Later that night, after the ultrasound was done, after the discussions of costs at daycare were done, after Zachary was picked up, fed, bathed and sent to bed, Mike and I sat in semi-shock. It was weird to think that I was pregnant after so long trying. It was hard to fathom that I had two babies growing inside me.
We fell asleep and at 2 a.m. I woke up, terrified. I realized we were having two babies. Two babies at one time. What would we do???? How could we afford this? What would this do to Zachary? A sudden bout of nausea overcame me and I ended up in the bathroom throwing up every little thing I had for dinner. Mike joined me in the bathroom and asked me if I was beginning morning sickness. I replied, through tears, "No, we're having twins!!!!!!"
For weeks after, I became sullen and angry as I tried my very hardest not to resent my pregnancy. I felt like we had ruined our chances at having a normal life. Things began to change so fast. Mike is lucky enough to work for a company with multiple shifts and especially lucky to work with a company that respects him and was willing to change his shift so that we would have no daycare costs. I work during the day and he works at night. It is not very fun for us as a married couple, but we'll be saving nearly $3,000 each month in daycare. I was worried about how this would affect Zachary. He is our everything. I know that us having a newborn in the house would reduce the amount of attention he gets, but can you imagine having two newborns? I was worried about everything and I was taking it out on my family.
One day Mike pulled me aside and asked me what was wrong. I couldn't tell him. I felt like the worst person alive. I was questioning whether we made the wrong decision because my decision to pursue fertility treatments was causing such huge changes in our family. He kept at me until I let it all out. I was upset, I was regretting becoming pregnant, I was worried I was going to hate the children I was busy growing. And I was terrified that I was an awful human being for having these feelings. Mike let me know that he had been through all of those feelings himself. That he still had them sometimes. But that we were headed this direction now and the only thing we can do is face it together as a family and know that we are strong enough as a family to handle any and all challenges thrown at us. It was a strange foreshadow to what would come next.
Wednesday, October 22, 2014
The Ultrasound
It seemed to take forever to get from the Beta test to the first ultrasound. Having been seen by the doctor on almost a weekly basis for the past six months, I started to go through withdrawal. Plus, having a history of miscarriage and infertility, that time was spent sitting on pins and needles waiting for definitive answers.
The day finally came that we had our dating/heartbeat verification ultrasound. Mike and I drove to the office we'd been so familiar with for so long and saw the doctor who had never lost hope in us. As we walked into the ultrasound room, I remember Mike joking with the doctor, "Just don't tell us it's twins and we'll be fine." The doctor responded, "I really doubt it's twins, you only had one good follicle this time!" We started the ultrasound, holding hands, waiting to see the tiny precious flicker indicating a strong heartbeat. The doctor cleared his throat. "How do you feel about twins?" There, on the screen, sat two tiny jellybeans. Two tiny heartbeats. Two tiny humans growing.
Mike's exact words were "Are you fucking kidding me?" and he dropped my hand. He turned ash white and the nurse later told us she was fairly certain he was about to pass out. I started crying. Not because I was upset (certainly I was surprised!) but because there were heartbeats. We had what looked to be a viable pregnancy.
I was fairly angry at Mike for the way he reacted. All I wanted was to complete our family and he was upset at the very time that we were finding out that we were on the road to doing that. After the ultrasound, they brought us into an office so they could give us the paperwork to complete the transfer from their care back to my regular obstetrician. I yelled at Mike about his inappropriate reactions until the nurse walked in. He kept apologizing but insisting that he was thinking about things like daycare costs and having to buy a bigger vehicle.
The nurse brought in all our paperwork, gave me tips on how to handle pregnancy and we got two teddy bears that showed the world we were leaving the practice successfully. Those bears will be given to the twins when they're born.
The day finally came that we had our dating/heartbeat verification ultrasound. Mike and I drove to the office we'd been so familiar with for so long and saw the doctor who had never lost hope in us. As we walked into the ultrasound room, I remember Mike joking with the doctor, "Just don't tell us it's twins and we'll be fine." The doctor responded, "I really doubt it's twins, you only had one good follicle this time!" We started the ultrasound, holding hands, waiting to see the tiny precious flicker indicating a strong heartbeat. The doctor cleared his throat. "How do you feel about twins?" There, on the screen, sat two tiny jellybeans. Two tiny heartbeats. Two tiny humans growing.
Mike's exact words were "Are you fucking kidding me?" and he dropped my hand. He turned ash white and the nurse later told us she was fairly certain he was about to pass out. I started crying. Not because I was upset (certainly I was surprised!) but because there were heartbeats. We had what looked to be a viable pregnancy.
I was fairly angry at Mike for the way he reacted. All I wanted was to complete our family and he was upset at the very time that we were finding out that we were on the road to doing that. After the ultrasound, they brought us into an office so they could give us the paperwork to complete the transfer from their care back to my regular obstetrician. I yelled at Mike about his inappropriate reactions until the nurse walked in. He kept apologizing but insisting that he was thinking about things like daycare costs and having to buy a bigger vehicle.
The nurse brought in all our paperwork, gave me tips on how to handle pregnancy and we got two teddy bears that showed the world we were leaving the practice successfully. Those bears will be given to the twins when they're born.
Friday, October 10, 2014
Injectables
After finding nothing wrong during surgery, I was pretty depressed about our chances. We met with our doctor again and went over everything we had been through thus far.
One great thing about our doctor was that he was an incredibly nice guy. He is passionate about his chosen field and is very sensitive to the emotions that infertility generates. I cried more than once in his office and always felt very comfortable asking any questions that came up. I have recommended him frequently.
He suggested we move on to add an injectable medication to my cocktail of drugs. We would follow the same schedule we had been - cycle day 3 ultrasound to verify no cysts, days 3-7 Femera taken between 6-8 p.m. each night, day 10 ultrasound to measure follicles, and, if everything went well, trigger shot that evening. The difference is I would add Follestim, an injection containing FSH every other day on days 3, 5, 7, and 9. Another shot to give myself. Yay.
We started with the new month and things seemed to be progressing nicely. On day 10 I went in for my ultrasound and they didn't find a single follicle that was mature enough that they felt comfortable having me take the trigger shot. I was devastated. I was sure our journey was going to lead to IVF and I was still uncertain if we would ever be ready for that path. They were fairly confident, given a little more time and a little more medication, I had one follicle that would develop, so they suggested I take another shot of Follestim the next night and trigger two nights later.
This was the cycle I conceived. I was positive that I wouldn't, but the doctor said to take a pregnancy test fourteen days after I triggered. I did. Two pink lines. I woke up Mike. I didn't believe it. Two pink lines. We were going to have a baby!
I called my doctor when they opened and they had me come in for a beta test (that measures the pregnancy hormone HSG). My initial numbers were well within a normal range for a "normal" pregnancy but that's not really what matters. They want you to come back within 48-72 hours to make sure that your beta doubles. That's the true sign of a strong pregnancy. The numbers doubled. They declared me officially pregnant and told me, barring any issues, to come back at week 7 of my pregnancy for a dating ultrasound and to verify the baby had a heartbeat.
Somehow, my most depressing cycle ever had produced the most fabulous results.
One great thing about our doctor was that he was an incredibly nice guy. He is passionate about his chosen field and is very sensitive to the emotions that infertility generates. I cried more than once in his office and always felt very comfortable asking any questions that came up. I have recommended him frequently.
He suggested we move on to add an injectable medication to my cocktail of drugs. We would follow the same schedule we had been - cycle day 3 ultrasound to verify no cysts, days 3-7 Femera taken between 6-8 p.m. each night, day 10 ultrasound to measure follicles, and, if everything went well, trigger shot that evening. The difference is I would add Follestim, an injection containing FSH every other day on days 3, 5, 7, and 9. Another shot to give myself. Yay.
We started with the new month and things seemed to be progressing nicely. On day 10 I went in for my ultrasound and they didn't find a single follicle that was mature enough that they felt comfortable having me take the trigger shot. I was devastated. I was sure our journey was going to lead to IVF and I was still uncertain if we would ever be ready for that path. They were fairly confident, given a little more time and a little more medication, I had one follicle that would develop, so they suggested I take another shot of Follestim the next night and trigger two nights later.
This was the cycle I conceived. I was positive that I wouldn't, but the doctor said to take a pregnancy test fourteen days after I triggered. I did. Two pink lines. I woke up Mike. I didn't believe it. Two pink lines. We were going to have a baby!
I called my doctor when they opened and they had me come in for a beta test (that measures the pregnancy hormone HSG). My initial numbers were well within a normal range for a "normal" pregnancy but that's not really what matters. They want you to come back within 48-72 hours to make sure that your beta doubles. That's the true sign of a strong pregnancy. The numbers doubled. They declared me officially pregnant and told me, barring any issues, to come back at week 7 of my pregnancy for a dating ultrasound and to verify the baby had a heartbeat.
Somehow, my most depressing cycle ever had produced the most fabulous results.
Thursday, October 9, 2014
Surgery
After three unsuccessful months of trying with medication and trigger shots, we sat back down with our doctor. He told us he thought my potential endometriosis was playing a larger part than we initially thought and we had reached another crossroads.We could either move forward with surgery to hopefully take care of the endometriosis the doctor suspected I had or we could move forward with IVF.
IVF scared both of us. I know two couples who conceived via IVF and both told me it took them a very long time to be ready. The costs of IVF are overwhelming - you're typically looking at either one cycle at around $12,000 or you can purchase (at the office I was at) a "guaranteed" set of cycles at $20,000. That got you four cycles of IVF and if you weren't pregnant at the end, they would refund you the cost of the procedures. They do not refund the costs of the medications and those are typically what are so overwhelming. Plus, IVF is very taxing to your body. We decided we would try the surgery.
It took about a month and a half to schedule the surgery - We based the surgery around my cycle and then had to postpone it another month because of a previously scheduled trip to visit my family.
The day of the surgery we were at the hospital bright and early. I was called back into pre-op. They got me in my gown and booties and then let Mike come back. I was poked, prodded, spoken to by several different hospital staff members and finally the anesthesiologist came. He smiled, held up a needle and said "Bar's open." He injected the happy juice into my IV and the world became a soft and hazy place. Everyone laughed and called me a cheap date and then I was kissing Mike see you later (they don't say goodbye in pre-op) and I remember being pushed to the operating room. The only thought I remember was thinking they should clean their hallway - it was filled with extra hospital beds.
The very first thing I remember after surgery was being pushed in my bed towards recovery. I heard someone say "Nope, didn't find a single thing, clean as a whistle." I knew somehow that they hadn't found any endometriosis. I started crying and the nurse asked me "Honey why are you crying?" I couldn't answer yet, but inside my heart was breaking. I was so sure there would be a REASON why we were having such difficulty getting pregnant and if I didn't have endometriosis, it meant I had unexplained infertility. Which meant...a game plan just got harder.
It's a strange place to be in, wanting the doctor to find something wrong with you and being heartbroken when there is nothing wrong.
While I was in recovery, my doctor talked to Mike in the waiting room. Turns out, my gut feeling was right. They hadn't found anything. No endometriosis at all. The doctor talked about reasons he felt that I might be having difficulty obtaining pregnancy but we knew now with 100% certainty that it wasn't because of endometriosis.
After I woke up some more, I was moved to another step down unit. Here I had to eat, drink, and use the bathroom. Once I was able to do all those things, I could go home. Mike was allowed to be with me in this unit and I was eager to get out of the hospital so I completed my steps as soon as I could and then we were home. I had the surgery on a Thursday morning and by Monday morning I was back at work. We scheduled another meeting with our doctor and got ready for the next step in our plan.
IVF scared both of us. I know two couples who conceived via IVF and both told me it took them a very long time to be ready. The costs of IVF are overwhelming - you're typically looking at either one cycle at around $12,000 or you can purchase (at the office I was at) a "guaranteed" set of cycles at $20,000. That got you four cycles of IVF and if you weren't pregnant at the end, they would refund you the cost of the procedures. They do not refund the costs of the medications and those are typically what are so overwhelming. Plus, IVF is very taxing to your body. We decided we would try the surgery.
It took about a month and a half to schedule the surgery - We based the surgery around my cycle and then had to postpone it another month because of a previously scheduled trip to visit my family.
The day of the surgery we were at the hospital bright and early. I was called back into pre-op. They got me in my gown and booties and then let Mike come back. I was poked, prodded, spoken to by several different hospital staff members and finally the anesthesiologist came. He smiled, held up a needle and said "Bar's open." He injected the happy juice into my IV and the world became a soft and hazy place. Everyone laughed and called me a cheap date and then I was kissing Mike see you later (they don't say goodbye in pre-op) and I remember being pushed to the operating room. The only thought I remember was thinking they should clean their hallway - it was filled with extra hospital beds.
The very first thing I remember after surgery was being pushed in my bed towards recovery. I heard someone say "Nope, didn't find a single thing, clean as a whistle." I knew somehow that they hadn't found any endometriosis. I started crying and the nurse asked me "Honey why are you crying?" I couldn't answer yet, but inside my heart was breaking. I was so sure there would be a REASON why we were having such difficulty getting pregnant and if I didn't have endometriosis, it meant I had unexplained infertility. Which meant...a game plan just got harder.
It's a strange place to be in, wanting the doctor to find something wrong with you and being heartbroken when there is nothing wrong.
While I was in recovery, my doctor talked to Mike in the waiting room. Turns out, my gut feeling was right. They hadn't found anything. No endometriosis at all. The doctor talked about reasons he felt that I might be having difficulty obtaining pregnancy but we knew now with 100% certainty that it wasn't because of endometriosis.
After I woke up some more, I was moved to another step down unit. Here I had to eat, drink, and use the bathroom. Once I was able to do all those things, I could go home. Mike was allowed to be with me in this unit and I was eager to get out of the hospital so I completed my steps as soon as I could and then we were home. I had the surgery on a Thursday morning and by Monday morning I was back at work. We scheduled another meeting with our doctor and got ready for the next step in our plan.
Wednesday, October 8, 2014
The First Month
Infertility treatment is exhausting. It is invasive and time consuming and just all around consuming. It's hard to think about anything else when you're constantly being monitored and you see your nurses more than your own family.
Most REs (reproductive endocrinologists) start with as little treatment as possible. When we were given the diagnosis of possible endometriosis, we had two ways we could proceed. I could have a laparoscopic surgery to verify diagnosis (it is impossible to officially diagnose endometriosis without surgery) and hopefully clear up any spots that were causing issues with a laser treatment; or we could move forward with medication for a few months and hope to avoid surgery. We decided to try medication first as it was far less invasive and our doctor agreed with the path we chose.
You start every new cycle with an ultrasound. On cycle day 3, you go in for an ultrasound. They monitor to make sure that you don't have any ovarian cysts, because ovarian cysts will respond very positively to the medication and can grow out of control. If no cysts are found and your uterine lining appears to be shedding appropriately, you get the go ahead to move forward with medication.
My RE put me on Femara (generic name Letrozole), which is actually marketed to be a medication for use in post-menopausal breast cancer patients. The medication actually decreases the amount of Estrogen in your body. At first, we were confused. Why would we want to decrease estrogen? The reason is that your body basically goes into overdrive trying to replenish the lessened amount of estrogen and you develop stronger and bigger eggs. I took the medication every night between 6-8 p.m. from cycle days 3-7.
On cycle day 10 (yes, you get a calendar every month that helps you decipher these days), you go in for another ultrasound and bloodwork. They measure your follicles and estrodial. They're hoping to see at least one follicle at 16 mm or higher. If you have too many follicles, your cycle can be cancelled so you don't end up as Octomom. If you don't have any follicles that meet that size you either postpone for a few days and come back for more monitoring or cancel the cycle and start over next month. It's very hard to describe just how exciting it is for an ultrasound tech to tell you they see an appropriately sized follicle. And it's just as hard for an ultrasound tech to tell you...hmmmm... looks like only a few small ones so far.
Once your blood work comes back from the lab, your nurse calls you that afternoon and tells you if you can take your trigger shot yet. The trigger shot is HCG, yes, the pregnancy hormone. This triggers ovulation within 36 hours in the vast majority of women. You can't take a pregnancy test at this point because it WILL be positive. I was on a few infertility internet forums and lots of women "test out their trigger" to see the positive from the trigger shot fade and hopefully see two lines come back for a positive pregnancy test, but I never did. I didn't want to see two lines on a pregnancy test unless it meant there was really a new life being created.
Giving yourself a shot is a strange experience. The needles are tiny and you don't have to put them too deep, but it's still weird to do it yourself. The first month I gave myself a trigger shot, I was terrified. Mike asked me if I wanted him to do it and I told him that I had a feeling I'd have to learn (I was fairly confident it wouldn't happen the first month). It took me nearly fifteen minutes of preparing but I finally did it.
After the trigger shot, there are two ways that the RE usually goes. Either timed intercourse or intra-uterine insemination. Luckily, my RE didn't think we needed the IUI and so we were given orders (per the nurse) to "have relations" for each of the next three nights. It made me giggle every single month.
Seven days after your trigger shot, you're back in the office for bloodwork. They are now looking for your progesterone level. That indicates ovulation and your body's preparation to take on a pregnancy. Because this had been an issue for me in previous pregnancies, they were watching these numbers closely. The first month was the only month that my progesterone was cause for concern - it indicated ovulation but was a little low for their liking so I then went on progesterone supplements.
Fourteen days after your trigger shot, you take a pregnancy test. If it's negative, you wait for your period to start and you start the process all over. My first month was a negative so we moved on to month two. And three.
Most REs (reproductive endocrinologists) start with as little treatment as possible. When we were given the diagnosis of possible endometriosis, we had two ways we could proceed. I could have a laparoscopic surgery to verify diagnosis (it is impossible to officially diagnose endometriosis without surgery) and hopefully clear up any spots that were causing issues with a laser treatment; or we could move forward with medication for a few months and hope to avoid surgery. We decided to try medication first as it was far less invasive and our doctor agreed with the path we chose.
You start every new cycle with an ultrasound. On cycle day 3, you go in for an ultrasound. They monitor to make sure that you don't have any ovarian cysts, because ovarian cysts will respond very positively to the medication and can grow out of control. If no cysts are found and your uterine lining appears to be shedding appropriately, you get the go ahead to move forward with medication.
My RE put me on Femara (generic name Letrozole), which is actually marketed to be a medication for use in post-menopausal breast cancer patients. The medication actually decreases the amount of Estrogen in your body. At first, we were confused. Why would we want to decrease estrogen? The reason is that your body basically goes into overdrive trying to replenish the lessened amount of estrogen and you develop stronger and bigger eggs. I took the medication every night between 6-8 p.m. from cycle days 3-7.
On cycle day 10 (yes, you get a calendar every month that helps you decipher these days), you go in for another ultrasound and bloodwork. They measure your follicles and estrodial. They're hoping to see at least one follicle at 16 mm or higher. If you have too many follicles, your cycle can be cancelled so you don't end up as Octomom. If you don't have any follicles that meet that size you either postpone for a few days and come back for more monitoring or cancel the cycle and start over next month. It's very hard to describe just how exciting it is for an ultrasound tech to tell you they see an appropriately sized follicle. And it's just as hard for an ultrasound tech to tell you...hmmmm... looks like only a few small ones so far.
Once your blood work comes back from the lab, your nurse calls you that afternoon and tells you if you can take your trigger shot yet. The trigger shot is HCG, yes, the pregnancy hormone. This triggers ovulation within 36 hours in the vast majority of women. You can't take a pregnancy test at this point because it WILL be positive. I was on a few infertility internet forums and lots of women "test out their trigger" to see the positive from the trigger shot fade and hopefully see two lines come back for a positive pregnancy test, but I never did. I didn't want to see two lines on a pregnancy test unless it meant there was really a new life being created.
Giving yourself a shot is a strange experience. The needles are tiny and you don't have to put them too deep, but it's still weird to do it yourself. The first month I gave myself a trigger shot, I was terrified. Mike asked me if I wanted him to do it and I told him that I had a feeling I'd have to learn (I was fairly confident it wouldn't happen the first month). It took me nearly fifteen minutes of preparing but I finally did it.
After the trigger shot, there are two ways that the RE usually goes. Either timed intercourse or intra-uterine insemination. Luckily, my RE didn't think we needed the IUI and so we were given orders (per the nurse) to "have relations" for each of the next three nights. It made me giggle every single month.
Seven days after your trigger shot, you're back in the office for bloodwork. They are now looking for your progesterone level. That indicates ovulation and your body's preparation to take on a pregnancy. Because this had been an issue for me in previous pregnancies, they were watching these numbers closely. The first month was the only month that my progesterone was cause for concern - it indicated ovulation but was a little low for their liking so I then went on progesterone supplements.
Fourteen days after your trigger shot, you take a pregnancy test. If it's negative, you wait for your period to start and you start the process all over. My first month was a negative so we moved on to month two. And three.
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