High Risk . . .

. . . is what any pregnancy of mine would be, apparently. Not that this is a big surprise - after all, since I've had 6 losses, I'm under no illusions that a pregnancy would be anything other than high risk for the embryo/baby. But now, it would also be high risk for me too.

Walking home from work through the snow one day in February, just before my 40th birthday, I had a revelation: getting pregnant might not be a good idea. I am insulin resistant, have low thyroid, one diagnosed clotting condition and at least one un-determined one, I have migraines with aura and now high blood pressure. The high blood pressure is also labile - it can have some big spikes, even on beta blockers. After a bit of reading around labile BP, I asked to go on some anti-anxiety medication which, in conjunction with the beta-blockers has brought the blood pressure down to a really good level, but even so . . .

All of these conditions are ones that can get worse during pregnancy, causing risk to me and the baby. I am on five different medications for these various conditions, which carry minimal risks for the baby, but risks nonetheless. After more than 6 years of trying to get pregnant and stay that way, I realised that I might have to stop trying.

This brought a strange mix of emotions. My first thought was: how unfair - after everything else that's gone wrong, now this! My second thought was: this is a way out! At the beginning of this journey, I was NEVER going to give up. I was going to keep going until the menopause. A friend, who is also a counsellor, described her internal image of me as wielding a sword into battle, which is a fair description of my state of mind. I was going to fight anything and anyone to have a baby. But that fight takes its toll - on our finances, on our relationship with each other, on our friendships with others, on my health, on my career, on the rest of our lives - and although admitting defeat would be terribly painful, it would also be a relief of sorts. And having the decision to stop taken out of our hands would be an even bigger relief.

I have second-guessed every decision we have made along the way, wondering if a different one would have brought us the prize, blaming myself, my husband, the medics each time a decision did not lead to the desired end: a baby. I have wanted a reason for our failures - preferrably one that could be fixed, but at least one that would explain the subfertility and the losses. Although there is a large part of me that wants the trying, testing and treatment to stop, it would be so hard to make and stick to that decision independently, without the outside help of some kind of reason or sign. So, in a bizarre way, I almost wanted to hear that we should give up for the sake of my health. My GP, when I spoke to her about it, said that she thought that giving up might be the right thing to do but that she was not an expert and in the end it was up to us - which is true, but I wanted more information/opinion before trying to make that decision.

On a routine visit to the Family Planning Clinic, I mentioned my concerns about continuing to try to get pregnant and the doctor was absolutely lovely. It had never occurred to me before to use the FPC in this way, and I doubt it happens to them very often - a woman comes in who is desperate to be pregnant, looking for advice about stopping trying, when what they must be most used to is streams of young women desperate not to be pregnant and looking for contraception. Of course, ironically, that was me once upon a time! The doctor referred me to a high-risk obstetrician at our local maternity unit. We live in a big city with a huge teaching hospital, so the experts tend to be very expert and I knew I would be in good, experienced hands. All I had to do was wait for an appointment - and waiting is something I am an expert in!

In the meantime, I had another appointment with the blood pressure specialist - a large, pin-stripe-suited, serious and straight-forward man in his fifties (I think), who I like. Turns out, he and his wife have no children - they married late and tried, had treatment, but failed. I told him about my doubts about continuing to ttc and he said he thought that deciding to give up now "might be premature". Hmmm. He had referred me back to the haematologist I had seen when I was first diagnosed with Factor V Leiden, to talk about how my blood pressure diagnosis might fit with that and the rest of my isues in terms of my general health. So I had my appointment with her, and it turns out that she works closely with the high-risk obstetrician in managing pregnancies with clotting issues. She couldn't swear to it, but she thought it was unlikely that the high-risk obs would tell us to stop trying. She was reassuring about my health - noticed that I had lost weight since she had last seen me four years ago and said I looked better and healthier now, at 40 years old, than I did at 36. Needless to say, that made me feel great!!

Finally, we got the appointment with the high-risk obs. She was fab - warm but no-nonsense sort of person. She pulled no punches about our chances - low chance of conception and high chance of miscarriage. But, if we do get an ongoing pregnancy, although it would be high-risk, and we would be in and out of her office like yo-yos for tests, scans etc, she thinks that with the right observation and management, I could come out with my own health and a healthy baby. My GP had warned me that these high-risk chappies can be a bit gung-ho - after all, they are used to being presented with women who are three months pregnant and have just found out they have cancer and my problems could seem pretty minor in comparison - so I was a bit concerned that her advice was on that basis. I asked her straight out if that was the case. She laughed little, and then said quite solemnly that if she really thought that my life or a baby's life was at serious risk, she would not hesistate to tell me to stop trying. I believe her!

She referred me on to have a hysteroscopy, which is scheduled for next month, and I'll have an endometrial biopsy which will be analysed by the big miscarriage clinic in London. Then, if all is well, we will have a round of donor eggs. This will be our last go, frozen embryos excepting.

Of course, now there is sw.ine fl.u, and the advice from the NCT to consider delaying conception till it's all over. Since there is the possibility that this pa.ndemic could be with us for 3-4 years, delaying for that long is not an option for us - we've waited long enough! But, considering my profession and how generous 5 year-olds are with their germs, I think I ought to delay until either I've had the virus or the vaccination, whichever comes first (and if neither kills me!). I'll be making an appointment to see my GP to ask about getting in early with the jab, but I go back to school in mid-August and I don't like my chances of dodging the bug for very long once I'm with the new intake. Watch this space!!