Summary: Caroline is now pregnant after doing an aggressive IUI cycle in which she had six mature-sized follicles. It was roughly estimated that she had close to a 40-50% chance of getting pregnant and close to a 1-2% chance of triplets. She was clearly informed and she chose to take the risk. Now that she is pregnant, we are not out of the woods yet. There is always the risk of miscarriage, ectopic or multiple gestation and the only way to detect this early is with close monitoring of the pregnancy. We talked at her first ultrasound.
ME: Congratulations! You know, you were right. You didn’t need an HSG after all.
CAROLINE: I told you about my dream, right? But before we talk, Darryl and I just want to thank you and your staff. We’re just in awe!
ME: You’re very welcome. Regarding your dream, yes, you told me that you knew your tubes were open because of the dream, but forgive me for not writing that into your medical chart. Haha. Anyway, I know that you and I haven’t spoken in person since you got the good news, so today, you can ask questions after we do the ultrasound. My staff have been keeping me up to date. I see that your beta-hCG values have been rising very strongly. That is certainly good news. And how have you been feeling?
CAROLINE: Honestly, I don’t feel anything different. Maybe a bit tired, but I was expecting bad morning sickness. Sometimes, I ask myself if I’m really pregnant.
ME: No, don’t worry. Most women do have some symptoms, but there are some who have perfectly healthy pregnancies and yet, have no real symptoms. Today, you are 5 weeks and 5 days so we’re going to do your first ultrasound to count how many sacs you have. Are you nervous?
CAROLINE: No, not in a bad way. But I’ve very curious to see what we have.
ME: OK, let’s see then.
ULTRASOUND FINDINGS: There are two sacs seen! One measures 7mm in size and the other 5mm. They are both in the perfect location in the center of the uterine cavity. The ovaries are somewhat enlarged and measure about 5 cm each with multiple cysts seen. There are some faint yolk sacs in each gestational sac. No fetal heart motion is seen.
ME: Well, I see two sacs.
CAROLINE: That’s it? Only two?
ME: Only?
CAROLINE: I mean, whew. We were prepared for news of more, just in case, we braced ourselves for the possibility.
ME: Well, right now, there are two sacs. Now bear in mind that this doesn’t necessarily mean that both will survive. I try not to be negative, but I want to tell you the possibilities. Most likely, next visit, we will see two heartbeats, but anything is possible, including seeing no heartbeats. It’s sometimes even possible that a third sac will show up next week, although today I searched pretty thoroughly and I don’t see any evidence of a third sac. Sometimes, we see a small fluid pocket and have to wonder if that’s a small sac, but in your case, I don’t see anything other than those two big ones.
CAROLINE: Darryl will be relieved. And he is going to be so excited that we’re having twins.
ME: Well, remember, I caution you about telling too many people at this early stage. In fact, I wouldn’t necessarily tell casual friends about your pregnancy. You may tell your closest family members, but a lot could still happen at this point. And especially don’t tell them that you have twins yet. OK?
CAROLINE: (smiling with tears) I am just speechless.
ME: Do you have any questions?
I gave Caroline 10 minutes to call Darryl and returned to field her questions. Most of them were routine, concerning her progesterone, her activity limits and her dietary recommendations. She was on progesterone supplementation and was continued on her metformin. She was on prenatal vitamins and fish oil. I printed out three copies of the ultrasound pictures – one for the chart and two for Caroline. She was scheduled to come back in about a week.
Check here for episode 12 when published.
