The Perils of Pregnancy after Infertility and Miscarriage – From HPT to Anatomy Scan (Part 2)

My miscarriage anxieties began as soon as that second line appeared on the home pregnancy test that first day of our Hawaii trip. We were visiting my family and planning to cross the Kalalau trail off our bucket list. Our hike on the Na Pali coast of Kauai could have been a great analogy for pregnancy, but we actually never made it down to the paradise valley.

We settled at the halfway point for the night. The mosquitoes and mugginess made me cranky, and I freaked out that Sean wasn’t certain that his water purification kit effectively filtered out leptospirosis now that I was pregnant. Long story short, we proceeded to hike with our damp, and therefore heavier, packs on the now muddy trail the next morning. Looking ahead, we saw a narrow path no more than a foot wide above sheer cliffs and crashing waves.

Kalalau

After commenting that it was practically a goat trail, we literally watched a family of three wild goats cross that particular stretch. Sean considered what laid ahead along with my un-advanced hiking skills and paralyzing fear of heights and made the call to turn around.

I felt defeated. So many people before us have made it past that point to enjoy the fruits of the valley. (There are also accounts of people that have died trying to get there.) What if our failure was a foreshadowing of how our pregnancy would go? I fearfully thought. Unlike “normal” people, my anxieties of miscarriage didn’t subside after the first trimester marker; I didn’t really relax until we made it past the halfway point (~20 weeks).

Mile Markers and Challenges to the Halfway Point of Pregnancy:

The First Ultrasound

Everyone seems to think ultrasounds are all fun and games because they get to see their blob. If you’ve been through infertility and miscarriage like me, though, there’s a stark contrast. My very first ultrasound was traumatizing. As my new Ob/Gyn went through my medical history during our first appointment, she asked about previous pregnancies. “I had a miscarriage October 2013…  There was [a sac and fetal pole but] no heartbeat. I was maybe 6-7 weeks along… Genetic testing from my D&C showed a double chromosomal abnormality…monosomy X and trisomy something.” Tears started streaming down my face. The young observing resident looked at me with sympathy. My doctor decided to move on quickly to the ultrasound and assured me we will hear a heartbeat this time. Sean held my hand as we waited for the verdict. In that bated moment, I looked up at the ceiling and prayed that there was a heartbeat. “See?” my doctor said, as she showed us our blob with a flickering heart and let us listen to the loud, oh-so-mesmerizing choo-choo train sound of its heartbeat.

Symptoms Do Come and Go

Telling a pregnant woman who’s been through infertility and miscarriage to “just enjoy” their pregnancy is like trying to convince an abused woman that “love isn’t supposed to hurt.” Despite the unpleasantness of morning sickness, I wanted more. There were days I was blessed with the comfort of being nauseous and others during which symptoms waned, and I didn’t feel pregnant anymore. Sure, I had early pregnancy bloat and felt fat, but that’s just not as comforting as having to puke at least a few times a day. For me, the symptoms (sore boobs, morning sickness, abdominal bloating, heartburn, and fatigue) all came and went for days at a time and started to subside before 10 weeks. I know that symptoms can continue during a missed miscarriage, but waning symptoms do not mean you should worry more.

MaterniT21 Test

This test was offered to me because I’m over 35 years old, or of “advanced maternal age.” You can get this test when you are at least 10 weeks along, but my doctor wanted me to wait until 11 weeks just to make sure I was far enough along. I was told that my results would be available in 5-7 days; we waited and fretted for 2 weeks. I didn’t want to call because I was afraid of bad news. Finally, Sean called the doctor’s office and gave me good news. (Apparently, my doctor’s office only calls if there is an issue. It would have been nice to know that before waiting so excruciating long!) I was relieved and elated. I wanted to tell all my patients that day that I was pregnant. Note: Although the risk of having a Down Syndrome baby goes up after age 35, the statistical chance of not having one is 99.75%. The odds sound a lot better when reported as a percentage versus a risk ratio.

Listeria Hysteria

Considering how hard it was to get to this point, I surely didn’t want to risk my baby’s life for mere moments of gourmet enjoyment. I had been careful about lunch meats and smoked salmon all along, but then wondered whether I could eat chicken pate I made myself. While looking that up, I found that listeriosis can be found in homemade refrigerator pickles! I had eaten a few already without knowing and proceeded to freak out for a week or two about listeria. After reading this woman’s story, though, I realized that I could only do so much to lower the risks; the rest is up to the Universe.

The Anatomy Scan

We got our anatomy scan at 18 weeks. Our blob now looks like a baby! or at least an alien baby. Despite getting a negative MaterniT21 test, I was still worried that our baby may show markers or have a congenital defect. Our ultrasound tech made the appointment fun and enjoyable with her commentary, showing us our baby wiggling, waving with one arm above its head, and making an alien face. I saw a bright spot in the heart and knew from my obsessive researching that that could be a marker for Down Syndrome, but she didn’t say anything about it at the time. I decided to put my questions about the kidneys and other systems aside and enjoy the show. It was very emotional for both of us; I loved seeing Sean so excited about our baby. When the tech was done, she told us that everything looked good except she did note that one bright spot I saw. She explained that it was an echogenic intracardiac focus and does not indicate any type of functional defect, but that it is a soft marker for Down Syndrome. She also told us that it is very common in Asians, that up to 15% have that marker. We opted out of investigating further with an amniocentesis because (1) that procedure has a miscarriage risk of 0.5-1% plus we already had a negative MaterniT21 test and (2) it didn’t make much difference to us at this point.

When we got home, I admit I still did some research on echogenic intracardiac focus as a single soft marker, but then put any lingering fears aside. I’m loving my growing bump (now obvious) and body. And at about 19 weeks, Sean and I both felt the baby kick. I’m still aware that something could go wrong, but we’ve made it past the halfway point and are in good shape to have a healthy baby at the end of this adventure.

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