Nov 21, 2012
our little squiggly & welcome iclw
We have one beautiful squiggly measuring a day ahead (6w6d) with a heart rate of 139bpm. I am happy. I am feeling more hopeful than I have in a very long time. I was terrified that we would see an empty sac, but I was also really scared we'd see more than one baby. Twins are so special and wonderful, but after losing Aminadav and Naava, a twin pregnancy is too risky for us. With a singleton, I hope I will have a good shot of carrying close to term. Of course we have a LONG way to go before we are back to the prematurity/PTL concerns.
I will do another ultrasound next Thursday and then we will take it from there. This was my first pregnancy-related ultrasound in Canada and it was weird to me that they didn't allow Y into the room, didn't let me see the screen, and would only give me results via my doctor. It felt really paternalistic to be honest. However, they did give me a nice picture of Squiggly. It feels so strange to say that I am feeling happy and peaceful, but it's true!
For those just joining us through ICLW, welcome! For a brief recap, we recently learned that we are rather unexpectedly though wonderfully pregnant after a long-shot Clomid/Prednisone cycle while waiting to start a new IVF. We started fertility treatments in August 2010 and since then we've done 6 IUIs and 5 IVF transfers (3 fresh, 2 frozen).
We've had many failed treatment cycles and several losses - two early miscarriages and the loss of our beautiful twins, Aminadav and Naava, who were born catastrophically early last March due to PPROM/PTL.
This blog has been an infertility blog turned pregnancy after infertility blog turned infertility blog many times over. Through the past few years, I've written quite a bit about unexplained infertility, the IVF process, miscarriage, high-risk pregnancy, and baby loss. The posts that are most meaningful to me are those about Aminadav and Naava, my lost hopes and dreams for them, and my grief.
Whatever brings you to our community, I am so sorry for your struggles. This is a sucky club to be a part of, but thankfully for us it is populated by many courageous, funny, resilient, and bright women.
Jan 23, 2012
a long overdue update
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):
Dec 31, 2011
happy 2012 and an update!
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:
Dec 12, 2011
7w3d - still kickin'!
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:
Dec 11, 2011
the google monster
Dec 9, 2011
1st ultrasound - 2 heartbeats!
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.
Nov 14, 2011
one year ago today
Nov 7, 2010
6 week update
Today I am 6w3d. Last Monday I had my 3rd beta draw at 25 dpiui (5w4d). My hcg level was 3567, up from 279 at 18 dpiui, so thankfully my numbers were doubling nicely. We also saw Prof. L that same afternoon. He answered many of our remaining questions about lean PCOS, PCOS and miscarriages, and my over-response to the Clomid last treatment cycle. He did do an u/s, though he warned us that there would likely not be much to see. All we could really see was a small gestational sac, but it did give us peace of mind that at least Baby G implanted in my uterus. Also, we only saw one sac, so while we can't quite yet rule out multiples, all indications point towards a singleton pregnancy.
Prof. L told us that our chances of an early miscarriage are 15%, compared to the normal 10% (50% higher than average), but if we are able to detect a fetal heartbeat, the chance will decrease to ~7% and will again further decrease to 3% at 12 weeks. I am still so scared but at the same time so hopeful, too. When I was struggling to get pregnant, it was difficult to think beyond the excitement and thrill of some time getting a BFP. Now that I am there, I haven't really experienced the ecstacy I imagined because I am so frightened to lose the little life growing inside me. I am so scared of waking up one day soon to "game over" and having to go back to square one with the dreaded fertility treatments.
Everything about this process has been so hard and uncertain until now, it is difficult to imagine that anything could proceed smoothly without lots of emotional pain. In short, after a lot of disappointment, finally being pregnant just feels too good to be true. I am just trying to remember, that even if our odds ARE worse than the average couple, the odds are still in our favor that this pregnancy will continue and we will get our Baby G at the end of it all.
This weekend I had some serious stomach issues. We went up to the Golan for Shabbat and I was scared I was going to not make it during the 3 hour car ride. Thankfully, Y picked up some Zofran before we started our trip and things got much better for me. Since then I have felt much, much better.
Our next u/s will be next Sunday (exactly a week from today) at 7w3d. Unfortunately, Y won't be able to join me because the appointment will be in the middle of the day, the only appointment time we could get. We have another u/s at 9w0d, and then assuming all is well until that point, the next time I will see Prof. L is at 10w0d. I pray that I will get to see our baby's strong and perfect heartbeat next Sunday, the most beautiful image I can possibly imagine.