It's a Different World

In a previous post I described how the woman who is casually TTC is nearly oblivious to the 2WW that is such a dreaded experience for patients going through infertility treatments. It's more fodder for fertile envy, but it doesn't reach the same level as frustration as the 'I didn't know I was pregnant!' woman. This situation truly demonstrates how it is such a different world...

Our LVN approached me, a patient received a reminder that she was due for her HPV vaccine and scheduled an appointment. When the LVN asked about her last period, she replied "Oh, I think it was a few months ago..." She explained that she had a lapse in her insurance and stopped her birth control pills during that time. Her coverage was recently re-instated, so she wanted to get her shot and to restart her pills.
"Have you been using anything else for birth control?" the LVN asked
"Like what?"
"Condoms, spermicide, withdrawal, abstinence..."
"Oh....no."
"Do you think you could be pregnant?"
"Oh....no."

The LVN handed her a urine cup and briefed me on the situation. "It's going to be positive" she assured. "Maybe she has post pill amenorrhea." I countered, recalling my own experience of a delayed menstrual return after stopping birth control pills, although AF returned in less than two months for me and she was closer to four. We watched the test together -the blue test line lit up immediately. She measured fourteen weeks when I scanned her. "Maybe she should sign up for email messages reminding her when her period is due" I joked.

Except there was an aspect that it wasn't funny. I thought about all my patients with recurrent pregnancy losses or those experiencing infertility who hold their breath each day waiting to make it out of the first trimester. Here she was in the safety of the second trimester without experiencing any awareness of what those prior thirteen weeks represented. As she was young and this was her first pregnancy, maybe her obliviousness could be explained. Although I questioned if she did suspect she was pregnant and used the rouse of needing the HPV vaccine as a way of getting into the office. If that was the case, then she's a lot smarter than I previously thought.

It's fairly common that patients can't remember the exact day of their last menstrual period, but can produce an approximate range. I find that I often can't remember mine, as it becomes eclipsed by other dates, monitoring appointments, trigger time, the IUI itself and testing day. Maybe I'm not so different from unsuspecting fertiles. Often, I'll be satisfied if they can narrow it down to the beginning, middle or end of the month. This next patient would not be one of those cases.

I received report from our LVN "This is her fourth and it was an Oops!" she informed me "She wanted to have her tubes tied with her last pregnancy but her papers weren't signed in time.' I suddenly recognised the name "Bullshit. I signed her consents myself." I quickly checked her chart and my suspicion was confirmed. She went into labour before her scheduled C/section date and the on-call doctor didn't notice her sterilization intentions. "She thinks her period may have been sometime in May or June. You have your work cut out for you..." she warned.

"So, you're not quite sure when your last period was, but it may have been in either May or June?" I began
She just looked at me blankly for a few seconds and then offered,
"You see, my family is all girls and my sisters noticed I didn't have a period in July"
Oh, imagine having others who track your cycles for you! Oh wait -our partners and the staff at the REI clinic all do!
"So when did you suspect you were pregnant?" I asked
"Well, my mom looked at me one day and said 'I think you're pregnant'"
Oh, imagine having someone else spot your symptoms!
"When did you have a positive pregnancy test?"
"At the beginning of this month. But then I got my period."
"What do you mean..."
"I started bleeding for a week -just like my period"
You should have mentioned that earlier!
"That wasn't your period." I informed her "A period signals the absence of a pregnancy during each ovulatory cycle. You experienced a bleeding episode in your pregnancy."

The sight of blood would strike fear into the heart of a woman whose pregnancy was achieved with fertility treatments, one with recurrent losses or even an excited first time spontaneously conceived mom-to-be. The moment I spotted light pink blots on the toilet tissue, I knew that I was doomed. Yet a woman with an unintended fourth pregnancy can bleed for a week and merely attribute it as "her period". Didn't feel it was necessary to call or even to mention it earlier in the interview. I quickly proceeded with her scan. There was a viable single intrauterine pregnancy at 9 weeks without any visible explanation for her bleeding. Once we were done, I reviewed some of the causes for bleeding in pregnancy and explained why it was important to be evaluated during those situations. She reminded me that she doesn't want there to be a next time and asked again to have her tubes tied. I promised her that I would ensure it happens.

I've often commented how fertiles have no idea what it is like to walk in our shoes, how they can never appreciate what we experience trying to start a family. What is so elusive to us, is effortless to them. It's a different world, and just as they can't relate to our situations, we'll never understand what it's like to live in theirs.