After my miscarriage last year, I endured several months of irregular cycles. Frustrated, I began seeing a reproductive endocrinologist in September.

“What’s your goal?” my doctor asked. “To have normal periods or to get pregnant?”

“Yes,” I replied. I wanted the predictability of normal periods, but I was also holding onto hope that I would get pregnant again. While I was open to medication if my doctor recommended it, I was not interested in fertility treatments like IUI or IVF. 

After doing lab work and ultrasounds and ruling out uterine polyps (a previous culprit of my dysfunctional uterus), my doctor suggested progesterone because he believed my uterus needed help getting the message it was time to shed. His thinking was that some extra progesterone in the form of medication, followed by a noticeable dip in the hormone, would clue in my uterus and remind it to shed.

Plus, with my history of miscarriage, a little extra progesterone would be good for me at the beginning of pregnancy if I were to conceive.

Much like when I saw this same doctor about six years ago for uterine polyps, he fixed my uterus again. I started having normal cycles, and when he did an ultrasound in November, he said my endometrium was a normal thickness. He recommended I continue using the progesterone during the second half of each cycle — after ovulation — and told me if I got a positive pregnancy test, I should call the office right away.

Even though I hoped to get pregnant again, I was not confident I would actually give birth to another living baby. So I began planning for the future. I set a goal to train for and run another half marathon. I began thinking about enrolling my youngest in a preschool, so I could focus on expanding my freelance writing business.

A Positive Pregnancy Test

During the week of Christmas, I had two days of light spotting. My period was due within the week, so I figured the spotting was just a sign of that. With the busyness of Christmas, I didn’t give much more thought to the spotting, but December 25 came and went.

On the day after Christmas, I remembered that my period should’ve started, but I guessed that the progesterone was preventing the full flow from arriving. My doctor had encouraged me to take a pregnancy test before stopping the progesterone each month. Because of that, I already had a test in the bathroom linen closet. I decided to take it, and honestly, I thought it would be negative. I was sure it was just the progesterone that was preventing me from bleeding.

Within seconds of peeing on the stick, I saw the second line come into view. Two lines. Positive. I was seriously shocked. Mike came into the bathroom at that moment and saw my surprised face and the pregnancy test sitting on the counter.

“Whatcha doing?” he asked with sleepy eyes.

“Ummmmm, I just took a pregnancy test, and it’s positive. I thought it would be negative.”

He just smiled as I left the bathroom and told him I was going back to bed. It was about 7 a.m., and the kids were still sleeping, exhausted from the previous day’s Christmas excitement. When he rejoined me under the covers, he eyed me curiously. “You’re not going back to sleep,” he chuckled. I think we both lay there, thinking about the possibility of a fourth living child. Could it actually happen this time?

Though I wanted to believe everything would be OK, I really had no hope. For three nights in a row after the positive test, I had dreams that I was bleeding when I went to the bathroom.

Signs of Something Wrong

Since I got the positive test on a Saturday, I didn’t contact the doctor’s office right away. On Monday, I hesitantly called, afraid that telling someone else our news would jinx it. The nurse asked me to come in for a blood draw, so they could do a quantitative hCG test. I told her I could do it the following day, so she ordered that test and one for 48 hours after that.

I knew a single hCG reading didn’t mean much. It was the increase between the two tests that would indicate if the pregnancy was progressing normally… or not. I anxiously awaited the results of the second test. On New Year’s Eve, I got an email that my results were available in the electronic patient portal. I was afraid to look.

Besides the dreams, the results were the first indication of something wrong. My levels had gone up, but the number was slightly short of doubling. It was late in the afternoon, and the following day was a holiday. I tried not to worry and told myself that if there was really a problem, the doctor’s office would call on Monday.

And yet they didn’t. Tuesday and Wednesday passed, too. As the days went by, I was feeling kind of crappy. Not puking-nausea, but I-don’t-really-feel-like-eating nausea, which, for me, was a classic pregnancy symptom. I tried to tell myself this was a good sign, but I knew numbers don’t lie.

On Thursday, January 7, I called the doctor’s office. One of the nurses answered, and I could hear keyboard keys clicking as I asked about my hCG results. After a brief pause, she told me that something was wrong with her computer and she would have to call me back when she was able to pull up my chart. I knew this was a lie. She had looked at the numbers, but she needed to confer with the doctor before saying anything to me. She promised to call me back in a few minutes.

About 20 minutes later, a different nurse returned the call. She confirmed what I suspected. The doctor was worried about my hCG levels. Very bluntly and with no compassion, she said, “He wants to see you tomorrow for an ultrasound to rule out ectopic pregnancy.”

I had looked at my hCG results a dozen times since they became available in the patient portal, and I knew they were not ideal. But it never occurred to me that I might be having an ectopic pregnancy. I’m not sure why I didn’t think of it. Maybe it was the bleeding before the positive pregnancy test. If I had implantation bleeding, surely the pregnancy was in the uterus, right? How could it be in the tube?

At that moment, I was angry. An entire week had passed since my results posted. Why hadn’t the doctor’s office called me if there was an issue? Why did I have to call them? How dare they miss this?

On top of that anger, I was annoyed. The doctor wanted to see me the next day, on a Friday. My two older kids would be doing at-home learning, and my youngest would just be doing whatever wild toddlers do. My husband would be at work. No kids allowed at appointments because of the pandemic. How in the world was I going to go to an appointment?

I let the nurse know I was not happy. Friday was not possible for me. She pushed back, noting that ectopic pregnancy can be dangerous. It could land me in the ER, even in emergency surgery. I rolled my eyes so hard. Who did she think she was talking to? Someone who knew nothing about ectopic pregnancies? I ran through the symptoms in my head — stabbing abdominal pain on one side, vaginal bleeding, shoulder discomfort. I had none of them. But I knew they could come on suddenly, and I also knew going to the ER over the weekend would be even more difficult. My restaurant manager husband would be working long shifts, and all three kids would be home with me.

I was still annoyed. I let the nurse know that I didn’t appreciate the urgency of them wanting to see me the next day, especially because they missed the lab results. But I told her I would somehow figure out how to make Friday work. I scheduled the appointment as close to my youngest child’s nap time as possible, and I told my teenager he would be in charge for a little bit while I was gone. 

That night, I felt like my life was a cruel replay of exactly 11 months earlier. Just like with my last loss, I got bad news on a Thursday, and I would be having an ultrasound on a Friday that had the potential to wreck me. I spent Friday morning in a daze, playing out both scenarios in my head. If it was ectopic, they would give me a medication to stop the embryo from growing. If the pregnancy was in the uterus, I thought that meant everything would be OK.

A Mysterious Pregnancy

I arrived at the doctor’s office on January 8, feeling sick to my stomach. I was so nervous that I could hardly function. I sat in the waiting room for only a minute before the nurse called me back. It was the same nurse with whom I had the tense phone conversation the previous day. She took my weight and blood pressure, the latter of which was a little high, presumably because I was an emotional mess.

My mask covered my mouth and nose, but my eyes were still visible. She saw my tears and tried to reassure me: “It’s very possible everything is OK. We just want to make sure.” Then, she offered me the standard doctor’s office tissues. I declined and told her, “I brought my own soft tissues from home. I’ve done this before.”

Before she left the room, the nurse instructed me to undress from the waist down. I sat on the exam table, covered my bottom half with a sheet and waited for the doctor. After a few minutes, he entered the room and asked how I was doing, to which I replied, “I don’t know.” He wanted to know if I’d experienced any bleeding or cramping, and the answer was no to both.

The doctor began the transvaginal ultrasound, looking for my ovaries. He had to apply some pressure to my belly to find the right one, which looked normal. The left ovary, however, was possibly a concern. There was some blood flow activity on the screen, and he said it could be a hemorrhagic ovarian cyst. This type of cyst is typically not a problem, but he still wondered aloud, “Could this be an ectopic pregnancy?”

In my uterus, he pointed out what looked like a gestational sac, measuring five weeks, five days, which was exactly in line with my last period. He said the sac looked empty, and he would expect to see a yolk sac by that time. But ultrasound dating and measurements are not exact, so he asked me to come back on Monday for another scan. “Could it be a blighted ovum?” I asked him. He said it was possible, but it was too early to know for sure. The whole thing felt like a mystery we were trying to solve together.

At the end of the appointment, I was so confused. There was no definitive answer about an ectopic pregnancy. In fact, my doctor reminded me of the symptoms and told me to go to the ER if I had them over the weekend. Before I left, he asked the nurse to draw my blood because he wanted to get another hCG measurement.

After I got home, I spent what seemed like hours searching Google, looking for ultrasound images of the terms blighted ovum, ectopic pregnancy and hemorrhagic ovarian cyst. Being a layperson, all the pictures looked the same to me. Later that afternoon, I got a message that my hCG results were available. This time, the number was much lower than my doctor had hoped it would be.

I knew in my heart I was in for another pregnancy loss. And just like last year, I crawled into bed on a wintery Friday night and cried myself to sleep, asking the impossible questions with no answers. “Why? Why me? Why do I have to go through this again?” On Saturday morning, my doctor sent me a message in the patient portal, confirming what I already knew. My hCG was not at an appropriate level. He said he would still do the scan on Monday.

A Non-Viable Pregnancy

I’m not sure how I made it through the rest of the weekend, but somehow Monday arrived. On January 11, I drove to the same doctor’s office, took a seat in the same waiting area and sat on the same exam table. The same doctor came in and asked me the same questions. “How are you doing? Any cramping or bleeding?” And I recited the same answers.

He used the same transvaginal ultrasound wand to look at my uterus and ovaries. Like a recurring nightmare, he pointed out the same empty gestational sac, the difference being it measured 6 weeks now. And six weeks is far enough along to see a fetal pole, sometimes even a heartbeat. Another change was in my left ovary; the cyst had resolved.

My doctor said he was confident the pregnancy was not viable and most likely a blighted ovum. Now, he wanted me to be confident. Even though I had suspected all along that the pregnancy was not going to produce a living baby, I still couldn’t find it in me to let go. He offered to do one more hCG test, and I accepted. He said he would call me after the lab results came back, and we could decide what to do next.

That afternoon, the lab results hit the patient portal. Just like before, the number had increased only slightly, yet another indication of my failed pregnancy. I asked one of my friends, who had previously worked as a physician assistant, what she would do if she were in my shoes. After conferring with one of her midwife friends, she encouraged me to keep taking the progesterone and request one more ultrasound in a week. My doctor did call, and he said he would be willing to do a final scan before I stopped the medication.

While my friend prayed for a miracle, I was not so hopeful. My quasi-pregnancy nausea had waned. Still, I briefly imagined a miracle scenario — me lying on the exam table and my doctor with the ultrasound wand, stunned to see a tiny embryo thriving in my uterus. But I knew that story was highly unlikely. Throughout the week, I halfway grieved. It’s hard to grieve fully when there is still uncertainty and the reason for your grief still resides in your body.

One Last Ultrasound

About a week later on January 19, my appointment felt like a formality. The doctor knew what he would see on the screen, and I suspected the same outcome as last time. This ultrasound made it official: A blighted ovum, a non-viable pregnancy. My doctor told me I should stop the progesterone and give my body about a week to let the tissue pass naturally. I was mostly OK with this plan, but I knew my body loves to hang onto pregnancies, even the non-viable ones.

Just so we were on the same page, I added that I didn’t want to use misoprostol, the medication that forces the body to expel the reproductive tissue. I did that with my last pregnancy loss, and it was a horrible experience. If the tissue didn’t come out on its own, I wanted a D&C. I asked my doctor if he would be able to do the surgery, and he said it was questionable because of his clinic schedule. It would need to occur at the hospital, not the office, but he would try his best.

Not surprisingly, a week passed with no bleeding or cramping. On January 25, I called the doctor’s office, and they scheduled a D&C at the hospital for 12:30 p.m. the following day. My doctor was not available to do the surgery, but by that point, I didn’t care. I just wanted the whole ordeal to be done. In fact, I kind of liked the idea of going to sleep and waking up to know it was all over.

The D&C

On January 26, I did my normal Tuesday morning routine: Spin class, shower, coffee. The only difference was that I had to drink my coffee black. It was gross, but better than no coffee at all, I suppose. Mike was off work that day, so I had asked my mom to stay with the kids. She was more than happy to help, and I’m so grateful she was there because, as is common with hospitals, everything took much longer than we expected.

Even though there were multiple delays, most of the staff members at the hospital were kind and compassionate. They took Mike and me to a room in the labor and delivery unit, which I was not expecting. I thought I’d be on the surgery floor. However, we were tucked away from the L&D patients.

My nurse asked me a bunch of questions, drew some blood and started an IV. It was like a parade of medical team members after that. First, an anesthesiologist with a curt attitude asked me a list of questions and explained that they would use sedation, not general anesthetic. I was happy to know I wouldn’t need to be intubated.

Then, an OB and a resident entered. They went over some of my history and described what would happen during the surgery, making sure to explain the risks. They also let me know they would use ultrasound during the surgery to guide them and help them be sure they removed all the tissue. The OB then asked if they could do an ultrasound before the procedure. Confused, I asked why that was necessary when my doctor had already done three scans that showed an empty gestational sac. She said it was standard procedure before a D&C. I respectfully declined, explaining that ultrasounds had caused me enough grief over the past three weeks. They seemed to understand and didn’t push the topic. 

Hours passed. I wished I would’ve brought a book or even my laptop. I thought about how much work I could’ve gotten done in the absence of my children. My husband and I sat and talked. We even fell asleep — me in the bed, him in the chair next to me. At one point, I heard the faintest sound of a newborn crying. It stung for a second as I thought about how that noise was something only in the past for our family, not in the future.

Finally, at about 3:30, they said they were ready for me in the OR. Before they took me out of the room, an anesthesiology resident pushed a medication into my IV. I told my husband bye and that I loved him, and almost instantly, I started to feel the effects of the medication. I remember being wheeled into the OR. Forever a birth nerd, I asked, “Do you perform C-sections in this room?” The answer was yes. The medical team moved quickly and gracefully as I shivered. (Why are ORs so cold, by the way?) They put a warm blanket on top of me, and the last thing I recall was the OR nurse attaching stirrups to the bed.

The next thing I knew, the anesthesiology resident woke me by placing her hands on my shoulders and saying, “April, we’re done.” I couldn’t believe it was over so quickly. We were still in the OR, but they soon began wheeling me back to the room where my husband was waiting. As they pushed me through the hall, I asked the OB resident, “Did you do the surgery?” (It wasn’t clear to me before whether the attending OB or the resident would actually perform the procedure.) The resident said yes and that everything went well. She had removed all the tissue with no problems.

When I got back to my room, I had a new nurse. She said she would monitor me for about the next two hours before I could be discharged. All I could think was that another two hours seemed like an eternity. I just wanted to go home. But because I had such minimal bleeding and I was able to pee shortly after surgery, I think it ended up being less than two hours. I basically always have to pee. 

The nurse went over the discharge instructions and handed me the paperwork. I got dressed, and Mike and I began walking out of the L&D unit. I tried not to think about how most families who leave that area of the hospital do so with a brand-new baby. When we got to the first floor of the hospital, we went out the main doors and into the cold January air. It was nighttime, which somehow seemed fitting for the end of this journey. I put my arm through the loop in my husband’s and felt sad as we walked to the van.

Recovery After Pregnancy Loss

My physical recovery after the D&C was smooth. I didn’t have much bleeding, and I experienced very little cramping. During my follow-up appointment with my doctor, he asked about future plans. He said from a medical standpoint, it’s OK if I want to conceive again. I expressed my fears about getting pregnant again and reminded him that irregular cycles have always been my biggest fertility challenge. When I ovulate and menstruate normally, I seem to be able to conceive fairly easily. It’s staying pregnant that has plagued me lately. I’m scared I will keep getting pregnant and keep having miscarriages. He said it’s a valid concern, especially given my age.

Emotionally, I have struggled. I’ve started seeing a therapist, one who has also experienced pregnancy loss. She introduced me to a concept called radical acceptance. It means accepting your circumstances, even if you don’t approve of them. And that feels like exactly what I need help with.

I do not approve of two consecutive miscarriages. I do not approve of ending my childbearing journey without a rainbow baby. But not everyone gets a rainbow baby. I am grieving the pregnancies I’ve lost, but I’m also mourning the family of six I envisioned. It seems having four living children is not meant to be for us. Even though I do not approve of that story, I still have to find a way to accept it — radically accept it.