Goodness! You think you can just have a miscarriage and get on with your life! Not always, it turns out.

Note: there is some talk of miscarriage details here, like blood, so if that isn't your jam, perhaps give this post a miss. But note that miscarriages are a huge trial, physically and emotionally, and I'll be you know people who have been through it, even if you aren't aware of the fact.

In mid December of 2020, I turned up pregnant. We were so excited and surprised. We had been preparing for an embryo transfer as a part of IVF, and the doctor told us to wait a month to get my uterine lining just a little better. I was waiting for my period, and it didn't come and after a couple days I worked up courage to do a pregnancy test, which surprised the heck out of me with a positive result. All seemed fantastic for about a week, with nicely climbing HCG (pregnancy hormone) levels.

Just before Christmas though, I began to have some bleeding. I know that light bleeding can be normal, but then it picked up into a level that was clearly not normal, and I was sure I was having a miscarriage. Sadly I was right. But didn't it sort itself out all at once. That would be too easy!

I went in for an ultrasound to check things out. There was tissue and blood visible in the uterus, but no sign of a normal pregnancy. We gave it a week I went in for another scan. Same thing again. Meanwhile, my HCG was continuing to rise. 8000, 90000, then 27,000! I had been bleeding and passing tissue occasionally this whole time. The day after the scan I had a bad time. Contractions for a few hours and then passed a lot of tissue. I thought for sure that was the end of it.

Throughout all this I tried everything I could think of to complete the miscarriage naturally: Acupuncture, herbs (a Chinese herb mix from my acupuncture as well as my own mix of black cohosh, crampbark, dong quai, and others for pain). I craved hot baths - I'm not sure if the baths just helped with cramps, or if they helped move things along. They felt nice at least. Along with some homeopathics and a lot of journaling, hoping to let go, and not be holding onto things emotionally or spiritually. I am a big journaler, and always try to work through and acknowledge my feelings through writing and meditation. It doesn't magically solve all my problems but it sure helps me feel better.

Another week went by and I went in for another scan. This time the extra tissue had cleared out but my doctor could see a clear gestational sac, and there was no embryo, so this was clearly not a viable pregnancy. Also, the sac had apparently implanted at the top of my uterus, making it look like a cornual pregnancy. It was not located in the side of the uterus where it should be. The reason for this nonviable pregnancy was most likely either that it was genetically abnormal, or it didn't get the blood supply that it needed because it was implanted in the wrong spot.

We may get the answer to that question, because we are doing a genetic test to try to find out if it was genetically normal or not. I collected some tissue, and we'll see if there's enough information there to get a clear answer.

I really did not want to do the medical abortion or D&C, and hoped to handle it through natural means. However, at this appointment, it was obvious things were not moving along on their own, and it was time to take action. And my HCG was now 40,000! So my body was still supporting this pregnancy that wasn't going to go anywhere. Such tragic optimism!

So I agreed to do the drugs, mifepristone and misoprostel. The surgical option scared me because I didn't want the anesthetic or anything else poking around in my uterus. So at that appointment I signed the paperwork saying I was "choosing to end my pregnancy," which isn't exactly what was happening (thanks for kicking me while I'm down, legal department). The doctor who walked me through that was very kind and very irritated at the paperwork that was required. I'm assuming that was a part of the legal requirements for using those drugs, since it is the same process as a medical abortion. But one trouble with abortion laws is that they don't always differentiate between medically necessities like this and choosing abortions for other reasons.

Tangent: I won't go on a whole tirade here, but I firmly believe abortions should be legal and as much done as possible toward prevention, such as birth control options and making support available, like assistance for low income people. Abortions are tragedies to be prevented as much as possible, but they don't go away just because you outlaw them, they just become less safe and more terrible. Countries with illegal abortions have the highest abortion rates, which is not what anyone wants, believe me. End of tangent.

So I took the first drug, mifepristone, there in the office (they don't let you take it home with you for later). Mifepristone tanks the pregnancy hormones progesterone and estrogen, which apparently gives a better success rate when taken along with misoprostel. After a few hours I started having some heavy bleeding and clots. Annoying, but not painful.

The following afternoon I took the misoprostel, which causes contractions, and I hunkered down in bed to see how bad things would get. They told me to start taking ibuprofen before the misoprostel, which I chose not to do. I decided to see how bad it would be and take it if I needed, but try first to manage with CBD and California poppy. I felt the doctor's idea of pain management was pretty overblown after they prescribed me Tylenol with Codeine for my egg retrievals. Remember we have an opioid epidemic? Maybe don't prescribe opioids all the time? I had almost no pain with the egg retrievals, and took nothing for it. So I waited to see.

With the misoprostel I had bad cramps for probably six hours, but the CBD and california poppy helped to take the edge off, and I just slept as much as I could and toughed it out. It was painful, but manageable. I had more bleeding and passed a little tissue over the next day or two.

I talked to the nurse and she seemed to think all would be well, given that tissue has been passed. What I didn't really expect was for the cramping and bleeding to go on so long. I had cramping every afternoon for another five days or so, and I didn't pass what I believe to be the gestational sac until Saturday, having started the process on Monday. I can't be sure, but that's my best guess. After that on Saturday the bleeding began to slow down and I haven't passed any more tissue.

On the following Thursday I had another blood draw (I'm getting the know the lovely people at the blood draw place so well...) and the HCG had dropped to 12,000. Progress! My doctor spooked me though, but not being entirely convinced by that, she had hoped for a larger decrease. So I went in for ONE MORE scan, and got the confirmation that there was no visible gestational sac. Yay! So I'm all clear.

I'll go back for further blood tests to monitor the drop in HCG levels, which could take another month. I'm still having some spotting, but I assume it'll gradually taper off.

I had a chemical pregnancy a couple of years ago, and it was nothing like this experience. It was basically getting a normal period a week and a half late. This was intense. But that first time showed me with an HCG of 14 when I started to miscarry, and this time I had an HCG of 9,000. So there was a lot more growth happening. And that has resulted in having my period for a month, and a lot of physical (not to mention emotional) pain.

I wish I had been able to complete the miscarriage with natural means alone, but I am glad I had the medical option when it was needed. My goal now is to have good nutrition, lots of water, and fortifying herbs to help my body to rebuild after this strain. That and keeping my digestion happy, to help cleanse the system of excess hormones as well as drug residuals. (Digestion being a key part of the body's detoxing actions.)

I had a whiskey sour the other night, and I'm letting myself have a little more caffeine, an occasional cup of black tea, because it's just not that big a deal, and I damn well deserve some fun things. And a lot of Star Trek Voyager.

The up side, if you want to find one, is that my body seems to be well capable of supporting a pregnancy hormonally. I assume that if we can get us an embryo that is genetically strong and healthy, we will be successful. The likelihood of that with my eggs is unknown. But we forge ahead!

At least we have a plan moving forward. Get my body to reset and go ahead with the embryo transfer. We have four embryos, and if those don't do the job, we go to donor eggs. That would be a loss in its own way, but I don't feel that's a personal failing as I once did. It's just sucky luck to have low ovarian reserve and to have fertility struggles. I don't take it as personally as I used to.

I have a lot of thoughts on my takeaways after two and a half years of fertility struggles. I will make that my next post. I am not done with this fertility journey, and it is still pretty scary and I am tired of it. But it's a very different experience than a couple of years ago, and I don't feel persecuted by it anymore. I don't really know why it happens, but we'll get through it.

At the end of this miscarriage adventure (misadventure?), I mostly feel grateful to have my body back! I wouldn't have done anything differently. It's awful to suffer this loss, the physical pain, and to have a period that lasts for a full month, but it does make me appreciate my health. I realize more fully that pregnancy, even a short one like this, takes a lot out of a body. That should be acknowledged and not made light of, if you know anyone going through something like this. I took a lot of naps and was still tired. I only started to feel energetic again a week and a half after taking the misoprostel.

I cried a lot, grieving this loss. But I was somehow not as crushed as I was in my first loss. I hate to think that I am hardened by these experiences, but the last two years of failed attempts has been a lot of pain and I've had to find ways to cope, and I have sort of gotten used to it. You never really get used to it, but I was guarded in my hope this time. I did just begin to be hopeful there for a bit with this pregnancy, but cautious.

But I am still somehow optimistic. My intuition is so hopeful and I think our family is waiting, and will come to us soon.

Having a plan helps. Knowing that I am not just going to keep throwing myself against the same wall indefinitely. I am glad we are doing IVF, and are doing all we can do, and we will see what that gets us. I am grateful that we have the medical options we have, so we can do IVF, and use donor eggs if mine won't get the job done. And I'm grateful that my husband is sweet and supportive and keeps things lighthearted, when I get too serious.

If you experience a miscarriage, the best advice I can give is to have patience with yourself and to acknowledge that it's a big deal, even "only" a few weeks into the pregnancy. It takes rest and nurturing to help the body and spirit heal. And to trust your own judgment about good health and what works best for your body.

That's about all I have to report. It sucks. I'm still healing. I'm meditating, journaling and trying to pray more. I expect I have more emotional healing to do. I'm tired, emotionally. But I'm getting through.