OB appt, plotting and scheming along

I saw my OB today.  He did not want me to go to Chicago for the repeat TAC.  He will try to hook me up with a local TAC performing OB in Vancouver, who has done more than the average, and who can do it for me under provincial insurance, i.e. saving me 25000$.  I hope it works.  I have an appointment with this doc in June.

In the meantime, he seemed very confident that I can carry this next pregnancy without too many problems.  He even offered to do a double TVC, but I said no go, I want the TAC and only the TAC.  He  said it would be better to avoid having another major surgery, like the TAC, but I said whatever, what I really need to avoid is another stillbirth, or a micropreemie delivery.  A surgery is a nuisance, but a stillbirth is a tragedy.  I would rather be cut up from my nose to my toes than lose another baby.  I still remember Adrian lying limp in my arms and I never want that again to another one of my loved-loved-loved-so-much babies.

As for the lower uterine segment, it will need extra care in ultrasounds over the last trimester, but he really thinks that it would have healed well and that it will not tear.  However, I am not to work, but rather to stay put in Vancouver with an ultrasound wand up my whazoohah.

I only want one more baby.  I promise.

dr. Haney appt summary

The phone appointment with dr. Haney went fabulously.  I thought he was very intelligent and the things he said made perfect sense.  Essentially I am lacking the internal sphincter provided by the top of the cervix at the level of the internal os.  Therefore it needs to be replaced.  Hence the TAC.  The TVC only provides a barrier beyond which the membranes should not funnel, hence leaving enough column of mucus in the cervix to stop bacteria from ascending, but there is not a proper barrier like it is in the case of the TAC.   I might dedicate an entire post at some point to writing the things that he said, because they are worth reading by anybody who has had PPROM, PTL, and IC.  Essentially he thinks they are all effects of the same cause, which is loss of integrity of the internal sphincter and hence the column of mucus gets shortened in each case, and bacteria ascend.  The progesterone that we all get given is meant to thicken that mucus.

My problem, however, is that the TAC has eroded through the wall of the uterus and has been removed.  He said that he has only heard of two other cases like me in the world, none of them his.  (Insert exclamation mark here!!!!!!!).  WTF?  Do I REALLY have to have the rarest of rarest things happen to me?  I mean this guy is seeing the majority of TACs performed in the world and even he is at a loss of what to counsel me?  This after having another two exceedingly rare things happen before, which are not even related (one was the delayed pneumomediastinum after the laparoscopy, the other one the heavy bleeding two weeks after delivery due to SIPS).  Both of these things are super rare.  I mean super duper rare.  Only one other case of pneumomediastinum reported in the literature, and only 1% of post partum hemorrhages are so delayed, who knows how many are due to SIPS).

I should be in the Guiness book of records under "worst luck in obstetrical endeavours".

Anyway, he counselled that I get an ultrasound every week of my next pregnancy to make sure that the new TAC which he wants to insert is staying on the outside of the uterine walls, and that later on the scar from the previous erosion is not bulging out and about to give (i.e. ahem, rupture and kill the baby and perhaps me as well).

Should I go to India instead?  Equal amounts of money, two surgeries less, and two trips to a country that I would in any case like to visit in my lifetime.

Today I am seeing my current OB who probably does not know how to get out of this mess in a polite way.

tomorrow's appointment

This week I have two appointments of some importance, one with dr. Haney over the phone to discuss the situation, and one with my obstetrician in Vancouver to plan which way to go.  Hopefully I will get some more clarity by the end of the week.  I am definitely leaning towards carrying the baby myself.  Today I have asked MrH, if this were Emma we were talking about, how would we feel if somebody else carried her for 9 months instead of me?  I personally would feel like I miss her terribly.  I have felt very close to Emma during my pregnancy, and both MrH and I felt that a lot of bonding took place during those 9 months, so I am not in a hurry to dismiss those feelings.  I guess if I really cannot get pregnant, then so be it, but I am thinking that I should at least try.  And then there is also the question of how much money can one afford to spend on these things, because I might end up spending both the cerclage+IVF 35000 usd followed by the surrogacy 35000 usd.  And I am not rich.  By any means.  In fact, I will probably need to pull out all of my RRSPs for that (my retirement savings).  And go back to working full time.  I don't know.  I think for now I should take it one step at a time:  I will be able to get pregnant, I don't see why not.

These are the things I need to get in place before the cerclage can happen:
1.  a sonohysterogram (and the travel to Vancouver for it) to see what is the thickness of the uterine wall around the tear from the cerclage.
2.  a hysteroscopy or a hysterosalpingogram to see if I have any adhesions from the prior D&C's.

I have to try to organize both for my one week off in June when I was supposed to be on vacation in Vancouver.  Neither of them is doable in my home town.

It is just a lot of work at this point.  I have very little emotional reaction to any of this.  Surgery?  just a lot of work.  Travel there, travel back, recover, can't lift Emma (bummer, have not thought of that yet, how am I going to care for her).

I have to figure out some things, but other than the inconvenience it will be ok.

surrogacy

I have spent the weekend researching gestational surrogacy in India.  It is very tempting.  To carry another pregnancy, I would have to have the TAC replaced again, this time by dr. Haney, at 25000 USD expense out of pocket.  I would not go for anybody else doing it, because unfortunately my previous cerclage was placed a bit too high and eroded into the body of the uterus, so now a repeat cerclage needs to be very accurately placed.  Nor am I a candidate for TAC during pregnancy, again because of the need for accuracy of placement.  These are things that dr. Haney emailed me.  I need to talk to him on the phone.

Unfortunately, with the repeated D&C's that I had after my hemorrhage, I might not even get pregnant, and end up spending all this money (and another surgery, I lost track by now) for nothing.  While a surrogate in India would likely get pregnant and carry the baby to term with most likely no fuss and no complications with the same embryos that my body might fail.

I have thought long and hard about which way to go.  I am still mulling it over, but I think I am going to go for the repeat TAC this summer, and pursue another IVF sometime in December, if my cycle returns and I am not still breastfeeding.  I would miss the embryo and later on the fetus, with all that distance to India!  to spend a whole pregnancy apart from my own fetus is very difficult.

But it is honestly a good option for me.  If all else fails, I know there is this option as well.  It would cost about the same as the TAC plus another IVF fresh cycle.

TAC cost 25000
IVF fresh 12000 (with ICSI)
total 37000

Surrogacy with IVF/ICSI and travel :  35000 according to a bunch of blogs.

Very tempting...
Repeat cerclage... not so tempting... how many more surgeries do I have to go through?

I oscillate between one option and the other with the speed of a bumble bee.  I need to sleep for about one month on this before I can say I made up my mind fully.  In the meantime, I want to enjoy Emma.

once infertile, always infertile

Despite having this wonderful child who exceeded all my motherly expectations, I am still finding myself thinking like an infertile.  I am still (due to work, and also due to the age group that I belong to) surrounded by pregnant women.  The good news is that I now feel like I belong among women as a gender, and among humankind as a species.  The bad news is that I am still having a hard time thinking about how long it is going to take me to get pregnant compared to other, normal people, and also feeling a bit worried about my health during a pregnancy, given that, um, I almost died last time.  Last two times.  I hemorrhaged both times, once badly, the second time almost fatally.

That being said, I still feel somewhat inferior to any other woman who can get pregnant naturally (and easily) and work or maintain a normal life during the pregnancy, then deliver and...not be scared shitless of dying while doing it.  I crave normalcy.  I want not to be quite so special for a change.  But it is not possible.  I am infertile.  I have incompetent cervix.  My uterus ruptured 360 degrees around the transabdominal cerclage, and is now weak all along that line.  And, to top it off, I have some weird placental site involution disorder that nearly killed me last time.

Why me?

All these thoughts take my attention away from Emma, and that is the true tragedy.  Reality has been good to me.  I am still alive.  But I am upset at myself for not being as happy as happy can be around my daughter, and not completely basking in the miracle that she is 24/7, without thinking about any other things that put me down and under.

I did not post anything on Mother's day because I am conflicted.  On my very first Mother's Day with a live baby, I would have liked to say how happy and blessed I feel about having Emma in my life, but at the same time how I felt that pain and shame of not being a mother for so long...almost like it still was reality.   I have a hard time letting go of my infertile self...I have a hard time forgiving myself for being imperfect in all these ways...and I definitely have a hard time embracing my courage and persistence, and basking in my success/good luck...

In other words, I still need to blog.

9 months today

Emma is 9 months old today!  In honour of her anniversary, both MrH and I ate way too much chicken.  I bought a Hutterite chicken (Hutterites are like the Amish, all I really know about them is that they keep to themselves, they are very unlikely to read my blog, and they raise very good free range chicken, which I periodically cook in the oven impaled on a diet coke can that I drink on my way from the butcher shop).  Today I was too tired to even find an empty can, so I gave the chicken a quick shower in the sink, I dried it up with a fluffy towel for comfort of baking, applied salt and pepper to the armpits, and plopped it in the oven at 400 F lying on a cookie sheet.  I forgot about her.  I was actually too tired to go check on her until about 1.5 h later, when I found her sooo crispy and delicious that I kept on eating the skin.   I must have eaten the skin off the entire 5 lb chicken, because I am quite sure MrH did not eat chicken skin (his cholesterol would ooze out of his ears if he did) and the chicken is quite positively denuded.

I am sick with chicken-skin-itis.  Or something.  I feel like I am going to poop a puddle of oil tomorrow.

Now, onto Emma's latest cute achievements.  She can officially stand up and fall on her padded bum and stand up again and fall again exactly seven times in one minute.  I have timed it.  The amazing thing is that she does not stop after one minute.  She can go on and on.  I thought doing five sets of 15 jump squats is a lot, but if I tried to keep up with my kid, I would be feeling like an old woman.

The cutest thing she is doing lately:  when we sit at the table to eat dinner, she grabs both my hand and MrH's hand and waits for us to pray.  We usually pray holding hands, and include her in the circle, and it is so cute when she initiates the hand holding, knowing that we are about to pray before dinner.  Divine!  This child of mine makes me want to kiss her all day long.