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IVF

The iceman: A husband’s perspective on delivery

by Alex on July 3, 2009

A note of caution: If you are currently pregnant, this story is one you may want to wait and read after you’ve delivered. By reading further you agree that neither the author nor Wiser Mom nor anyone connected with the blog may be held liable for contact PTSD symptoms, nightmares, hysteria or other undesirable effects incurred from reading the following account.

There is a huge backstory leading up to this, some of it was documented in real time on this blog. But for those of you who need a refresher or are new to the story, this post drops into it when Myg was exactly 35 weeks pregnant. She had been in the hospital for a week with mild preeclampsia after a third trimester filled with ER visits and two other hospital stays—one overnight and one five days long. Unexpectedly—we had been told a few hours earlier that it would be another week—the OBGYN team decided on the morning of week 34 and 6 days that it would be best to induce labor immediately and not let Myg’s condition deteriorate. The babies were healthy in utero and would most likely be fine after delivery, whereas Myg would only get sicker and not begin to recover until afterward. We catch up with our protagonists at 4 a.m., January 22, 2009:

Myg is being rolled into the operating room for delivery and I am right behind her in disposable scrubs and surgical mask. Twins are considered high risk, so all twin deliveries are done in the OR, just in case. A Pitocin drip to induce labor was started about nine hours earlier, and she was given an epidural at 11:30 p.m. that worked just as you’d want—she has gone through transition smoothly with not too much discomfort and is now 9 cm dilated. She has also been given magnesium sulfate—known in the medical parlance as “mag”—to control her preeclampsia symptoms. Mag will keep her blood pressure, already high and spiky, from getting out of control. It also has a host of nasty side effects, including the possibility of hot flashes that some recipients have said feel as if you’re burning from the insides and your eyeballs are melting. The other effect is that it is a powerful muscle relaxant. Exactly what you don’t want when you’re about to deliver a couple of babies.

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The last belly pic

My previous experience with operating rooms is that they are cold. But as Myg is wheeled into the OR to deliver our twins, I don’t notice the temperature. I notice the table. The scene is like something out of David Cronenberg’s Dead Ringers, which should put a chill into anyone who has seen the film and anyone who doesn’t get the reference should be thankful they don’t. The operating/delivery table has padded swivel legs and stirrups that my memory says are stainless steel, but that sounds unnecessarily cruel, maybe they were just worn leather. Like the straps you’d find on an electric chair in Texas. Overhead, a large array of klieg lights dangle at the end of an articulated arm looking oddly like a female mantis with the severed head of her lover held in the caress of her deadly mandibles. A wall made of monitors and other machines that go bing! stacked about twelve-high is teetering dangerously close to the table. The only man in the 11-person delivery team sits next to them in oversized glasses holding a clipboard or notebook or tablet computer. He is unmistakably Hell’s bookkeeper. Other odd apparatus are arranged about the room but my attention is focused on Myg as she is helped onto the table, still strapped in, and her feet are arranged in the stirrups and a flimsy sheet is arranged over her.

Once again, Myg explains to the doctor and the nurses that we’ve had no birthing classes, no Lamaze, nothing, because she’s been on bedrest since week 26 and no one at the hospital could find any resources that would come to the house, other than the midwife/dula team we can’t afford because I’m in grad school and Myg’s on disability and frankly, we’re as poor as we’ve ever been and thought that it was the best time to have twins because we plan everything and it always works out—just not how we plan it, or we would have gone to birth classes in the second trimester when Myg felt well enough to go on vacation—therefore, we’ve only read about delivery. Yes, in a book. Oh, and online, too. (This works for me, give me a book with instructions and I’m golden, not so much for Myg, and she’s the one that has to do it, so I’m nervous but keeping a good attitude.) No, Myg hasn’t watched A Baby Story, because she’s terrified. (Five months after delivery she still can’t bring herself to watch it.) We need some coaching, please. The staff says not to worry and explains that when she feels a contraction she needs to take a deep breath and hold it and when they tell her to push she needs to push like she’s shitting a watermelon and keep pushing as long as she can—they’ll count to ten—and then she can relax until she feels the next contraction or like she wants to push.

And that’s it. Ready for your skydive/bungee jump/moon launch? Good, me too.

I sit at my wife’s head, looking down at the part in her hair. I want to kiss it, but my mouth is covered by the mask. The delivery team sees a contraction begin on the monitors and they all say in disjointed unison like a girls’ rugby scrum: take a deep breath, now PUSH, hold it keep pushing don’t let it out one … two… three… four… don’t let it out keep pushing and Myg lets it out and stops pushing around seven.

She looks at me with a holy shit expression that says this is not fun I do not want to do this but I have no choice oh fuck…

I whisper sweetly into her ear and she tries to relax for the brief couple of minutes before the next contraction. I try to say encouraging things. I hold her hand. I feed her ice chips. And it goes on and on and on. Myg gets tireder and tireder but continues to labor. Labor. The word in its most radical form. She labors.

Of all the things I am in relationship to Myg, at this moment I am nothing but an ice machine.

I am an ice machine.
I am the best ice machine.
That is all.

The iceman. I’m good with a Styrofoam cup and chips of ice. See? I can get them out of the cup and put them into your mouth where they melt and soothe and if I knew where the crushed ice machine was I could refill the cup all by myself. And when you stop to think about it, what else does one need in life but some ice chips? All your needs can be met with a foam cup full of ice.

With every contraction the routine is the same. It goes on and on. The mag has made it next to impossible. Myg gets tired. I just want to sleep, she says. Can someone else take over for a bit? She tries not to think about the fact that this is Baby A, nicknamed “Doot” in utero, and that after she gets this done she has to do it all over again for Baby B, “Bing.” She’s ready to be a mother. Or, she really wants to be done with pregnancy and wants these kids out of her, at least.

The team all cheer her on with every contraction and it’s annoying. If it’s annoying to me, I know it has to be irritating her. Myg, amazingly diplomatic, says, okay, I only want one of you to count. She points to the resident. You. You get to count. Everyone else has to be quiet.

I know inside she is thinking along the lines of: Shut up, you dumb fucks, I know the routine now. It’s not complicated. I hold my breath, I push for an eternity, the kid doesn’t budge. I do it again. You had to go to med school for this? If you have any suggestions besides “push” and demonstrating that you watched enough Sesame Street to count to ten as a group, then please enlighten me. Otherwise, I’m coming off this table and there will be carnage that will require a SWAT team and weeks of forensic analysis.

The diplomatic tack works for about two more contractions. But now it’s clear that Doot is moving, they can see his head, everyone is more excited and seems certain that he is about to come out on the next push. Everyone but the bookkeeper starts shouting “encouragement” again. Myg looks at me and says, we’re done with this. I nod and agree. If we want more children, adoption, as we have often discussed, will be the way to go. We’re finished with the biological imperative. The Team tells me to come around to look from their angle. Doot is nearly here.

I walk around and look up between my wife’s legs at the mystery of mysteries, the holy of holies, the place I like to think is my playground and not anything that involves spectators. I’m a guy, I love sex. But I’m also a pretty waspy guy who was brought up right and went to church as a kid. Sex works best in the bedroom. Without a team of specialists with instruments and years of expensive training. And I know, I know, this is not sex—this is the end result of sex when all the pieces of the biological Rube Goldberg contraption fall into place. And we’re in a hospital. Everything is sterile and clinical and has nothing to do with my sex life with my wife and OHMYGODWHATTHEFUCKISTHATTHING? An angry red maw of engorged flesh has replaced Myg’s lady parts, and it’s being stretched wide by a red playground ball with wet black hair that I can just see a crescent of—no way is that thing coming out of that hole. It’s not happening. Meanwhile, the Team is grinning at me like they’ve just shown me the fountain of youth.

I admit, the miracle of life and childbirth are beautiful things, perhaps the essence of beauty—but it’s this as a concept, as an abstract. All the great and mysterious things about the universe, they are summed up by these moments but only metaphorically. In reality, it’s a gruesome visceral experience. It’s difficult, painful, and fraught with a lot of danger that modern hygiene and medical technology have mitigated but not eliminated. Sure, I love the primality. Put someone else’s spouse there and I’ll come in with a camera crew and wax eloquent like David Attenborough and win the Palme d’Or. But when it’s my beloved and my immanent offspring, I’d take no pain, no blood, and no risk if it were offered. Something antiseptic and external—stork delivery, even. I back away from the Team trying to appear nonchalant and not like I’m retreating from the mob at Bedlam.

Back around at Myg’s head, I smile and hold her hand. I lie. Just a couple of more pushes, babe. He’s almost here.

Myg pushes again. She has stopped paying attention to the cheering section. They’re doing it wrong. She has figured out that when she lets her breath out during the contractions and pushes not just with her stomach and bowel muscles, but even with her chest and neck, that they scream more encouragement and the baby moves better.

And I am also happily wrong. In just a few pushes, Doot arrives at 6:52 a.m. and gives a little cry as they hold him up and I look at my son—a weird red lizard dripping stringy white mucous, with what appears to be a version of Winston Churchill’s head run through a Play-Doh Fun Factory. They put him on the heat table and begin wiping him off and sticking his feet onto ink pads and making footprints. They put him in Myg’s arms for just a second and she is overjoyed and I’m choked up and she cries a little and then they take him back to the table where they swaddle him up and at the same time the doc is telling Myg she needs to get ready for round two.

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Doot chilling on the warming table, 30 minutes old

They break Bing’s water and ask Myg to give a push just to get him down into position. Myg is in a daze. She has successfully delivered a baby. She knows she can do it again, how about in 18 months? It’s about 7 a.m. The doc has her hand inside Myg, a contraction comes and Myg pushes and I see a slight look of surprise on the doctor’s face. I felt the cord, she says. She looks up at the monitor and says, okay, Myg just give me one more push, and I’m going to see if I can get his head into position. Myg pushes. No, I feel the cord. The doctor shakes her head and she gives some unseen unheard command.

The operating room, already burgeoning with attention to Doot’s birth, blossoms. The 11-person team moves in complex synchronous harmony about twice as fast as they had been. What’s going on? Myg asks. The anesthesiologist begins turning dials and jams a mask over her face. Are we doing a C? There is worry in her voice and I realize something has happened, something with Bing and they’re going to do an emergency C-section.

A nurse flags my attention calling me “Dad” and it seems strange but I know it’s me.  Follow me, Dad. She leads me out into the hallway with some rehearsed reason for why I can no longer stay in the room with Myg. You might faint, she says. Wait here. She points to a spot on the carpet in front of the delivery OR doors and leaves me there. I do as I’m told. After five minutes I begin pacing. I am worried but have faith in the Team that the C-section will go smoothly. I call my mother and tell her about the arrival of her grandson and let her know that the second is on his way. The doors slide apart and someone notices me as he moves past carrying arcane medical devices. The second baby is out, he says. I am relieved. He doesn’t say anything about Bing’s condition. I assume everything is fine. A manx cat appears pushing a small cart bearing Doot. The cat speaks. Do you want to come with me to the nursery? Apparently, it’s a nurse.

It’s not until hours later that I understand that when Myg pushed and the doctor felt Bing’s umbilical cord that it was a fairly rare and serious situation known as a prolapsed cord. The monitors showed his heart rate had dramatically dropped to 80 bpm when Myg had pushed. He would not have survived a vaginal delivery. Now I go cold when I write those words. On that day, I was supremely confident and ecstatic.

What they did not tell me and part of the reason I was in the hall during the emergency C-section is that because Bing’s heartrate was dropping they had to open Myg up immediately. As in before the anesthesia was in full effect. Myg apologized later to the surgical team for all the screaming. I didn’t hear a thing two sets of doors away in the hallway. Are you numb? The doc asked. You’re numb enough. Myg says the cut wasn’t painful, but that having her guts moved out of the way in a hurry was like having a wild animal pawing at her insides. The doctor knew she’d survive that trauma okay—the important thing was to get the baby out.

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Bing joins his brother in the nursery after escaping the womb via a window

Both of our sons arrived healthy and whole. Neither required any time in the NICU. They even made it through the bilirubin spike without needing light table treatment. As of this writing, they’ve quadrupled their birth weights. They smile and laugh and roll over. They grab hold of fingers and toys and eat solid-er food. They’re delighted to see me every time I enter the room. Because of my wonderful sons, these five sleepless months full of diaper changes and spit up and two babies crying in tandem at a 4 a.m. that lasts forever have been the greatest five months of my life.

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Husband becomes Dad

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First snuggle

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Jon & Kate Plus a Health Care Mandate

by Myg on June 29, 2009

I swore I wasn’t going to blog the Jon & Kate divorce. Then I read this:

Jon and Kate Plus Health Care – Would better insurance have saved this marriage?

If the Gosselins, whose efforts to raise eight kids have been chronicled over five seasons on cable television, had enjoyed, and availed themselves of, ready access to IVF — the most sophisticated, controlled and expensive form of fertility treatment — they almost certainly would not have had six children at once. “Just one more baby,” is how Kate described their goal after twins. Without the added stress of sextuplets, they would have had a fighting chance at not fighting nearly as much as they did.

That’s a quote from Liza Mundy, the brilliant author of Everything Conceivable: How Assisted Reproduction Is Changing Men, Women and the World. Mundy is a champion for reducing higher order multiple pregnancies through the use IVF technology (instead of IUI, which is less expensive initially but more risky for multiple pregnancies). She makes sound arguments that if health insurance covered IVF, surely we could reduce the number of these dangerous pregnancies, and the number of sad implications for those families where the ending isn’t so happy (or so damned televised).

She’s right, of course. But being right, fair, or rational will not spare her or anyone from the wrath of the insensitive and uninformed internet. I’d love to take on her trolls, which she does herself with aplomb and no small amount of tact. If you really want to get pissed off, please click through that there link and steel yourself for a genuine SOMEONE IS WRONG ON THE INTERNET experience.

Otherwise, I’ll sum up the troll talking points in my favorite way – with bullets! Alas, not real ones.

  1. Having a baby is a choice, not a right (no doubt uttered by anti-choice/so-called pro-lifers).
  2. Fertility treatments are elective procedures, like plastic surgery, and therefore a selfish exercise in vanity (Favorite comparison: IVF to Botox injections. Fucking Botox!)
  3. YOU WANT MY HARD EARNED TAX DOLLARS TO PAY FOR WHAT? (It makes no difference that we’re not talking about taxes, apparently.)
  4. If your body won’t conceive, maybe it’s telling you not to have babies. (No comment.)
  5. Why can’t you adopt? Don’t you know there are starving children out there who need homes? (How many adopted children do you have, asshole? Yeah, that’s what I thought.)
  6. You can’t have everything you want in life and you should count your blessings. (Just a simple “fuck you” will suffice here.)
  7. Fertility treatments should be “illegalized” because… (see numbers 1, 2, 3 and 4 above).

I don’t need to argue all of these points, because Mundy does it so much better, and much more level headed than I can. I will impose the moral fine on your troll asses though. For all ya’ll out there who think fertility treatments are an elective, selfish vanity procedure, I require that you surrender your ovaries or testicles before commenting on any more infertility related articles.  And, I’m putting all your children up for adoption.

How’s that feel?

Okay, now you’re allowed to comment again.

And another thing, about the poor Gosselins? They were SUCH ASSHOLES to each other, every damned episode, how did anyone not see a divorce coming? Seriously.

{ 5 comments }

Turn and face the strain

by Myg on November 4, 2008

Do you know what’s weird?

Waking up at 2am to pee, getting back in bed after you struggle to make room next to the dog, and staring wide eyed at the shadows on the ceiling in stark realization that your life is ending. I imagine if you knew the approximate date of your death it would feel somewhat like this. Only, granted, much worse.

This is me circa 2am, most nights.

And this is me in general: nary a good thing can happen without a moment of intense grief for what’s lost.

But to step back a bit, truth is I have been done with this part of my life for awhile now. Seriously, good bye. The last five years have been mostly too much work that was too hard combined with too much cancer and death in my family. Very little of the real work of my life got done because all I could do was trudge through another day of just making sure, in all seriousness, that nobody on my professional watch was going to kill themselves or get beaten, and if I wasn’t the world’s most miraculous therapist, so be it. Happily, everybody was left standing by the end of my clinical tenure this past March. Yeah I know. Go, me.

From January 2005 I’ve been trying to get pregnant, knowing full well that there was no way my body would bring forth a baby while I was under that kind of stress. It looks as though science is backing me on this one – there’s a study that says stress plays a role in up to 30% of infertility cases. To prove my point, about six months after my father-in-law died I got pregnant. I thought, yep, see, now that I’m not in acute grief I can conceive.

But just to keep me in the theme of depressing life shit, my pregnancy was ectopic. Stuck on the off-ramp, so to speak. And for a further dose of cruel poetic irony, I had to be treated with Methotraxate – a popular cancer drug – to end the pregnancy, otherwise it ran the risk of ending me.

With the ectopic pregnancy so went my chances for any kind of natural conception. And then it was onto the IVF ordeal, which began in July of 2007 and finally worked in June 2008. That was – holy crap in a handbasket – five months ago.

In any case, you know what I have say to the past five years of my life? SEE YOU IN HELL, BITCHES!

Sitting here thinking about all of this, on the eve of the most important election of my lifetime, I am realizing that if life-as-I-know-it changes as radically as I believe it will, I’m very much okay with that.

And so are Doot and Bing.

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Waiting for you. Week 21.

by Ms. Myg on October 24, 2008

I’ve picked up a bad habit – reading the blogs of other mothers, some of whom have some really, really awful stories to tell. But, oh! These blogs are good. The writing is good, the people are good, the stories are real. You can’t beat good blogging. It’s the new indie rock.

I found two of these new mom blogs because many women bloggers have, quite understandably, flipped the fuck out over John McCain’s assinine comments during the last debate about “health” of the mother being an “excuse” (I really wish I could render McCain’s sarcastic wrinkly finger wagging air-quote gesture in print somehow) that “pro-abortion” proponents use for protecting women’s reproductive rights.

The blogger backlash led me first to Uppercase Woman, by Philadelphia writer Cecily Kellogg. I’m now undoubtedly hooked, and the timing couldn’t be worse.  Why?  Well, Cecily was pregnant with twin boys four years ago, during the last presidential election. She had severe pre-eclampsia, diagnosed in week 22 (EXACTLY WHERE I AM RIGHT FUCKING NOW, btw) and lost both of them, four years ago this coming Sunday. But the story is even worse than that – worse than just “losing them.” She had to have a late term abortion after one of them died in utero and she was in danger of dying herself.

The other new mom blog I found is by a woman named Alexa at Flotsam. She shares another harrowing, god fucking awful tale about complications in her twin pregnancy. Her twin son had died from some mystery infection in utero and she ended up delivering her daughter at 25 weeks (she continues to blog about her daughter’s progress). Damn, damn, damn.

See why I shouldn’t be reading this shit right about now? But I have, so now I subject you as well.  Please, if you can stomach the kind of grief and heartache women face every day with this shit, read their stories. But for GOD’S SAKE, NOT IF YOU’RE PREGNANT! Especially NOT if you are pregnant with twins, like me! Wait until those little bugs are out here raising hell, at least.

But, if you are willing and able, here’s Cecily’s response to McCain and the recap of her story. (Scroll down to the bottom of the page to start from the beginning – there are a bunch of posts related to it.) Cecily, I know you’re dealing with some strong anniversary reactions right now and a lot of grief. Much love to you, fellow stranger.  Alexa Flotsam’s story is here, and it is equally powerful.

When you take 30 seconds to consider the reality for women who have to endure something as atrocious as the death of her unborn child or children at that stage of development, I hope you feel a very hard slap in the face. I hope it hurts. And by you I don’t just mean John McCain or Sarah Palin or any other so-called “pro-lifer” out there. I mean all of us. We all need to feel a little pain when considering how these kinds of issues become political footballs among the majority of us who will never have to face this specific brand of agony. But perhaps if we all hurt a little more for these brave, loving women, we might collectively come to our senses regarding the safeguarding of, yes, women’s HEALTH.

Glad I got that off my chest. It has been no small amount of emotional workout to keep my anxiety in check after reading those stories.

After reading a bit about all that can go so desperately wrong at this stage, I freaked out and called the nurse practitioner coordinator person at my OB/GYN’s office. This is the first time during my pregnancy where I’ve had to wait more than two weeks to see a doctor in person. Given a few things, like a) Cecily’s story, wherein she had severe pre-eclampsia at 22 weeks and was virtually asymptomatic and b) women who’ve undergone IVF are twice as likely to have pre-eclampsia and c) I was still unsure if I was feeling the boys move enough, or in the right way and d) I didn’t have a glucose challenge test scheduled yet and e) after my last ultrasound, it was not recommended I come in after two weeks for a new cervical length check like they wanted me to at weeks 18 and 16, I had some questions.

“Wow, that was a thorough voicemail!” she laughed when she called me back. Damn straight it was. I’m a social worker. I work in the health care industry, though off to the side now. I know that doctors, nurses, all sorts of medical professionals fuck up. Not intentionally, but in a “we’re so, so, so overworked” kind of way. They follow protocols more than instincts, and treatment protocols are dictated by insurance companies who have the ultimate goal of saving bucks, not you. Often these are tailor made for the general population and don’t fit your specifics. So yeah, I had questions.

And you know what? I was okay with her answers, which were that a) they’ve been checking my urine and blood pressure for early signs of pre-eclampsia and everything looked great – they really were not worried at this stage. b) I’d get the referral for the glucose challenge test (to check for gestational diabetes) at my next visit. c) What I described over the phone as possibly the movement of the boys sounded like it was indeed movement, not bad gas, and if I was worried at all, to come in and they’d check on me. And to call if I had any worries or concerns at all. I was okay with that, and since that day I feel them moving a lot more. Though I still swear it feels like gas in the wrong part of my body.

Anyway, you want to know how the kids are? This is what they say about week 21:

  • They are plumping up like little turkeys in there, baking away and packing on the pounds. Like mother, like sons.
  • They are wrinkly like prunes or like your grandpa’s ass, perhaps. Depends on your grandpa.
  • They are sucking their thumbs! Man that’s so cute to think about I can hardly stand it.
  • They do seem to be wriggling around a lot in there now, as though to say, “Mom, look, you’ve got to get a grip on yourself!” after my agonizing and worrying about it.

As for me? I’m just great, just:

  • IN PAIN! My back hurts. Oh, it hurts. It hurts a lot. But the good part is that it’s a new kind of hurt, not that same old boring hurt I had from guitar injuries. And the other blessing, seriously, is that about 5 minutes of back rub in the right spot does give me relief for about an hour. How I suffer depends on what I do.
  • Worried. Ah, sigh. What can I do? I go back to the doctor on 11/5, unless I really just can’t deal with it. Then I’ll go back earlier to hear the heartbeats and reassure myself I’m not really that gassy.
  • Did someone say gassy? Hullo, constipation? Upping my rations of Rasin Bran this week.
  • Big. And getting bigger, it seems, by the day.
  • Limited in my activities. This is self-imposed, due to my back pain (see aforementioned bullet 1). If I stand long enough to get my hair dry, I’m in pain. Fucking ridiculous. I know, my belly is big and heavy and yes, teeming with life. My back muscles are not up to it, at all. I do have a massage scheduled for tomorrow. I know that’s going to help, and my appointment with my back doctor is on the calendar. So hopefully I can do things like unload the dishwasher and fold laundry again shortly. Yeah, I’m really hoping for that.

You know what else? I seriously can’t wait for this election to be over. I hope, oh how I hope, that Obama does it. I hope he gets in and whips the government back into shape. I think he can. I think we can. But god am I tired of the election. I’m just tired of it.

And you know what else, else?

I still love being pregnant.

Check back in another 15 weeks and see if I’m still saying that.

Blogged with the Flock Browser

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Gross armpit lump story. Mmmm…did that get your attention?

by Ms. Myg on October 6, 2008

Week 18 – which I haven’t posted yet (I’m working on it!) had one full day of “Oh My God I’m Gonna Die” agony.  It had to do with that gross extra breast tissue under my arm (which I go on about in Week 17.) I actually went to my doctor’s office and saw the nurse practitioner (NP) for it. This was the second time I had this armpit evaluated. The first was back in April before I was pregnant, because it was swollen and it hurt. My previous OB/GYN announced it was nothing to worry about, and then he proceeded to not worry about it. No follow up. Fucker. Another reason I’m glad I changed docs.

This lump under my right arm sometimes swells up and really, really hurts. It used to happen during my period, and there was a smaller, harder more painful lump inside. Since getting pregnant, it has been fairly consistently swollen, and now there are two smaller, harder lumps in there which last week after examination, the NP stated were palpable nodes. Lymph nodes. I was referred that day for an ultrasound on my armpit to take a look. (As an aside, I must note that when I used the medical term for armpit (axillary) with the scheduling person at the Radiology department she asked, “What’s that?” How confidence inspiring, really.)

“If there’s an issue with the lymph nodes we’ll follow it. If they get worse, they may have to come out, though I’m not expecting that.”

Right.

Like a lot of people, I have a whole ton of cancer in my family so talk of swollen lymph nodes without any obvious infection symptoms made me go pale. Tell me not to worry all you want. It just. doesn’t. matter.

I had the ultrasound and the tech said, “Okay, place your finger exactly on the spot where you think there’s a lymph node.” I found the spot – it’s the most painful place on my body, so not terribly hard to miss. She put the machine over it. “I see nothing – no nodes.” We looked all over that engorged lump of fatty tissue and still, no lymph nodes.

“What is it then?” I asked.

“I have no idea” she said. Comforting, right?

Apparently there was no difference between the larger lump of fleshy tissue and the harder smaller lumps inside of it, according to the ultrasound. It was all the same gross stuff.  The tech left the room and showed it to the doctor, and he said “I dunno either.” She said it doesn’t look like breast tissue either – just some other fatty tissue.

“It doesn’t look bad,” she said. “You look upset! Don’t be upset! There’s nothing scary we’re seeing here. Just tissue.”

Okay, great. That’s easy for someone to say who has one iota of medical or biological know-how. I do not. Strange fatty tissue masses appearing randomly in my body do not make me happy.

I’m glad nobody is worried, sure. But I have to ask – why don’t the doctors want to find out what it is? Our medical system is mind boggling with its inexplicably bad communication with patients. If you had random fatty lumps growing in your body, even if they were not cancerous nor in any way dangerous, would you not have the curiosity to find out how the hell they got there?

I had a massage a few weeks ago and the massage therapist felt those two little hard lumps and said, “you have a couple of serious knots in here that are causing you this shoulder pain.” I let her work on them (and it hurt so fucking bad I can’t even describe it), and my nagging persistent shoulder pain did indeed decrease. But not the armpit pain.

So when the Nurse Practitioner announced they were nodes, I wasn’t happy. All kinds of things went through my mind.

I really wish I’d had the wherewithall to ask a ton of questions but I was so anxious my mind was blank. “What could this mean? What are the possible causes of this? How likely are they? What are some common reasons this could happen?” Etc, etc, etc. I didn’t ask any of those, and I take responsibility for that. But the nurse said virtually nothing other than, “Go get it looked at.”

So in the hours before I could get the ultrasound I combed the internet. Mistake! Why? Cancer, cancer, cancer. That’s why. Try googling “swollen lymph node” and “axillary” or “armpit” and see what you get. Lymphoma, breast cancer, Leukemia. These are not the things you should be reading about at 18 weeks pregnant if you don’t absolutely need to. Especially if you are like me, and in your immdediate family there’s one person who’s had breast cancer before age 40 and another who had Leukemia before age 30.

When I’m anxious I NEED information. Need it. But without doubt it would have been better to get real information from a real medical professional, instead of from the internet. Probably better to call the doctor back and ask the questions. Maybe next time I’ll be smart and do that.

Today I’m not worried. The lump has ceased to be painful for now, and what testing I’ve had doesn’t indicate any reason to worry. I know that elevated levels of stress are not good for the little guys inside and I’ve nothing to hang my worry on anyway.

A mammogram would totally rule out any scary cancer related stuff here, but obviously I can’t get that now. I had a baseline done when I was 37 because as I said, I have a lot of cancer in my family. It was perfectly normal. My breast exam last week was perfectly normal too.

When it’s all said and done I’ll get another mammogram anyway, given that some studies have shown an increased risk of breast cancer among women undergoing IVF treatment. But I’m not going to worry about it. No, really.

I’ve got maybe 19 weeks to go now before the little ones are here, and it seems if I’d like to worry, there are a great many other worries to choose from.

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Too pregnant: the quiet agony of high order multiples. Part II

by Ms. Myg on September 11, 2008

This is Part II of my saga of going from a quintuplet to a twin pregnancy, wherein I’ll cry foul and give you some additional stuff to read on the topic of multifetal pregnancy reduction. You can read Part I here. The conclusion of the story is here.

What they say about the third time

Two nail biting weeks after my third trial of IVF, I got a call from my nurse telling me I was pregnant. Not only that – my HCG levels looked really, really, really strong! Wow! In fact, she said, it could be more than one! Yippee! Maybe it was the twins I’d been dreaming of all along. It wouldn’t be more than that, of course, the risk was so low, right? “Nah…” I thought. But worried anyway.

I told my mom I was pregnant, to her extreme joy. And I told her that I might be carrying more than one baby. Her reaction – which is typical – was to joke around about having triplets or quads. “Manny, Moe and Jack!”  Somehow I didn’t find it funny. “Triplets or higher order multiples are a medical disaster, Mom.” I’d said. “Pray it’s not that.” She said, “When I was a kid, there was a family down the road that had triplets and they were fine!” Like many, she didn’t know much about all those families that haven’t had such great luck with higher order multiples.

See, if you pay attention to any kind of media on this stuff, the stories about multiples higher than twins are all these “miracle babies” triumph pieces. And to be sure, those babies who actually survive the pregnancy and go on to lead healthy lives are worthy of celebration – because they are indeed miracles of modern medicine. The operative word here is miracle.

You don’t see many news stories on the women who bravely decide to carry their higher order multiples to term and aren’t so lucky. Where are the stories about all the women with triplets and quads who miscarry? Or those who give birth and have still borns? Or those who have their babies at 28 weeks and those kids go on to suffer with all manner of physical and developmental problems? I’d venture to say you could actually find more real women with stories like that if you tried. But I suppose here’s one case where good news is more interesting to the media than bad news. “Woman pregnant with quads miscarries at 20 weeks” wouldn’t be much of a headline, would it? Too mundane, really.

Reality bites

In any case, after the news of my positive pregnancy test I was eager – and anxious – for my first ultrasound. With IVF treatment, you have a transvaginal ultrasound about a week after your pregnancy test, which is around week four. They can take a look and see how many sacs you have and if there’s a viable embryo growing. My doctor dimmed the lights and started poking around up there. My husband was at my side. “There’s one…” the doc said. “There’s two…hmmmm.” He was quiet for a few seconds. “Okay, there’s a third here. And, it looks like you’ve got a fourth one here too.”

“Four? I’ve got four?”

“Looks that way. But it’s still early. They may not all continue growing.”

The triumphant joy I’d felt at finally – finally – being pregnant vanished into an agonized frustration.

My mind raced to a cousin of mine who’d had IVF and had gotten pregnant with triplets. She miscarried the entire pregnancy. She’d been offered what’s known as multifetal pregnancy reduction (MFPR or selective reduction) but she didn’t go that route. Whether she miscarried as a result of that choice or for some other issue, she’ll never know. But I knew already, if that had been me, I’d reduce.

Now that’s what I was thinking about.

Still half naked on the exam table, I burst into tears. The doctor scrambled to find tissues. My husband squeezed my hand. I began asking about my options, where I could go, who I could talk to.

“It’s early and things can change,” the doctor said. “Let’s see how you do here over the next few weeks.”

“Is it likely that I’d naturally reduce all the way from quads to twins – without having a reduction performed?” I asked.

“Well, it’s not typical that it happens like that, but it could. And these days with triplets we can manage them pretty well. Either way, the odds of a decent outcome is roughly 50/50 whether you reduce or not, so it’s really your choice what you want to do.”

Bullshit

You know what folks? That’s simply not true. The odds of a decent outcome are definitely NOT the same whether you do MFPR or not. If you have MFPR and reduce to twins, your rate of losing the entire pregnancy is 6% – and that’s the same rate of potential loss if you have twins to start with. If you try to carry a triplet pregnancy, your rate of losing the entire thing is 25%, with another 19% of kids born as triplets dying before they turn one. Then there’s a greater risk of dangerous pregnancy complications for the woman. So don’t fucking tell me there’s no difference, okay? There’s a big difference.

My doctor was a coward. I don’t know if he was secretly religious or if fertility doctors are so bullied by lawsuits and the right wing that they’re terrified to tell you the truth about the actual data about multiples.  “It’s up to you.” he’d said. Well thanks for handing the responsibility to me – I KNOW it’s up to me. But, am I a fucking doctor? How am I supposed to make these decisions without the correct data presented to me?

Where to turn

It’s another situation where the patient is left to her own devices. My device? The Google. Now if you’re going to turn to Google to research something as gut wrenching as MFPR, be warned that you’re going to wade through a lot of garbage and for God’s sake STAY AWAY FROM FORUMS where a bunch of nuts lurk and tell horror stories.

Instead, I’d say start with this extremely helpful piece, believe it or not, from Yahoo Health. It’s called “Should I consider a multifetal pregnancy reduction?” and comes complete with a decision guide. It’s one of the more clearly written articles online on MFPR. One misleading piece of information in the article is that MFPR can be done during the first trimester. That’s true, but it can be done in the second trimester too, if your doctor is willing and capable.

Then, if you find yourself in the camp of considering MFPR seriously, please read “Too much to carry?” It’s an article written by Liza Mundy for the Washington Post in 2007. There’s also an excellent follow-up feature of Mundy taking questions from readers that’s also well worth reading.

The article itself features Mundy shadowing Dr. Mark Evans of New York City performing MFPR for two patients. It gives an account of the CVS (Chorionic Villus Sampling) procedure – a test for chromosomal problems that is given prior to reduction – and the reduction itself. I will not say it’s an easy read, but I will say it’s a must-read if you are in this situation and considering this procedure. It couldn’t have illuminated better for me what was in store.

Liza Mundy’s article was a reprint from her book, “Everything Conceivable: How Assisted Reproduction is Changing Men, Women and the World.” This Q&A segment where Mundy is asked about her experience writing the book is ripped from the book’s website:

Q: What most alarmed you?
A: The explosion in multiple births. No question about it. So many parents conceiving through ART end up with twins, triplets or even more. Many of us—and many ART patients, starting out—have the idea that a lot of very tiny babies, born as a set, are something cute or desirable—an entire family, delivered overnight! In truth, these babies are far more likely to be born premature, and to suffer from lasting and severe medical problems, and they place a great deal of stress on their parents. The industry needs to do much more to eliminate multiple births, and it can do more. I interviewed patients who had suffered so much tragedy and grief as a result of conceiving multiples, and inevitably they had not been adequately warned of the dangers involved.

I was rather upset to agree. I didn’t think I was adequately warned. Another point she makes is that fertility clinics are not required to report the number of resulting multiple pregnancies from their procedures, so it’s difficult to track exactly what percentage of women go through this special kind of hell. And although this is anecdotal only, from other women I’ve talked to or have heard about undergoing IVF in their 30s, it’s not at all uncommon to be pregnant with triplets or higher after the procedure.

Jump to part III.

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Too pregnant: the quiet agony of high order multiples

by Ms. Myg on September 11, 2008

I’m pregnant with twins now, but I started out with quintuplets. Yes, of course I had In Vitro Fertilization (IVF). These things don’t just happen in nature very often – with good reason.

My road from near obstetrical disaster to hopeful expectancy was gut wrenching and at times, dark and lonely. If you’re on it or even just curious about it, I want to share with you how it went for me, and hopefully offer something that might make the road a little easier for you.

The topic of higher order multiples hasn’t received the kind of media coverage women undergoing fertility treatment need. So, this post will be part of a mini-series on higher order multiples, and will include a mix of my personal story and some facts and resources you’ll want to know about.

Some background on my infertility woes

My own infertility issues stem from blocked fallopian tubes. One tube was blocked after a naturally occurring ectopic pregnancy I had in 2007. The other tube, who knows? “Could have been a number of things. An infection you had and never knew about. Maybe Chlamydia…” my doctor said, in front of my husband. Nice, right? “I’ve never had Chlamydia” I told him. “Well, you could have had it and not known about it.” Why did he keep going down this road? Seriously now.

The upshot was both tubes were jammed and my only option for getting pregnant was IVF.  In the context of the long initial explanation of the IVF process, our doctor talked about the number of embryos that might be transferred back into my uterus after fertilization. Briefly. My recollection is that this part of the discussion was real quick, with the risk of multiple implantations – multiple potential babies – minimized. To paraphrase,

“Given your age, we’d probably go ahead and put three or four embryos back, depending on the quality. There is a risk of multiples when you put more back, but the risk of triplets or higher is very low, and most couple are usually alright with twins if it works out that way.”

We were downright psyched at the possibility of twins, but not so much about the possibility of triplets or more. But the risk was very low, right? We didn’t ask any more questions about it at that time. Why would we?

Duking it out in the IVF ring

Our first IVF attempt didn’t produce very good embryos. There were four viable, but there was a good deal of fragmentation in each and they weren’t growing so well (if you’ve been down the IVF road, you know of what I speak, but if not, you can read about process here). Still, my doctor felt there was a small chance of pregnancy if we transferred all four. There was little worry about multiples as the odds of even one implanting weren’t good. So we went for it, and were predictably disappointed when there was no resulting pregnancy two weeks later.

During round two, the embryos looked a little better, but it was recommended that we go ahead and again put four embryos (all the viable embryos that we had produced that round) back as well, given our previous failure. We were more hopeful, and more disappointed when there was no resulting pregnancy.

For my third and final try of IVF that would be covered by my health insurance (love New Jersey for this – if you live here and have insurance, your carrier is required to pay for IVF or other fertility treatments), I had much better looking embryos. That didn’t stop the doctor from recommending we go ahead and put all five back. After all, we’d had such terrible luck before. And you know, my age. Who was I to question the doctor? I really wanted a baby and this was my last chance. “Put them all back!” I was wholeheartedly for it.

Edit: Jump to Part II

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