Twins, Take Two and What We've Been Up To...

What a year it's been! I can't believe 2015 is almost over. I last wrote just before the girls' first birthday (although I've been writing for myself privately). I survived the girls birthday! It was a very wide range of emotions the whole week, as had been the whole year. I love planning my kids' birthday. It just seemed so backwards at times though. I would be in one aisle of the store picking out plates and streamers and then go to another aisle trying to find something that would hold up to the weather for Cora's grave. I kept thinking I shouldn't have to get decorations for her grave, she should be here celebrating with Elena. I went to the checkout a time or two, in tears.

I am blessed to have a family that didn't even need to ask what they could do. They just did it. They knew that I wanted to celebrate both my girls but the preparations were difficult. My parents made all the food and we even had the party at their house. My little sister took care of decorations for the party and even some for Cora's grave. It really didn't help that just a couple of weeks before, I miscarried. We did a D&C the following week and I was having issues related to it all. Emotionally, I was spent anyway. We had transferred two of our last 4 embryos in January and spent a few days worrying about the possibility of twins, then to finding out it was one baby and a blighted ovum, to being devastated at our 9 week ultrasound that found no heartbeat.

I had several weeks of bleeding and lagging Hcg levels (for two months actually). I was eager to get on with things and finish this IVF journey. I wanted to do the last transfer as soon as possible. My levels eventually bottomed out and I finally got rid of the retained tissue from the D&C and my next transfer date was set...July 20th. Just 5 days prior to when the transfer was with the girls, 2 years before. I thought great, the same season of pregnancy, very close due dates. Could I handle this?

An uneventful cycle later, my beta came back at 462. That's very high. I knew two days after the transfer that I was pregnant and five days after the transfer, I confirmed it with a home pregnancy test. I knew I was pregnant with twins again and my beta just confirmed my suspicions. If I am going to be completely honest writing my feelings down, I will say I was not excited. I was a mess until my ultrasound. It's silly with how we need to procreate, to think "how could this happen?" but I did. We went back and forth about how many embryos to transfer and it just didn't make sense on so many levels to only transfer one, especially financially. We prayed about it and we felt we just needed to transfer two and that whatever happened was supposed to be. I also secretly thought, if Heavenly Father knew me at all, he would bless us with just one this time. Hahaha! When will I ever learn? I went into this last cycle believing with all my heart that we were carrying out the plan that was laid for us and that whatever happened was meant to be, even if that meant that we wouldn't have more children. I prayed for an entire year after the girls were born, every night, that my longing for one more child would be taken away and that I would no longer feel like there was another baby to come to our family. Honestly, I used to think that when a person said or felt there was another baby for them that they were just trying to justify their decision to have another. I could never relate to that feeling until this last year. The more I prayed to feel content and feel okay with not using the embryos we had, the more the feeling persisted and knew that I we had to have one more baby.

If Cora had lived, healthy or not, we would have been done. Embryos or no embryos. We had four embryos and consulting with our doctor, went back and forth about transferring one or two. With our cycle in January, we decided to transfer two but the weaker two. We had a great pair, and a pair that had one great one and one slightly weaker. We decided if that only one survived the thaw, we would only transfer one. If they both survived, we would transfer both. Half way through, we changed our mind and decided to transfer the stronger pair. We just wanted to be done and give us the best chance of getting pregnant. We got to the transfer and the message never got where it needed to go and they thawed the weaker pair, which both survived. Fast forward, we were pregnant with one and the second one never developed. It was an empty sac. I cheated and scanned myself at work (perks to working in L&D) and saw two sacs very early on. I will say, I cried for three days. I didn't know how we would survive this. We told close family and friends and started to get excited. We went to our 7 week ultrasound and saw one beautiful heartbeat and one empty sac. I was sad but knew I would be grateful for this outcome. However, walking out of that doctor appointment, my mind flashed to those two embryos and right then I knew we would be using them. The whole pregnancy, however short, felt so surreal...like a dream. It never seemed real. I was a little sick, but nothing too horrible. Around 8 weeks, I started feeling better. I knew something was wrong...I just knew. I had no signs of miscarriage but my heart just knew. My visiting teachers were over a few days before my 9 week ultrasound and I told them I thought something was wrong. They reassured me it was probably just first trimester jitters and I agreed. I had changed my appointment to three days earlier because the progesterone shots were going to kill me and I didn't want to keep doing them if I didn't need to. We went to the ultrasound and the NP asked why I changed my appointment. I told her that I needed to get off the shots (you usually get your weaning schedule at your 9 week appointment) and I quietly slipped in there that I thought something was wrong. As soon as the picture came up, we all saw it, no heartbeat. The baby was measuring 9 weeks so it happen fairly recently. I was just not surprised at all. We were left alone for a good cry and then discussed options...letting it pass on it's own, medication, or D&C. Knowing my body, it would have taken far too long to recognize the pregnancy had failed. The medication sounded horrible and I was far enough along that she warned that it would be painful. I opted for an in office D&C and scheduled it for the next week. Long story short, it went smoothly but I had some retained tissue that caused my Hcg levels to drop very slowly and bled for almost two months. I'm pretty sure I was lacking oxygen to my brain at that time. I was so tired and couldn't think straight. The tissue passed on it's own with my next cycle and we were scheduled for our final FET.

It was July by this time and I was eager to get on with things, although it was also a little tender. The whole thing was bittersweet. Closing a chapter in our lives. A very long 6 year chapter. I was mostly happy to have fertility treatments and the battle of infertility behind us but it will always be such a huge part of our lives. I guess it's a similar feeling to knowing you are having your last pregnancy or baby. Our transfer went smoothly on July 20th and I was on bed rest for a couple of days. I knew two days after the transfer that I was pregnant. The heartburn had already started and I just knew. Five days after the transfer, I didn't feel well and threw up. I ran to the store to get pregnancy test but didn't plan to take it for another two days. Well, I couldn't wait. I knew it was still early but I took it anyway. It came up positive right away and I told Michael. He seemed indifferent but assured me he wasn't and that he just already knew I was pregnant and he was nervous. He said that unfortunately, that little stick didn't provide him any reassurance. I agreed but this was a step in the right direction. We got my beta back and it came back very high at 462. I knew it was twins again and from our previous cycle, knew that it would be okay but I was still terrified. How were we going to do this?

We headed to our first ultrasound two weeks later and was not at all surprised that there were two heartbeats. We had a scare for a minute when the tech said she saw THREE sacs. She said it looked empty though. I made her look three times! It didn't end up being an empty sac, it was a bleed that caused no problems. There were two babies...for the time being. We just had a "one day at a time" attitude. We were pretty ambivalent to the situation. We were not convinced we were having two babies and told no one. We went back the next week...two heartbeats. We went back at 9 weeks...two heartbeats. It started to look like signs pointed to two.

We were released from the fertility clinic and had our first appointment with my OB/MFM. It was a LONG appointment that consisted of genetic counseling, an ultrasound, and clinic appointment. We were told our risks of having another chromosomal defect in one of the babies was a little higher than before and told what our testing options were. We opted not to do anything invasive and definitely declined that dumb blood test that told us everything was fine with girls (they are no longer recommending it for twins anyway). Our doctor told us we would do frequent ultrasounds and we would have as much information from that as we would any blood test. We had the NT screen at 12 weeks and it was not a fun appointment. I was a wreck! The poor tech, even knowing our history, was probably wondering why we were not happy or excited to see our babies. We were in the same room that we found our Cora might have a problem and the same room we were told she had passed away.  In those moments, I questioned everything we did and everything we were doing. I couldn't bare it. The tech cannot really tell us if everything was okay but she did at the end anyway because she knew how anxious we were. She said everything looked great and the measurements were well within the normal limits.

We left that appointment feeling reassured that so far, our babies looked healthy and were growing beautifully. We still didn't spill the beans about having twins yet. Having passed the 12 week mark was a milestone but still didn't feel confident we would be seeing two heartbeats at the next appointment. It was very overwhelming. My dad had had a heart attack less than two weeks before and things were chaotic in our families. No one needed the added stress of knowing about the twins.

We didn't plan on telling anyone until after my 16 week ultrasound and we could possibly find out the genders. We planned on a gender reveal right before Halloween. I had always wanted to have a gender reveal but it never worked out with my other two pregnancies. Michael wanted nothing to do with it. He thinks gender reveals are pretentious, a waste of time, and no one wants to come. I half agree but any reason to get family and friends together to eat and catch up is a good enough for me. We wouldn't have had the gender reveal party if people already knew about the twins or we were just having one. It was a fun, Halloween themed party and the kids wore their costumes and played a couple of games. Of course, there was yummy food too. My friend, Sharon, who was one of the only people in the world that knew about the twins made the "gender reveal pumpkins" and was the only person at the time that knew the genders. It was really fun to announce the genders and the fact we were having twins at the same time. Had we told everyone early on, no one would have been excited and they would have just worried like we did. We didn't need everyone else to be stressed out too.

Everyone was shocked and had no idea that we had been keeping this secret for four months. Some may have been annoyed that we weren't truthful but it was our decision to not tell anyone. We didn't want to stress people out but more than that, we needed to be excited about it before telling anyone and honestly, we weren't at first. Michael has lost 20lbs if that says anything and I've lost 10 lbs right along with him, although for slightly different reasons. We were terrified that we would be destined to repeat the past and equally terrified about the reality of four kids under the age of three. We never planned on having four kids, given how hard it has been to get them here. We always said if we could get two out of this process, we would feel so blessed. We just didn't think a big family was in the cards for us.

We are thrilled we are having a boy and a girl! My intuition told me from the beginning it was a boy and girl so I would have been very pleasantly surprised if it turned out differently. I still haven't completely wrapped my head around it. Chasing around two toddlers has a way of distracting you from things, sort of. I will update about how my pregnancy has gone until now. For now...

BABY BOY AND GIRL HALL

DUE APRIL 6th 2016

Not-So-Wordless-Wednesday...

I have been wanting to post an update all day but I had school in the morning, ripping my fingernails off in the afternoon, and then work this evening.  Oh!  I was ripping my fingernails off (it's okay, they were too long anyway) because I was waiting for the embryologist to call me this morning, which ended up not being in the morning, it was afternoon by the time he called.  I couldn't concentrate in class, I was staring at my phone, willing it to ring.  I have been in few situations in my life where nothing matters but that phone call and really, it should be a form of torture.  Then, it finally rings or you get a text and it's someone else (memo: I will call you Mom when I have news), baaaah!

Michael and I placed bets on how many embies we thought made it through the last couple of days.  Neither of us thought it would be more than four and we would be nervous but fine with that.  Well, all 6 are still "dividing beautifully"!  They are all 8-cells which is right where they should be.  What?!  I was so happy.  I'm praying tomorrow that they are all blastocysts (very important) and hatching out of their shells.  Yes, they actually have to hatch before they can implant.  The embryologist gave me instructions to arrive tomorrow at 9:30am and the RE will go over the procedure (they thread a catheter containing the best two embies through my cervix and place it 2cm from the fundus of my uterus), the grading of the embies (important for choosing the best two), and what to do after (stay in bed!).  The best part about tomorrow, other than the fact I get my embabies put back in me...Valium!  Finally, something forcing me to relax!  I have to say I am quite proud of myself for being so calm up to this point.  I thought I would be clinical by now.  I was anxious this morning before getting the phone call but I am fine now.  I know my demeanor is because of all the prayers.  It's definitely not in my nature to be calm about most things (I'm my mother's daughter after all...just kidding mom!).  I tend to freak out about things that have not happened yet.

I'm hoping that I've developed nerves of steel in the last couple of weeks because the next few weeks, until we find out if I really am pregnant, are going to be the hardest, most agonizing weeks of my life.  There is too much damage that can be done with a girl, her embies, and her brain.  Too many thoughts.  No, no, only positive thoughts here.  I can wait until I'm PUPO (more on that....stay tuned)!

A hatching blastocyst

After tomorrow, this is what I will be imagining my little embies doing.  Implantation.

Day 12: Stims, Ultrasound, Trigger...Oh, My!...

So, yesterday we went for my ultrasound and oh, boy...did I grow!  I still have 22 follies but 14 of them were over 17mm, 4 of them were 15-16mm, and 4 were 11-14mm.  That is crazy growth from the day before.  My doctor said she was going to wait until my E2 levels came back but she was positive the trigger was going to be that night.  My E2 levels came back at 2888 which is beyond perfect (it should double every 48 hours) and the nurse gave me instructions to trigger last night!  She said I was going to trigger at exactly 8pm and that I was to have nothing to eat after midnight on Friday.  I am also to start the antibiotic Friday night and Michael should take his last on Saturday morning.  My retrieval is set for Saturday morning at 8am and we need to show up at 7:30am.  I will be given an IV and sign paperwork and Michael will umm...do his business.  We are out of our minds excited today.  Work has been pretty tough for Michael lately and he called me on his way home, after I told him we were trigger last night, and his voice was so different.  He was still tired but I could tell he was so happy that this is actually happening.


We got everything ready for the trigger shot and just waited until the clock said 8pm exactly.  I was so nervous.  Michael has never given a shot like that before and it is not fun to think about a gigantic needle being shoved into your hip.  I, personally, hate giving those kinds of shots because I am always afraid I'm going to hit bone even though that is very difficult to do, but still...I was not excited even knowing I knew that anticipation was much worse than it was actually going to be.  He counted to three and it was over.  The HcG stung a little going in but it was not bad at all and I barely felt the needle.  I have been told that it gets worse though.  I start taking Progesterone the day of the retrieval and you eventually run out of places on your hip that are not sore after a couple weeks.

I feel like everything is falling into place.  We have all confidence in our doctors but this last week, we questioned whether they maybe have been too conservative with me since I am, as they say, still so "young".  We have said, "do they really know what they are doing?"  Well, they absolutely know what they are doing.  Going an extra day made me nervous because I felt like that was "not normal" but it was 100% the right decision.  I've got so much potential with these eggs and I am even starting to think that we might have a few good ones to freeze.  We just want to get one healthy baby but having embies to freeze would be gravy.
We are just excited that it is actually to this point in the process.  We get a call tomorrow letting us know how many eggs were retrieved, how many were mature, and how many fertilized and then it's just a waiting game with daily updates about how our embies are developing.  Oh, gosh...I'm getting anxious.  Prayers are welcome.

56 needles...

Day 10: Stims, U/S, No Trigger...

Day 10...I can't believe it! Yesterday's appointment was weird. I wasn't paying attention to the growth I had over the past day and left feeling very confused. I felt like I hadn't made any progress and that it was going to be forever until I was ready for retrieval. They had me order another days worth of meds (a precautionary $230) but when I went home to dose myself for the day I realized I had enough on one med to last me through Thursday. The injection pens have over-fill in them so I got a free dose and didn't have to pay for all of the meds. Pheww! I called the nurse to tell her this and also asked her to go over the numbers with since I left feeling confused. I actually had quite a growth spurt. I had 8 follicles over the 16mm range, 6 over the 11mm range, and 6 under 10mm.


Today.

I have 10 in the 16mm-22mm range, 6 in the 11mm-15mm range, and 6 still under 10mm. My RE said I had a 75% chance of triggering tonight but wanted to wait until the my E2 (estradiol, a form of estrogen) levels came back. My E2 level came back at 1800 which is good but the nurse said the doctor thinks I still have room to grow. I'm fine with that. One more day of growth is one more day of growth. She didn't have me order more meds so most likely my retrieval will be Saturday morning. This is good, I will not have to miss school or work next week since the transfer will be on Thursday instead of Wednesday. I go back again tomorrow morning for more blood work and another lovely ultrasound. I feel so bad for Michael. I've spent a week in his shoes having to drive the 30 miles to the U every morning and it totally blows. The traffic is horrible and the rising sun is blinding and it is SO early! I made our appointment for tomorrow a little later (8:30am instead of 7:45am) but Michael said with the time difference, the traffic is even worse so we will basically have to leave at the same time. Ugh.

Ahhhh! I'm getting super nervous. I hope my ovaries kick it into high gear!


Caution: Science ahead...ignore the information below if you don't care why the estrogen levels are so important.


Estradiol is a hormone that stimulates the lining of the uterus, causing the lining to grow, and to make itself ready for embryo arrival. (This is not estradiol's only function, but for us, it's the important one). Estradiol is tied into pregnancy by it's method of production: oocytes (eggs) contain follicles. These developing follicles contain 'granulosa cells'. These granulosa cells synthesize the estradiol and release it into the blood circulation.


 This means that more follicles produce more estradiol. This helps measure how many follicles are actively developing. The longer they continue to develop, the longer the estradiol level continues. As they develop, the level continues to rise. This rise can further indicate that the oocyte within the follicles is reaching its maturity.


 An example of the use of estradiol level is when it is measured during down-regulation cycles. In down-regulation we expect low levels of estradiol: below 30pg/ml. If levels are not this low, this suggests that the ovaries are not yet suppressed, and that the down-regulation should continue a little longer, until they actually are suppressed.


 Estradiol And Ultrasound Scans
Blood estradiol is also used in combination with ultrasound scans. Taken together they help indicate how (and if) the ovaries are responding to stimulation. Is there a response? Is it adequate? Is it excessive? To tell us this, the blood level has to be viewed in relation to the stage of pregnancy and the day in the cycle in which the level is being taken.

 For example, a level of 1500 pg/ml on day eleven might be considered acceptable in a stimulated cycle, as reflecting the presence of a reasonable number of mature follicles. However, if this level were present on day eight, it would be considered unacceptably high. It would almost certainly reflect the presence of an excess of follicles. At this stage (day eight) they would still be Immature ones. Their quantity, however, would suggest that continued stimulation would carry an unacceptable risk of developing OHSS-- ovarian hyperstimulation syndrome.

 Don't Expect Easy Comparison
Before we continue, one important point: levels of estradiol are not the same from person to person. They cannot simply be compared from one to another. People vary-- everyone is slightly different, and everyone responds to a different degree. Some more so than others. A level that is dangerously high in one person-- or dangerously low in a second-- might be normal and healthy for a third. This is why blood levels can't just simply be compared. It's also why blood levels can't always be interpreted with complete certainty in the first cycles. Without prior cycles to 'calibrate' the levels, the meaning of a level can only be determined as to what it usually means-- what it 'probably', or perhaps even 'almost certainly' means.

 Despite individual variation, estradiol level does provide very useful information.
 A Rough Rule-of-Thumb for Good Estradiol Levels.
Exact figures are not possible. As a rough guide, however, a level in the range of 150 to 500 pg/ml is generally considered reasonable for the eighth day of a stimulated cycle. An approximate doubling of this level every 48 hours is considered promising, as a sign of continued good follicle development.


48 needles! My belly gets a rest in a couple of days and then the butt gets all the abuse!

Day 8: Stims & Ultrasound

Quite of bit of growing in the last couple of days over here in the Hall house.  I went from 13 follicles to 20 follicles and from only 4 being over 10mm to 11 being over 12mm!  Yay!  I am very happy.  I found out today that they like to see a good number of the follies measuring 16mm or greater to be ready for retrieval but they again reassured me that I am right on track.  If I have as much growth in the next two days as I did from Saturday to today, I think I will be ready to trigger on Wednesday night.  The trigger is a shot of Hcg that ripens the follicles so they can retrieve them, exactly 36 hours after the shot.

The ultrasounds are getting really uncomfortable.  They aren't all sunshine and rainbows to begin with, but I was told my left ovary is twice the size of my right one and when they scan the left...OUCH!  Me no likey!  Okay, so fingers crossed and lots of prayers I will be ripe on Wednesday for retrieval on Friday!!

40 needles (I got an extra one yesterday since my fancy injection pen ran out of meds so I had to replace it and stick myself again), 37 days.

Day 6: Stims and Ultrasound

I guess we got good news today.  I'm not exactly sure what I expected from our ultrasound?  I knew and hoped that I wouldn't be ready for retrieval in the next day or two.  I knew that I would still have some cooking to do but I left our appointment today a little disappointed even though they said I was right on track.  So, my AFC was 15 (I said 16 before but I guess I remembered wrong).  Today they saw 13 follicles and they measure the follicles to see how mature they are.  Anything over 10mm is great.  Well, I had 4 that were over 10mm, 4 that were very close behind, and 5 that needs some catching-up.  Hmmm.

I admit I was really sad but they said I shouldn't be, I should be happy because I'm right within normal range for being on the stims for 5 days.  I still have about 5 days to go and I was told that others will probably pop up as well.  I asked a couple for fellow IVFers for a number comparison and they both only had 1 that was over 10mm at this point so I guess I'm doing okay.  I can't wait to go back on Monday, hopefully there will be a big change.

I'm starting to get anxious about all the variables in this process.  What if they don't get a lot of eggs? What if they are not mature?  What if they don't fertilize?  What if they don't continue to grow after they are fertilized?  There are so many major daily milestones.  I guess we just have to take it one day at a time.  I just want everything to go well and on transfer day, I want a couple of great embryos to snuggle in and few great ones to freeze.  That would be the ideal situation.