The journey of two guys ( with one cat & lot of great friends) trying to get through life and expand their family through surrogacy in Thailand.

Tuesday, November 26, 2013

Knowing Vs Not Knowing

Well, over a week has passed, but we’re not quite where we wanted to be. We’re back to the land of uncertainty. I had to wait a few days before writing this, because my initial reaction to the email we received would have shot this blog from a PG rating straight to an R rating. I think the term my mother used was….”mouth of a sailor this one.”

But, after a few laps around my Zen labyrinth (the halls of the hospital,) I am once again reminded that my life is pretty damn good, and I’m in a good place.

So here’s the scoop:

We received an email from our contact at New Life that said at this time the fetal heartbeat could not be detected and the fetal sac is too small. Our next appointment would be in one week.

And that was it.

There was nothing about what the doctor thought about the scan. Nothing about having run HcG levels to help indicate if the pregnancy was still viable. Nothing.

I guess the funny thing is: even if there was a HcG test, and even if we had a personal note from the doctor outlining his thoughts, it wouldn’t change the outcome of the pregnancy. It’s like waiting for the train. You keep looking at the scrolling marquee that announces the time of the next train; and if the marquee is broken or non-existent, then you begin to lean over and look down the train tracks to try to figure out when the train will arrive. The fact of the matter is the train will arrive when it arrives. Watching the little marquee doesn’t make the train come any faster or change when it will arrive. And our reality is that the pregnancy will remain viable, or it won't. Nothing we can do can change that. But there is a comfort in knowing; Or at least feeling like you know.

And right now, I long for that feeling of knowing, because not knowing simply sucks.

(This is perhaps another really difficult part about international surrogacy. We would have really wanted to be there during the scan to ask the doctor a million and one questions…but alas, that’s just not an option here. )

Fortunately, our contact was happy to elaborate on the scan. But we didn’t get the answer we wanted: “of course your pregnancy is still viable, and the fetus is happy. Actually, if you look really closely at the ultrasound image, you can see balloons and a tiny party hat on the fetus. It’s having a ball in there.”

Instead, we got a realistic view of the situation. Not detecting a heartbeat at 6 weeks is not a good sign. But it’s not time to give up yet. A fetal pole was visible, and measured about the right size for this point in development. We won’t know anything for certain until next week.

So, this Thanksgiving, we’ll be thankful that we even reached this point. We’ll be thankful that we still have hope. We’ll be thankful knowing that we’ve gotten to this point once, and if need be, we’ll get there again. And we’ll be thankful that we have a taste of what it would feel like to have our dreams come true…and that’s worth fighting for. 

Tuesday, November 19, 2013

Presumptive Vs Probable Vs Positive

In the world of Obstetrics, there are three stages of pregnancy confirmation: presumptive, probable, and positive. Believe it or not, a "pregnancy test" as we know it is not a positive (or conclusive) test; it only gives you a probable result. Here are some examples of the signs of pregnancy confirmation, and what other factors might be causing them:

Presumptive signs of pregnancy
·         Missed period  - Sorry, but if you’re 60 and you missed your period….probably not pregnant
·         Nausea / vomiting - Really? You thought eating sushi from the gas station was a good idea?
·         Weight gain – Are you American? Enough said. (But sadly…we’ve finally been dethroned of having the honor of fattest country in the world! Thanks a lot Mexico…)
·         Fatigue – Bad news, you’re not pregnant….more bad news, you have Lupus…
·         Breast Tenderness – You got a little out of control after reading 50 shades of grey…baby steps.
·         Quickening (A “flutter” of movement…when mom says, “I think I just felt the baby move!”) – Please refer back to gas station sushi. This can be gas or peristalsis.

Probable signs of pregnancy
  • Hegar's sign (softening of lower uterus), Goodell’s sign (softening of cervical tip), or Chadwick’s sign (vaginal mucosa turns violet-blueish) – I hope you aren’t basing your results after any of these, because they require palpation and some spelunking! So probably not things you would want to do at home. However, if you are, all of these things can be caused by pelvic congestion. 
  • Ballottment (By far my favorite!! This is when the examiner places a finger within the vagina, taps gently upward against the cervix, and leaves their finger there. This causes the free floating fetus to rise, only for gravity to make it sink back down, and the examiner feels a light tap on her/his finger….how cool is that?! It's not really used any more, but still very cool.) – Not sure what else could cause this. My nursing textbook claims it could be cervical polyps…but I’m thinking maybe a marble got up there somehow? 
  • Braxton-hicks contractions – Sadly, these can be caused by a tumor. 
  • Urine pregnancy test – The at home classic! The problem is, a pregnancy isn’t the only thing that can cause a positive. Pelvic infections, tumors, and simple user error can lead to false positives.
  • Serum pregnancy test – This is the one we in the surrogacy world all depend on! We get our Beta HcG levels, we compare how they change, and if they rise appropriately, surely we know we have a baby on the way, right? Nope. A molar pregnancy (caused by a hydatidiform mole, or a large mass, growing in the uterus) can also be the culprit. Also, a non-viable pregnancy can also cause these levels to rise. 

And this is where we are currently in our journey. We’ve gotten the coveted positive on the serum pregnancy test…and we’re over the moon thrilled. Our beta levels showed significant rise going from 120 on the first test, to 1793 on the second test that was taken just less than a week after the first. This means that the levels are doubling in less than 48 hours, and that seems to be highly desirable. The likelihood of anything but a viable pregnancy causing the beta levels to rise like that is really very low, and that feels amazing.

 But, we’re not letting our guard down just yet. It’s not until we get to the third stage of pregnancy confirmation that we’ll be able to relax knowing without a doubt that we have a viable pregnancy. And that third stage comes within the next week. For us, it will be an ultrasound to detect the heartbeat. Nothing else in this beautiful world can mimic that little flutter of a heartbeat within the womb, and so it is accepted as a Positive sign of pregnancy. Here are the other methods of solidly confirming a pregnancy:

Positive signs of pregnancy  (The only ways to be 100% certain that you have a pregnancy and nothing else could possibly be causing a positive.)
  • Ultrasound to visualize fetus in real time or detect fetal heart tones.
  • Doppler to detect fetal heartbeat.
  • Fetal movements palpated by nurse, nurse midwife, midwife, PA, or physician (Interestingly, movements felt by the mother don’t count. It sounds crazy, but one of the last case studies we had involved a woman with a psychosomatic pregnancy, or a pregnancy manifested only in her mind, right down to distended belly and her claims of feeling fetal movement. Very interesting stuff.)
  • Fetal movements visible through the abdomen (Not even the dreaded gas station sushi could do that!)

By this time next week, we should hopefully have a positive confirmation of our pregnancy. It’s amazing how much your life can change in one short week.

Here’s hoping for the best. 

Monday, November 11, 2013

Positive Vs Negative

The ten day wait is finally over. We prepared ourselves as much as possible for either result. Positive. Or Negative.

I said before that I’m always one to get the bad news out of the way first, so here it is…Unfortunately, Willow still has not learned to jump through a hoop of fire.

But the good news is that our surrogate had a positive pregnancy test!!!! So, I think it’s safe to say that makes up for it. ;0)

It’s still way too early to let our guard down and celebrate, as this result is only based on one HcG test and generally speaking things are so fragile right now. For all we know this could result in a chemical pregnancy; But just getting to this place is incredible. Even if things take a turn for the worse, it gives us confidence that we can get through this.

We have another test next week and hopefully we will see the HcG levels climb at the appropriate rate. Until then, Frankie and I will stay cautiously optimistic. Fingers crossed. 

Grow little embryo, grow! 

Friday, November 1, 2013

Two Guys Vs. Ten Days

Wow. I can’t believe we’re here. So the short of it is that we’re now in our ten day wait. I was expecting a two week wait, so ten days really doesn't seem that bad. But you can still imagine how slowly time seems to be moving. So, I've come up with fun ways to help time pass more quickly:

Teach Willow to jump through a hoop of fire.

Obsessively check my email to make sure I have the date of the pregnancy test correct.

Teach Willow to sleep on her head. (Already in progress)

Obsessively recheck my email just in case there was an update that didn't get forwarded to my phone, despite the fact that this has never happened in the past.

Teach Willow to ignore me when I call her name. (She’s all over that one)

Send myself a test email from one email account to another to make sure I’m getting my email in a timely manner.

Work on my wound care skills on the scratches Willow will give me while teaching her to jump through a hoop of fire.

And last but not least, ask my Thai family to send me daily emails from Thailand to ensure that the NSA isn’t blocking Thai emails to my account.

Yeah….it’s going to be a fun ten days.

Now, the long of it is a bit more involved. At the three day mark, Frankie had 7 good embryos, and I had 8. However, the morning of the transfer we were notified that unfortunately only 3 of Frankie’s embryos had made it to day five, and only one of them was of good quality. :-/  I still have 8, which is awesome but somewhat irrelevant given that our plans revolve around having a child genetically related to him. (He gets 6 weeks off at half pay for paternity leave, but it’s unclear if the pay or leave would apply to a child born that’s not genetically related to him.)

I suppose this is where the great 3 day vs 5 day transfer debate comes in to play. Did we save ourselves a lot of time and money by waiting until day 5 to make sure we only transferred strong, viable embryos? Or, did we needlessly loose embryos because they were in media longer than they needed to be? I really don’t know the answer, but I do know we knew that All IVF transferred on day 5, so it’s nothing we didn't sign up for. While it’s not an ideal outcome, with IVF you never know what will happen, so you just have to roll with the punches.

So, the embryo with a “good” rating, and a not so good embryo were transferred to our surrogate yesterday, and Frankie has one more not so good embryo frozen. Whether or not it would be worth trying again with that embryo remains to be seen. So, this might be our only shot with his material this time around. It certainly wouldn't put us out of the game just yet…but it would be a set-back.

However, we've decided not to worry about it just yet. What’s the point?! All it takes is one. And there’s as good a chance as any that one of those little blastocysts will be the one. And if not, well…. we’ll deal with it later.

And here are the little cell clusters we’re hoping will cling on to that lining:

So, for the next ten days we remain cautiously optimistic and hope for the best.  Fingers crossed.