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Not sure what Dr. to call and feeling very stupid

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  1. #1
    readyagain
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    Not sure what Dr. to call and feeling very stupid

    Hi Ladies - I am pregnant with quads and all 4 heartbeats are pefect 3 weeks in a row. I am freaking out - just made an apt. with recommended reductionist in Miami for a consult and I was planning CVS all 4 babies and they said no - only 2 get CVS and then other two are terminated? WTF? I am so confused. They also said they won't tell gender so I can have no input? I am seriously wondering what the heck I am doing... I wish I knew where to go... already over 8 weeks and not a lot of time left on this. Feeling just sick and the m/s is so bad hard to get to computer. Please let me know where to go ? Is it weird that I want CVS on all 4 to see if any of them are abnormal? Is it odd to know the genders? I am so not knowing what to do or where to go or who to talk to... feeling completely inadequate. It is hard enough having to go at this alone since DH is not on board on SR at all - he wants to risk whole pregnany to see how things go??? I just want to try to move forward and have the least high risk pregnancy that I can and try to live with the horrible thoughts that are crossing my mind.
    8 IUI's - all BFN
    IVF - transfer 3 BFP - DS 6/20/02

    IVF 2 - transfer 2 embryos BFP m/c 10 weeks

    IVF 3, 4, 5, 6 and 7 BFN - all own Eggs day three transfers

    FET (8) Donor Embie BFP DS 7-4-08


    FET ( 9, 10 , 11, 12 ) All Donor Embryos - THANK you to my DONORS all BFN

    Donor Cycle (13) - Transfer 1 blast and 2 pre-blasts - b/g twins


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  3. #2
    Besttwins
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    They are likely only testing two because they want to minimize risk. If the two they test are okay, then they take the other two. The goal, as my doctor explained it when I had my SR from 3 to 2 several years ago, is to take the ones farthest from cervix (to minimize risks). Many doctors will not reveal gender in advance of the procedure because they believe that should not be the basis of the decision. My doc wouldn't tell and then after the SR told me the genders of the babies I would have.

    The most important thing is that you have a doctor who has a lot of experience doing SR. Many women travel out of state (NYC, Philly, Chicago) to see those docs.

    Hope this helps. Best of luck.


  4. #3
    momto3angels
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    Congrats on your pg. I'm sorry it's coming with such difficult decisions. Besttwins is exactly right in her response to you. While the risk for complications with a CVS is small, that risk increases each time the procedure is performed, which is why the dr doesn't want to check all 4.

    As for gender selection, Besttwins is right again-the dr doesn't want gender to play a part in your decision. Unfortunatly this can make your decision extremely difficult because if you have 2 of the same gender, you might always wonder if things would have been different. Or perhaps you have a preference for one gender and if your baby/babies isn't/aren't that gender, it can cause wonder and angst. However, the goal you need to keep sight of is that regardless of gender, what you want is (a) healthy baby/babies.

    In my first triplet pg (fraternal trips concieved through 3 embryo transfer) I did a CVS test on all three and I actually had some complications (I fell into the 1% who had irregular results). However, I was so eager to know the gender of the babies. I desperately wanted a girl and they wouldn't tell me until I had made the decision not to reduce. Turns out, I had 2 girls and a boy, which sent me over the moon with delight. In the end, however, all three of them were born early and all three of them died. It was truly devastating.

    My next pg, I concieved a singelton and forwent CVS testing. I was longing for another baby girl. That baby was a boy. When I first found out, there was a pang of regret that he wasn't the little girl I had so wanted and come so close to raising. However, by the time that baby was born and then when he was placed in my arms, I couldn't imagine him being anything but a boy. He instantly became the light of my life.

    In my next triplet pg (conceived from a 2 embryo transfer with an identical twin split), I didn't' do a CVS test because we reduced the identical twins. I asked my doctor about CVS tests (a different doctor) and if it were possible to learn the gender of before reducing in case the identicals were girls and the fraternal was a boy, but he wouldn't do it. Gender should not be a factor in the reduction process unless there is a genetic reason (ie-we could pass some genetic disorder onto a boy or girl) and he kept emphasizing that I not lose focus on what I really wanted: a healthy baby. It wasn't easy to accept that but I knew he was right.

    It is hard when you feel like you you have lost total control of your body, your pg, your plans and dreams and I feel for you because I've been there. But try to make the best decision you can for you and your family and then don't look back.

    Hang in there and good luck.
    April
    Mom to angels: Hannah, Ryan and Abby. 10/24-10/28/03.
    Earth Angels: Joey b 5/08/05 and Laura b 5/26/07
    ==
    A butterfly lights beside us like a sunbeam. And for a brief moment, Its glory and beauty belong to our world…But then it flies on again, And though we wish it could have stayed, We feel so lucky to have seen it.


  5. #4
    momto3angels
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    I also wanted to add that I would strongly recommend you bring your husband to your appointment when you talk with the reduction doctor (who will most likely be a perinatologist). Prior to the appointment, write down any/all the questions you have. Although there are no certainties when it comes to pgs, there are statistics and it's good that you both here them. Consider asking the dr what the stats are for carrying a quad pg: what % of quad pgs make it to "term"? What is considered "term" for a quad pg? What % of quad pgs are born prior to 24 weeks? 26 weeks? 28 weeks? etc. What are the potential complications for babies born at 24, 26, 28, 30, 32 weeks? What are the risks associated with reduction? How many do you reccomend reducing (4 to 3? 4 to 2? 4 to 1?) What are the risks associated with carrying "to term" (for a quad pg) but still have complications/long term health issues for them because it was a quad pg that didn't carry to 38-40 weeks?

    Then go home and discuss it with your dh. Discuss the risks of reducing (include the emotional components that might come along with reducing). Discuss the risks of not reducing. Look at the numbers (stats) and then make the best decision you can and don't turn back. don't second guess yourself and don't feel guilty.

    I viewed my reduction not as taking life but rather as saving life. By reducing, I was giving my baby the best chance at coming into this world healthy and at or near term. I am assuming you went through some sort of infertility treatments to concieve--I did too-so the other thing I told myself was that science got me into this mess and science may be able to get me out of it.

    Hope that helps.
    April
    Mom to angels: Hannah, Ryan and Abby. 10/24-10/28/03.
    Earth Angels: Joey b 5/08/05 and Laura b 5/26/07
    ==
    A butterfly lights beside us like a sunbeam. And for a brief moment, Its glory and beauty belong to our world…But then it flies on again, And though we wish it could have stayed, We feel so lucky to have seen it.


  6. #5
    readyagain
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    April thanks for the words and kindness. I am just so sick over the whole thing. I am planning on the CVS of two or three next fri. and will go from that point If all healthy not sure if DH will allow reduction but I am so sick right now I am not thinking clear. I am 9 weeks and 1 day and wish I had some sign of what to do. I not feel I would do well with 4 premies but not sure the alternative will make me feel anymore empowered. Thanks again for listening and I will try to gather up the strength I need to move forward.
    8 IUI's - all BFN
    IVF - transfer 3 BFP - DS 6/20/02

    IVF 2 - transfer 2 embryos BFP m/c 10 weeks

    IVF 3, 4, 5, 6 and 7 BFN - all own Eggs day three transfers

    FET (8) Donor Embie BFP DS 7-4-08


    FET ( 9, 10 , 11, 12 ) All Donor Embryos - THANK you to my DONORS all BFN

    Donor Cycle (13) - Transfer 1 blast and 2 pre-blasts - b/g twins


  7. #6
    momto3angels
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    Ready again~I just read your signature and realized that you transferred THREE embryos-that this wasn't an IUI or a 4 embryo transfer-this complicates things a little because that means that two of the four are, for certain, identicals.

    There are 4 types of identical twins. When embryos divide very early the twins will have separate placentas. This type of pregnancy carries the same risks as a fraternal twin pregnancy.

    A slightly later split and the twins end up sharing a placenta but have their own amniotic sacs. These are mono-chorionic, di-amntiotic twins. There are increased risks of premature birth and disability for this type of twin.

    Later splits, the twins share the same placenta and the same amniotic sac. These twins carry an even great risk of premature birth, pgs complications and disabilities. They also carry a risk that umblilical cords will get tangled before or during delivery (they should be delivered by c-section)

    The final set of twins are the latest to split and they are conjoined.

    For all mono chorionic twins, there is the risk of Twin-To-Twin Transfusion Syndrome (TTTS) which basically means that one twin thrives while literally sucking the life from the other twin. For more info, check out this website: Twin to Twin Transfusion Syndrome Foundation Home Page

    This can also further complicate a quad pregnancy in that you would want to reduce the identical twins to reduce the risk of TTTS (that was one of the pirmary reasons my doctor wanted me to reduce the identical twins and not the singleton in my 2nd triplet pg. The identicals were mono twins so there was an increased risk for complications from the multiple status, then add the risks for TTTS and it wasn't worth it). Doctors disagree about whether or not it's necessary to reduce both identical twins but my peri felt that you wouldn't want to reduce ONE identical and one fraternal, that it would be better to reduce both identicals because you don't want to run the very slight chance that the medication used in the reduction could cross the placenta of the reduced fetus and affect the other identical.

    Sometimes it's possible to identify which are the identicals through u/s (that was the case for me) but sometimes it's not. However, the CVS test results would show which were identical.

    I know this is a TON of information to take in and it's all very confusing. I "studied" this twice-the first time in my first triplet pg and then again a few years later in my reduced triplet pg so I'm (unfortunately) more knowledgeable than they average person (but certainly not even close to the expertise of a medical doctor). I mention all this stuff to you so that you can ask these kinds of questions to your doc and then make educated decisions. In light of the identical twin issue, recommend you also ask the following 2 questions when you do have a consultation with your Dr:

    Since we only transferred 3 embryos and I'm pg with quads, that does mean that there is a set of identical twins. What does this mean for the pg? the reduction?

    Can you tell if the twins are di-di (own placenta, own amniotic sac), mono-di (share a placenta, own amntiotic sac) or mono-mono (share both placenta and amniotic sac)? What implications do each of these situations mean for the pg? for the reduction?

    If you have any questions prior to your appt, please do not hesitate to ask me.
    April
    Mom to angels: Hannah, Ryan and Abby. 10/24-10/28/03.
    Earth Angels: Joey b 5/08/05 and Laura b 5/26/07
    ==
    A butterfly lights beside us like a sunbeam. And for a brief moment, Its glory and beauty belong to our world…But then it flies on again, And though we wish it could have stayed, We feel so lucky to have seen it.


  8. #7
    readyagain
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    I am so glad you posted this! I did have 3 transferred and one split so YES a set of identicals. They are all residing in different sacs - as of last week at my 8 week apt. the Peri could not tell who was the identicals??? Does this sound odd? I am guessing it was just still too early to tell. I scanned myself yesterday and all 4 were moving around in separate sacs but I don't know enough to tell if they are sharing any placentas but separate sacs for sure. I know that when I had a phone consult with Dr. Evans in NY he said he can always tell - why can't my peri???
    8 IUI's - all BFN
    IVF - transfer 3 BFP - DS 6/20/02

    IVF 2 - transfer 2 embryos BFP m/c 10 weeks

    IVF 3, 4, 5, 6 and 7 BFN - all own Eggs day three transfers

    FET (8) Donor Embie BFP DS 7-4-08


    FET ( 9, 10 , 11, 12 ) All Donor Embryos - THANK you to my DONORS all BFN

    Donor Cycle (13) - Transfer 1 blast and 2 pre-blasts - b/g twins


  9. #8
    momto3angels
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    I'm not sure if you can "always tell" for sure or not. On my first scan with my reduction peri (not my regular peri-I went out of state for the reduction) he could not tell which were identical or fraternal. We scheduled a CVS test for either the next week or the following week (can't remember now-it was a few years ago). At that visit, he did a preliminary scan and he clearly saw a membrane being shared by two-so they were clearly the identicals and I forwent the CVS and had the reduction that day instead. It's my understanding that if they are Di-DI (do not share a placenta or an amniotic sac) there really is no way to know if they are identical or fraternal without doing a CVS to test the chromosomes (which will be the same in the identicals and different in a fraternal). However, it is possible that I'm mistaken about that.

    It's possible that your current peri can't see it because it's not clear yet. I can tell you that I had TONS of u/s: in my first triplet pg I had u/s every week and my second high risk singleton pg I had u/s every week, sometimes twice a week until 36 weeks (due to complications) and yet I would never have seen that membrane-I didn't see it until the peri pointed it out to me. Then I knew what I was looking for and saw it clear as day so it doesn't surprise me that you don't see it yourself. It may not be there (yet) or it may be that you don't know what to look for.

    Anyway, if you want the name of the doctor I saw, I have referred several women here to him and they have all felt like I feel about him: he's extremely skilled, can explain things to you in a way you will understand and has a good bed side manner (not the most important thing by any means but a good perk when you're dealing with something sensitive like reduction). Just let me know and I'll send it to you.
    I can honestly tell you that my experience is that while going through all of this, it was horribly stressful and sickening (although not the worst thing I've ever been through-that would be losing Hannah, Ryan and Abby, my first set of triplets) but in a few weeks, it will be 4 years behind me and it has very little negative impact on my life. I rarely think about it (unless I'm posting here) and it's never with heavy emotion like it was 4 years ago. Other women may have different expereinces, but for me, I am so sure the reduction was the right thing for me to do in my pg and for my family that it doesn't bring me angst at all anymore.

    Hang in there.
    April
    Mom to angels: Hannah, Ryan and Abby. 10/24-10/28/03.
    Earth Angels: Joey b 5/08/05 and Laura b 5/26/07
    ==
    A butterfly lights beside us like a sunbeam. And for a brief moment, Its glory and beauty belong to our world…But then it flies on again, And though we wish it could have stayed, We feel so lucky to have seen it.


  10. #9
    readyagain
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    I would love to know your Dr's name - even as a back-up. Thanks so much for your support and kindness. It means the world to me.
    8 IUI's - all BFN
    IVF - transfer 3 BFP - DS 6/20/02

    IVF 2 - transfer 2 embryos BFP m/c 10 weeks

    IVF 3, 4, 5, 6 and 7 BFN - all own Eggs day three transfers

    FET (8) Donor Embie BFP DS 7-4-08


    FET ( 9, 10 , 11, 12 ) All Donor Embryos - THANK you to my DONORS all BFN

    Donor Cycle (13) - Transfer 1 blast and 2 pre-blasts - b/g twins


  11. #10
    momto3angels
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    Sure, his name is Dr. Craparo and he's with Abington Perinatal Associates in Abington, PA (about 40 minutes north of Philadelphia, PA). Phone: (215) 481-4575

    I have nothing but excellent things to say about him. Hope that helps.
    April
    Mom to angels: Hannah, Ryan and Abby. 10/24-10/28/03.
    Earth Angels: Joey b 5/08/05 and Laura b 5/26/07
    ==
    A butterfly lights beside us like a sunbeam. And for a brief moment, Its glory and beauty belong to our world…But then it flies on again, And though we wish it could have stayed, We feel so lucky to have seen it.


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