Saturday, May 30, 2009

11w4d - Second perinatologist visit

We had a check-up at my perinatologist 48 hours after the CVS test to see how the trio is doing. The (awesome!) u/s tech did a quick check to establish that all three hearts were still beating (phew!), before listening and measuring each heartbeat individually. She reassured us immediately. I love medical professionals who understand the worry and anxiety, and who do everything in their power to minimize it.

We were too stressed on Wednesday (before the CVS test) to really enjoy the u/s experience and we were grateful to the u/s tech for taking her time on Friday. She pointed out teeny tiny fingers and toes, umbilical cords and other details. We saw our one little baby lying with arms crossed in front of his/her forehead and another lying in what looked like a very chilled position - with the little feet crossed like he/she was on a beach vacation or something! At one point, one of the babies "waved" at us. The little right arm came up and the hand was literally waving. We were mesmerized.

They were bouncing around at times too. I can't get over how fast they spin around and make somersaults. We are expecting fraternal triplets (triamniotic, trichorionic), but since week 5, two of the babies have consistently appeared to be very similar in position, gestational sac size, and with their other measurements. Yesterday, these two, now named Baby A and Baby B, were lying the exact same way.

The tech said she's never seen that before in a triamniotic, trichorionic pregnancy. It is uncanny. She printed an u/s picture for us - which I will scan and post at some point. It reminded me of another tech who commented that it looked like we were having twins and a singleton, even though we all knew at that point that they were from three different eggs and sperm.

I'd like to look back two weeks from now and know if these two kids are the same gender, and years from now, know if they share more facial features and personality traits... and whether Baby C will be the more independent one.

I love how each ultrasound brings us closer to our babies and bonds us with them. Our third perinatologist visit is in three weeks. It's amazing to think we'll know their genders then. Can't wait!

Thursday, May 28, 2009

11w2d - The CVS test experience - not for the fainthearted

The detailed ultrasound scan prior to the CVS test was incredible. We saw all three of them doing acrobatics in utero for the very first time. I always thought that they would move in slow motion through the amniotic fluid, but boy, were they bouncing fast! I promise, I haven't had any caffeine...

The last time we saw them (at 8 weeks), we could see a distinct head and body with limb buds, but no other distinguishable features. This time around, we could see noses, ears, fingers, and toes. Just amazing. My Dh must have whispered, "Wow!" a thousand times. We are in awe.

Here are the (beautiful) vital stats:

Baby A: 4.98 cm, heartbeat: 161 bpm, nuchal fold: 0.007
Baby B: 4.85 cm, heartbeat: 165 bpm, nuchal fold: 0.183
Baby C: 4.74 cm, heartbeat: 165 bpm, nuchal fold: 0.115

Thank you all for your encouraging words about the CVS test. The chorionic villus sampling test is more complex in a triplet pregnancy as the perinatologists obviously need a clear path to access each baby.

If you're having a CVS procedure for a singleton or twins, then there's very little to be concerned about. Like with everything, it's more complex with triplets. We had the u/s technician, and two perinatologists present. The two peris analysed each baby's position on the u/s and worked together in determining the safest route to take for each. Sometimes they can access all three trans-cervically, sometimes all three trans-abdominally, and sometimes they have to use both approaches.

I never luck out in the odds department, so of course they had to use both with me.

They accessed Baby A's placenta through my cervix first, and it was a breeze. I felt no pain whatsoever. It took a little longer than an embryo transfer, but the discomfort was from the spe.culum and my full bladder. I couldn't feel the catheter being threaded through my cervix, or the needle accessing the chorionic villi.

They then had me empty my bladder (phew!) so that they had a better chance of reaching the other two babies.

They accessed Baby B's placenta through my abdomen (no anesthetic, not even topical). The setup for each baby takes about 10-15 minutes as they reconfirm the position of each baby, and plan the best path for the needle. It was quite painful as they have to maneuver the (very long!) needle all the way in, and then move it up and down at least 3 times to get enough of a sample. Baby B's actual procedure was over in about two minutes. If it had gone any longer, I would've bit through my lip.

And then the torture started. They uhmmmed and aahed about how best to access Baby C's placenta. I should've known that this meant trouble. They finally found a safe path, but was nervous that the needle wouldn't be long enough to complete the up-and-down motion to get the sample. (Deep breath.) Some more discussion ensued before they went in. Once the needle went in, there was a long period with lots of incredibly painful maneuvering.

It felt like an eternity. I squeezed my husband's hand to kingdom come while trying to find my happy place as the pain just intensified with each needle movement. I honestly thought it would never end. The nausea crept in, and well, what you don't want to do is throw up with an eight inch needle inside you. And then - thankfully - it was all over. The relief is indescribable. They had me turn on my left side to get the nausea to subside.

After each procedure, the perinatologist uses the syringe to inject the sample into a petri dish, and then they analyse each sample to determine whether they have a sufficient amount of chorionic villi to culture.

The peri who came back to report said they have an excellent sample from Baby A, a great sample from Baby B, and an adequate sample from Baby C. Thank goodness for small miracles, because I sure as hell am not going back for more torture.

It will take the full 14 days to get the results back, so now we wait. Aaah, more waiting! After IVF, we should be good at this, right? Not.

Monday, May 25, 2009

11w0d - CVS test this week

We've decided to have a Chorionic Villus Sampling test performed this week to check all three babies for chromosomal abnormalities. Since I'm over 35, we would like to know what we're up against.

Although I'm not looking forward to the test at all and I'm nervous about the miscarriage risk, I can't wait to see the babies again. We hope to see them wiggle around on the u/s. Since we last saw them at 8 weeks, they have now almost doubled in size, have elbows and knees, and have developed distinct fingers and toes. In fact, there should be 30 fingers and 30 toes now - no wonder I'm so exhausted!

Aside from receiving the chromosomal analysis results, the upside of this test is that we'll know the gender of all 3 babies in 7-10 days. Given the abundant blessing we've received, I know I'm in no position to ask the universe for any more favors, but having a boy/girl mix would be an absolute dream come true.

Sunday, May 24, 2009

How we spilled the beans

A while back, one of my IRL friends asked if/how we've told my parents the big news. Before I tell you the story, you need to know that in yet another strange twist of fate, my due date falls EXACTLY on my birthday.

This is just one of many, many signals we couldn't avoid picking up on. Of course, since we're expecting triplets, they will obviously arrive long before my birthday.

So here's how we spilled the beans at five weeks (yes, major leap of faith required): I called my mom, who lives about 12,000 miles away, and chatted with her for a little bit. You know, to make things seem like our "normal" weekly calls. I had her on speaker phone so Dh could listen in, then I said, "Now mom, do you realize that 36 years ago this week - EXACTLY - you found out you were pregnant with me?"

She had no clue where I was going with this, but she thought about it, did the math and then agreed. And then I said, "It seems history will be repeating itself..." There was a stunned silence before she realized what I was saying and then a whole lot of happy, excited, tearful laughter interspersed with, "Really? You're not kidding? But it can't be. Did you do another round of IVF?" She knew about the first failed IVF, but not that we attempted another cycle back-to-back.

By this time, she was telling my dad to pick up the other phone in their house. He had been outside and didn't hear the earlier conversation, so we got to do the same thing all over again - this time with my mom listening to my dad's stunned reaction. What fun.

A week later, we called them again and said it looks like we're having triplets. It was around April 1 and my mom thought we were playing an April Fool's joke on her. She just wouldn't believe it. She must have asked me about ten times whether I was joking before she finally relented and congratulated us.

Sunday, May 17, 2009

9w6d - Elegy for PIO

Tomorrow we reach another significant milestone: the last PIO injection, and hopefully also my last infertility-related injection ever.

My refrigerator is still full of leftover Gonal-F pens, which I will donate to my clinic as soon as I pass the 13 week mark. Some part of me still doesn't quite believe that this will all work out. I guess that's just how it is when you're an infertile. You can never quite settle into it and enjoy the ride. I keep saying I'll believe it worked when I hold my babies in my arms.

My infertility clinic's discharge instructions said to stop PIO on May 18 (10 wks) and the pro.metrium by 12 weeks. Dh and I have been counting the days to the end of the progesterone in oil injections. We have never been so relieved to say goodbye to anything in our lives. Especially after what happened on Thursday. If you're squemish, stop reading now. You've been warned.

We've done more than 50 of these injections - and considered ourselves "experienced." Ha ha, you know a curve ball is coming. The unexpected happened. The needle kinda burned on the way in which happens from time to time, Dh pulled back on the plunger, there was no blood, so he bravely proceeded to inject the PIO. When he pulled the needle out, the blood didn't trickle, pour or gush out, but squirted and splattered EVERYWHERE. I guess he must have hit a vein on the way in, the needle plugged the hole while he was injecting, and when he pulled it out, well, the dam wall burst.

I was oblivious for a few seconds, because I don't have eyes behind my head (yet! that will surely happen when I become a mom of toddler triplets). In those seconds before I could put my hand on the spot, the blood sprayed all over him, all over the vanity, and all over the floor. It looked like a freaking massacre. It was all I could do not to picture a CSI team with a UV light inspecting the scene and wondering who had met an untimely death.

I started laughing.

Dh was clearly traumatized by it all, but totally keeping his cool. He grabbed paper towels and started wiping everything down, while I stood there still laughing my a$$ off because I couldn't believe the massive mess. It just wouldn't stop bleeding, despite my best efforts.

I grabbed some toilet paper, put pressure on it, but nothing worked. I decided to go down on all fours, hiney in the air, in an attempt to put an end to the craziness while Dh tried his best to stay a step ahead by wiping it all up. The blood flow eased, but by then our puppy pushed the bathroom door open to see what the commotion and excitement was all about. That pushed Dh over the edge and I had to swallow the rest of my giggles while pushing the dog out.

Oh my gosh, what we wouldn't go through to have children. The insanity of it all just never escapes me. In those moments, I always think: fertiles have no clue what we go through in pursuit of a family.

So, here's to you, PIO. Thanks for the memories, the bruises and the lumpy butt syndrome, but we're so done. I'm over you. Bye bye. And good riddance.

8w4d - First perinatologist visit

We had a 3-hour consult at the perinatologist. First, a nurse checked my weight (eek!) and blood pressure (low, as always), and then we had an opportunity to see our babies on the ultrasound. Aside from my bladder almost exploding, it was a wonderful experience. Imagine my surprise when the u/s tech had me lie down with *all* my clothes on. Abdominal ultrasound - what a concept!

The three little peanuts are all growing strong and still measuring exactly on target. Even though they are each in their own sac, two of them seem to be very close in proximity in my uterus, gestational age, heart rate, etc. Since the week 5 ultrasound when we only saw the sacs it almost looked like twins and a singleton. On every u/s since then, the two heartbeats and gestational ages have matched exactly, with the one little bean a day ahead, in a slightly larger sac (nothing to be concerned about, according to the doctor). Their CRL is about 2 cm now. The u/s tech said it out loud, "It almost looks like you're having twins and a singleton." My thoughts exactly. I'm wondering if the two little ones that are so consistently matching are one gender. I like to think that the big one is a little boy, and that the other two are little girls.

Oh, I love my new OB! She's a perinatologist (a Maternal Fetal Medicine specialist) who has tons of experience with multiples and other high-risk pregnancy experience. She also specializes in prenatal and postpartum mood disorders which are more common among moms of multiples.

She is about my age (mid-thirties), completed her specialty in NYC, and is very level-headed. I liked her candid and realistic, but also optimistic approach. Best of all: she is pregnant herself and due this summer so she certainly "gets" it. :) Her colleague(s) at the perinatology center will take over my care for the 12 weeks that she is on maternity leave, but she will be back by the time my delivery approaches.

Oh, and she said "You're young, healthy, slim..." (Did I mention I LOVE her?!) "...and you should have a really good outcome." The average triplet age at delivery is around 31 weeks. She is more inclined to have me go on disability earlier "no work/modified bedrest" rather than strict/hospital bedrest (unless complications occur).

She said the latest research shows that cerclages aren't always successful in preventing preterm labor with triplets, that I should aim to gain between 50-76 lbs (gulp!) and to just take it easy. I may not see her for every visit unless I experience complications, as they try their best to "normalize" triplet pregnancies, so I may see their nurse midwives, who are used to dealing with multiples, in between. I'm looking forward to things feeling "normal" for a change - and less medical. It's also reassuring to know the high-risk care is there if I need it.

In the waiting room, we met a mom with a 7-day old newborn who had a high-risk pregnancy. She shared her labor experience and impression of the hospital's L&D unit where I will deliver. It was a really positive, firsthand account and helped ease my mind about the personalized care they offer.

She said the nurses were amazing and she had the same nurse care for both her and her infant. Even though her son was in the NICU for awhile, when he was released from the level 3 NICU, he could stay with her in her room for as long as she wanted. If she wanted to sleep at night, they would take him, but it was on her terms. The food was great, and they have wi-fi. Yay, all my questions were answered in one afternoon. I was exhausted - and famished! - after the long visit, and fell asleep in the car on way home. Blissfully happy.

Monday, May 04, 2009

7w4d ultrasound: it's all good

I started bleeding the night before the ultrasound and was nervous that something had gone horribly wrong with the triplets. We waited longer than usual in the waiting room. Torture. The nurse eventually called me in for the blood pressure check.

I undressed for the u/s, as instructed, only to be told 10 minutes later that they'd prefer to see me in the room with the newer ultrasound equipment. So I happily dressed, moved to the other room, and waited another 30 minutes. By that time, I had to use the bathroom. So I got dressed again, went to the bathroom, and undressed again. Hopefully three time's a charm!

Finally... the Nurse Practitioner came in to do the u/s. For the first time ever, we saw all three embryos on the screen simultaneously. "Family photo!" the NP said. I could see all three heartbeats clearly flickering on the screen and the relief was instantaneous.

All three are indeed doing great. She isolated each baby's heartbeat so we could hear them individually. Strong heartbeats: two at 162, and one at 165 bpm. It was the most beautiful sound I have ever heard.

They are all measuring exactly on target. Their Crown Rump Lengths (CRL) are 1.52, 1.42, and 1.38 centimeters, perfect for their gestational age. We are so relieved and excited to know they're all doing well so far.

We graduated and when my RE came into the examination room to bid us a fond farewell, he had his palms together, his head bowed, a sheepish expression on his face and then said, "Guys, please forgive me!!" It was so funny. My RE is one of the most compassionate people I know, and I will surely miss his professionalism, optimism, and sense of humor.

Thank you all for your beautiful, supportive, encouraging, and funny comments. They make me proud to be a part of this amazing, caring community.

Friday, May 01, 2009

Pregnancy symptoms: fast and furious, to the 3rd degree

I had an "oh my gosh, this is real" moment this morning. It was 4:30 and I woke up from the nausea. My stomach was growling. So there I was, making oatmeal and practically inhaling it to get it into my stomach before I throw up. It hit me: I'm so very, incredibly, joyously pregnant.

Two nights ago, dinner consisted of pickled Harvard beets and avocado. Not quite pickles and ice cream, but equally bizarre. It was beyond delicious. You should try it. Really.

My body has been hijacked by three little peanuts who are already ruling my life. (Yes, I know, I should get used to it!)

They tell me:
- when to eat (now!)
- what to eat (fruit & veg only, thank you very much)
- what not to eat ( that's an order. don't even look at it!)
- when to sleep (now!)
- how much to sleep (all the time)
- when to drink water (now!)
- how much water to drink (all.the.time except when it makes me nauseous, which is all the time too)
- what not to smell (dog food, smoke, food cooking, perfume, deodorant, cleaning solutions.)

I'm a carnivore, but the thought of coming near red meat makes my stomach churn now. I've been sticking to chicken, but that routine is getting old fast. I'm a self-admitted chocoholic, but it seems suddenly toxic.

Oh, what a strange trip this is.