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The Big News

It's no secret that since Desmond's death in July 2016, we have wanted to have another child. There was a short delay initially because Dave had undergone a second vasectomy during that pregnancy, but in September 2016 we again traveled to St. Louis and he again had a vasectomy reversal (VR) with Dr. Thomas Sommers. VRs are never a sure thing but we had good success the first time (two pregnancies) so we were very hopeful. We did have a good return of sperm so we were good to go with trying. Unfortunately months went by with no luck so we returned to Boston IVF at The Women's Hospital, where we had used medicated IUI to conceive Jacinda in December 2014. Dr Griffin was very kind and said he believed that IUI could work for us again (especially since it worked on the first try with Jacinda!), but he wanted me to try a new medication. With Jacinda, I took Clomid, and I did not respond well, so I ended up having to take more and more of it until the side effects were terrible. This time, he wanted me to try Femara. It's technically a breast cancer drug, but when taken for only 5 days at a time it is useful for inducing ovulation. Our first two IUIs were unsuccessful, and at $1,300 plus medication costs, we weren't sure we should continue down that path. We took a break, and then in October we got a surprise positive pregnancy test without any medical intervention! Sadly, it only lasted a short time, and resulted in a very early miscarriage called a 'chemical pregnancy,' because my body was producing enough hcg (chemical) to show up on a test, but no fetal tissue every developed. This was disappointing, but also reassuring - we COULD get pregnant! This gave us the motivation to try one more IUI cycle.

I had a hard time responding to Femara, but finally after repeatedly upping the dose, I had 4 good sized follicles. I had the IUI on January 30.

They tell you to come back 14 days after the IUI (14dpiui) for a blood test but literally everyone I know starts testing at home before that date because COME ON! So on February 10 I started testing, and tested daily up to day 14.

Lines! Glorious lines!

My day 14 blood results came back positive with HCG at 41. I was a little worried because with Jacinda, at day 14 my test was 92. It could have just been that this time the baby burrowed in a day or two later than Jacinda did. I went back in 48 hours and my number had tripled, and after another five days, it had gone up a lot, so they considered it a viable pregnancy. An ultrasound was scheduled for 7 weeks, at which point they should be able to see a heartbeat.

I started to feel a little sick, and exhausted, and had random little growing pains, but nothing major. I really wasn't too worried about twins, even though we'd had 4 eggs, because my HCG levels were rather low and usually with twins they are considerably higher. The day came for our 7 week ultrasound - which was really unnecessarily unpleasant due to the nurse practitioner not taking a second to read my chart about having had a 19 week loss and therefore asking me ridiculous questions and taking for-ev-er to tell us there was a heartbeat - and we were told there was ONE baby, one heartbeat. Ok, good. One baby. The thought of twins terrified me, because of the increased risks to the babies. I was relieved. 

The nurse suggested we come back in a week just to confirm growth. I wanted to go ahead and switch to my OB office so we set up that appointment there instead. Dave went with me again, and as he was looking at the monitor mounted up on the wall, he said, "Is that two?" It all looks like gray blobs to me at this point so I said, "Two of what?" The tech said, "That's what I'm trying to figure out..." Then a few minutes later she said, "Yep. Two babies. Two heartbeats."

Usually if you google twin ultrasounds at 8 weeks, there are two babies spread out in different areas of the womb. Our babies could not be any closer together. 


We went back in two weeks for another ultrasound, even though the babies were measuring good for their age (just a couple of days behind), and their heartbeats were good. So at 10 weeks we went again, and with the 3D ultrasound got these pics of each of them:



Our doctor then told us she'd feared at 8 weeks they were conjoined at the head. Good Lord we had not even considered THAT horrible possibility! But at 10 weeks they had flipped head-to-butt so definitely not conjoined. 

The bad news was that they appear to be a rare type of twin called monochorionic/monoamniotic twins. This means they share one placenta and they are in one amniotic sac. This type of twin occurs in 1% of identical twin pregnancies, and in about 1 in 65,000 pregnancies overall. 

The prognosis for them is not good. Because they are in a shared sac, they are at increased risk of death from cord entanglement or cord compression. Because they share a placenta, they are at risk of Twin-to-Twin Transfusion Syndrome, something I don't yet fully understand but some complications can be that one twin receives far more blood and nourishment than the other, resulting in health problems or even death for both of them. 

The Jack Shephard quote from Lost keeps coming to mind, "Live together, die alone." Their lives are so inextricably connected, they both live or they both die. 

I am comforted in knowing that they have someone to touch, they are not alone in there. I am a little freaked out that they are identical twins (which have always creeped me out a little bit!). Most of all, I am full of worry and anxiety for their chances. Mo/Mo twins die before viability 50% of the time. That means half of all women who get pregnant with them will have them die before 24 weeks, usually before 20 weeks from what I've read. For the 50% who do survive to 24 weeks, the mothers have to go inpatient at the hospital to be continuously monitored - any deceleration in the baby's heartbeat and they perform a c-section right away. These types of twins are ALWAYS delivered by c-section because the risk of cord accidents is so high. Some doctors think 32 weeks is the max, while others push it to 34, but never more than that. So I get nervous when I start to consider that even our best-case scenario is terrifying to me. Living in the hospital, away from my husband, my children, my comfortable surroundings, for WEEKS, a c-section at a moment's notice if anything goes wrong, then a very long NICU stay for the babies who will be, at best, two months early. That's best case. They could be delivered super early, 24 or 25 weeks, with little chance of survival, or with life-long disabilities because of it. They could live for awhile and then pass away from prematurity. Or they could die before we even reach viability, leaving us to bury two more babies. As horrible as the hospital and all that sounds, I'd do it ten times over if it meant not having to bury two more babies.

What are the odds that someone doing fertility treatments ends up with twins - but not the fraternal type that almost always result from fertility treatments? Identical twins split from ONE egg, so it's a completely random occurrence. What are the odds that a mother whose last child died from an umbilical cord accident - an accident her doctor said "is like getting struck by lightnging" in its randomness and obscurity - then gets pregnant with identical twins with no membrane between them who have a 50% chance to die of the very same thing? That is insanity! Unfair doesn't begin to scratch the surface. But I can't and won't dwell on that. I get to be pregnant again! I get to feel little baby kicks. (Yes, already.) I get to eat weird food with no guilt! I don't know how long this will last but I want to enjoy it as much as I can, as long as I can. 

These babies are due October 23, 2018, two years to the day after my sister passed away. That is not lost on me. Even before I knew they were twins, before I knew the insane risks, I knew the date had meaning, that it is not a coincidence. Of course they will be born long before then, hopefully born alive.




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