To cerclage or not to cerclage!

Before going into the topic let me clear one thing, I am pregnant only with a singleton and not with twins. Actually, I never said that I am carrying twins. When one of my blog readers asked whether it is possible to see two heart beats with a single embryo transfer, I explained that it is possible for a single embryo to split and form two babies. I did have two heart beats within me - one mine and one my little one's :) My apologies, it is just a small prank! :)

After the 7 week scan, (will include all the scan reports as separate post next week!) I had scans every week thereafter. The seven week scan was perfect. The doctor who did the scan noted multiple myomas (small fibroids) in the uterus, so I stopped the supplemental estrogen which I was taking. After every scan I was able to relax a couple of days. Then the worry starts again. After going through so many setbacks in my journey, my mind refused to believe that all will be well. The 8 week scan was perfect too. Dr.Malpani actually said it was an excellent report. It was wonderful to see how much an embryo could grow in a week. I didn't have much morning sickness. That made me nervous all the time. During the 9 week scan, I was actually shivering  lying on the table waiting for the scan. Rajender was too shocked to see that and so was the doctor who did the scan. I could breathe only after he said everything looks good. 

The time for NT scan came. I had my NT scan at 11w2d. All was fine; the doctor who did the scan said that I don't even need to have any blood tests. That was (NT scan) such an important milestone and we did feel a lot better.

After the NT scan, Dr. Malpani was asking in every of his mail when I was going to have a cerclage. Not only Dr, all my family members were on the pro-cerclage team. The only person who didn't want me to have a cerclage is my gynecologist. She is such a good doctor and I am very lucky to have found her. She is knowledgeable, kind, patient, compassionate and empathetic. She could understand her patients' fear and concerns and could make them feel comfortable and secure. She told me, "I think your cervical problem during previous pregnancy was due to carrying twins. Until this moment I don't find any problem with your cervix (It was 4cm at that point). I will check you every week. If there is some problem then we can think of a cerclage". At that moment, it sounded too good to me. Having a cerclage is not without any risk. The biggest risk is losing the pregnancy itself, although, the odds for such happening is miniscule when the cerclage is done during early pregnancy before any cervical changes occured (I will write a separate post on cervical incompetence and cervical cerclage later). Even though I liked my gynecologist's suggestion, my previous experience with incompetent cervix made me very paranoid. As the weeks progressed my mind was playing all as sorts of games with me. "What if the cervix just opens and my baby falls down!", this fear was not allowing me to have a normal life.  Dr. Malpani told me, "you will feel much better after having a cerclage, please go for it". In Germany, they don't do a cerclage before 15 weeks. I told my gynecologist that I want to have a cerclage and it will give me peace of mind. She talked to the head of the clinic regarding this, he was a very good surgeon. But, unfortunately at that time he was going on a holiday for 2 weeks. I went and saw another lady doctor in the clinic who did all my early scans with twins. She was so happy to see me. When I told her I was pregnant again, her eyes were shining with utmost joy. She got married recently and with so much happiness she shared with me the news that she was pregnant too. She immediately arranged for all the tests that has to done before having a cerclage. She suggested me a doctor too who is well experienced in performing cerclages. When I was about to leave she asked, "Manju can I give you a hug". I still could feel the warmth and kindness in that warm embrace. This world is full of kind people!

My gnecologist in the following week took a cervical swab and sent it to the microbiology lab. I was eagerly counting days to have the cerclage. The microbiology lab results came. The verdict was "The swab was positive for Staphylococcus Aureus".

Did they allow me to have a cerclage? My cerclage experience is another interesting, educative story. Stay tuned :)

The Horrible 3WW and A New Beginning

Even the most difficult times of our life will be strewn with happiness. That was the case with my 3WW. I am thankful that I had the heart to enjoy those happiness amidst that horrible uncertainty. During 2WW, I was praying to God, "Please let it be a positive so that I can stay with my mom for some more time". I was away from her for 10 years. Every year, or sometimes once in two years, I got to spend only a couple of weeks with her. I feel guilty that she is alone with my very old grandfather. She herself is getting old. If the pregnancy test had been negative I wouldn't have been able to extend my stay in Madurai. I have to go with Rajender. I was away from him for more than a month and already every of his relatives were asking him when I would be back. My mother-in-law was too worried too that we were staying apart. So, when I got a positive, my joy knew no bounds. I had a valid reason to stay back.

The other reason for my happiness was our cats. We always had pets in our home. We had a peacock (actually a peahen), parrots, squirrels, rabbits, dog and even a wounded crow as pets. Actually, I was gifted to grow up with pets. Pets can teach young children many important life's lessons. They did teach me how to be caring towards the weak, to be compassionate, empathetic; they did teach me unconditional love and thus polished my nurturing skills. They not only taught me about life but about death too. Death of our pets did bring in lots of sadness and pain, but, those experiences were invaluable lessons which taught me how to grieve for the loss and get over it. It introduced me to the concept of death at a very young age and made me realize that death is an inevitable part of life. I think because of such valuable lesson I learned so early in life, I managed to get over many other losses in my life in a better way.

I must say I grew up with cats. There will be several cats running here and there in our home at any time of the year. When I left for Mumbai, for treatment, two of our pregnant cats have given birth. Oh, what a joy it was to see those tiny creatures! There were altogether 7 kittens. The most beautiful part about kittens was to observe them play when they grow a bit. When you watch those tiny bundles of joy you would forget all the adversities. Because of the 3WW I got the chance to be with them longer, to see them grow and to enjoy their playfulness and naughtiness to my heart’s content after a long, long time.

Rajender on the other hand was not used to pets as I was. He is afraid of them, or, the more apt expression would be, he is not comfortable with them. He thinks that they carry harmful germs. When he married me and came to our home, he was shocked to see cats roaming everywhere. And, he was more shocked by the way I play with them. He made sure that they don't come near him. If at all our cats wanted to be friendly with him and came near him, instead of shooing them away he would move away from that place quietly. This obviously increased our cats love and respect for him. The more he tried to be away from them, the more the cats grew fonder of him and wanted to get closer to him. They showed their love in so many ways. They used to cajole him by friendly brushing their body against his legs, (which made him keep his legs lifted away from the ground when he was sitting on the sofa :) or sometimes, when everyone of us were watching TV, the cats wanted to climb only to his lap and to no one else's :) When we were newlywed, one fine morning, I got up early and went to the kitchen to help my mom. I left the bedroom door open. I and my mom were chatting and suddenly we heard my dear husband's distress call, " Manju, Manju, where are you!" My mom was too worried. She said. "Go and see Manju, he sounds very disturbed". I ran to the room. On the cot, at one end, my dear husband was sitting with lots of sleep still in his eyes and I could see some fear too. On the other end of the cot one of our sweet little cats was sitting and watching Rajender interestingly and naughtily. I would never forget that scene. On seeing that, I broke into laughter. Rajender said, “I was sleeping and it came and laid between my legs"  He said, "It is not going away, I had to get up, please take this away". Our cat wanted some warmth during that December month's early morning. It usually finds some comfy place in between my mom's legs when she was sleeping. With the same expectation it went to Rajender. I removed the cat and came out. From then on until now, Rajender reminds me when I come out of the room in the morning, " Manju, please close the door" :)

One other thing I learned from our cats is the joy of motherhood. I have been seeing our cats get pregnant and giving birth from a very tender age. I have seen and felt a pregnant cat’s tummy so many times. It is a joy to feel the little ones from outside. When I keep my hand on a very pregnant cat’s tummy, I could feel the head of the little ones rolling inside. When they move, you get a tickling sensation in the palm, I used to enjoy it and would count how many heads are there inside. After giving birth the mother cat turns into a bundle of love. It purrs gently (the purring actually sounds like a little motor running inside its body) and feeds its young ones dutifully. I have even helped our cat birth its little one - worked as a midwife for it! It was such an experience to see it give birth. I have not only shared their happy motherhood times but also have seen them grieve the loss of their little ones. The greatest enemy for new born cats is a male cat, even its own father. If the male cat finds the place where the little ones are, it just bites and kills them. It is of course horrible! The reason why it behaves so is, if the little ones are no more, the female cat reaches its estrous cycle soon due to the lack of feeding period and gets ready for the next copulation! The plight of the female cat that lost its children is not any less than that of human. It cries and cries for days. It will keep on roaming around the place where the little ones were kept. Whenever it hears a mewing kitten somewhere it gets paranoid and runs around to see whether it is her children. Like every living being, it gets over its grief gradually, comes to an acceptance, and moves on!

I spent my 3WW with my mom and our cats. I ate very well, enjoyed all the native delicasies and my mom's cooking. I vomited very rarely. When compared to my pregnancy with twins it was a cake walk. I didn't have smell sensitivity, no constipation, there was no constant nausea, foods and its smell didn't turn me off. The more I felt better, more I was getting depressed. The only consistent symptom I had was gagging when brushing teeth.  When I get very paranoid I would take my brush and attempt to brush my teeth any time of the day :) My mom would look at me very surprisingly and with worry!

I literally tortured Rajender. I would call him and ask where he is. Whatever he says was enough to trigger my self-pity and anger. If he says he was with his friends or with his niece watching a movie, I got so irritated. I would cry, tell him all nasty things. I would say, "Here I am struggling every moment with uncertainty and fear, you left me to deal with all this alone and you are enjoying there", this was my constant accusation.  He would say, "I asked you several times whether I must stay back and you said I can leave. I will come back now". My mom on watching this got very angry one day. She said, “This is very unfair. You only asked him to go, I heard it myself, why are you now torturing him?” She would murmur, “It is not your fault, it is his fault. He has pampered you so much". I got so furious and told her, “When I have the heart to think about his happiness, his comfort, won't he think about me? It is his child too and how can he even come and ask me whether he could go? If he wanted to go, should I plead him to stay back?  I will never do that. That's why I asked him to leave". My mom had nothing more to say. She understood I was very disturbed and let me be the way I was. Not only with Rajender, to many of my loved ones I showed my anger and frustration. They understood me, forgave me. This is the reason why it is important to be with your mom during IVF times and not with your in-laws. If I have behaved the same with my in-laws our relationship would have definitely got strained. I also realized something after this incident between us, in any relationship compromise and sacrifice will not do any good. Make sure that you remain happy first. Only a happy person can keep others happy too!

At last, the day of ultrasound came. As the time got nearer I became surprisingly calmer. I prepared myself for the worst. I told Rajender that he must be strong. He said, "We have done our best, nothing more is in our hands, whatever is the outcome, please don’t worry". I told Dr that I will not mail him if there is no heart beat. He replied, “I will be praying and awaiting your mail". Before I entered the ultrasound room I looked at my mom. I was breaking down inside. I thought, “Whatelse and all she has to endure because of me!" I told her, "Amma, you must be brave. Even if there is no heart beat you must not worry too much, I will not worry too". I entered the room when my turn came. I felt I was carrying so many people's expectations, my heart was heavy. That was the first time in our 7 years of infertility history I was going to have a scan without Rajender. He was always with me for hundreds of scan I had before.

In the scanning room there stood the same lady doctor who measured my antral follicles. I gave her the necessary information. They first did an abdominal scan. Then they asked me to move to the other part of the room where they will do the vaginal scan. I looked at her and asked eagerly, "Is there a heart beat?" She said, “I have to look vaginally". There was a big screen in front of me and I could see the live scan picture on it lying down. I closed my eyes. My heart was beating so fast. The picture got clearer on the screen as the doctor focused on my little one and......

"THERE ARE TWO HEARTS BEATING INSIDE ME" :)

7dp5dt - faintest line on hpt!

Do you see a line in the above picture? :)

I and Rajender waited anxiously for 3 minutes and looked at the test window of hpt, it was white as snow, no sign of a line. I thought it was all over. After sometime, I again peeked at the test window without much hope. I felt that I saw something. Rajender also took a look. We were totally confused. Was it really a line? There was a shadow but it didn't have a pink hue to it. We then took a look at the second hpt which is a different brand from the first one. It showed a faintest possible line too, like a shadow. I felt happy, Rajender was happy too. The times where we celebrated for getting a line on hpt were all gone. We just looked each other in disbelief. Even if it is a positive we knew that there is a long, uncertain road in front of us. I called my mom and showed the line to her. I also warned her that she shouldn't raise her hopes too high. She said, "Manju, all will be well" I smiled at her in disbelief.
 

I took a picture of hpt and mailed it to Dr. Malpani. I know he will be happy to know the result. He replied, "Will you do a blood test, please?" I understood that he was not sure about that faintest line. I called the person who measured AMH, his name is Arun. He said that he will come and collect blood. He promised to give the result by evening. Those 6 or 7 hour wait for the blood test result was horrible; it felt as if the time stood still. When I got a call from Arun, my hands were shivering. What if the line I saw in the hpt was just an evaporation line, did I imagine it to be a positive! I picked up the call and he said, "It is a positive ma'm, your beta-hCG is 44". What a relief! I called Dr and he was very happy, he said that it was a very good value for that stage of my pregnancy. “Repeat the test after 48h”, he suggested. Everything appeared magical. I replayed in my mind all the events that happened during the last few months. I was in utter disbelief. “Are we blessed or will this joy end prematurely”-that was the question in my mind. I prayed, "God, if it is destined to end, let it end now. I can't go through another pain. It will cripple my life forever".
 

On 9dp5dt (48h later) Arun came to our home and collected blood again. I waited for the evening and for his call. He called promptly and said, “It is increasing”. I asked eagerly, "How much is the value?" He replied and my heart broke. It was a mere 65! It didn't double. The doubling time was 85h (31h-72h is normal). It increased only 47% (a 50% increase by 48h is considered normal)! I felt life is playing another cruel joke with me. After the initial self-pity and tears, I regained my original self. I understood that nothing could be done if it is going to end. On the other hand, I also wondered about the possibility of lab error. I called Arun again. Poor guy, he must have regretted his luck of having a customer like me. I asked him so many questions, I wanted to know how he transported the blood, was it exposed to high temperatures, what kind of test kit and machine they use, was it automatic or done manually, how was the standard prepared, whether it was done in duplicates or triplicates, did he use the same lot of test kit as it was done two days back. He was frustrated. At the end he told me, “please come with me I will perform the test in front of you” :) He also told me, why don't you give one sample to Bose clinic. It is a bigger lab which is there in Madurai for a long time and hence famous too!

In the evening, we went to Bose lab. They collected blood and said that I will get the result the next day evening. Again another horrible waiting game started! Next day evening I called them. Someone spoke on the other side. She said, your beta-hCG is 18! I was in shock, absolute shock. It took me some time to come out of it and think clearly. I thought, "What nonsense is it! I took hpt this morning and evening too, the lines are getting brighter than it was on 7dp5dt. Then how could the beta-hCG be 18!" I got so irritated and called the lab again. After I told my grievance, they connected me to the head of the lab. He introduced himself as a doctor. He said, “come again and give blood, we will talk in person”. I hided my irritation and asked whether they have my previous blood sample. He said that they still have it. So I asked him to repeat the test with it. He promised, “I myself will check your blood tomorrow and call you with the result". I kept the phone. I couldn't believe anyone. I thought, “how poorly they run labs in India, if I hadn't used hpt how scared I would have been by now!" I and Rajender again went to nearby medical shop, brought hpt, checked my urine again for beta-hCG, the line was getting brighter. It had a beautiful pinkish tinge to it. If the line is brighter than on 7dp5dt, my value can never be 18. And moreover, the sensitivity of hpt I used is 20 miu. I have to atleast have 20 miu in urine to have the faintest line!  This means my blood levels should be much higher. I gave a deep sigh of relief.

The next day morning, first thing I did was to call Arun. He was humble and kind enough.He came home for blood collection. It was 11dp5dt. I asked him to collect two samples, one to measure in his lab and one to send to SRL! 

11dp5dt report came and it was 116, a decent increase from the previous value which is 65. SRL report showed almost similar value. I started to have faith in Arun. That doctor from Bose lab called me in the evening. I picked up the phone and he said, " I checked it myself today and it is now 19". I don't know whether to laugh or to cry. I didn’t even have the strength to explain him, to say that their test is wrong or to shout at him. I just said OK and kept the phone. I decided I will never ever go to them! 

Then 69h later (14dp5dt) my beta-hCG was 242. 96h later (18dp5dt) it was 832.  The doubling time was never 48h or less. Except the first two values (where the doubling time was 85h) everything else fell within the 72h doubling time limit. I kept on having blood tests. After 25dp5dt it crossed the 10,000 mark. I haven't seen such shaky betas online and most women with such slow rising betas didn't have a happy ending. I was confused, sad and afraid. I cried many a day. I told Dr, “Dr, if this is not meant to be, let it end quickly. I couldn't bear this torture". He replied, "I am praying for a happy ending 36 weeks from now".

I didn't go for a scan early. I decided I will go for a scan only at 7 weeks and not before. If I go early and again if I end up with some uncertainty, like, sac is there, fetal pole is there but no HB, then that suspense will kill me. So I decided to have a scan at 7 weeks irrespective of Dr's advice. I was scared of ectopic but I was even more scared of an inconclusive report!

Rajender asked me, "Manju, will you stay with amma until your first scan, can I go to AP?" It was very boring for him in Madurai; his parents will miss him and would want him to be with them; he has friends there so that he will feel better there and moreover his niece, who is doing medicine, will come for holiday so that they could spend some time together."  I said, “Ok, you go there. I have to just go for scan and I will manage." I really, really thought he will feel much better in AP with his parents and sister. He asked me again and again whether he must stay back. Deep inside, I wanted him so badly near me; it was horrible to live with uncertainty and alone. But I wanted him to be comfortable too. I felt sorry for him when he sat at home all day without knowing what to do. So, I said firmly, “you can go, I will manage". One fine day he left to AP and I made him regret his decision!

The horrible 3ww started. My mom will buy everyday 2hpts for me (like buying chocolate when I was young). That was my only solace, taking pregnancy test morning and evening! The lines got thicker and thicker and when the test line reached the thickness of control line, it remained the same.

How did I get through the 3ww? What happened at the end of it?

The Easy Breezy 2WW

A view of Mumbai from the hotel we stayed (Photo courtesy: Virender)

We entered the most exciting yet dreaded part of an IVF cycle - the 2ww! Surprisingly it felt good, I was happy that I got one more chance to enjoy the thrill of a two week wait. Rajender was adamant that we must stay in Mumbai for five more days. I told him that it would be very expensive to stay back but he said, "we are together on our own after long, long time, we have spent a lot until now, what will happen if we spend a bit more?" True, after coming to India we were either in his home or in my home. Even worse, the last couple of weeks I was in Madurai and he was with his parents. We did miss our togetherness without any interference. So, we stayed back. Five days just flew by. We used get up late, have breakfast, troddle around the hotel area, do window shopping, drink tender coconuts, go back to our room, sleep. I also got to eat lots of Jamuns, one of my favourite berries! It is a seasonal fruit and I was lucky to have them everyday. In the evening he would take me to a nearby small restaurant, I would taste different chaat items (an assorted savoury snack) each day, while he would sit and watch me devour it with a cup of tea. He is such a picky eater. He wouldn't touch any food he is not familiar with (even if it is presented to him in the most tempting manner). New food and new tastes never pleases him. I, on the other hand, will never say no to new food varieties; I could taste and even enjoy them all. The agreement between us is, I can eat whatever I would like to, but I must not force him to have it :) He is not greedy for food or for anything else in his life. This attitude of him has made my life much peaceful, pleasant and enjoyable. 

In the hotel, where we stayed, everyone knows us; they even know the reason for our visit. We stay in the same hotel during each of our visit. Everyone there is very friendly. They try their level best to keep our spirits high. This time everyone were saying, "The room you stay now is a very lucky one, for sure you will come with your little one next time". The most beautiful place in that hotel is the terrace restaurant. They have aptly named it as serenity restaurant and the view of Mumbai from there, during night, will be so beautiful. You do feel serene when you sit there for some time.

After five days of stay in Mumbai, we were gettig ready to leave to the airport. It was early morning and I was brushing my teeth. When I touched the inner corners of the mouth with my brush, I gagged violently. Rajender came and peeked inside. What happened was the question in his eyes. This gagging sound, when I brush, was very familiar to him. I gagged when brushing teeth all the five months of my pregnancy with our twins. He got to hear it every day, every morning. We both looked at each other but we dared not to talk about it. I knew what he was thinking and he knew my thoughts too. Then, I was trying to wear a new top which I brought there a week before and it didn't fit me quite nicely as it fitted the day when I brought it. I was quite frustrated. We got ready, went to the airport, and boarded the flight to Madurai. I sat and tried to fasten the seat belt. I looked at my tummy and was shocked! It looked as if I was three months pregnant. Slowly I touched it, it was hard. I remembered that I decided not to take cabergoline, a prolactin suppressing pill, which was prescribed in the clinic to prevent ovarian hyperstimulation syndrome. Rajender told me several times to have it. Dr. Anjali asked me too whether I was taking it after egg collection. But, my stand was that, it makes me depressed and even more I have gone through 6 IVFs and I never suffered OHSS once. So, I decided not to take it!  I regretted my decision. Am I developing OHSS ? I was scared.

We reached Madurai. I was so happy to meet my mom again. On that day night, I had a dream, an erotic dream. I woke up being close to an orgasm. I touched my lower abdomen - is my uterus contracting was the immediate question in my mind. This has happened to me now a few times. It happens during 2ww (when you are on hormones after IVF) or during pregnancy and never on other times. In short, it happens when you are afraid to have sex or orgasm. Is it due to all the hormones we take, or due to long abstinence from sex? Is it our body's way of saying that we are in need of increased blood supply to uterus and hence it coaxes our brain to produce images which ultimately leads to an orgasm? Then, does it mean orgasms are actually beneficial and are we avoiding them? I would be happy if someone could share their experience - does an orgasm in 2ww lead to your BFP? 

Seven days after my transfer I couldn't bear the suspense anymore. I just want to do a pregnancy test and move on. It was becoming unbearable. During all my previous 2ww I got the nerves not to test early. I never tested until 12 days after transfer. But, this 2ww was killing me. I just want the suspense to end so that I could plan further. The thought that I have 6 frozen blastocysts, and the possibility of transferring them to Rita did give me some peace of mind; after all, I have a plan B! So I decided to test on 7dp5dt. Dr told me to buy two different brands of home pregnancy tests to be sure. In the morning I collected urine, added few drops of it to the test kit. I and Rajender held our hands and waited anxiously. And ...