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Needless to say, we have been a little busy lately. After everything we have been through, I can’t believe the twins are finally here!!! Seeing them for the first time was absolutely amazing. They are beautiful, they are perfect, they are more than I ever could have hoped for. I cannot thank everyone at the Center for Assisted Reproduction enough for everything. Thank you, thank you, thank you from the bottom of our hearts.

I can’t believe I’ve been on bed rest for over 3 months. When I first started this phase of my pregnancy, I thought that I would be completely crazy at the 3 month mark. Looking back, it has gone by so fast. I now go to my OB every week and she says keep going, one more week. She plans on cutting the cerclage in about 2 weeks and letting me go into labor on my own. At times I get so frustrated I feel like getting up and doing something. But then I get a reality check and remind myself that I’ve already been here for so long that 2 weeks is nothing! Big changes are coming this month and my husband and I are both excited and nervous.

I still remember the doctor’s face during my annual well-woman’s check-up when I was 41 years old. I had just shared with him that I would like to have another child. His tone changed to a very monotone, Dr. Spock articulation and he developed a sort of “deer-in-the-headlight” expression. “The odds are not good,” he said, and my heart sank. My oldest biological child had been diagnosed with a life-threatening illness at age 7. Although my desire to add to our family was still strong, my husband’s desire was not. For him, the equation became, “Children equal pain — the worst pain ever.” Our firstborn had to undergo grueling, disfiguring treatments and was not expected to live. We were told that it would be a long, slow process. The brain tumor that the neurosurgeon had removed would almost surely grow back, and because she had metastases down her spinal column that required full brain/spine radiation, future treatment options were limited. They could operate again. And possibly again, depending on the location of the recurrence, but ultimately this terrible disease would claim her life. Out of respect for my husband, I held off trying to get pregnant. He finally came around, but by then I was in my early forties. What my ob/gyn was telling me made it sound like it was now too late. Luckily, I sought a second opinion. And I eventually sought treatment from a specialist. These specialists are called “reproductive endocrinologists.” My first specialist was a young woman, and I could tell that she disapproved of my desire to have another child. Or maybe it was just my sensitivity to being over forty and trying to get “knocked up.” At the very least, she appeared less than enthusiastic about my desire to get pregnant. Looking back now, I realize that she was pretty much blowing me off. By this time, I was 43 years old. We had been “trying” on our own for awhile. I would get pregnant but then suffer an early miscarriage. I later learned that almost 50% of pregnancies for women in their forties end in miscarriage. Dr. First, I’ll call her, did not do any testing. Not even a blood test. I now know that testing my ovarian reserve and FSH could have saved me about 3 years, but initially I trusted that this doctor was doing all she could to help me. She told me that if I did not become pregnant with Clomid that I should move on to egg donation. “Egg what?” I remember asking. She explained, and I remember thinking, “No way.” I even told her that if I could not become pregnant on my own, then we would give up. I now know that this is a rather common response among fertility patients. Nobody wants to resort to donor gametes, and it takes awhile to wrap your head around the concept.

Fast forward through 2 years of trial after trial of Clomid without success. We looked at international adoption. Not as easy as everybody seems to think, especially given our age. And the time it involves. A minimum of 2 trips of 2-weeks duration to the foreign country and the whole process can take from 18 to 24 months! ” Gosh,” I thought, “I’m getting older by the minute, I cannot wait two years! Who will take care of my daughter and son and work to pay the bills if one of us is on another continent?” Nope. Adoption was not going to work for us. Finally, my wonderful, new ob/gyn (a woman, I might add) referred me to Dr. Kathy Doody at the Center for Assisted Reproduction. My doctor told me, “If the Doody’s cannot get you pregnant, then nobody can.” During my fist visit, Dr. Kathy was very direct and told me that at age 44, my best chance of getting pregnant was to use donor eggs. In fact, Dr. Kathy told me that she would not do IVF with my own eggs. The chance of success was just too slim. I really needed somebody to tell me that and not mince words. It helped to get that closure. I knew in my heart that she was right. And I immediately knew that I was ready to move on to egg donation. I still wanted another baby. Who cares if I have to “borrow” an egg? I would still be the birthmother, and the child would be my husband’s child. A flash of jealousy surged through my veins at the thought of some “young” egg joining with my hubby’s sperm. Then rational thought took over again, and I realized that it was more important for me to have this child, than to get hung up on what happens in a petrie dish. After all, my daughter (yes, she survived the brain cancer albeit with lifelong disabilities) and then 9-year-old son both strongly resembled my husband. A child born of egg donation would also probably favor him, and who would be the wiser, right? Boy, did I have a lot to learn. Looking back, I’m not sure how I really got through those days. But I kept going. Each criteria that I had to meet represented a step that I was capable of taking. Recent PAP smear? Check. EKG to make sure that my heart was healthy enough for pregnancy at my age? Check. Recent mammogram? Check. Blood work? Check. Psychological consult? WHAT????? Okay. Now my early paranoia reared its ugly head. They think I am crazy for wanting to have another baby at my age, don’t they? I knew it. What if I don’t pass? Should I be honest and tell this person that I am secretly a little jealous of the egg donor and all of her young, vibrant eggs? Should I mention that my husband looks a little sheepish when we discuss what characteristics he thinks are important in a potential donor? It’s like asking your husband to describe the woman he would marry IF something happened to you. God no. I’m going to keep my mouth shut. I’m going to be the most NORMAL person that psychologist has ever seen. Question: Does my husband have to come in also? Oh no, now we’re sunk.

After being monitored by my Dr. for a few days, she thought it best to perform a cerclage as my cervix was thinning at an alarming rate. She instructed me to go to the hospital, where they immediately admitted me. Needless to say, I was extremely nervous! Everything went by so fast and the procedure was over before I knew it. I had some mild abdominal cramping and spotting, similar to that of my egg retrieval but everything was back to normal by the next day. I am on bed rest for the duration of the pregnancy. It has been very frustrating because I feel like I have so many things to do to prepare for the twins’ arrival and can’t do any of it. I just keep reminding myself that each passing week is a triumph and it’ll be over before I know it. In the mean time, I get to leave the house for a Dr. appointment every few weeks and watch lots of television.

Last week I was inspired to blog about one patient’s success with weight loss. She lost a whopping 80 lbs. by making simple, modest lifestyle changes. This week I would like to share my enthusiasm about a new workout DVD. First, let me fill you in on a little background. I am the Queen of at-home work out videos. I love not having to worry about make-up or the latest trends in work-out fashion. I can wear my 80’s leg warmers and baggy 90’s work-out bicycling stretchy shorts with pride! Nobody is around to judge or criticize me. I do not have to keep up with some young twenty-something who has flat abs and “perky” breasts and who is really at the gym to check out the cute guys. And my rule at home is, “IF YOU COME IN THE ROOM WHEN I’M WORKING OUT AND MAKE FUN OF ME, THEN YOU MUST DROP WHAT YOU ARE DOING AND WORK OUT WITH ME.” This is a surefire way to get rid of any husband. And if he does take the challenge, he will forever respect what you are doing. After trying to keep up with what he considered a “wienie” step work-out, my husband steers clear of me when I’m exercising. I showed him!

Now back to the awesome DVD. The title is “Walk Slim,” by Leslie Sansone. I’ve been having some trouble with my left knee lately and purchased the DVD thinking that at least I could walk to maintain some form of regular exercise. I also thought it would be a great workout — sort of simple and low impact — for days when the thought of working-out is about as appealing has having a root canal. You know, for the mornings when I’ve indulged the night before by eating “just a handful” (funny, I seem to have HUGE hands) of buttered popcorn or some other forbidden something that leaves me guilt-ridden and feeling rather icky the next day. Walking is easy, right? The walking workout was probably going to be easy and a little boring, right? WRONG!!!! I loved it! Let me emphasize that again — I LOVED IT. It was easy, but what a workout. And my first mile flew by so fast, unlike the treadmill where I look at the time gauge in anticipation because it seems like I’ve been walking forever — and it only registers 1 minute and 30 seconds. Ugh, I think. Only 29 minutes and 30 seconds to go. What an eternity. The walking workout includes a warm-up period and 4 miles of walking. I had only planned to do the first mile, but it was so much fun and the time went by so quickly that I did two miles the first day and three miles the next. The leader, Leslie, looks like a real woman — the kind with hips and thighs and to use a tabloid favorite, with “curves.” And the rest of her work-out buddies are regular women ranging in age from twenty-something to fifty-something. And there is even one guy working out who is wearing a T-shirt entitled, “Forced to Workout.” This young, handsome guy could barely keep up with these gals! The walking starts out at a fairly brisk pace (think marching in place) and increases with each mile. In addition to walking, you use your arms and legs and believe me, I was breaking a sweat by the second mile. Leslie tells you that doing the entire 4 miles burns off the calories from one meal. She does not specify exactly how many calories she is talking about, but I figure that most meals designed for weight loss contain at least around 400 calories. Burning 400 calories in one workout is phenomenal. The final mile incorporates strength building moves using a band. And get this, I purchased the DVD, which includes the band, for only $9.00 at Walmart. What a deal!

At CARE, patients are often told to reduce their weight and lower their BMI. Studies have shown that obesity and a high BMI can lower your chances of conceiving. If your physician has encouraged you to lose weight and start a regular exercise program, I would highly recommend this walking workout. It is easy and fun and most importantly, it does not require an expensive gym membership or fancy equipment. It can be done in the privacy of your own living room at any time of the day or night.

Have you had success with losing weight? Do you have a great tip to help someone else eat healthier or start an exercise program? If so, please email me at patriciam@embryo.net. Have a great week.

Dr. McBride
CARE Psychologist

Okay, here is my first attempt at blogging. I had an inspiring visit with a patient today and wanted to share what she had to say with other CARE patients trying to lose weight. This patient is a young, African American woman diagnosed with PCOS two years ago. She was told that obesity is a factor in the development of PCOS, and was instructed by her physician to lose weight if she wanted to increase her ability to become pregnant. To date, she has lost 80 lbs., has no more cysts on her ovaries, and has normal menstrual cycles. She is so happy with her weight loss, and with the news that she can move forward with her plan to have a baby. I congratulated her, but also picked her brain about how she managed to be so successful with her weight loss efforts. Here is what she had to say: 1. She did not go on a “diet.” She just started making small changes that had a huge impact. For example, she gave up soft drinks and started drinking more water. 2. She started moving — playing Guitar Hero and Dance Revolution and took the long way to carry out the trash. 3. She started eating more vegetables and fruit and less candy and junk food. 4. She switched from white to whole wheat bread and pasta. More fiber fills you up and “keeps things moving.” 5. She stayed motivated by seeing the pounds melt off. 6. She viewed her new eating habits and exercise approach as a permanent lifestyle change, not a temporary starvation diet that you “stop” down the road. 7. The exercise and healthy eating had unanticipated benefits — she developed more self-confidence. 8. Her partner lost 60 pounds along with her! 9. She feels confident in her ability to eat healthy and manage her weight during pregnancy. 10. Do not give up! You can eat well and still lose weight. Deprivation is not part of the equation. I think the most important message here is that losing weight does not have to feel like a chore. This person had phenomenal success with a good attitude and reasonable dietary changes. No marathons, no weight lifting, no eating only grapefruit or cabbage soup. And she developed a healthy relationship with food along the way. Great job! Dr. McBride CARE Psychologist

I went to the Dr. and she became very concerned because my cervix was shorter than it should be at this point. She has put me on bed rest for a few days and wants me to come back so she can measure again. She said it either is naturally short or it has already started thinning for delivery. She explained that if it has already started shortening, she will perform a cerclage. So, I will go back in a few days with my fingers crossed that everything is okay but for now, I’m on bed rest.

…one of each! How lucky we are to experience the best of both worlds.

I had an episode of bright red bleeding, something that I never expected. I called my OB immediately and she told me to come to the office. She put me on bed rest for a week. The bleeding subsided after a few hours, but she says that all we can do is cross our fingers.

I’ve had another sonogram and can’t believe how fast they are growing. I was also able to finally stop the IM progesterone injections after having to continue an extra two weeks because my level wasn’t high enough. It is such a relief that my level finally went up. My husband and I are so excited and feel so fortunate. I would never have imagined when we started this whole process that it would take us almost a year to get to this point, but I’m glad we finally made it. It was well worth the effort.