Bring on the expert

I didn't think I'd have much to write about before Wednesday's appointments but I was wrong. As I've mentioned before, I participate in a couple different message boards (one for women who have had a tubal reversal done and one for IVF.) These message boards have brought a ton of support, cheers, and shoulders to lean on during the hard times over the last couple of years and yesterday, one of these message boards brought me a great deal of hope about my questionable cervix situation.

To recap my concern about my cervix, after having my first two children (so many years ago with no cervical issues) I had a number of procedures done to my cervix. I had chronic dysplasia for a number of years. Cervical dysplasia is an abnormal growth of cells and is considered to be a pre-cancerous condition. In 1991 I had laser surgery on my cervix and that worked for awhile. In 1997 I had a LEEP procedure. LEEP is loop electrosurgical excision procedure. With this procedure, an electrical current runs through a wire loop and a layer of the cervix is removed in the affected area. Sounds great, doesn't it? Oh just wait...it gets better! In 1998 I had a cone biopsy. This is a surgical procedure where a cone shaped wedge of tissue is cut out of the cervix and removed to check for dysplasia below the surface of the cervix. The thought of that makes my legs cross...tightly! Then later in 1998, I had a 2nd LEEP procedure done. WOW, right??? Now to put this in perspective, women who have had a single LEEP procedure are often warned they may experience incompetent cervix. I've had 2 of those procedures, plus laser surgery, plus a good cone-shaped chunk removed from my cervix. It's no wonder doctors like to say "you barely have any cervix in there" and "it's just a nub of scar tissue".

So back to the message board...last night someone mentioned incompetent cervix in response to a post I made and I said that was exactly what I've been worried about. I told her my history and within minutes she sent me a private message. She urged me to be careful and proactive as she had lost twins to incompetent cervix and suggested that I contact this doctor that specializes in cerclages. In fact he helped to pioneer the TAC (transabdominal cerclage) which is actually a loop placed around the top of the cervix through an abdominal incision. This has a high success rate, but there is risk associated since it is invasive surgery. A vaginal cerclage, where a pursestring stitch is put towards the bottom of the cervix, is more commonly used but has a greater chance of tearing and infection and a lower success rate. I had heard of TACs before but I was unaware that they could be done while one was pregnant so this was exciting news.

Anyhow, this expert in the world of cerclages actually practices just a couple towns away from me. (The other doctor she mentioned practices in Chicago.) She gave me the doctor's email address and said he'll normally do a phone consultation with you within a day. So I sent my email last night and tonight, just before dinner, the doctor called me at home. We talked for a bit about my history and he gave his thoughts on options that may be available. Of course, he cannot give actual recommendations without a thorough examination (I'd be a bit weary if he did) so he asked if I wanted to come into the office this week for an exam. You bet I do!! So I'll be calling his office in the morning and will go for an appointment this Thursday in Camden. At the appointment, he'll be able to measure my current cervical length via ultrasound and have a much better idea of how much cervix I lost from all of the procedures, how much I have left, and the condition of what is left. With that information he'll be able to give a real recommendation on whether a cerclage should be placed and if so, what method we should use. Added bonus - the guy participates in my insurance, thank god!

Can I just say, WOW? This doctor who I have never met, responded to an email in less than 24 hours, calling me at home to talk to me about my history and sharing his thoughts on my possible options. WOW again! This floored me (seriously, how many doctors do this) and filled me with a renewed sense of optimism. In addition to the 2 types of cerclages I mentioned above, he mentioned a 3rd type that may be a good option. It's a different kind of transvaginal cerclage that is done higher up on the cervix so it has the benefit of not requiring invasive surgery like a TAC would, but has more of the "staying" power of a TAC. Of course, we'll know more after he can see what's going on at Thursday's appointment but already I feel like I can sleep a little easier tonight knowing I'm going to see one of the experts in the country that deal with the more complex cerclage procedures. I'm extremely thankful for K on the message board for passing along the information!

So OB/GYN Wednesday morning, RE Wednesday night, MFM (Maternal Fetal Medicine) Thursday...will have much to post as the week goes by!

Thankful for a great Thanksgiving

Hi all! I hope everyone had a great Thanksgiving! We sure did. We had much to be thankful for this year as you all know. We ate too much (well I did anyways - DH is better at moderation than I am when it comes to food.) We spent the weekend with my family. Got to see my parents, my kids, my granddaughter L (who is now walking up a storm), my siblings, and the nieces and nephew. Granddaughter M is due to arrive late February so my DD is into her last trimester now and she's looking fabulous. We just had a wonderful weekend overall. Of course, I think I was a bit wiped out after all of it - after our drive home yesterday I slept for 13 hours, waking only to pee.

Over the weekend, we were all talking about how next Thanksgiving will be even more crowded around the table as DD, SIL, and I are all pregnant. DD like I mentioned above is due in February, my SIL is due mid-May, and I am due mid-July. The thought of all of those new babies around the table brings a smile to my face - I just want to be more confident that that really will be the case for us. At this point there is still a giant "IF" in the room - "if" we make it to to the 2nd trimester, or 3rd; "if" baby A continues to progress; "if" my cervix holds up. I wish I could tame Nelly Negative and let Polly Positive run free, but we've just been tainted by the last 3 losses so I guess it's going to take more time before I stop prefacing every sentence that contains the word "pregnant" or "baby" with the word "if". In time I guess, in time.

To end on a positive (albeit bittersweet) note, this past Friday we made it to 7 weeks, 1 day. This is now officially our longest pregnancy to date since we've been trying to conceive. Just under 33 weeks to go now!

A heartbeat...what a beautiful sight and sound!

Tonight's ultrasound was wonderful, beautiful, enchanting sight and sound. DH even did a cute little wacky dance through the waiting room as we left the RE's office. Can anyone say happy????

Ok, now you've noticed the post title "A heartbeat" and yes that is singular. Baby A is now measurable. It's crown rump length is 5.67 mm and it measured 6 weeks 2 days. We're currently 6 weeks 6 days, but a few days off is not a big deal. (A week or more at this early stage could be a big deal.) It's definitely progressed nicely since 6 days ago when we last saw it. And we saw that fluttering, flickering heartbeat on the screen - oh god, that was beautiful! DH and I were both smiling ear to ear! In fact, if a smile could wrap around one's head, that would have been us. The RE turned the sound on and tried to measure the heartbeat but we couldn't keep the u/s on the heartbeat long enough. But we did get to hear it, although briefly, before the audio would fade back out (at least the heartbeat on the screen wasn't fading out or I would have freaked.) By next week's visit we should be easily able to measure the heartbeat because the embryo should grow quite a bit in the next week so maybe we'll have a better chance of getting an audio clip for everyone (thanks for the suggestion Michelle!)

Now, onto Baby B. It really doesn't look like there's going to be a Baby B for much longer. Baby B has not progressed at all really since last week. The sac is much smaller than Baby A and there is no evidence of a fetus in the sac - no fetal pole or heartbeat. So chances are the sac will eventually just be reabsorbed by my body and we'll proceed with a singleton pregnancy. While it's definitely sad that Baby B didn't progress and most likely won't, a singleton pregnancy would be much less risky, especially with my questionable cervix. At this point we have the attitude that everything happens for a reason. All along we've wanted at least one happy, healthy baby and I tell you what - we are going to love this one baby like crazy!!

So here are some pics from today:

First pic is Baby A - fuzzy I know, but it was measurable this time and we did see the heartbeat - AWESOME!!!



Second pic is Baby B (on the right). The crosses through the sac for Baby B was where the doc was measuring and coming to the conclusion that the sac is measurably smaller than A (shown to the left of B) and there was no evidence of a baby in sac B.



Third pic is one from a distance - or in other words, not zoomed in on the sacs. This pic easily shows the size difference between A on the left and B on the right.



So next week I have 2 appointments on Wednesday. I meet my new OB/GYN Wednesday morning and we go see the RE again on Wednesday night. Can't wait to have another peek at the little one.

I hope everyone has a Happy Thanksgiving! Thanks for being here for me all of these months and the fun will continue, I promise!

New symptoms popping up

Hope everyone has had a great weekend! Ours was pretty good. We drove up to Trenton yesterday morning to pick up more Endometrin. I tell you, the $99.99 we're paying per week for this progesterone medication is a real pain in the hoo-ha, but at least I'll be getting weaned off of this soon when the placenta can take over production of progesterone. We then continued North and visited the Princeton University Art Museum yesterday to view some art & take pics for a paper I need to write in my art class. They have a really nice collection there and the campus is quite beautiful. Then on a more unpleasant note, today I worked for 4 or 5 hours. Blah! Now normally I do NOT work on the weekends but for the particular project I needed to complete, it was much easier to work on it today without email or instant message interruptions and I'm very happy to say it's done! PHEW!

So on to my new symptoms. Yesterday I was nauseous as hell! All nausea, all day. I never did vomit (thank god) but it was that kind of nausea that makes you break out in a cold sweat and you think to yourself, oh, this cannot end well. Wow, I felt like shit! So after our little excursion to Princeton and our lunch date at Applebees, I came home and went to bed. And that my friends was symptom #2. I crawled into bed at 2:30pm and slept for 2 solid hours. It was like I told DH I was tired and within 5 minutes I was out like a light. Now today, the nausea was back to just mild queasiness but after I finished working and eating lunch, you guessed it - in bed and out like a light. So a sudden burst of exhaustion around 2:30 in the afternoon is my latest symptom.

On Friday I did contact a new OB/GYN office that has a number of maternal/fetal medicine specialists on staff and my first appointment with them is December 1st, so only a week and a half away! YAY!! If I wanted to go to their office closest to me I would have had to wait until January 4th, but by driving a few extra miles I can get in over a month earlier. And with my cervix, a month could make all the difference in the world. Pre-term losses due to incompetent cervix generally occur in the 2nd trimester - often between 20-24 weeks. An emergency cerclage (stitching the cervix shut) may be placed at that time (if there is enough cervix left to stitch by that time) but it doesn't always work. At that point it just may be too late to stop the early labor. If a doctor decides to do a preventative cerclage, that is often placed between 12-14 weeks. Those don't always work either, but it's often safer to do them as a preventative measure rather than an emergency measure. So waiting until my 12th week to even have my first visit with the OB/GYN...yeah, that wouldn't be a great idea in my situation. December 1st it is then!

And of course we're still waiting for Wednesday night to get here so we can have our next ultrasound...we just can't wait to see how the little ones will have progressed since we saw them last. Can't wait to post another pic for you all! And lastly, if you'll be traveling this week for Thanksgiving before I make my next post, I wish you safe travels to your destination.

What a wonderful day!

Ok - work is finally done for the day, dinner is done, DH is playing x-Box, and our dog is chewing an incredibly stink bully stick by my feet. So now I am taking a few minutes to write more about today since my earlier post was hasty.

We arrived at our appointment at 9:01 (thanks to shitty traffic) and proceeded to wait 25 minutes for our name to be called. All the while my stomach is so flip-floppy I feel like I'm going to hurl at any moment. What a ball of nerves I was!! And BTW, it wasn't just me. DH had a hard time falling asleep last night as his mind raced at the thought of how today would go, all we're going to need for multiple babies, where we're going to fit multiple babies in our little 2 bedroom apartment, etc. You know, all those things new dads worry about when they realize "Holy shit, I'm going to be a dad!"

Anyway, they called us in, I emptied my bladder, hopped on the table, and the doc & nurse came in shortly after. Doc said her hello's and then said that because this was only the 6 week ultrasound we may not see much. She said ideally what she'd like to see by this point is a gestational sac and a yolk sac. And that if we saw a fetal pole or a heartbeat that's cool too, but we shouldn't expect to see those this early on. Ok, so let's begin. She puts the vaginal u/s wand in and starts moving it around. She said she's going to look around first and then she'll explain to us what she's seeing. I spot the 2 sacs as she's fishing around with the wand but I don't say anything (after all I could be wrong and I don't want to sound like a Miss Know-it-all patient.) So she then says there are 2 sacs and she points them out to us. She instantly spots the yolk sac in the more prominent sac in the picture I posted and at first says she doesn't see a yolk sac in the second one. Then she moves the wand slightly and says, "oh wait...yep, there's a yolk sac in both." WOW!!! We're thrilled!! So 2 sacs, 2 yolk sacs - AWESOME news! The picture she gave us wasn't the best one, but oh well, we're just happy to have this first pic of our little ones.

Doc is happy with the results and says we'll repeat the u/s next week and that one should be the "fun one". By next Wednesday night when we have the u/s we'll be 6 weeks and 6 days so there's a really good chance of seeing the heartbeats. (Still a chance that we won't see them, but good chance that we will.) And the doc that's doing the u/s next week is my fave, Dr V. As you remember, he's the one who did my emergency surgery in August and managed to save my last ovary. So that u/s will be Wednesday night at 7:45pm - odd that they'll be open that late the night before Thanksgiving and damn that's going to be a LONG day of waiting for that appointment but hey, we'll take it!

So where do we go from here? Well, we certainly don't run out and buy two of everything yet. I'm no Debbie Downer, but I'm a realist and at this point we've seen 2 sacs with 2 yolk sacs, but a heartbeat is what we need to see before we can really say "We're having twins". Even DH said he feels the same way - like we're both beyond excited that so far everything is looking great and it looks like we're having twins, but it won't really sink in and be official until we see the heartbeats. Because a lot can happen in a week - perhaps they'll both have beautiful strong heartbeats next week (would love this option.) Perhaps one of them will just stop growing and we'll be down to a singleton (don't like this option but it does happen often and we'd love one as much as we'd love two.) There's even still a chance that there could be more than 2 heartbeats. If one of the embies split, one of the sacs we saw today could end up having a set of identical twins in it. (This most likely will not be the case, but it could happen and scares the shit out of me.)

So yeah, we'll wait to see what happens before we go stocking up on baby stuff, but I do need to call the OB and get my appointment made for after the RE releases me in a couple weeks. Since I'll be a high-risk patient now for 3 reasons (I'm old, it's multiples, and I have a cervix that may need to be stitched up) this blog will probably be hopping the entire pregnancy with OB & perinatologist appointments left & right.

But for now I'm going to sit back and smile. We have 2 lovely sacs with yolk sacs. They are in the uterus this time so it's not an ectopic pregnancy. Within the next week, we'll get to see our new additions again. And then the very next day we'll spend a wonderful Thanksgiving with my kids, my granddaughter, my siblings, and my parents. Life is very, very good.

Double the fun with TWINS!!

Only have a minute here so I'll come back on for more later but so far it looks like TWINS!! I say so far because at this point we were able to see 2 gestational sacs and each sac had a yolk sac but until we see heartbeats, we won't know for sure. But what we did see were all good signs for only being 6 weeks along. The doctor was not at all worried about not having heartbeats and such yet since it is really early - as she put it "the next ultrasound is the fun one". So we go back next Wednesday night for ultrasound #2 and hopefully we'll see more development and heartbeats. For now, here is the first picture of our babies. I've circled the 2 sacs so you can see what the heck I'm talking about. WOO-HOO for 2!!!

Big day tomorrow

Wow! Tomorrow we'll be 6 weeks pregnant! Can you believe it's already been two weeks since I had my first beta and found out we were "officially" pregnant? These last two weeks flew by! But the bigger deal about tomorrow is it's......drum roll please...........ultrasound day!

So here's what tomorrow's ultrasound will tell us. If you remember from my ectopics, when I went for my ultrasound the gestational sac was seen outside of the uterus. This time we want to see that sac (or sacs) INSIDE the uterus. Now that I have no fallopian tubes we have a much better chance of NOT having an ectopic, but you never know so that will be one thing they check.

At this point if all is well, inside the gestational sac they should be able to see, at a minimum, the yolk sac and a fetal pole. The fetal pole is actually the start of the fetus and the crown-rump length will be measured. At this point it's so small it will be measured in millimeters. But this measurement helps to give them the "age" of the fetus. For example, I may be 6 weeks pregnant tomorrow, but perhaps it will measure a little smaller, like 5 weeks and 4 days.

They will also see if the heartbeat is visible. The heart usually starts beating in the 5th or 6th week so we may get lucky and see the heartbeat(s) tomorrow - and boy, I sure hope we do. If no heartbeat tomorrow, it could just be too early and we'd need to go back sometime next week to check that the heart(s) has started beating. If we see that heartbeat tomorrow, we can relax (just a little) as we'll have made it through this first hurdle. Ok, in the infertility world maybe this is really our 100th hurdle but you know what I mean. Miscarriage rates decline some after the heartbeat is seen.

And then there's the million dollar question EVERYONE wants to know - how many are actually in there??? The poll is showing twins still in the lead so we'll see if that holds true tomorrow. Like I mentioned a few posts ago - it could be one really strong one. Or it could be 2, 3, or if some split after the transfer it could be 4 or more. We just won't know until the ultrasound tomorrow. Now if there are multiples and they're each in their own gestational sac, we'll know they were separate embryos that survived. If any multiples are in the same gestational sac, we'll know an embryo divided after transfer, thereby creating identical multiples.

So with all of that, now we just wait...12.5 hours to go. Now I just have to figure out how I curb this excitement to actually get some sleep tonight. Good luck with that right??

4th beta - 11,603!!!

I had a dream last night that the nurse called with my numbers and said they were 1099. And she seemed happy by this number while I was sobbing uncontrollably saying "you dingbat, that means my number went down!" Why I called her a dingbat, I do not know!

But dreams are definitely not reality today. The nurse called with my 4th beta results and as you saw in the post title, the result was 11,603!!! Doubling time is 50 hours and OMG, we are so excited. What a wonderful Monday!

And now we're so close to seeing what we've got cooking. Now we just wait for the ultrasound. BTW, is it Thursday yet???

Much better today

Definitely feeling better today. For one thing, I haven't been crampy at all, except for the pinchy pully cramps in the uterus area and I know that feeling IS normal and good. But no hot-period-feeling cramps today. And second, no spotting whatsoever today. Goop stayed white, Amanda stayed happy! I feel kinda silly for getting nervous yesterday, but then again after all of our losses I guess nervousness isn't so silly of a reaction. So today, feeling more myself, I got my hair cut (desperately needed a good sprucing up) and got through the homework I've been putting off for the last few days. Two things scratched off the to-do list, yippee!

I'll head to the doctor's tomorrow morning at 8am for my next beta and then start the intolerable wait for the results phone call starts. That wait is so yucky!! I swear, I carry my phone with me EVERYWHERE on beta day with the ringer on high. And despite these safeguards, I constantly check my screen to make sure I haven't missed a call. I know, I'm a nut!!

So, where do we want the results to fall? Thursday's beta was 3066 and this beta will have been 4 days later. So to have the number double within 48-72 hours, we want to see that number between 7726 - 12263 (of course higher than 12263 is super fine too!) Basic rule in this case - the higher it is, the happier I'll be.

And ladies and gents, just think - only a few more sleeps until ultrasound. We already have sparkling apple cider chilling in the fridge for after the event on Thursday and DH was asking me if I think they'll give us a picture while we're there. Hell, I'll beg for one if I have to. We just want to be able to gaze for hours at that first baby picture! So with our beta tomorrow and ultrasound on Thursday, I think this is going to be a very exciting week!

No pink goop this time

Ok, I feel a little less nervous. I'm still crampy but not as bad. And as I did my second suppository of the day the plunger was back to having white goop on it. That's right, no pink goop on the plunger this time! I'm sorry, I know that's such an unpleasant image but hey, I warned you when I started this blog that it may be loaded with TMI.

So say it with me now - YAY for white goop!!