QuestionDr. Ramirez,
I've written to you before and really appreciate your expertise.
I'm 37.5 y/o and have four children (including 1-1/2 year old twins, 3 year old, and 5 year old) all but one conceived via IUI and IVF. I have a history of an ectopic in 8/07. In August 2009, I had a twin miscarriage after an IVF in trying to conceive our 5th child (we'd love a large family, but my age is pushing the clock). After a long miscarriage process and watching HCGs fall to zero, I was finally ready to cycle again in January. My RE put me on Gonal-F & Menopur, and we were planning on doing CGH/microarray chromosomal testing. AFter 4 days of being on stims, my body wasn't responding well like it usually does, and I think I only had 6 follicles, and my estrogen wasn't that great either after 4 days (like in the low 400s). We decided to cancel and try again in February hoping that it was just a bad cycle. When we canceled, obviously I stopped the stimulation meds, and I was told to trigger with Novarel to ensure that everything is ovulated and to decrease the risk of a leftover follicle for the next cycle. I triggered close to the time that I would have normally ovulated. I thought since I stopped the meds that only one dominant follicle would continue to grow and we didn't want to completely waste that month of trying. So when I ovulated, we had intercourse, and now I'm pregnant. I'm thrilled, but I'm also filled with worry. We were going to do chromosomal testing and obviously with this semi-natural pregnancy, I'm worried about a miscarriage or chromosomal issues. An early ultrasound at exactly 5 weeks, 0 days confirmed that there are two gestational sacs in the uterus that were size/age appropriate. Thank goodness that they implanted in my uterus. However, initially, my second beta HCG didn't double every 48 hours, but the third and forth beta had great doubling times (38 & 48 hours). My last beta at 21dpo was 6857, and my progesterone was 102. I have very scant bits of brown spotting every day. I'm also a stay-at-home mom and I pick up my toddlers constantly during the day. My twins are 37-38 lbs. Am I jeopardizing the pregnancy by all this lifting? I've been having cramping on and off but there's no way to get around the lifting during the day. Is the cramping normal? Also, should I worry that the second beta didn't double appropriately? Since I triggered close to my natural ovulation, I don't know if the embryos that have implanted were overmature or undermature, etc. Is that a concern? I'm just filled with worry. I realize that ultrasounds are the best gauge after intial HCGs to determine pregnancy viability, but I just wanted your opinion whether things are looking okay up to this point. Thank you, Dr. Ramirez!
Monica from Chicago
AnswerHello Monica from Chicago,
First of all, congratulations on getting pregnant. Technically, you underwent an ovulation induction with timed intercourse cycle (that is what it is called). And it was successful at that.
At this point there are many unknowns. Those unknowns are really in the hands of nature/God, so despite all the potential pitfalls, worry about them does not solve anything. The worrying and stress itself could potentially be detrimental to the pregnancy.
That being said, certainly you are at increase risk of a genetic abnormality due to age. You'll have to wait and see. Because you have twins, the earliest testing you could do would be an ultrasound for nuchal lucency at about 14 weeks gestational age. But keep in mind that it could all be normal as well.
The cramping can be normal with pregnancy. We often refer to this as "growing pains." Unless it is accompanied with bright red bleeding, I would not worry about this. It would be best if you did not lift your toddlers but women have been doing that for ages and still had successful pregnancies so it is only a precaution and not a mandate.
The bHCG's are behind you now so you have to wait and see how the pregnancy continues. They are of no relevance at this point. In terms of the egg maturity, you can be assured that the eggs were mature otherwise they would not have fertilized.
So, don't worry so much and look forward to your pregnancy. Congratulations.
Edward J. Ramirez, M.D., FACOG
Executive Medical Director
The Fertility and Gynecology Center
Monterey Bay IVF Program
www.montereybayivf.com
Monterey, California, U.S.A.
for additional information check out my blog at http://womenshealthandfertility.blogspot.com check me out on facebook and twitter with me at @montereybayivf
