My Infertility Journey, Part Three: 2021-2022

So far, this is probably the hardest post I've endeavored to write. My feelings are still very fresh as I reflect on the loss of my Baby Strawberry earlier this year. However, this is the part of my journey that led me to create "Confessions of a Pineapple," this is my confession of what it has been like to experience a miscarriage after infertility and ectopic pregnancy.

A 2,000-mile journey across the United States of Ameria

Time to TTC Again?

Part Three of my infertility journey begins right after part two, which I shared last month. I followed my California doctor's advice to see an OBGYN soon after our move across the United States. I wanted to ensure my body was healing correctly after my laparoscopic surgery in preparation for TTC again. At this point, I also wanted to pursue my previous suspicions of having PCOS.

At my first appointment with Dr. R, a local OB-GYN, she reviewed my medical records and scheduled me to have a hysterosalpingogram. A hysterosalpingogram is a special x-ray where they place a special dye into the uterine cavity to ensure the uterus and fallopian tubes are not blocked and are a normal shape. This test revealed that everything looked normal, and my HCG levels had returned to zero, so we were cleared to start TTC in March of 2021.

A Diagnosis for PCOS

While at this first appointment, I also brought up my suspicions of having PCOS. When I explained my plague of facial hair as a teenager to current, she asked me to lower my COVID mask so she could observe. Preparing for this, I let my facial hair grow out. Dr. R jumped back in surprise at how much hair I had growing on my neck, chin, and upper lip. She also considered my irregular cycles, which according to the Rotterdam Criteria, in combination with facial hair, can be sufficient for a diagnosis. However, Dr. R. also wanted to do bloodwork and an ultrasound to confirm our suspicions. Both results revealed that I indeed had PCOS.

With this knowledge, I decided to prepare to see a fertility specialist. My reason for this was multifold. One was that we now had fertility insurance through my husband's new job. Second, I was exhausted from cycle tracking, only to go through a loss. Third, I wanted an expert to help us grow our family because we want several more kids.

At this point, I was desperate to be pregnant but terrified of having a repeat ectopic pregnancy.

The Fertility Specialist

It took several months to get everything sorted to see the fertility specialist. I had to coordinate every step with the fertility insurance. The fertility clinic immediately requested all my medical records and health history before scheduling an appointment. Then once they had everything, they were scheduled for about a month. My first appointment was mid-may.

Once I got to the appointment, Dr. M brought me into an office where I sat across from his desk. Harlen could not attend this appointment, but Dr. M took the time to inquire about our family goals and lifestyle. Then he walked through all my previous health history and test results. Since Harlen had gotten me pregnant twice, he likely had normal sperm. Still, we may consider getting a semen analysis to ensure everything was within normal parameters. Essentially he said we had eggs, sperm, and a uterus, all the things required to make a baby. The options on how to proceed would depend on how rigorous we wanted to be with our treatment. He believed we would probably succeed with Clomid since it had worked for conceiving Hazel. He also said Letrozole was an option and that most people had fewer side effects than Clomid, with similar results statically for conception. If we wanted to go more rigorous, we could pursue IUI or IVF. Ultimately he gave me the knowledge and options so that we could pick what we felt was right for our family goals.

On the day of that appointment, I was on menstrual cycle day 50, which was one of my longer cycles. Before I left the first consultation, Dr. M did some more bloodwork and ultrasound to confirm Dr. R's diagnosis of my PCOS. I decided I wanted to try Letrozole, so Dr. M called in the prescription for me to start on day 3 of my next cycle. I felt so confident that I would be pregnant within the next three months. I've organized the following treatment protocols to help outline our timeline. However, most of them will feel like Deja Vu, and for me, as I went through them, they felt that way!

Cycle 1 - Letrozole Round 1

About a week after my fertility clinic appointment, I started a new cycle and took Letrozole for five days, starting on day 3 or 4 of my cycle. Thankfully, I didn't have the side effects that I had with Clomid, and I got a positive ovulation test on cycle day 18 with my OPK, and the bloodwork at the fertility clinic showed that I had ovulated. However, my pregnancy test two weeks later was negative, followed by the start of a new cycle.

Cycle 2 - Letrozole Round 2

The protocol for Letrozole round 2 was the same. On cycle day 16, I had a positive ovulation test with my OPK. Again my pregnancy test two weeks later was negative, followed by the start of a new cycle.

Cycle 3 - Natural Cycle

We had planned to continue the same protocol. However, there were some complications with my insurance, so I could not get my prescription filled. I was very disappointed, but we still tracked with OPK's. Since my cycle was so long, it took two kits, but I never got a positive ovulation test. After 41 days, my next cycle began.

Cycle 4 - Letrozole Round 3

We got everything sorted out with the insurance company, so I could get my prescription filled, and I continued the same protocol as the first two rounds of Letrozole. I had a positive ovulation test on cycle day 15. Which again resulted in a negative pregnancy test followed by the start of a new cycle. I was getting pretty angry with God. I felt I was doing everything I could and had been taught He would do the rest. Long story short, I didn't much feel like praying anymore.

At this point, I reconvened with Dr. M. I was so frustrated that I wasn't pregnant that I was ready to proceed with IVF. Dr. M gave me a folder about the IVF process and costs. He said that they were currently scheduled out for three months. Harlen also did a Semen Analysis around this time, which returned normal. Given that we seemed to be ovulating, correcting for the PCOS, and everything else seemed in normal parameters, Dr. M said we were heading into the unexplained infertility zone.

Cycle 5 - Letrozole Round 4

Around this time, Harlen was frustrated with his current work situation and wanted to change jobs. However, I didn't want him to change jobs because our fertility insurance would cover IVF costs. We determined to try a few more cycles with Letrozole and prepare to save up for IVF out of pocket in case he changed jobs.

So I followed the same protocol as the previous rounds of Letrozole, desperately hoping for this cycle to be the one. I had a positive ovulation test on cycle day 17, with a negative pregnancy test two weeks later, and started my next cycle.

Cycle 6 - Letrozole Round 5

At this point, I was feeling very defeated. I was pressing Harlen heavily to go ahead and get our first round of IVF scheduled. Around this time, Several companies interviewed Harlen. One company offered an incredible job opportunity to Harlen. I pressed him to ask if they had any fertility benefits. They didn't have fertility benefits; however, they offered increased pay to compensate. Harlen and I decided that taking the job was the best option for our long-term goals despite losing the fertility benefits. I was feeling pretty low about losing our Baby Jellybean and taking so long to get pregnant again. That month Harlen insisted that we have a special fast together, asking God to send us a miracle. We did it together, but my faith was just as low as my hope.

My protocol for Letrozole remained unchanged. I thought I would cry if I had to pee on another OPK test stick. Honestly, I didn't even use an OPK because of burnout. My hopes were so low that I didn't take a pregnancy test for a while. I waited longer than required. When I finally took the pregnancy test, two lines indicated a positive pregnancy test. I was excited but also scared to find out if it was ectopic.

Pregnancy Location and Dating Ultrasounds

Both Harlen and I were ecstatic but also cautious. I called the fertility clinic to schedule an ultrasound for dating since I didn't know when I ovulated and to verify the location of the pregnancy. Those who have a history of ectopic pregnancy are at increased risk of having a repeat ectopic pregnancy.

My first ultrasound was on December 16th, which confirmed that the baby was safely in my uterus and measured at five weeks and four days gestational age. My doctor wanted to have me do one more ultrasound the following week so we could hear the heartbeat. During the second ultrasound, I heard baby Strawberry's beating heart, and the baby measured at six weeks and three days. Since everything looked normal, I "graduated" and was told to schedule my first prenatal appointment with my OB-GYN.

Christmas Announcement

Since everything looked normal, I decided to make a Christmas-themed baby announcement. I slipped copies of our ultrasound into baby socks, wrapped them up, and placed them in my in-law's stockings on Christmas morning. After opening presents, we called my parents to tell them the news. And I posted the following on my social media:

Most importantly, we told our three-year-old daughter. I bought some Usborne books to help prepare siblings for the baby. We told her how big the baby was, using fruits each week of our pregnancy.

First Prenatal Appointment

At eight and half weeks, the baby was the size of a wild strawberry; I had my first prenatal appointment. My sister and her baby came to visit for a few weeks in January, coinciding with my first prenatal appointment. I asked her to watch our Hazel so Harlen could go with me.

Harlen and I sat in the waiting room talking about our future with our Baby Strawberry when we were called in for our ultrasound. We walked back with the sonographer. Moments after placing the probe on my belly, she said, "I'm so sorry, I'm not getting a heartbeat." after a pause, she shook her head and repeated, "I'm not getting a heartbeat." My heart stopped. The next few minutes were a blur. Harlen and I walked to the waiting area to see the doctor in shocked silence. Harlen stared at me with worry in his eyes, unsure of what to say. I was fighting back the tears, but they soon broke through.

I had never met Dr. P before this appointment. As we met, she expressed her condolences. She told us that given baby was measuring a week behind and had no detectable heartbeat, it was almost inevitable that I had a missed miscarriage. Essentially the baby had died, but my body hadn't recognized it yet. She said if we wanted, we could come back for a repeat ultrasound in a week to be sure.

She also gave us three options on how to proceed.

1. Expectant Management - This is where you labor at home and let your body complete the process naturally. She would give a prescription for pain medication as an aid.

2. Medicated Induction - Medication causes the uterus to contract and complete the process quickly.

3. Surgery - The last option was to have a D&C.

Given that I had previously heard a heartbeat and the baby measured behind, I knew chances were very slim, but I still wanted to do a repeat ultrasound and take some time to determine which option we would take.

Preparing my Support System

The drive home was a blur. I probably cried the whole time. Walking in the door, my sister saw my tears and knew something was wrong. As she hugged me, I whispered, "they couldn't find a heartbeat." I was thankful my sister was visiting because it was a much-needed distraction from my preoccupations.

I sent several texts to a few friends and family members asking for prayers. I knew that I couldn't get through this alone, so I needed to have friends and family close. The following week was a rollercoaster of wanting to hope for a miracle but knowing chances were low.

Repeat Ultrasound

Our follow-up ultrasound yielded the same results. I sat in the waiting room to see the doctor. Next to me were two pregnant friends openly talking about their pregnancies. Every word stung, and I wanted to jump up and yell at them to "shut up," for those who know me would have been very out of character. One of them was the exact gestational age my baby would have been. She talked about how easy it was for them to get pregnant the same month she quit birth control. They talked about infertility and pregnancy loss openly, but I don't think either knew what it is like to experience it. I know these strangers probably won't have said those things if they had any idea what I was going through, but it felt very personal somehow.

When I met with Dr. P, we discussed our options again. I didn't want surgery and wanted my body to take things when it was ready, so I opted for expectant management. I then picked up my prescription for Ibuprofen and bought super-sized pads in preparation.

Bleeding and Passing Tissue (not for the faint of heart)

The following Sunday, after we returned from Church, I started having mild cramps, so I took some pain medication. We went to my in-laws for dinner, and after dinner, I started having some hot flashes and more pain. I went home and set up the bathroom because I didn't know how long the process would take.

I finally started to have some bleeding, and I spent most of the time on the toilet. I figured it would be a while, so I turned on a hallmark movie, "Christmas in the Smokies." Ironically, the film takes place in Tennessee and is about saving a berry farm. The pain was not unlike labor contractions. I also decided to take some Tylenol. The blood clots gradually got larger, some the size of a golf ball. When the movie ended, I had a clot about the size of a lemon, which I determined was probably getting towards the end of the large ones. I went to bed because I was tired.

The bleeding continued like a heavy period for several days. I continued on Monday as best I could. I didn't want my daughter to worry too much. Since I had passed most of the tissue, I decided that I needed to update those on social media. Since I wrote a poem for Baby Jellybean, it felt appropriate to write one for Baby Strawberry.

My baby Strawberry,

News of your coming made our hearts merry,

The news that would follow was very scary.

In my arms, it's you I will never carry.

Hearing your beating heart,

was just the start,

Your growth was showing well on the chart,

Soon to follow from us, you did depart.

My silent fear,

Did yet appear

Your silent heartbeat, we strained to hear.

The silent sound still ringing in my ear.

Our dreams of no more silent nights,

Once filled us with delights.

Now you've gone to heavenly heights,

I pray that you will be with the angel lights.

While you are flying,

My heart is sighing,

I hear your silent crying

And Christ's Atonement, daily, I'm applying.

This time we have will help us grow.

With two above and three below,

It's tough; I know

But in Heaven again, we'll say "hello."

With time and prayer, our hearts will be healed.

I hold to knowing in the temple we are sealed.

To our covenants, we will hold,

God's plan we trust will unfold.

The same day that I posted to social media, I had a dear friend reach out to tell me that they were going through the same experience. I hope to have her share her story with us soon.

Recovery

After the weekend of passing tissue and blood, I had heavy bleeding for about a week. Then I had spotting/light bleeding for about another month. Physically I think I recovered pretty well. Dr. P had me come for an ultrasound to ensure all the tissue had passed. She wanted to have me wait for two cycles before TTC again, but there wasn't an apparent reason for this. Desperate to TTC again because of how long it's already been, I reached out to Dr. M, my fertility doctor, for a second opinion. He said that as long as my HCG reached 0, I could start as soon as my next cycle.

Emotionally my recovery took a bit longer. Going through two losses and infertility back to back left me pretty depressed. I have a prior history of depression. After prayer and discussions with my husband, I scheduled an appointment with my primary care physician to ask for antidepressants. My Dr. was very understanding and supportive and put me on Zoloft.

Little by little, I've improved. I decided to become an advocate for infertility and pregnancy loss and thus began this very blog. While I wish I was now nine months pregnant and heading to the hospital to deliver my baby, I have found a lot of peace and healing through writing.

As with Baby Jellybean, I'm planning to give Baby Strawberry a real name. I just haven't found the right ones yet.