Contribute $ to fibroid research/ what do we need studied?

So what if you want to help give money to support firbroid research? Here are some ideas based on my research.

Brigham and Women's Hospital Fibroid Research Center is a possibility, they are doing the sister study and many others -- exciting stuff. I gave money last year to a specific researcher at the University of Toronto, Galene Pron, Ph.D., who is studying fibroid embolization and fertility.

I did a search on Yahoo of the words "fibroid research" and got some interesting results as well. You also can search through the PubMed site or anywhere online and see what research has been done and contact the researchers directly if they provide email addresses.

Also the March of Dimes is doing a push again premature delivery of infants but they aren't talking about fibroids. We might be able to help drive the point home by sending comments and cash at them.

Oh, by the way, this reminds me that I was in touch with the Women's Clinical Research Center here in Seattle and suggested some study ideas to them. They evidently are only doing pharmaceutical industry funded studies which irked me. Here is a list of the things I sent to them:

What happens to fibroids after menopause? Anecdotally they are supposed to shrink but there is no research evidence to refer to.

I would love to see a study that would help get women in for a routine ultrasound at age 25 and then 30-32 to help catch fibroids early since pelvic exams are often useless.

How about diet/dietary changes and how that affects growth? I think that stress and restrictive eating contributed to my fibroid growth.

What hormonal profiles and body types are linked with fibroid growth.

What about pain from fibroids – I have it but it isn't my fibroid that is hurting me, it is adjacent. I'd love to see imaging that would demonstrate what exactly is hurting. Lots of doctors dismiss this type of pain.

What about a comparison of waiting until menopause for symptoms to recede versus having a hysterectomy on quality of life.

In reading this study report, Myomectomy: a retrospective study to examine reproductive performance before and after surgery (http://humrep.oupjournals.org/cgi/content/full/14/7/1735),
I noted the following mentions of incomplete research
on the topic:

"Many reports have considered intramural fibroids and subserosal fibroids as a single group, and little attempt has been made to analyse the two groups separately. However, it is possible that the impact of intramural fibroids on reproductive outcome is quite different to that of subserosal fibroids."

"few studies have considered the reproductive performance prior to myomectomy, including the presence of infertility and miscarriage, and hence have not examined how myomectomy alters the reproductive performance."

"there are no prospective data to suggest whether or not intramural or subserosal fibroids increase the rate of pregnancy loss, and to what extent they are the cause of recurrent miscarriage"

"The value of myomectomy for subserosal fibroid is a particularly controversial issue. Our series included 10 cases whose outcome appeared encouraging (conception rate, 80%). However, its effect upon the rate of pregnancy loss requires a much larger observational or randomized control study."

"In our study the reproductive outcomes before and after myomectomy were compared and the subjects did not undergo myomectomy as part of a prospective randomized controlled trial. So far, no such trial has examined reproductive outcome following myomectomy. Until a multicentre study has been carried out, the only available, retrospective, data suggest that myomectomy may improve reproductive outcome."


As a patient I have been told, though I have been unable to find research that backs up these assertions, that:

* c-section will be required post myomectomy

* doctor would be unwilling to work with me as a fertility patient unless I have a myomectomy

My bad bleeding

Starting approximately two weeks ago I started feeling wired like I had too much drip coffee, and kind of anxious feeling as well. I don't drink caffeine regularly and rarely have coffee at all so this was weird. I also didn't have a lot of stress at work or at home so it was even weirder. Then last week I started having insomnia, I was getting up in the middle of the night for hours an ultimately only having 5-6 hours of sleep. It kept getting worse and that anxious feeling kept building. I also had a loss of appetite. It was like something was seriously off in my system.

Then I started feeling vague pregnancy symptoms last week as well, like a vague recap of my first week pregnant including some itchiness, breast fullness, light nausea and my thyroid felt funny again as well. I had two faint positive pregnancy tests on Friday and Saturday but they didn't get darker. On top of everything I was experiencing I felt utterly confused. On Monday I had a beta HCG draw and it was 13, down from 46 a month ago (or perhaps I had a chemical pregnancy?) The nurse called and said that it was probably residual beta from my miscarriage in July.

I continue to feel awful and anxious and tired and then Monday night my period arrives, the second one since my miscarriage. It is very red and very viscous, there is no slimy mucus to it, and not really clotting either. It just is very runny bright red blood. I easily bled 2 cups worth at least, it is hard to estimate since I would have gushes when I went to the toilet. I had a headache, my body felt full of cold water, my thyroid felt strained. I also had odd cramping. I stayed home from work yesterday and took ibuprofen and vitamin C which did seem to help control it somewhat. I also went for an acupuncture treatment and that helped with some of the symptoms, I didn't feel so watery inside any longer. I woke up this morning and had hardly bled at all overnight, practically just spotting. I feel dry and clotting in my abdomen.

I called my RE this morning because I want to get to the bottom of this. It isn't just my fibroid, it isn't just the miscarriage and I'm not taking meds or herbs so something is just out of whack with me.

Since someone posted about von Willebrand's Disease (VWD) in the past year I've thought that I had a predisposition towards it. I brought up my long periods and nosebleed problems as a child, plus my anemia but no doctor has responded to the symptoms (tell me the patient doesn't need to suggest the disorder and I won't believe you). My father is very prone to bruising and I am a bit as well. We'll see. I did see this page on the All About Bleeding/VWD site that talks about how some hormones can influence bleeding problems. As I recover hormonally still it is very possible and also women in my family have noted thyroid problems post pregnancy. I did ask for a check of my thyroid hormones weeks ago as well as on Monday but they didn't write the script for that. I'm going to ask the doctor about getting it checked.

http://www.allaboutbleeding.com/vwd_and_you/view.asp?id=4634

Oh, and you know how I love my links, I found this one that I thought was a good reference about NSAIDs and menstrual bleeding:

Nonsteroidal anti-inflammatory drugs for heavy menstrual bleeding (Cochrane Review)
Lethaby A, Augood C, Duckitt K
http://www.update-software.com/abstracts/AB000400.htm

My Ghost Pregnancy

I had a massage appointment yesterday, the first one with this practitioner since my loss in July, though I did have a massage after my m/c just at a spa with a couple friends. I highly recommend getting a massage after you have a miscarriage especially one with some abdominal work, you will probably cry during it but you are crying anyway so why not let it out while you reconnect and take back your body. It really helped to get rid of the pain in my abdomen.

After my appointment my practitioner asked me about my massage. I talked to her about it in great detail, from the physical pain, to the emotional anguish, the heightened physical sensations I experienced and the continued sorrow. I cried and used up quite a few of her tissues. I told her about how most people want miscarriage to be as long as the word is -- over in an instant. But miscarriage as we all have seen is a process and even after your body heals there is a lot of emotional trauma of the experience that needs to be worked through.

I told her about my ghost pregnancy now, the one that has me comparing calendar dates and events to where I would be in my pregnancy, should I have stayed pregnant. I told her how hard it was as I approached the dates around the end of my first trimester, and as August closed and I should have been shopping for maternity clothes.

I also confided that I can stand the thought of seeing my pregnant SIL who is due a week later than I was in February. And how every pregnant belly jumps out at me. Or how I can't really look at babies anymore because it hurts.

I talked about things that people had said or done for me that were helpful, more than half of them were things that women said to me here on the Internet. We talked about how miscarriage is combination of life and demise, birth and death take on new meaning in this process.

She thanked me for sharing with her, and admitted that she had never really known what happened in a miscarriage or that it could take so long. She also asked if there was anything she could do, or that I could do to make sure others in my life knew how I continued to feel. I'm not sure though writing a letter comes to mind. I also feel, though perhaps it isn't fair or nice, that I should share this experience in such a way to make it a tear-jerker, like in the movies where they make you cry. Then I would know that I had gotten through to them and made them hurt too.

Last night I had a dream, I've been having such vivid dreams this whole summer. In this dream I was in a clinic and I was losing a second pregnancy. In the next bed over was a woman who was losing a baby in her second trimester and there was blood everywhere. I remember wrapping my arms around her and crying into her hair and she wailed on my shoulder and I told her how sorry I was. It isn't the kind of dream one can forget about easily. I know that it was triggered in part from talking about my miscarriage in such detail, but it shows me how changed I am in that I had no horror at the blood, only sorrow.

Miscarriage Factoid

I had a miscarriage in July, actually it was more like an abortion since my body didn't miscarry on its own. Having seen the dark side I would like to share some information with you that you probably don't know.

Miscarriages are not like in the movies, over in one scene. They take time, they are painful, and recovery takes weeks if not months. Also, miscarriages are really awful and anguishing. I used to think when I heard about someone's miscarriage "oh that's so sad". To go through one is a 4-dimensional experience of hell and enlightenment. It's more than sad. To the pregnant mother her baby, this idea of baby or embryo or fetus, it died. It doesn't matter that something was wrong with the pregnancy, we have really strong instincts to take care of our young and being pregnant is no different. Even if you couldn't see the baby it was still there and it died along with the idea of being a mother, your new family and all the planning and changes that one would have to make in preparing for the baby's arrival.

If you hear about someone having a miscarriage you need to reach out to that person and at least say you are sorry for their loss, no different than if you heard that someone's parent died. Don't start trying to think of things beyond that such as "it was for the best", "it wasn' t your time" or "it's God's will" -- you don't know and those things aren't helpful. Things you can do are send flowers or drop them off yourself, send cards or letters of condolence. Don't expect the greiving mother to take phone calls, it is really hard to talk on the phone I've found when you can't stop sobbing.

Also, the pregnancy might have ended but that pregnancy has marked time for the mother and father. The due date is supposed to be a difficult time, any other events one had imagined from clothing or furniture shopping to holidays are reminders of the non-pregnant state, that baby that isn't coming. Keep your love and support coming if you can, it is greatly appreciated.

I'll do a separate posting about what to do if you are having a miscarriage or are helping someone through the actual physical process.

Between a fibroid and a hard place

I've been on this long journey over the past 2 1/2 years. I went from not being ready to get pregnant, panicked about the thought of it, to where I am today which is still recovering emotionally from the loss of my first pregnancy.

Along the way it hasn't been easy, I found out I have a large tumor in my uterus which is called a fibroid. It is benign but they don't really go away on their own. It may be compromising my fertility but the only treatment offered to me was to have major abdominal surgery to have it out which could cause pelvic adhesions which could really compromise my fertility. I'm damned if I do and I'm damned if I don't (I'm beginning to notice that theme in my life...hmmmm...)

My fibroid and I are having our second anniversary this week since we first met. Maybe I'll bake a cake. I have not named my fibroid though I know women who have. And I only have the one, I'm monogamous when it comes to uterine fibroids.

At any rate I've done a lot of research into male and female fertility, hormones, supplements, diet, lifestyle, and a ton about fibroids and other gynecological conditions and I'd like to share with you what I have learned. I do think there is more than one way to skin this cat and I hope you find my research worthwhile.

(This was my very first post here.)

Other Causes of Pelvic Pain Besides Fibroid Degeneration

A common complain of women with fibroids is abdominal Pain. This pelvic pain can come from from fibroid degeneration, when the fibroid outgrows its blood supply and dies, but that's fairly rare and there are other possible causes of pelvic pain including (an incomplete list):

Appendicitis

Constipation

Adenomyosis -- endometrial tissue grows into the wall of the uterus and can form pockets that bleed each month

Endometriosis -- endometrial tissue grows on other pelvic structures outside of the interior of the uterus and swell and bleed with the hormones produced as a part of your menstrual cycle

Ovarian Cysts -- mature follicle that does not rupture and can grow pretty large, if they rupture they can be quite painful. Some cysts are normal and most of the time they are just reabsorbed. There are other forms of cyst which require medical intervention such as dermoid cysts, endometrioma, and sometimes chocolate cysts.

Ovulation -- mittelshmerz is pain that is felt around ovulation, perhaps from the release of the egg or perhaps from irritation from fluid released from the follicle

Pelvic Inflammatory Disease -- bacterial vaginosis, gonorrhea, and chlamidia can all cause infections in the pelvic cavity

Pelvic Adhesions from prior abdominal surgery or infection -- a d&c or IUD can sometime result in an infection as well

Fibroid Pressing on blood vessels or other abdominal structure

Cystitis -- bladder infection

Kidney infection

There is also a diagnosis in traditional chinese medicine/acupuncture called blood stagnation which can cause pelvic pain and is generally associated with gynecological conditions such as fibroids. Liver stagnation is usually part of the diagnosis as well, the liver being the major detox organ in the body and one that is also associated with emotion and grief in chinese medicine. I've found acupuncture to be helpful in managing my pelvic pain, as well as breathing exercises that promote movement in the abdomen. Here's a link about blood stagnation that you might find useful.

All About Blood Stagnation
http://www.acupuncture.com/Herbology/bloodstag.htm

If your doctor checks you out and you are still having problems then
you might consider the blood stagnation possibility.

I finally got my period, the first one since my miscarriage in July, this past Saturday (Yeah! Time for a party!). My beta was still up last Friday, I hope to have another draw today to see if it has gone down more.

In the meantime I've noticed that my fibroid has gotten dramatically smaller over the past couple weeks (even more cause for celebration!) I've got a call into the doc to see if I can get another u/s to check on it as I'm starting up on my chinese herbs again and I want to know what we're working with. We'll start trying on the baby-making in October to give some time to treat my fibroid with herbs and acupuncture.

Now if this extra fat around my middle would just go away then I would be back to normal....

It's raining, it's pouring...

After I found out about my fibroid I cried a lot. I cried for 3 days when they told me about my fibroid. I was so upset that my eyelid twitched for 3 months after that! After every doctor's appointment I had I was an emotional wreck afterwards.

A mean RE at the local university fertility clinic told us on a Friday that we needed IVF with ICSI and that we woudn't be able to conceive on our own. The next day we had to go to a wedding and someone from asked me discreetly about my fibroid (we lied and said that was what the Dr's appt was for, we didn't want any one to really know about our fertility problems) and I lost it and had to leave the wedding before the toasts. My partner couldn't get out of there as quickly for social reason so I just sat in the car and cried for 20 minutes by myself on a side street.

I had another time last spring, right after my HSG when I found out my uterus was wrapped around my fibroid and my doctor told me I should probably have the fibroid out. I went to dance class a couple days later -- surely dancing would help me feel like my body was mine again. But there was a guest instructor and when she wanted me to correct my pelvis alignment and I left the class sobbing.

Over Christmas my OB that I had made 2 months beforehand come up so I decided to get another opinion. Aside from crying the entire time in her office when I left I started sobbing in the parking garage and had to wait a long while until I was settled enough to drive.

Another time, at the beginning of the year, after yet another Dr appointment I had to leave dance class again and just cried in the hall while I waited for my partner to finish. It was all so stressful, I was unclear as to what to do, and it seemed like we would never have children without some major medical interventions.

Nutrition and medicine

"The doctors of the future will give no medicine, but will interest his patient in the care of the human frame, in diet and in the cause and prevention of disease."

--Thomas Edison


In case you didn't know, most medical schools do not offer adequate training in nutrition to medical students -- even today. Ever notice that most doctors won't even ask you if you are getting enough rest or drinking enough water? We could be living on potato chips for all they know.

Naturopathic medicine in contrast focuses on the body's ability to heal itself and nutrition is a key part of this -- hence why some of us have had some improvement of health while under the care of naturopaths. In the ideal world of the future all doctors will look at us holistically and help identify imbalances before they become issues. I'm not saying naturopathy is better than allopathic (western) medicine, but I am saying that you will feel a bit better cared for since they try to get to the bottom of the causes of what ails you -- including psychological, spiritual, emotional, causes, etc. I got my anemia finally in check after other doctors telling me that it was normal for some people -- and I'm feeling much better now.

Since we know that western doctors aren't getting this training it is important that we seek out information about the role of nutrution in our health issues on our own. Doctors might even agree with you when you ask if you should be taking B-12 for instance, it just might not be something they offer you on their own.

Here are a couple links to learn more:

Nutrition Education in U.S. Medical Schools (1985)
Commission on Life Sciences (CLS)

Naturopathic Medicine - Philosophy

Oh, and if you are interested in controlling bad cramping pain then you might consider some of the suggestion for controlling prostaglandin production on these pages:

What causes Menstrual Cramps and Pain (Western and Oriental Medical
Perspective)

25 Ways To Handle PMS

Beta Numbers

Here are the blood test results after my retained POC was diagnosed in mid-August.

543 on 8/12

259 on 8/17

145 on 8/23

78 on 9/1

46 on 9/10

Beta HCG - What it is

Beta HCG is the pregnancy hormone. The fertilized egg and embryo produce it and it cause the corpus luteum to sustain and continue producing progesterone to support the pregnancy. It come from the embryo, not the ovary, uterus or fibroids. I don't know if it contributes to fibroid growth directly, but the progesterone/estrogen produced in pregnancy sure do.

BASELINE ULTRASOUND

A baseline ultrasound just helped to provide a comparison measurement before and after treatment. My RE wanted to see how it was doing since it had been almost a year since the previous scan. Without it I would have no way of knowing if it was larger or smaller than it had been so how would I be able to just if the treatment was really working.

I arranged for a second ultrasound to see if there was any change
from the acupuncture and chinese herbs, but note that I waited 4 months with continuous treatment -- change if any would come slowly
my acupuncturist assured me. I mentioned that I was pregnant for this second ultrasound so it is possible that there was additional
shrinkage but the pregnancy hormones didn't provide a clean comparison.

Your doctor may do yearly ultrasounds to monitor your fibroid, you
may want to go more frequently if you feel a lot of changes, every 6
months perhaps. If you are wanting to try to evaluate the affects of
a particular treatment a baseline comparison before and after will
help you to see the affects.

Fibroid Growth in Pregnancy - SIZE CHANGE

Considering that my fibroid only grew in the 18 months prior to treatment and then shrank back 2 cm I think that is a pretty big change. I knew that when I got pregnant I might experience growth (though I hoped I was the rare girl for which it would shrink) but it was important to me to try to shrink it beforehand.

It did grow, and quite a bit but what can one do. We were ecstatic
that we got pregnant and were taking it all in stride, unfortunately
no embryo developed so I had to have a d&c to terminate since my body was happy cooking along. It also shrank back some right away, I'm hoping we can shrink it some more.

My fibroid I could feel prior to my getting pg and it was 6x7cm. It
grew a lot, at its peak measurement it was up to 9x11x11cm. A couple
weeks ago it was dropped to 8x9cm. When my bladder is full it is
really bad, when I'm lying down you can see it bulging out and it is
more uncomfortable than prior to my pg. Some pairs of pants I have
are also uncomfortable now because they put too much pressure on my
lower abdomen (I know you are probably clucking your tongues at me
telling me not to wear them then).

So, I know I have beta still in my system so it probably isn't
shrinking as much as it might eventually. If you have fibroids and
know by measurement or physical sensation (pelvic pressure, etc.),
how long did it take for them to shrink down for you?

I could live with the pressure prior to my pg but now I feel the
pressure so much that I keep thinking I might want to have it out.
Still, I will first try to shrink it back with acupuncture and herbs
which worked before.

So, can anyone share with me how long until their fibroids shrank
post pregnancy?

Frankincense and Fibroids?

I found this page while surfing that mentions some additional herbal treatments, what got me curious was that this one mentioned frankincense which is one of the ingredients in the chinese herbs my acupuncturist had me taking in the spring -- when my fibroid shrank.

http://www.nspforum.com/faq/bbs.cgi?read=938

I started acupuncture treatment in January and had an ultrasound a couple weeks later to help provide a baseline measurement. My fibroid at the beginning of February was 6x6.5x9cm which was larger, mostly longer than the 5.9x6cm in September 2002 when it was discovered, or 6x7cm in March 2003. I started on herbs in March and took them for about 6-7 weeks only, all the while going for weekly hour-long acupuncture treatments. I stopped taking the herbs because I had an issue with bad bleeding during my period which freaked me out, these are strong herbs and not to be used during pregnancy or during menses. My acupuncturist said the herbs are intended to "break the blood". I scheduled a follow-up ultrasound for the beginning of June and as it would happen I had a positive pregnancy test that same morning. My fibroid was back to 6x7 though the ultrasound was not taken on cycle day 3 since my period never arrived. I'm amazed that there was that much of a change.

Here are the ingredients in my supplement, TumoSolv which is formulated by LongLife (http://drhuang.biz/LongLifeMaster.asp):

Bureed tuber, Zedoary, Fritillary tuber, Prunella, Sargassum, Frankincense, Myrrh, Angelica

I don't know if they sell to the public but I would advise anyone interested in trying it to seek treatment though a licensed practitioner of Oriental Medicine and Acupuncture.

My fibroid is still enlarged from my pregnancy, my body is still producing beta HCG though it is slowly dropping. I'm back in weekly acupuncture treatment and soon I'll start using the herbs once again.

I just thought I would share since I did try very hard to be controlled in my evaluation of my fibroid size before and after treatment and I did have positive results. I hope that this gives you hope and inspiration as well.

In His Grace

Ecstasy.
In His grace.
Something important in store for me.
My closest hour.

The watch wheels spin slowly
the sky turns electric blue, or turquoise
a color really that no words can hold.

The pineapple and the family tree
take sudden shape
from here springs all life.

In the rays of sun, from my front porch
I could touch the stars.
It is completely silent and
the world around me has turned
vivid warm shades.
I catch my breath and pull closer,
the heat penetrates me.
I need to be in the light;
indoors I feel a chill across my skin,
it creeps and is unfriendly.
I go into the light.

I decide that Joan of Arc
had a miscarriage and that was why
they killed her.
And Morrissey, he doesn't actually like
gladiolas
he just tells people that so when
they come at him with flowers
it just reminds him of the fact
that they don't know him at all.
How clever he is.

I tried laying in the bed, on the cloth sheets
settling down, taking a rest
surely I had something to do with it.
I turn, I bend, I contort.
There is no relief.
Please let it stop.

I drink red wine and eat chocolate;
chocolate might be able to keep the pain at bay.
I make tea, hot passionflower tea,
so named in memory of Jesus's crown of thorns.
The tea is soothing some and the pain calms for
a couple of hours.

The doctor said take ibuprofen
was he kidding me?
It is like my uterus is trying to rub itself clean.
Pain radiates from below my ribcage
half way down my thighs.
That is more than half my body mass I think.
More wine, I need more wine
and heat, but I'm not allowed to bathe.
A hot water bottle, a red rubber vessel,
becomes my most prized possesion
filled to the top with hot water.

I breathe deeply,
isn't that what women do?
But breathing is for putting out babies
and there is no baby here
just a cruel test drive
a fire drill
an exception.

Except that God wants me close
closer than ever before; he needs me
to be strong, so strong
I'm not strong enough.
But his rays wrap around me
the growing light and love
I'm not alone, why I'm not sure
and no, it wasn't so clear right then
but I'm sure of it now.

God's children die for our sins
and mine, yes mine too
but not any more than anyone else's
and my baby didn't even come
it wasn't time yet, not our time.
Will it be soon?

So Many Days

I am a waterfall, the weight which pulls down constantly;
a fork, its tines twisted and useless;
a witch wanting to take babies from their mothers
because everyone should know how empty I feel.
I am like Scotland, rubbed raw of her Caledonian forests;
a bird frantically wanting to make nests;
an old teacup with a rotten egg.

I want to be hope on the horizon of a distant ship;
a comfort to those at my breast;
all daisies and dragonflies.
I wait, I count days, so many days

Grieving Loss

I think the hardest part about early loss, especially for us first time mothers, is that we are just starting to get used to the idea of being pregnant and beginning our plans for the next year and then suddenly you aren't expecting anymore. One book I have talks about how it is helpful to recognize that you and your husband are grieving different things -- you each had your own hopes and dreams about your baby. Over the past week my partner and I have had some ups and downs, sometimes he's the only one I can talk to about it and other times I hate how he acts about our loss. Try to use your extended network for support and not just your husband, it can help a little in my experience. But do let yourself grieve.

A new article/research that looks into the role of progesterone and
estrogen as influencers of fibroid growth.

Sex steroidal regulation of uterine leiomyoma growth and apoptosis

[The abstract is available to anyone, the full text requires a
subscription or you can pay for 24 hour access.]


UPDATE ON ME
My beta dropped this week from last week from 543 to 289 (thurs to
tues) which is a good sign and the doctor says we can just wait and
do another blood draw on Monday (the other alternatives were a repeat d&c or methotraxate - yuck!).

The rest of my bloodwork came back normal, which is good since I've
been bleeding/spotting for a month.

My basel temperature also dropped for the first time since the
miscarriage (where it dropped just one day) and is the lowest it has
been since I got pregnant. Keep your fingers crossed that all goes
well and that I get my period in the next week.

I got measurement info about my fibroid, here's for the last 4
ultrasounds (approximately) -- in September 2002 it was 6x6 cm:

Feb 2004 - 6 x 6.5 x 9 cm

June 9 2004 -- 6 x 7 cm (day I found out I was 2.5 weeks pregnant,
with weekly acupuncture treatments and chinese herbs starting in
January)

July 8 2004 -- 9 x 9 x 11 cm (after 3 weeks on 100mg supplemental
progesterone and one week prior off to the ultrasound - 6.5 weeks
pregnant)

August 17 -- 9 x 7 cm (with beta still elevated post miscarriage)

Interesting Facts

Male DNA doesn’t kick in until day 3 of cell division…

“Surprising to many, the male genome (sperm DNA) is silent in the first 3 days of embryo development. The oocyte drives the development and cleavage of the early embryo. On Day 4, a critical switch occurs, and the male genome is turned on. At this time, the maternal and paternal genomes begin to work in concert to orchestrate the activities of the newly developing embryo.

It is at this time - Day 4 - when abnormalities in the paternal genome may begin to have what can be profoundly devastating effects on embryo development. Therefore, using sperm with abnormal DNA for ICSI may lead to normal fertilization and early embryo development yet be followed by embryo death expressed as a failure to implant (no chemical pregnancy) or early pregnancy loss (prior to an ultrasound-confirmed heartbeat.)“

from: ICSI and SCSA Sperm Diagnostics

http://www.inciid.org/newsletter/feb/scsa.html





Maternal RNA helps fertilized egg read DNA instructions

“From the moment of fertilisation, the embryo grows as the cells of the fertilised egg multiply. However, there is a problem. How can the DNA be read if the materials needed to read it have not yet been produced? The answer is that they are provided by the mother in the form of mRNA and proteins. The early stages of development are controlled directly by the mother's genotype for about the first three weeks, in humans, after which the embryo's DNA takes over.”

from: Conception and Development

http://www.gender.org.uk/about/04embryo/44_cncp.htm





Paternal DNA grows placenta and gestational sac, maternal DNA grows healthy embryo

“...These observations suggest that genes expressed by the paternal genome are directed towards the development of extraembryonic tissues essential to support the growth of the embryo, while the maternal genome appears to be geared towards expressing genes that contribute to proper embryo development. The opposing tendencies of the male and female genomes as well as the elucidation from mouse studies that Igf2 and Igf2r are imprinted genes with conflicting functions led to the development of the most widely recognized theory of imprinting, the ‘parental conflict’ hypothesis (Haig and Graham, 1991; Moore and Haig, 1991). This theory proposes that the paternal genome has evolved to express genes that favour the extensive use of maternal resources and lead to optimal fetal development and growth, thus ensuring transmission of the father’s genes to the next generation. On the other hand, genes expressed by the maternal genome serve to counteract the effort made by paternally expressed genes, and limit investments in embryo development and growth in favour of salvaging resources for future pregnancies.”

from: Potential significance of genomic imprinting defects for reproduction and assisted reproductive technology

http://www.humupd.oupjournals.org/cgi/content/full/10/1/3

Too much progesterone -- looks like fibroid grew

I'm still recovering from my miscarriage post d&c and I'm thinking that my uterus is mostly back down to its smallest size, wrapped around my fibroid. I had a feeling that my fibroid grew during the early weeks of pregnancy but since the uterus was enlarged it was hard to be sure. Now though, when I lay on my stomach (doing some exercises on the floor last night) I can feel my uterus/fibroid as I lay there. Big bummer eh? (I had a 6x7cm single intramural fibroid on the right side of my uterus)

My doctor put me on supplemental progesterone since my levels tend to be low, 50 mg of progesterone via vaginal suppositories twice daily. The progesterone actually made me feel like I was on a roller
coaster -- I felt horrible. I only know it was the progesterone since I stopped taking it when we found out our embryo wasn't developing and I felt so much better.

My progesterone level when checked last fall was 9.4 ng/ml, when it
was checked when I got pregnant (about twice the number of days from
ovulation as when I had the previous test) it was 19.8 -- so it had
doubled in twice the amount of time. Studies have shown lower
progesterone levels have been linked to higher miscarriage rates
(http://www.inciid.org/fertinews/progthresh.html), although there is
some disagreement in the medical community as to whether or not
supplementing progesterone will help keep women from miscarrying.

So, I'm not sure if I just have lower progesterone and that's normal for me and it will be fine, or if it might have contributed to our loss (one can only speculate at this time). I imagine that it is possible that my progesterone was low and I needed supplemental but maybe not as much as I was given, or that maybe just the fact that my fibroid is present means that the extra progesterone is going to cause growth regardless and unless it is removed it will always cause the same problem. Hormone levels in early pregnancy aren't that high, so it is possible that this was more progesterone than I could handle and that it wasn't balanced out with the estrogen.

I'll let you know if I learn any more, if my fibroid shrinks any or
if there are new numbers from the ultrasounds I had in the past month about the size change from early June.

A message to another woman going through a miscarriage:

I found out on July 1 that we had a blighted ovum, so there wasn't a baby but just a gestational sac. I was deeply sad the first few days about not getting to be a mother. My doctor had us do a follow up u/s the next week which confirmed that no baby was present.

I was offered d&c or to miscarry naturally, I also looked into mifepristone (RU-486) but my doctor said since I have a large fibroid that he didn't think it was a good idea. My doctor was out of town the following week and I opted to have the d&c on July 19th. I figured I was giving my body a good chance to figure it out on its own by waiting.

Well, nothing changed while I waited and it just got kind of frustrating in a way that my body was spending so much energy on a pregnancy that wasn't going anywhere. I would see pg women on the bus or walking downtown and think "I'm pregnant too, but with nothing" and I hated having that in common with them. I also found that I couldn't talk to most people about what had happened, since it wasn't over yet. People heard about our failed pregnancy but didn't quite understand that I was still pregnant.

I had the d&c a week ago on Monday and it wasn't that bad. My doctor is an RE and did an u/s guided procedure to just remove the products of conception and not disturb the endometrium. The full on scrape out type of d&c can lead to scarring. [link=http://worthwhile.blogspot.com/2004/07/im-back-and-i-survived.html]You can read about my d&c here[/link].

The d&c is just helping move along the process of ending the pregnancy. The body has one way to recover from pregnancy and it uses it for miscarriage as well as normal delivery. I'm sure the resulting symptoms are stronger the longer one has been pregnant since the hormone levels only get higher.

[b]I'm someone who likes to know the details about what is going on so I'm sharing my experience with early pregnancy loss with you but skip if you don't want to know[/b]

There isn't a lot of information about what happens post d&c and I don't want to freak you out but in order to prepare you (and others) I will describe what I experienced (and other may have different experiences):

Day 1: (day of procedure) Feeling a little out of it and tired the rest of the day.

Day 2: I went back to work but couldn't really do anything. I felt kind of numb about the experience. Some cramps and very light spotting. A hot water bottle helped.

Day 3: Felt very tired in the afternoon. Still light spotting and occasional cramping. Fairly productive at work. In the afternoon I started feeling really sleepy. I felt sick in the evening which I think was a combination of a 24-hour virus coupled with a big hormonal shift. I got bloated and had a fever overnight (probably unique to my experience).

Day 4: Headache, neck and backache. Stayed home. Still had a fever for part of the day. Slept in the afternoon.

Day 5: Still felt a headache, stayed at home. Cramps all day long. Around 4pm they started getting worse. I tried laying down but they were overwhelming. I had really intense cramping which hurt from just below my ribcage to halfway down my thighs. I took ibuprofen but it didn't really help. Red wine and a hot water bottle offered the best relief. I started bleeding finally around 10pm. The labor like cramps went on until 2:30am at which time I guess they subsided or something because I fell into a deep sleep.

Day 6&7: More cramping, headache, backache and now sadness. Sadness and anger at having to go through this experience.

Day 8: Back to work. Very weepy. Still uncomfortable with cramping.

Day 9: Stayed at home. Saw my chiropractor for a regular appointment (treatment for a back injury) and asked him to do what he could to make sure nothing was contributing to the cramping pain. In the afternoon I had a massage and the massage therapist gave me an abdominal massage, not deep tissue or anything just helping go over the middle. I cried during that part. I ran a little way with my dog in the park and my breasts were killing. I realized when I got home that lactation had kicked in.

Day 10 (today): Stayed at home again. I was feeling very exhausted today. I had an acupuncture appointment this morning to help balance me out. He told me that my liver was out of balance and that it was throwing off my kidney and spleen as well. He said that the bleeding aggravated my anemia and that there was some blood stagnation. He helped get rid of a lot of the pain in my abdomen. I asked him what I could do for my liver since it seems to be the most out of whack and he suggested a small amount of red wine -- which I had already been taking each day and really did seem to be the only thing that helped.

I looked up in my medical endocrinological text today about the lactation thing. Evidently 3-4 days post delivery the levels of progesterone and estrogen drop and prolactin has the stage to itself, those other hormones no longer suppressing its action on the mammary glands. It is supposed to go away on its own, provided you don't add any stimulation, in about a week or so.

The only thing that I would do differently if I could turn back time would be to know about this process ahead of time so I would be more prepared than the fact sheet they gave me that said "you may experience some cramping and bleeding" and I do wish the doctor had given me a prescription for a strong pain killer ahead of time.

The other thing I think we should accept is that society doesn't expect women who have gone through labor to deliver babies to go back to work right away. I think we need to remember that if we who have miscarriages experience labor, that we give ourselves the same TLC that we would want as a new mother.

I'm really sorry for your loss but hopefully knowing more about the physical process will help you through it. It is an emotionally and physically draining experience but allow yourself time to grieve and recover. I think I'm going to wait a fully cycle to try again, but maybe not.

I had the worst time yesterday from about 4pm. I was having what I can only describe as someone stabbing me multiple times in the abdomen with a sword and then dying. These were uterine cramps that were probably similar to labor. My uterus decided that it was time to redecorate and worked really hard to rip out the old endometrial lining. It went on for hours, from 4pm until I fell asleep and was still squirming when I got up to pee at 2am.

I tried everything I could think of -- red wine (4 glasses), passion flower tea, lemonbalm tea, chocolate (no really, it is supposed to help), anti-cramping meds I had from France when I had salmonella poisoning, a hot water bottle. Finally I took a muscle relaxant at 12:30 and that seemed to take the edge off a bit, at least it helped me sleep. I felt like a bit time drug abuser, and normally I'm such a straight-edge person, but I had to do something.

I finally had some more productive bleeding so I guess all my uterus's hard work was paying off. It was so bad I considered taking a taxi to the hospital and asking them to give me a sedative.

My partner isn't here, he left for Los Angeles yesterday to spend the weekend with his brother and mother. It's his brother's bday. I'm so glad that I knew not to go, I had a feeling something like this might happen and I couldn't imagine going through it on a plane!

I'm feeling better today and my exciting news is that yesterday my basel temp was 98.2 and this morning 97.8 -- the lowest temps I've had since I was pg. Actually this morning's temp puts me back below the CL and so we have actually reset the cycle on my body! Yeah!

ouch! Agonizing and debilitating cramps

So Wednesday night I lost half of my pg belly -- that was pretty dramatic. I can't believe how fast my body was reorganizing itself.

Today, Friday I missed work again since I still had a killer headache and some cramping. This progressed to major agonizing cramping around 4pm that had me moaning and writhing in pain. I ate chocolate -- helps keep anandamine, a pain and tranquilizing substance the body produces (similar to THC in marajuana) around in the body longer. I drank 2 glasses of red wine, took an anti-cramping drug I got in France a couple years ago when I had salmonella and then drank 1/3 cup of passion flower tea. I then tried breathing exercises and sat in the summer heat on my front porch with a hot water bottle for 2 hours and finally my cramps started to subside.

I was then able to go out for dinnner with friends, drank more red wine, and the cramping was pretty quiet for a couple hours. Then I went to a friend's house and she's an herbalist and made me lemonbalm tea which, like passion flower, is supposed to be a nerve tonic. Drinking that and holding the hot mug to my belly both helped some as the cramps were coming back.

I wasn't having any major bleeding until about an hour ago, still light by the menses benchmark but red and not dark like before. I feel like someone has stabbed me with a sword a couple times in the abdomen and I'm dying to be honest. I'm now having another glass of red wine and going to go to bed with the hot water bottle clutched to my abdomen in spite of the heat wave we are having here in Seattle. Whatever it takes.

OUCH!

I hope this subsides by morning.

I was so sick yesterday and my partner had to go to work in the morning and I was worried. Last night I even told him the nice things I wish he would say to me -- "I'm sorry you aren't feeling well", "I'm sorry this is so hard on your body", "I love you and I want you to be better". He then goes, "I'm really glad you have that out of you and had the procedure done." I gave up and asked him to bring me a hot water bottle for the cramps which he did. What can we do but throw up our arms. They mean well. Come to your girlfriends for the real support.

Why does it seem like there isn't any information about what happens when you miscarry, not the clinical stuff but the physical stuff.

When I left work yesterday I was feeling a bit woozy so I bought a bottle of water before I met a friend visiting from out of town. We then walked to a pub and I felt like laying down but I decided to be a trooper and push through it. I drank about 36 ounces of water over the next few hours and got incredibly bloated. I remembered that the hypothalmus helps control our cycles and also is involved in managing how much water is in our systems -- its what decides when you have to pee. I figure that my brain and endocrine system is starting to make some big adjustments but I was so swollen. My skin felt hot, my breasts had shooting pains, I had a headache and my hearing was weird -- everything sounded hollow.

We took a cab home and I got in bed and took my temp with has been over 100 since last night and was over 101 for several hours. I ache all over, my back and neck and legs in particular -- sort of like when I get the flu. This morning I also had some intense cramps and my heaviest bleeding so far of dark menstrual blood but it isn't really heavy compared to my period.

My partner called the doc this morning and they say this is normal and expected. I can understand why reorganizing my body to shift functions away from the pregnancy is a big deal I just didn't know I would feel like I had been hit by a truck.

Is my experience so far similar to yours? Is each miscarriage its own deal? This is a fairly cruel process overall but I guess that's the way the equipment works. I just makes it even harder that we don't get to have a baby and instead have to go through this.

I was starting to get worried because I was only spotting ever so lightly. This morning I decided that some exercise might help so I did some ballet for 30 minutes and tried relaxing my uterus. This did help as the bleeding has increased, but it is still fairly light. I'm glad to be making some progress.

Actually a little while ago I went to the bathroom and had a cramp so bad that it brought tears to my eyes. I'm now sitting with a heating pad on my lap as I work and I think it will help take the edge off.

Adventures in miscarrying.

I've researched progesterone a lot and I've used both a topical cream and Rx vaginal suppositories. My progesterone level was low when I had my 7dpo test last October, and I have other small symptoms of low progesterone as well. My mother had low progesterone prior to conceiving my brother, after 3 miscarriages -- although she is allergic to iodine and has thyroid trouble.

My P4 at 19 dpo was 18.4 which is low I know. I used NPC (natural progesterone cream) for 4 days (19dpo-22dpo) and then the vag. suppositories (V.S.), 50 mg twice daily starting a week after that (there was a problem with the Rx so hence the delay.

My early pregnancy was full of queasiness (like motion sickness -- I recall it now from physical memory like being on a roller coaster -- which I hate!!!). My breasts were huge and sore, I felt like I was surrounded by cotton -- I couldn't think clearly. And my mood! I was like Attila the Hun there, snapping and losing it at the drop of a hat.

When I found out about my blighted ovum I stopped taking the progesterone and magically I felt 100 times better. I had no idea when I was taking it that it was the progesterone that was jerking me around so much. Now that I've finally kicked the bugger out (d&c yesterday) and I'm preparing myself for my next try (in a few weeks or so) I feel just so confused about the progesterone. It seems like it caused some fibroid growth, made me feel like HELL and hardly functional at all. I'm feeling reluctant to take it, at least in that high dosage the next time.

I didn't have any bloodwork done when I was on the V.S. so I don't know if my body is super killer at processing progesterone or if I'm absolutely horrible at metabolizing it so it just builds up to unbearable degrees. I guess I'll have to talk to my doc.

I'm back and I survived. Overall I have to say it was a relief to finally have this d&c done. I think it was all the prayers that helped make this easier for me. Thank you!

My doctor was great, so careful and conservative. He definitely has a lot of experience working in that area. The nurses were awesome; they were so nice and caring. The procedure was done in the operatory suite where they retrieve eggs for IVF patients. The nurses gave me warmed blankets over my shoulders and stomach and kept my legs and feet warm with towels as well.

Having had a more than typically painful HSG last year, I think that I was better prepared for the sensations which were similar but just more and longer. When I had my HSG the RE tried to help stretch out my uterus for better films, the uterus being wrapped around the fibroid. She did this by pressing the speculum in different directions which pulled on the ligaments I guess. I had cramps for days afterwards. I also have periodic pelvic pain from my fibroid so again, this wasn't shocking to me. If I had never had any such discomfort in my life it probably would have been worse. The nurses and doctor all said that I was a great patient with a good pain tolerance. They asked if I did yoga, I told them that I danced -- I think they were amazed that I could sit in stirrups for so long as it took a while for us to get started.

The worst thing was that it took 3 tries to get the IV started and I left the hospital with bandages on both arms.

My partner was there in with me the entire time which was a great relief, more than I would have supposed. Once the sedatives kicked in I kept babbling on and on about all kinds of things although mostly about how odd this experience was.

Yesterday afternoon I came home and took a nap on the couch for a while. Then my sister and one of my best friends came over and spent time with me for a few hours. my partner and I walked down the street for a late dinner at 9pm. I mostly felt tired.

I feel a little crampy today and I've had just a minor amount of spotting so far. My temp was a little elevated this morning so I'll keep an eye on that. It might just be my thyroid trying to adjust itself at this point.

I actually have less pelvic pain now than I did before the procedure, I think that is because of my fibroid already distending the uterus. My breasts are also starting to soften slightly -- yippee! My doc is still cool with me TTC with the fibroid intact. I did find out that he is leaving the hospital to go out on his own at the end of the month. He'll only be 30 minutes away in Everett, WA but still I'm bummed since that is a hike and it took so long to find someone I like and trust.

I have some tears trapped inside of me still, I know they will come out sooner or later but I'm doing pretty good over all. A little numb maybe but I feel like a survivor.

I dragged my partner out to a lavender festival this weekend. It was great to get away from home. We spent the night at a friends house and drove around the countryside today. I got a lot of fresh air and sunshine and didn't allow myself to mope around all weekend. I feel like it is crazy that our embryo didn't develop and that we've known that since July 1 but here it is the 18th and I'm still pregnant. Almost over finally. It's been an odd journey over the past couple weeks, including hormonal ups and downs. I'm feeling closer to normal today, not sure if it was the sun or if maybe my HCG is dropping. My nipples are still sore and my abdomen is still fluffy (aka: fat).

I'm about to head over to the hospital to get un-pregnant. I wonder how long it will take to get over this. My biggest thing now is finding some sanitary napkins in my purses that I can consolidate. I haven't bought any and I was just out when we found out we were pg in June. I hope I don't feel bad this afternoon. Send me your best thoughts and prayers please.

I'm about to head over to the hospital to get un-pregnant. I wonder how long it will take to get over this. My biggest thing now is finding some sanitary napkins in my purses that I can consolidate. I haven't bought any and I was just out when we found out we were pg in June. I hope I don't feel bad this afternoon. Send me your best thoughts and prayers please.

These were some of the more useful links that I've found in understanding what was going on with my blighted ovum/early miscarriage. I thought I would share.

GENERAL MISCARRIAGE

Understanding Miscarriage

Early Pregnancy Loss

Miscarriage Explained

Early Miscarriage

Miscarriage and PCOS

Missed Abortion

Post-partum Bleeding (lochia)

Miscarriage Information


BLIGHTED OVUM

Blighted Ovum

Blighted Ovum

Anembryonic gestation


DILATION AND CURETTAGE - D&C

Dilation and curettage

Dilation and curettage 2


MEDICAL MANAGEMENT (DRUGS)

Methotrexate For Noncancerous Conditions (Systemic)

Pharmaceutical Induction - Pitocin and Cytotec (Misoprostol)

Medical Abortions

Completing A Miscarriage


I found this study that was published earlier this year and it was interesting because it was both effective, used a lesser dosage than is commonly used in the US currently for abortion purposes and had fewer side effects.

Medical management of first trimester miscarriage (blighted ovum and missed abortion): is it effective?


NATURAL INDUCTION – NOT RECOMMENDED

I did find this link with information from midwives on ways to medically complete a "missed abortion".

Completing A Miscarriage

Here's someone's reading list from Amazon.com on herbal abortions -- no I don't recommend going that route, I found some other links that talks about how toxic it is for the mother.


RETAINED TISSUE

Detection of retained products of conception following spontaneous abortion in the first trimester

GESTATIONAL TROPHOBLASTIC DISEASE/ MOLAR PREGNANCY

Gestational Trophoblastic Disease


Gestational Trophoblastic Disease (Sloan Kettering)


"Of utmost importance is careful follow-up with serum beta HCG (BHCG) weekly until less than 100 mIU/mL and then every two weeks. The patient should have a careful pelvic examination every other week and a chest x-ray every 4-6 weeks. Once the titer of serum BHCG has fallen to normal levels, these two examinations need no longer be done; however, BHCG titers need to be repeated every 2 weeks for 3 months, then monthly for 3 months, then every 2 months for 6 months, then every 6 months for 3 years. Each patient should be counseled in the use of a reliable birth control method." (from the NIH site)


"Women should be advised to avoid pregnancy until hCG levels have been normal for six months following evacuation of a molar pregnancy and for one year following chemotherapy for gestational trophoblastic tumour. The combined oral contraceptive pill is safe for use by women with GTT (III-C)."
(from: http://sogc.medical.org/sogcnet/sogc_docs/common/guide/pdfs/ps114.pdf)

Embolization of Bleeding Residual Uterine Vascular Malformations in Patients with Treated Gestational Trophoblastic Tumors


Molar Pregnancy



GRIEVING, SUPPORT & RECOVERY

http://www.pregnancyloss.info/

SHARE – Pregnancy and Infant Loss Support

Pregnancy After Miscarriage (PAM)

Hygeia Foundtation & Institute for Perinatal Loss and Bereavement

Coping with the 5 stages of grief and bereavement

October 15th - Pregnancy and Infant Loss Remembrance Day

What is Grief?

Crazy. I just got off the phone with my 95 year old aunt. My family is back East and I haven't really been in a good place to talk about what has happened with my pregnancy. I sent email and hoped that my parents could pick up the slack.

My aunt didn't know, somehow she missed the email. I think she was calling me because she was excited. She started telling me about the loss of her only child, stillborn, some 70 year ago. She also lost her husband, and her best friend died towards the end of her pregnancy -- all within the same year. I'd heard this story before but not from her. When we finished talking I could tell she was crying. I feel so terrible for her suffering, and for bringing back bad memories.

I'm having a bad day today so I stayed at home. I was dreaming about the d&c scheduled for Monday and I woke up feeling very emotional and out of sorts. Monday my procedure is scheduled for noon, no food after midnight, only clear liquids until 5:30 AM or so and then I'll be on a fast. I can only imagine how crappy I will feel post procedure since I'll still have the HCG in my system -- and that seems to be what makes me puky/hungry all the time.

I don't know what to do except pray for all the lost babies and for their mothers.

I saw this posted on a couple other sites and thought you might be interested.

quote:

“Miscarriage Research Opportunity
Researchers at Women Care, an organization devoted to improving medical care for women, are conducting an exploratory study of women who have experienced a miscarriage. The purpose of the study is to identify what changes can be made by the medical professionals who care for women before, during, and after a miscarriage.

The researchers will be focusing on a woman's level of satisfaction with her healthcare providers and will also gather data on what options women were given, what information they received, and post-care treatment and follow-up.

Results from the study will further our understanding of the care extended to women during a miscarriage and will provide valuable information to the medical community as to the unique emotional and physical needs of their patients.

Study participants must be 18 years or older and have experienced a miscarriage (pregnancy loss before 20 weeks of gestation). Participants will complete a research questionnaire, which will either be emailed or mailed to them. The form will take 15-30 minutes to complete.

If you are interested in participating in this important new research please contact the research team at : womencare@pclink.com or Women Care, 224 Benton Avenue, Wayzata, Minnesota, 55391.

Thank you in advance for your participation in this critical study.”

I had the option of scheduling the d&c with the other doc this week but I've never seen her and I really like my RE. He's out of town this week. With a "missed abortion" it can take until weeks 10-16 for the body to recognize that the pg isn't happening I understand. For some women that won't happen at all and their bodies just keep increasing the production of HCG.

No, I don't have any signs that anything is subsiding, it is a little tiring and the worst is that being around other pg people I think to myself "I'm pg too, but not with a baby" -- it is a little isolating.

In the meantime, I'm going to try to hire some painters to patch and paint our hallway/stairwell, dining room and living room. Our house is from 1906 and the walls need some repair. I would do it but my neck always goes into spasm if I do too much since I've had whiplash twice. I better start calling around today to start getting quotes. Hopefully I'll get pg again soon but I wouldn't want to be around the paint fumes in early pg so I better use this TTC break wisely.

I asked my partner yesterday and he said that he did want to start trying again as soon as we're able to. My goal is to be pg by the time I have my next dental appointment right before Christmas since they know and I would hate to have to tell them that it didn't work out.

I don't know what it is that makes me research so much. I think it is just my nature, I feel more comfortable when I know what is going on. My mother said that as an infant I would scream when she put me in the bassinette because I couldn't see what was going on. If they placed me in the baby seat inside of the bassinette I was fine since from that position I could look around. I think it is related to that this researching bug I have.

I'm tired of being pregnant, my symptoms are growing again; they had subsided when I stopped taking the progesterone. I have a tummy that I couldn't exercise off if I wanted, my breasts are hurting more in the morning and my nipples are sore too. I'm also having weird food/appetite things again where I'm hungry but feel yucky or starving and eat way too much. It is hard to eat properly since half of what I eat sits like lead in my stomach. Just one more week until it is over.

It is a little bit interesting getting to watch the symptoms without having them be as emotionally charged as when you know you are growing a new life inside of you. This is my fire drill, just preparing me for the real thing. We were talking last night and my partner said he had played his first game of basketball since turning 40. I said well I got pregnant while I was still 33 and he replied "I got someone pregnant before I turned 40!" It was kind of funny.

We had over a bunch of friends for a party last night and this included 3 small children and 2 pregnant women. I was dreading anyone asking me when we were going to start a family since we've been trying so long (that much they know) but most of them we hadn't told we were expecting.

I try to protect myself, however I need to, when around talk of pregnancy, babies, etc. While I'm happy for people as well, interested and excited for them all, I know that I'm just too sensitive right now to be able to communicate about that with them comfortably. At the same time, I feel like I have more respect and understanding for how awesome (the older definition) the process of bringing new life into the world, and even caring for small children from both my brief window into pregnancy and from watching the changes our friends with children have gone through. I might not be able to share in their enthusiasm but I want pregnant women to be able to complain and fuss and worry and hope to their hearts content -- it is part of the process.

I thought that you might be interested in this new research, I think it offers some solace for those who have miscarried.

Fetuses give mothers a gift of cells, study says

It's my birthday and I'm how I thought I would be, not in the mood for celebration. My great-aunt phoned from NY this AM at 6:50!!!! She's 95 so I won't fault her for that. I just don't want to talk to my family at all though. I did leave a message for my parents a little while ago, I haven't spoken to my mother since we found out about our B.O.

My partner's family was all here before, my little nephew too. And his sister-in-law, the one who is due in February. I feel numb around them kind of. The party tonight is going to be hard, I'll probably go hide in the attic or something. His mother and SIL did make all the food for the party yesterday so we didn't have to do anything which is really nice. I just wish I didn't feel this way.

Today I'm crying, at least right now I am. I guess I had to hold it in all week at work so I might as well let it out now while no one is around.

I dreamt last night that my uterus kept swelling on the non-fibroid side so that I had a large lump on one side of my abdomen. Since my gestational sac is still growing that might be the cause. I'm sooooo tired this morning, I think because I didn't have enough sleep last night. I'm due to call a client in 15 minutes to review a PowerPoint presentation -- I need to go review and see if I can come up with any intelligent questions and poignant things to say. Maybe I can send someone else out for coffee.

I'm getting my hair cut today for my birthday, I colored my hair last night -- just enough gray in my dark hair to make it noticeable and with the pg I was holding off coloring it. Now I have the opportunity to be pg and break all the rules -- I can eat soft ripened cheeses, clean the litter box (we don't have one but bear with me), travel internationally, not take my vitamins (although I probably should), eat sushi, dye my hair, eat junk food, drink coffee -- how about them benefits?

The second u/s yesterday showed again just a big empty sac, that keeps growing. Actually the sac size matches almost to the day the length of my pregnancy. My RE is due to call me at work today to discuss my options. It is frustrating to be pregnant but not -- you want to be either not trying and not pg, pregnant with a healthy baby or trying. This is purgatory.

The prospect of a d&c (dust & clean I saw someone refer to it as) kinda freaks me out

I had my follow up u/s this morning and my gestational sac now looks like an hourglass and the doc couldn't rule out that there wasn't anything growing at the top side of that hourglass (farthest from the u/s vaginal probe). He said it is possible that it is just the mild calcification in my fibroid that could be bounding the sound echos around. My fibroid may be the thing that is squashing the sac in the middle like that. Still there is no reason to believe that my fibroid has anything to do with the apparent lack of an embryo inside of me.

Just to be sure my RE has me going for a high-end u/s series (abdominal and vaginal both) in radiology this afternoon.

My partner was so sweet in that he wanted to come to the appointments with me, both for moral support and to see what is going on. Aside from that thought, it is amazing to see the extremes he has gone from "it was too soon for us anyway" to "it was mine too and you have to let me deal with this as well". Just as paradoxical as the infertility discussions so many of us have had with our partners. Me I wanted to sit on the couch and watch TV all weekend and just grieve, he on the other hand went on a cleaning mission both inside and outside the house -- probably to take his mind off of things.

We were totally at each other over the weekend we were both so stressed by the news from last week's u/s. He wasn't listening to me and that was really getting on my nerves. No, it wasn't like I was asking him to put the laundry in and he wasn't listening, this was more like I'm not sure we should have 50 people over on Saturday for our birthday party because I don't know how I'm going to be emotionally. We're working past it.

PG loss isn't something that is easy to take at all. I hope that you are spared from this experience but it can and does happen.

Still let's keep our fingers crossed for this afternoon's u/s results.

I haven't posted here so much in a while, I was off of NPC (natural progesterone cream) for a while during my acupuncture treatment for my uterine fibroid. I did have a positive pregnancy though and my RE had me use progesterone suppositories. Last week I found out that we have a blighted ovum so I stopped using the progesterone. I thought I would add my experiences with being on it and off of it in higher doses just to help add to the information pool.

The week I found out I was pg, several days after AF was due I was having a lot of light contractions in my pelvis. My progesterone tested at 18.4 ng/ml at 18dpo (I think it was). I used my Emerita for a few days until the Rx was filled (prescription was lost at first - argh!) and that helped keep the cramps under control.

I started using the suppositories (50mg) as directed, twice a day when going to bed and before I got up in the morning; about 20 mins before I was advised by the nurse and I shouldn't worry about it after that since that was about all my body would absorb so she had heard from the pharmacist. Vaginal progesterone suppositories aren't fun, they melted for hours and added to the discharge so I had to wear a pantyliner at least and they might still leak onto underwear and clothing.

I thought my pg symptoms were really crazy how strong they were -- sore, sore breasts, bloated belly, mood swings, my head felt like it was full of cotton, nausea daily (mostly felt like motion sickness coming on)... Now that I'm off the progesterone I have to say that I feel sooo much better and more like myself. I haven't had any cramping really since I've been off the suppositories, my breasts are still sensitive but not quite so "punchy", and my belly is more normal.

I stopped using the progesterone cold turkey in the hopes that it would help my body realize that the pg wasn't progressing but no such luck. My temps are still up in the AM (around 98.6), no sign of anything vaguely looking like spotting or cramping.

My fibroid feels enlarged but until my uterus isn't swollen by the pg anymore I can't tell really about any growth. I didn't have any constipation problems from being on that much progesterone, actually after I stopped it my digestive system was totally blocked feeling and it's taken every diet trick in the book to get things moving again (sorry if TMI).

So, my experience with higher doses than we use for topical treatment is that progesterone is really strong stuff. (and don't put it anywhere near your breasts as I learned months ago, that will make them blow up like balloons and hurt like the dickens -- although I had the same reaction with the higher dose suppositories).

I'm doing okay. Feeling majorly blocked in this weird way and I am having strange dreams like military or police taking me away because I'm in this odd status of pregnant/not pregnant. Last night was one after another dreams about trying to get the pregnancy tissue out of me. I have a follow up appointment with my RE tomorrow AM to see what's up.

Stopping the progesterone, plus the emotional upset has really messed up my digestion. I don't have a major loss of appetite but when I do eat I can only eat a half portion before I feel horrible. I've also been horribly constipated, which I wasn't before stopping the progesterone. My breasts are still sore but not as over the top large as they were with the progesterone. That progesterone is really strong stuff, it made me feel like I was in a haze, contributed to bloating, heightened my mood swings -- not fun stuff. I'm glad to be off of it.

I also wanted to add that I took a HPT yesterday and it came back negative. My test on June 9th was so strong it just about blew me over. Having the negative test means that my body is starting to shift gears already. I do have to say that I'm feeling very tentative and unsure about this next part in the process. I wish it would just be over, actually if it could just mirror my period symptoms I would be satisfied because at least I know what that feels like.

The thing that is so strange to me is that there is so much talk and information about infertility, pregnancy, and childbirth but there doesn't seem to be a lot of information about what happens when the embryo dies. I feel oddly blocked and uncomfortable in my lower abdomen. I don't know if it is mild contractions or what, it isn't that specific. My body has already started making shifts, my breasts are significantly less firm, my belly less bloated. I feel less in a haze than I did while the hormones were up, my head is more clear than in weeks. I'm not as thirsty and already I'm not having to get up 3 times a night to go pee. I have a loss of appetite but that it normal for me, especially when I'm grieving. My sleep pattern has gotten even more wacky but I'll just ride it out.

I find the early pregnancy process to be fascinating in a scientific way; that the recognition of the fertilized eggs can trigger such dramatic hormonal shifts and at the same time how the mother's body helps so much to foster the egg/embryo in the early weeks. My body was so ready for this that it took it a long time to see what had happened. I am thankful that I knew what happened before instead of having random bleeding and not understanding the cause. Minor blessings but still worth recognizing.

I don't know that I'm stronger than anyone else, I have sorrow as well but I try to embrace it. I can't talk to anyone because it makes me cry too much, I can write about it though, that helps me get it out.

I had a transvaginal u/s, the 5th one I've had in the past couple years. The sac was well defined, in the fibroid you can see tissue details. My period is like clockwork and I've never missed a period since I started menstruating in 1984. I also was charting and my CF was really clear as to when ovulation was, I either ovulated on May 23 or 24.

I really don't think there is anything growing inside of me beside the sac. The doctor even said, with someone who is so clear on the dates (and I have been charting since April 02) there should be a well sized embryo with a heartbeat at this point. I just don't see how it could have been missed although I have heard of doctors missing women's small fibroid on u/s as well. I do have a follow-up u/s scheduled for next wednesday since the doctor said they don't dx blighted ovum with just one u/s.

I took a HPT today to see if my hormones were dropping and it came back negative. [it must have been due to dilute urine] I think that is a good sign, at least my body is starting to move on. My sister and a friend have called me but it just makes me cry to talk to people right now. How did it happen that we went from waiting at the doc's office to see our embryo's little heartbeat to nothing. What an emotional rollercoaster.

I emailed my acupuncturist and he said it was best to work with my RE on this part. I'm hoping that my body won't be stubborn and that stopping my progesterone suppositories will help to end things naturally. I had felt a shift in my hormones this week anyway, perhaps if I am lucky it was a reduction in HCG production.

I did find this link with information from midwives on ways to medically complete a "missed abortion".

Completing A Miscarriage
http://www.gentlebirth.org/archives/miscrg.html#Completing

Here's someone's reading list from Amazon.com on herbal abortions -- no I don't think I'll be going that route, I found some other links that talks about how toxic it is for the mother.

http://www.amazon.com/exec/obidos/tg/listmania/list-browse/-/3HF72ORQ4LT0R/104-7136724-1655966

That term "missed abortion" doesn't bother me as much as "miscarriage" (or as much I expected it would) since my mother had three miscarriages before she had us three kids and besides to me, right now, that term "miscarriage" sounds like I did something wrong and I don't think I did.

It is not even 5am yet and here I am awake again to the reality. When I woke up I had my left hand laid across my uterus. I guess this is even bothering me in my sleep.

blighted ovum - pregnant with nothing

I had an u/s this afternoon which showed a good-sized gestational sac but nothing inside of it. The doctor was relieved that I already knew what it was -- a blighted ovum (aka anembryonic gestation). I feel so perplexed though, human condition-psychologically challenged and all that. I went from pg to pg with nothing. I'm still pg and my body is still hormonally chugging along.

Having to tell the group of family and friends what has happened will have its own challenges and I wonder if I can tell them in email or a letter. Right now though I'm just wishing I could get off this train to nowhere and just have my body be normal again.

My partner was shocked because he didn't know that such a thing could happen at all. I feel bad for him, he was so excited about our pregnancy.

There are lots of good things about this, I know some of you who have had recurrent losses probably don't feel that way even if you ever could -- I'm sure I would feel the same way myself. My list of good things:

1. I got to be pg for 3 weeks
2. I got to stop being a fertility-challenged person for a few weeks
3. I got to stop worrying about my fibroid and how it might be impacting my fertility
4. We proved that our equipment worked
5. We did it without medical intervention
6. We didn't have to do IUI in July as planned
7. I got to miss my 7-day period for once in my life
8. I've learned more about the amazing process of gestation first-hand
9. I was waiting until this u/s to tell people at work so I don't have to now
10. I get to be me again for a while (if the sadness doesn't overtake me).

My sincerest condolences to everyone who has to go through this.

Does anyone have any advice on how to get my body to flip the switch and change tracks? I contacted my acupuncturist already and hope to see him next week. Maybe he will give me some Chinese herbs to take. Please help me.

it is disappointing but yes, we did prove that the equipment works. And I got to be pregnant for a few weeks even. And it made my fibroid seem like not a big issue and I even got to give the infertility stuff a break. Those are all good things in my book.

I hope you don't mind my sharing but I think we've all been through enough for you to understand. It's just kinda weird going from potential to nothing. I have been and still am pregnant even though there isn't anything other than the sac growing, so this doesn't negate that experience at all. In some ways I'm a little glad because riding on the pregnancy hormones can be a little rough. I did notice some change this week, maybe my body was starting to drop off production of HCG. I felt awful today, even before the u/s though. I already planned to take tomorrow off so I had an extra long weekend. If I am lucky my period will come while I'm away from work and I won't have to have a D&C.

It still is an amazing thing to see, even if for a very short while, how your body can shift gears and start running this other program. I hope you all can experience it -- and me too again soon.

I asked the doc and he said that we should continue trying on our own and just wait a month for my cycle to get back to normal after this fully clears out.

It wasn't me, I didn't miscarry (that seems to place blame on the woman I think), it was just a bad combination of chromosomes. I'm thankful that it is early if this had to happen.

My worst day ever

My u/s didn't go well this afternoon. I have a well sized gestational sac but it looked empty as anything. It looks to be a blighted ovum. I'm a little bummed right now, packing up my stuff at work to work from home tonight.

I have a follow-up u/s next week just to be sure but I think it is over.

Today I feel totally icky and beside myself. I just feel restless and ill and weepy and nauseous all at once. I leave in a few minutes for my u/s and check up with my RE.

I don't have a scale at home so I don't know what my weight change would be. I feel bigger but who knows.

One of the foods that makes me really nauseous is the smell of rice, you know that corny-like smell it sometimes can have in asian restaurants. Someone brought some into the office before I left for lunch and I was about to... I don't know what would have happened but I did feel ill so I left for lunch.

I had two perfect peaches this morning that were heaven. I was craving them so it was especially nice. What are your favorite fruits right now?

I'll post after my u/s a little later.

a post to another woman dealing with MFI...

We had REs tell us we probably needed do do ICSI as well, it was basically presented as "you can work up to it however you like but it is probably what it will take". We tried the alternative medicine route and supplements instead and I'm still in disbelief that we did it but we're in our 6th week now.

Have you consulted yet with a urologist (UR) who specializes in (male) fertility issues? Out of anyone we worked with he was great to have as a backup and he thought we could do it with my partners numbers (see my sig below) even post vasectomy reversal. Have the S/A tests included tests for antibodies, it isn't a standard test. Also, the UR had us do the SPA test to see how the sperm reacted with the egg membrane. We did that test in May, the test results came back positive and we coincidently conceived the same cycle. He felt that the SPA (sperm penetration assay -- aka hamster egg test -- poor hamster) was useful as a next step in our diagnosis.

Dr Perloe had also suggested to us that the sperm DNA fragmentation test would be worthwhile but we didn't have to go that far.

ICSI is expensive and (not to alarm you but this made me wary) might possibly damage the fertilized egg. I know we have read articles, etc. it is just that a friend of mine is a microbiologist researcher working with reproductive research and he told me that among his colleagues there was concern that this is still a new procedure and the long term risks were uncertain.

You could try IVF with rescue ICSI (just in case the sperm aren't doing their job in the dish) instead.

Go for the vitamins and exercise for your partners/husbands though -- selenium, zinc, vit.c and antioxidents. You want to have sperm that are strong and can optimize the best ones to be stronger.

I really appreciate my vasectomy reversal buddies online, they are the only ones who know what it is like to be in a relationship with someone you can only cross your fingers to have a child with. It is a big gamble and it takes a lot of emotional strength to get through it, especially when you are fighting with a strong biological desire to have children (that would periodically hit me and I couldn't talk to anyone about it). I even asked my atheist partner to pray for me (he does have a spiritual bent in spite of himself), I told him that he should do it because I wanted him to (while crying of course).

My pg symptoms have shifted this week, less of the car sick feeling and now onto vague nausea (there is a difference I swear). Yesterday I threw up in the morning, right before I had to head out the door to my chiropractic appt. I think my prenatal vitamin didn't agree with my stomach. Today has been better. I've been able to push through the fatigue more now, I think it has evened out a bit as well so I'm not quite so sluggish in the afternoon. I have my ultrasound tomorrow afternoon -- can you believe it will be July already?

I'm going on a picnic with a friend on Friday and skipping out on work for maybe the full day. I didn't get to go to NY so I'm due a little R&R. I'll probably be doing some catchup work for the office over the weekend anyway.

Just FYI, someone at my office is in a relationship with a man who already has teenagers, a divorce (of course) and a vasectomy. She's going to be 40 in October and struggles with the fact that her fertile window is closing but her boyfriend, however committed he may be, is not interested in having any more children. Everyone here is lucky enough to have a partner/spouse who was willing to undergo an extremely uncomfortable procedure to restore their fertility. Count your blessings.

A woman I met on the chat yesterday told me to eat sour things like lemonade and sour candy; she said it helped her through her pregnancy. I've been drinking a lot of limeade and grapefruit juice and it seems to go down easy enough. I read that anemia can make m/s worse and that taking b-vitamins can help (although taking vitamins is tough when you are feeling already) I tried candied ginger the other day as well, it helps with seasickness so I thought it might help. It was difficult to think of it as appetizing but it did seem to alleviate some of the stomach discomfort.

Email to a friend

> You may remember my telling you about my fibroid and
> needing surgery and
> all that -- doctors were so wanting to cut me open
> and it felt so
> intuitively wrong. I had even scheduled surgery for
> the beginning of
> October and I cancelled it. The rest of last year I
> spent every weekend,
> and many other days whenever I could slip it in,
> researching more about
> fertility and fibroids. I met with several more
> doctors, consulted with
> a researcher in Toronto all to try to get a better
> handle on what my
> options were. I was pretty depressed too so that was
> why I wasn't
> calling really.
>
> At the beginning of this year I finally found a
> reproductive
> endocrinologist I could get along with who was far
> more supportive than
> the other 2 I had spoken with about our situation. I
> also started going
> for acupuncture treatment weekly starting in January
> and had my
> partner taking lots of vitamins and supplements to
> help improve his
> fertility as well (he had a vasectomy and reversal
> and his morphology
> was poor). I figured that Western medicine wasn't
> offering that many
> options so I had to try the alternative route to
> help preserve myself
> and my fertility. If that didn't work then we would
> try fertility meds
> and insemination -- but we put that off until July.
>
> I have some news though, I'm 5 weeks pregnant with
> our first baby. I
> can't tell you what a relief it is and we are
> soooooo proud that we did
> it ourselves without medical intervention. Our baby
> is due in February.
>
> So anyway, I'm in a much better place than I was
> last summer/fall/winter
> and I would love to see you.
>
> Take care and I'll drop you a line in a few weeks to
> set up a date.

Crazy day today. I woke up and while half asleep was sure that a) it was Sunday and b) that I had slept until noon. I actually woke up at 6:30 today and rather that check the Ovusoft boards I decided to bake a coffee cake.

So, while it is in the oven (the coffeecake that is) I'm drinking raspberry leaf tea and eating a homemade blueberry muffin (I go through baking waves and I'm on one right now). About 30 minutes later though I have an odd feeling come over me and I make my way to the bathroom and throw up a couple times and then it is done. Soooooo weird.

Yesterday I was actually feeling more normal and less queasy, I thought I was getting lucky and that my body had balanced whatever was off balance. Well, that is not entirely true as I started gagging yesterday when I caught a strong whiff of cleaning solution but I factored that as being just my sensitive nose.

My acupuncturist and I have been emailing and he said he can help with nausea and fatigue. I'll probably go for a visit next week and he can let me know if everything feels all right from an energy standpoint although I'm feeling pretty good I think.

Training for the Olympics

1) A book I read about infertility mentioned that for women infertility is like training for years and not being able to play in the Olympics, that's partly why it is so frustrating to us. It also said that it takes men on average three years before infertility hits them the same way as it does us.

2) My partner was kind of bopping along doing his own thing and there I was last September with my surgery approaching and I had a meltdown. I can't have this surgery I told him, I don't think we've tried everything we can yet and we don't even know if this will improve our outcome -- what if it is just your morphology that is the issue and not my fibroid? (!!!!!)

When he realized the gravity of the situation we were facing with major abdominal surgery for me and saw how upset I was he had another S/A and had them check for antibodies (can you believe I was going to have surgery without him checking that!?!) He wasn't willing to take supplements last year until after this all happened as well and that took some time as well.

He wasn't keen on the IUI but accepted it as part of the phased approach to dealing with our infertility. Now that we are pregnant he's so funny because he lets out little things like telling my sister that it feels natural to be having a baby (as an expectant father now of course and as if not being able to procreate was unnatural -- this from the man who had a vasectomy in the first place so he wouldn't have kids!!!), how he thinks his anxiety was related to his infertility, and to see how ready he is for this adventure of starting a family. I see how frustrating it must have been for him but he didn't really talk about it with me at the time.

My partner is fairly communicative but fertility is a difficult topic for men for some reason. I think it reminds them of impotence and challenges their masculinity and sense of self -- much as it challenges our maternal instincts and makes us climb up the walls in anguish.

The book you might want to refer to, it is about understanding the emotions and frustrations of infertility:

Experiencing Infertility

My uterus is expanding on the left, the opposite from my 6x7cm uterine fibroid so now I have two little mounds just below the skin about a 1/2-1/4 inch. I think I might have said before, but I'm not sure if I posted it here, in December my doctor said that my uterus was the size of a 14 week pregnancy. I'm used to my fibroid so it isn't a huge concern (we'll just watch to see if there is any rapid growth). The thing that has my attention is that I need to prepare for a change in my pants and skirts sooner rather than later since there isn't much room left in my pant fronts already.

I'm scared of going into maternity boutiques still so maybe I'll just have to buy a larger size for a while.

I just finished the Girlfriends' Guide to Pregnancy over the weekend and evidently it is common to either have more sex drive or none at all. Orgasms are supposed to be more intense as well. I recommend using a lubricant since things are a little changed hormonally and that definately helped me.

My tummy is sticking out too. Looking at myself in profile in store window reflections at lunch I thought -- who is that pregnant woman? No one else would think so but the boobs don't look like mine and the matching belly sure looks to me like something is up. Just keep eating healthy foods and don't worry about it I guess. The appetite seems to come with the territory.

Don't you all find it so amazing that our bodies are able to switch gears this way. It is amazing to see the changes, I feel like I'm just a passenger myself along for the ride.

We tried to abstain for 3-4 days before a S/A but also made sure that we were helping keep production up all month long. In other words you will have better results if your partner is having frequent ejaculations the whole month through (1-2 per week we tried to average, more if we were in the mood).

In May we did an SPA test (sperm penetration assay) which they do a basic S/A with as well. We BD on the 14th, abstained for 4 days and did the test on the 18th and then BD again for the next 4 days and I ovulated on the 5th day. We got pg this same cycle.

Sperm Penetration Assay links

http://www.regence.com/trgmedpol/lab/lab11.html

http://www.infertility-male.com/labtest/spabackground.htm

I noticed this morning when lying down that my uterus is starting to
grow to accomodate the pg a little more. With my 6x7cm intramural
fibroid on the right side (which the uterus has be heretofore wrapped around) it is now starting to expand on the left side. So, if you feel my lower abdomen you can feel two lumps side by side. I'm just finishing my fifth week so it will be interesting to see how things grow. I expect that my fibroid will move up and out of my pelvis but it will be interesting if the distended uterus pushes it to the front, side or back. My fibroid isn't causing me any problems, it doesn't feel to me like it is growing and I'm able to still go to modern dance class just fine. All good so far.