The Scoop on Ectopic Pregnancies

Looking back over the blog I realized that we have not posted anything about Ectopic Pregnancies yet we have quite a few ladies on the board that have experienced them. So let's go over what a Ectopic Pregnancy is and sign and symptoms to look for. I personally have not experienced one so if any of the ladies that have would like to chime in on anything please get a hold of me.

What is a ectopic pregnancy?

An ectopic pregnancy, or eccysis, is a complication of pregnancy in which the embryo implants outside the uterine cavity. With rare exceptions, ectopic pregnancies are not viable. Furthermore, they are dangerous for the mother, since internal haemorrhage is a life threatening complication. Most ectopic pregnancies occur in the Fallopian tube (so-called tubal pregnancies), but implantation can also occur in the cervix, ovaries, and abdomen. An ectopic pregnancy is a potential medical emergency, and, if not treated properly, can lead to death.

About 1% of pregnancies are in an ectopic location with implantation not occurring inside of the womb, and of these 98% occur in the Fallopian tubes.

In a typical ectopic pregnancy, the embryo adheres to the lining of the fallopian tube and burrows into the tubal lining. Most commonly this invades vessels and will cause bleeding. This intratubal bleeding hematosalpinx expels the implantation out of the tubal end and is a common type of miscarriage. There is no inflammation of the tube in ectopic pregnancy. The pain is caused by prostaglandins released at the implantation site, and by free blood in the peritoneal cavity, which is a local irritant. Sometimes the bleeding might be heavy enough to threaten the health or life of the woman. Usually this degree of bleeding is due to delay in diagnosis, but sometimes, especially if the implantation is in the proximal tube (just before it enters the uterus), it may invade into the nearby Sampson artery, causing heavy bleeding earlier than usual.

If left untreated, about half of ectopic pregnancies will resolve without treatment. These are the tubal miscarriages. The advent of methotrexate* treatment for ectopic pregnancy has reduced the need for surgery; however, surgical intervention is still required in cases where the Fallopian tube has ruptured or is in danger of doing so. This intervention may be laparoscopic or through a larger incision, known as a laparotomy.

*Methotrexate, abbreviated MTX and formerly known as amethopterin, is an antimetabolite and antifolate drug. It is used in treatment of cancer, autoimmune diseases, and ectopic pregnancy.

I've suffered an ectopic pregnancy, but my hCG keeps rising.. what could be going on?

There is a chance that you are still retaining tissue from your loss, you may be going through what is called a heterotopic pregnancy, or you may be going through a persstent ectopic pregnancy, either way you should be in contact with you doctor about your concerns for testing and monitoring.

Heterotopic pregnancy

In rare cases of ectopic pregnancy, there may be two fertilized eggs, one outside the uterus and the other inside. This is called a heterotopic pregnancy. Often the intrauterine pregnancy is discovered later than the ectopic, mainly because of the painful emergency nature of ectopic pregnancies. Since ectopic pregnancies are normally discovered and removed very early in the pregnancy, an ultrasound may not find the additional pregnancy inside the uterus. When hCG levels continue to rise after the removal of the ectopic pregnancy, there is the chance that a pregnancy inside the uterus is still viable. This is normally discovered through an ultrasound.

Although rare, heterotopic pregnancies are becoming more common, likely due to increased use of IVF. The survival rate of the uterine fetus of an ectopic pregnancy is around 70%.

Successful pregnancies have been reported from ruptured tubal pregnancy continuing by the placenta implanting on abdominal organs or on the outside of the uterus.

Persistent ectopic pregnancy

A persistent ectopic pregnancy refers to the continuation of trophoplastic growth after a surgical intervention to remove an ectopic pregnancy. After a conservative procedure that attempts to preserve the affected fallopian tube such as a salpingotomy, in about 15-20% the major portion of the ectopic growth may have been removed, but some trophoblastic tissue, perhaps deeply embedded, has escaped removal and continues to grow, generating a new rise in hCG levels. After weeks this may lead to new clinical symptoms including bleeding. For this reason hCG levels may have to be monitored after removal of an ectopic to assure their decline, also methotrexate can be given at the time of surgery prophylactically.

What are some signs and symptoms I should be looking for if I do become pregnant?

Early symptoms are either absent or subtle. Clinical presentation of ectopic pregnancy occurs at a mean of 7.2 weeks after the last normal menstrual period, with a range of 5 to 8 weeks. Later presentations are more common in communities deprived of modern diagnostic ability.
Early signs include:

• Pain in the lower abdomen, and inflammation (pain may be confused with a strong stomach pain, it may also feel like a strong cramp).
• Pain while urinating.
• Pain and discomfort, usually mild. A corpus luteum on the ovary in a normal pregnancy may give very similar symptoms.
• Vaginal bleeding, usually mild. An ectopic pregnancy is usually a failing pregnancy and falling levels of progesterone from the corpus luteum on the ovary cause withdrawal bleeding. This can be indistinguishable from an early miscarriage or the 'implantation bleed' of a normal early pregnancy.
• Pain while having a bowel movement.

Patients with a late ectopic pregnancy typically experience pain and bleeding. This bleeding will be both vaginal and internal and has two discrete pathophysiologic mechanisms:

• External bleeding is due to the falling progesterone levels.
• Internal bleeding is due to hemorrhage from the affected tube.

The differential diagnosis at this point is between miscarriage, ectopic pregnancy, and early normal pregnancy. The presence of a positive pregnancy test virtually rules out pelvic infection as it is rare indeed to find pregnancy with an active pelvic inflammatory disease (PID). The most common misdiagnosis assigned to early ectopic pregnancy is PID.

More severe internal bleeding may cause:

• Lower back, abdominal, or pelvic pain.
• Shoulder pain. This is caused by free blood tracking up the abdominal cavity and irritating the diaphragm, and is an ominous sign.
• There may be cramping or even tenderness on one side of the pelvis.
• The pain is of recent onset, meaning it must be differentiated from cyclical pelvic pain, and is often getting worse.

Ectopic pregnancy can mimic symptoms of other diseases such as appendicitis, other gastrointestinal disorder, problems of the urinary system, as well as pelvic inflammatory disease and other gynaecologic problems.

What causes Ectopic Pregnancies?

There are a number of risk factors for ectopic pregnancies. However, in as many as one third to one half of ectopic pregnancies, no risk factors can be identified. Risk factors include: pelvic inflammatory disease, infertility, use of an intrauterine device (IUD), tubal surgery, intrauterine surgery (e.g. D&C), smoking, previous ectopic pregnancy, and tubal ligation.

Will experiencing an Ectopic Pregnancy lead to fertility problems in the future?

Fertility following ectopic pregnancy depends upon several factors, the most important of which is a prior history of infertility. The treatment choice, whether surgical or nonsurgical, also plays a role. For example, the rate of intrauterine pregnancy may be higher following methotrexate compared to surgical treatment.

*** All this information was obtained by certified sources on Wikipedia.org

Interesting Article

Pressure to Father Child
Please take some time to read this article.

Short version: Timed sex can lead to issues with men's libido and the researchers don't recommend more than a few months of timed sex. Some men also are more prone to erectile disfunction and straying after prolonged timed sex. 

 ____________________________________________________________________________

Long version: 

 "Any couple trying for a baby is told that timing is everything. But pressure to perform when their partner is at her most fertile drives men away, according to research. 

One in ten men has had an affair because of the pressure of rigorously timed sessions, while four out of ten claimed it made them impotent.

More than 400 men took part in the study, which found the pressure to conceive a baby caused men acute stress.

Fertility experts routinely tell couples to time intercourse to coincide with the window when a woman is ovulating. There are even highly sensitive devices designed to help couples work out – down to the minute – when she is at her most fertile.

But as the number of timed sex sessions increased so did the men’s level of stress, according to the research carried out in South Korea. None of the men in the study had ever had sexual problems. 

 

The finding supports several previous studies showing that men who are under stress produce less testosterone, which has an effect on their libido.The authors suggested couples should be made aware of these risks and attempt timed sessions for no longer than three months at a time, with breaks for a few months in between. 

Timed intercourse seems to impose a substantial degree of stress on male partners, inducing erectile dysfunction and, in some cases, causing them to seek extramarital sex,’ they wrote in the Journal Of Andrology. Andrology is the branch of medicine concerned with diseases in men, especially the reproductive organs.

They added: ‘It is clear that the greater instances of timed intercourse trials, the more incidences of erectile dysfunction and extramarital sex and the greater the desire to avoid sex with the intended partner.’ All the couples in the study had been trying to conceive naturally for a year.

The authors noted that having to sleep with their partner at a specific time ‘becomes a burden and is carried out as a job to be done, which imposes further stress’. They believe that higher levels of cortisol, the stress hormone, being produced by the body was to blame for lower testosterone. 

Professor Allan Pacey, a senior lecturer in andrology at the University of Sheffield, said: ‘I’m glad someone has studied this, as the single biggest concern for men – usually when their partner is not in the room – is that they really find it a struggle when their partners are obsessed with timing.

‘While it is useful for couples to be aware of the fertile window, obsessing about it is not helpful at all. Men are being phoned up at three in the afternoon and told that the green light is on and they have to come home immediately.’

Professor Pacey, also chairman of the British Fertility Society, added: ‘If couples are having regular sex two or three times a week, they will hit the fertile window.’

In the UK the age limit for free IVF treatment is to be raised to

42. Currently only women up to 39 are allowed three free rounds of NHS fertility treatment. Draft guidelines being put out for consultation by the rationing body Nice could allow 8,000 more women in their early 40s to benefit. At present they have to pay up to £5,000 per treatment."

Summary taken from this post on the Infertility board on thebump.com

OPKs: Positive or Negative?

One of the most asked questions on TTCAL is "How do I know if my OPK is positive or negative?". It can be hard to tell sometimes. Hopefully this blog post can help clear up any confusion and make your TTCAL journey a little easier.

First let's recap what OPKs are and how they work. OPK is short for Ovulation Prediction Kits.These tests pick up the Luteinizing Hormone (LH) surge that is produced just before ovulation. Just like a Home Pregnancy Tests (HPT), these tests come in different forms; strips, cassettes or midstream.

When is the best time to test?
This all depends on how long your cycles are. Use the following table as a guide line as to when to start testing.

Cycle	Start Day
21	5
22	5
23	6
24	7
25	8
26	9
27	10
28	11
29	12
30	13
31	14
32	15
33	16
34	17
35	18
36	19
37	20
38	21
39	22

The best time of day to test would be late afternoon. Anything from 2pm is advisable until about 8pm. Reason being that LH is more concentrated in your urine later in the day, as opposed to early morning. FMU is not recommended when testing with an OPK.

Try limiting fluid intake before testing, as well as holding your urine for 2-3 hours before.

If you are taking Clomid/Fertomid it is recommended that you do not start testing until a day or two after your last pill. Sometimes these fertility pills can cause a false positive.

How long do I test for?You will need to test until you get your positive result i.e. detecting your LH surge. This can vary from 4 days to 10 days depending on how long your cycles are. The shorter your cycle the less tests you will need. You would most likely “see” your surge within 4-5 days from testing.

 What is a positive, I have two lines???
This can be a bit tricky. Since an OPK does not “read” the same as a HPT. A line is NOT always a positive line on an OPK. You will need your test line to be darker than or as dark as the control line. A faint test line only indicates some LH being picked up, not your surge. So keep testing until your test line gets as dark as the control line.

I have my positive, now what?
Once you get detect your surge, you can ovulate 12 – 36 hours after your positive result. (Bear in mind you can wait as long as 48 hours.) Intercourse (BD-Baby Dancing) can take place the day of the positive OPK; you can skip the next day and BD after that. Although you shouldn’t really miss more than two consecutive days of intercourse when Trying to Conceive (TTC). Of course there is nothing wrong with every day either as long as your partner does not have sperm health issues. If you are tracking your Basal Body Temperature (BBT), keep BD until you confirm your thermal shift.

All  above Info came from Making Babies

And since it is always easier to compare your OPKs to a picture, here are a few diagrams and pictures of different types of tests that will make it easier to figure out if your OPK is positive or negative.

See how the bottom one is as dark (if not a little darker) than the control line. That is a positive result. The 2PM test is not quite positive but almost there.

Another example of an OPK test, same principle.. not positive until the test line is as dark or darker than the control line.

Left (Not Positive), Right (Positive)

Then of course the lovely Smiley face!

Recurrent Miscarriages

This article talks about how it is not all on the woman. Interesting read.

http://mthfr.net/recurrent-miscarriage-causes-look-beyond-the-woman/2012/04/06/

Women with IBS have a possible higher chance of m/c

Found this article released a few days ago about the link between Irritable Bowel Syndrome and Miscarriage.

http://www.irishtimes.com/newspaper/health/2012/0410/1224314560778.html

"Rules" aka etiquette for BFP posting

Please remember that the following was on request, several requests actually. Also, this is blunt. It is intended to be blunt.


When is it OK to post your BFP announcement on this board, instead of going directly to PGAL and posting your announcement/intro there? Good question. Back in August, NoahBear wrote a lovely post for the blog that covered the subject well, and gave gentle guidance that relied on people's common sense.

www.ttcalblog.blogspot.com/2011/08/to-post-or-not-to-post-bfp-story.html


Prior to and since that time, there was a struggle on the board. Frankly, it got ugly. Many people who had been part of a core group of support here left under nasty suggestions that this board be 'controlled by and for newbies only', and anyone who had been here for more than 6 months should just leave. It was even suggested that they 'go back to m/c-loss' if they couldn't be happy for a random fly-by posting a 'Squeeee! I'm KTFU!' on the board.

Those sorts of suggestions were vicious and terribly painful to women who had been giving support and guidance to others and rarely asking for any themselves for a very long time. They were the glue that holds us together and provides continuity to our community. Only some of those lovely ladies who were hurt have come back. And of course, almost every single one of the women who wanted the oldies to leave have graduated and moved on. Because that's how this works. Most of you will be graduated and moved on in a few months.

However, one good thing that happened during all that, was that after almost a year of back and forth struggles trying to make this board a more supportive place (without becoming the puppies and rainbows barfing hell of babygaga.com), we found common ground and agreed upon certain ideas about posting (and graduate participation). After a few weeks, the first BFP post came and everyone held their breath. Then, only happy 'Congrats!' came and were from both newbies and oldies. Then another and another and another. Graduates felt free to come and post support for us, and no longer felt kicked out and rejected by us. Our community began to repair itself.

In time like an occasional hailstone in the rain, we noticed a few absolute newbies who had only posted for less than a month start to post BFPs. But, not wanting to bring back the all out nastiness from the past, people let them slide. Then there were a few call outs posted, the ONE sacrifice everyone had agreed on in order to find peace. But, when PSAs were posted reminding people that call outs were a no-no, the response back was 'Oh yeah? Well, the Rules aren't in the blog!' When a very new person found success on her first cycle in TTCAL, left for a few days, and then came back to post a BFP, and it was pointed out that it felt like a 'neener neener' post, the response back was 'Oh yeah? Well, the Rules aren't in the blog!'

Well. Now the 'Rules' are in the blog.

Whereas before it was left to your common sense, now it's spelled out. There is still some room for interpretation of course, we aren't toddlers, or at least we're not supposed to act like it.

Etiquette for Posting BFPs on TTCAL

1) If you are fortunate enough to find success on your first cycle or two on TTCAL, it's a pretty good bet that you should go directly to PGAL and post a BFP/Intro post there. The board as a whole hasn't yet had the chance to really get to know you or your struggles. Their happiness for your success is likely to be overshadowed by their pain of seeing yet another newb flash through and leave them behind. Posting now would only serve to hurt others. PGALers will be excited for you and welcome you with open arms. (Of course, if you were here giving support for months while you were TTA before you were TTC, then of course you've been here long enough.) Do remember that when you move over from m/c-loss you may move over with a group of women you know and feel comfortable with, but that doesn't mean that the rest of the women on TTCAL know you yet.

2) If you've been here actively giving support 3-6 cycles, and participating in the board as a member of the community, post that bad boy BFP up! If you read posts but don't respond to very many, or if you just start your own threads and don't reply much to others, then this doesn't apply to you. If in doubt, review your posting history. If the entire first page of history is all on TTCAL, all recent, and almost entirely support to others posts, you're probably fine.

3) If you're a member of 6+, then you get to post your BFP without thought or worry about it. You've been providing support and knowledge to 'generations' of TTCALers long after all your questions were answered for you by others. You've earned it. (But that's rather the point isn't it? BFPs are intended to celebrate the long-awaited success of our friends who have struggled.)

4) BFP posts should include a 'bfp warning' in the title. If you've already included a ticker in your siggy as fast as all that, please put a 'ticker warning' in the title. For reference, most graduates who post a BFP (or intend on coming back and offering support) chose not to use a ticker for a while, or use a typographic ticker ("my baby's progress"), instead of a graphical one (i.e. the fruit ticker or pictures of the developing embyo). Only graphical tickers should need warnings on BFPs. Graduates with tickers of any kind are always welcome to participate of posts started by people with 'PGAL/PAL Welcome' in their siggies, no warning needed.

5) Call out posts are absolutely not cool on this board. If you are so excited and happy for someone that you don't feel posting your comments in the OPs BFP post with everyone else is good enough for you, send a PM or call them out on PGAL (you do know that they read through those congratulation replies over, and over, and over again, right? Yours wouldn't go unnoticed. Really.). But the 'call out' posts were the price we paid for board peace. This isn't about being mean to you, it's about NOT being cruel to women who are hurting. Getting your umpteenth BFFN and logging on to TTCAL looking for support because you are losing hope seems pointless if the first page is all call outs for the latest graduate to leave you in the dust.

6) If you are new to the board, and someone is called out for their BFP post and you think it's uncalled for, perhaps you should stop, listen, and learn before condemning the very women who you will be seeking support and knowledge from, before criticizing them for calling someone out for an inappropriate post. If you are unlucky enough to be here for more than a few months, you'll figure it out fairly quickly.

7) Always remember that the intention of these rules are to provide a reminder about etiquette. Etiquette is not something to make yourself feel good, it's to make others feel good.




~Written by Petra from TTCAL

Awesome New Pregnancy Test and SALE!

Eearly-Pregnancy-Tests.com is offering a sale in excitement for a new pregnancy test.

One that allows you to see how much hcG is in your system!

Too good to be true? Maybe. I'll remain skeptical but optimistic.