Hcg after the holidays

Me and my husband have been trying for over a year now. And the latest baby dancing, we made sure that its in the whole week I was ovulating. Fast forward to 17May, night before our 2 week holiday trip, I tested positive for urine HCG. I needed to do it so I know if I can have a glass of wine or not during our trip. I was so happy by the result, but morning of 18May when I woke up, I had some bleeding over the bed sheet and I was thinking, oh no! We still proceeded with this trip but on that 18May, I managed to fill in the pad by afternoon. I didnt have any intolerable pain, I was walking, site seeing. A little bit of cramp was there and a palpitating sensation around my umbilicus, this was the reason we had to see a dr right away in Belgium.
They did blood works and it was showing 9 HCG only. My last menstrual period before this bleeding was 15April and I normally have 34 days cycle. So I suspect I was about 4 weeks this time. The dr also did a transvaginal ultrasound where she said she couldnt find anything and maybe its really my “period” which came today. She advised to carry on another set of tests after 2 weeks and I can go on with my travel plans. This period like bleeding last for about 3 days.
Fast forward to a week after that trip to a Belgian ER, I checked my urine HCG again and it became darker line. This HCG kit will tell if ur levels are above 25. I still dont have that much pains, but Ive been very tired because of the trip and sometimes feeling light headed because of the sun and too much walking. And today, I checked my urine HCG again and its a really confirmed positive. I dont know the levels. I will have the next blood tests and scans by 1June only.
Ive also been having brown mucus like discharges for 2x now since that trip to ER, but I read somewhere that when u get a TV scan, sometimes u get these discharges afterwards. Theres a weird sensation on my right side but it has been there for a long time now.
Just wondering if there is someone who had the same experience? Even if not on a holiday, but bleeding while pregnant? I would really love to have a baby but I am actually setting my mind not to expect too much as I cannot deal with heartbreaks. I am open thinking that this might be a case of ectopic and it is disheartening for sure.

My husband and I have been together for 9 years next month. Because of my PCOS, my cycles have been out of whack and so we never used protection and never got pregnant. Well last year I lost a lot of weight and got my cycle back around the holidays and boom: pregnant 3 months later. I found out the day before my birthday. Literally the best gift I've ever received. The pregnancy lasted 5 days after we found out. In our excitement we told all our friends and family because we were just so elated and full of joy, just for that all to be taken away in the blink of an eye and then have to turn around and tell everyone oops, just kidding. Honestly, telling my parents that they weren't going to be grandparents yet was the hardest thing I've had to do in a very long time. I felt so stupid, powerless, and foolish. I knew better than to shout it from the rooftops, but all I wanted to do was celebrate the life growing inside me.
I had a chemical pregnancy, unfortunately. My hcg levels never got above 35. I've never been more devastated and confused in my life. I asked myself questions like "is it because I was still in my meds?" "Is it because of the PCOS?" "Is it because my body rejected my baby?" Unfortunately I'll never know the answer, but my doctor has reassured me that it was nothing I did, that it was likely genetic abnormalities that caused my body to terminate it. It doesn't stop the questions though. Like how does she know for a fact it wasn't me? She doesn't. No one does.
Not only that, but I keep thinking I shouldn't be this devastated because at least I didn't have to have a DNC, right? It was just a chemical. The baby's heart most likely never even began to beat. I keep thinking I'm a fool to be this heartbroken over an embryo. But my heart... my poor heart is shattered. I've never loved something so deeply that instantly. I've never wanted anything more in my entire life. And now I have all this love that I don't know what to do with. I feel lost and aimless. I feel a deep, guttural sadness that I've never experienced. And the fear of it happening again is crippling.
I keep telling myself that I need to take care of myself for my future child but in the back of my mind I have so much doubt and fear that my happiness will be snatched away from me again. My gut tells me that our suffering isn't over and I'm fucking terrified.
I just want my rainbow baby. 💔
I appreciate you reading this if you made it this far, and I'd appreciate any kind words, books, helpful content creators, or any suggestions of any kind that you think might help me and my husband get through this. Sending you all love and baby dust. ✨💖

I was shocked to learn i was pregnant when i tested the day my period was due, just to be safe before a holiday party. My fiance and i were absolutely thrilled! We had preemptively frozen embryos a year ago and so i reached out to fertility doctor, who then put me on supplemental progesterone due to my age (38), and had follow up bloodwork and ultrasounds 1-2x a week. At 6.5 weeks, sac was still empty so they had me maintain meds and come back in a week, which confirmed blighted ovum. I was presented with three options for miscarriage treatment and based off how early and where my bloodwork was, doctor suggested natural and had me stop progesterone. I bled for three weeks, with heavy clots at times, and followed instructions of making a follow up appointment once bleeding had finally stopped for over 24 hours. I go in for bloodwork and ultrasound to ensure everything is empty and learn sac is still there & still have hcg of 2500. Dr. scheduled me for D&E which happened this past Monday. I thought i was going to have to go to hospital from how much i was bleeding when i got home, but it luckily tapered off after a few hours.
Im so depleted mentally, emotionally, and physically. Obviously doctors would have no way of knowing how long this would go on for or i would have gone right for D&E. I thought it was finally behind me, and instead i had to take it a step further. No baby ever even moved into this sac…. Why is it taking so long to evacuate?
I didn’t even have 3 weeks of enjoying pregnancy; i’ve had over 6 weeks of processing a miscarriage. I feel doubly betrayed by my body that now theres another thing it didnt do that it was supposed to. I’m never usually emotional but this has me crying at any and everything. I have such restless sleep. I am so short with everyone. Small talk feels crippling. I have nothing to give, and having to get the procedure was a setback in so many ways. This feels like pregnancy purgatory.

Trigger warning: MMC and CP
First time venter, I really need to right now. Took a pregnancy test this morning and got a vvvvfl. You would think: that’s great, congrats! But I’m 15DPO… I think at least. It should be much darker. So I started crying immediately. Am I experiencing yet another CP?
We’ve been trying for about a year now. First got pregnant February last year. I was so happy and blessed, because it was our first month trying! Unfortunately, it resulted in a missed MC at about 8 weeks. I had an medical induced MC on Easter (I called it bloody Easter, but my humor is broken). It was traumatic and I ended in the ER two weeks later due to severe blood loss.
After about three months, I got my first period again and started to heal. We began truing again and got pregnant in October, which resulted in a CP. Yet again, I was heartbroken.
With the holiday season, I noticed I had a lot of unprocessed emotions and feelings from my MMC and CP. I was a wreck during Christmas and told my husband I wanted to go to the doctor for further checks. My husband has been supportive and sweet, I can’t wish someone better! He agreed. Our doctor (GP) instructed us to get my husband checked out first, because it’s easier. His results came back good. So now it’s my turn, although I don’t have a date yet.
What makes it more frustrating is I know I have a chromosome deviation, in which it is more likely to miscarry. My GP knows this too. Sometimes I wonder if I should’ve get help earlier because of this. On the one hand, I’m scared my analysis will cone up empty (or good) and there’s nothing to be done. But it would totally suck to if they find anything new (other than that deviation).
In the meantime, we’re still trying (as you do). I got very confusing symptoms last week and was convinced I was pregnant. Well, I did a test this morning and guess what? I am. But I already think it’s not gonna stick due to the lightness of the test. Also my temp dropped this morning. It’s still high (36.92, which is normal for me post-ovulation), but I came down from 37.1.
I’m so mad and sad right now. Why? Why can’t my body do this? I’ve read somewhere that it can be possible to get a BFP later due to the HCG hormone not rising as fast as other women. But I don’t have hope. So I guess I just wait til AF shows up… I have no AF-symptoms whatsoever, but with this test in mind, I feel it’s coming one way or the other…
I just needed to vent this. Thank you all for being my safe space 💕
For anyone interested, my FF chart

TLDR:
Trust the process and your NBME/UWorld results
Questions and consistency are key
Try and find a study buddy for accountability
Ensure enough sleep (especially in your final weeks of dedicated)
Make personal Anki flashcards
Hey guys
This post is mainly for people who have literally a baseline of 0 when starting their prep and are a non-US IMG. Although I have a few tips for people currently revising in general.
This is going to be a long read and the purpose of this is just to share my own experience and I hope some aspects of this will help you in your journey too. I am a huge fan of this community since it has helped me get through the past 6 months of preparation so I appreciate every one of you who has ever contributed here. I literally spent 12 hours one day in summer collating advice messages from here to collect what people who scored amazingly well had done which I referred to frequently in my final weeks. I also watched every YouTube video I could find on STEP2 and tried to listen to their advice so I guess this is kind of what I have tried and tested.
Prior to STEP2CK
2 years ago, I got humbled after getting a lot lower than I was predicted in STEP 1. I then flopped my medical school exams the same year so I really wasn’t feeling great at all and it took a huge hit on my confidence. After spending last year reflecting on how the healthcare system in my country crumbling apart and where I would like to see myself in the future I decided to bite the bullet and start planning my revision - which is one of the most important parts of my journey.
I had forgotten pretty much everything from my third year of medical school since I had taken a research year. When planning, I decided to split my revision into three phases
Phase 1: Foundation building (3 months - July to September)
To establish my first base I watched all of divine intervention shelf videos for internal medicine, obgyn, pediatric and psych (I think there were a couple more) which are free on YouTube. I made flashcards on some of the concepts he covered that I just didn’t know. I thought these were amazing and really hit home a lot of the high yield points - he teaches by first principles which I love.
I heard that doing lots of questions was key to the success of STEP2CK so to further build upon this knowledge from divine, I decided to start using AMBOSS (before starting UWorld). I reviewed all the answers for AMBOSS even for the questions I got correct and made Anki flashcards that summarised what the goal of the question was trying to get at. I started with mixed questions and timed since in my head I was thinking that forcing myself to have random questions from the beginning would make it easier down the line. I don’t think there is a correct way to do it but I think it was good early on to force myself to not to be so system oriented since before doing the question I would already know what general category I would be tested on.
I was humbled and started with only around 40% correct for a set of 20 questions - I started to doubt my own abilities but after reading all the positive comments on here I just told myself to use this question bank as a learning tool (I still stand by this even if you are starting with Uworld) and that there was no way on earth I was going to be starting with high scores. I initially started doing around 20 questions a day building up to around 1 block of 40Qs a day and by the end of the 3 month period I had covered around 75% of the question bank.
Structure of my days in phase 1
Since I was on hospital rotations, I would spend each morning doing AMBOSS before getting to the hospital. I would then spend lunchtime reviewing the block. In my break times I would review my personal Anki cards. In the evening, I would relax for an hour or so for dinner and would typically also listen to a divine intervention podcast after dinner on a walk. For the rest of the evening, I would watch a couple of boards and beyond videos.
However, I feel like these videos are definitely not necessary for the majority of people since it was just to cover content that I had not yet covered at medical school or had not seen for over a year (I have online meded is just as good) - also I have still not covered peds/psych at med school yet 💀. I finished boards and beyond at the end of August. Other resources I used in this phase included Pixorise for the primary immunodeficiencies and also a few of the micro videos from sketchy since I forgot all of micro. Again not so necessary if you have recently done STEP1.
Phase 2: UWorld (2 months - October to end of November)
I still had around 25% of AMBOSS left and at this point I thought I had developed a pretty strong base. I would do a block (40Qs) of AMBOSS and then half a block of Uworld a day. Upon starting UWorld, I realised that AMBOSS was actually a lot more challenging than UWorld but looking back I think this was a good thing since it meant that I was challenged from the very start. I finished AMBOSS with a score of 63%.
I then transitioned into doing 60Qs of UWorld a day, averaging around 70-75%. I would put in a physical notebook a summary of the question I got wrong and would review this every night before going to bed - do what works for you as I have also heard of people putting these notes into Onenote/Uworld flashcard or notebook as well but the principle of writing things physically makes things stick for me which is why I do it.
Structure of my days in phase 2
I would do a block in the morning, a block at lunch and then review it all in the evening. The only other resource I used to supplement here in the evenings was Dr High Yield who again is amazing. Again I made personalised Anki flashcards for the concepts he covered that I didn’t know. I reached 50% of my way through UWorld at the end of this period and was doing 80Qs a day at this point.
I would like to say here as well when starting UWorld, it is imperative that you take the time to read all the options even if you get it right. This initially takes a really long time but in the overall journey I think it is worth it since you learn reasons to rule out a lot of the options - questions becomes a ruling out game. I would review my flashcards in my break times. I would also listen to a divine intervention podcast on my way to the hospital every morning.
Quick note on divine intervention - absolute legend would put him on in the background when I was in the gym or walking somewhere and honestly he hits so many important points that come up in the NBME exams. I thought 37, 97, 100, 13, 184 and 325 were the most important and I overall listened to them around 3 times throughout my entire revision period.
Phase 3: Dedicated (1 month - December to start of January) - 5 weeks dedicated also christmas holidays so had a month off from medical school
Week 1
After rereading a lot of posts on reddit and a couple of YouTube videos, I noticed that those who scored extremely well were the ones who did tonnes of questions. I therefore decided to increase my questions to 100Qs a day. (2 blocks of 30 and 1 block of 40)
At the beginning of my dedicated, I did my first mock, scoring 256 on NBME 10. I continued pushing 100Qs a day, doing all my questions in the morning and then reviewing them in the afternoon - going to the gym at lunchtime to recharge just so I could maintain sanity. Try your best to look after your physical health in the dedicated period since it can really make a big difference to your studying efficiency - even if this involves just going for a walk.
Week 2 and 3
In the second week of dedicated, I bumped up my questions to 120Qs a day and in the third week I bumped these questions up to 160Qs.
I finished UWorld with 2 weeks to go and finished with an average of 78%. I did NBME 11 after week 2 and I did UWSA1 and NBME12 in week 3 (see scores below).
In the past, reviewing questions had taken a long time (between 60-90 minutes of reviewing per block) so I decided to use a timer which led me to reviewing only the questions I was getting wrong and forcing me to pick out the most important explanations. At this point, I was also only just glancing through the explanations for the questions I was confident and getting right. This tactic definitely enabled me to increase my question volume since I was able to get much more done.
Week 4 and 5
I had also seen on reddit to do CMS forms in the final 2 weeks of preparation since it shifts you away from the UWorld style of questions since they are often trying to trick you. NBME and the real thing are more straight to the point. I did the latest two forms for each of the CMS forms and overall I agree if you want to aim for a really high score they can be extremely useful just to squeeze those extra points but if you are done with UWorld, you are definitely good to go.
Personally I did not do a second pass of UWorld even for the incorrects since when I did around 100Qs of the incorrects I ended up just getting questions correct since I had memorised the questions (probably since I had only recently seen the questions - unlike students in the US who have not seen these questions for quite a while since they would have only used them for shelf exams).
In these last two weeks, I would do 3 CMS forms a day and did an NBME every 2 days.
In my final week, I did AMBOSS risk factors, screening and vaccinations and quality improvement. These struck many of the high yield points so I would highly recommend doing these.
I did NBME 14 5 days before my exam and the new new free 120 3 days before the exam.
NBME advice
Mock exam tip: For every NBME, I would go to the silent section of the library that also had dividers to simulate the real experience and would also start at 8:30 every time. I would also only have protein bars or nuts in the breaks when doing the exams and not go on my phone since I wouldn’t be doing that in the real thing. In my head, doing this would just make test day seem like a normal practice exam which in the end really helped.
Notebook: With the NBMEs, I made a notebook just like I did with UWorld and wrote down the questions I got wrong into it. In the last two weeks, this is what I would read before going to bed since concepts from NBMEs do repeat albeit a few but even these few provide extra time for you to do other questions in the real thing.
Sleep: One of the most important things I learnt at this point was burnout. In my final two weeks, I had prioritised doing questions and reviewing over my sleep which was all over the place. You can see below how many score had a dip before NBME 13 which did worry me quite a bit. From that point I decided that I would always have 8 hours of sleep and made it a non negotiable. Following this, I had a 20 point increase in UWSA2 and a ten point increase to NBME 14.
Day before the exam
Basically I followed dirty medicines routine. I forced myself to wake up at 4am and to watch the sunrise. I headed to the park to finish my NBME book. I then came back and chilled with my flatmates for the rest of the day - they made sure I did not fall asleep. I watched the sunset, prayed and then fell asleep at around 9:30.
Day of the exam
I did not have the best quality sleep since I woke up several times but altogether by the time I woke up at 6 I had around 8 hours of sleep and felt fairly refreshed which I was thankful for.
I followed dirty medicines video advice on having oats with eggs and one cup of an americano before heading off to the testing centre.
In terms of the exam itself, it was more like NBMEs/Free120 in terms of vagueness but at a UWorld length. There were a handful of the HPA style questions but I find these a lot easier than reading the typical vignettes. Biostats questions were extremely easy just standard gimme questions you would see in UWorld. There were also many ethics questions which AMBOSS covers very well. The first few blocks were definitely quite manageable and UWorld/NBME prepared me well for it. However, by the time I was in my 7th/8th block I was so utterly exhausted and I practically collapsed as I left the exam room. I would recommend to avoid this situation by maybe doing 3 extra blocks of Uworld after doing an NBME mock or combining NBME with Free 120 just so that your body knows what it feels like since I honestly wasn’t really processing anything in the last block.
One of the Redditors mentioned this but with the way NBMEs write their exams, they can often give you symptoms that all point towards the diagnosis (like RLQ pain from umbilical region indicating appendicitis) and then there might be a scientific finding like an ultrasound finding (maybe of an ovarian cyst) or like a lab value like a raised HCG - please just ignore this since it is just putting you off - I can say that I saw a good couple of these in the real thing. Demographic of the patient is also often a key giveaway.
Tip for breaks: Some YouTuber mentioned doing star jumps in their breaks. I did this and a couple of press-ups and would go to the bathroom to splash water on my face before each block. I would also consume a protein bar every other break and sip some coffee. This really helped in my first 6 blocks since I felt refreshed after every block.
As you can see my Uworld score was closest to my predicted but I speculate this is more because the NBME curves are harsher than the real thing as the questions definitely more resembled the NBMEs/Free 120.
NBME 10: 256 (80%) (2/12/23 - 35 days out)
UWSA 1: 263 (83%) (12/12/23 - 25 days out)
NBME 11: 256 (80%) (19/12/23 - 21 days out)
NBME 12: 259 (82%) (26/12/23 - 17 days out)
NBME 13: 249 (77%) (31/12/23 - 13 days out)
UWSA 2: 271 (88%) (4/1/24 - 8 days out)
NBME 14: 261 (83%) (7/1/24 - 5 days out)
New New Free 120: 84% (9/1/24 - 3 days out)
Average CMS form score: 85%
Actual: 272!
Honestly if there is one thing to take away from all this is that STEP2 is highly dependent on how many questions you’ve done since it relies on test taking strategy unlike STEP1 which was more reliant on flashcards. I usually took 2 half days off a week to recharge. I think that consistency and having a routine are equally as important.
If you have got to the end of this I hope you can come away with one or two things you can utilise for your own revision. I wish you all the best of luck and most of all trust the process 🫡

I wanted to share my experience for others because when I was looking for answers, I couldn’t really find what I was looking for.
At 10DPO, I got my first BFP. Unknowingly, I was about to embark on an absolute rollercoaster.
12DPO- I had my first set of betas drawn and HCG was 15. My family doctor then called and told me that the number was just too low for it to be viable. I mourned and cried all during the Christmas holiday. My GP told me to wait it out and it was going to be a chemical pregnancy, I would begin my period within a few days. Like clockwork, I began to bleed and for 4 days, a decently heavy flow.
1 week later at 19DPO I decided to take an ovulation test that was blazing positive. Me thinking that was strange I took a pregnancy test which was a much darker positive than I had previously. Google sending me down a rabbit hole, I went to the ER where they confirmed my HCG was at 90. Not quite doubling every day but near enough that at that point, ectopic was not a concern.
21DPO (5W0D)- 2 days after my time in ER the early pregnancy clinic did an internal ultrasound (which showed nothing) and more blood work; HCG had more than doubled to 217. Doctors told me this was not typical of an ectopic pregnancy but because they still couldn’t see anything in the uterus, it was still considered a pregnancy of unknown location.
29DPO (6W1D)- 8 days later from 217, my beta HCG only reached 584. Doctors said I would begin to miscarry and sent me on my way.
6W4D- HCG 767
7W0D- another internal ultrasound and HCG 870. Doctors then told me they saw a 2.4cm mass on the outside of my fallopian tube and believed this was an ectopic pregnancy. Was given 1 dose of methotrexate.
7W4D- HCG 1198. Doctors advised that there is usually an increase after MTX
8W0D- HCG 823. MTX is working and I can finally close this chapter
Things to note are that throughout this I never had substantial bleeding except for very early on when I would have expected my period. I also experienced no pain or cramping. No shoulder pain.

Hi everyone,
I've been spending a ton of time on this subreddit over the past few weeks after our 20-week anatomy scan raised concerns about a congenital heart defect that can be associated with 22q11.2 deletion syndrome (also known as DiGeorge syndrome or a 22q microdeletion). We just got the results from our amnio back and everything is clear!
We are so incredibly grateful and relieved to have these results. Being in limbo was extremely difficult and I think I must've read every post on this sub about heart defects and microdeletions during that time. Now that we've got our answers, I wanted to share our story and the resources we found helpful in case it's useful to anyone else who is similarly in limbo now or in the future.
Timeline:

• I'm currently 34, will be 35 at my EDD. I've had one healthy full-term pregnancy followed by two (missed) miscarriages, both of which were at 11 weeks. The first MC seems to have been an anembryonic pregnancy; testing on the second MC showed that the issue there was trisomy 16.
• Due to previous MCs, we had beta HCG testing (weeks 3-4) and numerous early ultrasounds (at weeks 6, 8, 10, 12, and 14), all of which were totally normal.
• Had an NIPT test (MaterniT21 PLUS Core) that came back at 13 weeks and was negative for T21, T18, and T13. (In retrospect, a big part of me wished that we had done an expanded screen that included microdeletions just to have some information on that earlier on, but I know lots of folks have issues with false positives on those...)
• 20+1 - Anatomy scan. They had a hard time getting they a good view of the heart, but had concerns about the aorta potentially being too narrow (coarctation of the aorta), so we got referred for an echocardiogram.
• 21+5 - Fetal echocardiogram (some delay in scheduling due to the holidays -- our anatomy scan was the last business day before Christmas). The cardiologist was able to rule out coarctation of the aorta and other more severe congenital heart defects, but diagnosed baby girl as having a right-sided aortic arch, which can be associated with a 22q microdeletion.
• 22+0 - Meeting with genetic counselor. Our GC's estimate (based on fairly recent research with a pretty large data set) was that about 5% of cases of an isolated right aortic arch end up having 22q deletion syndrome.
• 22+1 - Amniocentesis performed. Given our history, I was really nervous about doing anything that would add even a small incremental risk to the pregnancy. But it went really smoothly and I'm so glad we did it. At our GC's recommendation, we got a FISH screening for 22q and a full microarray. We decided not to do whole exome sequencing because our GC advised us that there aren't known associations between right arotic arches and single gene conditions, so it seemed like this level of analysis would likely just raise more questions then it would resolve for us.
• 23+4 - Amnio results received. We ended up getting the FISH and microarray results at the same time (directly from LabCorp), both came back as normal with no issues identified on 22q (or elsewhere). GC followed up shortly thereafter via patient portal to confirm our reading of the report.

Given the timing of everything, we felt that it was important for us to use our time in limbo to learn as much as we could about 22q deletion syndrome so that we would have clear sense of what to do if the baby ended up having that condition. In addition to looking at academic and scientific studies about 22q, I tried to read a lot about the experiences of people with 22q and their caregivers as well as accounts from folks who chose to TFMR for 22q or a similarly "gray" or "spectrum" diagnosis. The single most helpful thing that we did was have a conversation with a genetic counselor at our local children's hospital who does a lot of work with children who have 22q. She was able to tell us a lot about the numerous and compounding challenges that those kids tend to face across a variety of domains and gave us very realistic and practical advice about what the resources are like in our area to help those kids and their families. It was a very tough conversation in some ways, but incredibly useful. I'm also lucky to have a great therapist who specializes in pregnancy loss and pregnancy/neonatal complications and it was incredibly useful to be able to talk through things with her during this time.
Specific online resources that I found particularly helpful included the following:

• National Center for Advanced Translational Sciences / Genetic and Rare Diseases Information Center on 22q11.2 deletion syndrome
• UC Davis Health (MIND Institute) resource page on 22q11.2 deletion syndrome
• 22q11 Europe Series on YouTube
• Unique / RareChromo Guide on 22q11.2 Deletion Syndrome%20FTNW.pdf)
• GeneReviews - 22q11.2 Deletion Syndrome (McDonald-McGinn et al. 2020)
• Practical guidelines for managing adults with 22q11.2 deletion syndrome (Fung et al. 2015)
• Neuropsychiatric aspects of 22q11.2 deletion syndrome: considerations in the prenatal setting (Bassett et al. 2016)
• A French collaborative survey of 272 fetuses with 22q11.2 deletion (Besseau-Ayasse et al. 2014) (full PDF available through Google Scholar)
• Views of adults with 22q11 deletion syndrome on reproductive choices (McNeill et al. 2020)

My heart goes out to all of you out there who are in limbo -- the last few weeks have been one of the most difficult periods of my life. Hopefully some of this was useful, happy to answer any questions folks may have.

For context, I'm on doctors prescribed testosterone therapy. Started in December of 2022. I'm taking 200ml of test cypionate split in 2 doses. And taking hcg. 750 is split in 3 doses. Over the holidays I developed pretty bad anxiety. I decided to check my levels, and my T was 875, but my E2 was 66. The range was 20 to 44. So I'm prescribed anastrozole. Should I take 1mg after each dose for a couple of weeks to bring it down, and then lower the dose for maintenance? Doctor wasn't very clear on how to lower it and keep it in check. Other symptoms I had was tiredness, weakness in the gym, and low sex drive/ poor erections.

Trigger warning: Hcg levels, possible loss
I need some advice... Here's the story: 12/30/23 I went to the ER with excruciating cramps and had been bleeding for 2 weeks AFTER my period. After deciding that I could be pregnant, they found out my hcg levels were 240 and told me to follow up in 2 days to see the rise. Well 2 days later 1/1/24 they were at 238. That's not much of a decrease but they diagnosed me with "threatened miscarriage". After severe cramps, lots of pressure and still bleeding, and passing what I thought was tissue... January 10, I went to my local university (more equipped and better staffed, always busy, one of the best in my region) hospital in more pain that was more concentrated on my right side. After a transvaginal ultrasound and more blood work they determined that my cervix was closed, and my right ovary was "messy" with some internal bleeding (not enough for concern since I was still talking and walking) and I have a gestational sac that they were able to see. She said she thinks it's my corpus luteum helping my pregnancy survive. My hcg levels were 135. Went back yesterday and this morning I woke up to a notification about test results. 1/12/23 My levels are 145. Is this a good sign or are we getting our hopes up? Of course I stopped trying for the holidays, stopped tracking everything, and here we are! I'm pregnant and I don't know what's going on or how far along even. I was diagnosed with "Abnormal Pregnancy in the First Trimester". Any advice or successful stories would be great. Thank you. Sorry for the wall of text.

Firstly I know I’m by far not the worst off of all of you wonderful people in this club none of us want to be in. I’ve only had one pregnancy and it ended in a ruptured ectopic with tube removal. I still have my other tube. I don’t know if it works but I have it. And I know that’s a lot!
It might just be part of grieving but I don’t know how anyone moves past this. I’m desperate to try again ASAP so I can rid myself of the uncertainty and move forward to a conclusion - whether the result is that I am able to conceive or not - but I am also terrified. I nearly didn’t TTC the month this happened as I had a different surgery scheduled end of Jan for something unrelated, and keep kicking myself like maybe if I’d just waited and sat a few months out pre-op this would never have happened. I’m terrified of another ectopic. I didn’t have the worst rupture in the world but it was so scary, and so traumatic trying to get taken seriously at the hospital. I spoke to or attended the early pregnancy unit at the hospital every day for 11 days, with severe pain and heavy bleeding, before they located the ectopic and validated I wasn’t going mad. Even though I’d had plateauing and spiking HCGs. I can’t imagine going through that pain or emotional turmoil again.
For those of you who have TTC or been fortunate enough to have success after an ectopic, how did you cope? I can’t imagine the wait for placement scans, or HCG checks. How do people withstand the uncertainty? My partner and I want to get a holiday in the diary so we don’t feel our whole lives are being paused or dictated by something so out of our control, but I can’t imagine ever feeling comfortable to leave the country whilst TTC after the experience I’ve had. Is this totally irrational or does anyone else fear this too?
I acknowledge this all probably sounds very dramatic, but it’s really knocked me sideways. It’s just one miscarriage and it’s just one tube, but I’m so scared for the future and don’t know anyone who really understands, and it’s hard to open up to friends or family when they have so many platitudes like “at least you got pregnant” or “I’m sure good things are right around the corner”.

My husband and I got pregnant the first time we tried last year - it was a very welcome surprise, as we were on a holiday and I was convinced that I wasn't going to get pregnant quickly.
I started haemorrhaging at 5-6 weeks, was told that it wasn't a miscarriage and that there was still a chance that the pregnancy could progress well but that it would depend on the next few weeks. After two weeks onwards, it was pretty clear that I had a blighted ovum as there wasn't enough growth for the 8-9 weeks I was meant to be at.
I had a D&C at the start of December, my HCG levels are now back at 0 and I'm waiting for my first period but otherwise feel physically fine.
My feelings about this whole experience have been so, so mixed.
I find that I'm telling myself a lot of the things that I see do upset many on this thread (when said to them) - my husband and I are both relatively young (30), conceived quickly and can get pregnant. I'm also lucky that I have a flexible desk job where I can WFH and take quite a bit of paid sick leave. I know that I'm more fortunate than a lot of people and I even sometimes say these things when telling the few family and close friends that we've told, maybe because I feel like otherwise they aren't sure what to say.
At the same time, that baby was so, so wanted and I struggle because there wasn't even a baby to grieve, I only ever grew a gestational sac. Just because this whole thing has been 'neat' and there weren't further complications, in theory we can try again soon, doesn't mean that I don't grieve for what could have been and it also doesn't mean that this last few months feels like I've been in limbo - but I find it difficult to express that generally and with anyone who isn't my husband or my mum, and even then most of the time I think I compartmentalise too much.
I've been distracting myself quite a bit with various projects, and have definitely felt misdirected anger. Mostly though, I find myself just waiting and planning for the future. Sometimes I worry that I'm not able to fully enjoy the present right now, and I should appreciate and be grateful for being young and in a loving relationship. I don't know how everyone gets through TTC journeys, full time jobs, and everything else life throws at us.
I read a lot of the posts on this thread and feel less alone. Thinking of all of you.
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33 y/o Male here, current test levels:
Total Testosterone - 321 ng/dL
Free Testosterone - 66.6 pg/mL
SHBG - 25 nmol/L
I will try not to make this post terribly long but I feel I need to explain thoroughly to give a picture of my current feelings on doctors and testosterone. For the better part of a year, I have noticed a downgrade in my gym work ethic, motivation in general, energy levels and sex drive. I have been an AVID gym bro for about 7 years now and I have been 100% natty during this time. I have done bulks and cuts along the way, dabbled in powerlifting and about 2 years ago I was in the best shape of my life after a cut sitting at 192 lbs and very lean. Since then, I have noticed a decrease in all of the above mentioned things and I'm sitting at 250 lbs. I go to the gym regularly still, my diet is not the best but it's still prepped meals for the most part. I am unable to see the progress I was able to 2 years ago so this led me to start getting my numbers checked.
I first got my levels checked 6 months ago by my primary care provider, I raised an interest on the findings of the testosterone being as low as it is and they simply waived me off. I was persistent that I would like to address the issue and asked to be referred to a urologist, which they granted. Upon first meeting with the urologist he agreed my test levels were low and at the bottom of the reference range but wanted to test again to double check. He went ahead and mentioned options with me at that time saying we would most likely start with Clomid since my girlfriend and I are still planning to have children in the near future but he also mentioned potentially Test w/HCG. The labs came back over the holidays and I got a call the week after xmas from his nurse telling me everything was normal and that I did not need any kind of therapy. I demanded a meeting with the urologist since this was the opposite of what we discussed, I thought there was maybe a mix-up. Met with him today and he said the same as his nurse, a complete 180 from what we talked about. He said my test was "where we expect it to be" at my age and that it was within the range based on urology standards...blah blah blah he basically rushed me out the door when I brought up the prior conversation we had.
Here are my test results from 2 years ago:
Total Test - 656 ng/dL
Free Test - 118 pg/mL
SHBG - 44.1 nmol/L
I'm just at a loss currently. I really feel that my test being much lower is the cause of my issues (fatigue, decreased performance physically, lack of sex drive) and I cannot get a doctor to address it. I would just take test as I can definitely access it at my gym but I would really prefer an alternative that will not mess with fertility. My girlfriend has been on board with everything through this as my sex drive is basically non existent and I'm just at my wits end with doctors. Does anyone have any advice, should I try another doctor, an endocrinologist maybe? Are my levels actually just normally and I'm coping with this? Feel like I'm losing it.

When I (31F) found out I was pregnant with my first at 5 weeks, I was cautious not to get overly excited. My older sister and cousin had both just suffered miscarriages within a week of each other in early October, so I was not naive to how common they were. But after TTC for 6 months, I can’t say I wasn’t over the moon to finally see those two pink lines on the positive test. Waiting for my 8 week appointment was grueling and riddled with anxiety + morning sickness. Thankfully, my first OB appt. went great. Baby had a strong fetal heart rate (156 bpm) and was measuring right at 8 weeks. Thinking everything was going to be fine, my husband (32M) and I decided we’d announce the pregnancy to our families over the Christmas holiday (I’d be 11 weeks and almost in the “safe zone”)
We told my side the day before Christmas Eve, and breaking the news to my sister was hard, despite her reassurance she couldn’t be happier for us. We attended Christmas Eve mass the next day, and then headed to my mom’s house for dinner and games. While preparing some of the apps, my sister surprised us by telling us she was ALSO pregnant again!! We were SO excited to raise our babies together…
Not even 10 minutes later, I felt the all-too-familiar feeling of cramping. I excused myself from the kitchen and went to the bathroom where I discovered some moderate bleeding. I was frozen in fear as tears steamed down my cheeks, immediately thinking the worst had happened. I don’t know how, maybe it’s the bond of sisterhood, but somehow my sister knew something was wrong and came to check on me.
I called and spoke to my OB (who was thankfully on call on Christmas Eve), and she advised us to keep an eye on things and what to watch for. We ate dinner as planned and I tried my best to avoid letting my mind wander into darkness. My husband and I drove home after dinner in silence as I cried, preparing myself for what I could feel was about to happen.
The next morning (Christmas Day) the bleeding had gotten worse, and I told my husband we needed to go to the ER. We walked in at 8:30am and three hours later (after being poked and prodded) they told us our baby no longer had a heartbeat…a deafening silence I will never forget. I was discharged and sent home to miscarry my baby with nothing but a mild painkiller and anti-nausea medicine.
I cannot stress this enough…how completely and utterly ill-prepared I was for what was to come.
I went home that afternoon in a daze of disbelief. It hadn’t fully sunk in that I was carrying my dead baby inside me, and probably had been for the last week or so. My husband and I’s immediate family rushed to be with us, and we celebrated Christmas the best we could with sadness in our hearts. Thankfully, the bleeding and cramping was still fairly manageable and I felt up to the company.
Not long after everyone had left and my husband went to bed, I felt the most excruciating cramps and pressure of my life. No pain meds or heating pad would help. I stayed up until 2 am in pure misery until I finally pulled myself off the couch and crawled into bed with heavy eyelids.
At around 7:30 the next morning, I awoke to the sensation all women know… The feeling that I was about to drip blood the second I stood up. I was right.
Immediately, I sprinted to the bathroom and passed 2 of the largest clots (bigger than my fists) of what looked like reddish/amber colored jelly. I knew it had begun. I could feel my uterus contracting and the pain was unbearable. My husband rushed to the store to buy me period panties and the biggest pads I’ve ever seen, because unlike every medical professional had told me, this was nothing like a “heavy period.” I was completely unprepared - soaking through my light pads in seconds.
The fear and anxiety I now felt was for my own body, unsure of what was “too much blood loss” and terrified by the things coming out of me. My husband returned in the blink of an eye and helped to get me situated back in bed.
A few minutes later, I felt another gush of blood escape and fall down my legs and onto my bedsheets. Another massive clump was expelled and the cramping continued to intensify. I went through 4 pairs of pants within a matter of 30 minutes.
I finally gave up on pants and wrapped my lower body in a towel as I sat back on the toilet. I felt lightheaded, nauseas (gagged into the trash can beside me), like I was actually going to sh*t myself, and so dizzy. I passed two more large clots and then fell to the bathroom floor. The cold tile floor felt good on my body as I waited to regain my strength. I pulled myself up around the toilet and something inside me told me to scoop out the tissue before flushing.
There in my hand was my tiny baby, her eyes staring into my soul. I was absolutely devastated but relieved to feel the pain subsiding. I could feel my contractions slow down as my uterus began to constrict. Lying there on the bathroom floor, I screamed at God in anger and wept for him to keep my baby safe in His arms all at the same time.
The jelly-like clots continued to pass that day, but the cramping grew less severe with the pain meds I was provided. I thought the worst of it was over… I was wrong.
The next day I felt okay, I wasn’t in nearly as much pain as the prior morning, but that was all about to change. Around 2pm that afternoon I began to feel that horrible cramping, like contractions and immense pressure on my rectum. I laid with a heating pad for a couple hours, hoping that it would go away. When I went to go to the bathroom, the sensation was much different than before. Something solid and definitely not jelly-like fell out of me as I straddled the toilet I began to hate. I knew the material was different than everything else I had passed, so I also scooped it out and was immediately terrified. The material was firm and felt like an organ. It looked almost as if it were a human heart - a strange irony about placenta. This image I will never unsee, but I also knew we couldn’t just flush it down the toilet.
The rest of the week I continued to bleed and pass more “jelly-like” tissue that was smaller than the others. It took a full 10 days for the bleeding to stop, and I visited my OB to make sure everything was okay. They told me there wasn’t any remaining pregnancy tissue, but my hcg levels were still testing positive…a sick and twisted paradox in pregnancy loss.
I’m physically feeling much better now, but my heart has been shattered into a million little pieces. Our baby’s tiny casket arrived this evening and we will be holding an interment service for her in the morning.
I know not everyone gets the chance to say goodbye to their baby like this, and I’m just grateful something inside me told me to look.
I know this experience isn’t truly over yet, as there’s lots more tests to be run and therapy in my future plans. But I just have to say, being in this club really sucks and it’s so unfair….

34yro male Long story short with my results:
Canada so metric units:
September 2023 (felt like crap)
Testosterone Total 5.9nmol/L (reference range 8-35)
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November 2023 (felt like crap)
Testosterone Total 4.4 (8-35)
Testosterone Free 114 (175-700)
After that I got referred to a TRT doc who specializes in hormonal therapy.
December 4th 2023 (felt ok)
Testosterone Total 9.4 (8-35)
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And another test:
December 28th 2023: (felt good)
Testosterone Total 9.7 (8-35) - suddenly in range, but lower range.
Testosterone Free 238 (175-700)
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Worth noting that my T levels used to be in the mid to high range in my late 20s.
So the TRT doc suddenly sees the results above (in range) and says that my body is able to produce. He says that based on the previous results he could easily put me on TRT but that would make no sense, since the TRT would shut down my natural production - which I kind of agree, but... He asked me "what happened in your life that suddenly in December your T is in range.
Well, life and holiday happened. December 28th was right after the Xmas break and I was sleeping really well, overeating and reduced my workout to minimum - not sustainable long time.
When he heard about my sleep he recommended to look deeper into my sleep and wanted to refer me to a sleep specialist (not CPAP, apparently we have a world-class doc in town specialized in sleep studies who takes the big picture).
Anyway, the TRT doc gave me another bloodwork requisition to see how it looks like again and follow up.
The TRT doc was really hard to get to, originally my appointment was in March but they called me with the last-minute cancellation and spot available and I went there right away. The March appointment was too long for me so I contacted Science & Humans (online TRT clinic in Canada) and that's why I had another bloodwork done in December 28th. Based on the results they said that I am a good candidate for TRT - while the TRT doc said that based on the same results we should look deeper what is happening.
I'm on the fence here - the TRT online clinic is obviously all about money so they want me on TRT. The TRT local doc says "let's wait and look deeper". I don't know who is right and what to do.
Do nothing and wait?
Start HcG only to enhance my natural production?
Go on TRT?
Go on TRT & HcG?
All I know is that my T levels are crap majority of the time. I felt better even with low range testosterone but I likely won't be able to achieve that. My reasonable voice inside says don't start trt unless you absolutely have to because you will shut down your natural production.
All other affecting bloodwork tests were in range such as thyroid hormones, prolactin, estradiol, PSA. My hemoglobin was in the higher range already.
Any thoughts would be appreciated.
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Hello everyone. I’ve been on the paragard IUD for almost 4 years now and last week, 12/26, I found out I am pregnant. My last period was 11/12, and I have made the joke that I always “bleed for the Virgin Mary” during the holidays. So this year, I was expecting a period a bit before Christmas but it turned into 2 weeks being late on my period. My breasts were tender for a week straight and I was having bleeding but it was only light and at the top of my tampons. Something inside my gut felt like I was pregnant. So the day after Christmas I didn’t waste time that morning and I got three tests. lo and behold, 2 lines almost immediately. Obviously super shocking, exciting, and baffling but then soon became fear. You hear horror stories about IUD’s causing ectopic pregnancies or the IUD being shifted or puncturing something. My OBGYN office luckily got me in that afternoon. My doctor wasn’t in, so they had a nurse practitioner see me. The office confirmed that I was pregnant and then proceeded to ask my questions of pain and bleeding. I was the first she’d ever seen. I’d not really had any pain, just light pulling sensations and spotting. She let me know I was probably 6 weeks along. I asked if they could remove the IUD asap and we got to it. She could see the strings and she said all looked well and got my IUD out (which hurt like a MF). They’ve ordered me to have my HCG levels checked every two days, and so far I’ve had two blood tests. She said if it’s an abnormally high number it could be ectopic. First came back at 10k IU/ml and the two days after came back 15k IU/ml but because of the new year holiday I didn’t get to have my next blood work done until today. So I am hopefully expecting at 40k+ IU/ml number ? No one has called me to talk to me about what the numbers mean or indicate so I’ve had to google everything and I believe that’s a safe number at 7 weeks. I called the emergency on call nurse on Friday because I passed a big old clot, maybe possibly from the IUD removal and she said 10k was high but the internet says otherwise…would love some insight into this and if anyone else could shed some light on this craziness. Anyone else have an IUD baby? I’m staying hopeful and praying everything is viable. ❤️

I was in the ER on 12/17-12/18 bc I had pain on my right side and light bleeding. They did an ultra sound and found what they believed was a cyst on my left ovary. My HCG levels were 117 and I was 13dpo. I got my levels checked again 17dpo and my levels were 1233. My doctor doesn’t seem super concerned bc they said I could wait till after the holidays to get another ultra sound. I no longer have the pain and I haven’t bled sense but I’m freaking out bc the earliest we can get an appointment is Thursday. Do these numbers seem normal? I’ve never been pregnant before so I’m just very anxious. I occasionally feel a slight pinching feeling on my ovary but the ER said that can be the cyst.

I have had the best support from this group and wanted to share our update in hopes to help anyone else going through the same.
My husband and I cannot conceive naturally because of male factor infertility, and we have done five rounds of IVF so far. We decided to do a fresh transfer in May, and it took. However, my HCG rose slowly, and the pregnancy ended sadly in a blighted ovum. Fast forward to October when we did another IVF round. I was going to test all the embryos this round, but our doctor insisted that there was one embryo that looked so good that she wanted to do a fresh transfer. So, I did. And it took. My HCG was rising appropriately, and everything looked great on the weekly scans I had from weeks 6-11. The baby had a strong heartbeat, measuring three days ahead and I could see the baby move and wave on the ultrasounds. I could almost not believe how well things were going. Until week 11 when I got my NIPT results back.. Positive for Trisomy 21. I got the results in the morning on my patient portal, even though I had specifically told my OBGYN to call me if the results were alarming. So I panicked and did not know what to do. My doctor finally called me six gruelling hours later, told me that she had only ever seen a false positive once for T21 and she got me an appointment with a MFM the next day. This was December 22nd. One day before most clinics and doctors' offices closed for Christmas. The MFM did a thorough scan for almost an hour and found every single soft marker for Trisomy 21. No nasal bone, increased thickness of the nuchal fold, and EIF. I completely broke down in front of the doctor and it was the worst hour of my life. The MFM told my husband and I that we could do a CVS, but we would have to wait three weeks because of the Christmas holidays, but that he could tell us with 100 percent certainty that this was Trisomy 21 and possibly even more health issues. I did not want to wait another month in limbo, so we decided to make arrangements for TFMR. We live in a red state so we could not do it at home, but thankfully our IVF clinic (not in a red state) helped us set everything up and got us an appointment a week after. Worst week of my life having to wait for something so horrible. I'll also add that I had TERRIBLE morning sickness, nausea, vomiting every day, exhaustion, food aversions to pretty much everything (I lost 15 pounds in two months), and generally feeling completely not myself the whole pregnancy. Of course, I did not mind this when I thought things were going well with the pregnancy and everyone kept telling me this was great news because it meant things were progressing well with the baby. But to have all those symptoms, while knowing you were about to terminate, was extra cruel.
Fast forward to a few days after the procedure. The procedure itself went well. Amazing doctors and nurses and the hospital was incredible. I was exactly 13 weeks at termination. My husband was with me the whole time (except the operating room) and I felt safe and cared for. I cannot believe that some women have to go through hordes of protesters yelling and shouting at them while having to go through something so awful. If you have chance to choose a hospital, I highly recommend it. I did not feel anything during the procedure, and I only had some cramping and bleeding afterwards. I have had some cramping every day, and light bleeding but it is less and less. The worst part physically is that my boobs have tripled in size, they are super painful and rock hard. Apparently, this will go away in the next few weeks... (I hope!) Psychologically I felt relief after the procedure, and I still feel that we made the right decision. It does not make it any easier though. Mornings are the worst, and I find that I start crying and get very sad if I stay in bed too long, so I try to get outside and go for a little walk to get some fresh air, which has helped a lot. My mood has been all over the place- crying, feeling ok, relieved, guilty, disappointed, fear and anger.
I keep thinking why us? Why me? I am not even that old! I am healthy and have been on an egg quality diet for over two years since I started IVF! But... As you have all said here and what my doctors said too.. It is just a fluke. Bad luck. I would not wish this on anyone.
If you have to go through this, I wanted to just write what helped me in this process in hopes that it might help you too. Before finding this group, I felt so alone and I had no idea what to expect, but after reading your stories and finding support and love from you all, I felt so much less alone and more prepared for what was to come.

• Advocate for yourself. Find good doctors that will care for you and give you the best advice and information.
• Know that you do not have to explain everything to everyone. I told five people (my immediate family and one friend) about what was going on and to the rest we have just said "We lost the baby". Even my MFM told me this, because not everyone will understand, and you do not need to explain or justify anything to anyone.
• Talk to your partner about your feelings and reasons for your decision. I did this a lot with my husband, and it helped with knowing we were making the right decision for us.
• If you are doing IVF, and if you can: Test your embryos... I thought there was NO WAY we would get unlucky twice, and our doctor was confident that our embryo was perfect and with a perfect grade, but after this I am never transferring another untested embryo. It is just too risky. Ironically, this embryo was the best grade we have ever had. Even better than the Euploid embryos we have frozen.
• Let yourself feel all the feelings and be kind to yourself. In the days after the procedure try to get some fresh air or go for a little walk if you start feeling depressed. Hormones are all over the place and your body is going to be confused for a while, so it is important to take care of yourself and your body.

Like I said I am no expert, and I am still only a few days in after the surgery. I know I have a long way to go, but I am sending so much love to all of you going through this nightmare. I hope you find strength and support and the positive ending you all deserve.