He is my miracle, even according to the reproductive endocrinologist who worked with me during seven intrauterine insemination (IUI) cycles, until I achieved a successful pregnancy—me, a DES (diethylstilbestrol) Daughter with a T-shaped uterus, one-third normal size.

He is my miracle who, although I was dilated at 27 weeks of pregnancy, the result of my DES-induced uterine abnormality, and having contractions at 31 weeks, stayed put until his due date—February 10, 2005. 

He is my miracle who was born in acute respiratory distress because he had aspirated meconium (his first bowel movement, in utero), yet rallied in the Neonatal Intensive Care Unit and was released four days later, on Valentine’s Day.

He is my miracle who eliminated the issue of my blaring biological clock, enabling my relationship with my brand-new boyfriend, whom I met nine days before getting pregnant via insemination with donor sperm, to progress to marriage and my husband’s adoption of him.

He is my miracle who grew to 9 pounds 7 ounces before birth, stretching my tiny T-shaped uterus into a larger arcuate uterus, making it possible for me to get pregnant during my second in vitro fertilization (IVF) cycle this summer.

My son is my miracle who has contributed to the realization of so many of my dreams.  Yet, while his presence, from conception to now, has been so powerful in my life, he will always be my baby. 

The book Love You Forever (Firefly Books, with its 68^th printing in 2004), written by Robert Munsch and illustrated by Sheila McGraw, communicates this concept more effectively than I ever could.  I’ve had the book for five years, and I have yet to read it without crying. 

The book’s back cover reads:

“A young woman holds her newborn son and looks at him lovingly.  Softly she sings to him:

I’ll love you forever,                                                                                                                                                           I’ll like you for always,                                                                                                                                                     As long as I’m living,                                                                                                                                                        my baby you’ll be.

This is the story of how that little boy goes through the stages of childhood and becomes a man.

It is also about the enduring nature of parents’ love and how it crosses generations.

Love You Forever is a book that both children and adults will enjoy—over and over again.”

Tonight, I feel so emotional about my son turning 5 that I can’t read Love You Forever.  I know I would bawl, and, considering that I’m in my 29^th week of yet another high-risk pregnancy, any physical and/or emotional stress should be avoided.

So, instead, I keep remembering how happy I was when my son was two weeks old, and a nurse at his pediatrician’s office called to confirm an appointment.  I answered the phone, and she asked, “Is this my son’s name’s mom?”

I knew how blessed I was to be able to say yes.

And, today, five years later, I still don’t take my role for granted.  My son is a gift, a miracle, entrusted to me. 

And, my husband, who chose to be his father, feels exactly the same way about him.

Tonight, I’m going to vent about “fat talk.”  

First, I have to admit that my family’s comfort with “fat talk” has been generated by me—by my jokes about my extreme weight gain.  Because I am self-deprecating, my family members assume I am comfortable with them being me-deprecating.  And, while I usually am, laughing along with the teasing, I hit my limit in the past few days.

Of course, being on bed rest for three weeks has minimized my sense of humor, while maximizing my size.  My bra size is now a 38E—an E, for God’s sake—up from its normal 34C.  And, the frightening thing is that, sitting atop my massive pregnant belly, my breasts actually look petite.

I am so happy to be pregnant at 41, elderly in the reproductive sense—as in literally reproductively elderly, as my diagnosis is “Elderly Multigravida with Antepartum Condition or Complication.” 

I am so happy to be pregnant considering my “antepartum complication or condition,” which is my uterine abnormality, the result of my mother unknowingly taking the synthetic estrogen diethylstilbestrol (DES) for nausea when she was pregnant with me.

But, while I feel so blessed to be pregnant, it’s not easy to live with the significant, body-altering side effects of the medications necessary for my two in vitro fertilization (IVF) cycles, one of which is weight gain.  Nor is it easy to live with the fact that the initial IVF weight gain is then topped with the necessary pounds of pregnancy.

But, because of the loss of one of my twins in September, I added unnecessary pounds through emotional eating in my attempt to cope with the death of my son, whose tiny body was still inside me.  I added unnecessary pounds as I hoped that my body would absorb him, rather than abort him, so that my other son would be saved. 

So, I have gained well beyond the recommended amount of pregnancy weight.  I’m not only pregnant, but also fat.  I know it.  My family knows it.  But, I don’t want to hear “fat talk” anymore.

My nearly 5-year-old son is the main perpetrator.  Sunday night, while we were lying in bed talking before he went to sleep, he asked if would put my arm around him.  I did.  After 30 seconds, he grunted and said, “Can you move your arm?  It’s too heavy.  I think it weighs 188 pounds.”

Monday, out of the blue, he said, “Mama, you’re a big, fat ninja.”

I know why he called me big and fat, so I asked, “Why do you think I’m a ninja?”

“Because you’re fat,” he giggled.

To me, fat would be the least likely adjective to use with ninja, but, then again, I’m not 4.

Yesterday, at bedtime, he started singing, “You’re a fat ninja.  You’re a fat ninja.”

Today, he announced that we were going to play “dinosaurs vs. people.” 

“Who gets to be the dinosaur?” I asked, because he has a remote-controlled dinosaur robot that can kick the asses of any of his toy people.

“You do,” he said.  “Because he’s fat.”

“Nice,” I responded sarcastically, knowing full well that he thought I should have the fat dinosaur because I’m fat.  “Fat dinosaur should be matched with fat Mama” makes complete sense in his young mind.

Hearing my tone, he tried to recover.  “Well, his tail is skinny.”

So, tonight, when he once again complained about the intolerable weight of my arm around him, I decided to have “the talk”— as in “the talk about fat talk.”

I started by asking him how he’d feel if people called him fat. 

He said, “If I was fat, and people called me fat, I would punch them in the face.”

“Do you want me to punch you in the face?” I teased.

He giggled.

I explained, “I know I’m fat.  But, after the baby is born, I will lose the weight.  And, until then, it sometimes hurts my feelings when you call me fat.  I know it’s true, but sometimes it hurts my feelings to be told the truth every day.”

“I’m sorry.”

“Sweetie, it’s OK.  You didn’t know it hurt my feelings.  But, now that you do, can you please not call me fat anymore?”

“OK.”

We’ll see how tomorrow goes…

When I was trying to get pregnant six years ago, my reproductive endocrinologist performed a hysterosalpingogram, which revealed that I had a T-shaped uterus.  The result of exposure to diethylstilbestrol (DES) that my mother took while pregnant with me, my uterus was underdeveloped, one-third normal size.  Further, my doctor explained that, while a normal cervix, the bottom portion of the uterus, is about 3 cm in length, mine was 6 cm.

My extra-long cervix didn’t serve me well during my pregnancy with my son, who is now almost 5.  I was dilated at 27 weeks of pregnancy, hospitalized and given steroids to advance my son’s development in case he was born pre-term, and then put on bed rest.  At 31 weeks, I was further dilated, my cervix was funneling, meaning thinning out from the inside, and I was having contractions, so I was hospitalized again.  After 13 weeks of restrictions, I gave birth to my son on his due date, thank God, which gave me confidence that I could accomplish the same with a subsequent pregnancy.

My son, all 9 pounds 7 ounces of him, stretched out my uterus a bit while he was in utero.  When my new reproductive endocrinologist performed a hysterosonogram last spring, prior to my first in vitro fertilization (IVF) cycle, he described my uterus as arcuate.  Bottom line:  It’s still deformed, but now slightly less so.  This gave me further confidence that, if I could get pregnant again, I could carry my baby to term.

I did get pregnant with twins during my second IVF attempt, losing one in my eighth week of pregnancy, but this time I have an unanticipated problem: placenta previa, meaning the placenta is completely covering my cervix, which can cause hemorrhaging and/or pre-term delivery. 

As I near the 27-week point in this pregnancy, I have become more and more anxious about the combination of incompetent cervix and placenta previa.  Before yesterday’s appointment, I was consumed with fear about the repercussions of my cervix failing me once again, but this time having the placenta on top of it.

At my 16-week appointment, the ultrasound technician said my cervix was 5 cm long and closed.  At my 21-week appointment, my doctor said it was 4 cm and closed.  And, because of placenta previa, he told me to get extra rest, not lift anything and not have intercourse.

My husband and I have not been intimate, but getting extra rest and not lifting anything has been nearly impossible.  So, with almost four weeks between my 21-week appointment and yesterday’s, I was worried that my cervix had become dangerously short, as it had when I was pregnant with my son.  And, with little supporting the placenta from below, I worried I could hemorrhage, forcing either my son to be born way too early or me to be hospitalized for an extended period of time in order to prevent pre-term delivery.  My friend Jessica just told me that one of her close friends had to be hospitalized for two months because of placenta previa.  With a workaholic husband and a 4-year-old, I need to be home…

During my trans-vaginal ultrasound yesterday, the technician said that my cervix is at least 6 cm long—and that she’s being conservative.  She said she was having trouble fitting in all on the ultrasound screen to be able to measure it. 

Shocked, I asked if four weeks of no intercourse, minimal lifting, and minimal extra rest could have resulted in my cervix returning to its original length, and she said yes.  But, when I met with Dr. M afterwards, he said that it’s likely been 6 cm all along—and, that, the two prior ultrasound technicians, not expecting a super-long cervix, just hadn’t caught all of it on-screen when they were taking measurements.

He called my cervix “world-record-length” and said the doctors in the practice want patients to have a cervical length of at least 2 cm, while 2.5 cm is considered ideal.  He said to have a cervical length of 6 cm at this stage of a pregnancy—25 weeks—in his view eliminates any concern about pre-term delivery.  He also said that my placenta previa looks a little bit better, so the placenta could move up in the next 15 weeks, enabling me to have a vaginal delivery after all.

Oh, and I only gained 2.3 pounds in the past four weeks, which I blame entirely on the snow boots I was wearing during my weigh-in.

With such good news yesterday, I’m feeling extraordinarily Zen for the first time in months…

• Lots of extra rest
• No lifting
• No intercourse

I know that my uterine abnormality, initially a T-shaped uterus now stretched by my previous full-term pregnancy into a slightly larger arcuate uterus, is the reason I battled infertility. 

I know that my uterine abnormality and a prior surgery to remove precancerous cells from my cervix are the causes of my cervical incompetence during pregnancy. 

I know diethylstilbestrol (DES), the useless synthetic estrogen given to my mother when she was pregnant with me, is the reason my uterus never fully formed—and is therefore deformed. 

I know the sexually transmitted Human Papilloma Virus (HPV) is the reason I had precancerous cervical tissue, hence the reason part of my cervix is missing in action.

But, I had no idea why I am currently experiencing placenta previa, yet another complication in my already high-risk pregnancy.  Being an information junkie, I’ve looked it up.

You and Your Baby: Pregnancy by Dr. Laura Riley, OB/GYN (Meredith Books, 2006), the book given to me by my high-risk pregnancy practice, states that placenta previa “happens in about 1 in 200 pregnancies.  You’re more at risk if you’re older, if you’ve had several babies, if you’ve had a prior birth by cesarean, or if you smoke cigarettes.” 

What to Expect When You’re Expecting by Heidi Murkoff, Arlene Eisenberg and Sandee Hathaway, B.S.N (Workman Publishing, 2002) gives the following explanation for placenta previa in its “When There’s a Problem” chapter:

“The risk of having placenta previa is higher in women who have scarring of the uterine wall from cesareans, uterine surgery, or D & Cs following miscarriage.  The need for greater placental surface area due to an increased need for oxygen or nutrients on behalf of the fetus (because of smoking, living at a high altitude, or carrying more than one fetus) may also increase the risk of placenta previa.

In Your Pregnancy Week by Week by Dr. Glade B. Curtis, OB/GYN, and Judith Schuler, M.S. (Da Capo Press, 2004), the authors state the following:

“Placenta previa also occurs more frequently among smokers.  The rate of occurrence increases by 25% in moderate smokers and 90% in heavy smokers.”

and

“This problem is not common; it happens about once in every 170 pregnancies. …  The cause of placenta previa is not completely understood.  Risk factors for an increased chance of placenta previa include previous Cesarean delivery, many previous pregnancies and increased maternal age.”

Older?  Increased maternal age?  Yes.  Advanced maternal age starts at 35, and I’m 41.

Several babies?  No.  I’ve had only one.

Many previous pregnancies?  Yes, but except for my pregnancy with my 4-year-old son and my currrent pregnancy, I’ve only had a prior pregnancy last until the 6^th week.

Birth by cesarean?  None.

Scarring of the uterine wall from cesareans, uterine surgery, or D & Cs following miscarriage?  I’ve had none of these three procedures.

Smoker?  I’ve never smoked cigarettes.

Living at a high altitude?  Nope.  I live in a Chicago suburb.

Carrying more than one fetus?  I was carrying twin boys, one of whom passed away during the 8^th week of pregnancy, then was absorbed by my body, making him a “vanishing twin.”  His gestational sac was at the top of my uterus, with my surviving baby’s at the bottom.

So, based on these three pregnancy books, I can conclude that I am one of .005% of pregnant women to have placenta previa because of my age and/or because I was originally carrying twins. 

Of course, I wonder if my DES-induced uterine abnormality is also a cause.  My uterus is one-third normal size, so it contains less surface area for implantation as it is.  Then, during my second attempt at in vitro fertilization (IVF), I became miraculously pregnant with not one, but two, embryos, both of whom had to fight to implant, with one going high and one going low.

The fact that I am one of .001% of women to have a congenital uterine abnormality has to be a factor…  How could it not be? 

I am so sick of the havoc and horrors DES continues to wreak on my life—and the life of yet-another of my unborn children.

However, at the 10-week mark, I’d already been “closed out” by the IVF clinic because the staff’s job—getting me pregnant—had been completed, and the head of the Maternal-Fetal Health group determined that I could go three weeks between appointments—unless I needed to get a peek at Baby A to calm my nerves. 

Not wanting to look like a crazy person, I waited until my scheduled appointment this morning.  I waited the full 3 ½ weeks between appointments—and ultrasounds. 

And, it wasn’t easy. 

I’m not nauseated anymore.  Not starving.  I have more energy.  And, while I recognized that this lessening of symptoms could be tied to my exit from my first trimester, I worried that it might mean that Baby A had died too. 

While we did pre-implantation genetic diagnosis (PGD) to assure the chromosomal health of our embryos prior to implantation, and while chromosomal abnormalities are the primary reason for first-trimester pregnancy loss, we still lost Baby B.  No explanation, just speculation. 

His gestational sac had been separating from my uterine lining during the fifth week of pregnancy, so I believe that his development was stifled during those early days, that, although he was a fighter whose sac reattached itself properly, he couldn’t make up for the lost nutrients and the stunted growth of critical parts of his teeny-tiny body.

My uterine abnormality—an underdeveloped, one-third normal size T-shaped uterus that my 4½-year-old son stretched out while he was in utero, making it now a slightly larger arcuate uterus—has too-thin uterine lining.  I’ve lost several babies as a result, including, in my opinion, Baby B.  So, I will always worry about Baby A.   It’s impossible to suffer from recurrent pregnancy loss without feeling constant, underlying fear until delivery.

So, I was nervous today. 

I was especially stressed because every subsequent period of visitation with my stepsons is harder for my son.  (Since early September, my 15-year-old stepson has been away at school, so my son only sees his 13-year-old brother until the holidays.) 

Saturday night, my son had the meltdown of his life when I insisted he stop playing the Lego Star Wars video game with his brother because it was time for bed.  (See my “You’re Such a Bitch” blog, dated October 17.)  Sunday night, he cried at bedtime, when he had to separate from his brother.  Yesterday morning, he was teary-eyed when we dropped his brother off at school.  Last night, he bawled, knowing it was our last night together, that this morning would bring a week’s separation.  He cried, “I don’t want him to have to go back to his mean mom.  I love him.”

And, this morning, after the school drop-off, he cried again.  And, every time, I think, “Please, God, make sure this baby is OK.”

Because my son needs him, needs to become attached to a sibling who will still live with us when his older brothers leave again and again, a sibling on whom he can focus when he’s feeling abandoned and lonely.

And, as of today’s ultrasound, our baby boy is perfect.  He’s now 8.3cm from the top of his head, his “crown,” to his “rump.”  His heart is beating 150 times a minute, which the ultrasound technician deemed “good.”  I saw him moving for the first time, waving his little arms. 

The technician zoomed in on his face, showing me his nasal bone. 

I asked why she was measuring it. 

She said, “Oh, we don’t measure it.  We just check for its presence because most Down’s babies don’t have a nasal bone.”

She said she also was going to check his neck because Down’s babies have thicker necks, which I knew.  She measured his neck several times, coming up with the same number, showing its reliability.  She said his neck is normal, but I already knew that would be the case—because of PGD.

Last, I asked her about Baby B, for I saw his gestational sac and body, both of which looked miniscule sitting on top of Baby A’s.  She said he is being absorbed, outlining all that is left of him in his sac.  At this point, 4 ½ weeks after learning of his death, I am focused on the future, on the health of Baby A, so I primarily felt relief that my body is doing its job.

I still feel sad, especially because I started carpooling with twin boys, who are so damned cute together that, every time I’m around them, I feel a sense of loss for my baby, for my son, for my stepsons, for my entire family.

It know it will be easier for me when I can’t see him anymore.  Three and a half weeks ago, during my 10-week ultrasound, he looked so normal that I was looking for his heartbeat, although I knew he was dead.  Today, Baby A’s development was so stunningly significant, next to Baby B’s shrinking body, that I experienced full acceptance.

Baby A (bottom), 8.3cm from crown to rump. Baby B (top) in his gestational sac, both of which are being reabsorbed by my body.

When I met with the doctor, a brand-new one this time—and one who mentioned his twin sons, of course, for I’m tormented by twins these days—he said that he wants me back during my 16^th week for a transvaginal ultrasound to determine if my cervix is closed.  When I was pregnant with my son, my premature dilation wasn’t evident until the 27^th week, but he wants to be safe, which I appreciate.

So, I need to wait three more weeks for another ultrasound fix.

I can do it. 

But, I will hate it.

Me neither.

I didn’t expect to be single when I turned 35, the beginning of “advanced maternal age.”

I didn’t expect to have my only child, at age 36, as a single woman who conceived using anonymous-donor sperm.

I didn’t expect to suffer from infertility as the aforementioned single woman trying to have a biological child.

I didn’t expect my infertility to be a result of a misused, misrepresented medication, the synthetic estrogen diethylstilbestrol (DES), which was given to my mother when I was in utero.

I didn’t expect to meet the love of my life nine days before getting pregnant during my seventh intrauterine insemination (IUI).

I didn’t expect my son to have a father figure in his life from the day he was born.

I didn’t expect to get married at age 38.  Actually, I was 38 ½…

I didn’t expect to marry a man who had been married before. 

I didn’t expect to be a “second wife.”

I didn’t expect to be a stepmother.

I didn’t expect to throw myself into these roles, to read every book about being a stepmother and mother to sons, to be in weekly Family Systems Therapy in my attempts be the best wife, mother and stepmother I can be—and to still come up short. 

I didn’t expect to be pregnant at 41.

I didn’t expect to have such a difficult pregnancy this time around, considering that my formerly one-third-normal-size T-shaped uterus is now a larger arcuate uterus, my uterine lining is now sufficiently thick, we’d done preimplantation genetic diagnosis (PGD) of our embryos, and I’d already proved that I could carry a 9 pound, 7 ounce child to term, to his actual due date.

My life is made up almost entirely of circumstances, events, relationships that I never would have imagined. 

But I love my husband and feel that he is the best match for me I’ve ever found—and vice versa.

My son is an absolutely amazing little person, fully of humor and affection and empathy.  Yesterday, I vomited in the morning and stayed in bed all day, and, when I took a bath in the late afternoon to try to make myself feel better, he knocked on the door, peeked around it, and asked, “Do you need help with anything?”  He’s 4 ½…

And, I love my stepsons and, even though I didn’t bear them, I would do anything for them, and I have always put them and my son first, above anything related to my husband, me and our relationship.  Maybe that hasn’t always been the best for my husband’s and my relationship, but they’re children, so how do we not make them the priority?

And, this pregnancy is hard.  Others’ reactions to my pregnancy have made it even more difficult, almost intolerable.  But, my pregnancy with my son was difficult too, and it was worth every blood test, every ultrasound, the hospitalizations, the best rest, the anxiety, the 60-pound weight gain, the 17 ½ hours of labor, the three epidurals (because the first two didn’t take).  He is worth any misery I experienced—and then some.

And, this baby, dubbed Baby A, who is hopefully still alive inside of me, he will be worth it too. 

So, no, my life isn’t what I thought it would be.  I’ve come to my later-in-life happiness in unconventional ways.  But, while it isn’t what I’d expected, in some ways it is far richer and more rewarding than I ever would have imagined. 

And, our little Baby A, whom I guess doesn’t need to be called Baby A anymore, since he’s the only living baby inside of me, will enrich our lives even more.  I know it.  Otherwise, I wouldn’t have undertaken this complicated, sometimes painful, journey through infertility to high-risk pregnancy once again.

This knowledge of how much Baby A will enrich our lives comes from the experience of raising my son.  Therefore, this knowledge also makes the loss of Baby B all the more devastating.

Losing yet another child, a child whom I had seen in four previous ultrasounds, a child whose tiny heart had been pulsing inside of me, a child who had grown teensy little arms and legs, isn’t part of what I thought my life would be like.

I’ve lost seven unborn children.  My husband has lost two, our baby girl embryo who didn’t implant in June and now our son. 

This isn’t what we thought our lives would be like.  But, we have no positive alternative but to keep living the unexpected, complex lives we—and God—have made for ourselves.

My 4-year-old son stood next to me, so he could easily view the ultrasound monitor, so he could see his brothers, how they’ve grown since he saw them at the in vitro fertilization (IVF) clinic, and hear their hearts blipping. 

But, today there was only one heartbeat. 

Baby B died within the past few days, based on the doctor’s analysis of his growth.

The technician calmly told me she didn’t see his heartbeat.  She was emotionless.  She said she was sorry.  She said she wished she had better news.  She said that Baby A looks fine, as if to compensate for the loss of his twin.

I didn’t react.  I couldn’t react.  My 4-year-old was right there.

She asked if I was going to see a doctor after the ultrasound, and I said I had only a nurse appointment, so she said she’d notify the nurses of my status, then return.

While she was out of the room, I explained to my son that one of the babies had died.  He hugged me, with tears in his eyes, and said, “But I wanted two babies.”

Feeling as if I was outside of myself, I reassured him.  I said that it was OK.  I said that there must have been something wrong with Baby B.  I said that we are still going to have one baby. 

But I shouldn’t have said that, for we could lose both.  I think I was trying to reassure myself, as much as him, with that wishful-thinking statement.

The technician returned to say that one of the doctors was going to meet with me, but there wasn’t a room available, so we would have to wait in chairs in the hallway.  She said they didn’t want us to have to go back out in the waiting room.

So, my son and I sat down to wait, and I tried to call my husband.  I tried his work phone twice, and twice it went into voicemail, so I called his cell.  During the work day, I NEVER call his cell, so I thought doing so would alert him that there was an urgent matter.  It went into voicemail too.

A nurse came to retrieve us, weighed me, took my blood pressure, then another woman, who never identified herself, asked me if I’d had an ultrasound.  I said yes, that that’s how we found out that Baby B is dead.  She then escorted us to Exam Room 4.

I tried to call my husband again and again.  I needed him, but kept getting his voicemail.

This is when I lost it.

I tried not to, because of my son, but I’d just found out that I’d lost my baby, I know that losing one could mean the loss of both, and it became impossible to act as if that didn’t matter.

So I cried.  My son walked over from the rotating stool he’d been playing with, and he hugged me.  I told him that I’m sad that one of the babies died, but that I’m tough, that I’ll be OK.

I tried my husband’s cell phone again, with no luck, and I kept crying.

My cell phone rang, with its caller ID showing that my husband’s colleague Jessica was calling.

I picked up and said, “Jess, we lost one of them.”

“I’ll get him now,” she said.

He got on the phone a minute later, and I told him that we lost Baby B.  He asked how I knew, and I told him there was no heartbeat.  He said he was on a conference call that he couldn’t get off of, but it should only last a few more minutes, then he’d call me right back.

A few minutes later, Dr. H came in.  She is the only doctor in the practice with whom I’ve met, so it was a relief that it was her, rather than some stranger.

She said she was sorry.  She said that Baby B had grown since my last ultrasound, that his three-day lag behind his twin had become about a week’s lag, so he must have died within the past few days.

She said that Baby A looks great, that he has little arms and legs, that he is “staking out his territory.”

She said that we’ll never know why we lost Baby B.  While we did pre-implantation genetic diagnosis (PGD) with our IVF cycle, it is impossible to test for every possible abnormality.

I asked, “What happens now?  What are the chances that I’ll miscarry both?” 

She said that miscarrying both is possible, but she thinks the odds are slim.  She explained that I had two separate pregnancies, two genetically distinct babies in two different gestational sacs.  She said that, considering how strong Baby A appears to be, it is unlikely that the loss of Baby B will affect him.  She said that my body is probably going to reabsorb Baby B over time, that during each ultrasound his gestational sac will be smaller, that eventually he may simply be a calcification that looks like a white dot on the ultrasound screen.

With that, my cell phone rang, and it was my husband, so we ended the consultation, and my son and I left the office.

I told my husband that I felt better, which he thought meant that Baby B wasn’t really dead.  I explained that he was, but that the doctor had reassured me about Baby A. 

Then I revealed something I’d never voiced to him—or anyone else—before.  I was so attached to Baby B, our little underdog who came back from near-death weeks ago, that I’d been afraid that I would love him more than Baby A. 

And, now he’s gone, my tiny less-than-one inch to whom I’d become so devoted.

And, what I don’t understand right now is the reason.  Because, as we all say, when we need to be reassured that there is some grand plan that explains our suffering, “Everything happens for a reason.” 

Why did this little guy implant, because I would have been fine if only one embryo had done so?  My husband and I had only hoped for one child, never considering, based on my difficulties with embryo implantation, that two would ever have been possible. 

But, once I knew that there were two of my husband’s and my babies inside of me, I loved both of them, and I wanted both of them, but I was told in that first ultrasound that Baby B, smaller in his “considerably smaller” gestational sac that was separating from my uterine lining, was likely dying.

And, I spent a week coming to terms with that, the loss of him. 

But, at the ultrasound a week later, a week after doing once-daily progesterone-oil injections, he was fully attached to my uterus, he had grown, and he had a heartbeat.  So, I assumed that the problem had just been an implantation issue, way too common for me with my DES-induced misshapen uterus with too-thin uterine lining. 

I was overjoyed.  But I was still cautious.  But, then two days later, I had another ultrasound, and both babies had grown, giving more reassurance.

And, then last Wednesday, I had yet another ultrasound, and, at this point, Baby B was within a couple of millimeters of Baby A, which could have just been due to margin of error.

So, with all of this good news, I started to get comfortable with the concept of having twins.  I imagined their close twin bond.  I imagined every member of our family reveling in twice the love.  I starting seeing twins everywhere and asking their parents about them.

And, now Baby B is gone.

So what is the reason for him to have lived these past 3 ½ weeks, for me to go from acceptance of his death, to pure joy at his comeback, to boundless love for him, only to have him die now?

I feel like I will be able to cope and move on if I can just understand the reason. 

My doctor has already said I’ll never know.

So, I just have to have faith, although right now I feel like God has been fucking with me. 

How many babies do I have to lose? 

Why did I have to experience the horror of seeing my dead baby on an ultrasound screen this morning?

Why do I have to live day to day, for the next few weeks, with the knowledge that I have two babies inside of me, one living and one dead?

What, please, is the reason?

After doing in vitro fertilization (IVF) with pre-implantation genetic diagnosis (PGD), my pregnancy with twins was confirmed by blood test on Monday, August 17.

I had my first ultrasound at my IVF clinic on Wednesday, August 26.  The technician identified my twins in their gestational sacs, but said Baby B was separating from my uterine lining, and his sac was considerably smaller than Baby A’s, leading her to believe that Baby B was dying.  She said that, if my body absorbed him, making him a “vanishing twin,” Baby A would be safe.  But, if I miscarried Baby B, I would perhaps lose Baby A also.  I started doing one-daily injections of progesterone oil, and I waited, anxiously, for the next week’s ultrasound. 

My second ultrasound was on Wednesday, September 2.  Baby B had miraculously reattached himself to my uterine lining, both babies were growing, and I saw both of their heartbeats.  I cried.  I was overjoyed.

But on Thursday, September 3, I started spotting. 

I increased my progesterone-oil injections to twice a day, per the IVF nurse, whom I paged.

I had another ultrasound the following morning, on Friday, September 4, as part of my initial consultation with the Maternal-Fetal high-risk pregnancy group at the local hospital.  The technician identified two subchorionic hemorrhages in my uterus, but also both heartbeats.  She also let me listen to the heartbeats, showed me how both gestational sacs were securely attached to my uterus, and reassured me that the hemorrhages weren’t affecting either of my twin boys.

Five days later, on Wednesday, September 9, I had another ultrasound, my final one at the IVF clinic, as part of my close-out consultation.  Once again, I saw that my twins’ tiny little macaroni-sized bodies, yolk sacs and gestational sacs had grown; viewed their pulsing hearts, little lights flashing inside their translucent forms; and heard their heartbeats.  All of this reassured me.

But I started bleeding again on Sunday.  Once again, I had no cramping or pain associated with the bleeding, so I tried to stay calm.  The spotting was lighter than before, and it stopped the same day, so I relaxed a bit.

All week, my body has continued to exhibit positive pregnancy signs:  I’m exhausted; I’m starving; I have acne; my stomach is growing daily, it seems; the veins on my chest are still prominent; and my breasts are still sore. 

But, my body has deceived me before. 

Five and a half years ago, I knew from my blood tests that my baby was dying, that the miscarriage would commence shortly, but my body kept exhibiting pregnancy symptoms until the miscarriage started, making me convinced that some mistake had been made—that blood samples had been switched, or my baby was making a miraculous comeback. 

From that experience, I know that my body will continue to do its job, fighting to sustain these babies, until they’re gone.  So, my body can’t be trusted.  My body doesn’t recognize pregnancy problems; it, like me, overlooks them, in its valiant attempt to protect its offspring.    

Because my body can’t reassure me, only ultrasounds can.  And, while I go in tomorrow for an appointment with the Maternal-Fetal group, it is only an appointment in which a nurse will explain every aspect of the practice to me.  But, while I won’t be able to see my babies, I will be able to hear their heartbeats.  So, at least I’ll have that to sustain me.

But, after four ultrasounds in three weeks, I crave the full ultrasound experience.  I want to see my babies, not just hear them. 

I might resort to begging.

I have hated driving to downtown Chicago over and over, always having to give myself 90 minutes of travel time, because of varying, unable-to-be-estimated traffic patterns.  My appointments have sometimes lasted a mere two minutes, the time necessary for a blood test, after which I’d climb back into my car to start the long drive home to the suburbs.

I have hated being repeatedly stuck in alternate veins located on my inner arms, opposite my elbows, for these blood draws.

I have hated having my legs in stirrups for countless vaginal ultrasounds to check the growth of my follicles and the thickness of my uterine lining. 

I have hated the dozens of injections that I’ve had to give myself in my stomach, my thigh and my backside, their resulting bruising, soreness, bloating, headaches, exhaustion and other side effects.

I have hated twice having a needle inserted through my vaginal walls to retrieve my eggs from my ovaries.

I have hated the three-times-daily Endometrin® vaginal progesterone suppositories, necessary when ovaries are unable to sustain a pregnancy with their own progesterone production because they were punctured full of holes during the egg retrievals.  The cottage-cheesy vaginal discharge is repulsive.

I have hated the emotional impact of undergoing treatment for infertility, the need to have hope to make it through the process, yet the constant underlying fear of failure, the fear of how I would possibly move forward if I failed.  Not to mention the feeling that failure would somehow be my fault.

I have hated having to dip into my retirement account for the money to pay for our out-of-pocket costs for our two IVF cycles.

I have hated the “you’re-not-pregnant” phone call.

But I loved the two embryo transfers, seeing our babies flickering across the ultrasound screen like shooting stars, as they were released from the catheter and entered my uterus.

I loved the congratulations phone call, confirming my pregnancy.

I’ve loved the three ultrasounds since, when I get to see my little guys, their gestational sacs, their tiny pulsing hearts, their growth.

During yesterday’s ultrasound, my cervix was closed, which the IVF coordinator said is “very good.”  She found Baby A first, and she deemed his heartbeat and yolk sac as “good.”  She said the same about Baby B’s heartbeat and yolk sac. 

She noted that I still have some separation in my uterine lining between the two gestational sacs, diagnosed last week as one of two subchorionic uterine hemorrhages, but, because I’m no longer spotting, “It’s alright.”

Yesterday was the first that she’d mentioned the twins’ yolk sacs, so I asked exactly what they are.  She said that each yolk sac “provides nutrition for the embryo before the placenta takes over.  They provide the blood supply and nutrition to each fetus.  Once the placenta takes over, the yolk sacs will shrink gradually.” 

Near the end of the ultrasound, my doctor stepped in.  He declared, “What we have is not 100% success.  It’s 200% success.” 

The IVF coordinator led him through the ultrasound results for each baby, then he told me to get dressed, then we’d talk in his office.

As she finished up, the IVF coordinator handed me my first ultrasound picture featuring both babies at once, which I held as I walked into my doctor’s office. 

Our Twins: Baby B (left) and Baby A (right)

As I sat down, I showed him the ultrasound scan, then asked if he’s worried that Baby A’s gestational sac is so much bigger than Baby B’s.  He said no, that what is most important is the size and growth of each embryo and the strength of each baby’s heartbeat, all of which are on track for their gestational age.

I asked him for the exact measurements of each, which were 11.1mm for Baby A and 9.9mm for Baby B.   But the clinic’s ultrasound machine, which he described as one of the best available, has a standard of error of +/- 1mm to 2mm.  With an only 1.2mm difference in measurement between Babies A and B, the reality is that no difference in size may exist. 

He went through my chart, telling me that, for the purposes of calculating my due date, the first day of my last period must be listed as July 17, even though I really got my period in the afternoon on July 18, therefore July 19 was the official first full day of my menstrual cycle.  He explained that, because my cycle was manipulated, because my IVF egg-retrieval was August 1, the first day of my last period must be determined as July 17, regardless of reality, which makes my due date April 23. 

“No one can change these dates,” he said.  He wrote them on his business card and handed it to me.  “When you’re asked for these dates, you give these.”

He told me I can stop taking my once-daily dose of baby aspirin, can reduce my progesterone-oil injections from two to one a day, and can stop both the progesterone-oil injections and vaginal progesterone suppositories on September 26, when I hit my 10^th week of pregnancy.

I thanked him for getting me pregnant, and he said, “I told you it would work.”

He was always so positive, even after the first failed cycle, which I had assumed was his attempt to keep my spirits up, knowing that depression doesn’t faciliate success.

Even though the majority of my experiences with the IVF clinic and its staff were negative, the doctor and nurses, the genetic counselor and the reception staff were all wonderful to me.  The torturous treatments they prescribed and conducted were simply necessary to achieve pregnancy in a 41-year-old woman with a uterine abnormality.  Yes, that 41-year-old, six years into advanced maternal age, with an arcuate uterus, is me.

So, although I was so relieved that yesterday was my final appointment, my close-out ultrasound and consultation, I felt sad because of all of the emotions I have experienced at the clinic, with my doctor and nurses, and because I am so grateful to every member of the staff  for helping me become pregnant.

As my doctor escorted me to his office door after our closing consultation, I wanted to hug him, but I barely know him, and our relationship is purely a professional one, even though his profession involves major emotions.  So, I just shook his hand, not wanting to make him uncomfortable.

He told me to come back to visit, to show the staff the babies. 

And, I’ve already decided that I will hug him then.  I will hug every single one of them then.

Dr. H. was accompanied by a resident, and she asked if it was OK if the resident asked me some questions.  I said it was fine.  But, after outlining my history, the resident said not a word, posed not a question.  I think my case may be too complicated for those who aren’t fully trained.

I am 41.

I did in vitro fertilization (IVF) with pre-implantation genetic diagnosis (PGD).

I am seven-weeks’ pregnant with twin boys.

I am a DES Daughter, whose formerly T-shaped uterus is now a slightly larger arcuate uterus, thanks to my 4½-year-old son stretching it out when he was in utero.

My uterine abnormality puts me at risk for cervical incompetence.

My prior two surgeries to remove pre-cancerous cells from my cervix—a colposcopy and LEEP—also put me at risk for cervical incompetence.

I have Rh- blood, while my husband’s is Rh+.

Since my egg retrieval, I have been inserting vaginal suppositories of Endometrin® three times a day.

I take one baby aspirin and one prenatal vitamin each day.

Because I’m prone to anxiety and depression, I also take one 20mg dose of Fluoxetine®, the generic form of Prozac, daily.  (I switched from Cymbalta®, which is not safe during pregnancy and breastfeeding, to Fluoxetine prior to my IVF cycle.)

I have Reactive Airway Disease (asthma), which worsened during my pregnancy with my son; however, I have already consulted with my allergist, who has prescribed medications that are safe during pregnancy.

At my six-week ultrasound, one of my twins, Baby B, was not fully attached to my uterine lining, and he and his gestational sac were “considerably smaller” than Baby A and his sac.

At my six-week ultrasound, I was told Baby B would likely die, and, if I miscarry him, I may miscarry Baby A also.

Because of Baby B’s gestational sac’s separation from my uterine lining, I was prescribed once-daily intramuscular injections of progesterone oil.

At my seven-week ultrasound, Baby B’s sac was fully attached to my uterine lining, he had grown, and he had a visible heartbeat.

However, the day following that IVF clinic ultrasound, I started spotting, which the Center for Maternal and Fetal Health’s ultrasound technician had just diagnosed as originating from two subchorionic hemorrhages inside my uterus.

In response to my spotting, the evening before the IVF nurse had directed me to do twice-daily injections of progesterone oil, rather than the previously prescribed one a day.

In my only successful prior pregnancy, I was dilated starting at 27 weeks’ gestation, so was hospitalized to receive the steroid injections that advanced my son’s development, then put on bed rest.

At 31 weeks of pregnancy, I was dilated further and having contractions, so I was hospitalized again, then sent home on bed rest. 

My son was born on his due date, at a whopping 9 pounds, 7 ounces.  However, he aspirated meconium (his first bowel movement, in utero) into his lungs during delivery, so he was born in acute respiratory distress, spending five days in the Neonatal Intensive Care Unit.  He had no long-term repercussions; however, he has Reactive Airway Disease, just like me.

I handed Dr. H the 2004 X-ray of my T-shaped uterus, plus several pages of information about the pregnancy risks for DES Daughters, printed from the DES Action USA website, www.desaction.org.  Thankfully, Dr. H is very familiar with DES exposure and its ramifications, but she said she’d take the materials I’d provided because some members of their nursing staff may need to be educated. 

Because I’ve never had the special, more-comprehensive pap smear necessary for DES Daughters, having just confirmed my DES Daughter status six weeks ago, Dr. H said that the one of the doctors in the practice would perform the exam at my next appointment.

My IVF clinic had faxed the results of my two previous ultrasounds, and my former gynecologist had faxed the results of my colposcopy and LEEP, both performed in summer 2003.

Dr. H asked for the contact information for each of my doctors, so she could consult with all, my primary-care physician, who is my gynecologist, the reproductive endocrinologist and genetic counselor at the IVF clinic, and my psychiatrist.  I was very impressed with her thoroughness.

She then laid out the facts. 

With my twin pregnancy, three outcomes are possible:

1. Both babies will die.
2. One will live, with the other dying.
3. Both babies will live.

She said that my uterine bleeding is not a concern if it is my only symptom.  However, because of my Rh- status, she said, if the bleeding worsens or continues, as is, for days, I will need a shot of RhoGAM® to ensure that my body doesn’t start rejecting the twins, if one or both are Rh+ like their father.

She explained that it is rare for twins to be of differing sizes so early in a pregnancy, that such differentiation usually happens later, when the uterus is filled to capacity, with one twin having a better blood supply.

But, she said, the sizes of my twins, based on the ultrasound measurements, are very similar: .54cm for Baby A and .46cm for Baby B.  She said this differentiation could simply be the result of the ultrasound technician being a bit off with her measurements, so difficult to gauge with such tiny embryos.

But, she explained, “Because your uterus is abnormal…”  Then she stopped herself and said, “I don’t mean to call it abnormal, but…”

I’m well aware that it’s abnormal, so, around me, there is no need to pussyfoot around the issue.

She continued that, because of my uterine abnormality, its blood supply may not be able to sustain two babies.

And, with that statement, any hope for peace of mind vanished.  As my twins get bigger, their needs will increase along with their size.  And, perhaps, at some point, my DES-induced, deformed uterus will not be able to provide one or both with the blood supply necessary to survive.

This is where I want every single pharmaceutical representative, every single researcher, every single salesperson, every single doctor who knew the risks of prescribing DES to pregnant woman to have to live what I’m living, because only then will they know the damage they’ve done, both physically and psychologically.

Dr. H suggested that I meet with a nutritionist because these twins of mine are “parasites” who will take everything they can from me, so I need to make sure I’m eating well enough for all three of us to thrive.  I understand her point, but I hated hearing them called parasites.  “Parasite” is such a negative term. 

In closing, she went over the practice’s “Maternal Age Chart for Twins at Amniocentesis,” stating that she would follow up with our genetic counselor to learn exactly the chromosomal abnormalities for which our embryos were tested.   She then walked through the document, “Management Protocol for Twin Gestation,” to give me an idea of what treatment to expect throughout the pregnancy.  She said, while the goal is to deliver at between 38 and 40 weeks’ gestation, twins are normally born at 35 weeks, which, for me, is near the end of March.

In closing, she told to make an appointment in two weeks for a meeting with the nurses, in which they will go over everything I need to know about the practice, plus I can hear fetal heart tones, then another appointment one week later in which I will meet with a doctor to have a physical exam, including my DES Daughter pap smear, plus hear fetal heart tones again.

I walked out feeling relieved that both babies are alive, that they’re still growing, that the source of my spotting has been identified and is not affecting the twins.  But, I had thought that, because my uterus is larger than ever before, because my uterine lining is the thickest it’s ever been, because I’d been able to successfully carry my 9½-pound son to term, that I could also successfully carry these surprise twins of ours.   And, maybe I can.  Hopefully I can. 

What I learned is, just like when I was pregnant with my son, I have to take every day as it comes, every positive appointment as a mini-triumph, every additional week that I’m pregnant as miraculous. 

And, because stress will not help me or my sons, I have to let go, to give this pregnancy up to God. 

That, and take my Prozac every day and never miss an appointment with my psychiatrist…