pain management for arthritis

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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Email Exchanges

After returning from my MFM appointment yesterday and processing the information about the continued shortening of my cervix, I emailed my MFM to see if there is anything specific I should be doing to manage this pregnancy.  The below is our exchange which helped me feel a LOT better.

“Dr. F:
I know that what I am about to ask is somewhat subjective but your opinion is valuable to me as you have experience with how cases like mine tend to progress.
Do you recommend dialing back my activities/social engagements at all at this point? I know that bed rest presents its own health risks, and I’m not really referring to that as much as running errands, doing housework, going to parties/etc. Is there any benefit to staying off my feet when I can?
Friends are planning a baby shower in 4 weeks. Invitations are set to go out but I’m hesitant to send them. Clearly, I can plan to have the shower and realize that anything could happen and it may not go forward, but do you have concern that I may not make it to 31 weeks?
I realize that you cannot say with certainty, but I’m more looking for your opinion based on your experience.

Hi,
I figured those would be things that’d come to your mind…
As for your activity level, I definitely do not recommend bed rest, but dialing back your activity somewhat in terms of housework and such is certainly reasonable. Listen to yourself and adjust your level of activity to a level that is comfortable to you.
As for the baby shower, at this point I don’t really see a reason why you shouldn’t make it for quite a while longer. We had a negative FFN, after all. While you are certainly at risk for preterm birth, you are still far from being in the highest risk category, so I tend to think positively.
And yes, of course we are ultimately unable to predict with certainty, but I’d send those invitations out.
I hope this answers your question, feel free to call or email if there is anything else I can help you with.
:)

Best,
Dr F.”

That is, until today, when I came home from a morning out and decided to Google, you know, for fun and because it is so well advised, “short cervix pregnancy outcomes”.  The bottom line is that even if there isn’t consensus on what causes a short cervix or even what the best treatment approach is, there is evidence (and a lot of it) that a short cervix (under 2.5cm prior to 24 weeks and some studies suggest even under 2.5cm prior to 28 weeks) is highly correlated with preterm delivery prior to 34 weeks.  And, the shorter the cervix and the earlier it presents, the earlier the delivery.  So, back to email I went:

“Dr. F:
I am trying to do my best to live my life and be mindful of how I am feeling.
I know we are doing what we can and I am happy to be 27 weeks along. I know outcomes improve significantly at 28 weeks and so that is my short term focus.
What I think is playing the most on my psyche is not what we did or didn’t do, but the fact that even if there isn’t consensus about how to treat women with a short cervix, there does seem to be a lot of evidence that shows that a short cervix (under 2.5 cm prior to 24 weeks (and even under 2.5cm prior to 28 weeks)) is highly correlated with preterm delivery (prior to 34 weeks). This just has me on edge, worried about pPROM and will I know what to do to give this baby the best shot if something does happen.
I am not sure how other women, with short cervices or even early dilation do it.
Any advice (other than to stop Googling “short cervix pregnancy outcomes”) would be appreciated.
Thanks.

Hi,
I hear you, but I still firmly believe that not placing the cerclage was the right thing to do! Your first pregnancy just didn’t fit into any of the risk categories we talk about these days. Don’t forget that the single biggest risk factor for a preterm delivery is a prior preterm delivery, and you didn’t have one.
Theoretically, based on all those new guidelines, a “correct” management of this pregnancy would have included – possibly, maybe – a cervical length screening examination at 22 weeks (which would have been normal) and otherwise only a cervical length assessment if you became symptomatic with uterine contractions (which you are not). Based on current guidelines you would not receive im or vaginal progesterone, nor cervical length assessments, because your risk for preterm birth is low. We may never have known if your cervix was shortened if you simply delivered at term.
But, now we looked. Based on the fact that someone looked in your last pregnancy, and used cerclage (which is not considered indicated unless you’re dilated in a first pregnancy).
So, now we’re stuck with it. I often wonder, since you’re not the only patient who is stuck in the confusing world of cervical assessment and preterm birth prevention, if we’re not creating a lot more anxiety than we’re preventing adverse outcomes.
I think you’re doing the right thing in taking it week by week, but I also do not want you to loose too much sleep over the noted cervical shortening. I do believe that your pregnancy will continue for quite some time, and if – IF – we get into the PTL/PPROM situation we’ll after all have some interventions available.

The refraining from Google-ing anything would probably help.
:)
Does this help?
Feel free to call or email if there is anything else I can help you with.
Best,
Dr. F.”

I feel better, again.  The short goal is to get to 28 weeks as outcomes improve significantly then.  Six more days.  Beyond that, though, is my fervent hope that I get to 34 weeks.  I am trying to take this one day at a time, trying to will myself to calm down and not succumb to freaking out or doom thinking.  And, I am mostly calm and circumspect.  But it takes a lot of effort to be and I don’t win all the time.

“One day at a time, — this is enough.
Do not look back and grieve over the past, for it is gone;
and do not be troubled about the future, for it has not yet come.
Live in the present, and make it so beautiful that it will be worth remembering.”
~Ida Scott Taylor

2 comments to Email Exchanges

  • Meg

    It is very difficult to control our circumstances. You are certainly doing all that you can to give this baby the time he needs to develop fully. The one day ata time has worked so far. Keep on keepin on!

  • Anna

    I am so glad that you have your Dr, she seems very helpful and reassuring. I’m also glad that you are feeling better, managing how you feel can be tricky when everything is so important (it was for me when I was pregnant). You can do this, mostly calm and circumspect sounds good to me, just hang in there. We are all sending positive thoughts your way all of the time,x

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