Answers and more questions.

My thoughts going into my appointment last Tuesday were simple:  'Get my blood drawn to find out if my levels are back at 0 (please let them be) and ask Dr. Lyons for a referral to another doctor because as much as I love her, I just can't walk into this office anymore.'

Here is how things went...

I'm sitting in the ob office waiting for my appointment with Dr. Lyons and just had a conversation I wanted to share.

The woman who took my blood when I got here offered me her condolences. She is the first one to do that, as far as lab techs go. I was taken aback for a moment and then said thank you. She told me she had 3 miscarriages.. After having a son. She lost the first at 4 months the second at 5 months and the third at 4 months. She told me the names they had picked out for each one, which were all girl names because she had wanted a daughter so badly. I asked if she had any testing done and she said she did and found out she had a blood-clotting disorder and she never was able to have another baby. And they didn't adopt because her husbands parents wouldn't have accepted it.  Just when I was about to start crying she said, "But I have a wonderful son and 3 beautiful grandchildren." And she said it with a smile. I thanked her for sharing her story with me and I truly meant it. It helps me to know that even if our worst fears come true, we will survive. We will continue smiling and being happy for the son we do have. And it also made me feel so very blessed for our families. Who would be nothing but supportive of any decision we make in the future as far as children go.

Here is how the rest of the appointment went:

Dr. Lyons nurse, Tami, came out and got me and I instantly started feeling a little better about being there.  She has always been so kind and today was no exception.  When we got in the room she asked me how I was doing.. not the kind of "How are you?" that you say to someone passing in the hall at work.. the kind that you know the person really cares because they stop, look at you, and wait for your answer.  She told me how sorry she was and we talked a bit about what happened.  

Even though I had planned on "breaking up" with her, when Dr. Lyons came in I felt such a sense of relief flood over me.  I hadn't seen her through this last miscarriage and it was SO GOOD to talk to her.  The first thing she said when she shut the door was "I'm so sorry Mandy."  and she gave me a hug.  She pulled up a chair so she was sitting next to me and we talked about a lot of "stuff".  Here is the run down:

She looked at my blood results from the last time we were in the office, which was the day we had the ultrasound and saw the baby.  She looked at my progesterone level (the growth hormone that sustains pregnancy until the placenta takes over.. which could also be why the baby was measuring a week small already) and she instantly had a plan.  She said it was at a 5 and at that point in my pregnancy I should have been at 19/20.  When I looked it up later I found this:

According to the Advanced Fertility Center of Chicago, progesterone levels need to be above around 15 ng/mL for a pregnancy to be viable.

and this...

Even an egg that implants properly can be threatened by low progesterone -- if a woman's progesterone is below 15 ng/mL, even if the egg has implanted in the uterus, she's at risk for a miscarriage.

So.  She told me that when we get pregnant again I need to head to the office and get my progesterone levels tested right away and then monitored from then on out until we are "out of the woods" so to speak.  If my levels are low, even at 17/18, she will put me on a supplement.  She is an advocate for progesterone supplements because of the results she has seen during her career.  I trust her and I think this is the right plan.  I did ask if there was anything else we could do, because I didn't think I could do this a third or fourth time, and she said at this point there is nothing else that warrants concern.  The ultrasounds didn't show anything abnormal with my uterus and because I have already had one healthy, full-term pregnancy it's a good chance I will have another.  But I still don't know why we lost our baby in August.. and possibly another in June.  That's what still worries me.  But this has given me hope again, that we may have found an answer.

__________

One thing that I am confused about, and this isn't something I thought to ask at the moment, but why don't they monitor these levels from the get-go in all pregnancies?  All they did was take my blood like usual and run a test. It seems like such a simple thing to do... and could possibly save many, many babies.  Also.  Dr. Lyons said if she would have seen these results that day she would have called me in to the office to put me on the supplement immediately.  Why didn't that other smily-face doctor do that?  Did she even look at my results?  If she did, didn't that number concern her?  Nobody can say that would have saved our baby, but it nobody can say that it wouldn't have either.  

I certainly do not want to start getting bitter and placing blame, but these things do tug at me when I really start to think about it.  

But.  I am focused on trying to stay positive.  Trying to cope in the best way I know how.  I read this on one of the blogs I follow.  I hadn't read it in a while, but Amy asked if I had read it recently and sent me the link to this post.  I found something that I have really tried to hold on to this past month..

 “Don’t squander joy. We can’t prepare for tragedy and loss. When we turn every opportunity to feel joy into a test drive for despair, we actually diminish our resilience. Yes, softening into joy is uncomfortable. Yes, it’s scary. Yes, it’s vulnerable. But every time we allow ourselves to lean into joy and give in to those moments, we build resilience and we cultivate hope. The joy becomes part of who we are, and when bad things happen—and they do happen—we are stronger.” (from Daring Greatly, Gotham Books, 2012)