After the Sadness

It’s tough to know in advance how you’ll respond to these things. You’re always in uncharted territory, even if the territory has been trodden by countless others. You can read all the books and blogs you want, but when you’re in the forest, you’re in the forest. The map is never the territory.

As a wise friend of mine said, grief has its own half-life. It also has its own process. Denial had worked for me in the past, so for a while I hoped for a miracle. But when that didn’t work, there was no Anger or Bargaining. Just waves of sadness and frustration. Then we were able to accept that this is the road we’re on. It didn’t quite take the turn we had hoped for. But life is still very good.

I’m not saying this loss is easy. It never is, especially when you’ve invested six months and many thousands of dollars into the outcome. We had just begun planning an exciting year only to find the most exciting part retreating into the mist, and we have no idea when or if we’ll ever find it again. Another month? Another year? Another life?

Still, losing embryos at 5 1/2 weeks isn’t in the same ballpark of grief many couples have gone through. I read about one woman who conceived twins after five years of trying only to lose them at 20 weeks to a prematurely dilated cervix. (I refuse to use the grossly judgmental term ‘incompetent cervix.’) Another woman’s seemingly healthier twin passed away shortly before birth, and the other little girl died after spending sixteen months in the hospital. I’ve never been in either of those forests, and I hope to God I never find myself in them. (Thankfully both women went on to survive the grief and have healthy children.)

I’m also glad I’d done my research and knew miscarriages weren’t anything particularly rare or exceptional. I was well aware pregnancy was always a hope, never a guarantee. A lot of women are totally blindsided since it’s talked about so rarely.

We were able to send tissue for analysis, and a few days ago we got the news that Nymeria was a chromosomally healthy boy. It’s tough news in two ways. One, in another quantum iteration, he could actually have become a child. Two, it gives us no easy answer about why the pregnancy failed. But it’s also reassuring in a way. It’s our first confirmed genetically normal embryo. We can make ‘em! Now we just have to make one stick.

Nymeria’s namesake is a female dire wolf, so I was thinking about retroactively changing the embryo’s nickname. Conveniently, there is one more living male dire wolf on Game of Thrones. Unfortunately its name is Shaggydog and, well, no. I asked Ahmed what we should call him, and he said Nymeria was a fine name for a boy embryo, too. So now it’s a male Nymeria I imagine running among the clouds.

His gestational sac grew just fine, and that’s what gave us the positive pregnancy tests. But the embryo stopped developing early on for some reason. It’s a condition known as a “blighted ovum,” though it should more accurately be called a blighted embryo. It happens in up to 10% of pregnancies, but in most cases—about two-thirds—the embryo is chromosomally abnormal.

No one knows why it happens to genetically normal embryos. The official diagnosis seems to be “bad luck,” though there may be causative factors, such as our horribly stressful trip home, the subchorionic hematoma our Tulsa doctor found, or my thyroid hormones getting way out of whack. My TSH should have been below 2.5, and it stayed reasonably close to that in Turkey, but it somehow got all the way up to 6.2 by the 18th day of gestation. It had never been that high before.

I was never told that the elevated estrogen during pregnancy can wreak havoc with your thyroid levels, or that the effect is even more pronounced during IVF or a frozen embryo transfer because estrogen levels are inflated even higher. I also wasn’t told that the embryo in the first trimester depends entirely on the mother for its thyroid hormone supply, so if the mother’s levels aren’t sufficient, it can cause serious problems. I had to find all that out by doing my own research, and it was too late by the time I understood the situation.

The elevated TSH might also have been the reason I felt so “down” after getting back from Turkey, over and above the normal pregnancy tiredness and travel stress.

As for the second gestational sac (Summer), it was most likely chromosomally abnormal and simply reabsorbed, a phenomenon called “vanishing twin syndrome.”

So yeah—that’s two pieces of bad luck. The good news is, if it happens once, it’s not any more likely to happen again unless I do have some kind of autoimmune or blood clotting issue or a polyp or something. My uterus was tested earlier this year for anomalies, and none were found, but polyps can be missed, and they can grow quickly. It’ll be heartbreaking if we lost a potential kid for something as common and easy to treat as a polyp.

Part of me doesn’t want to be too sentimental about the loss of a particular embryo. After all, there are effectively, if not literally, an infinite number of biological children Ahmed and I could have. (Even identical twins growing in the same gestational sac are two different people.) We lost one of those possibilities (before he even really got started), but that leaves infinitely many more, and we only plan on having two or so (God willing). Who’s to say which two should get that vanishingly rare chance?

But another part of me wonders what that particular boy growing at that particular time would have been like. I can only picture a mini-Ahmed but maybe with a few of my features: lighter hair, attached earlobes, asking endless questions and driving people crazy. I hope he has a good life in that other quantum iteration.

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