Fudging It

I've said before I'm a fan of the little white lie. I'm not a shameless and unabashed user. I'm just a simple fan. I'm not an addict, but sometimes it's just the thing.

So here's my latest. In order to throw the few friends of mine IRL that know that I eventually will be back on the TTC bandwagon off of the pregnancy watch trail (after all, my m/c was SIX MONTHS ago, I should be halfway through my next pregnancy by now) I'm telling them all (all four of them) that my doctors are recommending I wait a year before TTC again. So I'm fudging expectations in the longer wait direction. At the same time, I've devised a plan to fudge reality in the direction of a shorter wait. It's not bulletproof. And it's nothing spectacularly clever. I'm just going to be assertive with Dr. OBG. And negotiate. If my levels stay at less than 2 in four weeks (rather than six) I will ask if I can start testing monthly. How could she say no? My veins are collapsing under the weekly pressure for chrissakes (and I'm not afraid to tell that story....or to cry). Then, if, after 4 or 5 months the levels are still under two, I'll ask if I can start TTC again. If by then there hasn't been one blip of evidence of recurring GTD and she STILL says no, well - one of our condoms might just happen to break. Because that would be ridiculous.

I'm getting WAY ahead of myself. After all, I only got one less than two result. And Dr. OBG is always giving me harsh reminders that this is my BODY we're talking about - don't try to make it into a science experiment. So I have no reason to think she'll help me out. But while I know I shouldn't be foolish with my body, it doesn't belong in solitary either. It doesn't deserve to be punished like this. It may be ready in, say, 5 months to grow a new life and why-god-why would I stand in its way when that's the only thing on earth that I feel like I have yet to achieve before I can feel truly fulfilled? And when, while I'm young enough, I'm not that young. If I'm going to have m/c's I need to be able to move on more quickly from them. And even if we assume the unlikely - that this was a partial molar pregnancy - six months is still a long wait to prescribe. Or at least standard. 7.5 is arbitrary and ridiculous.

I'm still waiting for Dr. GO to come through. I want him to be my second opinion but I'm afraid he might be biased - not wanting to step on Dr. OBG's toes. Maybe I should call him myself. I've thought about divorcing myself from Dr. OBG completely, but the problem with that is that I've invested in her. My history is laid out in all its glory, fresh in her mind and she is bound to be particularly attentive when and if I do get pg again. "Attentive" as in "early and often betas and u/s's" which I would love, nay, absolutely require to maintain any semblance of sanity next time around. On the whole, do I wish I had gone with another OBG? Yes. Unequivocally. There are a number of things I don't like about mine. We don't gel. She doesn't get me. But she's smart and while she's not perfectly right for me, she is good. And her office is really really convenient. And I've heard wonderful things about her from people who have had successful pregnancies.

Here's an analogy. I got married in January, and I've changed my last name for ALL relevant purposes except health insurance. So I'm still Astrid Maiden-Name at the Dr.'s office. And my reasoning is - I was in the middle of a pregnancy and m/c at the time my name was changed over, there was a lot of follow up work, changing my name in mid-stream on my health insurance, given all the OBG office visits, oncology visits, infusion visits, lab visits, prescriptions, phone calls and bills being mailed, etc. would have been a monumental headache for me without any redeeming gain. I feel similarly about Dr. OBG. Could I be marginally happier and feel more comfortable with someone else? Yes. Is she that bad? No. Is it worth switching mid-stream? So far not.

As long as I'm getting ahead of myself I should address what I would tell my four friends-that-know if I ever do get viably pregnant. If it doesn't happen for a year, notwithstanding earlier attempts, then I won't need to do any explaining. If it happens on the first few tries, I'll just explain that either a) an accident happened or b) things were going better than the Dr.'s expected and we were given the green light. (Look at me being all optimistic!) I have a feeling they'll all have forgotten by then, or even moved on from being such fixtures in my life - even six months seems like a lifetime away and plenty of time for friends to become distant or forgetful. This thought is one of the things that makes me so sad. The concept that I want to be pregnant, not just as soon as possible because I'm getting impatient, but because I want to be pregnant in my current life situation. It's really the perfect time. And I was so so close. I have a bunch of first-time new mom friends, I have parents young enough to have fun with their grandkids and for the grandkids to remember them later in life, my sister is potentially moving to town this year, and DH and I are finally established, have a house and great careers, and are ready, right now, to welcome the new responsibility into our lives. We're also relatively young. I was thinking today that I wouldn't have wanted kids any earlier. That I am going to be the type to get better with age and that I will be a better mother than I would have been at 25 or 26. So I have no regrets, just wish it would happen soon!

In the way of some explanation as to why the long wait - some of my commenters have been asking and I apologize for not setting out the details. When HCG levels don't decline appropriately after a m/c or D&C, i.e. when HCG levels go up or plateau after the pregnancy is over (instead of coming straight down in a matter of weeks), doctors suspect that the pregnancy was a molar pregnancy or that some remaining placental cells have developed into gestational trophoblastic disease (GTD) which can manifest in anything from a benign growth of cells (like a tumor) to a metastatic cancer. HCG is a marker for the disease so when someone is not viably pregnant but their HCG stays elevated after a m/c or even a full term pregnancy, it's an indication that this GTD could be persisting. When my HCG levels plateaued, the doctors treated me with chemo to stop the cell growth and hopefully send the HCG down as a sign that the GTD was 'cured.' And my levels did go down, slowly. Arguably more slowly than they would have if it was GTD that was actually causing the plateau. But GTD is, in a rudimentary sense, cancer. Uncontrolled growth of cells. And it can come back, even after HCG has gone to zero. So if what I had was GTD, the doctors want to keep checking my HCG, for 7.5 months, to make sure it stays at zero. If I got pregnant within that time, it would be difficult, if not impossible, to tell if the rise in HCG was due to GTD or the pregnancy. And if it was GTD on top of a pregnancy, the consequences could be dire for me or the baby or both. After six months the chances of a recurrence of GTD go down to an infantescimal amount. Although the risk never really goes away completely - like any cancer.

I understand the arguments in favor of waiting. I understand this is my health we're dealing with. But I also have not received a concrete diagnosis of GTD or a molar pregnancy. What I had could have been left over tissue from the m/c or just a ridiculously slow metabolism of HCG. And even if it were molar, it would have to have been a partial molar because NO evidence of a molar pregnancy was found in my post-m/c pathology report. And the typical wait time after a partial molar is 3-6 months. Not 7.5. And I'm willing to wait until, well, December-ish is my goal. But not until next February.

All of this of course will depend on whether my HCG levels stay in check. The TTC start date is somewhat of a moving target. If my HCG goes up and I do have further complications with GTD, the clock might start over. The timeline will be adjusted either way as we go along, probably. And ultimately, it's my decision. Right now I'm just trying to decide which course of action - which version of 'fudging it' will least anger Dr. OBG.