but no. My best friend had fallen asleep between the time it started and ended. I wanted to call my mom, but by the time I realized that it wasn't over, it was after 10:00 already. Plus I didn't want to alarm her. Then I thought to call my cousin. I knew she wouldn't be asleep, but she lives so far away and I didn't want her to drive too far so late. Eventually I fell asleep.
The next day I don't know what I expected. I took off from work and stayed in bed for most of the day. My best friend pressed to get me out of the house and I agreed to meet up for dinner. To my surprise, the process of miscarriage was much more physically daunting than I thought. I mean, what did I know? I thought I was just tired/ weak; typical female stuff. But by the time I walked from my car to the door of the restaurant, I could not even stand while they looked for seating.
Upon further research, I learned that recovering and healing after a miscarriage can take a few weeks to a month or more. I just couldn't imagine that. But I eventually lived it out. I came to the conclusion that it was like giving birth to a very small baby. When I thought about it that way, I understood why my body didn't just bounce back like after my usual bout with cramping and heavy bleeding.
I took off for 2 more days and then returned to work. Back to business. Nobody knew except my still very small circle; my mom and dad, brother, cousin, best friend, and a co-worker.
THE DEETS:
✅ Frozen Embryo Transfer (FET)- the transferral of a fresh or frozen embryo into a woman's uterus, during a cycle of IVF
✅ Mosaic embryos have different proportions of normal and abnormal cells. A low-level mosaic would have mostly normal cells and a lower percentage of abnormal cells. A high-level mosaic would have mostly abnormal cells and a lower percentage of normal cells.
✅ Progesterone- a hormone produced by the ovary that prepares the lining of the uterus (endometrium) to allow a fertilized egg (embryo) to stick or implant. Medications used during IVF to prevent the early release of an egg (premature ovulation) affect a women's progesterone levels, so a progesterone supplement is prescribed to make up for this decrease in the ovary's ability to make progesterone.
✅ HCG (Human Chorionic Gonadotropin) - the hormone detected by pregnancy tests
✅ Expectant management, allowing your body to pass the tissue on its own, is one treatment for early pregnancy loss. It is the most natural option, as it does not involve medication or surgery, but it is more unpredictable than the other treatments. Most women pass the tissue within 7-14 days of a miscarriage diagnosis.
SOURCES:
fertilityanswers.com
reproductivefacts.org
acog.org (The American College of Obstetricians and Gynecologists)
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