Saturday, September 30, 2006

Our Five Month Schedule

Since I’m using this blog to journal about the girls, I’m posting their schedule so that months from now I will be able to remember what this time was like. If you’re bored, feel free not to read it. Our day usually goes something like this: Sometime between 6:45 and 7:30am, we all wake up (usually L. first). It only really happens at 7:30 on a day that it’s very important that Rob or I am somewhere very early and are counting on the fact that the L. and E. always get up at 7 or earlier. Since I’m typically up at least once in the night to pump, Rob is most often the one who does their 7:00 feeding. Since they’re twins and, consequently, get a little less snuggling and individual time with us, I like to feed them one at a time so we get a little extra cuddling and one on one talking time. However, they have absolutely no patience with this early in the morning, so we put them in their Boppy pillows and sit between them and talk to them both while they’re being fed. L. has recently been experimenting with holding her own bottle, which has been fun to watch. I try and get an extra half hour of sleep. When they’re done eating, Rob gets me up and I shower and then pump and eat breakfast while I play with the girls. We change them out of their pajamas and into their daytime clothes. This is actually the time of day they are at their most fun- they smile and laugh a lot and their favorite morning activity is what we call “going to the gym” where they play in their Gymini (thanks, cousin Jamie!) They are least likely to regard tummy time as the cruel oppression that they believe it to be early in the morning, so while Rob gets ready, we do some of that. They’ve both been rolling (mostly front to back) really well during the past few weeks, so eventually they usually turn themselves over and put a stop to it all. About 8:45, I wrap them up in their blankets and lay one on each side of me on the couch to read a couple of pre-nap books. Right now, our favorite is The Belly Button Book by Sandra Boynton. I sing their nap time song for them and they roll in to rest their faces against my leg until they fall asleep. This nap usually lasts anywhere from one to two hours. I take this as an opportunity to sleep myself, which sometimes means my sleeping with whichever baby is in the pack and play in our room (which ever daughter goes down first gets put in their room). About half an hour before they wake up, I pump and get their lunch bottles ready. Sometime between 10 and 11, everyone gets up (again, usually L. first) and I feed them their lunch. Then it’s play time. Since it’s always exotically hot here in Atlanta, usually we’re inside having some blanket and toy time or sitting in our Bumbo seats reading and talking. Often, there is singing and dancing. When I first read in Weisbluth’s Healthy Sleep Habits, Happy Child that small babies had a hard time tolerating more than two hours of being awake until about six months, I assumed that it was a lie- but I believe it now. An hour and forty five minutes or so after they get up they start to get sleepy and cranky again. They are soooo much happier and fun to be around when we keep them on a schedule that ensures they’re only awake for a couple of hours before we try and put them down. So between 12:30 and 1, we read and they’re back down for their afternoon naps; this one only lasts about and hour or so. Keep in mind that when I say they “go down for a nap,” I mean that within a half an hour of each other they fall asleep- they seem to take turns waking up a fair amount still. I pump while they sleep; when circumstances permit, I also try and each lunch. Between 2 and 3 they are up again. They eat their 3:00 meal, have a diaper change and get ready for our big activity. This is the time of day we put on our sunglasses and go for a walk and do things outside. Or we go places like Target or anywhere that gets me out of the house. We’re back by 4 or so for their mini-cat nap, which usually lasts around 45 minutes and which I usually let them take lying beside my legs on the couch. Then it’s time for Rob to get home. He plays with E. and L. while I pump again. Then it’s time for baths, a massage and their 7:00 bottle and, finally, bed. We co-bed them in one of the cribs- during naps, when they sleep more lightly, they wake one another up, but at night it seems like they initially sleep better when they’re together. E. likes to roll over and lean her head on L.-it’s really sweet to see. They’ve been going down pretty well, but E. tends to wake up every 45 minutes or so until about nine. Every night, one of them, (and it’s usually someone different each time), wakes up in the middle of the night. She’ll go right back to sleep if we bring her to bed with us.
All the infant books say that we need to put them down sleepy but awake, but we have the hardest time doing that without a lot of crying. Our house is so small, that even with white noise machines, any amount of yelling wakes everyone up. If any of the moms out there have any advice for getting E. and L. to go to sleep without assistance from Rob and I while minimizing crying, I would love to hear it. Any non-moms opinions would be appreciated, too. An occasionally a baby sleeping with us is fine, but the fact is for people who are less than three feet tall, they take up a phenomenal amount of space, so I think co-sleeping is out. Rob and I are both tempted to sleep on the floor some nights when they try and come to bed with us. Any suggestions?

Friday, September 29, 2006

The Outcome

“It was good” is my short answer for “what was the outcome?” if the two babies I’m pushing in the stroller don’t make it abundantly obvious. It started out auspiciously- on August 8, the first day of the IVF cycle, my antral follicle count, the baseline number of eggs one has ready to mature in a given month was 16, which is perfect. So they started me out on a low dose of stimulation drugs. Things went a little less well from there. The birth control pills and lupron had shut down my body so well that I was over-suppressed, so the doctor keep ratcheting my dose of the Gonal-F until I was taking the maximum acceptable dose. Every morning when I went in for my ultrasound and blood work, there was the constant speculation about whether or not they would cancel the whole cycle. Thankfully, the night of my 14th day of stims, I got the go-ahead that they would do the egg retrieval on Monday. They retrieved 10 eggs, 8 were mature, the embryologist fertilized 3 and all 3 survived to transfer. And that began our anxious 12 days. I’ll skip over that part, because it was, well, anxiety-provoking and not a little depressing.
But on September 6, after the longest day of work EVER-- my poor clients- God help whoever was hoping that I could focus enough to help them save their marriage THAT day- we finally got the call that we waiting for. We were sitting on our couch, watching the movie Love Actually that my wonderful cul-de-sac friends from college had sent as part of my in vitro support kit, when the phone rang. It was Lynn, the nurse that had been our nurse and contact person daily the whole cycle. She asked if Rob was there, so my heart sank- I thought she might want him there because she was going to give me bad news. So he picked up the other phone and she told us “Congratulations!! You’re pregnant!” I asked her if she was kidding and she said that she typically didn’t joke with the IVF patients. That’s when I burst into the hysterical crying and said something about it having been so long. I asked about the hCG number and she told me it was 269.3, and they liked to see it about 50, which was our first inkling that there might be more than one baby. Then we sat, stunned for a few minutes and started making a few calls. My sister, Erin, was the first person we told. We had community group that night, so we left early for it, so we could walk the nature trail near our house and process everything. The men and women were meeting separately that night, so we both got to tell the groups of people who had praying for us and had organized the 48 hour of prayer after our embryo transfer. It was an incredible night.
Later that week, my hCG had more than doubled, which was our second inkling there might be more than one baby on the way. Two weeks later, we had our first ultrasound and saw both of their beautiful, blinky little heartbeats. It only took about another twenty weeks for us to believe that they were really coming.
Two weeks ago, on the 6th, we loaded up our two live, take home babies- E. rode in the Bjorn with Rob and I wore L. in my wrap sling and we hiked the nature trail again. This time last year we had no idea how wonderful this would be and I don’t think after everything, either of us had the ability to hope or imagine that we would finally, really, get to be parents.
And as it turned out, the whole world figured out what was going on with Brad Pitt and Angelina Jolie, who as near as I can calculate, got pregnant two weeks after we did. Somehow, I feel like it was a lot less of a hassle for them.

Saturday, September 16, 2006

Like Baby Killer Whales

One night last week, at about what I would conservatively estimate was three in the morning, L., who was asleep in the pack-and-play at the foot of our bed, woke up. Now L. is a talker when she wakes up- she is content to lie in bed and chat with her mobile or even just herself until someone comes to get her. E., on the other hand, when she wakes up and finds herself without one of her adults, begins to cry in such a way that lets you know that if she was mobile and knew how the phone worked she would be on it to report you to Family and Children’s Services for gross neglect. Anyway, on this particular night E. was asleep in our bed between Rob and me. (If your first thought on hearing this is “I would NEVER allow my child to sleep in my bed, well, then, you have never had two five month olds that you were desperate to keep from waking one another up when one of them began crying. For someone who has been prevented from working out by a twin pregnancy and the subsequent having two babies for the past year, I can move remarkably fast to prevent this from happening). So L was awake and talking, which woke Rob and I up at about the same moment. In the light that comes in from the street outside our house, we could see E. As we watched, she woke up, stretched out and heard L. and gave her huge, gummy smile, obviously delighted to hear L. and started to babble back. L. got quiet and listened and then she started talking again while E listened. They conversed in the dark for probably about five minutes before falling back asleep. Rob commented that it was a lot like listening to killer whales communicating across miles of ocean that you’re always seeing on documentaries. Except in this case, the miles of ocean were about eight feet of queen sized bed and the whales were just two babies who have recently begun discovering the other one. The whole incident reminded me of this picture of E. (taken by Erin) and her stuffed whale her Aunt Erin and Uncle Elliot got her. The other is a picture of L, also taken by Erin that makes me smile.

Sunday, September 10, 2006

The IVF Letter

Because of popular demand, I'm posting the e-mail I wrote to walk my friends and family through the in vitro process when we decided we were going to let people know we were doing it. We knew we would need the emotional and spiritual support, which everyone provided beyond anything we could ever have imagined. So fresh from July 2005 here it is:

Okay, here’s the deal:

Many of you have expressed a certain amount of curiosity about what exactly our in vitro procedure will entail. As most of you know, I am not offended by direct questions, nor am I afraid to tell you in breath-taking detail- more detail than you could ever have hoped to learn about my reproductive health. Given my inability to discern who really wants to know what about what I’m doing and who wants to just pray vaguely for us in the days to come, I decided to write this out so that you would have a handy reference, leaving you more free to devote precious brain cells to thinking and talking about how I’m feeling emotionally, what’s really going on with Brad Pitt and Angelina Jolie, the earned run average of each Atlanta Braves player, etc., rather than what exactly each of the (on average) three shots a day I will be taking does.

The Suppression Phase
“why are you suppressing me?”

I started the birth control pill on July 4. I will take three weeks of the active pills. Basically, the purpose of this is to trick my ovaries into shutting down, so that my doctor can more precisely control my hormone levels and not have to deal with any cysts leftover from a previous cycle, which might throw my hormones out of whack. Rather than take the placebo pills in my pill pack, I will start a new pack on the 25th of July. On that same day, Robert will begin injecting me every twelve hours (within an inch of my navel) with low dose Lupron, which will, as some put it, shut my brain down. In reality, just the part of the brain that makes eggs grow and waits around until an egg is producing enough estrogen and makes you ovulate (the hypothalamic-pituitary axis, if you are keeping track at home). That way, when I’m maturing a number of eggs (God willing), my body won’t cause me to ovulate prematurely or screw up the hormonal environment in which the eggs are growing. After a week on Lupron, I will stop taking the pill and just continue having my twice daily shots.

Egg Stimulation
On August 8th, we’ll go into the doctors and have our first ultrasound and blood draw, to make sure my ovaries and brain are sleeping appropriately. If so, that next day we’ll start stimulation drugs or “stims,” as the hardened IVF veterans call them (these are also abdominal injections). We’ll also drop back to one shot of Lupron (the “brain control” drug”) each morning and I’ll get a dose of stims every twelve hours. After a couple of days to let my ovaries get going, each morning, I’ll go in and have my blood drawn to check my estrogen levels and an ultrasound to take a gander at my ovaries. The average woman requires 9 to 10 days on stims, but my previous experience with injectable fertility drugs suggests that I am a slow grow-er of eggs, so for me it might take longer. It’s just important that you don’t have to stim longer than 14 days, because, well, the eggs don’t like to and everyone wants happy eggs.

Egg Retrieval
When the estrogen level in my blood and my daily ultrasounds indicate that my eggs are mature (I’m assuming they’re whining less and not having door-slamming snits anymore when they get grounded for violating curfew?), Rob, my trusty shot giver, will give me a shot of hCG, the pregnancy hormone, which tricks the eggs into thinking they will ovulate in 36 hours. If all goes according to plan, at that point we go in 35 hours later and have a minor surgical procedure to retrieve the mature eggs (“egg retrieval”). With a needle. I cannot emphasize that point enough. A needle. In my ovaries. Should you want to discuss this procedure in more detail, please phone me and I’ll gladly give you additional information. Fortunately for blood and needle hating Rob, he will not have to participate in this little activity, except for the part where he drives me home, because DO NOT BE DECEIVED, I WILL BE SEDATED. Hopefully, my eggs will be of good quality. The embryologist will play some smooth jazz and fertilize the eggs we want fertilized with Rob’s sperm, which, fortunately for him, are about the only things not retrieved via needle in this whole process. They’ll call us the next day and let us know how everyone is growing. Any leftover eggs will be frozen, because I’m taking part in a little experiment. (I would LOVE it if every thing that we’ve been through might allow some of my single friends, who have been faithfully waiting for God to bring them the right person, not to have to grieve the loss of the dream of ever being able to have a biological child with Mr. Right, should he happen to come along when they’re 41 instead of 36). Meanwhile, once I’ve slept off my sedation, I plan to drink Coke, shoot up heroin, ride roller coasters, run marathons, eat shellfish, smoke cigarettes and all the other things you’re not supposed to do in the pre-ovulatory phase for fear of damaging egg quality and in the post-ovulatory phase for fear of hurting a baby. Because my eggs and embryos will be somewhere else and I will be blissfully free of responsibility for 72 hours. Because, as you all know, if there is a phrase to describe how I’ve been throughout this whole process, it’s “laid-back” or “blissfully calm” or “very Zen.” And probably, I will not be worrying at all. Then again, I may just lie on my couch whining to Rob about how my giant, bloated ovaries hurt, so he had probably better bring me the remote control because I don’t want to get up. Who’s to say which I’ll feel like? Lucky, lucky Robert.

Embryo Transfer
Whichever, 72 hours later, we will go back for “embryo transfer,” wherein all the embryos who feel no bitterness about being conceived in the lab will be returned to my uterus. We don’t care if they’re boys or girls; we just want them to have 8 cells and not a lot of fragmentation. Humor me and pray for this when the time comes. Our prayer is that there will be three of them. I am told that this part of the procedure involves no needles, just lying perfectly still for an hour with a full bladder. (Which reminds me- the day after egg retrieval Rob will start giving me injections of progesterone in my hip, which, from what I understand hurt like, well, a shot that takes 60 seconds or more to give, due to the fact that the drug is the same consistency of heavy olive oil and has to be given slowly. I’m really excited about that. Another fun progesterone side effect is anxiety and sadness). For the next 48 hours, I’ll be on bed rest. If you’re in the Atlanta area, please feel free to come on over and listen to me complain about how bloated and anxious I feel. Probably also sad. It’ll be a great time that really reminds you why you decided you wanted to be my friend in the first place.

Anyway, about two weeks later, we’ll go in, have a blood draw, and get a call that afternoon letting us know how everything turned out. It’s seems strange that it took so long to write all of this down and that the finding out whether the time, the physical, emotional and financial investment that this is for us has really paid off or not takes just an instant. And I’ve been thinking a lot about what that instant will be like for us, either way.
I appreciate so much everyone’s love, support and prayers for us during this time. Thanks, too, to all for you who have touched my heart by reading up on in vitro and watching clinical documentaries and all of that. (And to all of you who feel like they could open a gynecology practice because they’ve gone walking with me on a day I was feeling chatty.) As I know you can imagine from what I’ve written, so many things can go wrong at each step of the way and I feel nervous about each and every one, but most of all the last one. I’ll try and keep everyone updated what we’re doing every little bit, so that you’ll know better how to pray. If you don’t want regular e-mails, please feel totally free to let me know. Several of you have asked if you can forward this to others who are praying for me- if we’ve had that talk, please feel free to do so. Thanks again for your faithfulness in lifting us before the Lord.