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.
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| 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.
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| 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…
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| 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 himJ Anyway, 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!!!
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| 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!
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| 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!
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| Fifth ultrasound photo at 9 weeks 6 days |
Dear Nicole. How far along are you now? Ive been informed i am having momo twins though its still early days for me. Best wishes MrsD xo
ReplyDelete26 weeks now. Best wishes to you and your twins!
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