We had a positive pregnancy test at the end of August last year, a day before my period was due. My husband was cautiously excited, but I was mostly terrified as I awaited my fate. Would the HG (hyperemesis gravidarum) monster come back or would I be spared?
I immediately set up a consult with my OB, but the earliest I could get in was at 7 weeks gestation, which is the standard time frame for the first prenatal appointment. I tried to get into another OB practice sooner, but everyone was booked out and didn’t seem to care that I considered my pregnancy to be high-risk.
My husband is a physician and I’ve been through an HG pregnancy before, so we felt confident that we could navigate the next three weeks without an OB. We knew there would be severe nausea and vomiting preventing me from eating or drinking throughout my first trimester and that it may persist throughout the entire pregnancy. I would likely lose 15% of my body weight (as I did in my first HG pregnancy), and since I was starting the pregnancy at 93 lbs (17 BMI), that amount of weight loss could be fatal without medical intervention. There was also a good chance I would miscarry.
We narrowed it down to two options: take the pregnancy as far as we could and terminate if my life was at risk, or terminate early before we got too emotionally attached and my body sustained too much damage. Either way, we were going to be aggressive about using medications to treat my symptoms as soon as they started.
We knew that the two most effective medications for me would be Zofran and Prednisone. They wouldn’t stop the nausea, but they might prevent me from vomiting and getting so dehydrated that I needed to be hospitalized. Zofran is a drug I already take as needed for my GI illness, so I knew that I tolerated it well, but the benefits were mild. Prednisone is what we’d really have to lean on.
The first time I ever tried a course of prednisone was to manage an allergic reaction to Penicillin. Even on a low dose, I noticed that a lot of my chronic symptoms such as fatigue, brain fog, irritability, and achiness seemed to improve. I felt as if the dark cloud I had been under suddenly lifted and I was the person I was always meant to be. Prednisone reduces inflammation and suppresses the immune system, which led me to believe that my chronic illness had an autoimmune component to it.
In my past research, I had stumbled upon the theory that hyperemesis gravidarum was an autoimmune disease as well and that prednisone was effective in treating it. However, good luck finding a doctor who will prescribe it during pregnancy. There were some older studies showing a slightly increased risk of cleft palate with the use of prednisone in the first trimester, but newer studies found no risk. Cleft palate can be detected early enough in pregnancy that there would be an option to terminate. But OB patients are a litigious group and most doctors don’t want to take that gamble. The way we saw it was that if you weigh the small, equivocal risk of cleft palate against the substantial risk of low maternal weight gain associated with uncontrolled nausea/vomiting, it seemed obvious that prednisone was the right choice.
The monster arrived at 5 weeks (one week earlier than it had in my past pregnancy). I stopped being able to eat right away, but the combination of Zofran and Prednisone was keeping me from vomiting. However, the amount of Prednisone I needed to manage the HG quickly increased. I went from 5mg to 20mg daily in a matter of days. We weren’t sure what the upper limit of prednisone should be, and we became concerned about the effects that a high dose would have over the next few months. I might be more prone to infection, my bones could weaken further (I already have osteopenia), and the longer I took the drug the harder it would be to come off it.
Going into this pregnancy, I had doubts about whether I even wanted a kid, but now they went into overdrive. I’d have to really want it to survive what was coming, and I didn’t know if it was in me. My husband wanted it and reassured me that he would take care of me and not let me die. But at 6 weeks, I decided to call it. We terminated the pregnancy 5 days later.
The next few months we took time to grieve and get my health back on track. We spent time relaxing in the country, took long walks, and impulsively got another puppy. I worked on accepting that if we wanted to have a kid, I would have to surrender the pregnancy to a surrogate. So once I resumed ovulating, we went back to our fertility clinic so we could begin the process of freezing our embryos. Over the next few months, we went through several blood draws, genetic testing, and the required counseling. During this time, we were using the pull-out method perfectly at all times and were eager to get an IUD back in as soon as possible after egg retrieval.
Two days before our appointment to freeze my husband’s sperm my mother texted me about a fertility clinic that had a storage mishap destroying thousands of embryos. I told her I had just read about it in the news: a fertility clinic in Cleveland suffered a freezer malfunction destroying thousands of embryos. How devastating. These couples spent all this money (~$20k per cycle) and took all those hormones so they could start a family, and now it was all gone. How could the fertility clinic let this happen? I didn’t even realize this was a risk we were taking with storing our embryos.
My mom texted back that she was actually referring to a clinic in San Francisco where the same thing happened on the same day (totally unrelated and random). Oh shit. I quickly googled it, and my heart sank when I read it: it was my fertility clinic. I predicted that there would be a class action lawsuit and they’d be out of business in no time. We would have to start over at another clinic.
About a week later we had a consult with the other fertility clinic in town and learned that some of our records would be transferable but some tests would have to be redone. We could do the IVF cycle in a month or two.
But it was too late. I could feel the changes in my body and I knew it: we were pregnant again.
Continue reading: “I Handled This Pregnancy All Wrong”