Life with Twins + 1: Long Overdue Update

So I don't know whether this blog continues to get any traffic, but it suddenly occurred to me that there should be an update of sorts.

Our twin boys Quinn and Liam were born at 30 weeks and 4 days (10 weeks early) on December 29th, 2014 after a very complicated pregnancy. I had TAPS (Twin Anemia-Polycythemia Sequence), which is a rare subset of Twin to Twin Transfusion Syndrome. This started developing at the 16 week mark of my twin pregnancy, and I was monitored fortnightly with ultrasounds until 24 weeks, then it was weekly, several times a week and DAILY by the end. I wasn't admitted early to hospital on bedrest purely because of 3 year-old Rowan at home. But I did spend half of my day at the hospital by the end of it.

Being a mother to premature twins was confronting and our boys spent 6 weeks (Quinn) and 10 weeks (Liam) in the NICU, followed by Special Care Nursery. Liam was diagnosed with Neonatal Chronic Lung Disease and spent eight months on home oxygen before being weaned from it in August 2015. Quinn suffered a minor brain bleed (IVH)  in the early days after birth but scans have showed that there is no longer any evidence of a bleed... phew!

Both boys are now 15 months old (12.5 months adjusted age) and are currently walking, learning to talk and being extremely cheeky to 5 year-old brother Rowan, who continues to adjust to his life being turned upside down by twin toddlers on a daily basis.

4 days before I delivered our twins (30 weeks exactly here)

Liam and Quinn shortly after birth, TAPS confirmed upon delivery via emergency c-section.

Leaving hospital for the last time, 10 weeks later!

3 months old (Liam is on the left in all pictures from here down)

6 months old

8 months old

10 months old

Happy 1st Birthday!

14 months old with big brother Rowan at Easter 2016

While I don't really update this blog regularly anymore (it was there for me back when I needed the outlet), I post regularly on Instagram as Aurian82. If by some chance you're reading this and want to connect, you can find me there. xx

7 Weeks... it's TWINS!

Yesterday we discovered at our first ultrasound that there are in fact TWO babies on the way!

On the trip  home from the scan Matt and I started discussing the logistics of not being able to fit three child/baby seats across the back of our car and what that would most likely mean for our family (I don't like driving huge cars/4WDs), double prams, and will we ever get any sleep again after the babies are born?!

However, it's all so far away (and yet.... it isn't!) and as we're both thinkers (as opposed to do-ers) it's time to start talking about it. Then there's the fun part of coming up with extra baby names (squee!) and deciding such things as finding out the sex of the babies before they're born. We were leaning towards waiting until birth to find out had there been one baby, but now that there's two we'll probably find out for practicality reasons. Not that I'm displeased with that, unconsciously I think I probably wanted to know anyway.

Three children when both Matt and I saw our family with two? If this all works out, we are definitely done now!!

So here is what we know so far:

• The babies are identical
• Our single embryo split into two before it implanted into my uterus (basically a 48-hour window between the embryo being thawed and implantation beginning)
• Each baby has their own amniotic sac (a VERY good thing, I'm so relieved!)
• The babies share a placenta (so there is a potential risk of twin-to-twin transfusion syndrome developing, worst case scenario)
• My due date is still in early March, but it's likely that they could come in Jan/Feb, depending on how everything goes (scary...)
• I'll be monitored more closely because of the twin pregnancy, mostly through ultrasounds (which could be as often as every 2-3 weeks)
• This will make one heck of a pregnancy scrapbook!

When it was all sinking in yesterday (put it this way, Matt's initial responses to the ultrasound technician telling us that the embryo had split and there were two babies was a loud "OH SHIT!", and I could barely say a word except for muttering "TWO! ..... TWO! ..... TWO!"), my best friend gave me a good laugh. She said that the weakest of our embryos (as I called it, this one took 6 days to get to the 5-day blastocyst stage suitable for freezing) thought "I'll show them..." and went above and beyond the call.

And indeed it did! It also made me realise that this little one decided upon the stealthy 'divide and conquer' approach to survive, so now I have dubbed their collective tummy name as 'The Overlords'. No peas in a pod around here, that's for sure!

(and it's amused me today because I can throw random comments into the conversation such as "the overlords are hungry" and "the mission for uterine domination continues". Ahh, small things :P)

So here they are, meet the Overlords, both measuring at 6w5d (Rowan always measured two days smaller also).

In the picture, you can see one yolk sac in front of the other (the circles in the middle), with a baby at the top and bottom.

5 Weeks Pregnant

After using the last of our four frozen embryos (from 2010), a very straightforward transfer followed and the wait to the pregnancy blood test begun. 

There were a few things we did differently this time which may or may not have contributed to finally getting that elusive implantation:

• Acupuncture (immediately before and following the embryo transfer)
• Progesterone support (400mg pessary, twice daily)
• Dilatation & curettage (D&C) in the month prior to our transfer cycle 
• Herbal support from my naturopath (I have a post-transfer mix that I take 3 times daily)
• Keeping a consistent body temperature (no super-hot showers or very cold foods/drinks for 5 days following the transfer; blastocysts are temperature-sensitive)
• Taking it easy (no heavy lifting)

I'd like to hope that one or several of these things tipped the scale in our favour (or simply, that what we thought was our least strong embryo - left until last - was the one that actually came through for us). 

I am on progesterone support for rest of the first trimester and while it's a bit yucky, if it means a healthy pregnancy for the next couple of months then I will gladly continue it.

I found out about this pregnancy at 6dp5dt, I had a temperature shift (37.3C from 36.8C) following a day of mild cramping (I put this down to implantation in hindsight) and woke up in the middle of the night with a rapidly beating heart and sense of something being 'different' in my body. This intuition was pretty much how I realised I was pregnant with our son (now aged 3) so immediately recognised it. I got up and took a test... and sure enough it was positive!

This wasn't the original in-the-middle-of-the-night test, but
instead one I took the next day to confirm BFP.

Normally I wouldn't test so early during a FET cycle but the signs were too strong for me to ignore. I am sensitive to HCG and have a strong sense of what's going on in my own body. In our other (unsuccessful) transfers, there haven't been any moments like this, just continued failed cycles after 5, 6 or 7 days post-transfer (another reason I pushed our IVF specialist for progesterone, following self-research). 

I have had two blood tests recently - one at 10dp5dt (15DPO) and another at 16dp5dt (21DPO). The first came back with HCG=198 / Progesterone=128. The second showed HCG=1600 / Progesterone=100. I have one more blood test in a week's time, and then our first ultrasound (!!) booked for 7w0d to confirm sac and heartbeat etc.

In the meantime I'm continuing to parent our three year-old son while starting to get hit with tiredness (hello Nana nap!), queasiness in the afternoon and growing breasts (I'm small up top to begin with so changes there are generally pretty obvious). I've taken a 'beginning' belly picture but won't post it just yet until I've got something to compare it to - last pregnancy I took pictures weekly but this time I think I'll do it every two weeks (or at least in the earlier stages).

My due date is March 5th, 2015 (two days shy of my 33rd birthday). :)

Psst...

It worked!!!

FET #4

After my surgery last month in preparation for our upcoming Frozen Embryo Transfer (the fourth one since November 2013), we're getting ready for transfer day this week.

The surgery itself went smoothly with little recovery time and, after the effects of the anaesthetic were out of my system, I felt back to my usual self. The last time I had a D&C (dilatation and curettage) was back in 2008 along with the diagnosis and partial removal of endometriosis, and the recovery time was a little bit longer so I wasn't sure what to expect this time around.

Ready for surgery, supportive husband is tired.

I started taking progesterone a couple of days ago (the first time I've had medication as part of a FET cycle) as my cycles are on the shorter side. My IVF nurse and our specialist agree that my body might be getting ready for a period before our embryos get a chance to implant properly and start pumping out HCG. So here goes nothing, hopefully progesterone is the last piece of the puzzle in our failure to conceive through FET cycles so far. In comparison, the cycle that our son was conceived in was an IVF stim cycle (with progesterone support in the second half of the cycle).

So far so good in terms of the hormones, I've been slightly crampy for the past 24 hours (like in the lead-up to a period) but nothing major. Hopefully I don't get too many other uncomfortable side effects with it, time will tell.

Next time I update will hopefully be news of a successful embryo transfer in three days time!

Scrapbooking Infertility and/or IVF Journeys

Here's the thing about scrapbooking... most of it is about showcasing happiness and contentment. I've fallen victim to this too in the past - it's easier to put on your rose-tinted glasses and write/create about what makes life great.

But what about the aspects of life that aren't so great? In my personal case, I'm talking about loss, infertility and IVF. Back when we were trying to conceive Rowan, I didn't include our infertility journey in any of my scrapbooking. I kept this blog (private at the time) as a place to get out all of my feelings about the process, and in my eventual pregnancy album made a single page where I chronicled the path we took to where we ended up:

(click image to see more detail)

In reality, the journey to conceive a child could have very much been a separate album. It might not have been the most positive album in parts, and over time I've learnt

FET #4 Preparation

Looks like we're about to start again! Saw the IVF specialist today and I'm booked for surgery in 4 days (a curette) to clear everything out and encourage positive immune response to embryos. It's all a bit over my head at the moment and very quick turnaround time, but at this point in time we'll give almost anything a try once to get my body in peak condition to welcome an embryo!

For more information about what we are trying and why it was suggested by our IVF specialist, see this article. Essentially, the point is to injure the endometrial lining so that the body rushes immune cells to the area, therefore giving the uterus a boost or so to speak. There have been some interesting studies about the positive effects these procedures have on women experiencing unsuccessful IVF attempts, I've discovered today. The effect of the immune cells lasts around three months too.

Interestingly, we got stats on the embryos transferred so far... 1 x B grade and 2 x C grade (transferred in that order). This last embryo? It's running a little late but got to being frozen in the end. Running late? Sound at all familiar? ;)

(for the record, Rowan's embryo was an overachieving early one... traits just like Matt!)

I also pushed for progesterone in the second half of my cycle (as recommended by our IVF nurse) and got a prescription for that too. So while I've prided myself on having 'natural' cycles so far, it's time to throw a little more at it and see what happens...

Another Negative FET Cycle

We lost another of our precious embryos this morning. To say I'm disappointed would be an understatement. With every embryo that I don't get the chance to grow and nurture beyond 10 days brings us one step closer to the realisation of potentially undertaking more full IVF stimulation) cycles.

We have one remaining frozen embryo left from the cycle that Rowan was conceived in, and have an appointment with our IVF specialist next week to talk about the next step (probably some progesterone support for the second half of my cycle). Years earlier, when pregnant with Rowan, I mused over one of those embryos joining us again one day, a special 'twin' (conceived in the same month) but born years apart. I always thought that was cool. With each loss we have, I feel sad that this might not be the case.

Can I even call these unsuccessful cycles 'losses'? It feels almost like a mockery of those women who carried babies for much longer. I'll never know whether any of these three embryos kept growing, tried to implant into my uterus or even started forming foetal/placenta cells.

If there is one thing I'll care to admit though, it will be that I'm glad every embryo we have had thawed so far has done so successfully... and all have made it home to within me once more.

FET #3

We signed the paperwork to begin FET#3 yesterday, after a break since January, when we unsuccessfully had FET#2 (a break well needed due to emotional reasons). Two frozen embryos remaining, fingers crossed that one of these is the sticky one...

I saw my naturopath during the week, I always feel so empowered after seeing her because she is like a doctor, natural health practitioner and psychologist all rolled into one. She listens to what I've got to say, asks thought-provoking questions and is all-round a great person. In the time I've been seeing her (on and off since 2009, when I was seeking advice following my endometriosis diagnosis and related cycle problems), I've been pregnant once, she twice and between us we have three beautiful, healthy boys. I met her eight month old at my most recent appointment, he's such an engaging little creature (the 6-8 month stage is one of my favourite baby times, despite it being teething time; I love the developmental leaps that happen then).

Anyway, I'm getting sidetracked (see, babies will do it to me every time!). I'm now on a course of herbs (slightly altered from the formulations preceding it) very similar to what I was taking when undertaking IVF first time around with Rowan but, rather than targeting egg quality this time around, it has to do with progesterone support (for implantation and healthy placenta formation). I'm getting some blood tests done over this weekend to see where my progesterone levels are at, as I've been having some funny-looking cycles this year - mostly very short ones, but with equal time between starting, ovulating and starting again. So rather than it being a short luteal phase potentially causing inadequate time for implantation (which was one of my initial fertility hurdles, it has naturally sorted itself out after my periods returned when Rowan was 7 months old), there might be something else going on.

To be honest, it frightens me a little that there could be something else lurking beneath the surface. Last time around, sure - we went through a lot before the initial IVF stuff - but we were successful pretty early on with that. This time? There's a 60% chance of success every time we go through a FET using our embryos, and so far we haven't been on that side of the figure yet. If this cycle doesn't result in a sticky embryo, I'm going back to our IVF specialist attached to the hospital in order to seek advice before we use our last remaining embryo. Personally, I'm hoping that there's a simple (ha!) explanation to not being able to fall pregnant this time (we haven't been preventing pregnancy since Rowan was 6 months old... and he is 3 now).

If I have to go through another full stim (IVF) cycle I think I'll cry, I really will. And yet, I'll push through... because I can't dwell on what isn't, simply what is. I haven't found peace with that yet, but perhaps in time I will. And hey, maybe a little more positive thinking on my part wouldn't go astray?

Embryo on Board

So this happened today....

Today was the day we used one of our four frozen embryos, created during the same IVF cycle from 2010 that Rowan was conceived within. Luckily for us, the first attempted thawing worked and we still have three in storage (1 x B-grade and 2 x C-grade; Rowan's embryo was an A-grade). The photo of the embryo in the bottom right was the one transferred, it looks lumpy and doesn't fill the whole cavity (despite being an expanded blastocyst) because it was still rehydrating at this point. The embryologist assured us that it was already looking good and doing everything that it should.

It's been a long month in terms of additional testing and appointments, trying to get everything lined up in order for the FET (frozen embryo transfer) to take place. And now I wait... wait until December 4th for a blood test to find out whether or not we'll get an early Christmas present. ;)