I have my next OB appointment on Friday, and I will just have to put on my assertive pants and talk to her then about the metformin. I think I am going to have to bring Birdie with me, which isn’t good, because I will already be flustered trying to keep her under control. I did stop taking metformin for a couple of days before the blood test last week, but I went right back on it after the test. I am somewhat curious about what my body does without metformin, and perhaps if I fail the one hour (like I did with Birdie’s pregnancy), it will be more ammunition for me to want to stay on it.

One thing that has caused slight worry is that I got a letter with the combined results for the NT test, with both the measurement and blood test. It came back as a 1/215 risk for Down syndrome. That’s slightly higher than the background risk for my age (1/230). When we had the NT scan done with Birdie, the risk went down from 1/300 something to 1/5000. It must be the blood portion of the test, because the measurement looked fine according to what I could find online. I spent a few days worrying about it, and have been doing my best to just put it out of my head. 1/215 is still not terrible odds, and I still need to do the second part of the screening, another blood test in the next few weeks. There is nothing that I can do about it.

It kind of bothers me that all I got was a form letter in the mail from the MFM group that did the ultrasound, and I haven’t heard anything from my OB’s office about it. I am not going to have an amniocentesis. I will not take that risk of losing this pregnancy. I have heard of a new test that is noninvasive and is able to detect Trisomy 21 by a simple blood test. It is very new, but supposedly is available nationwide since January 1st. I will be asking about that test.

I think I am starting to feel the baby move. Little flutters here and there, mostly at night when I am lying down and still. I am nearly 17 weeks now. I can’t believe how quickly this is going by. I am tired a lot of the time, but generally feeling pretty good. I have been having a little bit of sacroiliac pain like I did last time. With Birdie’s pregnancy it started around 16 weeks too. I have been doing the stretches and exercises that my physical therapist recommended last time, but if it gets much worse I might request a referral back to her. Finding someone to watch Birdie will be challenging though.

Birdie is hilarious. She is starting to talk more and more in simple sentences. In Target today, she was saying “Daddy, where are you? Oh, THERE he is!” She loves to play with her baby doll and wrap her up in blankets. She loves loves loves books. We got a Brio train set recently and she loves to play with her choo choos. She loves to give hugs, and just in the last couple of days she will repeat “love you” if prompted. She is definitely in the tantrumy stage though. For as wonderful as she is, she can be challenging. Everything is so intense with her, intense joy to intense anger over being denied anything.

I was totally unprepared to have to fight about this, so I just didn’t say anything. And then I came home and became more and more angry. What the fuck? I do not want to go off metformin. I truly believe that it is what kept me from getting gestational diabetes and kept Birdie to a reasonable 8lbs 3 oz.

The way she tried to sell it was by saying that there are now better medicines. Well there isn’t! There is nothing new. Glyburide is an oral medication much like metformin except that it functions totally differently. Metformin is an insulin sensitizer. It decreases the amount of glucose your liver puts out and at the same time it makes it easier for your muscle cells to use insulin and glucose more efficiently. Glyburide causes your body to pump out MORE insulin. I have insulin resistance, so my body already has too much insulin – I don’t need more! They have the same effect – to lower the blood sugar, but they work totally differently and glyburide causes more side effects, like hypoglycemia and increased weight gain (because of the higher insulin). Who knows if my pancreas could handle having to pump out more insulin. I think it would make me more likely to develop diabetes!

The studies I have read have both had the same concerns about metformin and glyburide, that they cross the placenta, and while both seem to not cause any problems for the fetus, long term studies have not been done, so they are not recommended for everyone at this point. There are a number of studies that have been done regarding with with PCOS staying on metformin during pregnancy, finding that metformin can prevent gestational diabetes, does not cause preeclampsia, and that the babies do not get too large due to high blood sugar.

When we got referred to the maternal fetal medicine specialist for an unrelated matter, he was a total asshole and said he wanted me off metformin. I ended up talking with another doctor in the practice who was more open minded and said that I could stay on it if I wanted. I was fine, Birdie was fine, and Birdie appears to be perfectly healthy. At her 2 year appointment, she was 95th percentile for height and 75th for weight. I told her last time that I was aware that more studies are needed to confirm that it is perfectly safe during pregnancy, but that I was willing to take that calculated risk. It is known that babies born to mothers with gestational diabetes are at a much higher risk to develop diabetes themselves later in life, so perhaps if I can keep from getting GD, it will help Birdie.

I get my metformin prescription from my primary care doctor, so it is theoretically possible for me to continue taking it against my ob’s wishes. Or I could go in talk with her and fight for it. I am considering putting together a printout of studies about metformin and writing up a note about my reasons for wanting to stay on it and dropping it off at her office. I figure it would give her a chance to read the studies and have a chance to think about my reasons rather than just trying to argue it out in a phone call or at my next appointment (4 weeks away).  I hate conflict, and I really don’t want to fight about this. I really don’t want to find another doctor. In general I like her. I have been so pissed about this all weekend though, and it makes me mad that I have to even go through this argument again.

The nuchal fold measurement was between 1.2 and 1.4, which she said was good. We won’t get the blood test part of the results for another week or two. The baby looks good though. It was great to get to see it again, and to see it move. Part of me still cannot believe that this is happening. She switched to 3d, and at first we couldn’t see much of anything, but then we could see the arms and legs.

S and I went out to lunch afterwards and then rushed home to clean the house and get ready for Birdie’s party. It went really well, better than expected. Everyone had a good time, Birdie was a total ham and cracked people up, and everyone left by 7pm. We had a slideshow going on the tv of pictures of Birdie, and at the end, I included two ultrasound pictures, with a little note saying due in July. The slideshow was going on in the background and cycled through 200 pictures, and no one seemed to notice when it went through the first time, so while we were having cupcakes, I froze it on the ultrasound. One of S’s aunts finally caught it and said something and everyone was surprised and happy. I felt like an odd fertile imposter who was getting away with some big scam. I had to keep reminding myself to relax and just go with it. We ended up telling my family over Skype. They were all gathered at my uncle’s house for a party and it seemed like as good a time as any.

So, it is out. And it is scary, but okay. Birdie’s birthday went well. We had a good day overall. I am exhausted and can’t wait to fall into bed, but first, here are a couple of ultrasound pictures.

I hope hope hope that things look good at the ultrasound that morning, because it will really suck to have to put on a happy face for the party if there is cause for concern. On the other hand, if things look very good, perhaps we will share the news with the very small group of family and friends that night. I am 12 weeks tomorrow. I would feel better about waiting for the combined results of the blood test, but that would be another week or two, and we probably won’t be seeing some of these people for a while.  At the same time, I am nervous about telling anyone. It will probably feel scary whenever we do decide to share the news, so maybe I just need to get over it. If something happened at this point, I don’t think we could just pretend it never happened.

I am starting to feel less nausea, which is nice, because wow, it sucked for a while. I have lost a couple of pounds and am now about 5 pounds less than when I got pregnant with Birdie. I find it difficult to believe, because I am eating A LOT. Hunger wakes me up around 2 or 3 and I get up to eat some yogurt or cheese and crackers or cereal.

I really want to rent a doppler this time. I wanted to last time as well but never did because I didn’t think my first OB would approve it. Have any of you rented one? Which company did you go with? Did you actually need a prescription for it? How early could you hear the heartbeat on your own?

She changed the EDD again to July 5th. Because of the revised again dates, I had to really push them to move the NT scan up, because waiting until Dec 28th would have put me out of the window. So now I get to go on Birdie’s birthday, December 23rd. I hope we get good reassuring measurements and results. I am feeling like this is too good to be true, and with my age, it is something I think about a lot. Please let this baby be healthy.

I am feeling very nauseous but am so thankful for whatever reassurance I can get. It has been a rough two weeks. The week of Thanksgiving I got hit with a very bad cold on top of all of the morning sickness. It was brutal, and I couldn’t take anything. Birdie was her normal active self and I barely got through it by letting her watch way too much tv, eat crap food, and tried my best to keep it together. It didn’t help that S was gone for two nights, and my in laws don’t help at all when anyone is sick because they don’t want to catch anything. I get it, and I don’t want to get them sick either, but I was borderline not able to function. In my family, when someone is sick, you help them out. I guess in his family it’s every man for themselves. It’s like when you need help the most, they disappear. Can you tell that I feel kind of bitter about being far away from my family at times like this?

Then once I was finally better, Birdie got it, and then S. Our house has been a snotty mess and is just now finally getting somewhat back to normal. I can’t complain though. Somehow this miracle baby is hanging around and growing. I couldn’t be happier!

I am so relieved and happy to have seen a heartbeat today! All week I kept going back and forth between feeling hopeful and feeling completely doomed. I went to the appointment by myself because S did not get back from his work trip until late tonight. We could see the heartbeat immediately. It was beautiful. Unfortunately the speakers were not working so I did not get to hear it, but I got a picture of it. 162 beats per minute.

The embryo is still measuring a week behind but had grown appropriately and measured 6w 6d. I discussed the dates with her and we can’t quite figure it out, unless I ovulated several days after S and I last had sex and somehow one of his slow sperm fertilized it. Based on the measurement of the embryo today, she thinks we conceived on the 15th or 16th, but the last possible date we could have sex was the 12th. Whatever. As long as it is healthy and growing and things look good, I will just have to let it go.

This is a terrible picture, and is completely off center (again perhaps indicating my ob’s lack of ultrasound expertise?). The baby is on the far far left. You can see the yolk sac a bit above the embryo.

She is changing the due date to be July 10, 2012. I will go back for another ultrasound in 3 weeks. I pressed to get a nuchal translucency scan (she said not many of her patients ask for it), and will get that done with the maternal fetal medicine group at the hospital sometime the week after Christmas (if things continue to go well).

Oh my god you guys, it’s alive! Thank you so much for all of the positive thoughts and kind comments!

To clarify further and answer some questions:

Here is a picture of the ultrasound photo from Monday.

The crown to rump length is actually .34cm not .5cm like I posted. Based on that measurement the dating is 6w 0d. Based on my LMP, and confirming that with the reasonably high beta of 1300 at 20dpo, I should have been 6w6d. I know it doesn’t seem THAT terribly far off, but its far enough off that there should have been a visible heartbeat.

Yes, my OB did the ultrasound. I switched to her at 20 weeks pregnant with Birdie, so I didn’t have any ultrasounds with her directly before. My RE did the 6 week and 8 week early ultrasounds with Birdie, and their ultrasound machine is awesome and the RE himself did the scan and had no problem finding the heartbeat at just 6 weeks. My OB did transabdominal first and saw the sac but not very clearly, so she switched to transvaginal, and she was very apologetic and not very aggressive with the wand (which on one hand was nice but on the other hand maybe that is why she had trouble?)

Obviously I’ve had dozens of transvaginal ultrasounds and I feel like I know what my uterus and ovaries look like. Nobody has ever had a problem with finding them before. She kept finding my right ovary, which had the big corpus luteum cyst on it. Then she found the left one, and then the uterus. I could definitely see the sac, but it took a while for her to be able to move the wand such to get a clear picture of the fetal pole or yolk sac. It was very blurry. She finally froze the screen and took a measurement. She said she thought she saw a flickering, but it was too small to take a measurement.

I am really really hoping that it is just the limitations of her skills or machine, but really, she should know how to do this, right?  I mean, I wouldn’t expect her to be super skilled like my RE who uses ultrasounds to do egg retrievals, but I am assuming she does this fairly regularly…. Could my uterus be tilted now after the pregnancy and c-section with Birdie, and could that be making it difficult to see clearly? I feel like I am going crazy and grasping for anything that might give me hope.

It was all I could do not to call yesterday and today and beg for a scan early. But then, I realized I don’t want to have another inconclusive scan and have to worry and wait more. Plus, S is gone for work over the weekend and I don’t want to find out bad news and then be alone and have to figure out what to do.

Maybe I will see the heartbeat just fine Monday morning. Or maybe I will be devastated and have to wait to miscarry or decide to have a d&c. S doesn’t get back until Tuesday, and it is a holiday week, so I have no idea how that would work. Or would they wait another week just to make sure it hasn’t grown? Have any of you had to have a d&c for a missed miscarriage? What was it like? How much pain was there?

I thought about calling my old RE’s office and begging them for an ultrasound, but they are no longer covered at all by my insurance, and I don’t even know if they would see me without a referral after this long (2.5 years since graduating with Birdie’s pregnancy). I thought about saying I’m spotting and cramping and trying to get an ultrasound somewhere else, but I’m not spotting or cramping, and I don’t want to say that I am if I’m not.

I am so nauseous still. And ravenous. And exhausted. It really sucks to feel so shitty and be almost convinced that this pregnancy is nonviable.

At the same time, this was a bonus pregnancy, a surprise – a very happy but unexpected surprise. I am already so emotionally invested in this baby though, and I can’t just tell myself oh it won’t be a big deal if this doesn’t work out. It will really suck. But, we do have Birdie, and I feel far less desperate for this to work out than before we had her. She has been so sweet and funny and adorable, especially since we found out, and I know that if it doesn’t work out, I have to pull it together to be there for her.

I have been so torn all week between preparing for the worst and not giving up on this baby. I kind of came to the conclusion that I can wallow in misery for this entire week and then be even more miserable if it is bad news, or I can keep some hope alive and not give up on this baby. Either way, bad news will be awful, but right now, I am still pregnant. I want to try to savor every day that I am still pregnant, regardless of if and how it ends. I bought a little newborn outfit the other day. I keep talking to the baby, willing it to grow strong and perfectly.  There is nothing else I can do. It is completely out of my control.

Now, it wss my ob and not a highly trained ultrasound tech. Their machine didnt look totally shitty but it also was not the nicest i have seen. Could it be still viable? A very small maybe. The doctor doesnt seem terribly worried but i dont think she gets how sure i am of dates. She did have some trouble finding my uterus at all, so perhaps she isnt super skilled at very early ultrasounds or maybe my uterus is tipped and it made it difficult to measure. I will have another ultrasound next monday.

I should have known better than to think this could be true.

Edited to add: sorry, i should have been more clear. We did see a fetal pole (she did not call it as such) and measured crl as about 5mm. So it not a completely empty sac, for what that is worth.

And I think I have some appropriately big news.

I am pregnant.

I have been visiting my family with Birdie for the past ten days. When we first got here, I was not feeling so good. I chalked it up to something I ate at first, then thought maybe I caught something on the plane. After observing me complain about several days of nauseousness, and seeing me turn green from the farm smells at the pumpkin patch we visited, my aunt said “Maybe you are pregnant.” I laughed at her. I told her that would be extremely unlikely.

A few days later I was still feeling pukey, so I broke down and bought a test, fully expecting it to be negative. I was shocked to see two lines pop up immediately, the test line super dark.

I called my doctor’s office and arranged to get a beta drawn at the only lab within 30 minutes, at the small hospital where I was born. The first beta was 1382. The second beta was 3100. Progesterone is 30. I am 5 weeks along, apparently.

I don’t know how this happened. Well, I know how this happenens for normal people. But S has 3% morphology. I am still breastfeeding Birdie, only once a day at bedtime, but still. My cycles are still pcos irregular. And the funny thing is, S had a month full of travel. He was home for like 6 days out of the last 30. I was not keeping track of anything, but I think we only had sex like twice this entire month. He came home from one trip with a cold, then went on another trip, then we were all healthy for maybe three days and then I came down with a sore throat and felt like crap, then he left for another trip, and we left to visit my family a week later. I must have ovulated during that 3 day window.

You may be wondering how S is taking this new development, since we have been in disagreement about trying for a second baby, as discussed in recent posts. He was in shock at first. We both were. Hell, I still am. He is taking it far better than I expected. He said that one of his major objections to having a second kid was all the drama of the year of fertility treatments, the way the hormones made me crazy, the worry, the mood swings, the crying, and the financial toll of paying for treatments entirely out of pocket. Bypassing that drama makes it not as stressful to him.

The next day he was a little more freaking out, worrying about how we would handle an infant, the lack of sleep, the logistics. The day after that, he was in a much better space. He told his parents, and I think think their excitement and joy was contagious. It has been difficult, being only able to talk on the phone and skype, and having a three hour time difference. He misses Birdie and I so much, and we miss him terribly too. By the time we get home, he will have not seen us for 25 days. I think we appreciate each other more and cannot wait to be all together again in just a few more days.

Of course, this could all end at any time. The numbers are encouraging, but I want to see a heartbeat. I have an ultrasound scheduled for November 14th, which seems so far away. It is weird not being under the close monitoring of an RE.

I cannot believe this happened this way. I am incredibly thankful and realize how special this surprise bfp is.