IVF in Kerala - Triplet Pregnancy

We did IVF- ICSI and conceived!. Read here about the IVF

Then started the OHSS symptoms.

It's TRIPLETS!!!

Well, facts are always more complicated than fiction, no doubt. In the last two weeks, especially on one particular moment today morning, my life changed entirely. Whatever I was, whatever I was planning for myself, whatever I was expecting in the future..everything changed so drastically..I am yet unable to believe, and I am exhilarated, I am scared, although what can be the consequences and implications of it all I may not fully grasp until after many years.  

After coming home on 5^th, my parents went to their house to fetch the things for a stay that might be little longer than expected before. When Ramesh left for office, I sat alone. I felt very nervous about my P.G. course. If I do not go to complete the course, then it might become a problem (as described in the post 'Post Graduation'). Besides I did not want to waste the first two semesters of hard work, good fun and good marks. So just to make myself believe that I would be going, I booked train tickets to Chennai, on the 11^th July evening train, for myself and Ramesh. Then I called up my friend and P.G. classmate Sari and transferred the next semester’s tuition fees of around Rs.45,000/-.  

The next couple of days I spent reading something and worrying about everything. On 10^th my parents returned, and my mother took over cooking from the maid. Mily, our pet dog was allowed everywhere inside the house before, but since my parents were worried about pet allergy to pregnant women, she was now allowed only inside the sitting room.

On 11^th  (Monday) morning we went to the hospital, got the blood check done and found that Beta hCG doubling rate has reduced. I was very anxious, and my face showed the anxiety while waiting outside DrTC’s room. He saw me through the half door and we were called inside. He said the Beta hCG rate will get reduced as time passes, and later it will stop entirely. There is a  chance of increased hormone production by body at the end of the gestation period, and a very remote chance of recurrence of OHSS, but it will not be nearly as severe as the one before. He said that the ultrasound scan report says that it was multiple gestation, and he confirmed it by doing a vaginal scan. I told him that I was planning to leave for Chennai that evening, and he said outright that I should not go. There would be another scan on 19^th, and once it was done we could take a decision. If it is indeed multiple gestation, then I would have to take bed rest. I got very agitated by this. We left the hospital, and I cancelled the tickets. The waiting started again. I was too anxious. Anyway, I spent day and night lying down, reading and watching TV. In between we also went to watch ‘Salt n Pepper’ and ‘Harry Potter VII’. ‘Salt n Pepper’ talks about food and the opening scene song sequence features a lot of mouth-watering delicacies. But my stomach was still tight, no trace of hunger, and I missed feeling hungry watching those scenes. HP-7 we watched on 18^th  -a late night show (somewhere deep inside I knew I would not be watching another movie in a movie theater for a very long time to come). Ramesh was tired from office, and he generally disliked HP movies ("books are so much better!”), so he started snoring loudly. People in front rows turned around and laughed. I felt so embarrassed, but there was no way to wake him up.  Gradually he stopped snoring, still slept through the movie.

Today morning I had yet another ultrasound and vaginal scan. My father came along with us as he had a body check-up (after the angioplasty a few months back) at another hospital on the way. We dropped him there and went to our hospital. This ultrasound was done in the main block of the hospital, in the main scan room. The lady doctor with the accented Malayalam did the scan and she gave her findings to the person typing the report. (Online I have read many stories of pregnant women talking about their scans etc. where the doctors show them the monitors and discuss the results. But here it is not like that. We are considered ignorant, delicate weaklings with whom the important medical information about our own body cannot be shared). She was telling something and I noticed her saying ‘triamniotic’. A mild anxiety crept through me. Really, it can’t be triplets... My mind went numb. I could not pray for anything except that all was well. Even if it was triplets..well, whatever God gives, I should happily accept..after all these years..I closed my thoughts and concentrated hard on praying all was well…

I came out, saw Ramesh waiting there and told him that there might be some unexpected news. He frowned, but kept quiet. Then we went to DrTC’s room. The senior nurse was standing outside the room. She called me aside and said ‘Hey, it’s triplets!!’ I smiled, but it was forced. ’ Really?’ I said. ’Yes, Congrats! And now you take good care of yourself’. With that she went inside. I came back and told Ramesh what I was just told. He smiled, but I could not really make out if it was real, or forced. Then we were called inside and DrTC was sitting with a huge smile. He did not know that I was told, so with all the air of breaking a life changing news (which it was), he said, ‘You know, it’s triplets!’ ’Yes, we heard’ I said. The first thing I wanted to know was if I could go back to Chennai. He said, yes, I could, but then if there was some mild problem, or if there was a spotting (bleeding during pregnancy which to some extent resembles a period, but much less in quantity. It is a common occurrence, nothing serious most of the time, yet scary enough), then I might have to visit a hospital there, and as soon as they found out about the multiples, they’d make me stay in the hospital. Unknown hospital, unknown people, unknown city. And if there was any serious problem, then every single person in the family would blame me for going. So, really it was up to me to decide, and yet I had no options. I said I had a comfortable room to stay, good helping friends around. He laughed at this and said I was saying all these because I had no idea how complicated and difficult life could become during pregnancy. Ramesh offered that he could come and stay with me, and again doctor said, the problem was that things were unpredictable. If something happened then all the effort, all the sufferings, all the money, all the prayers and hope everything would be wasted. And so, finally I had to face that tough moment of actually realizing that I was not going anywhere for the next year. I could not believe it.

Then we talked about the babies. Doctor explained that I might have to stay in bed at least in the last trimester, and he would prefer if I stayed in bed during the whole time. Since the first day of my last period was 2^nd June, my due date for delivery, that is 40 weeks completion, was 8^th March. It might not go full term, but it would be very good if I could carry on till 37 weeks or 36 weeks, or at the very least 33 weeks when babies' lungs would be mature enough to breathe. I looked at the calendar and wondered if I could carry on till 14^th February- Valentines day, that is one day before 37 weeks complete. I felt strong and willful, and somehow felt I could carry my babies full term. We discussed many things, like other couples with triplets, the possibility of my continuing the studies later etc. Then DrTC said in a serious tone- ‘It is not going to be easy, carrying three babies, and going full term. You have to rest completely. Then after the babies are born, it will feel like a kindergarten at home. You will need a lot of patience. You have a choice to do selective reduction, that is, there is a procedure in which the weakest foetus is identified and reduced, so only twins will be there. You can opt for it, but then I would advise against it. Because of all the complications, there is a good chance that if we do this procedure, the other babies also might get harmed.’  ‘Oh, We are not planning any reduction’- Ramesh said quickly.  I had read that sometimes when there is a triplet pregnancy, and there is a health issue, then in that case it is better to do selective reduction so that at least the two surviving babies are healthy. So I wasn’t very sure, and remained quiet and listened to the doctor. He said, ’I am not advising selective reduction for two reasons-one, you both hoped and tried so much, and when you got such a blessing, it is not right to do such a thing when you actually can afford to not do it. You are well settled, you can afford three babies. Then you have the support of the whole family. People do selective reduction when they can’t afford to raise multiples due to financial problems, or because they don’t have enough help. Your case is different. I agree that it will slow down your career growth for may be a few years, but well, it will also enrich you in many ways. Second reason is that the process itself needs to be done expertly. And it is not something we have a lot of experience in. Anything can go wrong, it can affect the other fetus also, I am not saying it will, but it can. Also it is not necessary that the fetus that gets reduced was the weakest. It is just an assumption after studying certain characteristics. So, now the decision is up to you. Think about it, and decide wisely. Your decision, whatever it is, is right’

We came out, and I said, ‘In a way it is good now that we know where all the three transferred embryos are, because otherwise I would have wondered where the third embryo went, whether it is in the tube or something..but then the three frozen embryos, what will they do to them?’ Well, we may never find out.

Much later, experience made me wonder about selective reduction, the technique of identifying the embryo to remove if we so decide-in case of multiple pregnancies. If the criteria for selection is weight, then what we find from experience is that the baby born with the least weight is the smartest one. If the criteria is survival instinct, well, how do they identify if an embryo has more survival instinct? Anyway, that is for experts to think and decide. 

As we started back, we discussed selective reduction. Ramesh would not hear of it. I also did not want to do it, now that the doctor assured that if I could carry at least 35 weeks, then the babies would have no major health or developmental issues. So, no selective reduction for us. We picked up my father on the way, told him the news and he got very excited. We reached home, told Amma. She got thrilled too, but also very worried about the health risks for me and for the babies. 

We are planning to go to my parents’ place and stay there for a few days, to get things settled there and my parents can come with us for a longer stay. I am doing a lot of internet research on pregnancy, especially IVF, that is how I read about ectopic pregnancy, where the baby can get stuck in the tube. Also I read about birth defects when it is a multiple pregnancy. The possibility of autism and other developmental problems due to pre-term delivery. I am having all kinds of bad thoughts these days. I am inventing all sorts of reasons to worry.

I was worried about many things at the time and I could not really appreciate the abundant blessing I was provided with. But later we realized the dedication and expertise with which DrTC and the rest of the doctors and nurses approached each case and the care they give to each one.

NEXT...First trimester

OHSS after IVF and pregnancy

I did not have to undergo anymore tapping.  I got my release from SICU on 1^st July, and presently got shifted to room 408. On 30^th June I requested doctor if I could be discharged. He said no way, if he had admitted me the first time- the morning of my OHSS start- the situation would not have become so complex, now there was no way he would discharge me and send me home until he was very sure that everything was stable. Anyway he said I can be shifted to the room, and SisG bid good bye saying that let there never again be another stay at SICU.

Thus began a new routine. My parents would bring breakfast from home (an hour away) every day and when they reached Ramesh would leave for office. Lunch was  arranged to be brought from a nearby hotel, and in the evening when Ramesh came,  my parents would leave. Ramesh would bring tender coconut every day. Every morning before breakfast my blood sample was taken for testing Beta hCG. Initially five bottles of Albumin was given as IV every day (Albumin from Reliance, called Alburel. It actually costs only about Rs.1800/- per bottle, but after all the overheads etc., the hospital gives it at Rs.5000/- per bottle!). Later this became three bottles per day and was stopped gradually, along with saline IV.

Finally, since Beta hCG was doubling properly and OHSS stopped, I got discharged today. Doctor scheduled the next visit for 11^th, and said that I should not leave for Chennai before that. I am worried, but trying to relax since full-fledged classes would not start before 11^th , hopefully.

NEXT...Precious threesome

OHSS after IVF - Bloating stomach and paracentesis

When I was admitted I never thought I’d spend so many days here.. Anyway, I am still here. In the first few days here I could not completely believe it that I was really pregnant. It is only when the sisters who come on a regular basis to check my vitals take a look at my file and comment something like ‘Won’t the baby be hungry? You should eat something, no?’, that I actually believe that I might indeed be pregnant. I befriended most of the nurses, especially the head nurse SisG, who is about 30 and the mother of two school going kids. She had passed IELTS and had a UK work visa but somehow could not go. This made me respect her even more. The other nurses were also quite friendly and helpful except for a few. I spent my days watching the variety of patients coming and going from SICU, and their behavior. They watched me curiously from a distance because I looked so much at home sitting and walking and calling nurses by their names and talking to them and laughing and all. My mind was numb because I did not want to think about all the work I had to do, especially regarding my course, job etc.

A second paracentesis was needed the day after I got admitted itself, that is the very next day after the first tapping, on 26^th. This was done in the afternoon, 3 pm, I think. In the morning when DrTC came, he checked my Beta HCG and said there is a high probability that I have twins. It had become a routine to look forward to the blood test every day morning, and to see beta HCG count mounting. I felt thrilled at the prospect of having twins, but doctor warned me against over hopefulness. When I was taken to OT for tapping in the afternoon, plasma IV was given along with saline. During tapping my body started itching, as if I was being bitten by mosquitoes. I complained many times to the doctor that mosquitoes were biting me in the OT during tapping. Now that I think about it, it is to their credit and the way they cared, that they did not laugh at me, though the doctor just said that OT is free of mosquitoes, even free of bacteria. Then I realized the stupidity of my complaint, and rephrased it to say that I feel allergic to the bed sheet. Then my body started swelling here and there, and DrA, the young and cheerful general physician who was in charge of the IV said that it was an allergic reaction to plasma.(I didn’t feel one bit conscious of the fact that a handful of people, men and women, mostly of my age group itself, were present in the OT during tapping. I had not felt any awkwardness even before, when I was having ovum pick up or embryo transfer. They were all very professional, and I did not feel any more embarrassment than I would have felt if they were looking at my hands. I noticed that DrA turned away when the nurses pulled the sheet from my legs to start tapping, and I assumed that he must have joined recently, and might not come often to see this kind of procedure. On the other hand during my treatment with DrTC, he rushed to the OT one day saying that he wanted to see a particular delivery in progress because he wanted to watch a particular gynecologist at work. These young doctors shared their knowledge, and shared the opportunities they had to learn new information from each other’s case patients). That day also, the painful part was cleaning the pelvic area. Everything else went well, and approximately 3 liters of fluid was drained. At one moment I laughed at some joke someone cracked, and jerked slightly, and felt something sharp against my skin: 'shh don’t move', said DrTC, and I saw him look at me with sudden concern. (I don’t know if my skin was cut, or if something else happened,  but later in the years that followed, whenever there is a brief but sharp pain in the pelvic area, I regret that moment).

After the tapping I was brought back to SICU and DrA gave me an Avil injection for the plasma allergy. Drowsy darkness washed over me, such intense sleep, that my eyes were instantly shut from the effect of Avil. Rght then my parents reached from Alappuzha. Amma came to see me at SICU. My eyes kept closing, my body was still swollen, and I was tired from the tapping. Amma got really frightened seeing me in that condition. I told her what the doctor said in the morning- about the possibility of twins. I expected her to jump with joy, but she remained unhappy and worried about me.  She said that Ramesh had already given the news, and that he was really excited and happy. Then she left and I slipped into a sort of coma. 

The next tapping was done two days later, on 28^th noon time. I was determined to get two days between the tappings, like the doctor said, and I barely got it. He had instructed me to exercise slightly by walking a little, and every day I walked as much as I could inside SICU. At least one hour each every morning,evening and night. Besides this, when there was no one to occupy the bed on my right side, which was at the far end of the nurses station, I used to go behind the curtain there and jog and jump slightly, just to reduce the heavy, full feeling in my stomach. In order to stop the IV saline I started drinking 5-5.5 liters of water daily, including tender coconut and my daily couple of cups of tea. However try as I may I could not get myself to eat the egg whites. Hospital canteen had good rice gruel, and I forced it inside. I hate gruel, however good. All this effort had only one aim- I desperately wanted to get discharged from hospital before 8^th July, Friday, and reach Chennai before 11^th, when classes would start, since I could not afford to break the course. My mind was set upon release. I had no idea how silly I was to even faintly assume this possible. Thus the days in SICU were hard work, sincere, tough effort both physically and mentally, to get over OHSS. SICU was not very strict in my visiting hours unless there was a patient who needed solitary care, and I had four visits every day-Ramesh came every morning and night with breakfast and dinner, and mother and father came every noon and evening with lunch and tea. The food smelled delicious each time, with mouth watering mango pickle, but my taste buds were not functioning. So I just smelled the food heartily, tried to eat mightily by reading Archies and Balarama and all (for which DrTC and DrA regularly teased me saying that this is what they teach at Engineering Colleges), but still everything tasted bad and worse, my stomach could not take anything in. The nurses’ company was good fun, DrTC came twice everyday (including Sunday when he came with his new wife- a pediatrician), still I felt lonely and just wanted to get back home somehow, and move on. May be, if it was not my QIP course period, but my vacation during college, or leave during college/office, I would not have minded the stay, probably would have even enjoyed all the attention, but that was not to be.

Today (30-6-11) when doctor came, he was ready for the fourth tapping. I was taking my regular walking exercises, and I thought he would appreciate that. He did not, and he even looked a little concerned about the way I was exerting. I said I don’t need the tapping and he suddenly looked skeptical. How come you are all right so suddenly, he demanded. Then he checked and understood that it was not that the fluid was not there, but just that my body was adjusting to it, the strain was still there inside the stomach. He checked beta HCG also and was satisfied and left. Later I asked SisG to inform doctor that I felt heavy and would like a tapping. Doctor came, checked and said that we’d wait for a few hours, and if the heaviness lessens we would not tap, let’s not introduce foreign stuff into the body unnecessarily. The heaviness and bloating was not my imagination, it was very real, he said. But because my abdomen muscles were strong the girth of belly was not increasing beyond a limit, and that did not mean that the strain was not there. However it was best to wait for some time. So here I am, waiting to see how it will all go.

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