getting technical

The genetic counselor called me back and she states that the risk ratios I was given *do* take into account the nuchal measurement. Age is also factored in, along with race and weight. So I nosed around the internet to get more info. Here is what I found. It turns out that the nuchal measurement grows as the baby grows. So an average measurement for an 11 week fetus will be smaller than for a 13 week fetus. My baby measured 12w4d (64mm) at the ultrasound, even though I was 12w2d based on my ovulation estimate. For now, I will take it that the baby was 12 and a half weeks for purposes of comparing to the internet numbers. There is a table that shows the measurements for 3000 women at 12 weeks and 2500 women at 13 weeks. The nuchal measurement average for a 12 week fetus would be 1.7mm (mine was 1.4). The nuchal measurement for a 13 week fetus on the average would be 2.0mm. Since my baby measured 12.5 weeks, the nuchal average measurement expected would have been 1.85mm. So my baby's nuchal thickness was much smaller than average. Somewhere below the 25th percentile. FYI, they get scared when the measurements are above the 95th percentile, which would be 2.6mm and 3.0mm at 12 and 13 weeks.

Here is the address of the table I referred to if you are interested:
http://www.greenjournal.org/cgi/content-nw/full/100/4/648/T2

See below for the blood results.

blood testing results back

The first trimester screening blood results are back. The likelihood of Downs Syndrome purely based on my age would be 1 in 24. The likelihood based only on the blood test are 1 in 110. While anything over 1 in 220 is a "positive" result, it is actually a good result for my age, and there are a lot of false positives for ladies over 40. The likelihood of trisomy 18 based on age alone is 1 in 87. Based on the blood test, the risk is 1 in 5400. I asked if these numbers take into account my great nuchal measurement of 1.4mm. They do not. She still does not have the doctor's report in my file about that. And then she asked me how far along I am and I'm 13w4d, so she said it's now too late for a CVS. {big eyeroll} I TOLD them if they waited until I was 12+ weeks to do the first tri screen there would not be time to do the CVS. They ASSURED me there would be time. Only nobody bothered to call me from either my OB's office or the fetal testing office regarding my bloodwork results when they came in. Not that it really matters. I'm not going to change my mind about choosing the amnio over the CVS based on these blood results. But it would have been nice to have the option.

Great Nuchal Results!

The nuchal measurement was 1.4mm. Anything under 2 is great. Anything 4 and over would be bad. This is really good news, because the nuchal test, although just a screening test, is fairly accurate at predicting Downs or Tri 18. There is a bloodwork portion to the testing as well, and I should hear back on that in a week or so.

The baby measured 64mm crown to rump and was wiggling, stretching, kicking and waving all over the place. Very active and cute. The 64mm means the baby is measuring ahead for dates. If it was supposed to be 51mm on Monday, 2 days ago, and should be 71mm on next Monday, 5 days from now, then over halfway there after 2 days is wonderful. Maybe this baby will be tall like papa.

My progesterone test from Monday came back too. That was 50. So a full dose had me at 60, and a half dose has me at 50, I think the placenta is kicking in. I feel safe going down to 1/4 dose now and stopping altogether on Monday. Should be fine and hopefully no cramping or spotting.

The other prenatal panel tests were perfect as well. I don't have HIV, Syphilis, Hep B, Rubella, Gonorrhea, Beta Strep, yeast or gardnerella. My TSH is 1.978, well within normal. My urinalysis was completely normal. My CBC was normal, with the red blood cells at 14.5, a very healthy number as the normal range is 11.3 to 15.5. I guess they didn't run a beta this time. OK.

So I am celebrating. I actually did a Happy Dance in front of the nurses at the hospital in front of my MIL when we went into the other room after the ultrasound. I was dancing around singing "1.4, 1.4, 1.4...." WOOOHOOOOOOO!!!!!!!!

Holding my breath

I feel that I have been patient. Waiting for the days to tick by. Waiting for the genetic testing. I'm starting to get nervous about it. DH and I went through the genetic counseling before our last amnio, and I remember flipping the pages to look at the statistics for 43-year-olds, anticipating that we would try for another child. The statistics were 5% genetic problems. That means 5% of the 43-y-o pregnancies who made it as far as 16 weeks had diagnosable genetic problems, such as trisomy 21 or 18. Now that may seem a small percentage at first glance, but when it is a matter of life or death, 5% is huge. For example, if you were to be undergoing an elective surgery and they told you there was something wrong with your heart and you had a 5% chance of not waking up from the anesthesia, would you go ahead with it? I think not. So here I sit, nervously biding my time. Hoping that the nuchal test this Wednesday comes out good, and that I can hold off for the amnio in June. If things are bad, I will rush in for an immediate CVS test. As I sit here typing, my little baby is tapping away at my insides. And my heart is heavy with worry.

First OB appt today

I ran out of the house super early this morning for my first appointment with the obstetrician. It was exciting. The baby's heartbeat on the doppler was 166. Halfway between boy and girl heartrates, lol, so no information there. The doctor said that I could reduce the progesterone in oil dose back down to a half-cc since my progesterone draw last friday was 60. He says that the placenta is now making progesterone, so even at half the dose it will be above 20. He gave me a lab slip for 2 weeks to get a progesterone check to see that the level doesn't drop too much. He says that 13 weeks is when he has ladies stop the shots altogether. I look forward to that. My buns are quite ouchy! He also did the standard pap smear and ran the normal prenatal panel of bloodwork. I'm not sure exactly what that entails, but I will get copies of my results faxed to me next week. I think there is a beta hcg in there somewhere, so it will be fun to see what that number is now. He is on board with the plan of getting the nuchal and first tri test, then deciding on CVS versus amnio. I hope I get to do the amnio, and that the nuchal is good. That way I don't have to take my Lovenox break until later. Blood pressure was 112 over 75. Urine had no protein or sugar. He supported me on the meds I am taking and agreed that it is best to be cautious about this pregnancy. There is no room for error here. This is probably my last shot at it.

More stress and confusion

Here's what I found out today. My RE wanted me to get the CVS, so I called his guy, Dr. Porto in Orange. He apparently does a lot of CVS tests, and even did the wife of my obstetrician. I wonder why my OB sent me to someone else, when Dr. Porto was good enough for his wife? So my big question when Dr. Porto called me this afternoon was will the Lovenox and baby aspirin cause a problem with the CVS procedure. He says that the Lovenox is a problem, and I would need to stop it 36 hours before the procedure, and not restart it until 24 hours after. The baby aspirin is not a problem. I discussed with him the fact that I have positive tests for IgM antibodies. He told me that maybe it would be best if we did a full consultation, so that he could look over all of my labwork and decide if it is OK to stop Lovenox at 11 weeks or if it would be better to go with a nuchal test and bloodwork, then decide if it might be better to wait for an amnio. The amnio is done later, so I could go longer on the Lovenox without stopping. Sigh. Then the lady in his office calls me back and says we are out of network, and the consult would cost $1100 cash (out of network deductible) and the procedures would be covered at 50%, such as the $1600 CVS would cost me $800 cash. I wonder what DH will say. Sigh.

Another perfect ultrasound

I had the presence of mind to jot down notes during the ultrasound today, so here are the statistics. Heartbeat was "over 120" and strong, but his machine doesn't measure it like a doppler. The gestational sac was 22mm (I think it was 15 last time). The yolk sac was 4mm (good that it is small, apparently). The embryo was 11.6mm, up from 3mm last time, perfect growth! And he measured the corpus luteum as 14mm. He didn't measure the free fluid but said that it had gone down and there was much less of it. Overall another perfect ultrasound. I need to look up the exact measurements on the internet to find out the exact day of my measurements, although perhaps I should just relax and enjoy this healthy pregnancy.

EDIT: I went to a website and the 7 week measurement is 8mm for the embryo. Add 1mm for each day. If I take 11.6 to equal 12mm, then I measure 7weeks plus 4 days (the difference between 12 and 8mm. My ticker reads 7weeks and 4 days today EXACTLY!

Another thing. I asked when he would be kicking me out. He said he would follow me another few weeks until around 10 weeks. In that case, I said, what about CVS, Nuchal Translucency tests and all that. He said that for my age it was appropriate to go straight to CVS and skip the nuchal, because the NT test is more for younger women. It only screens for downs. That makes a lot of sense to me. I can't understand why my OB wants to put off the CVS testing and have me do the general screening tests first, when I am really so old and high risk. And I had 2 amnios with the other boys. So why would we do *less* testing with this baby when I am so much older now? My RE's advice sounds perfect. I will cancel the first tri screening with the other guys and go to his doctor at UC Irvine for the CVS test. That will give me a lot of peace of mind for the rest of the pregnancy. I have very little confidence now.