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.