In the second trimester!

Words I can't imagine saying, actually. I did go for today's ultrasound, and I spent like 5 minutes shaking after I saw that everything still looked fine. Then came the bit where I spontaneously burst into tears.I eventually calmed down, but still sounded like I was on speed every time I opened my mouth to ask the doctor a question, which was, as you would imagine, a lot of times.

As of now, everything is fine. The baby measured fine, and the heart rate with 158, which was a good number. The nuchal translucency was an extremely reassuring 1.2 mm, with no heart-linked issues spotted at this point. I really like this fetal medicine specialist (she is definitely going to be getting an awesome review from me; I'm a big believer in acknowledging medical excellence). She was very kind, calm (great bedside manner) and very well read...It is super nice when I start sprouting stats that people actually connect the dots in a logical manner because they have seen those studies too and have evaluated them objectively.

We drew blood for the dual markers, and I should have those results in 4 days.

I rhetorically asked: there is no non-invasive fetal DNA testing in India yet, right? You could have knocked me down with a feather when she said that there is.

There are 2 options: BGI, a Chinese company that uses the same technology as Sequenom (massively parallel sequencing). They are already operational, but their website was not too informative, and the one study they had published  was on very small sample subsets. Update: more digging has revealed that thier test (NIFTY/iGeneScreen) has been fairly well validated. I'm confused as to whether it also tests for Turners/klienfelters syndromes. If it does, I need look no further.

Natera (they test Turners and the 3 trisomies) uses an SNP-based analysis, and their Panorama test has been extensively scrutinized, but is not YET available in India..it may be here soon.

Both would just collect blood here and ship back to the home labs, which is fine by me. I prefer Natera, will wait and watch for a bit.

But as of now, all is okay(!!). Lets hope that the blood tests bring good news in 4 days.

I have a baby with arms and legs and hands and feet and a beautifully delineated spine, and a heart with chambers. I cant believe that is actually happening.  

where things are at

Tomorrow marks the 12-week point, which is when the surrogate goes to the OB as per this package I've signed up for.I checked out the OB online; it looks like regular patients score the doctor herself, while surrogates are seen by assistants, unless there is something irregular.

Le sigh. I'm so not loving the prenatal deal that came with the surrogacy package, but I'm learning to work around it without a blood vessel in my brain popping. When this is over, I'll be providing a full picture of surrogacy in Mumbai: how the recruitment occurs, how much is paid, how much the surrogate gets, where the money goes, what is done, all that jazz.

There was supposed to have been an ultrasound tomorrow (does not sound like it is the NT scan) but just the first visit with the OB, or rather, as I found out today, one of her many assistants. I was kinda geared up for it, and I just found out today that it can't happen tomorrow. Bummer.

I did find a good prenatal testing center, which comes with its own fetal medicine specialists. So this Saturday, J goes in for the NT scan there, and I'll go with her, with my mom in tow.  My lovely, lovely friend M, who came down from Philly to New York to hold my hand during that ill-fated final ultrasound in my last pregnancy warned me to take my mom with me as she is my good luck charm.

Most people, if they had gotten to this point, would be talking about this baby like it were a done deal.
In my first pregnancy, I was like that.

Now, I sat and debated with my mom what would be the next step in this pregnancy fails. But my tough attitude is wearing at the edges.I always act like everything is just a stumble, and nothing can make me truly fall, like everything can be overcome, and life can return to an even keel, no matter what happens. I've learnt to be that way in the past 3 years, and it has been invaluable.

But if this fails, I will fall, atleast for a little bit. I'm getting attached to my little one, and to hope.

Looking good!

I'm really, really glad my mother went for this ultrasound, because she did get to see her grandchild. And he/she was doing well well. I'm really scared to say this...but as of now, there is no cause for worry.

Here are the stats: Has grown very rapidly, and measuring ahead (10w6d at 10w3d) with a pretty normal heart rate of 167 (in normal pregnancies,the heart rate increases from 5 weeks to 9 weeks, normally peaking at 180, and after, you usually see a decline in the heart rate.This does not occur in Trisomy 21 pregnancies, which is why a high heart rate after 10 weeks is associated with this condition.Well, here the normal decline occurred, so YAY.

I almost don't want to put this image up, because we are a species haunted by superstition...the last time I completely relaxed at an ultrasound (8w1d; almost picture perfect), things had ended 4 days later, out of the bloody blue. I'm also scared to provide a nickname to this baby...one popped into my head the minute I saw this picture. I'm afraid to put up his picture (yes, I assigned gender in my head). All of this is based on past experiences...I did all of these things and those pregnancies ended: yes, I am quite ridiculously superstitious.

I'm not scared of hoping though, even if it gets to be only for a little bit. I may actually try to screw up the courage to go for the next ultrasound, which would involve the NT scan. Today, I'm happy. Lets hope I get to stay this way.

The balance between optimism and pessimism

Thank you all for your comments and your support and just coming here and reading, it means a lot to me.

Gwinnie, thank you for sharing what you did---I'm so glad you got your happy ending, and I'm also sorry that you had to go through that fear. Its difficult to say what the right way to handle things is...I've seen stories of women clinging to hope when you kind of looked at all the writing on the wall and you knew things were done. Personally, I've gone the opposite direction, I've seen the faint scribbles and partial markings on the wall, and jumped to conclusions. Unfortunately, until now, with pregnancies 1 and 3, those conclusions turned out to be the correct ones.

Yet, I know, both approaches (clinging to hope vs. jumping to conclusions) have flaws, and unfortunately, we will never be able to find the perfect middle ground.

According to my parents, the best middle ground is to not think about it at all, and surprisingly, I do manage to accomplish that (around 80% of the way), most days other the ultrasound day, and the day before/after.  

But the days of the ultrasounds? That is when I am pretty much reduced to a gibbering mess,
Tiara asked me whether I felt optimistic, when I met her, and I told her that most days I'm neither optimistic nor pessimistic. Not on these days though...here the darker emotions rule.

Its around 10w3d, and J goes in for her next U/S today, around now. I agonized as to whether I should go along or not. In the end I decided not to. I have pregnancy PTSD, more specifically, ultrasound PTSD. I don't want to go there and see a heart that beats no more, never again. My mom (my amazing mom) has gone in my stead...let us hope she gets to see her grandchild alive and doing okay.

The utter suckiness of ultrasound days

Thank you all for chiming in. The day of the ultrasound is always incredibly stressful for me, and no matter what, I'm always shook up that day. I spent Saturday evening crying, and my father told me that I needed to not get so emotional during this process. I told him that I'm only emotional in fits and bursts, and that I would be fine on Monday. Turns out, that was true. I'm fine today, and I will continue to be so till  the next scan in 2 weeks, at which point I'll turn into a wreck again, unless things look picture perfect, and they never probably will.

There is no telling what will happen now. The lag in growth IS a bad sign. Does it mean 100%  that it will translate in miscarriage? No,  but it sure does raise the odds.

Then again, as somebody commented, miscarriages can come out of the blue. Pregnancy # 2 grew at just over 1 mm per day, and had a pretty normal seeming hearbeat (150 at 8w1d), and everything stopped 5 days later.

Btw, here is an interesting fact: while there can be a larger variability in measuring the sac, inter operator variability in measuring CRL is much lower: one interesting study noted that one person measured 6 mm, a second person would measure between 5.4 and 6.7 mm, a +/- error of less than 1 mm. So no matter who is measuring, I'm behind.  
 

Reproduced from http://onlinelibrary.wiley.com/doi/10.1002/uog.10075/full#tbl3

Right now, I'd give myself a 50-50 chance of making it. I found this very interesting study from England. They got a batch of patients who looked like they may miscarry in the early ultrasounds, and took 2
ultrasound readings in the first trimester, and looked at what cutoff of CRL growth predicted miscarriage most accurately. Note that normal growth in most viable pregnancies is about 1 mm per day.

All the pregnancies shown in blue made it, while the ones shown in red did not. Based on this, the authors concluded that if CRL increased at less than 0.2 mm  per day, you had no chance. If the increase was 0.4 mm per day, you had a pretty high frequency of loss, but some did make it. Note that the authors only observed them till 11-12 weeks; some of these may have been the viable trisomy category (which is the absolute worst case scenario). At around 0.7 mm growth per day, things seem split down the middle, and that is where I stand. My chances are definitely lowered, but things may turn out to be okay.

And very importantly, today, I am okay. And I'll be okay no matter how things pan out here.

Not looking good

There was a heartbeat, nice and strong, at 178.  There has been growth too, up from 2 mm the last time to 15 mm today. The problem is, at the last ultrasound at 5w6d, it was measuring 5w6d.  Today, at 8w3d, the embryo is measuring 3-4 days behind, at 15 mm (16 mm is supposed to be the normal 8 week CRL).
Normal growth everyday is supposed be 1 mm. This baby is growing at 0.7 mm every day, which is exactly the value I calculated in my first pregnancy. I then had freaked out, everybody pooh-poohed me, and then my mom left, and I discovered my first miscarriage 5 weeks later, which just made it all so much worse.

When the doctor at RMA NJ was asking about my pregnancies, he specifically asked me whether there had been a slowing of growth between 2 ultrasounds (measuring on target at one point, and then behind the next).

According to the conversation I had with him, and reading the accounts of many many women freaking out, it is fine if you are consistently behind (For example, if you measure 6 weeks when you are supposed to be 7, but at the next ultrasound, the lag remains the same and does not increase). But if your growth lag increases with every passing week, then that pregnancy is *probably* on its way out.  This is borne out by both what the RMA-NJ doctor said they observe frequently, this study, anecdotal accounts on the internet,  and what I observed in my first pregnancy.

However, the other thing is that J has been barely eating, because her nausea is so bad. I'm hoping the slower growth is due to poorer nutrition;while that is far from ideal, many women who starve through the first trimester go ahead with no issues. She is also having dizzy spells, which make me wonder how her iron levels are. My RE advised against iron supplementation right now because it makes the nausea worse, but I wonder how anemic she is at this point, especially if she is feeling dizzy. I don't know if poorer nutrition retards growth, or rather, how poor the nutrition has to be to achieve this. She is atleast taking folic acid (and some vitamin D), but nothing else. I had a really long conversation with her about nutrition today, and her options.  We'll see how much good it does.

I've almost resigned myself to the fact that this one may end. If it does not, it will be a very pleasant surprise. My parents talked me out of testing again in one week, because if the lag has only increased but the heartbeat is still there, that just creates more stress. But, on the flip side, if the heartbeat stops soon, I don't want to wait weeks to discover that, for multiple reasons. As a compromise, we agreed to retest in 2 weeks.

What a good place to be in, again. I don't want to be the one freaking out. But I've seen warning signs in each pregnancy (except my second, which looked close to perfect till it was over) and when I talked about them, everybody told me to stop drawing conclusions on insufficient information and stop worrying for "no good reason." Unfortunately, I was right then. I'd really, really like to be proven to be completely wrong in this instance.

All the goodwill in the world

A fellow blogger Paige lost her first baby to pPROM in 2010. I just found out she lost her twin boys, possibly to incompetent cervix. I found out about Paige's pregnancy a few weeks ago, and I was hoping so badly for a happy ending for her, and everybody wanted things to go well for her, so very much. All the goodwill in the world---we feel like it should be a powerful thing, and yet it is but a leaf in the wind that proves utterly ineffective all the time. Who has the power? Who decides these things? Is it the most likely possibility decided by "n" number of biological variables working with or against each other, unaffected  by outside influence? Or is it the universe's will?

My mother keeps telling me that no matter what I do, I have to have the sanction of destiny for it to work out. Maybe, maybe not.  Its a question that my brain keeps circling around, and will continue to circle forever.

I'm heartsick because of Paige. This is her blog: I request you all not to go there to silently watch, but only go if you want to truly commiserate.  

I'm sorry I've been silent about my situation: the ultrasound was delayed this week because my RE's receptionist did not book an appointment well enough before hand and could not get a slot. It will happen hopefully tomorrow. J would be about 8w4d along. Don't know what I will find...mostly comfortably numb, except for moments of that familiar heart-in-your-throat panic when I actually think about it. If the baby is still fine, this would be the furthest any pregnancy of mine has come. I know there is a lot of goodwill coming my way too. I wish something like that could have been the deciding factor, instead of an unseen, incomprehensible power running the show.