Making Babies Is Hard

So I have had bloodwork and scans done to evaluate our slow beta rise pregnancy. Here’s the details.

17 DPO hcg 167.3 progesterone 64.6 [ecstatic]

19 DPO hcg 221.5 (32.4% rise in 48 hours or a doubling time of 118.56 hours) [uncontrollable grieving]

21 DPO hcg 345.6 (56% rise in 48 hours or a doubling time of 74.79 hours) [stupidly hopeful again]

26 DPO hcg 972 (51.3% rise in 120 hours or a doubling time of 80.44 hours) [sad but coming to terms with a likely impending miscarriage]

28 DPO hcg 1351.2 (39% rise in 48 hours or a doubling time of 101 hours) and ultrasound found a gestational sac in my uterus measuring 4+7 so exactly 1 week behind [absolutely grateful it’s not ectopic, fully expecting a MC now]

33 DPO hcg 2647 (30.8% rise in 48 hours or a 123.7 hour doubling time) progesterone TBD. The nurse practitioner sent me for another scan since I guess an ectopic pregnancy with a pseudoaac is still on the table. My gestational sac or whatever is still measuring a week behind. [Pissed]

I am still peeing on Wondfos however the last 10 days all look the same to me. I still have queasiness and fatigue and sore breasts but the sore breasts are getting less each day.

The US tech tried to say that maybe our dates were wrong. We corrected her and said we did a medicated IUI so that’s impossible. I’d think that introducing my wife to her would have been a clue that we weren’t some heterosexual couple banging it out multiple times a week. Awkward silence was followed by the tech saying she’s also measuring my cyst. Apparently I have a corpus luteum cyst that may or may not have been caused by the Clomid. It can also happen in some unmedicated pregnancies so IDK. It’s a huge fucker though. It’s over 6x4 cm on my right ovary. That explains all the weird twinges and pinches and pulls that I’ve been feeling. I’m still just so grateful that it’s not ectopic.

Also I found out I have a retoverted uterus which explains the terrible constipation. Instead of pointing forward my uterus points backwards. It’s a mostly benign finding that doesn’t normally cause problems unless it doesn’t correct itself and flip forward later into a pregnancy. That’s not a problem for today.

The nurse practitioner ordered another beta hcg and progesterone for the morning (33 DPO) because I refused to have another ultrasound just 48 hours later. I just don’t see the point. Weekly, sure. But 2-3 days between ultrasounds is insane for what looks like a failing pregnancy. I mean beta times do slow as pregnancies progress but it’s not a good sign that I’ve slowed this early and I’m already so low and far behind that even if we get a yolk sac or a fetal pole in a week or two there’s probably something chromosomally wrong with it and it probably won’t make it to the second trimester. I have read enough TTC forums to know better than to get excited at “progress” with a shitty beta rise. So many ladies get told that miracles happen and you never know by everyone then so many of those women update their flair or come back and say they miscarried that pregnancy.

The clinic thinks I’m being nuts for not having hope at this point.

So we got beta #4 back and it was 972 after 120 hours. It’s a bit slower than the second rise but it’s way better than the first. The doctor wants us to repeat the blood work and also get an ultrasound on Friday to confirm the location and rule out an ectopic. Thankfully my favorite ultrasound tech is going to do the scan and i 100% trust her to find it wherever it is. She’s as amazing as she is sweet. I’m so thankful that she works at my hospital.

I have no idea how to feel about all of this. On the one hand it would be amazing if this was just a slow starter and we got to carry to term. Maybe it’s a boy. Boys never do what they’re supposed to do. Maybe my higher BMI just slowed things down. Or it could all go south in the next few weeks and end in miscarriage.

1. In a normal healthy uterine (IUP) pregnancy beta hcg levels should “double” every 2-3 days in the first few weeks then it slows down and can even plateau as the pregnancy progresses

2. A rise of at least >53% in 48 hours is acceptable for a normal IUP

3. A rise of <35% in 48 hours signals big trouble

4. Hcg levels are the signal of a healthy pregnancy and there’s nothing you can do to help it rise and raising it artificially with shots will not delay or resolve the inevitable

5. An early slow rise in the first few weeks indicates a possible ectopic pregnancy whereas an initially normal rise that slows below the acceptable doubling threshold indicates potential impending miscarriage

6. Most miscarriages are caused by chromosomal problems and are just bad luck. It was doomed to failure from the beginning as soon as sperm met egg. About 1/3rd of embryos have chromosome issues that make them incompatible with life.

7. Hcg is an indicator for the health of the placenta and it also tells your body to make progesterone which helps you stay pregnant.

8. If your hcg level dips the odds of it rising again are very very slim. Usually a drop = miscarriage. Rare exceptions include vanishing twin syndrome where one twin fails and gets reabsorbed but the second twin survives.

9. Your hcg level has to be over 1,000 at a minimum to see anything on an ultrasound

So IUI #5 our first medicated IUI cycle with the reproductive endocrinologist worked but the pregnancy may not be viable. I tested out my trigger shot and by 8 DPO (assuming I ovulated the morning of the IUI) the hcg from the trigger was out of my system. The very next day we got a very faint positive. On 17 DPO I got the first beta drawn and it was 167.3 which was slightly above an average of 130ish for my BMI. We were ecstatic and we stated to get hopeful that this was real and in 8 months we would be bringing home a baby. "Dont get too excited" I thought "it still needs to double." I have a LGBTQ baby onesie hidden in my sock drawer from the cycle 3 chemical prefnancy. Once the beta rises and we get a dye stealer on the FRER I'll give it them to my wife.

We repeated the beta 48 hours later and got the bad news phone call. Our beta only rose 32% to 221. Not good. That’s below the minimum threshold of 35% for a viable uterine pregnancy. My progesterone was a healthy 64.6 so at least we don’t have to worry about that in the future. No progesterone supposities needed.

A beta hcg level should nearly double in 48-72 hours. They like it to rise at least 60%. A rate below 53% in 48 hours is abnormal and needs further monitoring. A rate below 35% in 48 hours is considered a non-viable pregnancy. Even if you make it to a heart beat around 6-8 weeks the embryo usually fails soon after and then a miscarriage occurs. Most miscarriages are caused by chromosomal issues that occurred way back at the moment of conception. They’re mostly unavoidable and there’s usually nothing that can be done to prevent them. We just have shitty luck that we are likely having 2 chemical pregnancies in a row. Only 2% of women who have miscarriages have them back to back like this. Yay!

So 48 hours of uncontrollable crying passed and our third beta was 345.6 which is a 56% rise. So that’s better but the doctor’s office still warned us that we are probably headed towards either miscarriage or an ectopic pregnancy. We have to wait.

They said that they wanted us to repeat the blood work in 5 days and once the hcg level is over 1,000 it’s time to do a scan to see where the sack is located. If it’s in the uterus then we will let nature take its course unless hcg levels drop. If they drop then we will probably do misoprostol suppositories or maybe a D&C to speed up the miscarriage.

If the sac can’t be found we will be fored to wait a few more days then do another scan.

If the sac is found in a tube then I have to take Methotrexate (which is a chemo drug that dissolves the fetus and would also stop us from TTC for 3 months) or possibly have surgery before the fetus tries to kill me.

Of course there’s like a 1% chance that a miracle will happen and our baby will survive past the first trimester but I’m not going to bank on maybes and wishes. The internet is full of slow beta rise success stories but so many of them get a heart beat and then a week later it’s gone so I’m going to try very hard to not fall into false hope to just end up crushed. Or many more of them think their 53-75% rise is "slow" when really it's considered totally acceptable. Every body is different and people make hormones at different rates.

My feelings about this shroedinger baby are complicated. The joy of being pregnant is completely gone. That hopeful wistful bliss has been sniffed out. Every pregnancy symptom is now a cruel reminder that my baby is probably incompatible with life and will very likely pass soon. I worry about every single internal twitch or pinch wondering if it’s ectopic and I’m about to blow a tube and nearly die. I feel like my body has been invaded by a monster and I just want to clear it out so we can move on and start over and hope for a healthy normal pregnancy. I wish I’d never had my betas drawn but I’m also thankful that I’ve been forewarned because some women go to their 6-8 week appointment and get blindsighted and I’d rather cry at home than in the doctor's office with an ultrasound wand up my vagina.

Waiting is so difficult. I just wish we knew what was happening either way. At least if the ultrasound comes back with bad news we can move forward and do something instead of standing still in this beta hell.

I thought I'd share our experiences with cycle 4 and 5. Cycle 4 was another natural at home IUI with the donor who gave us the CP in cycle 3. We timed ovulation with cervical fluid and cervical checks and OPKS then confirmed ovulation with basal body temping. Yet again we had another issue with the OPKs. There was a huge gap of time between the peak reading of the Clear Blue Advanced Digital and the extra wide Wondfos. For those of you who didn't know the technical side of an OPKs you are supposed to get a positive or peak when your Lutenizing Hormone reaches the threshold of the test. Wondfo and most other internet cheapies are positive at LH > 25 mIU/mL. Clear blue advanced digital is a little different because it tracks estrogen plus LH. Estrogen peaks first then falls as LH peaks. The Clear Blue advanced digitals are supposed to switch from high (flashing smiley) to peak (solid smiley) at LH > 40 mIU/mL. Twice now I had an issue where I got a peak on the CBAD but my wondfo with the same urine was still negative. That should NOT happen. I can only conclude that the peak reading happens when your estrogen level falls even if the LH hasn't really surged yet, or the LH threshold is more sensitive than the manufacturer thinks and advertises. We timed the IUI #4 for 38 hours after the first positive wondfo which ended up being like 48 hours from the peak CBAD this time. I got my temp rise around the time we inseminated. IUI #4 did not take and I got my period.

We took 2 cycles off to recover our finances a bit and also close and move into our new house. I am so glad that we were not TTC while moving into the house. It was a super stressful period of time with a lot of physical exertion and extreme fatigue. We barely had time to eat and often didn't. We were in survival mode. And between painting and moving furniture and getting the house ready for us to move in it would have just been too much. It was a very difficult decision to make at the time but in retrospect it was 100% the right decision for us.

We also started working with a Reproductive Endocrinologist because we decided that our finances would be better spent doing 1-2 medicated IUIs while we saved up in case we needed to resort to IVF. We worked with Boston IVF at their Albany clinic because they're subsidized from NY state and they frequently do remote monitoring for people who don't live locally. Their IUIS are $250 and their IVF is $4,500 plus medication and in cycle monitoring.

I took this time to go extra hard on my diet and also complete all of the testing that our RE ordered. I lost an additional 20 pounds by eating 1,200-1,300 calories a day. It was hard.

We did 2 ultrasounds (the HSG we'd already done with my OBGYN) so we had to do the SHG/SIS, and tons and tons of blood work including genetic testing mostly to make sure that I don't carry Cystic Fibrosis. That was an unpleasant $900 bill for blood work. Thankfully everything came back completely normal and our insurance (Aetna) covered all of it. I ended up testing CMV negative however our doctor did allow us to use a CMV positive (not an active infection) donor. I reasoned that the risk was miniscule and if IUI is good enough to use for an HIV+ partner then CMV shouldn't be an issue either. Plus we had already inseminated with him twice at that point and I still tested negative. My OBGYN also agreed that CMV status wasn't a big deal unless the infection was active and you/they currently had symptoms.

Once all of the testing was done they offered to let us do an IUI cycle either naturally or medicated. We asked for drugs and I got my period the very next day. I went for a CD 3 ultrasound and blood work and then they prescribed me clomid 50 mg for cycle days 4-8 since we had a test result timing issue and I couldn't start it on CD 3. The clomid was cheap at $19 and we picked it up from our usual CVS pharmacy. Then on CD 12 we had another ultrasound and blood work and this time we traveled the 90 minute drive to the clinic and paid the $575 monitoring fee to avoid another timing issue. I had a 24.4mm dominant follicle, two 14ish mm follicles, a 13mm follicle, and a few other tiny ones. We got the clear to trigger that night. I tested with OPKS to make sure I hadn't ovulated yet and I hadn't. For the trigger shot we used Ovidrel which was $53 from a mail order company who delivered it to our house. I have a latex allergy which causes a rash at the contact site and at first the mail order pharmacists didn't want to prescribe it to me because there's latex inside of the pre filled syringe however once I told him that I just get a minor rash with prolonged contact and I'm a nurse and I would take a benadryl at the first sign of redness or itching at the injection site he relented and agreed it should be fine. I didn't develop any problems. We triggered that night then went to the RE for the IUI 38 hours later.

The actual insemination at the RE's office was pretty disappointing. My wife sat in a chair in the corner while the nurse inseminated me. It was a very cold and clinical experience. She was nice enough but not chatty or friendly and it didn't feel like a special moment. I also forgot to ask for our vial so that ended up in the trash I'm sure. We were clearly a task to be accomplished in their very busy clinic. Even my wife felt a bit disappointed afterwards. I laid on the table for 15 minutes and tilted my hips down on the side with the big follicle. I put my pants back on and we paid our $250 and we went home.

The next day I started to test out my trigger shot with the wondfos. By day 8 you couldn't see a distinct line and even the FRER was negative. I kept testing and the next day we got our first very faint positive on our FRER. I've been testing the progression daily with FRERs since then and my lines are darkening okay although I am still waiting on our dye stealer and the Wondfos are super slow to change. On 17 dpIUI our first beta was 167.3 and my progesterone was 64.6. I go for another beta in the morning to see if it's doubling correctly.

I had zero pregnancy symptoms before the BFP. In fact I was so sure that it would just be another CP for the first two days because I had absolutely zero symptoms. I was actually planning for cycle 6 in my head and getting ready to cry when the FRER turned positive again and the line was darker.

TMI warning!!!

Now that I'm 4w+4 pregnant I have symptoms. There's queasiness that comes and goes sometimes for hours or a half a day at a time. I haven't had much food aversion although sometimes I can't tolerate drinking anything carbonated. I'm frequently tired and I'm taking naps which is rare for me. Everything sappy or sad makes me get teary eyed and I have to work to not cry. My boobs alternate between sore and itchy. My temperature is still solidly above 98F. My uterus cramps sometimes and in the first few days I had a lot of sharp pinching feelings and then one really good pulling sensation like someone has stabbed a crochet hook through my right side and was trying to pull my uterus out through the side. I can also only eat small meals because eating too muhh makes me feel gross. For a few of the early days I felt vaguely UTI-ish with a dull full ache and frequent trips to pee however I never had any burning or pain and peeing did make it feel better. Now I'm having bowel issues. I've never had so much heart burn and gas and minor constipation. It's embrassing! I also did not expect all of this mucus discharge. I have a near constant wet feeling and keep having to go to the bathroom to check for blood because it constantly feels like how you feel right before your period starts. Thankfully I haven't had any spotting or bleeding. We have our first OB appointment booked for January 9th.

Here are the charts and BFP progression pics!

https://imgur.com/a/YRhS8O5

We are in cycle 3 now (and our first try with our new donor). Man this was the cycle of stress. Between trying to buy a house that looks like it’s not going to happen anymore and me going strict again on the keto diet plus being more consistent with the intermittent fasting my ovulation date was late by 2 days. Also, I basically lived in OPK hell for like 4 days. I peed on sooooo many tests it’s not funny. I decided to add the clear blue advanced digitals this cycle and wow did they confuse things.

So if you don’t know, the CBAD tests are different than other OPKs because they track LH and estrogen. I also track estrogen with my ferning microscope. I can say that the CBAD and my ferning microscope correlated. However I got my peak CBAD on CD 12 at 11:20 PM yet my Wondfo was negative. I’m not sure how that is even possible because the Wondfos detect LH at 25 mIU/mL and the CBAD picks it up at 40 mIU/mL which means that the Wondfo is more sensitive and should have been positive at the same time as or before the CBAD. I can only surmise that the CBAD gave me a positive when my estrogen levels dropped which just so happened to occur a few hours before my LH surge. Is this a big deal for this cycle? Probably not. But could this be an issue for someone with highly variable cycles? Maybe. It’s something to keep in mind.

So we got a peak CBAD on CD 12 at 11:30 PM then the Wondfo was positive on CD 13 at my next test at 3:30 AM.

We inseminated on CD 14 around 7:00 AM which means we were in the 27-32 hour area depending on which OPK was right. We confirmed that I’d already ovulated before the IUI because my cervix was not as open as it has been before.

My temp rise was also slower this cycle. I’d blame that on the intermittent fasting. I’ve done cycles before on strict keto and occasional IF and it didn’t affect my temps this way. If you look at my overlaid chart though it actually doesn’t look too different than the others

Sperm banks aren’t something that there are a lot of reviews of which is weird because we review everything now. Imwhen my wife and I were first getting started I did a ton of research on banks. We knew that we wanted 2 features. They had to be cost effective because we’re not rich people. And more importantly they had to be willing to ship to a residence. Believe it or not but wanting to have sperm delivered to your house rules out almost all banks. The banks hat we ended up choosing is NW Cryobank which is in the PNW. We live on the East Coast in upstate NY however the distance has not caused us any problems. Our sperm ships in 2 days and arrives without any issues. The bank has been very good about working with us to resolve a billing problem that we had with an old expired credit card and updating the monthly storage fee.

Now NY does require a doctor’s signature showing that you’re under the care of a physician in order to have spent shipped to your home but that’s a one time thing and it was just a one page document. Easy least. My OBGYN was happy to sign it.

Their prices are exceptionally reasonable compared to other banks. I don’t know how some banks get away with charging over $1,000 for a tiny vial of sperm. Did you know that they get 3-5 vials per “sample?” Meanwhile the donors get paid something like $40 a visit. I understand that they have a lot of overhead costs with cryogenic storage and they have to do genetic screening and std screening but still that’s a huge markup and it feels a bit unfair. My wife doesn’t make sperm. We can’t make a baby without a sperm donor. It is hard enough to know that my wife won’t share any genetics with our child without also having to pay a small fortune for that privilege. It feels like adding insult to injury. Thankfully NW Cryobank is reasonable and still does all of the genetic and std testing and they also do sales just about every quarter. For Black Friday we got 40% off 4 vials! That’s basically buy 2 get 2 free. I love our sperm bank.

I like Doctor's Best for vitamins. I have been taking their prenatal and a krill oil. Supposedly it's better than fish oil? IDK but it's eco friendly and it has DHA for growing baby brains and there's no fishy tasting burps afterwards so that's a win. I have also been taking 100 mg of CoQ10 for a few months now. 💊🦐

I also just added more Vitamin D because the pre natal does not have a lot. And then when it looked like IUI #2 wasn't going to take I bought some royal bee jelly pills. 🍯🐝

Man that's a big pill! It's the biggest pill in my ever growing hand full of pills. I went from taking 1 antihistamine a day to swallowing a handful of pills in one go. I am swallowing fistfulls of pills now like a 90 year old woman. The things we do for conception...

I also tried a fertility/women's tea with red raspberry leaf in it and you guys it was sooooo nasty and it gave me like 10 pimples overnight so it now lurks in the back of my cabinet and mocks me every time I go to refill my new rainbow pill organizer with more of my giant pills. ☕️🤮🤦‍♀️

I think at this point I probably take more pills now than I would if I were just doing a medicated cycle lol.

Preface: we are currently in cycle 5 but I wanted to upload my old Reddit posts for continuity and because all good stories start at the beginning. Spoilers: cycles 1-4 definitely fail. But here are my thoughts throughout this whole TTC hell.

I’m a huge data nerd so I thought I’d share. Finding IUI success stories helped me a ton in planning and prepping. I also read a ton of peer reviewed studies to figure out the timing, agonized over charts and test results, and watched a bunch of OBGYN YouTube videos.

My wife and I just did our first IUI at home. I’m a nurse so we were comfortable DIYing it at home. My wife performed the insemination like a champ. She was nervous at first but I walked her through it and prepared everything and it went just fine. She was scared that the catheter was hurting me but honestly I didn’t even feel the catheter. The speculum was the most annoying part. My cervix was a perfect SHOW so she had a good target to look for although it was a little angled so it took a few tries to get the right positioning and every time I moved my cervix moved and she had to find it again.

My cycles are usually 25-26 days long and I get a lot of EWCM. Between temps and OPKs and saliva slides we decided to inseminate tonight which was 24 hours after the first positive urine OPK and also during a positive fern slide.

After the IUI I rinsed the catheter and syringe with a tiny bit of the saline and squirted it into my menstrual cup then inserted it. I plan to leave that in for about 12 hours to catch any fallout and keep it close to the cervix. According to research we have about a 20% chance.

Supplies: disposable speculum, sterile preservative-free saline flushes x2, sterile long q tips x2, 1 mL slip tip syringe, IUI catheter, washed sperm, towel, headlamp (OMG this was a lifesaver so just buy one and thank me later because no amount of lamps would have been enough).

I’m officially in the TWW you guys!

Link with photos.

https://imgur.com/a/vissw2C

Edit: this cycle did not take.