Over the past month, K and I have been preparing to start trying to conceive again. During that process, we’ve had to balance a lot of “what ifs” and medical advice. The simple fact is, no one knows why I had an abruption, so we are left guessing as to what adaptations to the TTC process might lessen our chances of a recurrence.
In meeting with our MFM, we can definitively say the following. All of these carry their own risks, so we’re balancing how reckless we want to be versus other, more practical concerns. The fact of the matter is, we cannot control for everything. So, what can we control that will help us feel more at ease? What must we absolutely do, and what can we leave to the fates? How can we feel both in control of the process, but not obsess over being in control (when we know, ultimately, that control only gets you so far)?
– There is a risk of recurrence. Because I used IUI (which, along with IVF, carries a higher abruption risk) and because we cannot eliminate other risk factors (such as smoking, since I never was a smoker), my risk is approximately 20% for a repeat abruption. That sounded high to me, as my research seemed to indicate 10%, so I’m hoping he over estimated. Risk: moderate to high, but nothing we can do about it.
– I am CMV negative. I hadn’t gotten tested for this before, but now know I’m in the minority who has not been exposed to this virus. Our donor is CMV igG positive but CMV igM negative, meaning he has been exposed to the virus, but was not actively infected when he donated. There is an extremely small chance the virus could pass to me through the semen, but we’re talking really low. There’s a greater chance – though still small – that I could contract CMV while pregnant. If I do, there’s a 20% chance the baby could end up with moderate to severe birth defects. Great. But ultimately, not much I can do about it. It didn’t happen last time, and the CMV status – which I didn’t know – had nothing to do with my abruption. We could switch donors, but I’ll get to that below. Risk: low.
– Oh, the ever present donor question. Should we switch? On one hand, there is a small body of research that suggests some placental issues, such as preeclampsia, are tied to sperm. It is also true that the placental formation is likely driven by the male genes. Do we know this for sure? No. Are there any placental abruption studies that link it to sperm? No. Can we, in our doctor’s words, guarantee that we are selecting a “safe” donor if we choose to switch? No. So what we weigh is having a full sibling to Ander or not. Then, there’s the fact that we have only 8 vials left, enough for 4 months of trying, and the donor is sold out. We thought that would be enough for a sibling, and it will… but will it be enough for two, now that Ander has died? Unfortunately, we don’t know, on either count. Then there’s the cost; we already pre-purchased the sperm after we had made it 18 weeks into the a “successful” pregnancy, so we’d be out a decent amount of money. Risk: moderate either way, unfortunately. K would like to use the same donor, so we have decided to do so, and I’m letting go of the anxiety about that decision. There’s only so much we can do.
– What I can do, to eliminate or lessen another factor that makes me anxious: get tested for clotting factors. My MFM didn’t think it was necessary, though he left it up to me, basically saying that if I’m worried about it, I could get tested. He also said that if I did have a clotting factors issue, that might just make me more nervous, and that Lovenox and baby aspirin carried other risks that could cause me additional anxiety. However, due to the fact that we decided to keep our donor, and due to a second opinion, I’ve decided to get tested. This will at least allow me to manage my anxiety about this. If I test negative, great; I can let it go. If I test positive, at least I’ll have some weapons in my arsenal. Risk: low. I don’t really have anything to lose, and don’t think I have a clotting factors disorder anyway.
So there’s that. We’re trying to balance being responsible and reasonable with being… not reckless, but rational? Are those all synonyms, lol? It feels reckless, to keep the same donor, but on the other hand – if this were my husband, it’s not like I would trade him in for the hope of an improved model, knowing that the new version could also be a dud, so to speak. It feels like… a reasonable risk. I got tested for CMV and and am getting tested for clotting factors. We’re seeing an MFM and will be heavily monitored, with ultrasounds starting at 8 weeks. K’s kinda like, look, we did everything “right” the last time, and we know how that turned out, so maybe we should let go of some of the control this time and let things be. I vacillate between that and “must control or else I’ll blame myself if something happens again.”
Of course, all this is moot until we get pregnant again. One thing at a time, right?