Don't Know Why

As we have shared the news of Jellybean's heart issues with people, we've have two main questions:

1)  Is it the same thing Lil' Bit has?  No.  If it was, doctors would be writing this up in medical journals right now.

2)  Do they know why both your kids have heart issues?  No.  There are lots of factors that can play a role in children getting congenital heart defects (CHD).  Below is our best understanding of some of those risks and why don't seem to be applicable.

Family History
This is generally the biggest factor, hence the big jump in probability of Jellybean having a heart defect once we discovered Lil' Bit had one.  However, to the best of our knowledge, there are no cases of a CHD anywhere in either my or Phil's family.  So, although Lil' Bit's having one increased the chance Jellybean would also have one, Lil' Bit had no increased risks.

Anti-depressant Use
First, an interesting fact:  The fetal heart is fully formed by roughly 7 or 8 weeks gestation, which is generally long before most people know they are pregnant.  Thus, things that occur later in pregnancy have no bearing on whether there are CHDs.  However, because I was taking my anti-depressant prior to and during that time period, and there is a link between the anti-depressant I have been taking and babies having CHDs, we were concerned about this.  However, the drug I took (my doctor just switched me to something new) is linked to a very specific type of defect which Jellybean doesn't have, and I didn't take any anti-depressants during my pregnancy with Lil' Bit.  I have had at least seven different doctors reassure me that this was not the cause.

Uncontrolled Diabetes
Children born to women whose diabetes was not well-controlled are statistically more likely to have a CHD.  However, because my diabetes is gestational, it is less-likely to be the cause of any issues.  My doctors reassured me this is generally applicable to women who are diabetic pre-pregnancy.  In addition, my A1C test at 3 months gestation revealed a nice low average blood sugar level of like 5.5 (well in the normal range).  Because this test provides an average blood sugar level for the prior 3 months, to the extent that there was any chance I had diabetes prior to pregnancy, it could not even remotely be considered out of control.  This was not the cause of either child's CHD.

Chromosomal Abnormalities
There are lots of chromosomal abnormalities that are associated with CHDs and, because I was 34 at the time the embryos were created, my kids were at a slightly higher risk of such abnormalities than if I had been younger.  Because we are unwilling to risk a miscarriage to have an amniocentesis done, we won't know until after Jellybean is born whether he has any such abnormalities.  We do know, however, that Lil' Bit doesn't have any and, because her embryo and Jellybean's were created at the same time, there is no additional risk for him based on my increased age during his pregnancy--the risk is calculated based on the age of the egg, which was the same for both kids.

IVF
This is the biggy, and it's somewhat controversial.  Initially, there was a fair amount of research that indicated a link between IVF, particularly with the use of ICSI, and CHD.  Subsequent research indicated that the increased correlation could be because of the increase in multiples (twins, triplets, etc).  Other research has shown that although there is an increased incidence of CHD among IVF users, it is because there is an increased incidence for couples who suffer infertility, regardless of the fertility method used to conceive.  Thus, whether Clomid, IUI, IVF, or natural conception after years of infertility, the incidence rate appeared correlated with infertility, not IVF.  We had seen this research and thought that since our infertility issues were largely structural--the result of blocked tubes from a ruptured appendix--rather than genetic or hormonal, we had a lower risk.  Guess not.  In any event, the current understanding is that children conceived using IVF do not have an increased risk of developing a CHD.

So, there you have it.  The only risk factors for CHD that might have some application in our case appear not to be the cause.  And, in truth, I'm not sure it really matters what caused it.  If it turns out I did something to cause it, would being able to beat myself up about it change anything?  No.  Would pointing the finger at IVF help?  No.  I think we would have made the same choices because the odds of any child having a CHD are just so darn small.  So, to the best of our ability, we're setting aside the need to know why it happened and just focusing on what we do from here.  It seems like a much better use of our limited physical and emotional resources right now.

Hello, Mr. Hole. We Meet Again.

These past few weeks I have been struggling, physically and emotionally, to get my life in order.  It hasn't really been working.  I tried catching up on sleep, taking time off work to get caught up, being good to myself, all of the usual things, but each day I have felt a little more in the hole.  Today, I was determined to make it a good day.  I got up, showered, got Lil' Bit to daycare, and headed off to work.  I never got there.  I got too overwhelmed just thinking about driving in.  I started crying too much for driving to be safe.  I headed home.  The worst part was, heading home made me feel worse.  I have always been capable.  People could (and did) say mean things about be, but I knew deep down that nothing they did could stop me from being capable and people would be able to see my ability.  My capability was my safety net, and now it was gone.

As I pulled into my driveway, I was racked with sobs as the negative thoughts flew through my head--"You weren't capable.  You couldn't make it to work.  You're useless.  How do you expect to take care of the kid you have, let alone the one on the way?!"  It was too much.  My mind looked up at the huge walls of the hole I had fallen into, curled up into a ball, and shut down.  It was frustrating and scary, but I am grateful that I was not so far gone that I could not see that this was a big problem.  It was my wake-up call.  I needed help.  I needed to up my meds.  Yet, even as I knew the truth of those statements, I railed against them.

"You're pregnant!"  I shouted at myself.  "You don't want to expose the baby to all that!"
"True," I answered myself, calmly and quietly, hoping to make myself listen to reason.  "You have done the best you could with that, but the time has come to say when."
"I don't want to!" I wailed petulantly.
"I know.  But you don't want to feel miserable and worthless either.  And you don't have to."
"I do want to be functional again.  Enjoy the life I have, the family and job I love..." I sniffled.
"Exactly.  You want to be you again."
I nodded, much like my toddler, hanging my head, knowing I was beat, but not wanting to concede just yet.
"It's okay," I comforted myself.  "This is not a moral failing."
"I know."
"Yes, but you don't believe me.  Yet.  But you will.  Once you're out of the hole, you'll look back and wonder why you fought so hard for so long, just like last time."
"But I feel like I'm taking the easy way out."
"You think this has been easy?  You did all you could.  You are a fighter.  But you can't out-think a chemical imbalance.  It doesn't work that way."

We sat quietly for a while--me, myself, and I.  And then I physically got up and contacted my doctor's office and left a message about getting my meds adjusted.  I hate feeling weak.  I hate feeling incapable.  But, I would hate myself more if I let things get worse instead of heeding the call and getting help.

And now I write.  I write so I can remember for next time, in case there is one.  I write so that maybe someone else can see their hole before it gets as deep as mine.  I write to remind others that they are not alone.  And, to be perfectly honest, I write to convince myself of the rightness of my choice--because I argue better in writing than out loud.  It's time to begin again, and find my way out of this hole.  And maybe, just maybe, now that I've seen this hole a few times, I don't have to fall in it again.  Here's hoping.

The Demise of Mutant M

So, back in January when I was undergoing my previous FET, I mentioned how my doctor had pronounced me a mutant because I didn't seem to experience any of the side effects of the medicine and, lo, Mutant M was born.  Sadly, Mutant M seems to have passed.  This time around, I have had headaches, stinging and slight rash at the injection site, and, most frustratingly, become an emotional wreck.  Every time I get into my car to go somewhere--work, the store, day care, dairy queen--I get all teared up and sad.

Now, there are any number of reasons for this.  One possibility is that I am totally stressed, which is making me emotional.  Possible.  But, honestly, if stress were going to cause it, I think I would have experienced it back in January when we were still learning how to cope with Lil' Bit post-surgery with meds and everything.  My personal theory?  My anti-depressants.  I am physically, chemically different than I was the last two times I took the Lupron and, since side effects are essentially chemical responses or reactions, it makes logical sense.  Ultimately, though, it doesn't really matter what has caused it.  And, at least now I can empathize with all the other ladies who experienced these symptoms.  Still, I (and likely Phil) am sad to see Mutant M go.  On the plus side, since this is our last try, I don't have to worry about whether it will bother me in the future.

So long Mutant M.  It was nice while it lasted.

18 days, 14 shots, and counting...