Feb 29, 2012

twins in the family?

I managed to spill a whole water bottle over my laptop a few days ago, rendering it useless until it gets to the repair shop, so I probably won't be writing too much until it gets fixed because I really don't like typing on the tablet. Yesterday marked two weeks on bed rest and two weeks more pregnant since the big bleed - I'll take it! Honestly, though, I feel like cabin fever is really starting to set in and I am beginning to go stir crazy.

My big outing of the week was going to the hospital to get my platelet function tests repeated a few days ago. Going anywhere with me is such a big ordeal these days and I am so dependent on Y. Using a wheelchair also really really embarrasses me and makes me feel so weird - I mean I can walk! Oh well, it is what it is, and I know the inconveniences and embarrassments are nothing if I keep my eye on the end goal.

One thing I actually wanted to write about a while ago is the questions people ask when they find out we're expecting twins. This issue is actually no longer immediately relevant, since I now spend all my time sequestered in my room and don't interact with the outside world, but I still think it's an interesting issue.

Y and I were always quite private about fertility treatments when we were going through them, so only our immediate families and a few close friends know about our ordeal. For a little background, both my maternal and paternal grandmothers were twins (obviously not with each other;-)). My mom had a miscarriage with twins (spontaneously conceived) and my cousins are spontaneously conceived triplets.

When relatives or people who have known my family for a long time found out through the grapevine that we are expecting twins, the common response was "Wow! Based on the family history I am not surprised at all!" I don't think anyone questioned for a second whether or not they are spontaneous - the possibility of IVF didn't really seem to register in anyone's mind given the strong family history.

Among friends or relatives on Y's side of the family, people right away asked if twins run in my family. I've always interpreted this as a perceived to be tactful attempt of asking whether the twins were conceived spontaneously or with fertility treatment. The fault in this logic is obviously that we fall into both categories - honestly, multiples do run in my family but obviously that has nothing to do with how we conceived multiples.

So of course we have enjoyed smugly and honestly answering that why yes, twins do run in the family - an accurate answer that is at the same time deceptively inaccurate at answering the real question usually thinly veiled underneath.

At first it didn't bother me - actually it made me feel a little smug knowing I wasn't really answering the question being asked and in some sense it was definitely a relief - an out from having to answer painful and personal further questions that quite honestly are generally never the questioner's business. It also really suited Y, who is super private and never a sharer of information.

But eventually, I started having mixed feelings about our easy out from never having to really talk about how our twins came to be. It began to feel a little disingenuous, especially among certain people.

When friends who we believe are going through their own fertility challenges asked whether twins run in the family, we gave our usual response, but instead of feeling smug, I started feeling like shit about it. It started to feel totally disingenuous, especially when talking with people we believe are struggling, too.

Not only did it make me feel like an impostor - passing myself off as a fertile myrtle, but it also made me feel like in some sense I was hurting the cause - perpetuating the notion that infertility is something to be ashamed of and keep silent about.

I always wondered whether we would be the kind of couple who would become more open about our infertility experiences if at some point we were fortunate enough to be expecting. So far, it seems like apparently we're not. I have surprisingly mixed feelings about this.

On one hand, I feel like it is really no one's business and we have a right to our privacy. I also can frankly be a little judgmental sometimes of people who are incredibly open with everyone they know about all of the sordid details, because sometimes I think it can have an AW-ish or strong woe is me component to it.

On the other hand, I feel deceptive and untrue to myself when I intentionally lead people to believe that the events that have defined my life for the past few years never occurred. It feels doubly deceptive if the people I mislead might be struggling with infertility themselves. What obligation if any do I have to the IF community to be open about our experiences? What does it say about me if I am unwilling to share - is that unwillingness coming from a place of shame?

If we are lucky enough to become pregnant do we have an obligation to share and educate others that we didn't have before or does this obligation not come into effect until we have actually made it to the other side with living child(ren) OR does it not exist ever - to each her own, with the understanding that what is right for some isn't right for everyone?

These are all unanswered questions for me. I am curious to hear your thoughts!

Feb 23, 2012

bed rest, day 10

Yesterday was my first foray into the outside world since getting home from the hospital. Wednesday is my appointment day. In the morning, we went to the MFM and did an ultrasound. There is still an area of bleeding. It is a little smaller than the initial area of bleeding when my last bleeding episode occurred, but I wish it was a lot smaller!

I am doing my best to drink lots of water, take my vitamins, eat well, and rest up in the hope that this damn thing will be reabsorbed and that the separation will heal. Today is my 10th day of bed rest. Honestly it is not so bad so far, if only because it is for a super important cause and I feel like a woman on a mission. I am trying to pace myself like this is a marathon - I pray that these babies will keeping baking for several more months.

We are still grappling with the move for the fellowship. My general feeling is that it is probably best to stay put in Israel for the long-haul now. I am more concerned that the stress of the move could tilt an already precarious situation in the wrong direction than actually going into PTL during the 12-hour flight.

The doctor did say if we are still committed to the move before the babies come and things are stable at 21-22 weeks that might be the golden window to fly. His reasoning was pretty morbid - if something catastrophic happens at that point, there is nothing we can do for the babies anyway, whereas if something happens at ~23-25 weeks, obviously there is something to be done. I try not to think about stuff like that too much, but my hunch is we will probably end up staying here and not flying at all.

Honestly, I think I am too scared to take the risk of flying even if the NICU care might be better in Toronto. It's a complicated decision, and I don't think we are going to be able to make a call on it until the time arrives.

After the MFM, I had an appointment in the afternoon with the hematologist. There are some platelet function tests that I did a few weeks ago that I need to repeat again next week. It's a little annoying they weren't repeated while I was in the hospital because the tests are only done at the hospital and only during certain hours and the hematologist needs to draw them himself. The main goal at this point is to develop a safe plan for my delivery since it may be be complicated by my fibroids, the placental issues, and my bleeding issues.

I am really trying to be more positive about everything. I got so down last week and I was really focused on my worst fears. Thinking about the babies as outside babies who will grow and thrive really helps me and I am trying to overcome my fear of looking at baby stuff. Honestly, spending some of my time looking at cute baby things online makes me feel better about things.

If anyone has any book/tv show/movie recommendations, I have plenty of time on my hands:) So far, I have been watching lots of Community and Party Down, two sitcoms I never got into when they came out.

Feb 20, 2012

please send your thoughts & prayers to Mo

I just stumbled across the horrible news that Mo from Mommy Odyssey (who I coincidentally mentioned in my earlier post today) had her water break last night. She is in her 22nd week with her little boy and they are waiting 24 hours to see if the fluid will replenish itself, but it seems like chances are not in her favor. Please send your thoughts and prayers to Mo. This horrible news breaks my heart.

eta: Last I read, they are going to induce. Sending so many hugs to Mo and her DH. So freaking unfair.

final update: Mo lost her sweet boy, Nadav. It is hard for me to come up with any words, so I will leave it at that. I am absolutely devastated for her. You can leave her your words of love & support on her blog (linked above).

grateful & thankful, but not enjoying it

I remember a little while ago Mommy Odyssey posted about how she hates being pregnant. I am joining that club, and I stand tall and proud.

Seeing our son and daughter grow with each ultrasound, watching them move around, beginning to feel movement, watching my body change and grow and my belly swell - I am in total awe of these things. They are beyond my wildest dreams.

However, my pregnancy has actually been overwhelmingly miserable, from hyperemesis during first tri and the beginning of second tri, to my bleeding episodes - the partial abruption last week being downright terrifying and the potential for a larger detachment that could potentially doom my little ones constantly occupying my thoughts.

The hyperemesis sucked (I put it in the past tense but without anti-nausea medication, I am still a mess) but it was manageable in the sense that it seemed like a necessary evil that I needed to endure in order to make it to the prize…'paying my dues' or something like that. There was a strong sense of purpose in my suffering and I never felt that it seriously threatened my pregnancy, at least not in an immediate sense, as long as I could stay adequately hydrated with IV fluids.

But with this partial detachment of my placenta and the fact that it is a chronic issue - I feel like such a time bomb and I am so scared for my little ones. Of course I am beyond grateful that we made it through the last bleed, that was a huge deal, but I just wish I could will time to pass, to at least be at 24 weeks and then after that 26, 28, etc… (maybe the etc. is a little bit much, but a girl can dream).

As an infertile who is now pregnant and worked so hard to get to this point (and let's not forget, was lucky enough to get to this point…many wonderful, strong women have endured more with less to show for it), there is definitely an expectation, both that I place on myself and that the IF community places on one another, that once you are pregnant you better well damn enjoy the pregnancy and also, that you should never complain once pregnant, because so many others would do anything to be in your position.

I want nothing more in the universe than to hold these babes in my arms, to watch them thrive and to grow and to have the honor to be their Eema and the joy of seeing Y have the opportunity to become an Abba. If we can get to that point, I just can't imagine - it will be so, so special and amazing. I am very focused on the end-goal these days.

My particular pregnancy experience (and I am very well aware this may be my only pregnancy) is not the wonderful, magical time in my life that I had hoped it would be. Rather, it is a means to an end. It doesn't mean I am not eternally grateful to be where I am right now, but I would be lying if I said it was fun or easy or that I am enjoying it.

G-d willing the outcome will be good and then it will be the most worthwhile negative experience of my life.

Feb 19, 2012

update & more on our situation

Thank goodness - I am home from the hospital and now on bedrest at home. Nothing like our sweet mattress and being able to sleep uninterrupted. Our cat is really happy to see me:)

The problem with the placenta seems to have been caused by those jerk fibroids I have. I started off with one stubborn fibroid in late summer 2010 when we began fertility treatments. After a lot of IUIs failed and IVF was put on the table in winter 2011, I had a hysteroscopy to check out the fibroid and assess whether it might be hindering my fertility.

At the time, it was just that one lone fibroid. We did see that it was not subserosal (the most innocuous kind that grows on the outside wall of the uterus), but it was termed "minimally invasive" and it was still quite small. We were advised that it probably wasn't quite worth the risks of surgery to remove it, but that we should keep an eye on it.

So on we went with a couple more cycles of FSH injections with IUI and then ultimately with several rounds of IVF. By virtue of the protocol, of course every time I cycled, my estrogen was brought to unnaturally high levels, and the fibroids love estrogen. So a few more fibroid friends popped up, and the original fibroid continued to grow. With the IVFs, I was taking oral estrogen pills as well, which I think was basically like fish food for my fibroids.

Anyhow, when I finally did get pregnant (hooray!!!) this past November, I had 3 fibroids, all of whom were enjoying growing along with the growing babes and my increasing estrogen levels. To make things a little worse, my E2 levels plummeted after this past IVF transfer and were dangerously low (~39 pg/ml), so low it was pretty shocking these little ones implanted (same thing happened to my friend T with the low estrogen that cycle). As a result, I was popping the oral estrogen pills like candy for a few weeks, hoping to make up for lost ground.

In short, what started off as a little fibroid problem, gradually became a bigger fibroid problem, Still, most fibroids aren't usually that dangerous during pregnancy. Even though they typically grow, you generally have to be pretty unlucky for a pesky fibroid to threaten a pregnancy.

My problem is it seems that one of these now quite large buggers is behind our son's placenta and as its been growing, its been jutting out putting stress on a weak spot in the placenta, which is what caused the partial detachment (ha, I prefer 'detachment' to 'abruption', it scares me less…if you want to google partial placental abruption be my guest…it's scary stuff).

Thankfully, fibroids generally grow the most during first tri and then stay relatively stable. We have a chronic problem in that this fibroid will be constantly putting pressure on the area of the placenta that separated from the uterus. At this point in the pregnancy, the hope is that the placenta will be able to mostly heal itself at the point of detachment, though my understanding is that on ultrasound, all we can really see is the area of bleeding around the detachment and from that estimate the size of the tear itself - the actual tear doesn't show up on ultrasound.

I actually had an earlier and less severe bleed at 9 weeks that landed me on bedrest at home for a week. In retrospect, we can see from the ultrasound that the bleed looks to have been in the same area the first time around, but at the time, that bleed was seen as an isolated event and hadn't yet been connected to one of the fibroids causing trouble.

Of course the problem is that each successive bleed has the potential to be larger and more threatening as the babies continue to grow, and at this point of pregnancy, unlike during the very beginning, if something catastrophic happens to the placenta of one of the babies, the whole pregnancy is threatened. If I have a major bleed post-viability (24 weeks), there are big decisions to be made and more options for intervention, since the babies could be delivered, but before then it is mostly just sit tight, rest, and pray.

Even though this whole thing is hanging over me like a dark cloud, I am eternally grateful to be home from the hospital still pregnant with my babies - and since we know the genders, I can now say, our son and daughter. When I went to the ER during my first bleed the notes from the doctor read "threatened abortion" and when I was being admitted this time around, the admittance note read "imminent abortion." How about "imminent live birth in 3.5+ months"? That is what I am going for here.

On Wednesday, we have an appointment with the OB where we will come up with a long-term plan. I am not sure if there is any chance we will get to Toronto before the birth of these babies. On one hand, I am thinking if it still might be a possibility assuming I can fly non-stop and lying flat, it might be worth it to still try to make it happen if the NICU at the hospital we would deliver at has better stats than here in Israel. There is a MFM in Toronto (Y's cousin's doctor), who is willing to take us on, and it sounds like she is really amazing, so I think I would be comfortable with that aspect.

We have been told it is very unlikely this pregnancy will go to term, so I feel like I should already start researching NICUs and reading up on preemies, since I am doing my best to adopt the positive attitude that I will have these babies post-viability and they will grow and thrive - trying hard to think positive and not dwell on the the dark thoughts.

Oh and on the hospital - so thrilled to be out of there! Almost a week and I was so ready to leave. We were 4-5 women to a room in an old ward from the 70s. They would often use the 5th (temporary) position in the room for a woman in the early stages of labor, among us high-risk pregnancies and miscarriages, too.

I realize they are so limited in space, they couldn't help it, but it's pretty horrible to hear a full or nearly full-term woman moaning with her contractions when you are a high-risk pregnancy before viability and likewise, it is pretty cruel for women miscarrying to be among us preggos, even if most of us are very high-risk. There was one woman in my room who was in her 12th week and had been there for a month for heavy bleeding - I really feel for her.

It was also so hard to sleep with the constant monitoring AND the occasional super loud snorer husband who would stay over. Luckily, I had many wonderful visits from friends and nightly visits from Y, which helped keep me sane (but that first night, I was so, so terrified). The hospital was the right place for me to be at the time, just really not so pleasant!

Feb 16, 2012

in the hospital

I guess I will start at the beginning. Monday morning I woke up in a spectacularly horrible mood. I was insufferably cranky towards Y. By mid-morning I was having fairly intense cramping. Unfortunately, I have had quite a bit of cramping throughout this pregnancy and as a result, I have spent a lot of time wondering whether my pain means something bad or whether it's in the realm of normal. The pain was pretty persistent and honestly I was very uncomfortable, so I decided to leave work in the early afternoon to rest.

That afternoon I was gripped by panic - not because of the cramping, but because I was feeling terrified by the pregnancy in general. It was like a red panic light was going off in my head and I had no idea why. I just was very scared that something terrible was going to happen. I told Y that I thought maybe I should see a therapist - that perhaps after all we had been through infertility-wise, my anxiety was out of control and I wasn't coping well.

In the morning I was still a little uncomfortable but excited to head to our first detailed (aka level 2) scan. The scan went really well - both babies look great and we found out we're expecting a little boy and a little girl. The only thing that was totally bizarre was that I broke out in a cold sweat during the middle of the scan and suddenly felt extremely nauseated.

I went to work in the lab and when I went to pee there was a little blood. I thought it was probably a little irritation from the cervical length check, but then blood started gushing out. Not what I was expecting to see at all. Thankfully, the emergency room is within a 5 minute walk of my research lab. I was very confused given that I just had a good ultrasound, but the ultrasound in the hospital showed a 5cm placental detachment of baby alef's (our son's) placenta. I have been hospital since then. There is really nothing to do at this point but bedrest and to pray that the separation heals. This morning's ultrasound was good, but needless to say, we're pretty scared and we've got a long way to go.

Feb 1, 2012

anxiety girl returns

Remember this chick?


I think she's back in rare form! I have this creeping unsettled feeling that is making me so anxious lately. I secretly think everything is a hidden sign of pre-term labor and it is my job to crack the case and figure it out. Every new pain arouses new suspicion and I feel like it is impossible to differentiate between what is just me being me and what is a potential issue.

Most days I am just still so shocked to be pregnant, to be gestating life and sporting this little baby bump and whatnot, it is so hard to imagine all of us coming out of this ordeal alive and healthy because me + reproductive success is such uncharted territory. I do take comfort in knowing that my anxiety is probably very common among People Like Me. It doesn't help that I was unusually anxious and neurotic before infertility and miscarriage entered my life.

I really pray that one day I can look back on this time of my life and think to myself how silly and unwarranted all of this anxiety is because I will have had my happy ending (the alternative is I will look back on this time of my life and reflect on what a sucker and smug self-entitled jerk I was to surreptitiously compare overpriced double stroller models and fawn over cute lamb mobiles like someone who might give birth to two intact children in the near future).

Of course the only thing that separates the wistful, omniscient "See, everything turned out okay" me of the future from the self-loathing "I told you so, sucker!" me of the future is the outcome of this pregnancy.

And now here is a summary of what actually happened this week in list form:

  • Horrible food poisoning over the weekend that incapacitated me through Monday. I think it was worse than it would have been otherwise because I am pregnant. Vomiting Olympics 2012 ensued. Things were finally brought more or less under control by IV Zofran. I still don't know what the culprit was, but I hope to G-d it wasn't the lethal baby-killing kind of food poisoning. We've heard the babies' heartbeats on the doppler since, so it appears they're still kickin'.
  • Discovered the show Homeland. Actually, that didn't happen this week, but it is an awesome show and I highly recommend it.
  • Hematology appointment...pretty uneventful (we like uneventful!). I go back in 2 weeks. The cancer building where the hematology department is housed is a very depressing building. Not only is the clientele largely very ill, but the building is incredibly physically depressing.
  • Lightning crotch:) Is this normal during early 2nd tri? I wasn't planning on enjoying this loveliness until later on. Shockingly, I find it contributing to my anxiety.
  • Bump shot - for better or worse, the first one I've posted (14w5d):