APAS, Pregnancy Complications, and Treatments

If I had a hard time conceiving naturally, sustaining a pregnancy is a whole new level of difficulty. Soon after I found I was pregnant, I went to Hi-Precision Diagnostics lab to test for APAS. I first heard about it after my second miscarriage in 2016, when my OB suggested I take a blood test. I didn’t know much but from what I understood, some women have difficulty getting pregnant or sustaining a pregnancy due to problems with their immune system. I shrugged it off back then because I didn’t plan on trying for another baby anytime soon.

But when I tested positive that fateful night of July 30, 2018, all the fears of my past miscarriages overwhelmed me. I just had to know if I was one of those women, and if I did have APAS, I knew I had to manage it right away to keep my baby alive. True enough, the results came and one of the levels was elevated. The mystery as to why I couldn’t conceive as easily as “normal” women was finally solved.

I researched about APAS online and stumbled upon a Facebook group of Filipino women struggling with reproductive immunological disorders. Joining the group proved to be helpful, as I read other women’s experiences and recommendations. While there are sad and scary stories, there are also inspiring posts of miracle babies and those are what I held on to.

One of my blood test results for APAS. Here it clearly shows that I’m positive for Cat 2.

What is APAS?

Let me cite this explanation by Smart Parenting: APAS, or antiphospholipid antibody syndrome, is “an autoimmune disorder [that] occurs when the body’s immune system makes abnormal antibodies that attack and damage tissues or cells.”

As an autoimmune disorder, APS occurs when the body makes antibodies that mistakenly attack phospholipids, a type of fat that’s found in the blood. This then causes blood clots to form in veins and arteries, which can lead to numerous problems and complications.

As far as I understand, there are five categories for this reproductive immunological disorder:

Category 1 is the Leukocyte Antibody Test, or when the woman lacks blocking antibodies needed to prevent her immune system from rejecting the baby.

Category 2 is when a woman’s blood is too sticky or thicker than normal. The blood flow is hindered, putting the developing fetus at risk.

Category 3 is the presence of antinuclear antibodies (ANAs), which attack the cells of a mother’s womb and the fertilized egg.

Category 4 is the autoimmune response to sperm antigen, which blocks fertilization itself.

Category 5 is the elevated presence of natural killer cells. While these are crucial to fight off infections and diseases, too much of NK cells can fight off pregnancy as well.

**Until now, I do not fully understand the science and explanation behind APAS, so I’m sharing this PDF file if you want to read up on it. This blog (click here) has also been a great resource for me.**

My blood tests indicated that I’m positive for Category 2. Just 1 out of the 5 categories. Still, this disorder will prove to affect my pregnancy greatly. My immunologist confirmed that most of my succeeding complications were a result, or related to APAS.

How my doctors managed my APAS

The first step for me in battling APAS was finding a perinatologist, or an OB-Gyne trained to handle high-risk pregnancies. There aren’t many from where I live, so while St. Luke’s Global is a three-hour drive from our place during the rush hours, it seemed to be the right and only choice for me. After a week of searching and panicking that I was wasting precious days without proper medical care, God directed me to a doctor who was readily available to see me.

She also referred me to an immunologist, who would manage my APAS. I was prescribed to take aspirin and inject heparin daily. These are blood thinners that would prevent my blood from clotting and harming the fetus. The immunologist wanted to address what was making my blood thicker than normal. He suspected that my immune system was more hyper than usual. To address this, he advised me to take two kinds of probiotics to “distract” my immune system. Aside from these meds, I was also put on steroids for three weeks to help calm my immune system. (At one point, I was taking up to 15 pills per day!)

SCH (Subchorionic Hemorrhage)

My Week 6 scan was encouraging–we saw the baby’s heart fluttering. On the downside, there was a small subchorionic hemorrhage forming in my uterus. SCH is a scary thing for me. Aside from the shock of seeing blood on my underwear, I believe I lost my last pregnancy because of this. I was put on strict bed rest as I was spotting on and off for about four weeks.

My immunologist suggested that I undergo intra-lipid infusion–a simple procedure where you’re given a blend of fatty acids and lipids through an IV. This was supposed to help the baby grow faster than the SCH. Thankfully, the blood clot was gone after one round and my bed rest was lifted just as I was entering my second trimester. I did continue the intra-lipid infusion for a total of five rounds, once a month.

Gestational Diabetes

In one of my routine blood tests, my perinatologist was alarmed that one of my sugar levels was higher than normal. It wasn’t that serious, she said, but she still referred me to an endocrinologist who then referred me to see a nutritionist. So during my second trimester, I was seeing four specialists: a perinatologist, immunologist, endocrinologist, and nutritionist.

Incompetent Cervix

My gestational diabetes was still manageable with proper diet until my 27th week–when I was admitted to the High-Risk Pregnancy Unit because my cervix was short and funneling already. My perinatologist was afraid I would go into pre-term labor, so I had to stay at the hospital for two days to get two rounds of steroid shots. These would help the baby’s lungs mature in case of premature birth. Because of the steroids, my sugar levels shot up and from this point on, I was prescribed to inject insulin four times a day.

By this time, my body could already feel the effects of all the drugs I’ve been taking. I was also getting physically weaker because I had to be put on bed rest again due to my incompetent cervix. Shortly after I was discharged, I saw a urogynecologist who inserted a pessary to temporarily close my cervix. This would hopefully buy me more time and prevent it from further dilating. My husband also got me a wheelchair so I could go around and have a small semblance of normalcy. I did not like the feeling of being lethargic and drug-induced, but I had to be diligent for the baby’s safety. I vowed to de-toxify after the pregnancy to regain my strength and chi.

Oligohydramnios (Low Amniotic Fluid) & Pre-eclampsia

Of all the complications I’ve been dealt with, nothing was more depressing than finding out that my amniotic fluid levels are abnormally low. This happened in my 29th week, and I had to stay at the hospital for a total of 11 days so I could be put on IV round the clock. I got discharged for three days but had to be re-admitted because my fluids are still getting low and my perinatologist did not want to risk a pre-term delivery. I was only 31-32 weeks by this point.

I stayed three more weeks at the hospital, and even spent my birthday and Valentine’s Day in confinement.  It was during this time that my blood pressure spiked up and I tested positive for pre-eclampsia. I also started having mild but regular contractions, so I had to take another medication to stop the contractions and also regulate my blood pressure.

I was getting weak, bored, and anxious. I questioned all the choices we made that led to this depressing point but I argued that we stuck to our doctors’ plan like obedient wards. Apart from my emotional distress, we were also getting drained financially. My husband and I are middle-class, working individuals and in no way do we have unlimited funds. If we totaled all the medications, doctors’ fees, procedures, and hospital confinements, the sum would be enough to build our home. I want to honor my husband for keeping his head in spite of our situation. Throughout our challenges, he’s prevented me from having panic attacks and always reassured me that everything will be okay.

37 weeks and counting

As I type this, I am now on my 37th week. My pessary has been removed, and I’ve stopped taking all my meds. I could give birth any time now! No one expected me to reach this far, not even my doctors. As my OB said, I’ve been dealt with every complication she could imagine, but my baby and I made it through.

This baby is truly a miracle. From his conception to his development and even the in-betweens. Even our financial status is a miracle–we’ve never spent this much money on anything, and yet we’ve also never made this much money in the span of eight months. It’s been a series of complications, but it’s also been a series of answered prayers. Truly, we’ve felt God’s faithfulness every step of the way.

The battle isn’t over yet. To be honest, I’m scared about labor and delivery. Because of my many complications, bed rests and hospital stays, I wasn’t able to prepare for childbirth. But in that moment of fear, I will try to remember the journey I’ve been through, and how God held my hand through it all.

“My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly about my weaknesses, so that Christ’s power may rest on me. -2 Corinthians 12:9

PS: I purposefully did not cite the names of my doctors and the cost of each treatment/procedure. If you want to learn more about how they managed my complications, or if you’re looking for recommendations, please PM me and I’d be glad to answer your questions! 🙂

My Infertility History & How I Got Pregnant

July 30, 2018, is now one of the most memorable dates in my life. I was three days delayed, so I decided to spend the day by moving and doing a general house cleaning. I dusted every shelf, swept the floor, vacuumed all carpets, did the laundry, and rearranged furniture. I thought physical activity would help my menstruation come along. The night before, I even drank soju with my husband, thinking some alcohol would also help.

I had two extra pregnancy tests from I don’t remember when, so in the evening, I said, what the heck, I might as well use them. Was I expecting to see two pink lines? No. I’ve had so many disappointments in the past that I actually didn’t think getting pregnant naturally was in my stars.

Struggle With Infertility: Polyps, PCOS, & Past Miscarriages

I got married in December 2012 although my husband and I didn’t plan to get pregnant right away. Mid-2013, though, we started to consciously try. I was 30 years old then. We didn’t consult with a doctor, but I did download apps to track my ovulation. Nothing was happening after three years of trying. I must admit that getting negative pregnancy tests month after month was a bit discouraging–not to mention, I absolutely hated it when relatives or even strangers would ask me why I still wasn’t pregnant.

Finally, in February 2015, I got a positive pregnancy test. Imagine my joy upon seeing those two lines! However, during my fifth week, I started spotting which soon after turned into bleeding. On my sixth week ultrasound, the sonologist couldn’t detect an embryo or even a gestational sac. My OB-Gyne termed it as a chemical pregnancy.

Source: http://www.healthline.com

Devasted but determined, I decided to try again. This time, with the help of a doctor. Since the chemical pregnancy, my menstrual cycle has been a mess. In December 2015, a uterine polyp was discovered after a series of transvaginal ultrasounds. I found myself at the operating table for an emergency D&C. Thankfully, the polyp was found to be benign.

After the procedure, I saw a fertility specialist regularly to monitor my ovulation. It was a grueling six-month period, from April to September of 2016. I was at the hospital almost every week for follicle monitoring. I had to take pills for fertility and ovulation. I also took a battery of tests–all of which turned out to be fine. My hormone levels were fine, my thyroid was fine, my endometrium lining was fine. Why I was having a hard time getting pregnant was still a mystery.

And then, during one of my regular ultrasounds, a sonologist saw multiple cysts in my ovaries. I refused to be tagged as having Polycystic Ovarian Syndrome (PCOS) so I decided to go for Traditional Chinese Medicine. There’s a TCM clinic in Panay, Quezon City which is run by Chinese nuns and I went there religiously every week for acupuncture sessions. After a few cycles, my period regularized and the cysts were gone.

Finally, I conceived by the end of September 2016. During my sixth week ultrasound, we saw an embryo with “good cardiac activity,” the report stated. But shortly after, I started spotting again. Subchorionic Hemorrhagemy OB said. Nothing to be done, but wait it out. Hopefully, the baby will grow bigger than the bleeding, or it will eventually bleed out. But by my 8th week, there was no longer a heartbeat. While I wanted to miscarry naturally, I had to undergo a D&C after a month of waiting to avoid infection.

Source: http://www.whattoexpect.com

In 2017, after the D&C (my second in two years), my hormones were so haywire that my menstruation became so erratic. There were months when I would bleed 30 days straight, and then there were months when I wouldn’t have my period at all. Although I didn’t want to go back to the hospital, I had to find out what was happening with my body. Apparently, I had a cyst in my ovary and I was prescribed to take pills. Again.

By this time, I was too tired, devastated, and frustrated. After a few months, I decided to stop all my medications and refused to see my doctor altogether. While I was worried, I just didn’t care why my body was acting the way it was. It was just too tiring physically, mentally, and emotionally.

At one point, I remember crying out to my husband and saying that I wanted to have my reproductive organs removed so I wouldn’t have to deal with these problems anymore.

How I Got Pregnant

I was convinced that I wouldn’t be a mother anymore. Not in this lifetime, anyway. After years of defeat and frustration, I finally decided to let go of all my negative emotions when 2018 came. I read “The Happiness Project” by Gretchen Rubin because I wanted to start my own happy story. I chose a word for the year: Deliberate. I would be deliberate in all my thoughts and actions–and always choose joy over jealousy, anger, and bitterness.

Writing my goals for the year, I did not pray to get pregnant at all. I wanted to be content with my life and be genuinely happy for the others who have had their wishes granted. Also, Enzo and I were able to buy a small lot the year before, and I wanted to focus all our energies into home building. I told my husband that IF we still wanted to have a biological child after moving into our own home, we would go the IVF route.

By February, I started the Keto diet and saw results almost immediately. Two weeks into the diet, I had lost around 8 pounds and my period came like clockwork the following months. By July, I had lost a total of 18 pounds.

That fateful night on July 30, 2018, as I stared at the pregnancy test, a mixture of emotions overwhelmed me. Disbelief, surprise, joy, anxiety, fear–all directed towards those two pink lines that slowly appeared on the strip. I was pregnant the third time around. Could my third time be the charm? Enzo and I said a little prayer for our little bean, gave thanks for this unexpected surprise, and committed our fate to His will.

I couldn’t say I got pregnant because of the Keto diet–I’m no doctor and no doctor would confirm this to me. All I know is that when I lost weight, my period miraculously came like clockwork. I also know that aligning my attitude and letting go of all negativity changed my life and I’d never felt lighter.

Currently, I am at my 36th week and counting. Every day I am amazed at our little miracle growing in my belly, who has defied all expectations and taught me about faith and hope and love.

Since announcing my pregnancy on social media, many women have reached out to me, sharing their own struggles with infertility.

I FEEL YOU.

I know how frustrating it can be, to wait for 2 pink lines month after month. I know how tiring it can be, the hospital visits and synthetic medications. I know how disheartening it feels, to see everyone else get pregnant except you. And I know how irritating it is, to be asked countless of times why you still dont have children.

I just want to say, IT’S OKAY. It’s okay to speak out and share your pain. It’s also okay to hide your pain. And while we will never know what the future holds, our miracles will happen in time—whether it’s in the form of a biological child or another blessing.

For me, it took 6 years of rainbows and storms. My miracle, more than this baby, is learning the lesson of letting go and choosing joy, always.

To be continued…