I realized with my toilet terror and poopy/pee pee messes that my prematurity awareness effort was somewhat back burnered. So as the month of November has flown by, this will likely be my last post on the subject for this year's prematurity awareness month.
I thought I might focus a little bit on this pregnancy for a change. When we started talking about wanting just one more pregnancy, our first action was to consult the OB/Gyn. At the time, December of 2006, I was seeing a new doc since we had moved back home in the spring of that year. This particular physician told us that she would start our fertility treatment with Clomid if we were really going to go forward at that time. Neither one of us was really anywhere ready to go forward at that time though. Taylor had just come off oxygen in late October, and had not met any developmental milestones really. The twins were just turning one year, which was a bittersweet time for us. There were so many unknowns yet about what the consequences of their birth would be. Still, we knew that someday we would want just one more pregnancy. The doctor told us that our first premature birth would put any subsequent pregnancy at high risk for another premature birth. There was however, no reason to think that we could not achieve a normal birth either, just a slightly higher risk for premature birth.
Eventually we were referred to another physician in the practice who was known to do more complicated infertility treatments. We set up a consultation with this physician sometime in the summer of 2007. Basically we agreed that we would use a similar infertility treatment that gave us the twins, but we would try more conservative dose. Multiples also increase the risk of premature birth, consequently, we would aim for a singleton.
In September it seemed that things were settling down quite a bit around here, and we agreed that we would try our first infertility cycle in October. The first day of my cycle I called the doctor's office to set up the initial visit to start the cycle. A great twist of fate though changed everything. Literally minutes after I made the call, Jon called me with the news that his after his first 90 days at his new job, they would not be continuing to employ him. I am super grateful that it happened that day, and not a few days later, but clearly it was not the time to begin trying for a larger family. When the nurse returned my call, I told her that something had come up, and we would not be starting a cycle after all. About two months later we found out that Jon's brother and sister-in-law were expecting. By our calculations, we would have been just days apart if we had gone forward with the cycle. So fate intervened for the better.
Insurance changes meant that our first choice in physicians would not be covered any longer, so we consulted with another physician in January 2008. We agreed that we would try a cycle when Jon started a permanent position somewhere. This happened in early March. So late in March we began our first infertility cycle. The new doc that we were seeing came highly recommended by many people that I had talked to. He was highly regarded by the other physician that we were going to see, and has a superb reputation among other physicians, I checked. Unfortunately, neither of these doctor's are actually certified reproductive endocrinologists (RE). Basically they both consult with RE's from Madison or Milwaukee when they feel it necessary. As far as I could tell, there were not any actual REs that practice here more than a few days a month. So we decided to go forward given the good recommendations and reputation. The doctor did a very hasty job of looking into my medical records that I brought with me from our first induction, and decided to go forward with the same dose. I ended up with a lot of follicles, which is actually what happened with our first induction, so it should not have been a surprise. This doc was totally overwhelmed by it, and refused to take the cycle any further under the premise that we might end up with higher order multiples.
You and I can sort of laugh about that now, since we ended up with higher order multiples anyway... But at the time we were devastated. We really expected to have just one cycle, and new that we could afford just one cycle. I had a really difficult time understanding why he was so freaked out by the result that I was totally expecting. As it turns out, there was a critical lab test that he didn't bother to preform which would have given a better indication of how many of these 17 follicles were viable.
In June we decided to contact our old RE from Milwaukee, and after seeing her, we chose to try one more cycle. She lowered the dose slightly, we still had around 15 follicles, however, only four of them were viable based upon my estradiol level. The rest of this is history. Despite the fact that we did only one IUI as opposed to the two we did following our induction cycle with the twins, we still ended up with all four follicles being fertilized.
My point in discussing all this is that just requiring fertility treatments put us at high risk for multiples, which put us at higher risk for premature birth. So once we were pregnant, our doctor outlined a plan to help lower our risk for premature birth. All of these measures have resulted from research funded by the March of Dimes. The success of our current pregnancy to date is highly due to these precautions. These include the cervical cerclage and the 17 hydroxyprogesterone injection that Jon has been giving me since our 15th week. Additionally I have been on limited activity and weight lifting. Before this pregnancy is over, we will also have the injections to help mature the babies lungs before birth.
So while these babies will be slightly premature due to the complication of my first c-section, it is unlikely that they will suffer many of the consequences that Taylor and Alivya have. So if you haven't already done so, please sign the preemie petition located on the right sign of our blog page. Also, take a minute to vote in our gender poll!
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