We had our first trimester screen (nuchal translucency) on Tuesday. This is a combined blood test and ultrasound exam where they asses the babies' risk for Down Syndrome and 2 other less common genetic problems. It is not a test, as in they can't tell you for sure one way or another, but they give you the odds of the babies having a problem. Our babies chance of having Down Syndrome is very low, 1 in 8,761. The chance of having one of the other two genetic abnormalities is less than 1 in 10,000. Yippee!!
The ultrasound tech gave us lots of photos but this office would not allow videos:( Mostly, Baby A, which they labeled as Baby 1 or Fetus 1 in the photos, was moving all around Baby B, who was in a spot where it was hard to get a good image. It was really pretty funny, it was almost like Baby A was trying to kick Baby B awake so that we could get a better view. Even after trying a bunch of things to get Baby B to wake up (coughing, drinking water, jabbing with the ultrasound probe (ouch)), we still didn't get a great view.
I wonder if that will be their personalities once they are born - one calm child and one crazy hyper child. Only time will tell!
We met the new obstetrician today. She was excellent and really took time to answer my questions. I will see one of the two doctors or two nurse midwives in their office monthly until 28 weeks (unless there are issues) and after 28 weeks, we will be in weekly. We will also be seeing a perinatologist (high risk doctor) in conjunction with the obstetrician due to identical twins, plus my hypertension and hypothyroidism.
Mommy at 13 weeks pregnant!
No more ultrasounds for awhile - gender scan in mid-March! We didn't get any clues in the pictures below, unless I missed something:) Enjoy!
Baby A profile with hand ready for a high five
Another Baby A profile
Baby A kissing Baby B on the head!
Both babies heads side by side. Chins are facing opposite directions.
I call this one "The Scream." (google the scream by Edvard Munch) Also kind of looks like alien heads.
Baby A wants a high five for efforts to wake up Baby B.
Yes, you can in fact eat too much fiber. It is almost as bad as not eating enough fiber. Apparently I excel at taking things to the extreme, there is no middle ground for me. Last week, iron, now fiber. All or nothing!
So, I guess my lesson for this week (and last) is that having more balance in my life will benefit me and my unborn twins, as well as those around me (and not becasue they have to sit in the same room as me after I ate too much fiber...).
Today was our 11 week and 6 day ultrasound. Babies look great and I am feeling well...other than the extreme exhaustion. Growing two babies is harder than you might think!
Getting measurements of Baby A.
Baby A moving around and Baby A anatomy.
Baby B measurements.
Baby B anatomy, Baby B finally moves, trying to get both babies on screen.
Baby A measures nice and big at 54.01mm = 12w0d.
Baby B measures even longer at 54.33mm = 12w0d.
Meanwhile, I "graduated" from the reproductive endocrinologist this week. They gave me a nice gift bag with a pregnancy journal and some other swag. What an excellent doctor's office - highly recommended! Reproductive Associates of Delaware
Happy RAD grad! Excuse my "I rolled out of bed for my 7:30am doctor's appointment" hairstyle:)
Anyway, so our RAD graduation means three significant things...well significant to me anyway...
The end of our weekly ultrasounds. Another example of too much of a good thing! We are spoiled for getting to see our beautiful babies every week and will only get to see them monthly for the next 2 months or so.
No more injections! Mike has had the distinct pleasure of giving me daily injections since October 31, 2012. We have been doing the progesterone injections since Dec. 4 and tonight will be our last night. I have to say I am a tiny bit apprehensive that something could go wrong after stopping the injections, but the doc assures me that it will be okay.
I now get to go see a regular obstetrician! I think this is significant for me because I have been hestant to picture myself going to a regular doctore like a regular pregnant lady. But, Mike and I went today for our first meeting with the nurse and we will see the doctor next Thursday, February 21.
So, now to focus on something other than the twins for a little while. Perhaps I will read my new pregnancy journal...
Being a vegetarian, I have been paranoid about not getting enought iron. I looked up good iron sources, and listed were liver and red meat...which I don't plan on eating. Another good source of iron is spinach, which I eat have been eating like crazy. We found a recipe for a spinach, feta, and ricotta casserole, which called for 2 pounds of fresh spinach. That is a lot of spinach... We had an entire reusable grocery bag full of spinach, and had to cook it down in batches to get it to fit in the casserole. Also, you can put spinach in eggs, on sandwiches, on pizza, in pasta sauce, in salads, pretty much everything I eat I have been adding spinach to...
Well, I learned that my iron levels are high, so maybe I can cool it a bit with the crazy lady spinach eating obsession. Which is probably good, becasue at work today, one of my really awesome co-workers made lunch and brought a vegan salad, complete with spinach... I looked at the spinach and thought, oh no! Not more spinach! So, I am thinking I might be "spinached out" if that it a thing. Is it a thing? I think its a thing...
So, at the doc yesterday, iron looked good, my throid hormones are within normal (thanks to the meds), and most importantly, our babies look great. The subshorionic hemmorage was about the same size, but it wasn't larger and there hasn't been any bleeding. The doc seemed fairly positive/optimistic about this, so I am not very worried at this point, but they do advise me to continue restricting my activity to virtually no activity...which is not as fun as one might think...at least there is time to blog:)
The babies are really moving around now. The videos from this week are the best!
This is Baby B kicking and moving all around! A future runner perhaps?
This is Baby A with the hiccups. Poor baby had too much amniotic fluid too drink.
The weekly ultrasounds have been the highlight of the last few weeks. I can hardly wait and then they are over so fast. So here, I can relive the ultrasounds over and over again! Yay!
Lesson learned here, zoom in more for the video, because this is a bit hard to see. Also, lots of glare... We will get this down one of these weeks. At nearly 10 weeks, everything is looking fine. Still a bit of the SCH visible (see my first post), but it is getting smaller each week.
Video of doc taking measurements of the babies. There is a lot of glare and we did not zoom in enough, so we will try to improve our skills next time!
How much do you know about twins? I knew nothing much a few weeks ago, but thanks to the internet, some books, some friends, and doctors, now I know quite a bit. And soon you will too (maniacal laugh...)!
No offense to a certain relative, but I was recently told that they hoped my identical twins would be one boy and one girl so they would be easier to tell apart. Hmmm.... I think some people need the skinny on some twin basics, call it twinforming you so you are not twignorant. Too many made up words? Okay, I'll stop.
What is the difference between fraternal and identical twins? Fraternal twins happen when 2 eggs are fertilized by 2 sperm, creating twins who share the same amount of genetic infomation as normal siblings. Fraternal twins can be boy/boy, girl/girl, or boy/girl and look as much (or as little) alike as two siblings normally do. Identical twins happen when 1 egg is fertilized by 1 sperm, and the resulting embryo splits and creates 2 babies. Twins share all of the same basic genes, and therefore are always the same gender. Our babies will either be two boys or two girls and look alike.
Identical twins come from one egg and sperm, fraternal twins come from two eggs and two sperm.
How do we know we are having identical twins if we don't even know the gender yet? The egg can spilt at various stages of development. This creates different combinations of sacs in the womb that are visible on early ultrasound images. Some types of identical twins cannot be diagnosed this early because they look like fraternal twins in the womb. Egg splits days 1-3: Babies will have separate gestational sacs and separate amniotic sacs. Babies will each have their own placenta. This happens 20-30% of the time and the babies will look just like fraternal twins in the womb. This is the safest type of twin pregnancy because with separate placentas, they babies are not competing with one another for nourishment. Called monozyotic dichorionic/diamniotic (di/di) twins.
Example of two separate gestational sacs, which would be either fraternal twins or di/di twins.
Egg splits days 4-8: Babies will share a gestational sac and placenta, but have separate amniotic sacs. This happens 60-70% of the time and is the case with our babies. Separate amniotic sacs prevent the umbilical cords from wrapping around the babies, but there is a risk of Twin to Twin Tranfusion Syndrome, where one baby takes most of the nourishment resulting in drastic growth difference between the babies in utero. Doctors will monitor our babies closely and this doesn't usually happen until after 22 weeks. Called monozygotic monochorionic/diamniotic (mono/di) twins.
Video of our babies showing one gestational sac and individual amniotic sacs.
Egg splits days 9-13: Babies share gestational sacs, placentas, and amniotic sacs. This happens 1-2% of the time. Increasingly risky pregnancy, but babies can be born healthy. Called monozygotic monochorionic/monoamniotic (mo/mo) twins.
Egg splits days 14 +: This results in conjoined twins and is very rare.
Image showing the effect of time on the development of identical twins. Top line is 1-3 day split, middle line is 4-8 days split, and bottom line is 8-13 day split. Ours are like the middle line, which is the most common type of identical twins.
Do twins run in your family? They do now! Genetically speaking, fraternal twins will run in a woman's family. A woman whose mother had identical twins is likely to be super fertile like her mom, releasing more than one egg each month resulting in fraternal twins. Geographically, there is a link between fraternal twins and country or origin, possibly due to diet, or just due to heredity. Identical twins are thought to be a random occurence and not linked to heredity or geography (the rate of identical twinning is roughly the same throughout the world). However, lots of people have multiple sets of identical twins in their families, so even though science says its random, I think science needs to study harder!
Are identical twins caused by fertility drugs? With many fertility drugs, ovulation (release of an egg) induction is the intended result. Sometimes, it is difficult to induce the production of only one egg per month, and many women produce multiple eggs, resulting in fraternal twins. With IVF, to increase success rates, many doctors transfer 2-3 embryos into the womb. The nice thing about IVF is you have total control over how many embryos you transfer. We chose to transfer only one embryo due to risks and complications of multiple pregnancies. Well, God had another plan for us and gave us two anyway. Our one embryo split and resulted in two identical twin babies. We are very thankful and blessed. I truly believe that our journey to IVF was meant to lead us to our twins, and when we chose to transfer only one embryo, God laughed and said, " not on my watch, this couple was meant to have twins." Wham, bam, split the egg, and twins it is. So here were are! That being said, there is a slightly higher incidence of identical twins in IVF patients. I have heard lots of different odds, in vivo conception has a 3 in 1000 (0.3%) chance of identical twins and in vitro conception has a 21 in 1000 (2.1%) chance of identical twins. I am sticking with act of God!
So really, whose side of the family has the twins? Yes, you are right, Mike's supersperm caused my egg to split in half. Just like that! Wow! I forgot, that's how we ended up with identical twins.
We have taken short videos at each of our appointments. If you have never seen a baby (2 babies) heart beat at a few weeks old, it is very exciting. Probably more exciting if it is your own baby, but who am I to judge.
In retrospect, I wish we had captured more on video at these appointments, but our focus has been asking questions in order to make sure we maintain a healthy pregnancy.
Ultrasound #2: 6 weeks 6 days - One heartbeat!
After we sent my mom this first video, which is only 9 seconds long, she requested a longer video for the next appointment. We were all prepared to take a great long video at our third ultrasound. Then we got the news of our twins! We were so full of questions, shock, amazement, and awe, that we ended up with about 20 seconds of video. Sorry mom! Next time...
Ultrasound #3: 7 weeks 6 days - Two heartbeats, oh my gosh!
At our fourth ultrasound, after we saw both beating hearts again, and the doc expains a bit about how we know they are identical twins. Ohhh, sounds like a blog post idea for later...I have learned some interesting things about twins! Doesn't the baby in the upper right look like a gingerbread man?
Ultrasound #4: 8 weeks 6 days - Two nice strong heartbeats!
Ultrasound #4: 8 weeks 6 days - Some info about identical twins
The fifth ultrsound shows how much more they are starting to look like babies rather than blobby gingerbreadmen (yes, men...I am feeling like they are boys!).
Ultrasound #5: 9 weeks 6 days - I see arms and legs!
So, at my mom's suggestion (mothers are always right), I will be posting information on our pregnancy online so that friends and family can keep updated. How did we end up with identical twins? Funny story...here's the short version. We miscarried this spring after trying to conceive for a long (very long...) time. We were very sad, but after a silly doctor advised to just keep trying, we decided enough was enough and went to see a Reproductive Endocrinologist (RE).
So the RE explained infertility as a host of minor problems that when compounded greatly reduces a person's chance of getting pregnant. My diagnosis included stage III endometriosis, a hole in one of my fallopian tubes, fused fimbriae on one fallopian tube, and luteal phase defect, making the chances of us conceiving on our own just about 0%.Our insurance required us to try some fertility drugs in order to have IVF covered (thank goodness our insurance provided some coverage!).Of course the drugs were a waste of time, money, and emotional energy, and it was a fight to get the insurance to pick up the IVF.
We started with medications in preparation for the IVF cycle in October 2012.In November, we got a giant box of mail order medications in the mail.How giant?Well, we were supposed to bring the whole box to the RE’s office for our “learn to give your wife injections” lessons and we felt ridiculous bringing the entire box with us…
If you don’t know anything about IVF, the basic idea is a woman normally produces one egg per month.Using medications, ovaries are stimulated to produce lots (10-30) of eggs all at the same time.The eggs are removed via a minor surgery and fertilized in outside of the body, which is where the in vitro part comes in to play (normal fertilization happens in vivo or inside the body).Once fertilized, the embryos are allowed to divide for 3-5 days before being transferred back in to the womb.Success rates vary, around 20%-50% of women become pregnant.Many RE’s will transfer 2-3 embryos (or more) at one time, increasing the chance of pregnancy.However, sometimes all of the embryos implant, which is why IVF is traditionally associated with twin and triplet (or higher or multiple) pregnancies.
Great short story, right?Should have called this a long story… Our stimulation meds started November 23, 2012.On December 4, 2012, our retrieval resulted in 15 eggs produced.Of the 15 eggs, 9 were mature.The eggs were fertilized by an embryologist using ICSI (intra-cytoplasmic sperm injection, they pick a handsome sperm and inject it into the mature egg with a needle) and allowed to incubate overnight.Talk about knowing exactly when conception occurred!11am on December 4 for us…The next day, we learned that 9 of our 15 eggs were mature and all 9 fertilized.On the third day, the embryologist checked our embryos and all 9 were continuing to divide, so we were able to wait for the Day 5 transfer (which is preferred over the Day 3 transfer if you have an adequate number of embryos).
On the fifth day, we went in for our transfer.Of the 9 embryos, 6 had formed blastocysts, which is a stage of embryonic development where cell differentiation starts to occur.In normal conception, an embryo takes 5-6 days to travel the fallopian tubes into the uterus, making the 5th day the ideal day for transfer.At this stage the embryos are ready to implant into the uterine lining and the timing is similar to that of an in vivo fertilization.
We elected to transfer a single embryo, the remaining 5 are frozen through a process called vitrification and viable for future pregnancies.Our RE’s office actually has slightly higher success rates with frozen embryo transfers than with fresh embryo transfers, presumably because your hormones are out of whack from all of the IVF meds. Why did we transfer a single embryo?Well, I have chronic hypertension (hereditary) and there are a lot of risks associated with twin pregnancies.We wanted to take the safest option for us and our children and it was reassuring knowing we had five more tries (with out 5 frozen embryos) without having to go through the entire IVF process again.
So Sunday, December 9, we leave our RE’s office, taking 1 of our 5 day old babies with us in my womb leaving the other 5 embryos to be frozen.Very strange feeling…
Next step, wait 2 weeks for a blood test to confirm success (or lack thereof).This was the longest two weeks ever.Longest!Our blood test was scheduled for Christmas Eve, so I was very nervous that we would get a big fat negative (BFN) making the Holidays even more miserable than they already are for an infertile couple.
I was so desperate for earlier news that I actually bought cheap (about $0.50 each) home pregnancy test (HPT) strips online and began testing every day after the transfer.One of the meds from IVF is the same as what you test for in a HPT, and gives you a false positive.It takes about 10 days for the drug to leave your system and it does so gradually, so I figured I would see the false positive “pregnancy” line slowly fade to nothing, then if it came back, I would know I was pregnant before my blood test.This was true, the false positive line continued to fade each morning.
Well, I never got my BFN! On Sunday morning, December 15 (equivalent to 11 days past ovulation, DPO, which is when most women are likely to get a Big Fat Positive, BFP), the line was distinctly darker.The next morning, darker still.Well I continued to pee on a stick (POAS) every morning and that line kept on getting darker, see the evidence below.I was cautiously optimistic going in for the blood test on Christmas Eve.
I peed on these... From left to right, the pink area you hold, the control line, the pregnancy positive line, the do not dip into your urine past here line, labels of when I took each test and numberof days past ovualtion (dpo).
Monday, December 24 - first blood test.They called about 1 in the afternoon that same day.My hCG (human chorionic gonadotropin, essentially the pregnancy hormone) was 1661 (20 DPO).I asked what I am sure you are asking yourself, is that a good number.The answer, well the numbers vary a lot between pregnancies, so we take another blood test in 2 days and if it doubles, that is a sign of a healthy pregnancy.Great, now I have to wait until the day after Christmas for concrete news…
Wednesday, December 26 - second blood test. hCG was 3663 (22 DPO), more than doubled.They also tested my thyroid hormone levels and found indications of low thyroid stimulating hormone (TSH) indicating hypothyroidism.Apparently this happens in about 2% of pregnancies and untreated can lead to a miscarriage.The solution?A pill every morning on an empty stomach an hour before I can eat anything...always fun in pregnancy.Now what?!Test hCG again on December 28.Really??!!Yes, really.
Friday, December 28 - third blood test. hCG was 7426.Looking good!
Monday, December 31 - first ultrasound.Pregnancy considered 5 weeks 5 days.Saw a “fetal pole” and “yolk sac.”Too early to see a heartbeat to confirm pregnancy is still viable…So we had to wait until the following Monday for another ultrasound.
First ultrasound photo at 5 weeks 6 days
Waiting until Monday has been like torture, starting with this first week…Torture.Good news, bad news, don’t know yet…have to wait until Monday!!!In your Jan Brady voice “Monday, Monday, Monday.”
Monday, January 7 - second ultrasound.We see a heartbeat.I got teary eyed with excitement.We took a video of the heartbeat and sent it to our closest friends and family, most of whom knew about our earlier miscarriage.Yay! Yay! Yay!They did find a rather large subchorionic hemmorage (SCH) between the gestational sac and uterus.Because of this and the fact that my ovaries were still very enlarged from the IVF, they advised me to severely limit my physical activity (no exercise, bending, stooping, twisting, lifting, etc.).The doc says they see this fairly frequently and it is a common cause of first trimester bleeding.It can become problematic if it keeps bleeding, so take it easy and wait and see.Well, I have gotten a lot of practice waiting and seeing…
Second ultrasound photo at 6 weeks 6 days
Monday, January 14 - third ultrasound.A day I will never forget.First, I need to mention that my husband Mike is a rock star and has come to EVERY SINGLE doctors appointment with me over the past 6 months – which has been over 60 appointments…The best husband ever award, hmmm, I will have to make that for himJAnyway, we both left work for our appointment.The doc found the baby right away and said, “Lady, I see two heartbeats.”I think I said no way, followed by a lot of “Oh my gosh!” after I saw the evidence with my own eyes.Right there were two beating hearts on the monitor in front of us!Talk about getting emotional.The doc had to get me to hold my breath to register the babies’ (yes, plural – we are having two!) heart rates.Mike took a video shortly after, which I should be able to post…my hands were shaking so much I couldn’t even point at the babies’ (still plural!) heart rates.SCH still there and slightly larger.The doc seemed significantly more concerned about this now, presumably because it is a twin pregnancy. So much for that single embryo transfer!!!
Third ultrasound photo at 7 weeks 6 days. Why upside down? I think it looks nicer this way...(or no matter how many times I rotate and save the image it still wants to be upside down)
Monday, January 21 - fourth ultrasound.Babies looking good.Heart rates and length are appropriate.SCH slightly smaller, but still there.Also now taking antibiotics for a UTI, triple yay!
Fourth ultrasound photo at 8 weeks 6 days
Monday, January 28 - fifth ultrasound.Babies still looking good.Now, if it were only closer to Monday.SCH still there but smaller again.We saw the babies moving their arms and legs, but of course they froze like statues when we tried to get a video of them moving!
Fifth ultrasound photo at 9 weeks 6 days
So that really was the short version, at least short compared to living it... If I can figure out how to post videos, I will post them as well!
