9 weeks

I'm officially nine weeks along and am crossing my fingers that the morning sickness begins to ease up soon. We had a pretty good weekend (i.e. no puking or near-puking encounters) although we did nothing but sit inside with the air conditioning on. I left the house once to go to Whole Foods where I filled my cart with Vitamin water, vitamin B6, Preggie Pop Drops and some other herbal concoction that is supposed to help with pregnancy-related nausea. Thumbs up for the Vitamin water, I am finally getting enough fluids. For some reason plain water and seltzer taste just aweful to me, and I don't want all the sugar that comes with soda and juice so the Vitamin water is a happy compromise. I'm making a conscious effort to each more which does seem to help.

My husband has been hilarious about the possibility of having triplets, coming up with all sorts of scenarios, some more realistic than others. He's excited that he'll be able to organize 2-on-2 soccer games (I'll be sitting on the sidelines drinking lemonade). However, he thinks we should forgo cribs in favor of just lining up the babies on the bed in our spare room. When I suggested that they might wiggle their way off the bed, he said we'd wrap them up like cocoons so they couldn't move. I mentioned wanting to use cloth diapers (we estimated we'd have 27,000 diaper changes by the time they're potty-trained) and he was adamant that "single use" diapers are the greatest invention since babies themselves. When I expressed my worry about the logistics of taking three kids somewhere, he told me he'd design a carrier for three babies with two on the front and one on the back and that he'd be sure to rotate them so they all got equal time in each spot. It's pretty funny, even if he clearly has no real concept of what small babies are like.

I'm not putting a due date ticker on the blog yet. Our likely gestational time is somewhere around 34 weeks which puts us at the end of January/beginning of February. Once we get a bit further along and accumulate more evidence that things are going well I might put one up.

Deep breath in

More than twenty-four hours have passed since we received the shocking news of our triplet pregnancy. Even with the three ultrasound photos on the fridge it doesn't seem real that there are three little beings inside me. That I might have three little babies by Valentine's Day. Wow.

We took the day off yesterday to process the news and make some plans. My wonderful husband came to me and said that everything was going to be alright, that this is our life now and we will rally the troops and do what needs to be done going forward. I also learned that no maternal fetal medicine practice wants to see us before 11 weeks even for a triplet pregnancy, which kind of surprised me. I guess all the risks associated with high order multiples come later and the first trimester is the same solitary ball of suckiness that any pregnancy is. So, I feel like we have time to breathe now.

Morning sickness (a.k.a. constant-will-it-never-end-I-want-to-crawl-under-a-rock-and-die nausea) continues to up the ante. There has been vomiting both at home and at work. Food in general continues to repulse me. We went to the grocery store last night and the smell from the seafood counter nearly knocked me over. I stocked up on my go-to nausea foods: Welch's grape juice (purple), gingerale, gluten-free pretzels, gluten-free crackers and some healthy foods I thought I could snack on all day (baby carrots, grape tomatos, apples, grapes etc) as well as some junky foods that sounded good like olive and pimento loaf and processed cheese slices. Each day I feel worse with fewer periods of reprieve, it's quite amazing actually, and very scary given that there are weeks left before I might expect some relief.

*Thanks to those of you who are hanging in there. I am delighted about my pregnancy, but the truth is that pregnancy is really scary and I feel the need to talk about those feelings here. I know there are many readers out there who are dying to be in my shoes and I hope to read about your BFPs and your own pregancy experiences soon*

A-B-C...1-2-3

My head is spinning: we currently have a viable triplet pregnancy. Three embryos, three separate sacs, three strong heartbeats, all measuring at exactly 8w2d. My RE looked at my report and said "I wouldn't have expected that 3 follicles was too many for IUI in a 39 year-old, but apparently it was." Holy mother of triplets, I'm terrified. Of the pregnancy, of the many possible poor outcomes, of having three infants to manage. And I know enough about multiple births to realize that you don't enjoy more than one newborn, you cope with them. My youngest two brothers are twins and I think taking care of them nearly robbed my mother of her sanity, quite honestly.

Even though it's early, we decided to tell our families and a couple of close friends who have been through difficult pregnancies. Really, at this point if something catastrophically bad happens, we'd tell them after the fact, so why not let them know now was our logic. Officially, we are pregnant and delighted and looking forward to happy healthy babies this winter. I know we have a long road ahead of us, and for now we're just going to take it one day at a time.

If anyone has thoughts or recommendations on high risk pregnancy specialists in the Boston area, please send me an email.

Crisis averted and weird dreams

I talked to the coordinator at my clinic and I can have my ultrasound tomorrow as scheduled. For some reason they only schedule them at 9 am which is the absolute worst time for me to get away from work. When it became apparent that I wouldn't be able to get in until next week we managed to work it out so that I can keep my original appointment. Phew! Given my current state of mind/body, it would have nearly killed me to have to wait another day, much less another week, especially given the fact that I would have gone in last week had I not been on vacation.

In other news, I've been having really weird dreams, some more obviously pregnancy-related than others. In one dream, my husband and I were handed quadruplet boys and were trying to sit them down side-by-side in the front seat of a convertible so that we could drive them to daycare. They were super slippery and kept falling into the space between the car seat and the door and I was trying to grab them by their arms and legs to pull them back up. One looked like an exact miniature of my husband and sat very calmly on the seat without moving. I picked up one of the wiggly ones and asked him his name, which was something odd like "Mandingo" and also why they were all boys when we had requested some girls. His response (of course he talked like an adult) was "you don't get to make those requests, that's not how it works." My other dream had me babysitting two sets of twin girls who were about 3 years old. For some reason their parents, who I didn't know, had let me take them to Costa Rica for a week. Two dreams with four kids in each, I hope it's just my paranoia about high order multiples and IUI and not foreshadowing of the future.

Home and sick

We had a good vacation. Great to get away and visit family that we only see once or twice a year. But, wow, was it hard to deal with the morning sickness and remain incognito regarding our pregnant status. Consider, for example, a brief list of things that made me nauseus while on said vacation. Items on the list include, but are not limited to the following:

*meat; appearance, smell and thought of

*fish; appearance, smell (especially if grilled or fried) and thought of

*coffee; appearance, smell and thought of

*cigarette smoke (not that I liked it before, but now even the faintest whiff makes my head spin)

*heat greater than 25 degrees celsius

*riding in a car on windy mountain roads

*the thought of eating

*not eating

We spent a week on the Croatian coast where it was stinking hot, didn't cool down at night and even with the A/C was well above 30 degrees celsius the whole time. We drove there and back from Sarajevo, through the mountains and around 76,000 stomach-churning turns. My husband's family, like all Balkans, eat a hot mid-day meal every day starring some form of meat or fish. I've never been a fan of a heavy lunch, especially in hot weather, but I've always liked my mother-in-law's cooking. People were perplexed at my small appetite, "you eat like a bird, are you on a diet?" but seemed to accept my explanation that it was hot and the food was heavy. They have always treated me like a bit of a delicate flower, with my fair skin and Northern European heritage, so I wasn't that conspicuous in the end (or so I think).

Three out of the six people in the house were practically chain smokers and Croatia recently repealed their smoking ban in public places; apparently it was interfering with people's civil rights to lung cancer or some such thing. Holy, holy, this was the absolute hardest thing about being pregnant on this vacation. I had three migraines, each triggered by cigarette smoke.

Somehow I managed to deal with the morning sickness by avoiding all of the activities on the above list and making sure my stomach was never empty. Which was difficult, given my almost complete aversion to food. It's weird, I sit down to eat, convinced I can't put anything in my mouth without hurling but after the first few bites I'm ok and can finish about a third of what I would usually eat. After eating, I feel better for an hour or two and then the bile starts to rise and I have to eat some carbs of some sort or drink juice. I also napped a lot, like an hour after every meal, and slept 10-12 hours per night but was never refreshed.

I am grateful for the constant reminder that I am, indeed, pregnant but am struggling to figure out how I'm going to manage at work. My job requires a lot of energy; I manage multiple projects and a lot of people depend on me being on top of things on a daily basis. There is no room for taking it easy over the next few weeks, or taking a lot of sick time, especially after having been away for two weeks on vacation. I guess I'll figure it out starting tomorrow, but I'm pretty stressed about the situation.

I also came home to a message from my clinic rescheduling my ultrasound and I may not get to have it this week which is a huge disappointment. I'll know more when I call in the morning.

One part queasy, nine parts paranoid

I woke up this morning feeling a little off. You know that fuzzy feeling of impending illness that precedes a virus where you don't feel sick yet, but you know something bad is around the corner? That's how I felt: I even told my husband I thought I was coming down with something. I skipped breakfast because I just wasn't hungry and headed to work. As I was walking through the parking garage, I started to feel really unwell and actually dry heaved a little but managed not to throw up - phew. I was convinced I was going to have to go home sick, but I had a meeting I had to attend first and was just hoping I could make it through without having to run for the bathroom. By the time the meeting was done (an hour later) I felt fine. No more sense of impending doom, no more queasy feeling and I was hungry enough to eat a Snickers bar. So weird. Does morning sickness feel like a virus, with chills and the works? I always assumed it was just nausea, like you had eaten something that disagreed with you as opposed to full-on stomach virus symptoms.

Now my dentist knows too

My husband asked me the other day if I was having a hard time refraining from telling people we're expecting. Truthfully, it doesn't feel real yet (still no symptoms) and it hasn't been difficult to remain mum on the subject. Until this morning, when I went in for a routine dental appointment and told the hygienist that I am pregnant in response to her inquiry about whether there has been any change in my health since my last visit. She congratulated me, as did the dentist and even the receptionist who had heard about it by the time I was checking out. It was really fun to tell someone, even though I felt like a bit of a fraud, since all the proof I have are the two betas and being one week late. I did learn that pregnant and nursing women should go in for cleanings every three months because the hormones can cause problems with your gums, so that's good information to have and probably worth the early disclosure.

We are leaving Saturday for a two week stay with my husband's family. Let's just say that we will be living in very close quarters and they are very observant and not afraid to ask questions. So, even though I feel fine today, I'm hoping* that I will start to have some pregancy-related symptoms while we are away. We're trying to figure out how to keep our news from his nosey family who will wonder why I'm nauseous or not drinking and whose first question when someone is ill is if she is pregnant. Honestly, they are lovely people and a very close-knit family but they are used to full disclosure (I can't tell you how many diarrhea stories I've endured over the years) and we want to keep this on the QT until we are out of the first trimester.

*Not that I'm some kind of masochist who is looking forward to nausea and fatigue, but a few symptoms would help reassure me that this pregnancy is still progressing.

Scheduled

The OB ultrasound with my clinic is scheduled for August 12, the day after we return from vacation, and also my mom's birthday. I'm hoping this is another good omen, just like the Cheerio was.

It's official!

Ok, even I am convinced that I'm pregnant now. My beta this morning was 848 and according to this handy calculator, my doubling time is 2.21 which is textbook perfect. I can hardly stand the excitement! The next hurdle is the OB ultrasound which they want me to go in the week of Aug 3, but we're going to be on vacation so I imagine I'll go in the week after. I know there's a long road ahead before I can cross "healthy pregnancy" off my parent-to-be check list, but today I'm just happy to be right where I am.

My heart is so full, I wish I could buy a round of BFPs for everybody who's been hanging out at the IF bar with with me.

Processing

Thank you all for the kind words yesterday, I really appreciate it. I spoke with the nurse and she said that the plan is to look for doubled beta by Thursday and then she will schedule my OB ultrasound at ~6.5 weeks, and assuming all looks good, they will discharge me to my regular doctor. Who I actually have an appointment scheduled with next week for a pap in anticipation of starting IVF in August. I might as well keep the appointment, who knows what could happen, plus it took me forever to get the appointment. Since I only started seeing her a year and half ago, I don't know her really well, so I'd like to chat her up a bit and make sure she's someone I want to continue with should this turn into a full-fledged pregnancy. I'd always assumed I would go with a midwife practice, but I'm not even sure if they take women at my age.

As for pregnancy symptoms, I really have none. Still a little crampy in a PMS kind of way and I feel slightly dehydrated but I've never seen that listed as a symptom. I feel totally normal, it's surreal to think that there might be a collection of cells burrowing into my uterus as I type this. (You can thank my husband for the imagery, he's full of medically correct but unromantic terms for this process).

In retrospect, I have been unusually tired the past few days, but we've also been really busy. We spent the weekend with friends who have an almost 3 year old which was really fun but exhausting. Last night friends from out of town stopped by for a BBQ with their two girls who are 6 and 4. Holy, holy, they had energy with a capital 'E'. They immediately started stalking the cats, going so far as to crawl under my bed to find the big one who is terrified of children. He quickly exited to the basement, but the little one had no such luck and was purred at and petted to within an inch of his sanity. Fortunately he's really good with kids (even at his advanced age and with his medical issues) and he did score a piece of chicken that one of the girls dropped on the floor. When they left at 10 pm I headed straight to bed, I was completely worn out and didn't even clean up the kitchen until this morning.

The glass was half full

Unbelievable.

After all the negativity and planning for the worst, my beta came back at 332. They will repeat on Thursday and then will determine whether or not I am truly pregnant. I almost skipped the beta today because I was feeling so crampy and expecting my period any minute. Huh. Dumbfounded would be the correct term to describe my current state.

I'm holding out for the repeat on Thursday before getting too excited but, wow, just wow.

If I wasn't feeling bad enough already...

Christ on a cracker, my clinic will simply not give me a break! Mere moments ago I received a phone call from the pharmacy about the prescription that was just faxed over for my next round of IUI meds. The IUI cycle that will never happen because if we do end up with a BFN on Monday we are switching to IVF and our RE knows this. We have, in fact, scheduled a consulation on the 24th to discuss this very thing. I told the pharmacy to put the order on hold while I called the clinic.

Fortunately, considering it is the first sunny Friday afternoon since May, a nurse was actually still at the clinic and picked up my call. She looked into my file and was appropriately surprised when she saw that I hadn't even had my beta yet. After a little more investigation, she explained that someone had verified that I had insurance coverage for another IUI cycle which automatically triggers a medication order. Once I explained that we were switching to IVF, she quickly said she would cancel the prescription order and put a note in my file. She even apologized, which was nice since she isn't the IUI nurse that I usually deal with and so was in no way culpable for the error.

I am a little irritated, not that I was inconvenienced in any real way, but that I am so clearly a number and not a face at my clinic. There is no personalized attention being paid to our particular situation, no one is trying to address our particular flavor of infertility, we are just chugging along the ART assembly line with everyone else.

And the doubt creeps in

Yeah, so I know I'm supposed to be gently incubating during this time between IUI and beta, but the reality is that the closer I get to Monday the more I Google to try to figure out the odds of getting a positive based on our particular circumstances. Not that it's even possible to figure out my exact chances, but I've been looking at studies of sperm quality and IUI pregnancy rate, stimulated ovulation IUI at my age and pregnancy rates etc. And the numbers, they are not good whichever way I look at them. First there's our male factor issue which was deemed "minor" by my husband's urologist, "suitable for IUI" by my RE and "pretty frickin hopeless" (my definition) by the literature. Most studies talk about requiring at least 10 million motile sperm after processing for pregnancy to occur, our sample was only 2.5 million. Other studies mention needing pre-processing motility to be >50%, ours was 26%. Rate of progression needs to be at least 3, our sample was rated a 2. Pregnancy rates overall for IUI were only about 7% per cycle for couples in circumstances similar to ours. No need to start thinking about painting the baby's room, that part seems clear.

I know they are just numbers, and a 7% chance is not insignificant enough for me to indulge in a pitcher of margaritas with a clear conscience, but chances, they are slim. I guess all I can do is wait for Monday and try to prevent myself from wasting $10 on an HPT.

1ww down, 1 to go

Seven days until my beta and, frankly, I don't feel a thing. No inklings, no hunches, no dreams about babies. Not even any anxiety about whether or not I am pregnant, not tempted to POS. Nada. We managed to have a relaxing weekend away in Vermont. A little hiking, a visit to the Trapp Family Lodge for dinner (their restaurant is excellent), a little sunshine and a whole lot o' rain. So, here we are back to normal life, back to waiting. I did go ahead and schedule that follow-up appointment with my RE in a "hope for the best, plan for the worst moment." Fun times.

And I thought things were going well

Not 30 minutes after I arrived at work (post-IUI) I got a call from my nurse scheduling my beta and asking me to make a follow-up appointment with the RE to discuss the next step. Reminding me that this was our third IUI (really, second) and we needed to think about what to do next. WTF??? Evidently, this IUI was already considered to be a failure less than an hour after it was over. I'll admit we didn't get the best sample, the numbers were considerably lower than for the first IUI, but they were still in the range that was acceptable for IUI. Couldn't they have let me enjoy the post-coital glow (so to speak) for a little while before getting all doom and gloom on me?

And on a tangental note, what do I have to do to get them pronounce my name correctly when they call me? Seriously, if one more allegedly literate person calls me "Elsie" after reading my name from my chart, I'm going to explode. Honestly, does anyone actually name their children Elsie anymore? I just don't get how so many people can mess this up. Internets, don't name your daughters Elsie, it sounds like a cow. And if you name them Elise, put a "y" in it like the mom on Family Ties because there are a lot of morons out there who will transpose the "i" and "s" which will result in a lot of cringing for your undoubtedly lovely daughter.

And that's all I have to say right now.

Your eggs are cooked

So said the ultrasound technician this morning after measuring my follicles. The left one is now 22 mm and the 3 on the right are 16, 16 & 17 mm. Ovadril tonight and the IUI is scheduled for Monday morning. Of course I have two meetings first thing Monday, fortunately I called both of them so I can easily move them to later in the day. Maybe I'm just more comfortable with the process, but I feel really good about this cycle. Fingers crossed.

Cautiously optimistic

Things appear to be progressing nicely, the follicle on the left is now 19 mm and there are now 3-13 mm follicles on the right, with my estradiol level up to 753. I am to take another 150 units of Gonal-F tonight and then go back in tomorrow morning for monitoring. When I pressed the nurse for more details (I'm getting much better at this) she said we are aiming for 3-4 follicles that are at least 16 mm in size and that she "wouldn't be surprised" if I used the trigger shot tomorrow night. I asked if the larger follicle on the left was problem and she said that it is likely to be re-absorbed and that we are really only working on the 3 on the right. I can't remember the exact details of our first IUI cycle, but I think we were in a similar boat with 4 follicles but one much larger than the others, except that time around using twice as much FSH. So far, so good.

In other news, I found the results of this study to be sobering. They were looking at the rate of live births in a cohort of women undergoing up to 6 cycles of IVF at a clinic in Massachusetts. In the paper they claim that they picked 6 cycles because Massachusetts has a mandate that fertility treatments must be covered by insurance, and that typical coverage in this state allows for 6 cycles. I live in this state and I definitely don't have enough coverage for six cycles of IVF: my insurance caps my coverage for fertility related treatment at a dollar amount that might pay for 2-3 IVF cycles, which is one of the reasons I insisted that we start with IUI (the main reason being that our doctor said we were good candidates). Anyway, the main findings were that the chance of having a pregnancy resulting in a live birth after six full cycles of IVF were between 65 and 86% for women under 35, but only 23-42% for women over 40. That's less than a 50% chance that I will take home a bio baby after a lot of treatment, much of it that will not be covered by insurance. I never really believed the statistics about the rapid decrease in fertility after the age of 35 because it just wasn't part of my life experience. My mom had a surprise pregnancy at age 37, one of my best friends just had her first baby at 40 after barely trying. I know their experiences don't mean anything for my odds, but hey, when you're not trying to get pregnant you really don't pay attention to these things.

I don't know how far I want to take this. Personally, when it comes down to whether or not I would pay out of pocket to continue trying to get pregnant after my insurance runs out, right now I don't feel inclined. Given my odds (I'll definitely be on the other side of 40 by then), I think I would rather spend the cash on adoption fees, assuming my husband is on board. Hopefully I won't have to make that choice, but hey, I like to be prepared.

CD8 by the numbers

3 measurable follicles: 2 on the right (11, 12 mm) and 1 on the left (15 mm)
2 more days of 150 units Gonal-F, then back on Friday for monitoring

1 last day of rain and cold before we see some sun

And so, it begins

It's CD3 and I've taken my first hit of Gon.al-F, courtesy of my awesome husband who is always willing to help me out with the shots. Even though they're subcutaneous and via a superfine needle, I much prefer having him do the injections. Funny how we both find it so much easier to be the caregiver than the patient. Four more days of 150 units and then I go in for monitoring on Wednesday morning. I can't quite believe that this seems normal to me now, the hormones and the blood draws and ultrasounds.

Game on

As anticipated, CD1 has arrived and we begin our last IUI attempt. Third time's the charm, right? At least I have the pleasure of driving to and from appointments in my shiny new (to-me) car. We ended up with a 2008 Hond@ CR-V and I think she and I are going to be great friends. It was a close contest between the CR-V and the T0y0t@ RAV4, but in the end I decided that the hatch-style rear door of the CR-V was going to work better for me. When we test-drove it I found a single Cheerio under the rear seat and took that as a good omen for this cycle. I've got my appointment with the anesthesiologist this morning, hopefully I come away from it reassured about my options if we get the point of IVF.

Hey, does anyone else use Tylenol for cramps? I am dutifully staying away from Advil, but don't think I can get through the next few days without some form of pain relief.