Thursday, June 28, 2007

Baby, sister

The Fertile Myrtle sister or sister-in-law is something of an infertility cliche. Here you are, trying for months or years to get pregnant, and when you innocently turn up at a family gathering, someone suddenly wants to make an announcement. While you might be sincerely happy for the parents-to-be, it can be hard to get such an up-close-and-personal look at someone else's journey through pregnancy, birth, and parenthood.

My sister didn't get pregnant while I was struggling with infertility. Instead, she got a divorce. She was not-quite-21 when she got married, to the man we now affectionately refer to as "that worthless sumbitch", and she was also two months pregnant. The pregnancy wasn't an easy one, with significant nausea and pregnancy-induced hypertension. When the anatomy scan showed that my niece had a cleft lip and palate, we all worried about whether the baby would be otherwise healthy or whether the cleft was associated with a more serious genetic condition.

At the time of my niece's birth, children weren't really on the horizon for me yet. I was 25, and G and I had been dating for almost a year; while I was sure that we would get married by that point, and starting to think about when that might be, I knew he wasn't quite ready to go ring-shopping. G and I had already talked about having kids "someday", but I wasn't in any big rush yet.

But then there came Grace, and everything was suddenly different. She was born six years ago on Monday, and I adored her from the moment I first laid eyes on her. There's a photo I took of her at just a few minutes old, as they were wheeling her from the OR to the NICU (for a few hours' observation, because of the cleft). You can't tell to look at it, but that photo was taken at the exact instant my biological alarm clock went off and started ringing.

It took me by surprise, the sudden and unexpected intensity of baby-longing, and it took me months to get my emotional balance back. I eventually got myself under control, though, and focused on getting engaged and married, and to settling into our life together. We planned to wait a year before getting pregnant, then were forced to postpone it by maternity insurance coverage, and when I finally went off the Pill in May 2005, well, you know the rest.

During my pregnancy, I asked my sister if she wanted to have any more kids. She laughed and said, oh no, she never wanted to go through pregnancy and infancy again. She wasn't in a huge hurry to marry her very nice boyfriend, and he already has three children himself, and she thought four kids was plenty. When my babies were born, though, I looked at her, and I saw myself back when Grace was born. She held them, and smelled their little baby heads, and murmured to them, and I thought, she wants another baby.

She denied it at first, but the other week, she mentioned to me that she was seriously thinking about trying to get pregnant. I think this is overall a good idea, as her boyfriend is just the nicest guy imaginable, and she's in a better place in her life than in her first pregnancy. However, as it turns out, there's a catch: he had a vasectomy five years ago. So it's not going to be as easy as a few candles and a bottle of wine.

She is researching vasectomy reversal, but she's also thinking about going for an extraction and IVF/ICSI. The success rates of the reversal are not stellar, from what I understand, and you often wind up doing ICSI anyway. I don't think there is any female factor to contend with, which would weigh in favor of going straight to IVF, but she might just do it anyway. In her (and my) very unique situation, IVF is somewhat less expensive, which is a pretty major factor for her.

I hate that this is happening to her. Nobody ever wants bad things to happen to her loved ones, of course, but the more so when you have first-hand experience with it. I know her resolution probably won't come quite as easily as mine, either.

Welcome to my world, little sister. I'm sorry you're here.

Tuesday, June 19, 2007


So, it's probably no surprise to many of you that I have been positively obsessed with the births of the Morrison and Masche sextuplets. After all, we did injectibles + IUI, triggered with 4 to 6 mature follicles, and got pregnant with twins and a maybelet. To a certain extent, it's just chance that the world isn't busy chattering about that stupid Emma B woman, so baby-crazy that she was willing to have a litter, with her cowboy doctor whose only concern was his success statistics.

Certainly, whenever I read about high-order multiples, I get a case of the shakes. It could have been me, with the six 22-week preemies rather than the healthy 36-week twins. It's even possible that it still might be me, someday down the road. After all, we plan to start treatment if necessary to conceive a third baby, and we haven't ruled out beginning with an IUI cycle before proceeding to IVF. I think to myself, we were so very lucky.

But you know what? We weren't lucky, really. Despite having all those follicles, the odds were overwhelmingly in favor of us conceiving no more than one baby. It's tough to get good statistics on IUI, because they're not reported to the CDC, and it's not as easy to measure follicles as to count embryos transferred. Still, we know enough to engage in drive-by statistics.

The overall IUI success rate is estimated at 15-20%. Since this includes IUIs with a single follicle and multiple follicles, let's assume that any given egg has at most a 15% chance of developing into a viable pregnancy. (This number is almost certainly on the high side, but this isn't a scientific paper here, just an off-the-cuff analysis.) So, if you undergo an IUI with six mature follicles, your chances of sextuplets are:

0.15 * 0.15 * 0.15 * 0.15 * 0.15 * 0.15 = 0.0000114 = 0.00114%

In plain English, about one in 100,000 women to do an IUI with six follicles will conceive sextuplets. For comparison, you are 17 times more likely to die in childbirth. If you are a no-risk singleton mother at term, your baby is 62 times more likely to die during birth.

One in 100,000, y'all. Think about how absolutely tiny that is. It's a 99.999% chance that it won't happen to you, even though you have six mature follicles. Wouldn't you think that 99.999% is a sure thing, that there was no way you would be the one to have the sextuplets?

Or let's ask ourselves, how likely is it that our six-follicle woman will have quads or quints, rather than sextuplets? Those are still pretty bad, right? Well, the math says that this woman -- let's be hypothetical and call her Emma -- has a 67% chance of conceiving twins (0.15 * 0.15 * 30 possible follicle combinations). This is no surprise, given that they're crawling around her living room floor at the moment. Her chances of triplets drop a whole lot, though, to just 6.75% (0.15 * 0.15 * 0.15 * 20 combinations). Emma's chances of quads are another order of magnitude lower, at just 0.7%, just 7 out of 1000. Finally, there is only a 0.045% chance of quints, which is pretty tiny. Add the risk of quads, quints, and sextuplets together, and there is a 99.25% chance that Emma will NOT get pregnant with high-order multiples, even though the conditions are right for her to do so.

Is it such a terribly stupid decision, to do something that has a 99.25% chance of working out OK? There are certain risk levels we all agree are unacceptable, especially when we're talking about children's lives and health. Other cases are a lot less cut-and-dried, and to me, this level of risk is one of them. If you look at the numbers, it's easy to conclude Brianna Morrison and Jenny Masche were no more cavalier about high-order multiples than I was, just overwhelmingly unfortunate.

Monday, June 18, 2007

A day late, but...

That knee post actually took me all weekend, so this is a day late. No matter, I still mean it.

Happy Father's Day, honey. You are the best husband and father we could possibly ask for. Thank you for all you do for us, and know that we love you with all our hearts.

Partially bad news

I know you've all been waiting with bated breath to find out what happened with my latest stupid knee incident, right?

Right after the injury, the doctor said that he thought it was a partial tear, and that it would heal well in the next couple of weeks. Of course, since I'm posting about it, you know that's not what happened. It continued to buckle on me, not to mention that it still hurts, so I called and asked the nurse to schedule an MRI before my follow-up, which was last Monday.

At the follow-up, Dr. Busybusy the knee surgeon said that the MRI was "just fine". It showed a partial ACL tear, which I've had for 13 years now, and no new meniscal damage, just scarring from the recent knee surgery. Basically, according to the MRI, the knee is just fine, but I don't think that tells the whole story. MRIs aren't dead-on accurate in detecting cartilage damage where there's scarring from pre-existing surgeries, and they can't tell how much of a partially-torn ligament is still intact, or separate out new tearing from the preexisting partial tear. Normal, fine, healthy knees don't routinely buckle and dump their owners on their asses. Normal, healthy knees let their owners squat and kneel, and walk up and downstairs easily, and not limp around all the time. I want to be just fine as much as the next girl, but I do more with my knee than have MRIs taken of it, so being just fine on MRI doesn't really mean too much to me.

Dr. Busybusy said, OK, maybe the buckling is just muscle weakness and incomplete recovery from the previous surgery, and could be treated with some more physical therapy. He sent me for a couple more tests to measure how clinically unstable the knee is, and to measure how much weaker the bad leg is, and I had those done yesterday morning. The very nice physical therapist who did the tests told me that she could tell I'd worked hard in rehab, because my bad leg actually measured as being slightly stronger than the good one. The instability measurement showed that the knee is a lot looser than my "healthy" one, enough that it qualifies as a clinically unstable knee. She said doing more PT wouldn't help the knee, since the looseness is structural rather than a muscle problem, and that Dr. Busybusy would probably consider surgical reconstruction.

So, a followup appointment is being scheduled with Dr. Busbybusy, at which I assume we'll discuss whether to do the surgery. If I want, I could just wait a while, and fix it whenever it tears the rest of the way, or when the looseness and the buckling cause even more cartilage damage. Based on the way it's acting, though, I think it'll tear again sooner rather than later, and I don't have so much knee cartilage left that I can be cavalier about losing much more. Also, it's causing some non-trivial problems with my life already, so it's not like I can just forget about it until something else happens. Just like my last surgery, it's probably a question of fixing it now, or letting it get even worse and fixing it later.

ACL reconstruction is absolutely non-fun. It's not like any knee surgery is a picnic, but I got off pretty easily back in February, with only a few days on crutches, and near-normalcy in a couple weeks. This time, we're talking about weeks on crutches and months of physical therapy, and nearly a year to reach full recovery. And it's not exactly the best time to go having knee surgery, either -- in addition to the nine-month-old twins (who are, I think, going to be walking quite soon), I'm doing a lot of freelancing, still trying to finish up the master's, and we're putting our house on the market and hoping to move.

I may well delay the surgery itself for a few months, and hope my knee doesn't get more damaged during that time. Eventually, though, I think it needs to be done. In retrospect, if I'd had an ACL reconstruction for the original partial tear back in 1994, I might have avoided both the recent surgery and this latest fiasco. More significantly, I'd have avoided doing more cartilage damage, and thus decreased my risk for future arthritis. I don't want to look back in twenty years and wonder if having the ACL reconstruction in 2007 would have spared me the knee replacement.

The whole thing is just impossibly frustrating. Knees may be a good overall design from a functionality standpoint, but they're very fragile -- injure them once, and they're never the same again.

Tuesday, June 12, 2007

Why I have resisted adding a third solid feeding

... because three baths a day is just too much:

Seriously, my little girls are the messiest eaters you've ever seen. Sometimes I can get away with a wipe-down after a feeding, but for the most part, they need a bath after every. freakin'. meal.

Theoretically, they are now eating three meals of solids a day. In practice, they eat two solid meals, and sometimes I give them a snack of cheerios, or a third solid meal if I happen to be really on the ball (i.e. it's happened twice). They have learned to self-feed, and they enjoy cheerios, tiny pieces of cheese, and pasta shells sprinkled with parmesan. I'm making my own baby food, and there is almost nothing they don't eat with gusto -- hummus, cauliflower, chicken, beef, sweet potato, broccoli, lentils, you name it.

At our nine-month pediatrician visit last Wednesday, Claire weighed 14 lb 10 oz and Katherine was 16 lb 4 oz; Katherine is 27 1/2" tall, while Claire is only 26". Katherine has shot up into the 50% height-wise, 10% weight, while Claire is 10% height and <3% weight. However, she has gained a full pound since our weight check of three weeks ago, and two pounds since the bronchiolitis took her down to 12 lb 10 oz. Clearly, the solids are agreeing with them.

In addition to the solids, the girls are still nursing at least 4-5 times a day. I saw Nico talk about quitting nursing, and it made me think. My original plan was to wean them after a year, so that we could start trying in earnest for baby #3, but I'm not sure that's how it's going to work out. At nine months, we are nowhere near ready to wean, and I have my doubts that this will significantly change three months from now, although I know that teeth (which they still don't have) might well change everything.

I'm also having doubts about just how ready I am for the arrival of a third baby. I know I certainly couldn't cope if you handed me another newborn tomorrow, but isn't useful one way or the other, since they'd be at least 18 months even if I got pregnant tomorrow. I'll post more about this at some point in the future, but for the moment, suffice it to say that I'm not feeling so much internal pressure to wean them ASAP so I can start trying to get pregnant again.

Well, technically you could say we're trying now, though this is partly due to dissatisfaction with various birth control methods. However, when I say "trying", I mean "take lots of artificial hormones, go through invasive procedures, and prepare myself for the possibilities of hospitalization and another multiple pregnancy, while mothering toddler twins". When you put it like that, why no, I don't really feel like rushing out and weaning immediately, just so I can get started. We'll see where I am in a few months, I guess.

So that's the state of the highchair right now, going well overall. The state of the nursery is not so good, as I am currently getting a colossal dose of karmic retribution for all that good sleeping they did from 10 weeks on. 9-month sleep regression, I hate you, please leave soon... but that's a topic for another post.

Tuesday, June 05, 2007

Bad Mother Chronicles, part 7534

Let's say your hypothetical nearly-nine-month-old has been displaying hypothetical signs of crankiness all day long. To stop the crying bout, you hypothetically pop her in her high chair and feed her a supper of hypothetical pasta, applesauce, and yogurt. When she spits it out all over her face, you turn to feed her hypothetical twin sister, and in the meantime, hypothetical baby #1 falls asleep in her high chair, with applesauce and yogurt all over her face. Do you:

a) wake the baby up enough to wash her face, bathe her, and put her to bed
b) let the baby sleep, slumped over on her tray, until she wakes up on her own
c) let the baby sleep while you reach for the camera
d) let the baby sleep, reach for the camera, and post the picture on the internets

Double extra bonus points when, a few hours later, the baby in question spikes a hypothetical fever of 102.4 degrees!

(She woke up while I was reaching for the camera, but the picture managed to catch the essence of tired baby anyway.)