At our 1st ultrasound (after IVF), we learned that we were carrying 4 babies (after transferring 2 embryos). We immediately knew that we would look into reduction. (The NP also mentioned it upon concluding the ultrasound.) By the next week, there were only 3 babies; 1 Singleton, and 1 set of monoamniotic, monochorionic twins. That means the twins share a sac and a placenta.
With 4 babies, reduction is a no-brainer. Yes, you can deliver 4 babies, but the risks are extremely high. With 3 it's just a tad less of a no-brainer (for us) because triplet pregnancies can be successful.
But first we need to talk risk.
At the top of the literature I received from the Maternal Fetal Medicine Dr. is this:
"In general the average delivery for multiples are the following:
TWINS: 36 weeks
TRIPLETS: 32 weeks
QUADS: 28 weeks
The risks increase if there are 'identical' fetuses."
Identical twins carry increased risk in general, but if the twins share a placenta, the risk is increased and if they are in the same sac, the risk is increased further. My twins share both.
Sharing a placenta creates a risk of Twin-to-Twin Transfusion Syndrome. One baby may not get enough nutrients from the placenta while the other baby gets too much. This is a cause of early labor. If they are in the same sac, the cords can get tangled and/or twist around the babies. This is a huge risk. In most cases (according to my perinatologist), a woman would check in to the hospital at a pre-determined week in order to get constant monitoring of the babies. She said this is very taxing on the mom and the nurses because the babies are difficult to monitor when that small. This would probably happen in the 20's (weeks).
Adding another baby into the mix increases each risk factor, pre-term labor, still birth, hypertension, gestational diabetes, etc.
She also went over all of the risks of pre-term babies, especially those born right after viability. I won't go into details because they are not fun.
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This was not exactly a hard decision for us. Both of us would have known at any point in our lives that this would be the right decision (we are totally on the same page which is great). We don't accept the risks for me, the pregnancy, the chance of actually delivering a healthy baby, or the difficulties in life afterwards.
This is the less popular part to talk about (life with 3 babies), but I'm not willing to put the strain on our marriage or other relationships that three babies would entail. We would need constant help from others. There would be no way that I could continue to work. I know that women do this successfully and I totally applaud them, but we can't do it.
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I live in San Diego, a very large city, but still both my RE and my perinatologist referred me to a doctor in Los Angeles. No doctors in San Diego do reduction. Besides - for this high risk procedure, you need to go to the best. This doctor gets rave reviews for her expertise and bedside manner.
She even called me personally to consult on the procedure.
We have to decide in the next day or so whether to do CVS (chorionic villus sampling) to check whether the babies all have normal chromosomes.
The reduction is done between weeks 11 and 14. The timing is to get past the natural highest miscarriage risk. The risk of miscarriage after the procedure is 5-7% (which is lower than the risk of miscarriage with triplets).
When we get there, she will have to consult on what she can actually do. If she cannot get to a baby, it cannot be reduced. Our singleton is below the twins which is good, because there is a higher risk of reducing the baby closest to the cervix.
I cannot wait for the procedure because I feel like this entire pregnancy so far is just waiting...waiting for it to be normal.
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I realize this is a very difficult subject to talk about and that there are many people who would not make the same decision that we are making. I believe most of these values are virtually unchangeable in people, so I do not try to change people's core beliefs. I ask that you respect our decision also. There is truly nothing that would change our choice, so I hope to avoid comments that are just designed to hurt. (Trust me, this has been quite a trying process so far.)
I am writing this post and sharing my story because it's real and it's not very common. I found one girl online (on Fertile Thoughts - there is a selective reduction board) going through the exact same thing as me - same doctor even - and it's really helped to know that I'm not alone.
I've always been extremely candid in my life and on this blog and I hope that you respect that.