Our Journey

2002 Uterine Fibroid Surgery #1

2003 1st consult with an RE, you know, just in case

2003 Got Married (at 37 (me) & 34 (DH) years old)

2003/2004 Naturally conceived pregnancies BFPs #1, #2, & #3 and miscarriages #1, #2, #3

2005 Uterine Fibroid Surgery #2

2005 IVF #1, BFN #1

2005 IUIs #1 and #2, just because, BFN #2 & #3

2005 FET from IVF #1, BFN #4

2006 Exploratory surgery to remove scar tissue from fibroid sugery #2

2006 IVF #2 (w PGD), BFP #4

2006 Emergency cerclage for IC @ 16w6d (5 months + 1 week of complete bed rest at home ensues)

2007 Our son is born @ 38w by scheduled c-section

2007 IVF #3 for baby #2, BFN #5

2007 IVF #4, BFP #5, miscarriage #4

2008 IVF #5, BFP #6, miscarriage #5

2008 IVF #6, BFP #7, miscarriage #6

2008 DE IVF #7, BFN #6

2009 DEFET #8, cancelled, embryos don't thaw

2010 Decide to adopt domestically

12.17.10 Profile is live with our agency

November 2011 Consult with RE re: donated embryo cycle

Early January 2012 Cleared to proceed with deFET

January 2012 Freeze our profile

1.20.12 deFET begins
2.12.12 eSET of one compacted morula
2.22.12 BFN

3.23.12 deFET #2 begins
4.14.12 transfer 3 embryos (1-8 cell, 1-5 cell, 1-4 cell)
4.22.12 + HPT
4.24.12 Beta #1 = 48.4
4.26.12 Beta #2 = 125.7
4.30.12 Beta #3 = 777.8
5.11.12 1st U/S - Singleton!
7.12.12 It's a Boy!
12.26.12 C-section: Baby G is born, 9#5oz, 20.5"

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Food for Thought

I met with one of the perinatologists who place cerclages at Kaiser.  I waited 1 hr and 10  minutes to see him and almost left, twice.  He had a ‘difficult case’ who went in ahead of me which caused the delay.  However, because the facility is far enough away from where I live (and somewhat difficult to get to), I really didn’t want to reschedule so I decided to wait.

He was younger than I expected, early forties maybe (which seems to be the Kaiser demographic), with a single hoop earring in one ear and well coiffed hair.  He had big hands, with big fingers and wide nail beds (I was fixated on the size of his well manicured mitts as they were in stark contrast to the small, delicate, sinewy hands and fingers of my prior OB who placed the cerclage during my pregnancy with my son.  I always believed that his small hands allowed him to get up there and pull down enough cervix to stitch).  After engaging with him for a bit, I could see how others found him arrogant or condescending.  I didn’t actually read him that way, I found him maybe to be cavalier with a tendency to over communicate his point almost on the assumption that the patient knew little or nothing about the subject at hand.

After measuring baby and listening to heart beat (he presumed it was my first time hearing it), we adjourned to his office to discuss his thinking/experience with cerclages.  I had been prepped by others that Kaiser is not pro-cerclage so I framed everything he said with that in mind (although I have already been approved to have one placed).  He asked detailed questions about all of my pregnancies, my myomectomies, my other cervical/uterine procedures, D&Cs, natural vs. IVF conceived pregnancies, and the progression of my pregnancy with my son.  He was honed in on the three first trimester bleeding episodes I had and that they included the passing of clots (this will become important when he later formulates his opinion of my cervical funneling and shortening).  He proclaimed more than once that I was an interesting case (story of my medical life).  He also commented that given the healthy progression of this pregnancy, that he would put my miscarriage rate for fetal abnormality at less than 3% at this point.

The condition of cervical shortening and/or funneling during pregnancy is no longer called incompetent cervix, (IC) (apparently cervixes united and gathered signatures on a petition to deem the term offensive) and is now called the more politically correct cervical insufficiency (CI).  And while it was long taught and a widely held belief that the cervical structure was incapable of supporting a pregnancy, it is now believed that true CI is more often a symptom of pre-term labor.  And, that other than having had a LEEP procedure which has been shown to literally weaken the cervical structure, most other intra-cervical procedures do not affect the cervix in that way.  It has been shown, though, that where first trimester bleeding is present, especially with clots, that that somehow sometimes causes second trimester cervical shortening and/or funneling.  And, that, if that is the cause of the shortening and/or funneling, that often times a cerclage is unnecessary.

To illustrate his point, he explained that if he traveled 1  1/2 inches up a cervix to place a cerclage and if that 1 1/2 inches then remained static over the course of the pregnancy, the cerclage was never engaged and therefore unnecessary.  On the contrary, if that 1 1/2 inches shortened to 1 inch (or less), that was proof that the cerclage was, in fact, holding things together (because without it, the cervix would have likely shortened all the way causing pre-term labor and/or loss).  He postulated that because my cervix remained 2cm post cerclage placement and throughout the duration of my pregnancy and that the funneling remained static, too, that I likely could have gone without the cerclage and the bed rest.  SNAP!  He made it clear that he was not questioning what we did or why just that in hindsight the fact that I made it to term with no post-cerclage change in the length of my cervix and without pre-term labor meant that the cerclage was never actually engaged to do its job.  SNAP!

He went on to recommend that a cerclage was probably unnecessary with this pregnancy and that we could begin weekly cervical surveillance at 15 weeks to monitor me closely but that I should have an uneventful pregnancy, could continue living my life, and that could include continuing to work out.  WHAT?  I explained that as rational, pragmatic, and informed as I am, I suffer from PTSD from my pregnancy with my son and that I could barely imagine a vertical pregnancy WITH a cerclage much less without.  I went on to tell him all that had been invested, emotionally and financially, in getting to this point and that there would be no other pregnancy and no other child if this one was unsuccessful.  He seemed to understand, if not fully appreciate, where I was coming from and did say that he understood that there was a psychological/emotional benefit to having a cerclage placed as insurance and if that was worth the discomfort of the procedure to me then he would have no problem placing it for me at at time of my choosing.  We discussed the risk of infection which he said was quite low as to be almost non-existent and that he wouldn’t let that dissuade me in the analysis of whether to place it.

He seemed to also be coming from the position that most patients want to avoid having a cerclage placed and he recounted many examples of women who came to see him with 2cm (or even 1cm) of cervix who, instead of having a cerclage, decided to take a wait and see approach and almost all of them went to term, walking around with a short cervix that never gave way (we did not discuss the cases that did not end well or why).  Again, he commented that I’m a unique case in that I am pro-cerclage (for obvious personal reasons).

It was an dynamic conversation with me peppering him with questions and him citing research and experience to back up his position, while never saying I couldn’t have one placed but seeming to want me not to place one and have it proven that I could have a normal pregnancy.

So much of what he said made sense and I understood maybe for the first time that maybe I don’t actually have CI but that the conditions present with my pregnancy with my son converged on my cervix in a way that made it look like I did.  I have had no bleeding with this pregnancy (KNOCK WOOD, universe) and gosh would it be nice not to undergo the emotional and physical stress of having a cerclage placed (the spinal block is of greater concern than the cerclage placement).  But here is the thing:  I do not think I am capable of living with this pregnancy without a cerclage.  I actually believe that I may not need one.  I actually believe that I could have a normal pregnancy.  But I just do not believe that I’m capable of attempting it.  I do not judge myself for feeling this way and haven’t made the final decision because I want to sit with this a bit longer and perhaps have another conversation with him and some of my other trusted medical advisers.

On my way out and perhaps as a final vote of confidence he said that he was excited to be part of the team caring for me and that he looked forward to my uneventful pregnancy.  I hope he is right.

“We plan our lives according to a dream that came to us in our childhood, and we find that life alters our plans.
And yet, at the end, from a rare height, we also see that our dream was our fate.
It’s just that providence had other ideas as to how we would get there.
Destiny plans a different route, or turns the dream around, as if it were a riddle,
and fulfills the dream in ways we couldn’t have expected.”
~Ben Okri

8 comments to Food for Thought

  • Anna

    I’m commenting here because I don’t have any useful personal information to add or a blog to post a link on, however you are in my thoughts whilst you make this tough decision. It’s great that you have options but for me, as somebody with many psychological scars from my pregnancy, I can totally see how the cerclage could contribute to your peace of mind, the importance of which can’t be underestimated. I’m glad that people are coming forward with their experiences in the comments section on the next post and hope that reading those comments makes things clearer and helps with your decision process.x

  • Jen

    Wow. What interesting information…I had a cerclage placed at 27 weeks (definitely out of the textbook kind of case) after my doctor tucked my son’s foot and my amniotic sac back up into my uterus. This was followed with bedrest of course….:) Like you I can’t even imagine a vertical pregnancy, PTSD from your previous pregnancy—that is the perfect description. Seriously. Off to read the new information post now.

  • […] Food for Thought » I Need Your Help If you read this post you now know that I have gotten new information […]

  • Mel

    That is such a tough question, but I think what I took away from reading this (and maybe you should have a few unbiased third parties read it to see if they take away the same thing) is this feeling that you will have regrets if you don’t get it and something happens, but you won’t necessarily have regrets if you do get one and don’t really need it. Does that help you make a decision?

  • Fascinating! This is such hopeful news. Obviously, you should go with what feels best to you. These bet-the-moon situations are so full of emotions that you owe it to yourself to do whatever makes you most comfortable. Imagine, though, an uneventful pregnancy!!! How awesome would that be? : )

  • Eb

    Ditto on the PP – great news that you have found a doctor that would answer all your questions. I hope your decision comes to you quickly and allows you to have some quiet and peaceful moments with this pregnancy.

    Thinking of you too, sending you tea, toast and hugs.

  • I had to laugh out loud at the cervix assembly voting on a PC renaming… :-)
    I guess it is thrilling to think that in theory you could, if you were able, to try a cerclage free pregnancy. I also totally understand why you would not really go that route. I think I would too, without having gone through none what you went through.
    I hope and pray that everything turns out right and your son ends up with a sibling. THAT would be perfect. Thinking of you.

  • Wow! That is just fascinating, given what you’ve been through–and I’d say it’s a fantastic thing to contemplate (though I don’t envy you the upcoming yea or nay decision-making!) Still–excellent news that he thinks you have the option of a vertical pregnancy.

    And, can I say that I lovelovelove the quote you’ve got at the end. I’ve never seen it put quite like that, and just–Yes.

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