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2nd Trimester

  • Posted on October 24, 2010 at 6:19 pm

On March 23, 2009, my husband and I excitedly made our way to a perinatologist’s office for my formal ultrasound.  I also had a genetics screening with a counselor the same day to go over the results of blood work done.  Despite my age at pregnancy (36) , I was confident that nothing was genetically wrong with my twins.

We sat in the office with the genetics counselor and she went over all the statistics of what she found.  We were as normal of a pregnancy as we could be, which was really nice to hear.  Even though I was more at risk for having a baby with Down’s Syndrome because of my age, the blood work came back that there was a very small chance the twins had it.   Everything was normal.  She did mention that I could have an amnio done on both babies to be absolutely sure, but I had already turned down the test before because I didn’t want to run the risk of having a miscarriage.  The chance of miscarriage is present enough when an amnio is done that I didn’t want to risk it at all.  After all the heartache, drama, and blood, sweat, and tears we went through to be at the place we were right then, I had no intention of causing any kind of risk, no matter how small, just to find out something I would eventually know about when they were born, anyway.  Plus, the idea of having a long needle plunged into my abdomen really squicked me out.

After the genetics counseling session, we were escorted to a room with a lot of very expensive-looking equipment.  The whole reason why I was having my formal ultrasound at this office and not my regular OB/GYN was because they had the very expensive-looking equipment that could do all sorts of interesting things, and my OB/GYN’s little po-dunk ultrasound machine could not.

I remember laying down on the table and waiting impatiently for the ultrasound doctor to get started.  This was a momentous occasion for us.  We were finally going to find out what our babies’ gender.  I really, really wanted a girl, but also wanted a boy.  How perfect would that be?  A boy and a girl.  That’s the ultimate perfect family.  One boy and one girl.  I kept saying it in my head.  I hoped the girl would look like me and the boy would look like my husband.  I just knew in my mind that we were having one of each.

The ultrasound doctor came in and briskly started the ultrasound, taking measurements as he went.  Focusing on Baby A, the doctor talked over our heads to the ultrasound nurse, rattling off numbers in conjunction with lengths of arms, legs, abdomen, etc.  I was fascinated with what I saw on the monitor.  There was one of my babies, moving and kicking, looking as perfect as could be.

Then, the ultrasound doctor moved on to Baby B, rattling off measurements and numbers as he did with Baby A.  He seemed to be spending more time focusing on Baby B, so I asked what he was looking at.  He said, “I’m concerned about the lack of amnionic fluid around Baby B.  I need to go get another doctor.”  When he left, I remember feeling hot and cold, all at the same time.  The ultrasound nurse continued to push down on my stomach to try and get a good angle on Baby B, but Baby B couldn’t change positions.  Another doctor came in with the original one, and they continued the ultrasound.  It felt surreal – like watching this all happen in a dream.  There I was on the table, there the doctors worked over me, conferring here and there about what they saw, the ultrasound nurse moving the wand around to try and get a better angle.

At one point, I heard over all the measurements and words being discussed about Baby B, that Baby A was a girl.  I remember feeling bereft, almost robbed.  Where was that ultrasound all new mothers talk about?  The one where the doctor says, while beaming down at the new mom, “You’re having a girl!” and points out the girl parts with a cute little arrow on the monitor, typing the words “IT’S A GIRL” next to the arrow.  Then the new mom goes home on a cloud, staring at her ultrasound picture in awe, imagining what her baby’s nursery will look like, what linens to buy, what colors to paint the walls, and what crib set will go best with the color scheme.  And, of course, within the hour, the ultrasound picture with the jaunty little arrow gets posted on-line to share with family and friends.

Instead of all that, my husband and I find out we’re having a girl because the ultrasound nurse was looking at the ultrasound pictures while the doctors worked on my belly to try and get the best angle they could to figure out what was wrong with Baby B.

My little Baby B was stuck in a placental prison, no amniotic fluid to swim in, grow in, or develop lungs in.  All the pressing down on my belly was to try and locate kidneys.  They couldn’t find any.  My little Baby B had Potter’s Syndrome, a congenital disorder where the absence of kidneys or kidneys that aren’t functioning cause the low amniotic fluid, which then cause the baby to not develop properly for lack of space, as well as lack of lung development.  The doctor found something else with Baby B’s heart.  We were asked to come back in a few days so that a Pediatric Cardiologist could look at the heart to determine what else might be wrong.

I sobbed.  I couldn’t believe what was happening.  I had told my family, my friends, all my students, and my coworkers that we were going in to find out what our babies were going to be.  I remember being so excited for one of my coworkers who was having twins, too.  She was six weeks ahead of me and had just found out a few weeks before that she was having a boy and a girl.  I wanted that, too.  I wanted to feel that excitement.  Instead, I was ecstatic for our little baby girl who was perfectly fine on one side, and my poor Baby B, squished and not able to form properly on the other.

Why do bad things happen to good people?  People have told me countless times that things happen for a reason.  God only gives us what we can handle.  God had a plan.  I don’t know what to say to that.  Despite my upbringing, I’m not a very religious person anymore.  Too many times, I’ve seen religious people turn mean and have treated those I love in a very unkind way.  I’m sure people had good intentions when they said they’d pray for us.  I even had a few people who didn’t believe what the doctors said and that we should just believe in miracles and our Baby B would be just fine.

If anything, we were not “just fine.”  We were anything but.  I don’t even know how we made it through the second ultrasound with the Pediatric Cardiologist.  As if having Potter’s Syndrome wasn’t enough, let’s give him yet another congenital defect that’s fatal!  Baby B’s tricuspid valve wasn’t closing, allowing blood to backwash back into the heart.  Eventually, the cardiologist said, fluid would develop in the heart and around the lungs.  If I were to go full-term with the twins, Baby B would pass away in-utero.

All I could remember thinking at this point was there had to be some way to save our Baby B.  With all the technology available today, couldn’t the doctors do some sort of surgery where they could give the baby a kidney?  And, the cardiologist did say that people can live with Ebstein’s Anomaly.  I’ve seen episodes of “House” – I know they can do surgery on babies while they’re still in the womb.  Of course, that’s just Hollywood.  In real life, if a baby doesn’t develop kidneys, the baby’s lungs won’t develop.  I remember the doctor telling us this in a matter-of-fact way, that our Baby B would not suffer and would slip away peacefully.

Peacefully.  How can losing your baby be peaceful?  It’s anything but peaceful.

1st Trimester

  • Posted on October 11, 2010 at 11:46 pm

Every day that went by, every Sunday that I stood by our dining room wall for a snapshot of my belly, was a step closer to what we wanted so badly:  a family of our own.  Two squirmy, little babies that we would love beyond all measure, dress in ridiculous outfits, and seeing them smile at us for the first time, laugh at their surroundings for the first time, and all the other firsts that come with raising two babies.

Every week, I had to go to the fertility clinic for an ultrasound to see how the embryos were developing.  Right after I arrived for my 6 week ultrasound, I felt I had to go to the bathroom.  I hurried into the bathroom and what I saw made my heart sink.  It felt like the ground dropped from beneath my feet – I was bleeding copious amounts of blood and huge clots.  I thought that there was no way I could still be pregnant and we’d have to start all over.  I kept saying, “no, no, no!” as I passed a few more clots.  I didn’t have any kind of pad or napkins to keep the bleeding at bay, either.  What a mess.  I cleaned myself up as much as I could and went out into the main area of the fertility clinic, telling the nurse in a wobbly voice that I was bleeding large clots.  She told me to wait in the lobby and they’d get me into a room as soon as they could and to try not to worry too much.

My husband was waiting for me when I came back into the lobby and when he saw the look on my face, he knew something was wrong.  I was pale and shaken.  I told him what was happening and we waited together for a room.  It was the longest 20 minutes of my life, it seemed.

When a room was available, we were ushered into the main area and I headed to the bathroom again to try and clean myself up.  Again, I passed some clots and more blood.  I started crying in the bathroom and was terrified to see what was going on inside me.  I didn’t want to know, but I also had to know what was going on in my uterus.  Were the little embryos we saw the week before still there?  Or was there nothing, like I suspected?

I bled on the table while the doctor examined my uterus.  There, on the monitor, were two little embryos, flickering at me.  The doctor said they both had heartbeats.  I had never felt more relief than at that moment.  The bleeding?  The clots?  What of that?  He explained the bleeding and the clots most likely were from my cervix having to compensate for the twin pregnancy – my uterus was already stretching and growing at a faster rate than a singleton pregnancy would.  Most likely, it was a burst blood vessel and it was probably nothing to worry about.  He recommended I stay on bedrest until the bleeding stopped and discontinue the baby aspirin I had been taking.

When I went in for my 8 week ultrasound, the bleeding had gone down to a persistent spotting.  When the doctor examined my uterus, he noted that there was blood in my uterus, which if it didn’t go away on its own, could cause some problems with the pregnancy in the future.  Yet one more thing to worry about.  However, by week 9, the blood clot had thinned out and looked like it was being absorbed by my uterus.

During the entire 9 weeks of monitoring by the fertility clinic, I had to have a Progesterone shot every night.  Because I didn’t produce enough Progesterone on my own, the nightly shot was vital for my pregnancy.  Without it, I wouldn’t have been able to maintain the pregnancy on my own.  I hate my body for that.  If only it would produce enough hormones for me to keep a pregnancy!  Then we wouldn’t have to pay exorbitant amounts of money for the privilege of having a family.

Eventually, I was weened off of the Progesterone – by week 9, my placenta would take over and I wouldn’t have to worry about not producing enough hormones to maintain the pregnancy.  I was released to my regular doctor with my fertility doctors’ blessings.  I missed them.  I missed their professionalism, their kindness, and their expertise.  But, most of all, I missed seeing our babies every week.  I was spoiled rotten by that fact.  Most women who have normal pregnancies don’t even get to see their babies on an ultrasound monitor until at least 8 weeks or later.  Our fertility clinic not only did an ultrasound once a week, but we got ultrasound pictures of them, too.

I was told to go ahead and call my regular OB/GYN and schedule a tentative appointment to come in for my first visit, as long as there were no issues by week 9.  Since there wasn’t, I was able to go ahead with my appointment, not scheduled until the end of the 11th week of my pregnancy.  I was crazy with impatience those two weeks.  I was so used to seeing our babies every week, that being expected to wait for over 2 weeks before I could see them again was pure torture.

That first appointment was frustrating, to say the least.  I don’t want to go into it here, but after being coddled by the fertility clinic, I felt almost neglected by my OB/GYN.  She didn’t seem to think my pregnancy should have been deemed high-risk because of my age and the fact that I was carrying twins.  She harped about my weight, which bugged me because I knew I had gained weight due to the hormones I was on for months and months.  While she was doing the ultrasound, she showed me exactly why the image of the babies was so fuzzy by pointing out the layer of fat on my belly that the ultrasound wand had to scan through.  Gee, thanks for that!  I was scheduled to come back in 4 weeks’ time for another ultrasound.  4 WEEKS????  Seriously?  Why so long?  I was told that once-a-month ultrasounds were the norm for pregnancies.  Again, I felt neglected, but there was nothing I could do.

The 4 weeks of waiting was torture, again.  But, I tried not to worry too much about it and kept myself busy with looking at my ultrasound photos from the fertility clinic.  When my appointment finally arrived, I was 15 weeks pregnant and feeling pretty good about myself.  I was feeling more confident that the pregnancy was progressing nicely.  My OB/GYN did another ultrasound to check the babies out and I remember seeing them on the screen, bouncing around.  They moved more than I had ever seen them move before, which made me laugh, which caused the wand to bounce and the image to move.  Then, she made a comment that kind of startled me, but I brushed it off as probably nothing.

“Hmmmm.  Baby B’s amniotic fluid looks a little low.” She didn’t seem to be too concerned about it, so, I decided I didn’t need to be, either.  The fertility clinic ultrasounds didn’t show anything, and how could something as drastic as low amniotic fluid happen so quickly between 11 and 15 weeks?

I was referred to a perinatologist office for my formal ultrasound at 17 weeks, where we’d finally get to find out the gender of our babies.  Waiting those two weeks seemed even more torturous than the 4 weeks I had waited before.  I wanted to know what we were having so I could start the preparations.  You know, buying clothes, deciding on a crib and changing table, room color, decor, etc.

I remember the excitement during that time.  Each week that passed, I felt more and more confident.  I could not WAIT for that appointment on March 23, 2009.

Infertility 102

  • Posted on October 7, 2010 at 6:16 pm

Once it was established that we would not have a family of our own unless we pursued IVF with ICSI, we decided to forgo buying a house and put all our efforts into starting a family.

This was no easy task.

In no time, I was met with a rather large box of drugs and had to start injecting myself with all sorts of hormones.  The color-coded calendar I had was rather intimidating, not to mention the first time I had to give myself a shot to stimulate my follicles.  I remember my hand shaking with the fear that the shot would really hurt.  I probably shouldn’t have looked at youtube videos about the kinds of shots women have to give themselves for IVF.  I remember one woman had bruises all over her belly from all the shots she had to give herself.

Thankfully, the follicle stimulation shot didn’t hurt… most of the time.  At one point, I had four different shots to take, all at very specific times of the day.  I even had to use a color-coded calendar to help me make sure I was taking the right drugs at the right time.  My husband also had to give me a shot in my hip every night after the transfer, all the way up to the day of the Beta blood test.

During the chaos of the first cycle, I had five ultrasounds in five days.  The fertility doctors had to monitor my follicles to the exact point where they’d be best for retrieval.  My follicles were responding so well to the drugs, one of the fertility doctors was very close to canceling my cycle because I had too many follicles.  Too many follicles can cause the follicles to not grow to the right size for egg retrieval.  Not only that, but my ovaries were maxed out and I was teetering on the edge of Ovarian Hyperstimulation Syndrome, which causes fluid to leak into the abdominal cavity and can be potentially dangerous.

When I look back on all of this, it seems so confusing and so overwhelming.  I really don’t know how I went through it all, other than to say that I had a one-track mind that was focused on nothing but doing what I needed to do to get pregnant.

Pregnant.  It seems like such an easy thing to do.  Egg and sperm meet, baby is conceived, nine months of joyous anticipation for the blessed birth.  This did not happen for us.  I had to shoot myself up with a ton of hormone drugs, have a wand shoved up my hoo ha more times than I could count, and I got very used to almost-strangers looking at my girl parts to the point where it didn’t bother me anymore.  I remember a time in my life that the mere thought of having a well-woman exam scared the crap out of me.  I had to deal with bloating and weight gain and my clothes not fitting me anymore.  But, worst of all, I had to deal with what seemed like EVERYONE around me getting pregnant and having cute, bouncy babies.  EVERYONE but me.

That first cycle seemed like such a surreal dream.  Here I was, standing on the precipice of something I had never experienced before in my life: having a baby grow inside me.  Even though my doctor was tempted to cancel my cycle because of my over-stimulated ovaries, he did not.  Apparently, my follicles grew enough to where they could be retrieved safely.  So, on with the cycle we went and I administered the shot that would ripen my follicles so they could be retrieved.  I went in on a Tuesday morning, my husband driving me to the clinic.  I remember feeling extremely bloated and uncomfortable, and well, nervous.  Who wouldn’t be?  We had just spent thousands of dollars on a procedure that wasn’t a 100% guarantee.

I was asked to undress and wear a hospital gown with the ties in the front.  I didn’t bring a pair of socks, which now that I think back on it, if I had known, I would have totally rocked a pair of cute socks.  I have a whole drawer full of cute, funky socks.  Instead, I went barefoot.  My legs were put into some sort of leg holders and strapped down and I was asked to scootch myself down to the very edge of the bed.  And then, the anesthesiologist put me to sleep.  When I woke up, my lower abdomen hurt and I was completely groggy and out of it.

The news was good, however.  I had produced 17 eggs.  SEVENTEEN!!!!  I couldn’t believe it at first, but then, looking at my swollen abdomen, I did believe it.

17 eggs retrieved, 15 of them were mature, and 14 fertilized.  That is an extremely high number.  Many women end up with maybe a couple of mature eggs and have to repeat the entire first cycle over again.  Two embryos were transferred and the rest were frozen, leaving us with ten embryos.

We were very lucky.

We went in for the embryo transfer.  It wasn’t a pleasant experience at all.  I thought one of the three fertility doctors I had been working with would be there for the transfer.  Instead, I got a doctor I didn’t know and he didn’t know my body very well because he couldn’t get into my cervix.  He had to place a SUTURE on my cervix to bring it up enough in alignment to where he could send the embryos on their way.  It was so painful, I tensed up and had tears rolling down the sides of my face, pooling in my hair.  After the procedure, and the two very best embryos (3-day blastocysts!) were placed through my cervix and allowed to float around in my uterus, I was told to lay there for 45 minutes and the table was placed at an angle where my feet were higher than my head.  I laid there in pain, the 45 minutes slowly ticking by.  Why is it that when you’re in pain and you’re forced to lay there, time moves excruciatingly slow?  My back was killing me because of the awkward angle I was in and all I wanted to do was go home.

Because I had a moderate case of OHSS and the fluid in my abdomen was pushing on my organs to the point where I couldn’t eat more than two celery sticks cut in half with peanut butter, my 2-day bedrest was pure misery.  My poor husband also had to run up and down the stairs to fetch me my breakfast, lunch, and dinner, since the only thing I was allowed to do was go to the bathroom.  I had movies to watch and books to read while I lounged around in bed.  Except, I was in massive pain.  I couldn’t sleep because I had been laying in bed all day and my back hurt beyond all measure because I had been laying in bed all day.

Needless to say, the entire experience of the first cycle was miserable.  I went in for my blood test on July 24th, 2009 and waited on pins and needles for my Beta result.  When the nurse called to tell me I wasn’t pregnant, I completely lost it.

It just didn’t seem fair.  We had put so much hope and faith and so much of ourselves into what we hoped would be the start of our new family.  In retrospect, it was most definitely for the best that I didn’t get pregnant that first cycle, especially considering the OHSS I had to deal with.  A pregnancy would have exacerbated my condition to the point that I could have had my abdomen drained of fluid.  Who knows?  It still hurt to know that it didn’t work.

With the high number of embryos we had, we were lucky that we were able to continue IVF with ICSI without having to go through another egg retrieval.  I told my husband that I didn’t think I could go through that again.  And yet, there are women out there who have to do one for every cycle.  The amount of stress it caused was unbelievable.  The 11 days I had to wait for my results was mind-numbing.  And all the doubt!  When I found out the first cycle didn’t take, I kept thinking it was something I did wrong.  Did I lift something that was too heavy and cause the embroyos to shoot out of my uterus?  What about that time I had a piece of chocolate?  Or how about that coffee?  It had to have been something I did, right?  I mean, two perfectly good, top-quality embroyos were placed in my uterus, floating around in there.  Why didn’t they take?  I guess that’s just how the human body works.

For the second cycle, I had to go in for a practice transfer to make sure they wouldn’t have to resort to putting a SUTURE in my cervix to align it properly.  All this because the doctor who did the first transfer had such difficulty.  The practice transfer went swimmingly well and it was determined nothing was wrong.

The second transfer went fine.  In fact, I felt absolutely no pain and was surprised that I didn’t.  Everything felt so right: I didn’t have any pain, I wasn’t bloated from OHSS, and I knew the doctor doing the transfer.  I was positive the second transfer would be successful.  I would find out a few days after my birthday.  What better birthday present than to have the gift of starting a family of our own?  Instead, I found out my sister-in-law was pregnant with her second child.  The devastation hit me like a brick wall.  I felt so miserable.  I didn’t want to feel jealous, but I did.  I didn’t want to be angry, but I was.  My thoughts were right back to what I was thinking before we started the IVF:  why is it so easy for some women to get pregnant and others, not?  That was a dark time for me.  I felt really, really terrible for thinking the way I did.

I had a few more tests run on me to make sure there was nothing causing my infertility, like polyps or cysts in my ovaries.  I had a hystersonogram just to be sure because he thought it interesting that I said I had spotting for several days before my cycle started and my cramps were out of this world painful.  I told him I thought all women had spotting before their periods – how else would they know it’s coming?  Oh, but that wasn’t true at all.  Most women might have a little spotting a couple of hours before their cycle starts, but not for days before.  This was news to me.  The doctor told me that there might be polyps and/or cysts in my uterus, causing irritation and not allowing the embryos to take hold in the lining, which would also explain the spotting and the horrible cramping I had every month.  He couldn’t find any reason why the 2nd cycle was unsuccessful and wanted to make doubly sure there was nothing in my uterus causing trouble before we proceeded with the 3rd cycle.

He said that if there were no polyps and/or cysts, then it was most likely that I had what was called a dysfunctional cycle.  And, that’s what I have because my uterus was pristine and clear as a bell.

For the 3rd cycle, my fertility doctor felt it would be best if we took a more aggressive approach and transferred three embryos, rather than just two.  Obviously, two embryos didn’t work in the past and I wasn’t getting any younger.  And, with three being my favorite number, and it being our 3rd attempt at a pregnancy, we agreed to have three embryos transferred.

This time, the original doctor we had our consultation with, the one who perused my medical chart and noticed my hormone levels were not normal, was the one who would do the transfer.  I was relieved because I felt he was the best doctor and the most thorough.  This is not to say that the doctor who did our second transfer wasn’t good enough – she was.  I just felt that if Dr. R did our third transfer, maybe we’d have a better chance.

And, we did.  Not only was I pregnant, but I was pregnant with fraternal twins – two of the embryos took.

Oh, I remember the joy.  But, I also remember the anxiety.  Looking back on my pregnancy, I really wish I could have enjoyed it more, but I was too scared I would lose the pregnancy and we would have to start all over again.