How did we end up pregnant with triplets?
- tripletsofmontreal
- Feb 3, 2021
- 7 min read
When Mathieu and I decided we wanted to start planning for a family we got right to it. That was fun, for a while, but when we didn't get pregnant right away, I started monitoring things more closely. I bought a basal body temperature thermometer and also ovulation strips . I also downloaded an app that would help me track my menstrual cycle and morning temperatures. The perk with the app I used, Kindara, is that it also has a built in community of other women who are trying to get pregnant. This community supplies not only a great deal of information, commentary on your cycle charts, but also solidarity and camaraderie in an area where I otherwise felt pretty alone.
After we had been trying, and I had been tracking all of my bodily data, for almost two years we were able to get an appointment with Dr. William Buckett, a fertility specialist, at the McGill University Health Centre (MUHC) in Montreal. I cannot say enough good things about Dr. Buckett. He is knowledgeable, kind and thorough. MUHC is a teaching hospital, so you are often working with residents, but with Dr. Buckett they have an amazing mentor and you can tell that they all have an immense amount of respect for him.
When you begin seeing a fertility specialist they need to do baseline investigations to try and identify and understand why you've been having difficulty conceiving. I had to have blood tests (to look for deficiencies and measure hormonal levels), ultrasounds (to look for abnormalities in the ovaries, follicle production and development, check the tilt and shape of the uterus, as well as check the cervix), and swabs (often done to check for acidity levels in the vagina and opening to the cervix). My husband also had to do testing. He had to complete blood tests, provide a sperm sample, and he also had his specialist examine his testes for anything out of the norm.
What we were able to find out is that Mat actually had something called a varicocele. This was identified through the doctor's physical exam. Basically, varicocele is a varicose vein that develops in the testes. This can affect fertility because the extra blood flow to the area can increase the temperature which then affects sperm production. We learned that there is a surgery that can be done to fix the varicocele, but it didn't guarantee conception and there would probably be a wait. Since his counts and quality were still in an acceptable range for treatment we elected to continue with the IUI process while also placing Mat on the waitlist for surgery.
IUI, or Intrauterine Insemination, is a fertility treatment that involves taking a sample of sperm (in our case from Mathieu), and having it inserted, through a catheter, directly into the uterus.
Since there are a few variations of how a woman can prepare her body for IUI, it's important that you know that I can really only speak to my own treatment and experience.
For me, a treatment cycle started on day 1 or 2 of my cycle (which means day 1 or 2 of a period). I would call the centre and they would have me come in to do an ultrasound and ensure that I wasn't already pregnant prior to starting treatment. Then, from days 3-9 (although it can be days 3-7 or days 2-8, it can vary depending on ultrasound results), I took injections called Gonal-f. Gonal-f is follicle stimulating, so it aids in developing the follicules in the ovaries to prepare for the insemination. The injections are not too bad. I promise, you do get used to it. The needles are a pen style, and are very easy to select your dose and use. During that week (or so) I went in around day 7 to check my follicle development. If the follicles are developing appropriately ( I was told that 14mm-18mm is appropriate) then it's time to plan for the trigger shot. The trigger shot is an injection that "triggers" your body to ovulate, releasing those appropriately sized follicles. In my case, the trigger shot was called Ovidrel. The trigger shot is usually done 24-48 hours after your gonal-f injection. Then 24-48 hours after the ovidrel injection you and your partner go into the centre for the insemination . Your partner provides a semen sample in one of the provided rooms (yes, there is indeed a computer and encouraging entertainment if needed). This has changed slightly since CoVid-19; now your partner can supply the sample at home and bring it to the clinic within an hour, as long as it stays near body temperature. A health professional collects the sample and it's taken to a lab where the sperm is "washed". When the sperm is "washed" basically it's looked at in a lab setting and only the best-of-the-best are kept for insemination purposes. This process can take several hours, so we would go for lunch and wait for our insemination appointment. When it was time I would go into the centre, wait my turn, and then using a speculum and a catheter, a doctor (often a resident at MUHC) would inject the sperm directly into the uterus. This process takes about 2-5 minutes. It's quick. It is not necessary to stay horizontal, although if you're more comfortable taking a minute to lay comfortably you are able to do so. I was however, advised to take the rest of the day pretty easy - no intense jumping activities. I'm pretty sure I interpreted that as instructions to settle in and watch HGTV for the rest of the day. After the insemination, I had to take progesterone suppositories (100 mg/day) until I either tested negative for pregnancy or until 12 weeks pregnancy when the placenta should be able to produce an adequate amount of progesterone to maintain the pregnancy. The progesterone suppositories are often prescribed because a low level of progesterone has been known to lead to miscarriage in early pregnancy, and by supplementing, it's thought to help mitigate this risk.
Typically the more times you try IUI the greater your chances of conceiving. We were really fortunate in that after our first IUI treatment we conceived our daughter, Sofia. Shortly after she was born my husband got the call that there was a spot for him to get his varicocele corrected. So, he went and had this procedure completed. (If you guys are interested in hearing more about this process and procedure let me know and I'll post more information about that). When Sofia was coming up on two, we decided that we wanted to start trying for another child. Unfortunately, despite our best efforts, and Mat's surgery, we were not having any luck. We decided to go back to the fertility clinic and attempt another IUI treatment. They redid some of the baseline tests to ensure that no new problems had developed and then they scheduled the start of our next treatment.
We were able to get pregnant on our first treatment, but unfortunately, I miscarried quite early on. My HCG levels came back lower than they would have liked, and then they continued to drop. Some people refer to this as a chemical pregnancy, but I had a wonderful nurse who said she hated this term as it minimized the fact that it was still in fact a lost pregnancy. I liked her perspective because I did in fact feel that loss and disappointment. We went through another cycle (which involved waiting for your period to start so you can start new injections, get more ultrasounds, and hopefully another insemination). This time, the IUI did not work, and I did not have a pleasant experience that day in the clinic (more on that maybe later). By this time, we were deep into the pandemic and summer. We decided to give it one more shot, even though there were so many unknowns in the world, we definitely knew that we wanted to grow our family. Often, after three unsuccessful IUI attempts a new conversation is had about continuing or trying (the very expensive) IVF, so we kind of felt like this was our "last chance". During my ultrasounds it was noted that there was one follicle that was of adequate size, and another smaller one that could potentially develop further. I was reminded at this point that fertility treatments can increase the chance of conceiving multiples and that if I wanted to continue treatment I needed to accept this risk. I accepted that risk. I finished the treatment, we had the insemination, and 16 days later when I had my blood test - it came back positive, really positive. I was pregnant. My HCG count was in the 1000s (to compare: when I had my test for Sofia, my HCG was 26).
I was curious and stressed about my HCG count being so high because, of course google will tell you it could indicate multiples, but it could also indicate genetic abnormalities. Also, it could be an indication of absolutely nothing remarkable (except that positive pregnancy result, of course). After the positive pregnancy test, I was scheduled for a viability ultrasound. This ultrasound is scheduled, usually during week 7 or 8, to assess the viability of the pregnancy and confirm its positive status. It was during this scan that Dr. Buckett got quiet. I said, "what are you seeing?"
He asked me, "Ummm well, what do you see?"
" I see more than one"
"Yes," he said, "It seems there are three."
Three. It seemed there were three: triplets. I didn't even have Mathieu there to process with me- due to Covid-19 protocols he couldn't' attend any appointments - but, I was probably in shock, as I didn't feel too affected by the news (maybe that high HCG test result had primed me a bit for this possibility). Dr. Buckett seemed a lot more surprised than I did. In fact, he confessed he forgot to take a picture of the ultrasound as he was so caught off guard by its contents (I did get one at the next appointment). He briefly spoke to me about associated risks with multiples pregnancies. Until I could be seen by a multiples specialist he would have me continue to be monitored at the fertility clinic. He sent a text message to his contact at the high-risk centre to get me an appointment as soon as possible (Also within the MUHC, but at a different location), and advised me that further conversations would be had about 'the decisions' that would have to be made in a multiples pregnancy. I will tell you more about these decisions in another post. I think I've probably tired you out with the length of this one already.
So, stay healthy and stay happy!
-Steph
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