and I'm back...

It's been a few days over a year since I last posted and I am ready to start this up again. We started TTC again in March 2014. I weaned N around that time for fertility reasons, which was a difficult choice.

In early June we thawed our four frozen day 3 embryos. Our hope was to thaw them on day 3 and try to grow them to day 5 and then do SET if any of them made it blastocyst. We knew the embryos weren't great quality and we didn't want to transfer more than one because we were explicitly trying to avoid twins because of what happened with our first twin pregnancy. We figured growing to day 5 would be a good selection device.

I guess it was too good of a selection device, because after preparing a fluffy lining with a couple of weeks of estrogen, none of the embryos progressed to day 5 after thawing. It was disappointing to have nothing to transfer, but I guess it also wasn't shocking since we knew the embryos weren't great and I didn't regret that we chose to attempt a day 5 transfer.

After the transfer that never was, I had a meeting with my RE to decide where to go from there. I knew that I wanted to get pregnant soon and never having had a spontaneous pregnancy, I knew that I wanted to continue with treatment. I was uncertain whether I wanted to start with something less invasive and emotionally consuming like Clomid IUI or whether I wanted to dive right back into a fresh IVF cycle. I also didn't know what our health fund would cover based on our circumstances at the moment.

Our RE advised that he would support me in whatever treatment that I wanted to do and in whatever order or combination I wanted, but that he still thought IVF was our most efficient path to pregnancy. Fair enough. After talking it over with Y and some soul-searching, we decided to proceed with our fourth fresh IVF in July 2014.

We did the antagonist protocol and the stimulation went fine. We got 10 eggs, which is pretty standard for me. Unfortunately, only 5 fertilized with ICSI which is a pretty low fertilization rate for us. Our embryos were in an incubator with an embryoscope, a time lapse imaging system that takes video of the developing embryos. It is a pretty cool recent invention that is supposed to help in embryo selection and gives the embryologist and RE real-time info about the embryos without disturbing them in the incubator.

Our hope was still to do a day 5 SET but based on our lower fertilization rate and underwhelming embryo quality, my RE advised we do a day 3 transfer. We weren't so psyched about this, both because day 3 hadn't brought us success in the past and because suddenly it made the question of how many embryos to transfer much more confusing, since day 3 SET doesn't have such great results.

The day of the embryo transfer, the embryologist and our RE reviewed the video clips from the embryoscope. Our RE told us none of the embryos were more than 6-cell, all had significant fragmentation, and none of them met the freezing criteria. He and the embryologist recommended that we transfer three (!) We decided to settle for two, even though Y had significant reservations since we were (and are) still both traumatized from the pregnancy with Aminadav and Naava.

Needless to say, much to the shock of our RE and myself (and not to Y), we got pregnant with twins again. I am now 17w3d pregnant with a boy and a girl, and it's been a challenging and scary road so far. I had light bleeding from weeks 5-7 due to a subchorionic hematoma. At the NT scan I was diagnosed with partial placenta previa, and during week 13 I was hospitalized due to a major bleed. This was really scary since chronic bleeding is what we believed caused PPROM (premature rupture of membranes) with Aminadav and Naava -- basically due to blood wearing down the amniotic sac like sandpaper. I rested at home for a week and then returned to work.

I also had a worrisome cervical length ultrasound about a week ago. It shortened significantly based on that measurement but then when another technician measured it a few days later, all was good. I am not sure whether my cervix is dynamic or whether maybe the first measurement was incorrect or what, but I will ask my doctor what she thinks when I have my regular appointment next week.

This whole ride is very scary for us....every day I just feel thankful to wake up still pregnant. The only way through this is to make it to each new day as uneventfully as possible -- 10.5 weeks til our first big goal. Meanwhile, N fills our lives with so much joy (and activity!). We are so blessed to have her here with us.

what we (think) we are owed

A few weeks back, Y and I went to our first infertility support group meeting. I am not sure that it was super helpful to us because most of the couples were at a different stage of their infertility journey, but the facilitator was great. One comment she made in particular stuck with me.

She said that when we first set out trying to conceive, we think that we are going to get the gold -- the gold being everything we want and on the time scale we want it. And then maybe it turns out it is taking longer than we thought and we need a little pharmaceutical help -- we are now going for the silver. Maybe then it turns out our problems are in fact pretty big so after the silver doesn't pan out, we're going for IVF  -- now we're aiming for the bronze.

Maybe after that we are in a position where we are getting comfortable with the idea of donor egg or a gestational carrier or we are pursuing adoption, and so we give up a little more of the original dream. I don't think the point was that any of the outcomes that aren't the first one -- everything we want and on the time scale we want it -- is somehow ultimately less good, but more that in order to get it, we may be finding ourselves sacrificing more and more of our original vision and all the while time is passing.

The truth is, I don't remember the original context of her remark, but it crystalized for me something really important. When we found out we were expecting twins and then later on, when we found out we were expecting a boy and a girl, I felt like everything that had been taken away from me in this journey was suddenly and unexpectedly gifted back, just like that.

In other words, we were going to get the gold. It wasn't without lots of sweat, tears, perseverance, sacrifice, and hard work, but we would get our happy ending -- what we were owed. The world was suddenly a fair place again, just as I had always known it to be until infertility and loss entered our lives.

We would have the two children we would have had if we had control over our reproductive fate and in the same time frame! A son and a daughter! It seemed too good to be true, but we did work really hard to get there, so why not? Why couldn't we have it all, get the gold, after our shit luck until then? It happens to others in the infertility community all the time, really -- from zero to two -- just like that.

Everything that happened to us until then infertility-wise sucked but it was tolerable and livable. It was something I was willing to put up with and rationalize, if we could then just get our happy ending. For lack of a better term, it was all within the realm of normal infertility suckiness. Par for the course.

And while it might have seemed sudden and unexpected when it finally worked and we conceived two beautiful babies, I felt like we deserved it because we are fundamentally good people who had worked very hard to get there. (But the unanswerable question that many of us avoid altogether in the moments of dazed self-congratulations then becomes what about everyone else on a similar road who has not been granted the same good fortune?)

Owed, deserved -- what dangerous words and concepts these are. I think you can probably already see where I am going with this.

I wasn't naive about the risks of a twin pregnancy -- if I look back at my posts during that period of time I don't think I was every really happy-go-lucky or flippant about the pregnancy. But deep down, even when the pregnancy became complicated, I fundamentally believed we would get our take-home babies -- that this would be very hard and scary, sure, but that we would also all make it out of this alive.

Even if you are particularly anxious and fearful, I don't think you ever really believe that you will be the horror story. In fact, isn't imagining the worst over and over again supposed to be some sort of protection mechanism? I am pretty sure that I subconsciously thought so.

So, obviously, in the end, we did not get the gold -- we came really close but we didn't get gold. Or silver. Or bronze. Actually, we didn't even place, we just pretty much careened off the course entirely.

What I want to get back to is this idea of what we are owed and what we deserve. It is something I struggle with in the present constantly -- this notion that we do all of this stuff and go through all of these trials and therefore it has to lead somewhere. It all has to be for something -- to ultimately fulfill some purpose.

But sometimes it's not.

Many times I see that women who have achieved their happy ending attempt to rationalize what it took to get there and find some meaning in it. For many of us, the journey can never just be an endless trek of failure, pain, and suffering -- it has to mean something and it has to have all been for something. The alternative is just too depressing and soul-crushing. It is not too difficult to rationalize the journey if you do get the happy ending, as I would have if Aminadav and Naava had come home with us.

But what about when that doesn't happen?

I know now I will never get the gold. I missed it entirely. What I mean by that is even if I do eventually get my living child(ten) in one way or another, I have lost too much that is irreplaceable for it to ever 'make up' for what I have experienced and what I have lost -- there will forever be my son and daughter missing from our lives, and that is not something fixable.

Until I lost them, the loss and sacrifice that I had experienced along this road deeply affected me, but there was nothing I had given up or lost that was unredeemable or unforgivable with the good fortune of the twins. It's not that I would forget the journey, but I was willing to bargain this for that and this (6 IUIs, 4 IVF transfers, a miscarriage) certainly seemed 'worth it' for what I could get in return (a son and a daughter).

How do I shake this idea of being owed a living child for what I have endured? It is so naive -- and yet a testament to how good and straightforward my life was until infertility -- this belief everything I work hard at will be handed to me. Life doesn't really work like that, I know, but part of me can't shake the idea.

When I had the very early miscarriage that resulted from the IVF cycle we did after losing the twins part of me was like "C'mon -- what did you expect, A? Of course it didn't work out. It never works out for you. Don't you get it by now?" but part of me was suspended in disbelief "How could it not work out -- after all of this don't you just deserve for things to work out?"

Part of me just can't shake the belief in the Very American Happy Ending. Hard work = a great reward. I try to shake it but there is a girl underneath who still believes in it. And yet it is ultimately so damaging to subscribe to that idea when life keeps throwing lemons at you -- if life hands us what we deserve, what does that say about Y and myself?

I still try to bargain all of the time. It is disastrous. I think to myself -- if we couldn't keep Aminadav and Naava, then the second best thing would be to have twins again. A second chance. We deserve to have twins. Twins are so special, I think.

But I know this is totally unrealistic, especially because we plan to only do SET in the future (as we did with our last IVF) since another twin pregnancy is too dangerous for us. Even if we did transfer more than one embryo, realistically our chances of both sticking around are quite low given our IVF track record.

I keep reminding myself that the goal is to have one healthy, living child who I can carry to term. Let's not get ahead of ourselves and get greedy, here, I tell myself. So I guess along side mourning the loss of my particular, beautiful twins,  I also mourn the loss of ever having twins again, which often felt like something special to make up for the lousy hand we had been dealt until then.

I have lost too much to ever think I can have it all again -- the gold has clearly evaded me -- but still there is that stupid quiet voice who says don't you deserve a happy ending? This can't all be for nothing, right? Aren't you owed a living child? Or two.

How about you? Do you struggle with this idea of being owed something or deserving it? Did you feel the gold or silver or even the bronze was taken from you only to unexpectedly get it all back (or not)? If you've had your happy ending, do you rationalize what it took to get there?

the embryo transfer blues

Despite my best attempts at apathy, TTC again is really hard. I so desperately want to be pregnant again, but everything I've been doing to try to make it happen feels like a form of punishment. I think constantly about how if the twins were to arrive now they would most likely be alive and well, and that causes me a lot of pain.

Every action we take to make a new baby is a reminder of the babies who were supposed to be here with us right now. Sometimes it is just too cruel. I do still think this was the right choice for us -- to jump back into IVF again so soon after, but it is hard and lonely.

Today we transferred one day 3 8-celled embryo with some fragmentation. I really only want to do SET because I am terrified of conceiving another set of twins, but I still have very complicated feelings about it. In some sense "needing" to do SET and the lowered chance of pregnancy with each transfer that comes with it feels like a punishment, like I am being reprimanded for something really horrible that I did.

And in a sense that's completely accurate -- I am being reprimanded for something really horrible that I did, it is just something that my body did that I had no conscious control over.

Honestly, part of me also would still really like twins. I am okay now with admitting that, but at the same time it is a very theoretical type of want, because another twin pregnancy, at least before proving that I can successfully carry a full-term singleton pregnancy, would just be too terrifying and too unfair to the babies (so despite my complicated feelings, no need to lecture me on what a bad idea it would be to transfer more than one embryo).

Anyhow, all of this talk of singletons vs. multiples is pretty moot at this point. Due to the premature rise in progesterone, Dr. T. thinks my chances of conceiving with this transfer are low. Of course this makes me feel pretty bleak. Actually, this really sucks.

I have been giving this little 8-celled soap bubble a lot of pep-talking, and of course anything at this point is possible -- if I have been on the wrong side of the unlikely statistics more than my fair share, isn't it possible to end up on the right side of the unlikely statistics this time?

I even promised this pretty little 8-celled soap bubble a ridiculously overpriced stroller and a loving home (you will not be surprised to know Y rolled his eyes at the ridiculously overpriced stroller part). Still, I am not very hopeful and it's bringing me to a sadder place than I imagined because I am bringing so much additional grief along with me.

The interesting news is that we still have four remaining embryos. This morning, one was 4 cells and the other three were 6 cells. All of them had some fragmentation. This doesn't sound stellar, but Naava and Aminadav both came from blasts that were fragmented 6-cell embryos on day 3.

Our lab isn't so good at freezing and thawing blasts (though they do use vitrification), so the current plan is to freeze the remaining embryos today on day 3 and then thaw them next month and attempt to see if we can grow one of them to blastocyst. Then we would attempt a day 5 SET, which is what we initially wanted to do with this transfer and we would have, but since my RE thinks our chances of implantation are lower due to the premature progesterone rise, we didn't want to…wait for it…put all of our eggs in one basket.

This plan is ok but puts a serious cramp in my style given that we were supposed to move to Canada on June 15! If this transfer is unsuccessful, the new plan is for me to stay behind in Israel solo to do the transfer after we've packed up all our stuff and moved out of our place. This would pretty much suck (goes right back to the feeling of being punished), but since I am a glutton both for punishment and opportunities to get pregnant, we all know that I will end up doing it. Clearly, what would suck even more is if I hang around for the additional couple of weeks only for none of the embryos to make it to day 5.

Between the move, TTC, and my work situation I feel like everything is in total limbo right now and nothing about this year is unraveling the way I hoped and anticipated (most notably the part where my twins were supposed to live and I was supposed to be totally overwhelmed with two infants this summer). Sorry if I am starting to sound angry, sad, and bitter, but right now, I think that's pretty much where I'm at.

they were here

When Naava and Aminadav were born, I was scared that they might look fetus and alien-like or somehow grotesque. I was afraid that when I looked down, what they actually looked like could never match up to my vision of them, what I dreamed they might look like.

Instead it was the other way around – they were so exquisitely and perfectly formed, my son and daughter, so beautiful and so human, beyond my wildest imagination. They were just miniature. I will never forget those tiny ears. Those tiny ears and their perfect intricate folds.

I remembered them from months before as embryos - blastocysts that looked like the surface of the moon magnified on a microscope screen. "Hey, I remember you!" I wanted to tell them, in awe of how much they had grown. The nurse placed them in a little box side-by-side, so that Naava was curled behind her brother. Yoel filled out the cards with their names for the chevra kadisha, the ritual burial committee, to pick up with their bodies.

I was wheeled down to the operating room for an emergency D&C since Aminadav's placenta didn't come out, and Yoel followed behind the gurney. That was the first and only time we spent with our babies.

1000 Oceans

Thank you to Mo for posting the Tori Amos song 1000 Oceans. I have been listening to it on repeat over and over the past couple of days and really connect with it right now.

Maybe because 1000 oceans feels like how far away I am from Aminadav and Naava, the two little souls that we came so close to spending our lives with. Maybe because it feels like 1000 oceans is what separates me from a totally different life in a parallel universe, the universe we were living in until last Sunday.

When I suffered my first (much earlier) loss, I spent a lot of time afterwards reliving over and over again in my head those happy last few days before the ultrasound that showed our baby had no heartbeat. How I felt like such a fool knowing I walked around so smug, so expecting of a baby, that unknown to me, had stopped developing.

These days I spend a lot of time reliving over and over again my last few days with Naava and Aminadav before my water broke and all hell broke loose. Our last few days as a family of four. I don't think so much about those initial awful moments when my water broke (more accurately exploded), the complete terror I felt and my shrieks and screams, over and over again, to Y on the phone, to myself, to the neighbor who called the ambulance. By then our fate had already been sealed. Those are not the moments on repeat.

Instead I think of those last few days on bed rest, how much time Y and I spent together in those last evenings, lying on our bed watching sitcoms once he moved the television set into the bedroom with our cat, Harriet, at the foot of the bed. (Harriet is usually not allowed in our bedroom nor are we typically the watch tv in bed type of couple - these are the types of allowances we made during this time.)

How the four of us would lie happily in the bed together in the evenings, Y and I both stroking my swelling belly out of habit. I was already having complications at that point but we were still happy and so blissfully and innocently in love with each other and with our sweet babes.

The hyperemesis, the bleeding, the bed rest - it all seemed part of a rite of passage during a difficult multiples pregnancy following infertility - challenges and some physical suffering for what would be a great reward. But not this - not this awful, horrible thing that came next. There was no rite of passage and there were no rules. No illusions of stay in your bed and you'll be safe, no bargains to be haggled, and no reward.

I think of our last Shabbat together, which was right before my water broke. I was so desperately bored and listless. I think of the fool again. There she is. There she is on the couch so bored, oblivious that these are her final hours with her babies. Always the fool. Always obliviously unaware to what happens next. It's never a happy ending. We've played out almost every possible variation on reproductive misery over the past few years; the only outcome that seems to have evaded us is the one that is most statistically likely - The Happy Ending.

I replay over and over again our final days with Naava and Aminadav, how as anxious and worried as we might have been, we still fundamentally believed that they would stay with us. I look back on my life in a parallel universe, a slice of time and a trajectory that existed such a very short time ago, but that life is now 1000 oceans away.

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!

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!

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.

a long overdue update

Oh my, I am so far behind! Time to get this thing updated and then try to update at least weekly. I have wanted to write for a while now, but it seems so daunting because I am so far behind. I guess I will back-track to more or less where I left off.

Between weeks 10-12 my morning sickness really spiraled out of control. I suppose during those 2 weeks I really had an alibi not to update the blog because most days I was so sick and miserable. I was on Zofran for a little over a month, and at first it seemed like a really good drug for me, but eventually, I started to get terrible headaches from it and I was still vomiting and dry heaving all day long.

I spent a lot of time at home, lying around in bed and feeling miserable for those 2 weeks. Y gave me IV fluids 3-4 times a week (basically on the days I couldn't keep anything down) and that did help a lot. I felt very fortunate that I could receive fluids from the comfort of our bed and that Y could more or less manage my dehydration. I think I probably would have ended up hospitalized if I didn't have my own live-in doctor, so I feel really grateful for that:)

Now I am taking Benadryl instead of the Zofran and I am doing a lot better, probably by virtue of just being out of the first trimester - still often vomiting a few times in the morning but functioning beyond that. Of course after reading Dr. Luke's book (which is often considered the bible of pregnancy with multiples), Y and I are both worried about my lack of weight gain, especially since I am starting off on the smaller side.

I really hope the eating will get easier over the next month and I will begin to pack on the pounds. Y bought 2 cases of Ensure and I am trying to have 2 cans of that a day since it is very nutritionally dense, though I am generally falling short of that goal. I really hope I can step it up.

Aside from the morning sickness, my pregnancy has been thankfully pretty uneventful over the past month (no more bleeding, knock on wood). I did have a few days of pretty intense cramping during my 11th week that made anxious. It felt way too much like menstrual cramps for my comfort. I went in for an ultrasound and also saw the OB who was on duty for urgent issues. He said that based on the location of my fibroids and the location of my pain, he thought that perhaps the cramping was from my fibroids growing and/or degenerating.

The cramping has returned a few times and it always makes me nervous, though it is unclear to me whether it is actually the fibroids, growing pains, or something else entirely. It was still a huge relief to see that the babes were doing well and thriving at the ultrasound.

Last Monday we went in for our NT scan. It was great in that the nuchal fold measurement for both babies was 1.3 mm, which gives us a very low risk of Down's. That was really the most important part.

It was a little disappointing because they used a dinosaur ultrasound machine with very poor resolution and the scan was done transvaginally (thought those days were over!) by a crochety old guy who was really rough. He gave us a few images, though it's unclear exactly what the point was since the images were just a nonspecific blur, literally.

As I already wrote, the most important thing was that the nuchal fold measurements were great and both babies are looking good and measuring appropriately. Speaking of which, while I am finding many things to worry about, I am finally no longer obsessed with vanishing twin syndrome, so that feels like a pretty big milestone to me! I am now finally accepting that this is a *real* twin pregnancy...pretty wild.

Earlier this week, we had our last appointment with our RE. I know most people have long since graduated from a RE by 13w2d, but the way they do it here is that you can continue to see your RE (instead of an OB) until the end of 1st tri. It was definitely bittersweet - it definitely feels like a big milestone to be moving on from the RE and becoming a "regular" pregnant woman, though I felt like Dr. T. really went above and beyond and I give him a lot of credit for our ability to reach this point.

On Wednesday, I have my first MFM appointment. I am feeling pretty nervous about that and I am hoping that I like the doctor and that we click. I really hope that Y will be able to come along, though it seems like his schedule might not allow him to join me. I also have a hematology appointment next week and I hope that goes well, too.

Today, the home doppler that I ordered arrived. Y was able to locate both babies' heartbeats within 5 minutes, which was really cool (though initially he just found mine). I remember how a month ago both babies were right at my pubic bone - now they have migrated up to under my belly button! I am also really showing now, which definitely makes the pregnancy feel more real. I am really excited to feel them kick, though.

Our RE told us yesterday about the early detailed scan that we can do during weeks 15 or 16. Here in Israel, it is apparently common to do 2 anatomy scans - one early one between weeks 15-16 and a later one between weeks 20-22. The first one is done at private ultrasound clinics and partially covered by insurance. It is not deemed medically essential but it is obviously a nice opportunity to see the babies and begin to identify any potential anatomical problems. Also, as an added bonus, gender can usually be determined. The later scan, which is the traditional anatomy scan, is totally covered by insurance and the one that is deemed medically necessary.

Anyhow, like most anxious parents, we thought the early scan sounded pretty good. Unfortunately, it seems we don't know the system well enough and today was already too late to book the scan. We are now on a waiting list, but it's a bummer we might not get to do the scan at all.

My last big piece of news is that Y got a fellowship in Canada in his desired surgical sub-specialty. In short, it means we will be crazy enough to attempt to move from Israel to Canada in early April when I am 24 weeks. That is the tentative plan, anyway, obviously everything could change dramatically if I end up on bed rest and/or have significant complications before then. I am hoping to discuss the logistics of the move with the MFM at my appointment on Wednesday to make sure our expectations are realistic.

I really can't imagine moving beyond 24 weeks, and even then, it is pretty clear to both of us that my only physical participation in the move will be getting on the plane! I am really proud of Y he got the fellowship, and if everything works out well, it will be great to be close to our families during the babies' first year. Well, I think that is more or less all the news that is fit for print. I will close with a few pictures from our ultrasound 2 weeks ago (11w4d):

happy 2012 and an update!

I have unfortunately been pretty shoddy updating these days. The past few weeks have been mostly good, but have certainly had their ups and downs! The most (unfortunately) eventful thing that happened was that last Friday night I started bleeding bright red. My last pregnancy, I had some brown spotting, which I was reassured was completely within the realm of normal. Unfortunately, it was in retrospect the only real sign of my missed miscarriage, so bleeding bright red at 9 weeks, even though it wasn't a lot, definitely brought back our worst fears.

I was still spotting the next morning, so we decided to go to the emergency room. It was actually my first ER visit ever in Israel, and the third one of my life overall, and I was surprised with how efficient and professional they were. Thank G-d the ultrasound showed 2 heartbeats, though the resolution on the machine was pretty poor, so we weren't able to see much more than that. It was such a huge relief - we were up the whole night Friday, trying to prepare ourselves for horrible news.

I had ketones in my pee when we were at the ER, so I got a few liters of fluid and IV Zofran. In general, the morning sickness has been pretty miserable, but it is what I would expect with twins, and honestly, it seems like a small price to pay as long as I can still get enough fluids and nutrients to keep the babies going strong. I have had a few particularly horrible days, but I seem to be in better shape now that I am on a consistent schedule with Zofran. I have it every morning first thing with a popsicle in bed and it seems to help start things off on the right foot.

Today, since it was the weekend, I procrastinated a bit on taking the Zofran and I really paid for it. Luckily, Y has brought home all of the supplies to give me IV fluids at home, which has been a great set-up. He has saved us many trips to the urgent care clinic or ER by giving me fluids at home, and it is much more comfortable to be in my bed than somewhere else.

Y and I have both been reading Dr. Luke's book When You're Expecting Twins, Triplets, or Quads and as a result, we are realizing how important proper weight gain is for a multiples pregnancy. Dr. Luke's main schtick is that you can maximize your chances of a positive multiples pregnancy outcome with proper nutrition and also by gaining a lot more weight than with a singleton pregnancy and than conventional wisdom would dictate.

I do believe that this is something worth focusing on since I feel like it is one of the very few factors I have control over in determining our pregnancy outcome. Honestly, it is quite daunting though, since she emphasizes the importance of weight gain early in pregnancy and I am having such a difficult time just trying to eat what I usually do, never mind 1000+ calories more, because of the morning sickness. Still, I am really going to try to step it up with the eating.

After the bleeding episode, we had a routine ultrasound and appointment with our RE. Initially, both babies were measuring 4 days behind based on CRL. As of last week, baby aleph was measuring 1 day behind and baby bet was measuring 2 days behind, so I am feeling pretty good about their progress. The only thing that is a little strange is that baby bet's gestational sac has been measuring behind. In ultrasound pictures, you can definitely see that baby bet has less room in his/her sac than baby aleph, whose sac is more consistent with his/her gestational age. Hopefully this is meaningless.

My fibroids also have been growing quite a bit, and the ultrasound tech pointed out one that is adjacent to baby bet. Hopefully, the fibroids will behave themselves and the babies will be unimpeded with all of the space they need to grow and thrive. The source of the bleeding was never identified, though everyone did say that bleeding is more common in pregnancies with multiples. I spent most of last week at home on modified bedrest as a precaution to minimize the chance that the bleeding would start again, and thankfully, I haven't seen anything since last weekend.

Our next ultrasound is the NT scan, which will be on January 16 at 12w3d. I am excited for that to be done and over with and I pray that it goes well - then maybe we will consider beginning to share our pregnancy. I have an appointment with a high-risk ob/gyn a few days after the NT scan and then a hematology appointment about a week after that.

In other news, I bought a home doppler online a few days ago and it should arrive very soon. I paid a small fortune in shipping since the 2 major options seemed to be ordering it from the U.S. (but with only one international shipping method which is express and very pricey) or via eBay from China (but with only one international shipping method which is 'economy' and could take 4 weeks). I decided to take the hit and order it from the U.S. with express delivery :)

I think that is pretty much all that is new around here - this was quite a long update. I still think about how fragile all of this every single day. As I am slowly becoming a little less anxious about miscarriage, though, I am also feeling more and more grateful to be where we are right now. I really hope and pray I will hold 2 healthy babies in my arms in 2012 - it will be the fulfillment of my wildest dreams if this all pans out. To my buddies still in waiting, I pray that 2012 will bring the fulfillment of your wildest dreams, too!

Lastly, here are a few pics from our last ultrasound at 9w2d:

7w3d - still kickin'!

I am so relieved today is over. Thankfully, both babies are still alive and growing! 7w3d is when I found out that my pregnancy was doomed last time, so I was pretty uneasy about having an ultrasound at 7w3d. Now I can finally begin to feel that this pregnancy is entirely different from my last pregnancy and stop with the constant comparisons. I can't believe I will wake up tomorrow morning at 7w4d and still (presumably) be pregnant...and so, the uncharted territory begins!

Baby Aleph, who was measuring 4 days behind last week is now measuring 2 days behind, at 7w1d. Baby Bet, who was also measuring 4 days behind last week, is still measuring 4 days behind but at least he/she is growing proportionately. Also, both babies definitely have a yolk sac, which is good to know after the scare last week when the u/s tech couldn't find Baby Bet's yolk sac! The nurse I spoke to told me today that she thought that was super weird and she had never seen in a report before that a baby had a heartbeat but no yolk sac was observed. I knew it was strange, too, but I am glad she waited until today to tell me she had never seen that happen before!

The only thing that is a little disconcerting is that both of the babies' gestational sacs are measuring quite small. I know I find something new to Google grimly and obsess over after every ultrasound. Also, I have a SCH. I am a little surprised because last week, when I was actually complaining of a little spotting, the u/s tech didn't find any source for it. This week she said that the SCH might cause more spotting or outright bleeding but hopefully it will just be reabsorbed. My next ultrasound is scheduled for 9w2d.

Since I can no longer button my jeans, I was brave and went to the maternity store to buy a belly band. My first pregnancy-related purchase - I really, really hope this is not something I will regret in the coming days and weeks! I know I made that mistake last time. I am trying to focus on being more grateful and less anxious. It is hard for me to feel properly appreciative and really, awe-struck that this is actually happening when I spend sooooo much emotional energy worrying. I now understand more than ever how you can remain infertile in mindset when you are, in fact, pregnant in body.

Here are some pictures from today of our little smudges:

the google monster

Need to STOP googling vanishing twin syndrome. I am performing my usual night-before-ultrasound CRAZY routine. The intense cramping that came on suddenly isn't helping things (I really hope that's just growing and stretching). I feel like we used up all of our good luck with our last ultrasound. Please let me see 2 growing, thriving babes tomorrow.

1st ultrasound - 2 heartbeats!

This is a pretty long overdue update. I wish my thoughts on blogging during pregnancy weren't so complicated and conflicted. The last few weeks have certainly been an adventure. For so long I was so hell-bent on just getting pregnant (a big deal), I never really thought very much about our previous loss or how it might feel to actually be pregnant again. When you're entrenched in the IVF circuit, it is just always one foot in front of the other. All you can really afford to worry about and obsess over is the next step. I think that kind of singular focus is a survival mechanism just to get through and it has served me well. It did, however, leave me pretty unprepared to deal with the anxieties of pregnancy.

The past few weeks I have spent pretty much in a panic, re-living the awful ultrasound that showed our baby had stopped developing over and over again in my head, continually trying to "prepare" myself for the other shoe to drop, if you can ever be prepared for that. My lowest point so far was last weekend, in the days leading up to our first ultrasound. My symptoms had noticeably changed late during my 5th week/beginning of the 6th week. They hadn't totally disappeared, they were just different. I had also begun to spot a little, which last time was basically the only indication I had (in retrospect) that I had lost the baby.

I totally convinced myself I was having another missed miscarriage. I even managed to convince Y I was having another missed miscarriage, and we spent a lot of time discussing how we would move forward from that (yes, my super rational, logical husband spent many hours discussing with me how we would move forward from my imaginary miscarriage).

I think the thing that really freaked me out last time was not knowing I had lost the pregnancy until the ultrasound. It made me feel even less in control and so carelessly oblivious - while I was buying my first pair of maternity jeans (will never do that again until I really, really need them), filled with a smug sense of purpose, I was totally unaware that I was walking around carrying a baby that was no longer developing. I know I can't prevent a loss from occurring, but after that I vowed to never be that happy-go-lucky oblivious girl again.

Anyhow, we walked into the fertility clinic totally somber and demoralized last Sunday morning, expecting bad news. How surprised we were to see one healthy-looking string bean with a heartbeat! "Is it just one?" I asked the u/s tech. I didn't mean it as an insult to the one fine-looking string bean, like "Is it just one?", but that seems to be how the ultrasound tech took it. I was just genuinely curious. "Don't say just one, one is great!", exclaimed the u/s tech. We both nodded our heads and agreed, one baby with a heartbeat was awesome! But then she said, "Wait....there's another sac," and then "...and another heartbeat." Wow, wow, wow.

Once I read over the ultrasound report I did find a few areas of concern - one is that both babies were measuring 4 days behind and the second being that the tech didn't observe a yolk sac for baby Bet. From my understanding, it is highly unusual perhaps even impossible to have a heartbeat without a yolk sac, since it is a developmental milestone that precedes the heartbeat. It is possible, however, to have either an enlarged or shrunken yolk sac if miscarriage is imminent. It is also totally possible that the yolk sac was just hiding and not visible from the angle the u/s tech was looking at. My RE seems optimistic, but says obviously there is nothing to do but wait now, anyway. My next scan is on Monday at 7w3d. Y can't come, so my friend B is going to come with me. I really hope both babies are alive and growing! Please G-d, keep them safe.