It’s been a long time since I updated the blog, which I suppose should be a good thing, because it means that my pregnancy has been relatively uneventful. There was a scare at our NT scan at 11 weeks (a thicker NT on Baby B), but after some more extensive testing, it turns out that everything should be okay. There’s still a slim chance of a heart problem or a rare chromosomal abnormality (like 3%), but we wouldn’t know about that until the 20 week scan. According to the tech, everything except the NT on Baby B looked great.

As for pregnancy itself, I have periods when I feel LARGE. And I don’t been a cute baby bump or anything like that, but just very large all around. I was in the plane the other day and it just felt odd to be so uncomfortable in a seat that size since I usually have ample room. I’m missing my lithe form, I suppose. I have a pounding heartbeat in my ears almost ALL the time, obviously from increased blood volume for the babes, but it makes me feel…very out of shape. I am also covered in pimples down my back (sorry for TMI), which makes me feel even more gross, if that were possible.

So, anyway, just hanging tight until our next appointment and praying daily that everything is okay with these babies and the many people I know who are pregnant right now.  I would love being pregnant if not for the incessant, 24/7, pounding worrying. The other day I used an in-home doppler and I wasn’t sure if I found a second heartbeat or if I just kept capturing the one baby. I also *might* be feeling fetal movements. I know it’s early, but I’m definitely feeling more uterine activity (pulling, mild cramping, flutters, etc.) which is reassuring, and probably explains why I’m finally showing.

Both beans were alive and well at my ultrasound yesterday. Phew! Baby A is measuring at 9w4d and Baby B at 9w0d. The nurse told me this was nothing to worry about unless Baby B falls a week behind. I assumed she meant a week behind Baby A, but she meant a week behind the gestational age.  The RE’s office was…well…the only word would be jubilant. They said that most chromosomal abnormalities surface in weeks 7-9, and that the likelihood of miscarriage was now very, very low.  It made me feel guilty for still harboring this deep and abiding worry about carrying the babes to term. Baby B had moved down a bit (and deeper behind the pelvic bone, apparently) and I worried that this was because s/he was trying to avoid the scarring in the upper part of the uterus.  The ultrasound tech (who seems very knowledgable based on my exchanges and the glowing recommendation of my RE) said that the dark spot by Baby B looked a little larger now, but it was likely just because Baby B had moved and exposed more of it. She thought it definitely was NOT a subchorionic hemorrhage but just the empty sac of a vanishing triplet. My ovaries have shrunk from 600ml to about 100ml…not sure what’s normal…definitely not 100ml, but they lifted my activity restriction, so for the first time in about 6 months I can return to some form of activity. Nonetheless, I think I’ll wait until after the first trimester.

I have my first appointment with my OB next week. I assumed I’d be able to have blood drawn for the MaterniT21 test at that point, but apparently I’d be paying out of pocket for it since I’m not “high risk” for chromosomal abnormalities. The genetic counselor said the default likelihood for genetic abnormalities with twins at my age is 1:400, which is higher than I’d like it to be, of course, but isn’t really all that high considering it’s a chance of like 0.2% or something along those lines. If I were told I had a 0.2% chance of cancer, I’d continue on my merry way, but somehow when those statistics are applied to my babes, I want them at 0.000000001%. Anyway, I’ll be doing a first trimester screening a week after my first OB appointment, so I’m not sure what the first OB appointment will even cover. I guess just weighing me and talking about nutrition and the C-section and what to expect in the coming months.

As my NP left the room, I kind of effusively thanked her and the other people involved in my care in their office. I REALLY loved them, and I don’t think it’s just because they got me pregnant so quickly. I’ve been active on the Fertile Thoughts forum, so I’ve seen the treatment that different ladies have gotten with their REs and NPs and nurses and this office is WORLD’S better. Night and day. They actually let me dictate my protocols to some extent…they were knowledgable about a relatively uncommon disorder…they gave me hope but were also realistic with me. Plus I’ll never forget the NP who went against a second RE’s orders (when mine was out of town) and allowed me to trigger…and thus fall pregnant. Seriously, Angie, these two hearts are beating because of you!!! Anyway, after this effusive thanks, the NP kind of paused at the door and said that these two babes were here because of ME — because of my lifestyle changes and my ability to be my own advocate. It was very sweet of her to return a sense of agency to me in this whole process, and again reinforced why I love that clinic so much.

I’m at 9w1d now. I had a panic attack last week when my symptoms suddenly subsided. The all-day nausea was suddenly gone, my boobs didn’t feel as large or tender, and my bloated belly seemed to be going down.  I tried to rationalize to myself that this was likely a result of the placenta beginning to take over the hormone production, but at 8 weeks it seemed a little early for such activity. ANYWAY, about three days later the nausea returned at full force…I spent Friday night dry heaving in the bathroom and basically just laying around miserable in bed.  I’m still exhausted, but it might be because my sleep schedule is completely disrupted. In any case, I have my 9 week ultrasound tomorrow, so I will be SUPER relieved to see that everything is still okay. I still feel the throbbing of blood around my uterus, so I feel like this has to be a good sign, and I haven’t had any spotting or cramping, thank God. Nonetheless, I worry. If I had a choice in the matter, I’d just go to bed now and sleep until my appointment tomorrow morning because I feel as if the day is crawling by.  Otherwise not much new to report, symptom-wise. I have some sort of eczema outbreak on my palms, and my skin starting breaking out again a few days ago, and the bloat has returned. I definitely feel as if I’ve gained quite a bit of weight, but then I’ve been trying my damnedest to do so since I read that twin moms should gain 25 lbs in the first trimester.  Now I’m wishing again that the nausea would dissipate, even though I was begging for it just last week.

I figured I should document some of my symptoms for future reference. The nausea was BAD today. I still haven’t thrown up, but I’d prefer it if I would. I woke up last night around 3 a.m. and just waited to puke…then thought I might be hungry so had a spoonful of almond butter and avocado…then felt worse and rushed out for some vitamin B6 and Zantac around 6 a.m. These didn’t help, of course. I also got some coconut water in the hopes that this will stave off some of the OHSS symptoms I’ve  been experiencing. I just can’t do the Gatorade. I’ve spent the day trying to pull myself together enough to focus on work.

Besides the nausea, the only real symptoms I have are severe bloat and shortness of breath, but I think those are OHSS related.

I also keep pulling up the picture of the u/s on my phone, both to reassure me about Baby A and to try and decipher if the small spots near Baby B are a subchorionic hemorrhage or a vanishing triplet or (scary thought!) a hiding triplet. It kind of looks like a vanishing triplet with a SCH because the dark spot closest to Baby B isn’t cloudy, as most u/s pics of SCHs are.  The second spot behind is cloudy, however, which could either be the SCH of Baby C or a fetal pole of Baby C. Anyway, it is what it is, so speculation won’t help.

I was a nervous wreck before my first ultrasound. I really didn’t think I would be quite so bad, but I woke up around 3 a.m. and just ended up tossing and turning in bed until I could finally start getting reading at 7:00 for my 8:20 ultrasound. The hubs was actually able to join me for the first part…I really wanted him there to comfort me in case anything went wrong…and we spent about 15 minutes in the waiting room, which is the longest I’d ever spent waiting there before. We didn’t really want to make chit chart or sit with somber faces, so we basically just fiddled on our phones. ANYWAY, there is obviously no reason to detail this minutia, but I suppose I’m still processing all of this. Fortunately the ultrasound tech positioned the screen towards us, so I could immediately see two gestational sacs in the uterus. I was beyond thrilled that the pregnancy was intrauterine but also pretty nervous about twins. Both babies had a heartbeat: 118bpm and 121 bpm, which the RE told us was right on track. They were 6.3mm and 5.9mm, also both on track (they should be 5-7mm at a 6wk scan). I think Baby B was in the 91 percentile for size and Baby A was in the 75% percentile. All of this was a HUGE relief to us. I think my husband and I are still processing all of this information, though. I had a pretty strong hunch that there were twins because I felt two sharp implantation pains on different days, but nonetheless it is sobering to have it on a screen in front of you in black and white.

Now for the not so good news. My ovaries were enormous. I wish I’d written down the measurements they’d taken. Basically, they were pretty certain that I had OHSS. I’d had blood drawn several days ago and everything was in the normal range, but they wanted the tests run again. There wasn’t any fluid in the abdomen, but my ovaries were so enlarged that the left one had kind of migrated upwards or something and had to be seen on a transabdominal ultrasound. The blood test results came back and everything is still normal…pretty much the same as before, maybe slightly better. They’ve told me to avoid activity, which isn’t hard because I have zero desire to do anything with this nausea and bloat. The main risk is that ovarian torsion would cut off blood supply to the uterus, but they said I should be aware right away if I experience this because the pain will be unbearable.

The other piece of not so good news is that there were two dark spots next to Baby B (the slightly stronger of the two). The RE thought this could be gestational sacs that stopped developing or a subchorionic hemorrhage or the hiding sac of Baby C.

I’m going back in a week to monitor the ovaries and make sure that those two dark spots are decreasing–although the dark spots seemed like a secondary concern to the enlarged ovaries.

All in all, I’m feeling blessed.

I’m at 6w1d and already the nausea has set in. The worst of it was probably two days ago…I spent nearly the entire day in a haze of queasy uneasiness. Now it seems to be coming and going, and I can’t detect a pattern. Sometimes it’s when I’m full, sometimes it’s when I’m hungry, sometimes it’s when I’m presumably neither. So the past three days I’ve padded down to the fridge, opened it, scanned each item, been disgusted in turn, and closed the fridge. I just couldn’t stomach the idea of eating anything even though my tummy was rumbling. So at 3pm yesterday, after eating nothing but a slice of toast in the morning with some jam, I decided enough was enough and I ventured to the store. I got a gallon of ice cream, some crackers, and some full-fat cottage cheese. I’m not sure why these are the only things I seem capable of eating. When I planned my pregnancy, I imagined that I would become even more OCD about my diet, with a perfect ratio of carbs, healthy fats, and protein. I never, in a million years, thought I’d be succumbing to ice cream and crackers in the sixth week But, as I rationalize it to myself, ice cream and crackers have to be better than nothing, right? It was SUCH a relief to be able to eat something yesterday.

But, more than this guilty feeling, my thoughts have been preoccupied with the purpose of all of this nausea. I know it’s created by the climbing hormone levels — most likely the increasing hCG. Perhaps the embryo needs the carbs and simple sugars and thus makes everything else unappetizing. Or perhaps the nausea ensures that mama isn’t expending unnecessary energy in other tasks. Or perhaps the nausea forces mama to sleep more. It just seems counterintuitive to me that the nausea typically indicates a healthy pregnancy.

I have my ultrasound tomorrow and I’m trying not to think about it too much. At this time tomorrow, I’ll have my feet in stirrups and my day shattered or made.

From “Early Maternal Serum B-human Chorionic Gonadotropin Measurements After ICSI in the Predction of Long-term Pregnancy Outcomes: A Retrospective Cohort Analysis.” Mamdoh A. Eskandar,^a,d Mesfer Al-Shahrani,^a Ayman Shaamash,^a Mohamed El-Emain,^b Mutaz Al-Ahmad,^c and Beverly Payodon^c

[…]

Measuring quantitative serum β-hCG has been used for predicting pregnancy outcome since the 1960s. Zegers-Hochschield et al [13] compared early hCG levels in patients who conceived naturally or through assisted reproduction and noted that the former had significantly higher hCG levels. Additionally, Confino et al [4] noted that the patients with poor outcomes (for example, miscarriage) had statistically lower hCG levels than normal pregnancies. Indirectly this may relate to a higher incidence of poor outcomes in ICSI pregnancies compared with naturally conceived pregnancies.

The predictive value of a single early β-hCG measurement on early pregnancy outcome has been studied by previous investigators [3-13]. Fridstrom et al [20] demonstrated that a day 14 post-ET β-hCG level of more than 150 IU/L had a 79% sensitivity and 78% specificity in distinguishing between viable and pathological pregnancies. Similarly, Bjercke et al [21] noted that pregnancies with a β-hCG level of more than 55 IU/L on day 12 had a 90% probability of reaching the stage of an ongoing pregnancy.

The results of this study demonstrate further support for the findings by previous investigators, and additionally, provide evidence of a correlation between early β-hCG levels and the probability of a positive pregnancy outcome. This may suggest that fetuses with higher initial production of β-hCG are more biologically competent and therefore more likely to reach the stage of delivery

In conclusion, in the current study we found that, in ICSI pregnancies, a single early β-hCG may help to identify pregnancies that will reach full-term and delivery. These results may help to reassure patients and help to identify high-risk pregnancies early on.

Yesterday marked 3 weeks since ovulation, so I guess I’m 5 weeks along in my pregnancy at this point. My first ultrasound is next Tuesday (6w2d) and I alternate between feelings of terror and hopefulness that everything will be okay. On the side of “things being okay” is the fact that I took a Clearblue digital test with the weeks estimator and it ticked over to “3+ weeks” yesterday, right on time. I’ve also been periodically taking FRERs and they’re consistently getting darker. My betas were strong and had a 38 hour doubling time, which I’ve been told is excellent. I’ve combed through multiple extensive and reliable research studies and found that my beta levels were off the charts, predicting a nearly 99% chance of live pregnancy.

On the side of things not being okay is the fact that I might have multiples, which would throw off the beta levels. Alongside studies on beta hCG levels I’ve also been reading studies about Asherman’s Syndrome (scarring in the uterus), which is freaking me the fuck out. I thought it might help to write out some of my fears here. First, most anecdotal stories online of women with Asherman’s are NOT reassuring. They are, without fail, the most heart-wrenching of heart-wrenching infertility tales. These women try for years to conceive, then suffer recurrent early and late miscarriages, then have multiple surgeries to try and correct the scarring, then realize they only have more scarring from the surgeries, then see an Asherman’s expert who is able to remove scarring after several surgeries, then maybe get pregnant and maybe carry a baby to term, but more often than not end up painfully accepting that they will not have biological children or doling out inordinate sums for IVF and a surrogate. The irrational side of my mind is just seizing with the possibility that this unending sadness and pain is in store for me.

Rationally, I need to remind myself that (1) the people who’ve suffered through the worst-case outcomes gravitate to blogs and online forums, as a way of dealing with the emotional trauma they’ve experienced, (2) studies of Asherman’s are unreliable because most don’t offer clear gradings (Mild, Moderate, Severe), and the amount of scarring in the uterus is crucial to the outcome, (3) almost all studies focus only on women carrying to term who’ve had their scarring removed, which means they’ve already come in for treatment because they’ve had difficulty conceiving or carrying a child, which means that their endometrium or tubes were likely damaged to the extent that conception without infertility treatments was not possible. I guess I’ll never know if was the HA or Asherman’s, but the fact that my HA treatment immediately got me pregnant makes me think that my lining was not a hindrance to my fertility. In fact, my lining was 8mm with 15mm follicles, exactly where it should be, and it has surely grown thicker as the follicles grew and as my progesterone continues to increase, so it’s likely that my mild scarring is deeply buried behind a thick endometrium at this point. PLUS, the scarring is in less than 1/3 of my uterus. Someone on an Asherman support site with scarring in 20% of her uterus fundus (the same location as mine) mentioned that two different experts refused to do surgery on her because they “don’t do surgery just for the hell of it.” To me, this means that they don’t think the possible risks of surgery are worth the risks of carrying a fetus with 20% scarring. I’m fairly certain that my AS is “mild” since it’s in less than 1/3 of the uterus and my RE described it as “filmy” (as opposed to thick bands, as you’d see in the “moderate” or “severe” category). I suppose this also means that there’s at least a 67% chance that the implantation wasn’t near the scar tissue, and perhaps this percentage is even higher considering that the high early betas imply a strong and early implantation.

Nonetheless, I am a complete bundle of nerves, and I’m not sure how I’m going to make it to next Tuesday. I’ve been running through the possible outcomes of this scan: (1) a robust singleton implanted on my left side, (2) robust twins implanted, one on left and one low, (3) singleton or twins, with implantation near the scar tissue, (4) a heterotopic pregnancy, with a viable pregnancy in the uterus and one in my bad tube, (5) no heartbeat…the embryo(s) just stopped developing, (6) ectopic pregnancy (or pregnancies) with no intrauterine pregnancy, (7) a molar pregnancy. There are other possibilities, of course, but these seem the most likely.

Honestly, I don’t know how some women do this with so little worry. I don’t know if this is just a character flaw or a product of infertility treatments or if everyone worries this way and just doesn’t talk about it

I had beta #2 on Monday (three days ago),rushing in first thing at 7 a.m. in the hopes of getting results that morning. I was on pins and needles afterwards and couldn’t really concentrate on anything. I even put off beginning several work projects because I knew if bad news came in I wouldn’t be able to pull myself together to complete them. ANYWAY, beta #2 was great!! It was 867 (at 15dpo in the morning) and it had been 263 (at 12dpo in the afternoon). So it had more than tripled in 72 hours. I had been scheduled for another beta on Thursday, but the RE was so happy with the results that she told me not to come in until my first ultrasound at 6 weeks, which will be about two weeks from today. I was sooooo relieved. In addition, the brown spotting that showed up around when I should’ve gotten my period is now gone.

I probably shouldn’t have been researching hCG levels, but I did end up spending an afternoon on PubMed just to try and be realistic about various risks (ectopic, multiples, placenta previa, and placenta accreta). I came across this research, from a study of hCG levels at 16dpo: “Low hCG levels between 25 and 50 IU/L are associated with a low probability of ongoing pregnancy (<35%), whereas levels of >500 IU/L predict a >95% chance of ongoing pregnancy.” My levels at 15dpo, 867, already placed me in that 95% category!!! I’m assuming my levels at 16dpo were at least 1,052, which means that even if I’ve got two fetuses to account for, my levels would be over 500 per fetus at 16dpo. I mean, I’m not sure if that’s how it works, but such numbers are reassuring to me.

The latest saga: I was talking to a friend with HA who just had her first child a few weeks ago and suffered from OHSS (Ovarian Hyperstimulation Syndrome) throughout her first trimester after using Menopur. I mentioned a few symptoms I’ve been experiencing (severe bloat, shortness of breath, and tummy tenderness) and she thought it sounded pretty similar to her experience with OHSS. So I called the nurse yesterday (I’m sure they’re convinced that I’m a nervous nelly at this point) and she said that the shortness of breath was a common complaint in pregnant women, even during the first 4 weeks. She said it was a good sign that my body was working in overdrive for baby. Nonetheless, she wanted me to come in for some blood tests just to make sure that I don’t have late-onset OHSS. As far as I can tell, the test results were normal, although almost all results were on the high end of the “standard” range. My BUN (blood urea nitrogen) was a little elevated, which could indicate some issues with my kidney/liver (which would point to OHSS), but a doctor friend reassured me that the BUN is often elevated and it needs to be interpreted alongside the Creatinine level (which was fine). So now I’m just waiting for a call from the nurse to see if I have to come in (yet again) for another test or ultrasound.