Tag Archives: heartbeat

19 February 2014

Before our scan on Monday I was looking forward to writing an update... but I changed my mind as the day progressed.  The past three days have been the most difficult passage of our journey so far.  To explain why I need to start at the beginning.   

When we arrived at the gynaecology clinic we knew that our appointment had been, (grudgingly), allocated as a follow up to monitor the OHSS - it wasn't designated as a an opportunity for an update regarding the development of the embryo(s). This meant that there was no guarantee that we would be given information on anything other than the state of my ovaries. I was hopeful though - there was always a chance that we might get a doctor who preferred spreading the joy to spreading the 'beggars shouldn't attempt to be choosers' gospel. Imagine my disappointment when our name was called by the very same doctor that we saw the last time. I swallowed my impulse greeting - 'You promised you wouldn't be here...' - in favour of the trusty gritted teeth smile. Hard to believe that the Foreign Office turned me down for a job in the diplomatic corps - surely my winning ways far outweigh my mathematical incompetence? Anyway she floored us both by volunteering the presence of two empty but sizeable gestational sacs right at the beginning of the scan and I think she was sufficiently disarmed by my tears and Archie's heartbreakingly proud, protective, loving, (stunned), smile that she lost the advantage and forgot to eulogise until I had my clothes back on. She did her best to reclaim lost ground towards the end of the appointment, telling us that while one ovary had gone down about half cm, (7cm), the other had gone up over a cm, (9cm) and that 'this was the problem with going abroad for IVF (sigh)' - but it's hard to be confrontational when no one will take you up on it. She tried repetition, pregnant pauses and simultaneously raising her voice and her eyebrow at the end of the statement to turn it into a question - but still no response. In fact we were so convincingly blank faced that even I was beginning to wonder if we understood what she was saying. Eventually she gave up, handed us a number for the Emergency Gynaecology department and told us to go to Accident and Emergency if I got to the point where I couldn't cope with the pain.

Understandably we sailed out of there on cloud nine. I had been as sick as a dog for the week leading up to the appointment with waves of severe pain and relentless nausea - but now it all made sense; both embryos were still fighting to survive, producing double the hormones and double the hcg. We were astonished, we were tipsy with trepidation, we were enraptured... little did we know that all this heady delight was to be supremely short lived. When we got home and began to digest the information we realised that, since the gynaecologist hadn't been with us the whole way through and she wasn't an obstetrics specialist, she was probably unaware that we were six weeks and 1 day into the pregnancy. I sent an email to Dr Romana and, while she didn't prophesise doom, she did confirm that at 6 weeks and 1 day she would expect to see a gestational sac, a yolk, an embryo, (or fetal pole), and, in most cases, a heartbeat. Google reaffirmed that an empty gestational sac at 6 weeks was highly unusual - sometimes it's too early to detect a heartbeat but the complete absence of a yolk and an embryo wasn't a positive sign - even if the development was delayed, it shouldn't be arrested to this extent. We were devastated.  An empty gestational sac at this stage is more often than not indicative of what they call a 'blighted ovum' - which basically means that the embryo has attached to the womb lining, creating a sac and causing the body to produce pregnancy hormones but that the embryo itself has stopped developing because of chromosomal defects. Eventually it will miscarry of it's own accord - in fact, if you were to stop taking the artificial progesterone, it would probably miscarry quite quickly thereafter. 

That same day we received our booking appointment, offering us a scan at 12 weeks, but given the current circumstances and the GP's promise of an earlier date, (because of my previous ectopic), Archie thought it was worth phoning and asking them to bring it forward. As soon as he mentioned the ectopic they were very obliging and offered us one the following Monday, (7 weeks and 1 day), so, in the end he didn't even mention the empty gestational sacs. We were doing our best to reassure each other that the embryos were just 'faffing' - which is what we call the art that prevents Archie from leaving the house within an hour of having made the decision to go out - but we were terribly shaken and it wasn't easy.

That evening, we missed a call from an unknown number and it rang again the following morning. It was the gynaecologist from the day before... she said she'd reviewed our case and she was keen for us to be seen again by the people at the assisted conception clinic and was going to pass our details on - we were to expect an imminent phone call with another appointment. She said it was to follow up on the OHSS but we both knew that there was a good chance she had gone through her notes after we'd left and realised that the dates didn't tally. The assisted conception clinic phoned shortly thereafter and offered us an appointment at midday today. This only added to our distress - to get an NHS appointment in less than three days for anything short of a dire emergency is almost unheard of.

When we walked into the clinic today we sat in the waiting room, silently holding hands and wondering whether there was even any point in being there. It was only 45hrs since our last scan - wouldn't it be better just to wait a week and have a definitive answer either way? We knew from our internet research that a gestational sac couldn't develop a yolk, an embryo and a heartbeat in less than 48hrs and, until/unless we had all three we wouldn't really be any further forward, (we were past even pretending to care about the OHSS). Eventually our name was called and a rather nice lady escorted us into her office. She asked some questions about the progression of our IVF and the OHSS and then asked me to hop on the reclining chair for a scan - I am so used to taking my pants off that I almost pulled my trousers down in the middle of the room - but luckily some sixth sense came to the fore and I intuited that this was to be an ordinary ultrasound, conducted by rubbing the hand-held unit over my lower abdomen. I lay back and she scanned my ovaries - which have been unerringly impressive throughout and didn't fail to deliver this time either. I am not sure why I am responding atypically to the size of my ovaries, (currently 11cm and described by the doctor as resembling a 'pair of melons'). Perhaps it's just that I know that if I complain the only thing they can do is put me in hospital - and I don't want to go to hospital - so maybe it doesn't serve my purpose to complain. I am in pain and the constant nausea is making it harder to drink - but I know what's going on and I know that they can't do much for me in hospital apart from give me a drip so, while I can still drink, I'm not going. Anyway, she said that my ovaries are 'massive' and that I will now need to take daily blood thinning injections to counteract the effect of the water being sucked out of my bloodstream... and then... finally... she said that she was trying to find my uterus. My ovaries kept hogging the limelight but eventually she managed to squeeze between them and asked us if we could see what she could see? I didn't know what she could see but it didn't sound like the kind of question you would ask if you were going to tell someone something bad. My hopes soared; 'What can you see?' My voice cracked. 'I can see a heartbeat,' she said and she pointed to a tiny flickering light on the screen. 'Hang on a moment - we'll just look for the other one... Ah, there you go, another heartbeat. Can you see it? Congratulations. Two little heartbeats. Twin one and twin two - and they're both exactly the size we'd expect them to be 6.1mm and 6.6mm respectively. I can't think what happened the other day - there must have been something wrong with the equipment. How awful for you. But it's OK now. They're doing fine.'

I started writing this post before our appointment this morning, when I didn't know what the outcome would be - I explained to Archie that the embryos had liked being written about, that they were happy the whole time I had kept the blog going, that maybe they didn't want to be a secret... that maybe if I wrote about them again I could save them. Of course it was nonsense... but our two little heartbeats are obviously partial to a wee bit of nonsense - which fills me with hope that their lives will be full of the little pleasures that make for lasting happiness.  We never thought for a moment that they might both survive and, even though there's still no guarantee, we are far too delighted to pretend that not telling you would somehow protect us from devastation if things were to change. We have already talked about how I will have to go back and edit the blog so there's no heartache over who was a B/C and who was a C/C - it's got teenage angst written all over it!

I will never forget the look on Archie's face when the doctor found our two little heartbeats; my best friend, my soul mate, my husband, my hero... my beautiful, happy boy and his fledgling flock - 'radiant' is a word too often reserved for mothers.