Chronic Illness Pregnancy: First Trimester

After three years, three months, and eight days of waiting, hoping, and praying… WE GOT OUR FIRST POSITIVE PREGNANCY TEST! Somehow, in all that time, we’d never gotten a positive. To learn more about what it took us to get to this point, check out the “Infertility” category on my blog, and read my previous post about our InvoCell/IUI cycle. While we were obviously quite happy, infertility robs you of the blissful ignorance many first time parents get to enjoy at the beginning of their pregnancy. Even if you haven’t ever personally experienced loss, you become acutely aware of when and how everything can go horribly wrong. Infertility is also extremely traumatic, and that trauma can cause you to subconsciously protect yourself by disconnecting you from the experience.

This post has taken me quite a while to write, because I was extremely dissociated from my pregnancy until very recently (I am 22 weeks pregnant while writing this). It felt like I was watching a very detailed vlog of someone else’s pregnancy, not that everything was happening to me. It’s a very weird thing to explain, but the people who have had the misfortune of dealing with infertility all have seemed to understand exactly what I’m talking about. It’s like a constant “when is this all going to go wrong” sensation, mixed with a lucid dream.

I am, however, absolutely thrilled I’m getting to write this update! After three years with no pregnancies, I was starting to wonder if it was even biologically possible for me to get pregnant. There weren’t any tests that said “no way” but the fact it just wouldn’t happen was making me wonder. We’re now almost positive it was all of the polyps, and if we struggle to conceive in the future, we’re going to immediately ask for a hysteroscopy to check for more!

A lot of couples don’t announce their pregnancy until after the first trimester, out of fear of miscarriage, which also means that the first trimester isn’t really talked about much. I knew that the first trimester was when you had “morning sickness” but really didn’t know how truly awful it can be, and felt completely blindsided when it happened! Everyone is different, and not everyone has extreme symptoms in the first trimester (and some people have even worse symptoms than I did), but every single person I’ve talked to that has ever been pregnant has agreed that the first trimester is the absolute worst part of pregnancy! I wish I’d known that ahead of time so I was a little more prepared!

Our announcement photo at 6 weeks pregnant!

First of all, how long is the first trimester? This number actually can vary quite a bit from source to source. If you divide 40 weeks into 3 trimesters, you get 13.3 weeks per trimester (which is 13 weeks and 2 1/2 days or so). If you divide 39 weeks into 3 trimesters, you get 13 weeks exactly. Both 39 and 40 weeks are considered full term pregnancies. Some sources say once you hit “13 weeks pregnant” you’re in the second trimester, while others say that once you hit “14 weeks pregnant” you’re in the second trimester. The apps I use to track my pregnancy all started counting the second trimester at 14 weeks, while my OB started counting it at 13 weeks. Many people think it’s 12 weeks, because that’s when the risk of miscarriage drops significantly (80% of miscarriages happen in the first 12 weeks). I’ll be using the apps for my trimester posts, just for consistency.

Also, in weeks one and two of pregnancy, you are not actually pregnant. Week one starts the first day of your period, the end of week two is roughly when you ovulate and conception occurs, week three is when the blastocyst is traveling to your uterus and starting to implant, and the end of week four is when you miss your period. Doctors start counting from your period, because it’s the most reliable “this is when this event happened” mark in a menstrual cycle. It’s also why your due date is an “estimate” and can be changed throughout your pregnancy. Since we did an IUI, my due date is unlikely to change by more than a couple days. Interestingly, only 3% of babies are born on their due date, so I’ve just been considering my “due date” as “late July” instead of an actual date!

I’m now going to share all of the “gory details” of my first trimester of pregnancy. It really wasn’t fun, but I do consider myself lucky in several regards. If you don’t want to know all the TMI details, I suggest you skip the next several paragraphs!

Pregnancy Symptoms

Before I even got my first positive test, we suspected something was going on. I tested early because either something was “very wrong” or “very right” and I needed to know if I needed medical attention for a serious illness or not! My first symptoms were extreme fatigue (flu level), dizziness, nausea, and severe diarrhea. The nausea could easily be written off as the progesterone injections, as they’d been making me feel sick the entire time I had been on them. But the fatigue, diarrhea, and dizziness were unique and either pointed to a severe gastro bug or pregnancy. These symptoms started about a week after the IUI, which would have been almost immediately after implantation. The average person is unlikely to feel any symptoms that early, but my body likes to overreact to changes. Diarrhea is not a common pregnancy symptom, at all. It also hasn’t gone away (though it is no longer “severe” by any means), so we’re pretty sure it is how my IBS has decided to react to the hormones coursing through my body. Completely unexpected, as my IBS was IBS-C until fertility treatments started, but at least it is consistent.

The next symptom to hit me was sore breasts. Now, when you read “sore breasts” you tend to think of the type of soreness you’ll get from over exercising a body part. That is not at all what first trimester of pregnancy “sore breasts” feel like. Holding perfectly still, it felt like my breasts were being smashed to smithereens. If I was changing and there happened to be a slight air current in the room, even one that was almost imperceptible, I wanted to scream. It was atrocious! The pain would wake me multiple times per night. I bought several different styles of soft bras to sleep in, to try to get some relief, and they only helped prevent increased pain as my shirt brushed across them. I had no idea that it was possible for my breasts to be that sensitive and painful, and I’m glad it wasn’t extremely long lived.

I also developed a strong aversion to sweets that lasted until December 24th.

My fibromyalgia and connective tissue disorder (hypermobile Ehlers-Danlos Syndrome) flared up, too. I hadn’t realized you get a burst of the hormone relaxin at the beginning of pregnancy, I thought it just came at the end of pregnancy. Nope, you get a large surge in the first trimester, than it slowly increases near the end of pregnancy as you prepare for birth. Relaxin is the hormone that loosens your tissues to allow your body to change and stretch to accommodate the baby and birth. When you’re already hypermobile, it causes a lot of extra joint pain. My pelvis and spine completely destabilized, which was really disheartening as I’d worked so hard to stabilize them prior to conception. Thankfully, they regained their stability before week twelve of my pregnancy. The extra loose joints, and all of the hormonal shifts, led to increased headaches and migraines, and nerve pain. It turns out, my fibromyalgia really acts of up during large hormonal shifts. Not only did every joint in my body hurt from the hEDS flaring up, but all of my skin and muscles felt like they’d been beaten by a baseball bat thanks to my fibromyalgia. I was very reliant on Tylenol and my electric throw blanket to try to get some relief.

“Morning sickness” is such an incorrect name, it would be laughable if you could laugh without getting sick. I was nauseas 24/7, and I had already been taking anti-nausea meds daily for years before conception. Thankfully, I never actually vomited, which is one area where I count myself lucky. (I’m pretty sure the meds are to thank for the lack of vomiting.) I didn’t want to eat, at all, but the less I ate the worse I felt. The first trimester was survived on plain buttered sourdough toast, oatmeal, gluten-free saltines, and water. Dinner was difficult, but I would force myself to eat at least a small amount of “normal food” every evening at dinner time. Because I wasn’t able to eat much of anything, I made sure to take my supplements/vitamins every single day, no matter how awful I felt. Then, one day between weeks 8 and 9, I woke up and felt absolutely fine. The nausea was just gone. I thought it was a fluke, but it never came back! Dan could tell when it vanished, because my personality and physical ability changed dramatically!

Our little bean at their 8 week ultrasound!

The diarrhea also wasn’t helping with the nausea or fatigue. If you’ve ever had severe diarrhea, you know it usually comes with feeling absolutely atrocious in all ways. I was losing fluids faster than I could replace them, I was extremely bloated and all of my pants were uncomfortable, I didn’t want to eat because it increased the bloating, and I felt so drained I could barely form sentences some days. After a week of severe diarrhea, I contacted my doctor and got the okay to restart my Bentyl, which is an anti-spasmodic medication that can help lessen diarrhea. Thankfully, it worked relatively quickly. The severe diarrhea was from about 3 1/2 weeks pregnant to about week 6 (roughly 2 1/2 weeks). I’m very grateful I wasn’t also vomiting, but if I hadn’t had the Bentyl I would have required IV fluids and/or hospitalization for dehydration anyway.

Another “symptom” that started right away, and is unlikely to go away until after delivery, is incredibly wild and vivid dreams! My dreams have always been extremely vivid, with all of my senses and full color and detail in every single one. They can be extremely difficult to tell apart from reality until after I wake up and realize things just didn’t quite make sense. However, with pregnancy, they’ve gotten absolutely wild! Pre-pregnancy, they’d follow a “script” and I could re-tell them to someone and have them make “sense.” Now, I don’t even know how to describe half of what happens, there is no script, and I usually wake up going “what in the world just happened?!” This symptom is mostly just highly amusing, though there have been some that get so intense they wake me up sweating or panting!

The Ewok was the only minifig we had!

How long did everything last?

  • I mentioned the duration of a few while describing them, but I’ll summarize everything here. We did the progesterone shots once per day from week 3 to week 6, then had to increase them to twice per day until we finally tapered off and stopped right at week 12. It was over 100 progesterone injections in total!
  • The nausea suddenly vanished sometime between weeks 8 and 9. I woke up one day and it was just completely gone.
  • The sore breasts slowly tapered down, and I’m not entirely sure when the soreness was gone completely. It stopped being notable after 8 weeks, as I stopped putting it on my weekly “highlights” at that point.
  • The severe diarrhea was short lived, but diarrhea in general has been a persistent symptom that still has not disappeared at 22 weeks pregnant. I expect it will continue for most of my pregnancy.
  • The dizziness was also thankfully short lived and only lasted until about week six or so. (This is a common symptom to have return in the second half of pregnancy, so we shall see.)
  • The extreme “can’t form sentences” fatigue lifted about week 12, with significant fatigue continuing until probably about week 16. At 22 weeks, I’m still not back to my pre-pregnancy “baseline” for fatigue, but I’m pretty close and I’m happy with that. Growing a baby is hard work, and being extra fatigued makes total sense to me!
  • The fibromyalgia flare seems to have been related to the progesterone shots, because it seemed to lift relatively close to the time we stopped them. It still flares more easily than it did pre-pregnancy, but I’m not in a constant state of pain anymore.
  • My body is still producing relaxin, and will continue until birth. I’m still having issues with keeping my pelvis in place, but my spine stabilized somewhere around week twelve. Overall, my physical therapist is thrilled at how my body is handling pregnancy through the second trimester, so I consider the “EDS flare” over now.
  • Wild and vivid dreams are unlikely to go anywhere until sometime after delivery, if ever.

Overall, we’re actually extremely happy with how well my body handled the first trimester. Everyone that knows my body was bracing for pregnancy to be a “near death experience” for me, and it wasn’t. Was I absolutely miserable through the entire first trimester? Oh yes, definitely! But was it that far off from what a lot of “perfectly healthy” people experience during the first trimester? No, it really doesn’t seem like it. My fatigue was elevated, and obviously the fibromyalgia and hEDS issues were unique to my body, but everything else seemed totally within the realm of “normal.” I feel extremely fortunate that my chronically ill body did not have a total meltdown upon getting pregnant.

One More Thing

I saved this for last, as it’s not a “symptom” and is not a common pregnancy related issue. Content Warning: bleeding. Throughout my first trimester, I had a significant amount of bleeding and spotting. The baby, thankfully, was completely unharmed by any of it, but it lead to significant distress for both Dan and me, and was the reason we had to increase my progesterone shots to twice per day.

The first trimester of an infertility pregnancy is primarily handled by the infertility clinic. Some clinics graduate you at 8 weeks, while others follow you until 12 weeks. We graduated from our fertility clinic at 10 weeks, right before New Years. My clinic does the first ultrasound at week 6 to check on viability. At that point, the baby is just a little stick, potentially with a heartbeat, hanging out in a small sack called the “yolk sack.” The yolk sack is a sack of nutrition that feeds the baby until the placenta is fully developed between weeks 10 and 12. We went for our six week scan, and were lucky enough to even hear the heartbeat for a moment! At six weeks, you may not even get a chance to see the heartbeat, let alone hear it! We felt very lucky!

Bee’s 6 week ultrasound! The central sack (dark circle) is the pregnancy sack. The white circle in the lower left of the pregnancy sack is a cyst (relatively common), and the hollow circle to the right is the yolk sack that contains the fetal pole!

When we got home, I had some really bad cramping. As I mentioned, I’d been having really severe diarrhea, so we assumed it was my intestines. I took some Tylenol and took a nap, while Dan went grocery shopping. When I woke up, I had to use the restroom (your kidneys get more efficient in the first trimester, so you are peeing constantly). My heart sank and I almost passed out when I pulled down my underwear, as they were absolutely full of deep red blood. I called Dan, told him to checkout with whatever he had already grabbed and get his butt home, because I felt like I was losing the baby, and then I called my doctor. She told me not to worry since there weren’t any clots, as she’d had women bleed so heavily they needed a transfusion, and to quadruple my progesterone dose and split it into two shots per day. Of course, this was the day before Thanksgiving (which is a Thursday), so we had to wait until Monday before we could be seen in the office again.

Dan came home to me absolutely sobbing, shaking, wandering around in the kitchen pantsless while trying to prep the progesterone shot. He got me calmed down enough that I could go lay on the couch, and he finished prepping the injection and administered it. We spent the next four days terrified of what we would see at the ultrasound on Monday. Having bleeding that heavy in early pregnancy is terrifying, and no one can say anything to take the fear away.

At the ultrasound on Monday, our little baby was growing appropriately, still had a strong heartbeat, and we saw the source of the problem. I had a fairly large subchorionic hematoma (SCH), it can also be called a subchorionic hemorrhage. An SCH is a pocket of blood that forms between the wall of the uterus and the amniotic sack, in about 1% of pregnancies. Yes, just one percent. However, for some unknown reason, they are far more common in fertility treatment pregnancies (especially IVF pregnancies) than in the general public. This article from What to Expect does a fantastic job explaining them.

6 weeks and four days. The barely there dinosaur figure in the lower right of the pregnancy sack is Bee! And you can see their heartrate was at 129! Up to the left, just outside the pregnancy sack, you can see a shadowy crescent. That crescent is the SCH.

The SCH in my uterus was less than 50% of the size of the amniotic sack, which my doctor said pointed to fantastic outcomes. She said a bleed that was less than 50% the size of the sack was very unlikely to cause issues with the pregnancy. While that was comforting, it’s still terrifying to bleed during pregnancy. Every single time I went to the restroom, there would be spotting either in my underwear or on the toilet paper. Thankfully, I never bled heavily again after that initial event.

Since an SCH can cause complications, I was put on pelvic rest, which is different than bed rest, stayed on a higher dose of progesterone, and got ultrasounds every other week to check on the baby. Pelvic rest means “don’t do anything that can stress the pelvis,” which means nothing inserted into the vagina, no orgasms, no lifting anything that causes you to strain (even slightly), and only low impact and non-bouncy exercises (no running, etc). I stayed on pelvic rest until week 13, progesterone continued until I was at week 12, and I had a scan every other week until week 12.

10 Weeks! The last ultrasound performed by the fertility clinic! Look at that little hand waving at us! The SCH isn’t visible in this view, but it was still there. It was resolving though, and barely visible.

Thankfully, everything worked out and baby is doing fantastic. But the first trimester was terrifying. We announced our pregnancy at 8 weeks, and barely told anyone about the SCH or the fear. It was really hard to be excited for ourselves when we were scared that at the next scan we would be told the baby had died.

If you’ve experienced the crippling fear that comes with pregnancy bleeding, please know you’re not alone! It’s scary, isolating, and traumatic!

CW over!

Thankfully, everything went well and we’re now past the halfway point of this pregnancy, at 22 weeks pregnant! It’s so hard to believe that in 16-20 weeks, we will be meeting our little Bumble Bee! I’ve had a few really kind followers on Instagram message me wondering if we have a baby registry, and we do. If you feel compelled to buy a present for Bee, or to help us recover from labor, please check out our Babylist registry, here. And please do not feel obligated to get us anything, your support has been amazing through all of this!

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