Thursday, August 17, 2006

Risk vs. Reward

My husband teaches business at the university level, and occasionally at home he is wont to burst furth with lyrical snatches of "business speak" that usually have as much meaning for me as colloquial Armenian. But one of the basic concepts I have picked up from him is that of risk vs. reward. Basically, if you want a reward, you have to take a risk. If you are squeamish about taking risks, you are "risk averse" (and should probably sink your ill-gotten gains into a nice safe index fund instead of picking some penny stock because you think its symbol is cute).

IVF is much the same way. The science boys and girls do all kinds of studies, and pontificate at length as to what the "best" way to do IVF is -- but the truth is that it's all a crap shoot. The best you can make is an educated guess. You know what statistics for your age, etc., tell you, but you cannot know what your particular body will do until it's done done it. And then you live with that.

To reiterate some past history: Last spring, we did our first IVF (with the same doc we are with now). We ended up with six very nice embryos (two of them already compacting at 3 days), and put all of them in. We ended up with a chemical pregnancy -- first beta of 19, second of 5.

We started cycling for this IVF in June. We got 15 eggs, of which 13 fertilized, using ICSI and assisted hatching. Two of those stopped growing in the dish, but the rest were quite nice. At that point we had a dilemma: what do we do with all these embryos? Frozen embryos in general do not do as well as fresh, and older women's embryos have an even more dismal rate of success. (I was 43 during most of this, and turned 44 just a couple of weeks ago.) In making the decision, we factored in my age, plus the fact that six very nice-looking embryos had previously done squat.

We decided to go for broke and throw all 11 in. Looking at the chem preg we had in IVF #1, I was thinking (along with my doctor) that the overall quality of my eggs probably wasn't that great. So I was hoping for at least one, but maybe as many as two resultant fetuses.

As you know if you've read previous posts, my betas showed that not only was I pregnant, but preggo with (probably) twins. That was a little intimidating, but hey, twins make instant family! We would manage.

Today I had my first ultrasound.

The screen was turned away from me, so I couldn't get anything from that. Actually, I was so nervous that I didn't even look at my doctor -- I just stared off into space and listened to her running commentary. But my husband (whom I had instructed to take notes) was looking at the doctor. He said he was watching her -- and suddenly, as she looked at the screen, he saw her jaw drop.

We had two empty sacs in there (not surprising) ... and four fetuses.

One fetus measured 7mm, two were 6mm, and one was at 4mm. The 7mm and 6mm are normal for their age (6w4d) but the 4mm is definitely small and may well bow out on its own, according to my doctor. Leaving us with ... triplets.

The problem with triplets is that due to the abdominal myomectomy that I had last year -- a three-hour operation that chopped me up pretty good, although it did seem to do the trick -- I probably can't carry triplets. (Although my doc did say today that she thought I would be fine for twins.) Also, statistically, triplets have all kinds of health problems and are much less likely to make it to the finish line than twins.

But the only way to resolve this problem -- unless Mother Nature takes it in hand and does it herself, which is certainly possible -- is to do a fetal reduction.

I have always considered myself pro-choice, and still do. (Although I think there is a world of difference between a first trimester abortion and a third trimester abortion. I will go out on a limb here and say that I think third trimester abortions should be outlawed unless it really is to preserve the life or health of the mother -- and by health, I don't mean her mental health.) But while it is easy to say that poor women with few choices should be able to get a first trimester abortion on demand, I admit I turn squeamish when I think about it for myself. This is not what you envision when you start in on the baby-making treadmill. You're thinking baby showers and poopey diapers, not fetal reduction because your uterus might rip asunder if you don't do it.

(I have to relate a story here which has stayed on my mind throughout the IVF process. My husband is a regular blood donor, and we once went to a congratulatory dinner for the donors who had given a certain amount during the year. The featured speaker was a very nice young women who, while pregnant with her third child, had suddenly had her uterus rupture. They rushed her to the hospital, of course, and she ultimately went through 26 pints of blood while the doctors labored to keep her alive. Twenty-six pints! The woman was a walking miracle.)

So stay tuned for developments, I guess. My next ultrasound will be September 1.


Blogger chris said...

congrats. I'm going to email you.

2:55 AM  
Blogger casey said...

It sucks, royally, that you can't just enjoy the fact that you're pregnant, even for a moment or two.

Here's wishing you grace and strength in the upcoming days.

6:52 AM  
Anonymous Victoria said...


I know we communicated yesterday, but I wanted to post that you will get through this and I know the path will reveal itself to you. In addition to the worry and concern, I hope you have moments of joy. This road is long and bumpy, but you have arrived, at least at this stop along the way.


10:36 AM  

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