Monday, February 21, 2011

The Conception Chronicles: Switch Up

This is the eighth installment in a short series about baby making.

After the chemical pregnancy disappointment, we decided to give poor Princess Charming's ovaries a break (and they remained swollen from the meds...).

So we gave it a shot with me.

In short, I am not reproductively exciting.   I had a simple CD3 check up and a simple CD 13 check up with a 20+mm follicle. One nice, mature follicle, just like is supposed to be there, ready to ovulate around CD 14.

I am so freaking normal.

So I triggered with a shot - which was interesting, though not as hard as I anticipated (it did upset the dog though) -   and we did the IUI.  The weirdest part of the whole experience was feeling myself ovulate - KAPO - driving to practice 22 hours after my trigger shot. And my lord did that thing make my boobs sore.

Then I proceeded to blow about $50 on pregnancy tests, since we did this smack in the middle of rugby season and I had a plane ticket to nationals for the day of my bloodwork. I didn't want to turn up for the game and have to tell my captain I couldn't play, so the obvious solution was to test twice a day from 10dpiui on. I would also like to point out you shouldn't need to pee TOO bad before you pee on a stick, because if you get the part where the result goes wet the whole thing is wasted. You also need to get ENOUGH pee on said stick.

Also, like any good maybe-pregnant-lady, I calculated my theoretical EDD. It turned out to be right around my birthday. We inseminated on my mom's birthday.

Alas, I am not expecting a little nugget in July. I like to think I'm not broken and just had bad luck.
We blamed it on the sperm and started looking for a new donor.

Saturday, February 19, 2011

The Conception Chronicles: Being Prepared

This is the seventh installment in a short series about baby making.

The wonderful world of fertility medicine has a "dirty little secret," selective reduction.  We've all heard about Jon & Kate Plus 8 and Octomom, and many have seen TLCs annual sextuplet follow up specials with the family in Iowa. The thing is, and its not talked about much on these shows, is high order multiple pregnancies are really, really risky to both mom and babies.  The survival rates aren't terrific, disabilities like cerebral palsy are fairly common, and prematurity is almost a given (even for "low" HOMs, your basic triplets).

A well managed triplet pregnancy has a 9% chance of miscarriage by 20 weeks and about a 2/3 chance of delivery by 32 weeks (a 32 week delivery will buy the babies, if healthy and all goes well, at least one month in the NICU). Moms are often on bedrest by 24 weeks to help keep the cervix healthy.

Why do I know these stats? Our RE like to repeat tell them to us (and remind us that triplet+ parents have high rates of depression, somewhat attributed to sleep deprivation). Our fertility doctor is pretty conservative in treatment protocols and strives for one baby, considering even twins, while generally pleasing to the parents, a (partial) failure on his part. While some people have these conversations early in treatment, we never saw enough development on the basic drugs to warrant it.

On the injectibles, Chris had a so-so response. She responded, but even with low and varied med levels and slow medicating (I won't bore you with the exact protocol, but it wasn't that bad - nothing like the IVF folks), she never had a super amazing lead follicle. So to get anything big enough, there is risk. Hence, "the conversation".

I'll preface this by saying we are kind of under the gun on the fertility thing due to impending insurance changes, so canceling a cycle is a big risk to us (not to mention the expense, though limited for us, and massive hassle of injectible meds).

Princess Charming and I discussed what we would do with HOM at length, and decided we are ok with selective reduction (to be clear, it is a pregnancy termination of one (or more) fetus done towards the end of the first trimester, generally for health reasons). We would reduce quads or more without question. The risks are just too high. Triplets are on the edge, and a harder decision. Twins are not on the table, as the risks of a twin pregnancy are not nearly that high.

There are about 18319294 issues that play into such a grave decision, a decision made that much harder for people who have had trouble getting pregnant in the first place. There's issues of finances. There's issues of ethics. There's issues of health for mom and fetuses and eventually babies. A fairly limited number of Maternal Fetal Medicine doctors are skilled in the procedure, and all (to my knowledge anyway) do extensive testing and counseling regarding the procedure for patients considering it.

I realize not everyone would consider reducing a HOM pregnancy, be it for ethical or religious or even insurance reasons, and have no interest in debating it (well, no more than I would be interested in debating abortion rights in general). If we ever have to cross this bridge, it will be a medically based decision for us, and most likely not one we will share with many, if any people. Just another rock in the infertility bucket of things polite company doesn't discuss, but a very important thing to work out with your partner before getting too far into treatment.

Tuesday, February 8, 2011

The Conception Chronicles: Ultrasounds and Noises

This is the sixth installment in a short series about baby making.

Grey's Anatomy really ticked me off last week Not because Callie got pregnant by accident, or some left field feminist issue with her bisexuality, or some random complaint about the legal implications of tweeting operations.

Because they lied.

Now, granted, I don't expect a medical sitcom (drama?) to be 100% accurate any more than I expect a crime show to use legit technology and timelines (Bones, anyone? I love Bones, and if their technology was real...well, I imagine there would be a lot less free murders and a lot more graphic artists employed by the FBI). But basic medical facts...

What am I bitching about?

The MFM resident told Callie she can't see the heartbeat until at least 8 weeks (or something similar to that). Now, I understand most women don't go for their first prenatal visit until between 8 and 10 (I think) weeks, and most OBs don't try to get the heartbeat with the external doppler until something like 10-12 weeks (this is entirely heresay, seeing as I have no experience with this). I can even understand that they don't want to be responsible for a mad rush of newly pregnant women to their OBs insisting on transvaginal ultrasounds on good machines that can pick up the heartbeat.

I do not, however, condone downright falsifying information.

We made a decision to have a D&C with the first pregnancy before 8 weeks. At 6 weeks, when you hope to see a fetal pole and MIGHT see a heartbeat (it starts right around 6w0d, give or take) we had a big yolk sac. And came back a few days later, given that was a "eh" prognosis. At that point, there was no heartbeat. Our doctor apologized, booked us one more "just in case you had an immaculate conception" ultrasound, and we went on our way.

Now, of course, Torres didn't have an IUI, and her ovulation and fertilization dates could be wrong, which is a good reason not to be 100% sure there will be a heartbeat at what she thought was 8w. BUT Grey's didn't bring this up at ALL as a reason. They just lied. Ugh.

Fun Fact: The fancy transvaginal ultrasound machine our RE has is snazzy. I don't know if the ones in OBs offices and such are as nice (seeing as I've never been to one), but it can do standard ultrasounds, those creepy 4d ultrasounds, measurements that automatically determine estimated gestational age, and heartbeats. The microphone on the end (I assume) of the wand is so fine tuned it can pick up the heartbeats of different fetuses by aiming at them, and then can give you a heartrate. I assume OBs have something similar and this isn't actually that cool, but again, never been to an OB pregnant and I still think this machine rocks.