Multiple Fears

F and I have always been weary of injectable cycles and its goal of super-ovulation. I have written about it before. We do not want multiples. Our original plan then, was to skip injectables altogether and go straight to IVF, with the hopes of qualifying for a shared risk program and having enough predicted success for single embryo transfers. We chickened out of our plan, however, and are in the 2ww of an injectables cycle. I had 4-5 follicles at the time of the trigger, though 2 might have still been immature at trigger, but I can safely say we for sure had 3. Part of me wonders if a more conservative RE would have canceled the cycle with the possibility of 5 follicles, which, from what I have gathered online, is the maximum before cancellation (or maybe Dr A suspected that 2 wouldn't make it in time? but for the purpose of this post, let's assume I had 5 follicles). So of course we talked about reduction. When Dr. A said I should ovulate around 5 eggs, I asked if 5 was too many (Most REs want 3-4 for IUI). and Dr A replied, "You are open to reduction if necessary?"

Absolutely. We only want one.

However, many infertility patients want twins. And I totally understand that desire. This will be our only attempt with fertility treatments. A singleton means a singleton, no siblings. Sometimes I find myself fantasizing about life with twins; there are many healthy twin pregnancies and I have friends who are twins and friends who have twins. It is the pregnancy and birth of twins that scares me. Many bloggers have beautiful twins, many bloggers have lost beautiful twins. I'm not going to go through all of the risks of a twin pregnancy because we all know them.

The New York Times Magazine published an article about the growing request for fetal reduction in twin pregnancies. Many of the interviewees were infertility patients and all of the pregnancies discussed were healthy (at the time of reduction) twin pregnancies. The article asks, what is it about reducing a twin pregnancy down to one that is so much more controversial than reducing triplets to twins or aborting a single fetus? It is worth a read.

The article points out the medical warnings given by REs--that it is definitely best to avoid multiple gestation--but also points out that most doctors do not believe reduction below twins is medically justified, and many refuse to perform reductions on twin pregnancies. Many of the couples interviewed had to travel across the country for fetal reduction. The couples who chose to reduce from 2 to 1 all have differing reasons but none of them seem to be medical, which I found odd. But then again, despite listing the medical risks associated with multiple gestation, the article was really asking ethical questions about fetal reduction in twin pregnancies, especially for those who are pro-choice, as well as for those who did not prevent multiple gestation, but accepted (ignored?) it as a very possible risk.

While F and I have discussed our fears about this cycle and agreed in a matter of seconds that we would reduce any pregnancy over 2, neither of us had heard of fetal reduction for twins. If you have 3 should you reduce to 2 or 1? That suddenly makes me feel really uneasy.

The article does discuss the secrecy and controversy of twin reduction, in fact many of the couples never told anyone about the procedure. Fetal reduction carries its own risks; for someone like me who could probably make a healthy twin pregnancy work, both in my body and at home, the decision is a no-brainer.

Since the IUI on Sunday, my 2ww fears are oscillating between thoughts that this didn't work, we are going to have to move to IVF, and that it will work, but that it will be a multiple pregnancy. It is either nothing or twins, and each outcome carries with it its own set of emotions, fears and decisions (no, not the decision to reduce). I can say though, that if those are my two options for results of this IUI, I CHOOSE TWINS. In a heartbeat (two heartbeats).