43 yo 6w4d twins via IVF

(18 posts)(8 voices)
  • Started by riccardomorri ago.
  • Latest reply from tianarahagalala.
  1. Hi everyone,

    I'm hoping you can help. I think I read every post on the SR board. Twice maybe.

    We got very lucky. We have male factor and got pregnant with twins (6w4d) on our first IVF with my eggs at the age of 43. I am very worried about genetic abnormalities due to my age. I have my first appt with my "OB" (only met him twice so far in the past year) on week 8. I do not have a peri yet. My OB's nurse recommended someone an hour away. I'm not even sure my OB knows it's twins. My RE appts are limited due to insurance issues.

    Okay, the "facts":

    1. My OB's nurse's assistant tells me the OB does the NT scan at 13 weeks.
    2. They recommend someone in my town for the CVS at under 12 weeks.
    3. They recommend the "hour away peri" for the amnio.

    Now the questions:
    1. Is it better to do a SR as early as possible? I would rather have the NT and amnio, but then are we looking at a SR at week 16-17? The CVS scares me.
    2. What are the pros and cons to having a SR done early? (can you define early)
    3. What are the pros and cons to having a SR done later? (can you define later)

    I am having a lot of difficulty finding good information and it seems an eternity until week 8. I had horrible dreams last night about logistics and timing and doctors and availability and waiting for test results. ugh.

    Thank you all for your openness, support, and willingness to share your experiences with others facing the same issues. I can only hope I don't have to reduce an embryo/fetus with a genetic abnormality, but if I do I want to make sure I give the healthy embryo/fetus the best possible chance and make the healthiest decision for all of us.

    Thank you again for any light you can shed on the timing.

    zia

    PS If both are okay we plan to have twins :-)

  2. My understanding is that typically they do SR around 12-13 weeks (that was my experience). We did the CVS at 10 weeks, although our doctor would have rather waited a few days to a week more if possible but our timeline didn't allow for it. We travelled from NC to NY to have the CVS and the SR done. I can't speak to the "pros" and "cons" so much but I can say be sure to use someone who is VERY experienced. I have also heard it is best to use the same doctor for the CVS and for the SR rather than use two different doctors. The benefit of the CVS is it can be done much earlier than the amnio so you will have your "answers" sooner as to whether to pursue the SR or not.

    Hope that helps a little

  3. I'm barging because I didn't have SR, but I can say although we waited and just did the nuchal (I was 39.9 at ER) that my understanding is that CVS has the same risk of MC as amnio--provided it is done by an experienced doc. This is an area where you really don't want to go with someone who only does a few a year. You would get answers substantially earlier than waiting for amnio. Good luck with your decision and your pg!

  4. First, I assume you already know your twins are not mono/mono? Identicals are very hard to reduce one and not the other. Fraternals are what is standard.

    Secondly, I agree with the others. You want a TOP doc and TOP clinic. I too am in NC and went to NYC to see Dr. Stone. ( I swear coralgarden and I don't know each other-- at least I don't think we do. I'm in the closet about SR (and most of my IF) in real life).

    And, it is by far best to have the same doc do the cvs/amnio and the sr, for, among other things, making sure they know which fetus is considered A and which B, in case things shift around, etc. You'd hate to find out that they SR'd the wrong one based on a mistake like that, which is one of the big reasons for using the same person for both. (Dr. S even went so far as to draw me a diagram (I had triplets) and give ME a copy of it to bring back for the SR appointment, in case HER copy got lost).

    CVS vs. Amnio--- both are very similar in terms of risks and information given, IF you go to an experienced CVS doctor. The only thing that Amnio tells you that CVS does not is spinal bifida type issues. (Which can be picked up by the 18 week u/s anyhow if something looks wrong). I don't THINK, though you might research it, that AMA increases your risk for those things, and I assume you've been on folic acid etc for awhile. .

    CVS is usually not done until at least 10 or 11 weeks, b/c (1) you want the fetus to grow large enough that they won't hurt it during the procedure inadvertantly and (2) it gives nature a chance to "work things out" on its own... lots of folks have a vanishing twin. If you get to 10 or 11 weeks and don't, likely you wouldn't have that, so that is when they do CVS or begin to look at SR if that is the issue. I had my CVS around 12w?; anything under 14w is considered low risk I think. (Mine was then b/c of the Xmas holidays etc).

    I had my nuchal test around week 10 or 11. Be aware that since you have twins, the APF b/w testing they usually use in conjunction with the nuchal test won't be applicable to you... it will show elevated risks just b/c you have more than one. My doc didn't even take my b/w because of that.

    If I were you, I'd look at CVS instead of amnio, just because amnio is usually not done until at least week 16 or even 18, and by then you are visibly pregnant, can sometimes feel the baby(ies) move, etc. To me, that would be so much more traumatic if I reduced at that point, vs earlier. In fact, I was able to have my CVS, wait 2 weeks for full results (there is a next day, most results option too), then have my SR all before anyone had a clue I was pregnant. I waited a week after my SR (at 13w1d) for an OB appontment, and then told people I was pg at 14wk1d.... which was essentially the start of my second trimester.

    And, let me tell you, you will feel a LOT better after SR, if you need SR, then waiting for it. Once it is done, you will begin to heal and really be able to focus on your pg.

    My other piece of advice, if you've made it this far, is not to tell ANYONE you are testing for defects and might SR, or that you SR if you end up doing so, because people WILL judge you. Just remember the vanishing twin thing I mentioned above, and use that if anyone knows you have twins now.

  5. I don't know if this will help, but we were also concerned about possible chromosomal abnormalities, but wanted to start with a less invasive test prior to risking CVS (even though MC risk is low, I still didn't want to chance anything given all we'd been through to get to the point of actually finally being pregnant - plus being a doctor myself, I know that someone has to be the "statistic" and I didn't want to be the 1 or 2%). We had our NT scan done at 11w5d and found twin B to have very enlarged NT, thus leading to CVS done at 12w (2 days after NT scan). We had results back the next day showing trisomy and went on to SR 1 week later at 13w1d.

    I think starting with the lower risk test and only moving on to CVS when it was obvious there was an issue made things a little easier on me. I definitely knew that if we did CVS first and both were totally fine and then something happened as a result of the CVS I would have been devastated. This way, we knew the risks going in, but given the abnormal NT scan knew it was worth it.

    And like everyone else has said, the overall risk is VERY LOW if you have an experienced provider.

    I am now 16w2d and doing well. I think doing SR early vs. later is a benefit too in that you can start to focus on the positive happy parts of finally being PG a little sooner.

    Good luck to you!

  6. Hi everyone,

    Thank you for sharing your experiences. I have an appointment on Week 9 with a Doctor recommended "independently" by both my RE and OB for the CVS (of course, my OB recommended my RE!).

    I would rather take your route and I guess I have to find out how flexible he can be with scheduling etc.

    It sounds like the timing worked out really well for you -- do you think that it is normal for these docs to work so quickly?

    I\'ll find out a lot more on Friday.

    Thanks!

  7. We did our CVS of triplets at around 11 weeks ... then we did the SR (3->2) at 13 or so ...

    I am now 24w2d and doing well. No complications at all ...

    Good luck, and I'm hoping for the best for you!

  8. Hi

    So if they do FISH (Fluorescence in situ hybridization) on the CVS they can typically have results in 24-48 hours. FISH tests for trisomy 13, 18, 21 and sex chromosome abnormalities (which are the most common chromosome abnormalities). The full genetic panel (which can include things like CF, sickle cell disease or other genetic illnesses specific to your family history) takes up to 2 weeks.

    They should be able to at least attempt the US for NT right after 11 weeks - and the test is real time: they measure the NT and you know right then and there if it is normal or abnormal - and whether you have to move on to CVS. There is no blood test done if you are pregnant with twins (it is not accurate) so this eliminates having to wait for these results.

    So, they should be able to accomplish all this in a timely manner....but sometimes it takes you being an advocate for yourself to get it done

    I wish you lots of luck and please let me know if you have any other questions.

  9. has anyone had cvs with triplets and s/r from 3-1??

    Here is my story:

    We had CVS on all 3 at 13 weeks due to two of the babies having cystic hygromas. From that it was found that both were going to have major medical issues if they even made it, due to this information our doctor said our best chance would be to reduce the two as the third baby was okay. At 14 weeks we did the s/r. Our doctors all told us that they would both jus absorb and the remaining baby would be okay. At 22 weeks we delivered one of the s/r babies. They said the remaining s/r baby would still absort due to how high it was and that the remaining baby was below that one. Our remaining little girl was doing good, but the hospital told us that if something happened they would not be able to save her as she was not viable until 24 weeks. I am still bleeding today at 2 days from 24 weeks and the last 3 days I have not felt our remaining baby move...at all. Also I have a doppler but can not find the heartbeat, we thought we found it but it could be mine... I have only read one story like mine and it did not end good at all for the remaining baby.....I am hoping someone out there has a good story or some advise as my brain is about to blow.... I am sooooo scared!! We have been threw so much I can not even imagine loosing her after everything.

    P.S. the only thing I feel is braxton hicks contractions and some tingling in my you know what..... that's all even when I lay on my back I don't feel anything. I am on bedrest until she is born or???

    I am hoping someone can help me....

  10. I'm sorry for your issues! I had a 3 to 1, and never had any complications so I can't really speak to yours. (I did have 2 distinct gushes of water within 2 hours of the SR, which scared me to death, but otherwise nothing). I think the delivery of a reduced fetus is extremely rare, though you are the second person to post on here about that.

    Sounds like you are close to 24 weeks. Hang in there! You should call your doctor and demand hospital bedrest, esp if you are having trouble feeling your baby. That way you'll know if something is wrong and maybe they can do something about it.

    Hugs.

  11. bubbles, my heart just stopped while reading your story. I am so sorry you are going through this and I am sending many good thoughts your way for your baby to be OK.

    My story is probably the one you read that is similar to what you are experiencing - s/r at 14 weeks, delivered one reduced fetus at 19w5d, and the second reduced fetus caused me to go into labor at 25w2d, and my son did not survive. I also had the complications of partial placental abruption and pprom (preterm premature rupture of membranes), which caused my son to not be developed enough to have a chance at survival when he was born. In addition, the second reduced fetus was found to be infected. If I hadn't gone into labor when I did, and Ben had survived, he would have been at risk for cerebral palsy and I could have had serious issues as well.
    While your situation certainly doesn't sound good, it definitely sounds better than mine.

    I am obviously not a doctor, but I think you need to get yourself to the best high-risk practice in St. Louis - and you are fortunate to live in an area with such great medical care available. I would think that you should be on full bedrest for the immediate future - at least until bleeding stops and there are signs that the reduced fetus has reabsorbed. I know that in my case, being on bedrest stopped contractions and probably gave me about 4 additional weeks - it still didn't give us a good outcome, but I know in my heart I did everything I could to try to save my baby and that makes a difference in my ability to go on after our loss.

    my heart goes out to you. please PM me or leave a message here if there is absolutely anything I can do to help.

  12. bubbles,

    I can't imagine what you are feeling right now. I think the previous two posters had some excellent advice.

    Please keep us posted.

    ~zia

  13. bassal and candace thank you both so much for the quick responce. We are praying that everything will be okay with our remaining baby but I am scared as I have not felt anything in 3 days now....no movement, nothing....I am going to the doctor tomorrow so we will hear something then, I am hoping it is all good news as I am not sure I can handle much more. Everything or lack of things scare me so much now!!!

    When they did the s/r on the one I delivered they had to use two vials cause they had problems....we (my dh and I) think that this may have been why it was so preserved and why my body would not just absorb it...just our thoughts. We have sooooo many doctors hear looking at our case and none of them know what to do our think, they all just keep saying that our case is not like anything they have ever heard...that is really hard to keep hearing when things are about our baby!!

    Candace-I am very sorry, it was your story that I read and I cried for you when I read your final outcome!! I was really hoping to hear that all went well for you and Ben at the end not just for you both but to help me feel better about our issue...We really don't have anywere to turn and that is why I came on to the board.

    bassal how far along were you when you delivered??

    Our little one also has the added issue of low fluid, I don't know if that is why I can't feel anything but even when her fluid was low before I still felt her kick.....I am sooooo scared to go to the doctor tomorrow, I am hoping she is okay but it is sooo hard to be positive even thought I know I have to be strong for our family and her.

    I know we all say this but this is our last chance for a baby as we cannot go threw all of this again, my dh is a mess and has cried so hard and so much that I don't know how to help him. I am lucky that I have 2 wonderful stepchildren but they are not even in the same state and they are both older one 13 the other 19, I have always wanted to have a baby of my own.

    Sorry to be so long winded and give to much info. I just really need help to keep me from going totally crazy!! I want everything to be good so bad, I already love her so much!!!

  14. Hi Bubbles,

    I am thinking about you. Update us if you can.

    zia

  15. bubbles,
    I checked back this morning just to see if you had posted anything. I do think the reason that you're not feeling her could be because of the low fluid - perhaps the fluid level has decreased even more and that gives her less ability to move. The doctor's visit will hopefully give you some reassurance though.

    I don't know whether using more of the drug during s/r would cause the fetus to not reabsorb. In my case, the s/r was quick and easy with no complications during the procedure, and we still had the reduced fetuses causing problems months later.

    I looked up your other posts and saw that you had posted on the bedrest thread that my buddy Cynthia started and I participated on until after we lost Ben. Cynthia and I continue to email each other. Keeping your sanity on bedrest when your baby is at risk and you don't know what the outcome will be is a challenge. Some things that helped me were having a neighbor stop by every afternoon - it gave me something to look forward to, and reading a lot of junky stuff and watching junky movies. If you don't have netflix, now is a great time to sign up!

    I will continue to send good thoughts your way, and please let us know what happens.

  16. Bubbles:

    I too am wondering how things went today. Let us know.

    To answer your question about my delivery, I went 1 week post-term (41 weeks exactly), though it is my understanding s/r pg's often do come a week or two earlier.

  17. Hi ladies, sorry I have not posted. We went for the u/s Wed. and found out she was gone... we delivered her that night at 10:30 pm. We are devistated!! I really thought she was going to make it. We are having a service for her with my family on Sat. we thought it was the best thing to do.

    I will try to get back on sometime next week, can't really say to much more today....

    Candace I would love to talk to you next week if you are able....maybe we could help each other....I don't know how my life is going to unfold now...

    We don't go back to the doctor for 2 more weeks to find out if they were able to see what went wrong...

    talk to you ladies soon, just can't say much more today....

  18. bubbles, I am so so sorry for your loss. I have kept looking back here for an update and when you hadn't posted I feared the worst.

    send me a PM if you'd like to talk next week.
    You can also find support from many women who have been through this on the loss board here - it is somewhat buried. Go to IVF and then Stressful Situations and then Pregnancy Loss.

    what did you name her?

    One of my friends also lost her baby on Wednesday. I can't believe I'm sending this to someone for the second time this week, but this is a poem that I found while preparing for my son's memorial. Your daughter will always be in your heart.

    And if I go,
    while you’re still here…
    Know that I live on,
    Vibrating to a different measure
    Behind a thin veil you cannot see through.
    You will not see me,
    So you must have faith.
    I wait for the time when
    We can soar together again,
    both aware of each other.
    Until then,
    live your life to its fullest
    And when you need me,
    Just whisper my name in your heart,
    …I will be there.

    ~Emily Dickinson~

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