What made the 7th pregnancy different from the other six?

 The short answer? There is no way to know for certain.

After five miscarriages with my own eggs, and one miscarriage of a normal karyotype boy with donor egg (same donor as this so-far successful pregnancy), one might think I would have some more solid answers.

But all I have are guesses, theories, gut feelings, beliefs—all of which come and go, trade places with one another, intensify and ring bells, depending on the day, depending on accumulated experience, depending on whims, depending on quasi-evidence.

I think this area of science and health causes similar levels of stress as does a cancer diagnosis (studies show) in part because of its slipperiness. And because of the sheer amount of time (precious time) it can take to find a way out of the tunnel, with no guarantee that one ever will.

I’ve been thinking about this question a lot because I want very much to be able to give a straightforward answer to any woman who is struggling with infertility and miscarriage. Particularly recently, as I continue to unstick from where I was stuck. The feelings of freedom do not come without a desire to help anyone who is stuck get unstuck, too. And without a sharp awareness that I could very easily still be stuck if things had worked out differently.

But I can’t give straightforward answers. I can’t say “just do this” to others, or to my future self who might want a second child. I wish I had better answers.

Still, I want to take the time to collect what I did differently, this time around, in one post, for easy reference, for anyone who might be interested. I think there are some bright lights in this collection, some reliable guideposts. (I might forget a thing or two, so check back for possible additions later.)

Lov.enox (and baby aspirin)

Lov.enox (I put a period in the name to help me not get spammed, and so WP doesn’t mistakenly think I am trying to sell it).

Number Seven is the only pregnancy during which I have injected this blood thinner, 40 mg a day. If I were a less analytical person, I would just say “yee-ha, that’s what did it,” and sing the praises of this blood thinner for the rest of my days.

But I have heard from a couple of REs, and have seen in the literature, that blood thinners and baby aspirin generally can’t have an effect until around Week 8. And my 6 losses (which, remember, includes one DE loss) all went south before Week 8. The OE losses happened before a fetal pole or heartbeat were present.

Still, it is possible that, in my specific case, with my specific body, I’ve always needed a blood thinner from the time of conception.

One theory claims that women who are of advanced maternal age (that would be me) have “stickier” blood. And this could negatively affect blood flow to the developing pregnancy.

Also, I have inherited from the Dutch on my dad’s side of the family Factor V Leiden, a blood-clotting disorder. But that is not exactly a bell-ringer. I have never had a blood clot, nor has anyone that I know of in my immediate family. I am Factor V heterozygous, which simply means I am carrying one allele of a gene for Factor V—which is, most likely, just hanging out and not doing anything, like lots of stuff that we acquire from our genetic ancestry. If I were homozygous, that would mean I have two alleles, and would be at a higher risk for blood clotting.

Long story short: Factor V is something that RE’s found in their comprehensive search for explanations for RPL and the like, and many are now saying that it is a red herring.

Still, if I ever get pregnant again? You can be damn sure I’m shooting up the enaxoparin!

Also: I’ve been taking a daily baby aspirin for about four years now (ever since the first loss). Everyone—REs, OBs— tells me to keep taking it, rather nonchalantly. I need to research what, if any, negative effects I might be unintentionally causing from such prolonged use.

Super-fertility and donor egg

This theory has always carried a lot of weight with me because it resonates so deeply with my personal, felt experience.

Super-fertility posits that some women have friendlier uteruses than others have. SF uteruses cannot distinguish between a “good” and a “bad” pregnancy. In studies, the uterine tissue of a SF woman will reach out and grab any fertilized egg that comes its way and will try to nurture it and grow it into a baby.

Women without this problem? Their uteruses will recognize that the pregnancy is not viable, and let it go, along with the monthly lining.

One of the things that has amazed me during this experience is the immediacy and ease with which I got pregnant. It is a serious mindfuck (and heartfuck). I felt so fertile, and yet so not-fertile at the same time. I still have that feeling that if I want to get pregnant again, I can—all I have to do is have sex with my husband, and it doesn’t even have to be timed all that great (although we did do the precision-timing thing, too).

The most important aspect of SF:  as I’ve said before, having a friendly uterus and a bunch of miscarriages does a number on your chances of catching a lucky egg. You are either pregnant, miscarrying, or recovering from a miscarriage—physically, reproductively, emotionally—all the time.

I often wonder if I had not had such an easy time getting pregnant if I would have been able to catch my lucky egg within a year or so. There’s just no way to know.

When looked at through this lens, my current pregnancy has been successful simply because it is donor egg. Because we’re bypassing the vast number of unviable eggs/pregnancies with my OE.

To back this up, I can point to my experience with IVF at CCRM with my own eggs—it resulted in 3 embryos, all of which were trisomies. I can also point to the fact that my five OE losses were early, never resulting in a fetal pole or heartbeat, and the vast majority of research says that this happens when there is a chromosomal problem going on in the egg or sperm. No way to know for certain, but arrows point to chromosomal problems in the egg due to maternal age (faulty meiosis).

This would make sense. This would be a story I could stand behind…

That is, if I hadn’t had a miscarriage with a normal karyotype donor egg pregnancy. That one throws in the wrench, raising questions of: Is it the sperm, too? Is it the sperm alone? Is it uterine, even though all looks fine? Is it the donor’s “one”? Was it a birth defect not detectable by karyotype test? And on and on and on…

Antidepressants

So that donor-egg loss could have been a fluke, or it could have meant something. In any case, it forced me to look at a more complex picture.

And I got depressed. Really depressed.

The 6th loss of my DE pregnancy, the baby I called Little Star, made me feel like I had been running toward a finish line, was almost there, I could see it, and then was thrown mercilessly back to the very beginning of the race by a completely mysterious force. I’d thought we had everything figured out, but it seemed like we knew absolutely nothing, once again.

Going on Zo.loft, at that point, was one of the very best decisions I made.

I recommend it to anyone who is struggling with infertility and miscarriage. That or any anti-depressant that works for your body chemistry. It helped me raise my baseline of functioning in a way that I simply could not do on my own.

Raising that baseline enabled me to do so much of what follows in this list: Changing my diet, art therapy, creative visualization exercises, consistent weekly psychotherapy, and the like.

It also turned the volume waaaay down on my responses to stimuli, which my poor body needed. The body and mind get exhausted and depleted from so much emotional and physical experience. They desperately need to rest! The anti-depressants help the body and mind acquire the rest and relaxation necessary to create a good home for a developing pregnancy.

Once pregnancy starts, you can wean yourself off of the drug within the first trimester (I believe I began weaning at week 8). You also have the option of staying on a low dose throughout the pregnancy. The huge benefits far outweight the negligible risks.

Rest, and quitting my job

This one would seriously annoy me to read about if quitting my job were totally not an option. I realize how fortunate I was to be able to say “Enough!” and get out of my toxic work environment.

For a long time, I could rationalize working there because I loved the patients so much, and I got so much satisfaction out of helping people. And we really needed the money. For one thing, it helped fund trips from New York to Georgia, where my embryos lived.

But once I had the DE loss, I knew it was time. Luckily it coincided with a sizable raise at DH’s workplace. The relief I felt upon quitting, and having the time to work on healing, was colossal.

In truth, I believe that I would not be pregnant right now if I had not quit my job. There is no way to prove this but I feel the truth of it in my bones.

If you’re reading this and you’re in a toxic work situ, and you can’t rely on a partner to support you for a time, then try to change jobs at least. This is my strongest recommendation, based on personal experience. Toxic workplaces—especially if you are an absorbing sort of person like me—seep into your cells, your dreamlife, your headpsace, your innards, your whole life. It was impossible for me to guard against its effect while struggling with IF.

During Social Work school, when I had most of the losses, I was under a great deal of stress at not-so-stellar internships. Again, I loved my patients and the work was fulfilling, but the administrative/supervisory people were not good. (I am quite certain, now, that I should have reported one supervisor, but I just didn’t have it in me at the time.) I often wonder if things would have turned out differently if I had been working in more supportive environments and had been under less stress.

Stress reduction

At the same time, I struggle with my take on stress and infertility and miscarriage. Mainly because I don’t want to tiptoe anywhere near the empty platitude, “Just relax”—one that particularly enrages me.

But while I do not believe that stress causes miscarriage and infertility, I do believe that stress exacerbates already compromised biological, physical situations.

We know that stress exacerbates physical conditions—intuitively and via medical research—so it doesn’t seem like a leap to me to make the connection between stress and IF/miscarriage.

We are precisely between a rock and a hard place. We are saddled with a condition (or more), and then we must manage our completely normal, human reaction to that condition–emotional stress—in an effort to not exacerbate that condition. It feels really, really, really unfair—a sense of injustice that can exacerbate the stress even further. Gaahr!

Still, we’re forced to deal. We have to. We have to control and manage it.

Managing stress, for me, was a three-year-long quest, and it involved becoming comfortable with my version of spirituality.

Spirituality, psychology, yoga

I used to never be comfortable with the word “God” or “prayers.” I was a seeker, a journeywoman, with an eclectic mix of spiritual “tools” in my knapsack.

I still am that woman.

But through this experience of profound repeated loss, my spiritual self intensified. I didn’t just say “we’re all one”; I actually felt it. My belief in God—or whatever word one wants to attach to the idea of oneness, universal love, the God in all of us—felt increasingly genuine. I began to experience myself as God experiencing Itself. I experienced moments of profound beauty and peace, sometimes on the yoga mat, sometimes in the woods, sometimes while receiving reiki or taking a Shamanic journey, sometimes while practicing The Work (Byron Katie), sometimes while talking to DH.

But it’s important to note that I wasn’t skipping through epiphanies or anything close to that. It was (is) work. I had (have) to practice. To keep training myself to reach toward love and light. Failing more often than succeeding—but that doesn’t matter. The point is the practice and the process.

I have reached a point at which I can honestly say that I accept all that has happened and, not only that, I see the beauty and perfection of it. I was able to reach that point of acceptance and appreciation before I became pregnant a 7th time—and I do believe that that had an effect on this last pregnancy. This baby is not my key to happiness; this baby is not rescuing me from darkness, saving my marriage, saving my life. I took care of all that before this baby came into being. And that’s huge. That feels bigger and more powerful than anything else on this list.

It wasn’t a change that happened specifically between the 6th and 7th pregnancies. It was a long time coming, a slow intensification. But it did feel particularly strong between #6 and #7. I had to defy reason—all signs were pointing to “This is NOT working. You lost a DE pregnancy. There is no hope.” But I had those two embryos, those two potential babies, our babies, waiting for me. I could not give up. Could not lose faith. I absolutely had to find a way to keep believing.

At the beginning of the three-year-long span of loss, I grasped onto yoga with all my might and showed up on the mat at least three times a week. There is no question in my mind that yoga saved my life then.

Yoga provided the doorway to all sorts of other wonderful spiritual and psychological experiences. I collected one tool after another: Byron Katie tops the list (Loving What Is), but there were also the yoga sutras and a wide variety of Eastern and Western spiritual texts. I also tried CBT, DBT, Freud, energy healing, reiki, creative visualization, Shamanism, and probably lots of other stuff I am forgetting. All of that is still with me, in me, and ready for me to pluck from my toolbox whenever needed. What a gift!

I plucked away between #6 and #7, and had the time to concentrate on my spirituality and intensify it in a way that was profound.

Does this mean that I am now always at peace? That I am always aware of oneness and the God in me? That I am always appreciative of the path that led me here and able to see its beauty? Oh no, no, no. I still call everything that has transpired a “nightmare” sometimes. I still feel resentment, pain, scars, trauma, and so on. But I practice choosing this other way of being pretty diligently, moreso than I ever have in the past. I am flawed, human, petty, and sometimes quite prone to distress. But I’m much wiser and more able to find peace. And one day I hope to pass on this wisdom to my son—making the story even more meaningful, making the experience something even greater to appreciate.

Art therapy

I didn’t want to lump art therapy up there in the last category because I think it deserves to be singled out.

When I quit my job, I started making art like crazy. Not since I was a kid had I had so much time and freedom to play with paints and pens, to collage and simply create. I just did a painting last night, one that we will take with us to the labor and delivery room and which I will use for drishti, and just walking into the nursery and seeing it there, in its tribal, primal colors, makes me smile.

Allowing myself to become a child again, playing, helped me connect to the child I was to become pregnant with. I visualized the essence of my embryos—in flowers, trees, birds, designs—and then I made those visions tangible on the page.

I made tangible images of me pregnant. Of me looking like I do right now! Manifestation.

Externalizing and making tangible was a very important part of the process of healing leading up to this 7th pregnancy. I took the art therapy very seriously. I did not trivialize it—in fact, I prioritized it. I did not have control over so much! But what I did have control over was visualizing and actualizing through art.

Even if it is quick scribbles, even if it doesn’t look exactly like what one envisions, it is so powerful.

What you create on the page is indelible. The image creates a lasting impression on the mind. The neurons and dendrites in the brain thicken around this impression every time you look at the image. Think about all of the images of horror we’re subjected to along this path—from negative pregnancy tests to far, far worse. Then think about creating counter-images. Counter the shit out of the horror. That’s what I learned.

We have to counter the horror, restory it, reframe it, provide for ourselves images of what we want, not what we want to avoid

Narrative therapy

Which brings me to narrative therapy. Instead of belaboring this one, I’m going to link out to a previous post, here: Narrative therapy and neuroscience: blogging and the storying of infertility.

Anti-inflammation and gluten-free diet

This was hard. This took more dedication than I thought I was capable of.

I recommend to anyone struggling with IF to get their Celiac Panel tested, just to see what’s what. I am not allergic to gluten, but I do have a moderate wheat allergy. Still, some studies show that there actually is a link between gluten and miscarriage—studies that were pointed out to me by Dr. Shapiro at RBA—so it just makes sense to go gluten-free, no matter what your test results are. I know. It sucks. But that’s what I discovered.

I was mostly gluten-free, but sometimes somewhat loose about it. After the sixth loss, however, I became much stricter about it. Because my Celiac Panel is clean, I don’t make myself crazy about trace amounts that might exist in certain foods, particularly since I am technically not allergic to anything but wheat (allergist said I could eat barley and the like, which I don’t).

When I quit my job, I also became dedicated to an anti-inflammation diet. See recipes here and here. I really did feel so much better. I had more energy and it made me happy to know that I was soothing my taxed immune system.

Because I decided definitively that I was not going invest money, time, and resources in immune therapies—not enough peer-reviewed evidence-based research to back it up, and many strong recommendations from respected REs to run away—I wanted to address any immune system issues that might be present at least in some way. Diet was the way I chose.

Do I think that my 7th pregnancy was different from the other six because of my diet changes? No. I don’t think going GF and anti-inflammation caused success. But I do think it helped create a platform for success. It reduced stressors and increased health.

I did go off of the anti-inflammation diet as the pregnancy progressed. That was a little scary, but I couldn’t figure out how to manage it. I am, however, still (expensively) gluten-free.

Conclusion

I think that’s about it. I left out things like the scratch biopsy—Dr. Shapiro’s preferred way of dealing with any immune issues that might be present, a process having to do with T-helper cells–because I had that done for both the 6th and 7th pregnancies. I tried to focus more on things that I did differently—or more intensely, reaching a new level—the 7th time around. I hope it’s helpful. It has helped me to appreciate the hard work and good fortune that led me here by putting it all in one place.

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7 Comments

  1. Sissy7

     /  September 29, 2014

    I always look forward to your posts. I have been following them since last year. You are such a inspiration.
    I was two weeks behind your pregnancy with a donor egg from RBA as well. Unfortunately, I lost the baby at 18 weeks. Results came back that it was a healthy baby girl. I have been struggling emotionally for the last two and a half months and am so lost. Everyday I get a little better and am trying to build myself back up to try again with one of the three embryos we still have frozen, but to be honest, I really scared.
    Thank you so much for being so open about you ups and downs and everything in between. Your blog has been so helpful.

    Reply
    • I cried when I read this. It’s just the most heartbreaking thing that you’ve experienced. I wish so much for you that someone or something had been able to explain what happened—it doesn’t sound like you received any theories? I’m giving you a hug right now and have been thinking about you ever since I read this yesterday. I hope you feel that healing is possible and that any or all of those three embryos will become your future family. Feeling lost is so scary. Keep reaching out to others. Keep chiming in. Much love to you. xoxoxo

      Reply
  2. Thanks for writing this. Very interesting to read. I wonder this often– I only had two miscarriages though, but also very early on, and I wonder if it’s something I changed for my successful pregnancy (baby aspirin? GF diet? Clomid?), if I have a lot of bad eggs, or if it was just really bad luck.

    Reply
  3. Former ccrm patient

     /  September 29, 2014

    These things are really hard to figure out. However, I would posit that the donor egg was the main difference. Yes, you had a heartbreaking devastating loss of a chrom. normal embryo. However, as ccrm told us having normal # of chrom. us not the whole story. We were lucky to end up with 2 Rlbs from CCS normals. But despite the high success rate some still don’t make it. This was explained to us as possibly single gene errors or mitochondrial errors that the general chrom testing doesn’t look at. Plus also uterine issues which you covered. Anyhoo congrats and wishing you a boring healthy rest of your pregnancy.

    Reply
  4. A beautiful post. So thoughtfully written. Sending so much love to you. You are going to be an amazing Mama.

    Reply
  5. Karen B.

     /  September 30, 2014

    I totally agree with the stress and toxic environment points. We tried to have a second child for over a decade, with two losses and a lot of heartbreak (not to mention physical and emotional wear and tear). We ‘gave up’ and stopped trying after twelve years. I was in a very stressful work situation, and, like you, loved what I did and the people I worked with but not so much the people I worked under. That situation became extremely toxic, and I left the situation (not completely voluntarily, but that is a long story and one that left the organization open to a major lawsuit) in April of 2009. Less than a year later, after significant emotional and physical recovery (including improving my diet and better managing my health issues), I found out I was very unexpectedly pregnant. I was of ‘advanced maternal age’ and high risk but I was pregnant. Thrilled beyond words. Sick and terrified, but pregnant and thrilled. Happily, after a two-week stint in the NICU, our beautiful tiny daughter came home to join her 15 year old sister. She will be four later this month. I wish blessings and happiness on you and your coming little one!

    Reply
  6. Sometimes you just never know what made the next one stick, there can probably be a million theories, but sometimes, it’s simply a mystery. I love that this ONE has stuck and you are glowing and enjoying every ounce of it!! Love that you have shared with us your heart and your experiences, it helps make the RPL not so isolating. It’s hard to do and I know that I admire your strength to continue and fight for your little ones! XOX

    Reply

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