Friday, March 29, 2013

6 week ultrasound

Early Tuesday morning, M's uncle passed away.  Because I knew M and N would be busy planning the funeral and hosting family, I moved the ultrasound appointment to Texas Fertility.  Rick and I promised that we would FaceTime them for the entire appointment; they wouldn't miss a thing.

We arrived exactly on time-- 11:15-- and so went back almost immediately.  Rick got M and N on FaceTime and we waited for Dr. Vaughan to come in.  When he did, I gave him our relevant history-- including that I'd been bleeding heavily the day before-- and then we got started.

We immediately saw two sacs, and then, with just the slightest bump of the wand, we saw the third.  Three sacs.  We started with sac A, which was anterior and therefore furthest from the ultrasound wand and most difficult to visualize.  Even so, we could immediately see both the fetal pole and the heartbeat.  He couldn't get it to focus clearly enough on the heartbeat to get a rate.  The fetal pole measured 5w6d-- completely normal.

Sac B also had a clear fetal pole, with a heartbeat.  That pole measured 6w1d and the fetal heartrate was 104 beats per minute.

Sac C initially looked empty.  But no-- then we saw another fetal pole, measuring 6w2d, with a heartbeat at 109 beats per minute.

All in all, three completely normal looking little fetuses.

Oh, boy.

Dr. Vaughan said "Tim's going to be mad... at himself."  (Tim = Dr. Hickman.) Yep.  Triplets were definitely not the goal.  He rolled the dice, we depended on his advice, and now we are the 1% risk group.  Pregnant with triplets.

Now that we're here, though, to me, there's no option than to soldier forward and do everything we can to ensure the best outcomes for these babies.  As Dr. Vaughan reminded us, we are not assured of triplets.  There are many hurdles to overcome (including this bleeding, for which he saw no cause, but didn't seem to be overly concerned about).  This is no walk in the park, unless we're talking a really scary, twisty-turvy, obstacle-filled park.  But I do still have an image of three babies at the end of this journey.  Three toddlers running around the C house a couple of years from now.

Here we go...

Bleeding

I thought the ultrasound would be the only exciting event this week- unfortunately not so!  Yesterday, I was standing talking to someone at work when I felt three gushes of what I knew had to be blood.  Sure enough, I went to the bathroom and my underwear was soaked.  Bright red.  I packed up and went back home to spend the day in bed.

My first instinct was that bedrest and hydration was really the only thing I could do.  I got in touch with Andrea at Houston IVF (Barb is out of the office) as well as Gayle, and they agreed it was best to lay low and wait for my ultrasound, since it was just a day away.  The blood slowed down a bit when I was laying down, but it was still going strong anytime I got up to use the restroom.

Rick called to check on me at about lunchtime.  When he did, I stood up and ended up (sorry, this is gross) passing an enormous clot-- about half the size of my palm.  I'd never bled in a pregnancy until the last one, and I'd never, ever seen a clot like this except maybe after childbirth.  Not an experience I was looking for!  I (gross again) picked it apart with a pair of tweezers to make sure it was really just a clot-- it was.  And my bleeding continued to be "pure" blood-- no tissue or fetal sac or anything.

The bleeding slowed substantially after that, but it was still definitely "bleeding" rather than "spotting."  No cramping at all, which made me optimistic it was not a miscarriage, but instead a SCH (subchorionic hemorrhage, a common IVF side effect).

But I really didn't know if we should expect 0, 1, 2, or 3 babies at the ultrasound this morning.

Monday, March 25, 2013

Procrastinating

I have a million things to do and not one bit of motivation to do them, so here I am updating on... a lack of symptoms, I suppose?  I still don't feel any different at all-- it's easy enough to forget I'm pregnant (possibly with a litter).  I had the teeniest bit of fleeting nausea this weekend, but under any other circumstances, I wouldn't have even taken note.  I also have a tiny bit of spotting that seems to be ongoing, which I think is just slight irritation from the Crinone, or possibly a cervical polyp again-- not concerning.  I've been sleeping through the night (once I start the progesterone, I'm usually up at least once).  Pretty normal appetite-- more than usual sometimes, less than usual other times-- that adds up to "usual," right?

I had lunch with a good friend today who knows a local mom who carried spontaneous triplets to 38 weeks (and then exclusively breastfed them for 6 months-- I'm pretty sure there's an extra special merit badge for that).  If we do end up in Tripletville, that's another person at the top of my list for people to talk to.

I truly haven't been thinking about the 2 vs. 3 question too much for the last several days.  Logically, it seems all signs point to three.  So that's what I've accepted for now, though I think actually seeing three sacs on Friday will still be shocking.

I'm 5 weeks, 3 days pregnant today.  So far, so good.

Friday, March 22, 2013

More conjecture

I was sitting here this morning feeling calm, cool, and collected and decided that all this worrying about triplets is for nothing.  Surely it's "just" twins, I thought.

Then I went back and looked at the betabase numbers.  I don't think I'd actually done the math-- I just knew we were on the very high end of the reported range.  Well, turns out we're in the top .7% or so of about 1900 reported beta values for twins.  I have to laugh, really.  What else is there to do?  I also looked back at the SMO numbers and we are way, way over what anybody reported for even quintuplets, so that's just not very helpful.

So, most likely triplets.  Triplets that may naturally reduce to two (or even one, I guess).  Or triplets that may hang in there for the duration.  Listen up, babies.  I'm ready if you are.  I am handing you the next year of my life (realizing that this experience will not end at the moment of birth).  Be strong, grow well, let's do this.

We'll have the beginning of some answers a week from today, when we have the ultrasound.  According to the papers Barb sent over, there's a 50% chance of seeing heartbeats at 6 weeks, and by 7 weeks, they should definitely be there.  7 weeks is also the week by which most triplets reduce, if they're going to, so our fate is still a little open even after next week's ultrasound. 

I have complete faith that we can handle whatever life has in store for us.

Wednesday, March 20, 2013

Preparing

M talked to his brother, P, who has (one year old!) twins.  P really loved their doctor, Dr. Robert Carpenter.  Well, it turns out that I had been leaning toward seeing Dr. Carpenter based on my own research.  So that was a happy meeting of minds.

At M's urging, I called his office today to set up a phone consult.  *If* we find out there are triplets on the 29th, we will have a phone consult with Dr. Carpenter on April 9th.  That consult will be to discuss the risks of triplet pregnancy and the possibility of reduction.  I will say upfront that I am not at all in favor of reducing.  If there was a problem with one of the babies, yes, I would do it.  But reducing an otherwise healthy baby sounds pretty terrible to me.

On the other hand, I recognize that there are risks to me and to the babies if we proceed with three.  I just don't think we should have transferred three if we weren't prepared to take on that risk.  Well, I don't think we should have transferred three in any case, but we did, so here we are.

Dr. Carpenter's office sent us a packet of triplet pregnancy information.  Probably most interesting to me was this:

NATURAL HISTORY OF EARLY PREGNANCY — There is a significant possibility of spontaneous loss of one or more fetuses between the time of ultrasound diagnosis of the triplet pregnancy and delivery. As an example, a study of the natural outcome of 38 pregnancies in which three gestational sacs were identified with transvaginal ultrasound (TVUS) at 21 to 28 days after ART reported triplet, twin, and singleton delivery rates of 47, 32, and 18 percent, respectively, with miscarriage of all three fetuses in 3 percent [5]. Embryo reduction spontaneously occurred primarily within the first seven weeks of pregnancy and did not occur after the 14th week of gestation.
Similar findings were reported in a series comprised of 6149 singleton, 549 twin, 132 triplet, and 23 quadruplet pregnancies monitored by ultrasound examination [6]. Sonography was initially performed at 3.5 to 4.5 weeks after ovulation and repeated every two weeks until 12 weeks of gestation. Spontaneous reduction of one or more sacs occurred in 20 percent of singleton, 36 percent of twin, 53 percent of triplet, and 65 percent of quadruplet pregnancies. Most losses were prior to the ninth gestational week; miscarriage of all three sacs occurred in 6 percent of triplet pregnancies. In addition, multiple pregnancies that experienced spontaneous reduction delivered earlier than unreduced pregnancies with the same number of fetuses (eg, triplets-to-singletons delivered 10 days earlier than unreduced singletons, triplets-to-twins delivered 4 days earlier than unreduced twins).
 
So in both studies, 53% of triplet pregnancies naturally reduced to twins.  Those are decent odds.

I still have very mixed feelings about "wishing" or "hoping" one of the embryos will stop developing.  I guess I just hope that everything will work out the way it's supposed to.

This quote was interesting to me too:
While some data suggest that triplets reduced to twins have higher birth weights and longer gestations, other studies have indicated that the gap in morbidity and mortality of triplet gestations is closing.
 
So carrying triplets isn't as dire a situation as it used to be?

He does say the prematurity rate is 80-85%, with premature being born prior to 37 weeks (that seems like an awful lot of triplets born later than 37 weeks to me, when I thought it was pretty commonly accepted that 36 was the end of the road).  15-17% are born prior to 28 weeks (scary early).  Which puts about 70% in the 28-37 week range.  He cites some data about triplet pregnancy histories, but the years included in the analysis are 1946-1992, and that seems outdated to me.  In that group, though, mean delivery was in the 33 week range, which isn't terrible.  Not ideal, but not super scary either.

Anyway, Dr. Carpenter reportedly is The Guy for statistics and data, which you know is a good fit for This Girl.  So, if we do find out it's three (or more!) next week, we've got another good member of the team.

Hungry, hungry hippo

Oh, good gracious.  I am starving.  So hungry.  I ate breakfast this morning, but I don't think it was enough protein (I had leftover cauliflower soup and some clementines) and I could eat off my own leg about now.  I'm holding out for a few more minutes to go with some coworkers to a fish fry on the Capitol grounds.  Hurry, people.  I am (we are) hungry.

I truly have not one bit of a symptom otherwise.  I've been sleeping just fine, good energy levels for the most part, no nausea.  Yes, I'm not even 5 weeks pregnant, so I think that is to be expected.  But I figured with the enormous hormone levels, I might have it a little rougher.  Not yet!  I think it's been closer to 5.5-6 weeks that I've experienced symptoms in the past.

Tuesday, March 19, 2013

Trying to be more eloquent

So, yeah, that was a big number today!  A very big number.

Here's the thing.  As hCG levels rise, the doubling time generally slows (you can look down to my "Jackpot!" post below to see the charts).  Specifically, once it's over 1200, the expected doubling range drops to 48-72 hours.  Doubling at 32 hours for a number as high as ours makes me feel like it's much more likely to be 3 embryos, each pumping out some strong hCG levels (divided by three, our number today would have been 1,673-- still 4 times the median for a singleton).

So, yeah.

I'm thinking it's three.

At 18dpo, a beta of 5,019 is:
  • 4.25 times the median for triplets
  • 6.23 times the median for twins
  • 12 times the median for a singleton
  • Pretty scary, if you think about it.
In the past, my betas have been about 4-5 times the median.  I do like to crank out some hCG.  No doubt.

Repeat beta

13dp5dt = 5019
Estrogen = 677
Progesterone = 66.2

32.85 hours doubling time.

Oh, crap.

Hey, bright side: no PIO needed.

Last HPT

Did one last test this morning. The test line is darker than the control line- Rick said I didn't even need to pee on it, I just needed to hold it close to my belly. For real, yo.

I'm sitting in the lab now, waiting to be called back. And then of course we get to wait all day for results. Good times.

M asked for a prediction and I said 3874. We shall see!

Monday, March 18, 2013

Tired

I'm sitting here yamning at my desk trying to figure out: is it an early pregnancy symptom?  Progesterone reaction?  Not enough sleep last night?  Avoidance tactic (I have two big projects I need to work on)?

Maybe I should get up and take a walk.  That would be more worthwhile than sitting here yawning.

In more energetic news:

The girls and I did a 5K yesterday morning.  Mariela was disappointed when she finished, because she didn't PR, but her spirits lifted when she got a gold medal for placing first in her age group (we did not tell her it was in a field of two!).  Andie did well-- about 30 minutes, so under a 10:00 min/mile-- and placed 8th in her age group.  I placed 34th in mine.  Ha.  I walked all the uphills, to keep my heartrate in check.  The guideline Houston IVF gave was under 140 bpm, which is really reasonable, I think.

We got up to run this morning, but about a half mile in or so, Andie got a stomachache and we turned back.  We've been running 3+ mornings a week really regularly since November.  I'd like to keep it up as long as is possible/reasonable/healthy.  Especially if this is a multiples pregnancy, I feel like I want to stay in as good of condition as possible through mid-pregnancy, when I think my size/condition will have me lay off.  I was telling Rick that I'd like to keep running through the exhaustion and morning sickness.  We'll see if that commitment sticks when the going gets tough.

Blood test tomorrow.  Hoping for a high enough estrogen level that I can lay off of the Estrace pills and just stick to patches (ha! pun!).  And a high enough progesterone level to stay off the evil injections.  Please!  And, of course, a nicely doubling beta level.  Not too worried about that, though.

Lovenox injections continue to be no big deal.  Actually acquiring them is a bit of a hassle-- my pharmacy can't seem to get enough to fill the whole prescription-- but the shot itself is a walk in the park.  A slightly burning park.

Saturday, March 16, 2013

How NOT to Take Lovenox

How NOT to take your first injection of Lovenox. A simple tutorial in three easy steps!

1. Watch the YouTube video where the woman insists it is the most horrific shot she's ever taken- specifically, way worse than PIO.  (Seriously-- do not watch this video if you are about to try Lovenox.)



2. Read the back of the packaging. Think about pig intestinal mucus.


3. Carefully examine the huge, spring-loaded syringe.


And, to be fair, here's the even simpler "How TO take a Lovenox injection" tutorial:

1. Pinch an inch and do it quickly just like any other subcutaneous injection. No biggee.

Yes, there's a little burning as the medication goes in, but it's no big deal and goes away within a minute or so. The big, scary spring just retracts the needle after the injection. And yes, it creates a bruise. But I was expecting big, black and blue and the reality is tiny (maybe half the size of a pencil eraser? or less even) and, for now, red.

One down, several hundred to go?




Friday, March 15, 2013

Jackpot!

Betabase.info remains down, but Wayback Machine saves the day!  http://classic-web.archive.org/web/20081001000000*/http://www.betabase.info

I took screenshots of the information I wanted.  Not every page was archived, but this is a very good start!

14dpo = 9dp5dt Twin Pregnancies (I did not bother copying Single Pregnancies, and Triplet Pregnancies wasn't archived): [Note that 662 is in approximately the highest 2-3% for twins; it is in the top 1% for singles; last time our number of 302 on this day puts us in the top 10% for singles; my pregnancy that started out as twins was in the top 2% for twins at 15dpo.  I like making hCG.]


18dpo = 13dp5dt Twin Pregnancies:


Triplet day-specific information wasn't archived.  Darn.

Overall Triplet Chart:


Overall Twin Chart:


 Overall Single Chart:


This is a few years old (2008, I think), but Doubling Times for Multiple Pregnancies:


Doubling Times for Singleton Pregnancies (from 2010):


And the data nerd REJOICES!  All is right in the world.

Lovenox

Barb called in my Lovenox prescription, so I start that tonight.

She said I will go in on *Tuesday* for the repeat test.  I assumed it would be Monday.

On Tuesday, anything over 1650ish will be good (doubling fast enough = 72 hours).  Over 4000 would be closer to our previous doubling time (about 35 hours).  Generally, the doubling times decrease as the numbers get bigger, though, so I think it will be 3000-4000.  Anything close to 6000 and I go right back into panic mode.

Just to save myself having to pull it up again on Tuesday, here's the SMO chart for 13dp5dt:

13dp5dtSINGLETON: 39, 90, 131, 214, 289, 313, 353, 434, 549, 732, 759, 773, 776.4, 876, 918, 921, 942, 1036, 1222, 1248, 1320, 1433, 1578, 1609, 1771, 2218, 2465
TWINS: 375, 411, 607, 708, 777, 878, 970.58, 987, 1244, 1271, 1297, 1320, 1334, 1334, 1340, 1400, 1561, 1597, 1654, 1724, 1729, 1768, 1801, 1944, 2172, 2240, 2564, 2866, 2896, 2984, 3323, 3501, 3507, 3728
TRIPS: 1478
QUINTS: 2470

Send good vibes to the technology gods, so maybe betabase will come back up too.

Live blogging results


N just texted that M is on the phone with Barb.

He will call as soon as he hangs up.

I AM DYING HERE.

M just texted: "Hey N and I are leaving for a bit.  Call you in a while."

I texted: "Shush."  And then my phone rang.

9dp5dt hCG beta = 662.

Barb says she's seen singletons with numbers like that, but I'm saying NO WAY.

I think this is a 2+ guarantee.

Barb says it's "definitely not triplets."

I don't know about that either.  I think triplets are still a real possibility, though I do feel a little less panicky than I did earlier.  Just a *little* though.  If you look at that SMO list, we're still at the tip-top of the range for twins and we smashed the range for triplets. 

Our result is 220% what it was last time.  The question remains-- round up or round down??  2 or 3?  We're all banking on two right now.  We'll see what Monday's repeat looks like and settle in for the loooooong two week wait for the ultrasound.



My fate

... Is behind that door. Waiting to be called back for my blood draw.

(cue dramatic music)

 
Edited at 11:20:
 
I'm not sure why I didn't learn my lesson last time around, but the wait for lab results is KILLING ME.  Well over 3 hours now-- doesn't that qualify as STAT?  The previous hold up was because the fax didn't go through.  I'd always blamed it on Houston IVF's fax machine, but maybe it's CPL?  I wrote M's fax on the order this time.  I really thought we'd know by now.
 
Does it just take a long time to count that high?
 
I need answers!
 
Edited at 12:00:
 
M asked me to call the lab.  I did.
 
Simi: "I was just calling to see whether my lab results had been faxed to my doctor's office yet?"
Lab: "What's your name?"  [I told her]  "Oh yeah!  I thought it was so strange that they marked it STAT, because it has to go out to Utah."
Simi: "What?  Utah?"
Lab: "Yeah, quant hCG, right?  It has to be flown to Utah."
Simi: "I think that must be wrong.  I've had this lab done a bunch of times and it was always run here."
Lab: "Hmm.  Well, maybe I read the computer screen wrong.  You can call the main lab and ask."
 
So I called the main lab and told them my doctor hadn't received the fax yet.  They confirmed that they actually just entered the order in the system and results would be ready in about an hour. 
 
Simi: "So it doesn't have to go to Utah?  That's what the local lab told me."
Main Lab: "What?  Utah?  No, we run that in-house."
Simi: "Well, that's what I thought, but I had to make sure." [and then we both laughed, a lot.]
 
Now I chill out until 1:00, at which point I will re-engage the obsessively-watching-the-phone part of my brain.
 
By the way, here's the test I took about 15 minutes after my blood test this morning:

 
Edited at 1:30:
 
Yeah, still no call.  Still no fax.  This is doing wonders for my productivity, let me tell ya.
 
Also no bueno: betabase.info is down, so when we do get results, I don't have my handy dandy reference ranges.  I always feared this day would come.
 
But I did look up the SMO "Master Beta Break Down List," which tells me the following:
 
9dp5dtSINGLETON: 8.4, 21, 39, 40, 48, 50, 51, 52, 55, 57, 60, 60, 68.9, 73, 77, 90, 90, 92, 93, 94, 96, 97, 99, 99, 115, 118, 120.5, 122, 124, 128, 133, 133, 137, 137, 141, 146, 147, 150, 151, 153, 156, 160, 199, 203, 210, 262, 285, 302 (this was me last time), 308, 345, 348, 360, 477
TWINS: 79, 119, 120, 127, 141, 147, 149, 160, 173, 180, 185, 187.51, 194, 197, 199, 200, 224, 234, 242, 243, 245, 248, 254, 255.3, 260, 274, 275, 290, 300.8, 306, 309, 320, 323, 329, 334, 340, 347, 350, 354, 363, 374, 379, 419, 432, 448, 496.3, 753
TRIPS: 89.5, 110, 123, 254, 289, 345, 374, 514
 
I think our number will be HIGH, just no telling how high.  We shall see.  SOMEDAY.
 
Patience is a virtue, patience is a virtue...

Wednesday, March 13, 2013

I got bored

7dp5dt.


 
Compared to 9dp/12dp last time:
 

I'm thinking today's is about the same as 9dp last time-- maybe a smidgen darker, though that test was taken in the morning, so it's actually more like 8.75dp5dt.

So let's say, just for kicks, that my hCG level this morning was the same as it was on 9dp5dt last time = about 300.  And let's say I have the same doubling time that I had between the two test last time, which was about 35 hours.  That would put us at about 775 on Friday and maybe 3000+ on Monday.

Holy moly.  That is squarely in my panic range.  ALERT! ALERT!

In other news, I figure there's a possibility that Texas Fertility will be closed on Good Friday, which would put our first ultrasound on 4/1, April Fool's Day, instead.  Now wouldn't that be a hoot...

Monday, March 11, 2013

More tests

Well, 12 hours after that first* faint BFP, I got the glaring one on the left below:

 
The other tests lined up on the right are from the last time around (ok, I may have been hoarding them).  I took this picture to show M and N how much DARKER the line is this time.  It's darker than it was last time two days later!
 
I starred "first" up there because Andie is sure she can see something on the 3dp5dt test as well.  Maybe so, but I never would have called it a line, because it's really more of an indication of where the line should be.  Impossible to describe.  Anyway, first BFP was either on 3.5dp5dt or 3dp5dt, depending who you talk to.

Here is today's test (and my messy desk in the background)-- 5dp5dt:

 
Twice as dark as yesterday's test.
 
Unbelievably enough, I think I'm done testing.  There's just no suspense in it!  I'll take another one Friday morning, just because I like to see how the line compares to the beta.  So maybe another on Monday for the repeat too, just for the same reason.  I'll keep the rest to send out to my friends/clients.
 
I will be shocked if our beta is less than 500 on Friday.  I'm expecting 900.  I keep doing triplet research.  Better to be prepared...


Sunday, March 10, 2013

3.5dp5dt = BFP

More accurately, just barely positive and only if you have good vision and an imagination.





Saturday, March 9, 2013

3dp5dt

Not yet! I tested at 2dp, 2.5dp, and 3dp. No lines yet. Not for lack of looking either- I've held those suckers at every angle in every light imaginable. Sometimes I convince myself that I can see where the line is supposed to go, but there's really not even a ghost of one yet.

I will test again in the middle of the night tonight (3.5dp) and then tomorrow at lunch (4dp). 4dp5dt is when I got my positive last time, so I do expect tomorrow's test to be positive.

Testing has not been nerve-wracking in the slightest thus far. I have a calm confidence and trust that everything is going to work out. The only reason I'm testing so often is because I have this silly obsession with catching the very first possible BFP (big fat positive). Once I get one, no more middle of the night testing- that's just silly.

Unrelated: I took out the ear needles. Ah. They were getting annoying- especially sleeping on my side. Needle-free, until I start Lovenox.

Friday, March 8, 2013

Into the freezer!

M just called and said he had good news and scary news.  Of course I knew what that meant.  "It's the same news, isn't it?"  It was.

They had one embryo to freeze!  4AB.  Pretty darned good.

And the scary side to that: it was the same stage as our two "runts" yesterday.  Eeeeeeeeek.

Still telling those little embryos to grow as much as they want to and trusting that it will work out the way it's supposed to.

2dp5dt

I have an OSOM in my purse and I'm going to test this afternoon when I get to a "true" 2 days past 5 day transfer.  It should be negative, but heck-- I have 25 tests and I ain't afraid to use them.

Oh, here's a fun new numbers game.  Working backwards from my beta last time.

Assuming a 24 hour doubling time first:

9dp 300
8dp 150
7dp 75 
6dp 38 
5dp 19 
4dp 10
3dp 5
2dp 2

Or how about by betas from Leo's pregnancy, when there were twins:

10dp 1400
9dp 700
8dp 350
7dp 175
6dp 85
5dp 42
4dp 21
3dp 10
2dp 5

So yeah.  Today's test will be negative.  Should I even bother?

Answer: yes.  In the name of science!  I need a baseline.

Wednesday, March 6, 2013

Transfer Day

Oh, how incredibly frustrating.  I typed out the full (long) version of our transfer day experience and my computer froze and lost it all.  I'd really hoped blogger auto-saved it.  No such luck.

Do I have it in me to write it again?  Let's see.

On Monday, when we got the fantastic Day 3 report, Barb emailed me: "We’ll still take about #’s   but right NOW DR H is thinking transfer of 2 …..unless there is an issue we are not anticipating –then he MAY consider a transfer of 3 embryos .  Have to see what transpires." 

M and I talked about it very briefly and agreed that, assuming there were at least two blastocysts on Day 5, we would not transfer more than 2.  Dr. Hickman had earlier told M and N that he had never recommended three embryos be transferred to a surrogate.  Well, turns out there's a first time for everything.

On our way to Houston yesterday morning, I got a text from M.  "Barb says Hickman wants to transfer 3 because we have 1 stage 2 blast and 4 morulas.  The morulas are sort of where we were last time, so he thinks three would be best.  He says as long as everyone is ok that is what he wants to do.  Just wanted to let you know beforehand so you could think of questions or whatnot.  Talk to you soon."

Holy moly.  Big decision.  I went into this match preferring a single embryo transfer (SET), had agreed to transfer two, and now was being asked to do three?  Yikes.  I do know Dr. Hickman is very conservative and doesn't stray outside the guidelines-- but now he was.  I texted Gayle who said she'd never known him to recommend three, and that with just one blast, she would do it.  She said if Dr. Hickman recommended it, there was a reason. 

Rick and I talked through a bunch of different scenarios.  This was not a decision I considered lightly.  I counsel clients against allowing for a 3-embryo transfer all the time-- I suggest limiting it to two in every contract.  And I believe in that too.  3 is a risk.  3 can become triplets.  Triplets = difficult pregnancies, premature babies, and possibly selective reduction.

Ultimately, I decided that with M and N's explicit agreement that they would support a difficult triplet pregnancy, should it occur, and that they would parent potentially premature triplets, should that occur, I would agree to transfer three.  The stage 2 blast (reminder: developmental scale is 1-6, 3+ ideal to transfer, 6 is fully hatched) and 2 morulas.  To be honest, I was still uneasy about the decision, and felt like a pretty big hypocrit.  But I put my faith and trust in Dr. Hickman's judgment.

When we got to the clinic, I went straight back for labwork.  Just one vial of blood, but she really got me-- my arm is red and beat-up-looking today.  Later on, I found out both estrogen and progesterone levels looked good.  No shots for now!

Then, I was supposed to be taken to acupuncture, but somehow got whisked back to pre-op instead.  And then I sat around for a long time doing nothing (alone at first, but then I asked them to go get Rick).  Here I am waiting (and looking a little anxious about 3, I think!):


Eventually they realized that I was supposed to be getting acupuncture (about 20 minutes past my appointment) and the acupuncturist popped in and got me needled up.  In the meantime, M had arrived and Rick went out to the lobby to meet him (N has a cold and stayed away this time).  Barb met them both out there, and talked through the information about the embryos and the risks and benefits of transferring three.

After the needles were out, the nurse told me they'd be back in a minute so I could sign consents.  I figured I would be looped in on the conversation Barb and the guys had, but nope.  The nurse popped in with a clipboard, said "You're transferring three.  Looks like they're good quality.  Sign here."  I flipped through the chart to see the embryo report too see what quality she was talking about.  It was what I already knew-- 1 stage 2 embryo, 4 morulas.  I still had some misgivings.  But I took a breath and signed.

Then Rick and I moved over to the procedure room, which had my name plastered on the door (we're in the right place!).  They made me say my name and how many we were transferring.  Then they checked out my bladder to be sure it was full.  I had 60+ ounces of water, so it darn well should have been.  It was.


M showed up.  The put him and Rick at my left shoulder, close to the table.  There needed to be enough room to wheel in the embryos in their incubator.


The embryos and Dr. Hickman all arrived at about the same time.  He started getting things prepared and reviewed that we were transferring three.  M asked something about why he'd recommended three and Dr. Hickman flipped through the chart and said it was based on embryo quality and our history.  As he was talking, he was having me scooch down on the table, placing the speculum, and getting the outer catheter ready for embryo transfer.

Then the nurse with the embryos piped up "I have an updated condition on the embryos!  4AA and two Stage 1 blastocysts."

Wait.  What?

Three blastocysts was never the plan.  What was going on?

M, Rick, and I were all shellshocked.  "Wait-- is it still your recommendation that we transfer all three?" asked M.  Dr. Hickman said it was.  Rick asked "What's the probability of triplets?"  "Miniscule," replied Dr. Hickman.  Rick pressed him to give us numbers.  "Standing here today, I'd say 1%.  If you get pregnant, 2-5%."

Had this conversation happened any sooner in the day-- or had I been asked to sign a consent at this point-- I would have stopped the train.  No.  Two blastocycsts was our agreement.  Two.  I only agreed to three because of quality issues.  Now we had one perfect embryo (you can't really ask for better than 4AA) and two slow-going blasts.

But it didn't.  It happened on the table, minutes before transfer.  And for better or for worse, I stayed silent and we all just went with it.  I took M's hand and said "Ok, let's do this," with a somewhat shaky voice.  And I laid back and let it happen.  I do have regrets.  I should have spoken up.  And I knew M was deferring to my judgment, so the decision really was mine.  What's done is done.

After more jostling around than I remember from my first two transfers, we got going on the embryo transfer.  The tube was inserted in the catheter through my cervix.  They loaded up the embryos and then they were pushed into my uterus, as indicated on the ultrasound by two white spots that were air bubbles loaded before and after the embryos.  Two little bursts of light, representing three potential new lives.



Here are the embryos, from a report at 9:11 that morning (not sure if that's when the pictures were taken, or just when they uploaded them to the report).  Most developed on the left, then the two stragglers.


After the transfer, I had to lay on the table for 15 minutes.  The acupuncturist gave me the option of placing needles right then or waiting until I had the chance to get up and pee-- I took option B, because I wanted to be able to relax and my bladder was not going to be able to do that!  So I ended up going back to pre-op for my treatment, and got to enjoy the Muzak song stylings back there.  Just like last time, she left me with two ear needles in each ear, to be removed on Saturday.
 
After transfer, like last time, we went to lunch at Pappadeaux.  Like last time, I ordered ginger salmon (post-transfer ritual, I guess).  We had lots of laughs and shared lots of nervous what-if scenarios.  I do have every confidence that if we do end up with three, M and N will rise to the occasion more than anyone else could.  It will be really, really, really hard.  But we will get through it.  If we have to.
 
We all agreed that for now, we'll stop panicking.  There's really no use worrying until we get beta results at the very earliest.  Our 9dp5dt beta last time was 302, so if it's 700+ this time, I reserve the right to flip out again. 
 
After hugs goodbye, Rick and I had an easy drive home-- all 5 (deep breaths, deep breaths) of us arrived safely.  I spent the rest of the evening lounging and gestating.  Watched "Best of Show" again, which always makes me laugh.
 
I believe in the importance of positive thinking.  I do very much hope that each embryo grows and develops the way it's supposed to and I'm sending those good intentions to them.  We can work out the details later.  For now, snuggle in, little ones.  Follow those mysterious, magical, genetic blueprints and see where they take you.  I'm trusting all of us have a safe and happy journey.
 
The short of it: I'm not really happy with the decision I/we made, and given ideal circumstances, I wouldn't have gone this way.  But we're here now and everything will work out as it should.
 
And be proud of me.  Here I sit at 1dp5dt with no urge to test.  LOL.  I've decided to take the first one Saturday afternoon, at exactly 3dp5dt, which should still be too early for a BFP.  I do think I'll see one on Sunday, though!

Monday, March 4, 2013

Oh, hello meds.

I am sitting at my desk, completely exhausted. Thank you, progesterone overload.

I was also starving by 10:30 this morning.

At least I feel confident that everything is working like it should!

Fantastic news!

YES!

Barb emailed me and told me transfer would be on Wednesday.  Of course, that wasn't good enough for me!  I need details!

FINALLY (lol), M called.  Everything looks great!

Of the 6 that fertilized, we have:

1 x 10-cell, 4- quality
2 x 8-cell, 4 quality
2 x 8-cell, 4- quality
1 x 5-cell, 3+ quality

8-cell is where they are expected to be at this stage and 4 is the best quality, so these are pretty fan-flippin'-tastic results.  Any anxiety I was feeling is gone.  Ahhhhh.

I feel like those 2 8-cell, quality 4 embryos are going to go the distance.  Come on, guys-- you've got this!  And that doesn't let the others off the hook.  Bundle up, little ones, because 2 or 3 of you are going in the freezer.

So, transfer is Wednesday at 12:30.  I have to be there by at least 12 for bloodwork, but really I need to wait and see when the acunpuncture appointment is-- I'm guessing I'll need to be there by 11:30, maybe.

Rick is going with me-- this will be his first time.  But as I keep saying, my two best pregnancies were the ones where he was there when I got pregnant, so this has to be a good luck charm!

Can't wait.  Good times are around the corner.

Waiting

What a terrible subject line.  Only because that could be the subject of every surrogacy blog post ever.

Today, I'm waiting for the Day 3 call.  Do I drop everything and drive to Houston for a 12:30 transfer?  Or do we have a bunch of happy embryos growing, so we wait until Wednesday?

(Chanting: Wednesday, Wednesday!)

Probably another hour to wait.  Guess I'll get some work done in the meantime.

Sunday, March 3, 2013

Bedtime snack

Transfer pineapple!

Also, a million pills.

Anxious to see what tomorrow brings. Grow, embryos, grow!



Saturday, March 2, 2013

Fertility report

M texted and called me with the fertility report this morning at about 10:30. Haven't had the chance to talk with him yet, because I was on the road to Houston (and driving someone else).

Anyway, results are:

18 retrieved
13 mature
6 fertilized

Looking back on my predictions, you'll see that's not quite as high as I'd hoped. Actually, it puts us right on track with the last cycle.

So hopefully on Monday there are still 4 or more embryos growing. I'm a little more nervous now, just because I feel like there's less of a cushion, if that makes sense.

Definitely still staying positive and I feel good about the cycle. Not sure I want to place my bets on having embryos left to freeze anymore, but I do still think we will have two pretty ones to transfer.

Friday, March 1, 2013

Retrieval

Egg retrieval was this morning.  M texted me at about 9 to say they had a preliminary count of 13.  I didn't realize that they did that last time too-- preliminary count of 9, and then they looked under the microscope and found 13 total.  Well, this time when they did the final count they found (drumroll) 18!  Sperm count was also super-high at 140 mil, so WOOHOO!  Can't ask for better than that.

13 is our lucky number, so I'll revise the mature egg guess to 13.  :)

18 retrieved
13 mature
9 fertilized
7 Day 3
5 Day 5 - transfer 2
2 to freeze on Day 6

Making cycle predictions is my new favorite pasttime.

M seems to think they may not call with the fertility report tomorrow, but they'd better!  Last time, I updated the blog at 11:00 am with the fertility report, so I'll start looking for it about then.  I'll actually be in the car headed towards Houston at that time.  There's a surrogacy get-together in Sugar Land sponsored by an agency I've never worked with, so it's time to do some networking!

They have our transfer tentatively scheduled for Monday at 12:30, but I feel pretty confident Barb will call that morning to cancel.  Again, looking back at the blog, it looks like she called at about 10 last time.  I hope it's not later than that, because if I need to get to Houston, I'd need to get on the road!