We started considering (and trying) for a second baby close to one year following the birth of our little gosling. Based on the fairly straightforward pregnancy the first time around and the naive belief in the gynae’s words that the complications following the first birth had no impact on my ability to conceive again, it never crossed my mind that we should face any issues.
My period properly returned one year after little gosling’s birth. I had felt some cramping from six months post-birth and some light occasional spotting from 9 months post-birth onwards, but it was around 12-13 months that it came back in all strength.
At around 9-10 months post-birth I had seen a GP. He advised a general ultrasound to check that all inside of me was ok. I had an ultrasound of the abdominal cavity, including ovaries and uterus, and everything was deemed in order. As I had expected, he suggested extended breastfeeding could delay another pregnancy. I had no intention of altering our breastfeeding journey, so I plainly ignored that part.
I had (and still have) a very positive recollection of my birth experience (shared here), but the negative emotions, the anger and anxiety that surrounded the post-birth complications and the way in which they were medically dealt with (my story here), took a while to fade away. I still remember conversations with my husband the weeks and months after it was all over.. He was seriously considering avoiding a second pregnancy and opening to the idea of adopting instead, just to avoid the risk of reliving the first post-birth experience. The idea of giving birth again brought me to tears.
I did not see a gynae for a while after the birth experience. The doctor who had followed my pregnancy had not answered my messages after the birth of my little gosling and that had made me feel disappointed and distrustful. I kept recommending her to other women around me, but I did not feel comfortable seeing her again. Neither me, nor particularly my husband felt comfortable going back to the gynae who had managed by post-birth complications. We blamed her for having to go through a second curettage and an abdominal surgery. The expat women around me saw one of these two doctors and I felt uneasy about seeking advice from strangers. I kept postponing seeing a gynae and felt reassured with my GP’s advice.
With all these in mind, we felt ready to try again. We were quite laid back about it, much like the first time, when we had just stopped using any contraception and let it happen (which it had fairly quickly, with no stress, just a few months later). This time we kept a closer look at the calendar. I was expecting it to happen as easily and naturally as it had then. It did not.
I remember seeing my GP at around 13-14 months post-birth. He made me pee on a stick, can’t remember why. What I do remember, however, is the deep sense of hope, followed by a huge disappointment when it came back negative. He suggested again that breastfeeding would be an obstacle to a second pregnancy and advised me to start tracking my ovulation to actively help my chances. We did that for a couple of months. I was ovulating each month, but no pregnancy ensued.
I got curious and stumbled online upon the concept of secondary infertility. This is the inability to conceive a child (or carry a pregnancy to full term) after previously giving birth, assuming the previous birth occurred without fertility treatments. Secondary infertility typically is diagnosed after trying unsuccessfully to conceive for six months to a year. No idea whether this timeline holds for parents of all ages (we were both 35+). None of the medical professionals I saw in the past year used that term concerning my situation, but I could not have been very far. It appears to be a phenomenon as common as primary infertility. It was a surprising discovery for me. The fact that it was a medical condition labeled as such somehow reassured me. It was something that happened. I also just had a colleague giving birth to her second child completely unexpectedly in her early 40’s, more than ten years after the first child and without purposefully trying to have a second child. So, we continued trying, more or less organised about tracking the ovulation periods.
A few months later we moved back to Brussels. Little gosling was 18 months old. I had the intention to see my regular gynae, but kept postponing for until after little gosling was settled into the nursery; after we came back from my grandpa’s funeral; after the one month Christmas holiday with my parents in Romania; after we had settled into our newly rented apartment…. Then the pandemics came upon us and somehow, going to the clinic and seeing a doctor for non-urgent matters became close to impossible for the first months. Ten months passed before I actually got to see my gynae. Little gosling was 2 years and a half by now.
The check-up was routine-like to me. I shared my story with the gynae – the expression of cautious disbelief on his face upon hearing how it all had happened! I asked whether there were any obstacles preventing me from getting pregnant again, as we had been trying for many months with no result. I remember asking this more out of curiosity and to check a box (since I was there anyway…), than out of serious concern that something could be wrong. We kept trying, without any pressure on us; we wanted a second child and gave ourselves time until we turned 40, but put no pressure on ourselves.
The gynae very calmly explained the ultrasound revealed something on one of my tubes that needed to be further checked. He had also noticed adhesions in the uterus, a rather common occurrence following surgical interventions like those I had experienced, he explained. He recommended both a hysteroscopy and a hysterosalpingography, which he described as specialised medical imagery tests, one resembling an ultrasound with a telescope going inside the uterus and tubes, the other a localised X-ray of uterus and fallopian tubes with a contrast substance. He also prescribed some blood tests. His tone and demeanour were calm and not a bit alarming. He said we would figure it out. As always, he would only call me if there was a problem with the results. I left the office without any alarm bells ringing.
I gave blood the same day. The following evening the gynae called me. The blood tests had detected the presence of the pregnancy hormone, but in a quantity that signalled an unhealthy pregnancy. I was shocked and froze on the spot (I had come out of the supermarket to take the call), trying to process it all. I had just had a normal period two weeks before. Gynae said it must have been a false period; the pregnancy was several weeks. And the embryo must have been what he had detected in my tube during the ultrasound. He called me back the next morning to redo the blood tests. If the hormone levels were going up, an intervention could become necessary in order to remove the ectopic pregnancy. If hormone levels were going down, there was a chance I could get away without an intervention.
I shared the news with my husband. He was equally taken aback. We had not seen this coming. We were dismayed. All I knew about ectopic pregnancies was the experience of a colleague who had undergone interventions to remove both her tubes following two consecutive ectopic pregnancies and had been left unable to conceive naturally. I found the prospect of another curettage daunting. It brought back all the anger and frustration from the post-birth times. It was all I could think about. I felt guilty and blamed myself for waiting so long before seeing a gynae. If only I had seen my gynae upon returning to Brussels! I blamed the gynae who had dealt with my post-birth complications for not alerting us to the risk of uterine adhesions and insisting on regular, frequent follow-ups. She must have known uterine adhesions were a common occurrence and a strong possibility in my case and that they could lead to possible difficulties for a second pregnancy, if left unchecked. Why didn’t she take the trouble of even mentioning this to us? If only she had…
I shared the news with a couple of my mummy friends for support and alerted my mom – in case of an intervention, we planned on flying her over to help with little gosling. One thing we had learned from prior experience is that one knows how you go into the theatre, but there is no guarantee on how one comes out and how long the recovery takes.
The next morning gynae did another ultrasound, to check whether there was any change with the tube. Everything looked the same it had days before. He explained the risks carried by an ectopic pregnancy as advanced as mine – more than six weeks. Rupture of the tube, internal bleeding.. And there’s a limited timespan before it ruptures the tube. An intervention, if required, would need to take place within days, to avoid the risk of the pregnancy rupturing the tube and provoking further damage.
I redid the blood tests. That same evening the doctor called with “good” news. The hormone levels had gone down (from 20 to 1), meaning the pregnancy was dying on its own. No intervention was needed. I felt relieved. And I still had my tube. The embryo would be expelled by the body at the next menstruation that would take place in 10-14 days. He insisted for me to make the appointment for the two medical imagery tests immediately after that. And I did.
A couple of days before the date for the tests, I started developing COVID symptoms. That week, little gosling’s nursery had been quarantined for a week upon detection of the virus among the carers. It was a Sunday. The on-call doctors told me to continue monitoring symptoms and see a GP if they persisted/got worse. The night before my tests, I developed a light fever. I called the hospital the next morning and was advised to cancel my tests and call back the following month. Both tests need to be performed within a certain interval at the end of the period, so one can’t really plan much in advance. Add to the uncertainty I felt about a COVID infection the frustration of having to delay the tests and wait another month. Luckily for us, we sailed rather easily through COVID, with only mild, albeit disconcerting symptoms.
35 days passed without any period. No, I was not pregnant. I was worried. What did it all mean? I went to see my gynae again. He confirmed the situation was unchanged, as well as the absence of a pregnancy. He revealed a bit more on the occasion, saying the tube where the ectopic pregnancy had been was dilated and I really needed to do those imagery tests to have a better look at them and decide the course of action. Particularly so if I wanted another baby. But even without it, it would need monitoring. There was the possibility of a rupture of the tube, in which case I risked an internal haemorrhage. According to him, the period delay could have been due to COVID and prescribed me some pills (Lutenyl) to bring about the menstruation. One pill and one day later, there it was.
It was a difficult period for both myself and my husband. We were feeling discouraged. Angry that all this should have happened to us. My husband was quite affected by the ectopic pregnancy and the idea of pregnancy loss. A chance lost. At the time, I was so shocked and so anxious about the possibility of yet another curettage and losing one tube, that I didn’t even fully realise there was a pregnancy in the middle. My knowledge of being pregnant was too-short lived and overtaken by other kinds of fears and thoughts, that it hadn’t really sunk in. We felt disheartened, lost. Anxious that we were losing so much time to get those tests done and have it fixed. We started thinking of all the other times my period had taken longer than the post-birth average of 28 days, wondering whether some of those had been ectopic pregnancies that just died on their own. After all, if I had gone to see my gynae a few days later, we would have never known about the ectopic pregnancy.
I had the tests done less than a week later. Another gynae. More shocked looks upon hearing the story of my post-birth complications. Another vaginal ultrasound prior to the tests, to make sure there was no pregnancy anywhere and to have an idea about the baseline. He said something to me that felt reassuring: I still had plenty of ovules left. At least that..
I had the hysteroscopy first, in the morning, on the last (6th) day of my period. I had taken some painkillers, as instructed, one hour or so before the intervention. The setup was very much like during a regular consultation, although it was in a special room. I was on my back, legs in the stirrups. Something was placed inside to keep the vagina open whilst the gynae worked his way up to the uterus with the hysteroscope (a tube with a telescope at its end), while watching everything on the screen. It wasn’t pleasant, but it did not hurt. I kept looking at the screen. All I could see was a pinkish tunnel. The gynae was having trouble advancing and said something about the cervix having an unexpected bend. Can’t remember much of the sensations really, apart from a general and gradually stronger discomfort with the tube moving inside me. Finding a way to make the tube advance took a while, maybe one or two minutes, maybe more. It felt very long to me, especially as I was feeling myself fainting. My blood pressure, quite low usually, got lower and both gynae and nurse started fretting a bit, the nurse rubbing my face and hands with something cold, holding my hands and talking soothingly, the gynae trying to speed up the procedure. I was almost out of it, when the doctor said he was wrapping up. He could not see much. Hopefully, the hysterosalpingography scheduled for a few hours later would feel better. In any case, he said, that would go much faster. He insisted not to forget to take my painkillers beforehand. I felt weak, but colour was coming back into my cheeks and a few minutes later I made my way back to the restroom to get dressed. Out of reflex, I locked the door after me, with both doctor and nurse instantly crying I should unlock it. What if I fainted in the bathroom and I needed help?!
I went back home, weary about the second procedure. Bought the exact painkillers the doctor mentioned and went back in the afternoon. It was during the second COVID-19 lockdown, so patients could not be accompanied to hospital appointments. The hysterosalpingography was done in one of the X-ray rooms and I laid down on my back on one of those big tables, with my feet up. It was super quick, it was done in no time. The contrast substance did not have much space to spread. Same doctor as in the morning told me one tube was completely blocked; the other one was also partially blocked and the uterus was full of adhesions. He spoke in a way that let on that the most likely course of action for a second pregnancy would be a laparoscopy, possibly followed by IVF. But my regular gynae would get the images and his report and would talk me through the options.
I left the hospital in tears. I felt anxious and hopeless, fearing the laparoscopy and losing my tubes. I could not make out what it all meant for the uterus. I called my gynae a few days later and he confirmed we needed to schedule a laparoscopy to see what could be done about the tubes and uterus. However, due to COVID constraints, he could not be definitive about the date. He was super prudent, not venturing into any speculations about the outcome. He’d only know once he got inside. It did not feel reassuring at all. We were in a state of constant anxiety about it. And impatience. It felt like it was dragging on and on..
I started reading about IVF procedures, thinking it would help ease my weariness. In hindsight, it was premature and only added to my anxiety. It sounded intrusive (needles would be used), uncomfortable, if not outright painful, the result was by no means guaranteed. It did not sound like something I was prepared to do.
The laparoscopy was scheduled for a few weeks later. A couple of days before it was moved back a week – the Friday before Christmas. I asked the gynae to give me a call and walk me through the intervention. I was very weary. I wanted to know more about what he expected to be able to do. One of the tubes was dilated a lot and full of fluid, a condition called hydrosalpinx. It was over 6.5 mm in diameter (compared to its original 1 mm) and the chances of saving it were aleatory, according to medical literature. The second tube was also in a bad state, a few mm dilated, but in a better shape than the other one. He would do his best to save them. The uterus was half closed, covered in adhesions. He would clear them and put on a coat of gel to protect it against further adhesions.
I recounted my laparoscopy experience here. The outcome was probably the best one could reasonably expect. One tube was lost, the second one was saved. He had also managed to recondition the uterus.
I went back to see my gynae a month later. He walked me through the procedure, showing me photos. I don’t recall much of what I saw, only the distinct sensation that it wasn’t pretty. The next thing he said startled me. He asked whether to send me already to start the IVF procedure. I was not ready to go down this road and my husband was fully supportive. I felt discouraged that conceiving naturally appeared less of a chance than IVF, or so I deduced from the doctor’s advice. I asked him whether it was really necessary at that stage. He said I was in a better condition to fall pregnant than back in August/September, before the ectopic pregnancy. Advised to give it a try for 3-4 menstrual cycles and prescribed pills to help with ovulation. He was also very clear that given my history, it was wise and important to detect the pregnancy early, to make sure it was fixed inside the uterus.
At this point, I was really discouraged. I saw no reason to hope and thought it unlikely that we would be able to conceive naturally. We decided to try for a few months and then see again whether my feelings about IVF changed. We talked about IVF and decided we were both ok with not going down that road, if I still felt uneasy about it.
It was end January. I had already had my period that month and lost the window for the pills this time. I tracked my ovulation, but none was detected. I took the pills in February and again in March. Afterwards I stopped. The pills coincided with the surge of painful pimples all around the vaginal area, vulva and area, which lasted quite a long time and were uncomfortable day to day and particularly dissuasive for any sexual activity. In my mind I established a quick causal link between the two – it was hormone-based and the only other time in my life when I had experienced something similar had been in the weeks immediately following the birth, when hormones are supposedly still running crazily wild. Ovulation happened those two months, but I suspect I had started tracking it too late, albeit following the tests’ instructions.
After my April period, I started tracking my ovulation earlier. After two empty tests, the third one showed the start of the period with optimal chances to conceive (a few days in advance to the calendar). Three days of ovulation in which we applied ourselves to the job :). On the day that should have been the second one of my following period, I did a pregnancy test. It was positive.
Both my husband and I were cautiously happy. We did not want to get our hopes up before confirming that it was a viable pregnancy. Our thinking was: first make sure it was fixed in the right place; then make it through the first trimester; then wait for the pre-natal genetic screening to come back ok. Only then would we take a breath and allow ourselves to truly enjoy it.
What followed were two weeks of feeling pregnant in a completely different way than the first time. Small, but constant discomfort was the norm. Tiredness. Anxiety. Imagining all the different ways in which things could go wrong. Finally, a healthy baby girl is growing inside my tummy, with a family of three waiting to meet her when she is strong enough and ready to come out.