Tuesday, September 17, 2013
"I totally don't think it's twins anymore," I announced to Jimmi last Wednesday after learning Lyndsay's pregnancy hormone level had gone from 523 to 1210 in two days. "I've read that the first number doesn't matter too much, it's how the number doubles in forty-eight hours that's more telling. Doubling is normal. When it triples or more is when multiples are really suspected. It only did a little more than doubling," I continued to explain. "If I had to guess, I think we started out with twins and one didn't make it." I was referring to Vanishing Twin Syndrome, a very common occurrence with IVF pregnancies, where one twin just disappears. It probably happens in non-IVF pregnancies, too, but since "normal" people aren't monitored as closely, they may never know they had a twin in there at all. "I guess we'll have to wait until Tuesday to find out for sure," I explained, knowing an ultrasound would be the only way we'd know if one or two buns are cooking.
As we drove the puppy to daycare for her weekly socialization, I waited anxiously for the phone to ring with a confirmation of our double blessing. Finally, as we were standing outside daycare with the dog trainer, my phone started buzzing in my hand. "I have to take this," I said as I backed away to get a bit of privacy. "Hello?" my voice was shaking. I don't care if it's one or two, but please let everything be ok. PLEASE let everything be ok! "Hey Suzanne, it's Lyndsay," she said with a strange tone to her voice. "So? What did you see?" I asked, hoping for good news. "Well," she began, "there are definitely two sacs!" But she still didn't sound right. Is one sac empty? Did we lose one? Is something wrong with my babies? "Did you see babies?" I questioned, knowing at this early stage, all we might see is a yolk sac and not much more. Heartbeats aren't usually visible until at least week six. "Yeah, we saw them," she confirmed. Them? Did she say them? "So there are two?" I asked with excitement. "We saw one in sac A, but in sac B..." Oh no! It's empty! She didn't make it! "there were two."
"What?" What did she say? "The second embryo split. There's one in sac A and two in sac B."
I had heard her both times but all that would come out of my mouth was, "Wait, what?" She laughed, "Are you ok?" At this point Jimmi was looking at my face and realized very quickly what was going on, even before I said, "There are THREE?" I silently started cursing all the jokesters on Facebook who commented that we were gonna have triplets, as I insisted that couldn't happen since we were only transferring two embryos and the chances of one of them splitting was like 1%. "Are they sure?" I asked, looking all around for Ashton Kutcher and a camera crew from Punk'd. But no one appeared. "The tech kept looking at sac B and then she finally showed me why. I have pictures. I'll send them to you."
A zillion thoughts were spinning around my head after the phone call ended. Triplets? How are we gonna take care of THREE babies?! "You know two will be identical and one will look totally different, right?" I said to Jimmi then proceeded to explain that the randomly splitting embryo produced identical twins, while the singleton would be fraternal. Wait! We aren't gonna have three babies! In the contract we signed with Lyndsay there is a specific clause about multiples. She only agreed to carry one or two, but not more than that. We have to reduce one! The tears immediately stung my eyes as I turned to Jimmi, "I don't want to kill one of our babies! They said this wouldn't happen! They said it was so rare we wouldn't have to worry about it!" But isn't that also what Dr. L said about my cancer diagnosis after another doctor suspected I had Small Cell Neuroendocrine Carcinoma of the Cervix? Yes, I believe his exact words were, "The chances of you having Small Cell are like three percent. Maybe a hundred in every hundred thousand cases of cervical cancer is Small Cell." And look what happened there! I was one of the hundred! Hell, I shouldn't even be alive today, right? My chances of surviving two years after diagnosis were like 20%. That's not a lot. I probably wouldn't take a bet with 20% odds at a casino because the odds suck! But here I am! And now we're pregnant with TRIPLETS! Damn overachieving embryos causing mischief for their parents already! That's it! They're grounded! I called my mom to give her the news and the waterworks started again. She talked me off the ledge, as she tends to do a lot, and told me not to worry until we have a real reason to worry. After all, it's still too early to see heartbeats and anything can happen at this stage. "I hate to say this but I hope there are only two heartbeats next week so we don't have to make this decision," I cried. "I don't want to kill my babies!" Jimmi and I drove in silence for a little while after I'd hung up with my mom. I just kept shaking my head at the thought of three infants and three cribs and three proms and three college tuitions and three weddings. Add the other two kids I already have and you'll see why the panic attacks started. "I think we might have to break down and buy a minivan," I joked as the words I never thought I'd say spilled from my mouth.
When we got home I immediately started scouring the Internet for information on the risks of carrying triplets, the risks of triplet births and the risks of selective reduction. Nothing I read about either decision did much to ease my mind. I was terrified and I just wanted the nurse from my clinic to call and tell me what the actual ultrasound report said. Lyndsay and I had been texting throughout the day and I was surprised at how calm she seemed. Shocked? Yes. Freaked out? Maybe. Against carrying all three of my babies to term - or as close to term as triplets can get? Didn't seem to be. "How do you feel about this?" I asked her. "It's in our contract that you'll only carry two." I didn't have to wait long for a response, "I have very mixed feelings about it. I personally don't like the thought of getting rid of one if we are all healthy and doing well, but that is your call. I think we should wait and see what happens with the heartbeats and what the doctors suggest." That was a great answer. I chilled out for a few minutes until I read an article about a woman who chose not to reduce her triplets and all of the problems she'd had during late pregnancy. And the issues the babies had after they were born were scary as all Hell! Of course, she ended the article talking about how all three kids are now four years old and doing well and she can't imagine the thought that one of them might have never been born. Well, that wasn't helpful at all. Then I started reading about selective reduction and the chances that reducing one might end in a complete miscarriage. Finding out that it happens frequently wasn't very helpful to my decision either. I knew, in the case of reduction, they'd have to dispose of the singleton because the identical twins are in the same sac. Removing one of those would be way too dangerous for the other one. But then I found out I was wrong. As I read further I learned that, when two embryos share a sac and the other is alone, they reduce both babies in the shared sac and leave the singleton because one baby is less of a risk to carry than two. Are you KIDDING me? So if we choose to lessen our pregnancy, it won't go from three to two, it'll go from three to ONE? Then there's still a chance that the singleton won't make it? This is BULLSHIT!
The phone started ringing. Finally, it was my nurse at the clinic, "Hi Suzanne. I guess you've already heard about the ultrasound?" she said with slightly less bounce in her voice than she usually expresses. "Yes. I know there aren't any visible heartbeats, but do we know if they're all viable?" She sighed and answered cautiously, "I don't know if this is good news or bad, but Lyndsay's numbers are great, all three embryos are measuring perfectly and everything looks healthy." I understood why this seemingly awesome news might not be so awesome. "The contract says she won't carry more than two. I don't want to kill my babies!" I started getting hysterical and she quickly tried to calm me down, "Look, it's so early. You haven't even seen the heartbeats yet. Anything can happen," then she continued, "But next week, if all three have strong heartbeats, you might have some decisions to make." I couldn't think straight, "Is it true we'd have to get rid of the identical twins and leave only one baby?" I could tell she was starting to feel my pain and offered to have one of the doctors call me back to answer my questions more thoroughly. "Ok, but please have him call now," I urged. "I'm taking my son to the orthodontist in fifteen minutes." My wish was her command as we'd barely been off the phone for 60 seconds when it started ringing again, "Hi Suzanne, it's Dr. M," he said. My voice broke as I responded and I could hear the concern on the other end, "You sound like you're crying. Are you ok?" I burst into tears, yet again, "No! There are three and I don't know what to do! Does this happen a lot?" He took a breath, "The chances of both embryos implanting and one of them splitting on top of it are about point five percent. It was a one in ten-thousand shot." Here we go with my Goddamn slim chances again. Why don't I play the Lottery more often? "So what are we supposed to do?" I asked hoping he had the magical answer. "Honestly, a lot of people give birth to healthy triplets these days. There are definitely more risks associated with it, though. Lyndsay would probably be on bed rest from about eighteen to twenty week until delivery. They'll most likely be very premature, though I've seen triplets go to thirty-six weeks. They may be very small and have to spend a few weeks in the NICU, which isn't fun." I asked about selective reduction. "It's really up to you, but reducing may not be a bad idea. Three babies is a lot to handle financially and emotionally." I had to ask, "Would you take the two identicals or the singleton?" He gave me the wrong answer, "We would take the two in the same sac because a single baby poses the least risk. The others might have twin-to-twin transfusion syndrome or other issues that we wouldn't have to worry about with a single baby." Not helping. "What are the chances the entire pregnancy would terminate if we reduced one or two?" I asked. "I have to be honest. It does happen. But, if it's done by a team with experience, it's only about a five percent chance of losing them all. That's not very much." Are you KIDDING me, Doc? You're talking to the Queen of slim chances here! "Let's not worry about this yet," he continued. "It's still very early and anything can happen. Nature may take the worry out of your hands," I knew he was talking about the possibility of seeing less than three heartbeats next week. "And you'll have some time to make the decision after next week," he assured me, "because we won't even do the procedure until about ten to twelve weeks into the pregnancy." WHAT!? What did he say? "Twelve weeks?" I shrieked. He could hear the pain in my voice, "I know it'll be much harder at that point, but we need to wait until it's safest for the remaining baby or babies." Oh my GOD! At twelve weeks it's a real baby! It's not a blob on a screen! It's MY BABY! "Try not to think about it yet," he attempted to calm me to no avail. We hung up the phone and my heart started to break.
And here I sit, quietly at my computer, in a daze and confused. I should be excited, right? I wanted one baby and now I'm having three. Of course I have the option of tossing two of them aside and hoping the remaining one makes it through. Or I can ask Lyndsay to carry all three and risk complications all around. What an awesome position I'm in right now! What's right? What's wrong? What's best for the babies? What's best for Lyndsay?
I have no idea.
Jimmi and I are flying to Minnesota on Monday so we can be there for Lyndsay's next ultrasound on Tuesday. As awful as it sounds, I'm praying for only two healthy heartbeats. I want this decision taken out of my hands. It's just too hard.