I sent the letter I wrote about my ultrasound experience off this morning. While it does not dull the loss or indignity of the past week, I at least feel better for having taken some sort of action, asserting myself to some small degree at a time when I otherwise felt helpless.
And so I move onto the question that has been tumbling through my mind, always the same words, but in varied tones: What next?
It is not a question that requires an immediate answer nor will any plan I develop now necessarily be immutable. But it insinuates itself into my every thought.
I have already decided to wait a few months, at least until we move back to the US, which we have now set for December/January. During that time, I will work seriously towards losing the 20-25 pounds I'm talk about cutting. And I can then get health insurance established in our new state--much easier to do when not already pregnant. Once I've established health insurance, I can also start looking into doctor options: will I be able to find an OB/GYN who can handle my case in our small town? will I have to travel to my in-laws' city? or even further to the biggest city in the state? After I have lost that weight, I will also update my life insurance policy, something that will be cheaper if I do it before I turn 35.
But that still doesn't address the specific "What next?" that's in my head. Those plans are all well and good, but they don't directly answer the how/when/if of another pregnancy. I remain overwhelmed by the range of options that are not really options; I can make any number of choices and reasoned decisions, but I've already learned that those are no guarantees for things working out.
I could simply wait until January or February and try again. Statistics generally suggest that even after two miscarriages, many women go on to have a perfectly normal third pregnancy. But I don't think I could enter into this again blindly and just let things play out as they will. And my midwife has all but said this would not be a good idea. In both of my recent pregnancies, all indications point to the death of the embryo between 6 and 7 weeks, and so it is quite possible that there is some problem with my body's support system at this point.
And so, at the very least, it is likely that I will need to try again with frequent testing and intervention. My gut feeling is that my body's not producing enough progesterone. No evidence for this, but none against it either. Some of this is wishful thinking too, as it would be the issue with the most straightforward solution. But this will probably mean an intense early pregnancy with blood tests every 2 or 3 days and immediate hormone supplements as needed, until everything levels off (and probably testing for several weeks past that, just in case). It means a much more medical pregnancy than before, working with a doctor instead of a midwife, starting out from a position of concern.
And I also have the option of changing up some of the variables.
The easiest change to make would be the donor. We could sift through the donors at our old sperm bank or pick a new one and see if we have better luck by making that change. We may not have a choice in doing this regardless, as we only have 3 more pop-sicles in storage right now and he's an inactive donor.
Or we could look at using Trillian's eggs instead. There's now a process by which a woman's immature eggs can be collected and matured in vitro. These eggs could then be combined with our donor sperm and the embryos frozen and stored; we would try one egg at a time, synchronizing the transfer with my cycle. This would be more expensive than going our usual route and might pose some geographical issues (e.g., initial procedure to be done in Montreal, could the eggs be sent to our state or would I have to make a monthly trip timed to my cycle?).
My biggest fear, of course, is that I might go through the process, with or without minor changes, but definitely with close monitoring, and still have another miscarriage. And the truth is that when I had my first miscarriage, I thought to myself that a second miscarriage would be the end of all of this for me, that I couldn't imagine putting myself in a position to experience this for a third time. That feeling still lingers a bit; although making a third attempt has become a possibility, part of me wonders if maybe I should just stop now.
Which brings me to the last two possible answers.
The first, one I know will be brought up by others, is adoption. This is something Trillian and I have discussed quite a bit, and we both agree that it is probably not the route for us. In particular, we look at the time we are investing and will continue to invest in Scooter's therapy and we can't imagine balancing this with the process of adoption. Moreover, the process is generally not very accommodating of families such as ours. In most adoptions, international or through the state where we will live, only one of us would be able to adopt initially. Whichever one of us did that would have to apply as 'single' and figure out how to appropriately fill out forms without outright lying about our family or saying anything that would disqualify us. After the initial adoption, we could then go through a second-parent adoption for the other parent, which basically means completing the process twice. The second-parent adoption is something we would do with a biological child too, but whereas it would cost just a few thousand dollars in that case, it would be a few thousand dollars added to tens of thousands of dollars for an adoption.
The final option we're contemplating, and contemplating seriously, is saying that we're done. Scooter is an amazing kid; we love him to bits and know how lucky we are to have him. We've always pictured our family with two kids, that was the plan from the start, but maybe it's not going to happen. Right now this option leaves me a bit sad, as it seems so final. There can be no 'oopsie' for us, no unplanned surprise. It would mean closing the door on a chapter of our life, actually that the door has already been closed and we didn't even know it at the time.
On the other hand, the longer we go without having a second child, the more I wonder if the time has passed. I wanted to be done having children by 35, not just because of the "Advanced Maternal Age" labeling, but also because Trillian is older than me and because I didn't want there to be too large of a gap between our kids. This last pregnancy would have put them at 2 weeks shy of 5 years apart. That, to me, was pushing it in terms of having kids who would be able to play together and enjoy each other's company. There was also an element in my push to have a baby now of making sure I was pregnant before Scooter's official diagnosis this fall so that I would already be committed to a second child and couldn't reconsider in light of whatever special needs he might need met. And so I cannot help but feel that I missed the window of opportunity and that stubbornly continuing to pursue a second child would be to the detriment of the family already here.
I know that this is not necessarily the case, that circumstances may shift, new opportunities present themselves. I know that I can change my mind a thousand times between now and whenever the final decision is made. I know that the family I have in ten years will be the family I'm meant to have. The future remains open. But the tears continue to fall for the might-have-beens.