Still not convinced

posted by Mel

After 5 days of waiting for the OB’s office to get back with me about my concerns about the gestational sac, I finally broke down and called them again. When they called back, the nurse had conferenced with the doctor, and neither of them even HAD our GS measurements. They just said the ultrasound looked normal. I, in the meantime, have watched the video anew and have now seen that, at 9 weeks, the sac was measuring just 4 mm larger than the embryo. According to the Internets (and not blinkie shiny naive preggo boards either– mostly abstracts from studies, like this one), a sac that is less than 5 mm larger than the embryo = 80% chance of a miscarriage.

After explaining my worries to the nurse, I get this response– We wouldn’t have even measured the gestational sac if you hadn’t requested it. It looks normal to us– cute, in fact. (CUTE?!) If it’s too small, there’s nothing we can do about it anyway. Get off the Internet, and enjoy your pregnancy.

How the fuck do I do that?

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19 Comments

Filed under always a manic infertile, Preggo

19 responses to “Still not convinced

  1. missanthropy

    I don’t know anything about gestational sacs and their size, but from what I have read, the same statistics apply to just about everyone’s first pregnancy.
    If you can, find a way to meditate, take a bath, go swimming, read a book, get a massage. Relax any way you can. Don’t put so much stress and pressure on yourself. I know that’s a lot easier said than done, but I really don’t want you to worry yourself.

  2. Shae

    So… I don’t know anything about this stuff either, but it seems to me that your chance of miscarriage has been related to your alloimmunity, and not to the size of the sac/embryo.

    I mean, your alloimmunity doesn’t affect how it develops, is that right? So it seems to me that if you’ve gotten through the alloimmunity hurdle, you have no special reason to look for trouble elsewhere.

  3. Unfortunately one can miscarry for a host of reasons, and getting past one problem doesn’t mean you won’t develop another. During our time trying to conceive, there have been many times when we’ve been told there was no reason to worry only to find that the dreaded thing we were worried about was right around the corner waiting for us after all. If the embryo/fetus (whatever it is right now) outgrows the sac, I am afraid it will suffocate.

  4. Shae

    Well, of course there are lots of reasons one could miscarry. I guess I was just echoing missanthropy’s sentiment that your chances now seem similar to those of other people, and maybe don’t warrant excessive concern.

    Not that it’s easy to not be excessively concerned.

  5. Gah. I don’t have anything useful to say, just that I’m sorry that you’re going through this.

    Wait, maybe I do have something useful to say. One thing I have learned is that abstracts can be really deceiving. If you want the full texts of any papers, drop me a note and I will send them to you. Old ones might take a few days to get, but anything from the past 5-10 years is usually available instantly.

    I think you can see my email address from this comment form…

  6. Io

    Oh damn. I seriously hope you are in the 20% that is ok.
    And wtf is up with your doctor blowing you off like that?

  7. jay

    no useful things to say except i think your nurse needs to go on some kind of course. jeesh!! and i do hope you manage to find some ease soon. xxxx

  8. medical staff often don’t keep up with the lit – I hope you are on the right side of the stats, though!

  9. I’m so sorry that the nurse was dismissive. Totally uncalled for. I’m so sorry that you’ve got so much anxiety. I am sending all my love. When can you get another ultrasound? Can you visit another doc? Anything to calm your fears. Hugs.

  10. you have got to relax, you really have. i know i’m not the best one to talk, but you still have got to! worry, as my dp would say, is not good for the baby, regardless of sac size!

    we are talking about 1mm here. perhaps the ultrasound tech measured wrong? 1mm is really really small, you know? and look at how fuzzy those images are that they pull up!

    please try to be calm. you are almost out of the first trimester! so close, you know?

  11. Jen

    Aww! I really hope you can get to the bottom of this and start to enjoy growing that little miracle. We’re sending some super powerful positive vibes your way 😉

  12. Cripes. I just hate that this is all so stressful and the doc’s answers are less than scientific. There has to be a middle ground somewhere in between the doctor and nurse talking about “cute sacs” and heady, wordy medical abstracts that look at blakc and white statistics only. I do think you should go see Tom for some acupuncture to help you relax a little bit – stress won’t help one way or the other.

  13. Carolyn

    Try not to worry (yeah right). Dr. Google and searching the internet can be very dangerous for your sanity. And the measurements could be off as they aren’t always precise! You are on the good side of this, I just know it. 🙂

  14. Katy

    As a noted, yet remedial, mathematician who obtained a Master’s degree in program analysis through statistical modeling (i.e. econometrics – bet you are impressed now, aren’t you?) at a prestigious university (albeit mostly from copying the homework of Haitian classmates) and for a cost that has left me fucking poor for life; I have computed that you are 100 percent most certainly going to worry yourself sick, while simultaneously becoming more and more pregnant, until such time as you determine that the baby can be supported outside your womb. This worry correlates to your desire to be a mom and there is no room for variance. In pregnancy, there is no perfect multicollinearity. (Does that mean what I remember it meaning? Google that and let me know, would you?)

    Let’s make this a word problem:

    Let A be an event in sample space – pregnancy. P(A) will be the probability of the event in repeated trials – % who do not miscarry. Then, in a total of n possible equally likely outcomes of the event – successful pregnancies – where m of them are healthy babies, we can define the ratio of health babies to pregnancies as the frequency of A.

    Shit. I am pretty sure this means that to have a baby you have to be pregnant first. It was supposed to be an equation to say that you cannot correlate the probability of miscarriage to gestational sac size because there are too many variables. Where did I screw up?

    BTW, when I read your 16-year-old study (ahem, do you think the cooter scans were that great back then dear? You know that doctor was totally eyeballing those sacs and using a black pen mark on his index finger to measure…) You did see that this was 8.2 miscarriages out of a universe of 537 pregnancies, right? The p values they spout out pretty much say that this event occurs about 3 out of 10,000 times (p=.03) when sac size is <5mm AND they do not state this as statistically significant. I read it that only the mom’s age could be statistically significant in thinking about maybe saying sac size was a concern.

    Now, call me and we can have a laugh about how I still can barely fart out a correct math problem answer and you can tell me what names you are thinking about. I’m going to offer to do the worrying for you so you can focus on names, breastfeeding, how to make homemade baby food, and preparing the animals for the baby who will be here, ready or not, in like less than 235 days. Also, can you Google stress acne and tell me how to fix my face?

  15. Co

    In my first tri, I worried A LOT. I worried when I ran really hard for 20 feet that I’d dislodged Embryo-O or burned him up or something. But the reality is… once a little embryo burrows in, it burrows in for long haul and tries really hard to grow. (Now I say stuff you already know… blah blah blah…) Most miscarriages are not caused by anything the mother has any control over. Usually, if a miscarriage happens, it’s because the pregnancy was not viable. It could also be because of the position of the embryo or the size of its sac or the mother’s body’s response to the embryo and all kinds of other reasons… still things mothers can’t control (at least not 100%).

    So, yeah, anyone can have a miscarriage. And certainly if you’ve had the history you have had why wouldn’t you worry?

    But, I used to try to remember that as precarious as it seems in the first tri, it’s not really THAT precarious. If it was that easy to miscarry (run 20 feet or whatever), then there would be no need for abortion clinics. Those little embies really do burrow in and try to stick around.

    I also tried to remember that difficulty conceiving does not necessarily translate to difficulty carrying. I know with your alloimmunity issues, it clearly does to some degree, but that doesn’t mean that other things will necessarily be wrong, too. (Stuff you already know that probably doesn’t help either…)

    I don’t personally believe all that “worrying is no good for the baby” stuff. But hey, you’d think that vomiting daily and not being able to eat anything except potatoes and white rice for 3 months would be bad for the baby, too, but hey, that’s the first tri for a lot of women and those embryos thrive. So, what’s a little worry?

    Besides how can you not worry? Nature’s pregnancy hormones certainly don’t make that easy. Neither do your past experiences. So, worry. I know you will anyway. But know that your worrying doesn’t affect the ultimate outcome and that hopefully, in just a few more weeks’ time when you’ve reached the 2nd tri or when you’ve had good u/s results or whatever, you can breathe a small sigh of relief, start to believe this pregnancy might actually end in a newborn baby, and have a whole new host of worries! (I hope that for you so much!)

    Oh, and to your commenter, Katy… I loved your comment. 🙂 (Probably because I’m a math/stats nerd, but also because it was a great comment.)

  16. Katy,

    Use bentonite clay to get rid of stress acne. It’s supposed to suck the zits right off your face.

    -v

  17. Katy

    Where do I dig that up? My flower beds are all full of gravel.

  18. You have to order it from some fancy-schmancy, granola online holistic living place. (so says the girl who just paid $55 bucks for acupuncture for her dog). Your previous comment? Hilarious.

  19. Katy

    My goal is not to be funny, but to make sure my Melody knows that mathematically, not even Patwick Fawwell could comment on the risks of miscarriage. (Translated: When do we get to start shopping for baby stuff?)

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