I have spent a LOT of time mulling over the big issue with this IVF.
One embryo or two?
I realize that this may look like I’m getting ahead of myself. We haven’t even started stimming yet, let alone hit retrieval or transfer. We don’t know how many embryos we’ll have, or what quality they’ll be, or even if we’re going to make it to blastocysts.
Rationally I know that, and I understand that, in some ways, investing all this time and emotional energy in this issue now is putting the cart before the horse.
But at the same time, it’s an important decision, and if I leave it until the moment where we HAVE to make the decision, I won’t be able to give it the thought it deserves.
E. is the product of a two embryo fresh transfer.
To me, that is the biggest reason for doing this again. This is what worked. We’ve had quite a few cycles now of things not working- eight other embryos in five other transfers have not worked, to be exact.
So there is the temptation to do the same thing again.
It’s also more than likely that a two embryo transfer would produce a singleton, just like with E. My sister did some research for me and discovered that, in my age group, a two embryo transfer that produced a successful (i.e., live birth) pregnancy resulted in a singleton 80% of the time.
And, of course, the odds of achieving any pregnancy are better with a two embryo transfer than with just one, although I’m getting the sense that just how much better is now quite heavily debated.
If we had insurance coverage for procedures, if cost was no issue, I would gladly do an elective single embryo transfer.
But we don’t, and it is, and we’re running out of options.
Plus, my body hasn’t exactly proved itself to be all that welcoming to those little balls of cells. E. is, let’s remember, my only pregnancy. We’ve transferred ten embryos (six Day 3s and four blastocysts) and only one of them stuck (that chemical pregnancy from the FET in October 2009 really doesn’t count given my initial beta was so low it was practically zero).
Every time I start to try to wrap my head around a twin pregnancy, however, I start to freak out.
In June a pair of articles on Babble garnered a lot of attention. They were written (anonymously) by a couple expecting twins. They used IVF to try to give their son a sibling. They hemmed and hawed and finally decided to transfer two embryos. They weren’t expecting, nor did they want twins, but that’s what they got.
Their articles were brutally honest. The reactions from the public were just plain brutal.
Admittedly, they didn’t always express themselves in a way that would encourage readers to empathize with their situation. But when I read the articles, especially the one written by the mum, I understood where they were coming from. I could see the anxiety, the fear, the sense of having lost control over the life that they thought they were going to have. I found another article written just this week, whose author also gave voice to some of the fears that I harbour, especially those concerning having to ignore the needs of one child to meet the needs of the other, something that I would face the moment I had two children, but something that would be even more heightened with the arrival of two babies simultaneously.
It’s easy for people to judge when they haven’t had to resort to IVF to get pregnant. Most people don’t even have to consider the issue of twins. Even mothers who end up with twins in a natural pregnancy haven’t had to weigh the decision whether to transfer one, or take the risk with two.
I know there are women out there who could go into a first ultrasound, see two heartbeats, take a moment to be overwhelmed, and then just be filled with gratitude for the two lives they were growing.
I’m not one of those women.
Everything about twins scares me. The high-risk pregnancy, when my pregnancy with E. and my experiences with my midwives had helped so much to heal the wounds of infertility. The fourth trimester, when I escaped PPD by the skin of my teeth when dealing only with one baby and with a husband who largely worked from home so he could be there for mental health checks much of the time. The whole first year, which, now that it is long behind us, has really driven home to me how much I prefer toddlers. Someone on my birth club the other day was commenting about how she longs for another baby, and I just found myself shaking my head. I want another child. Another baby? I’ll deal with that, because I’ll have to, but honestly, if I could outsource child rearing for the first fifteen/sixteen months or so, and get them back when they’re walking, sleeping through the night, down to one nap, and starting to really communicate, I’d be seriously tempted. I make no apologies for this either- the birth club has taught me that some people are just best suited to some phases of children’s lives. There are some mums on there who adore the teeny tiny baby phase and then there are a few of us who have really come into our own with toddlerhood.
Plus there are the associated financial costs of three kids rather than two. I don’t think the couple should have phrased it in terms of wanting to take their kids to Disneyland, but three university funds rather than two is not a small difference. We’d have to buy a car. It would be another ticket to see Q.’s family every couple of years. Maybe this sounds shallow, to worry about having to buy a car or about airline tickets, but it’s the sort of thing I think about. It’s the reality of how our life would change. I think it would be naive not to think about these sorts of implications.
Plus there would be the impact on my career. Twins would basically ensure that my career would be over before it started, as we would never be able to afford to have them in any sort of full-time care that would allow me to do anything in the academic world beyond very occasional contract teaching. (Daycare in my city, especially for the under 2s, costs significantly more than our mortgage payment.) You don’t recover from that sort of career path, and the first few years after your PhD is finished are your one chance to land a permanent position (assuming one even exists). I’m sure eventually, once they were in school, I’d be able to scrape together some contract teaching, but the reality is we’d be a single income family for a lot longer than expected.
Plus there is the added strain on a marriage. I’ve written before that Q. and I, while not struggling, have had to work harder at our marriage since having E. I know having a second child would add another whole layer of pressure, but I have to think that adding twins would be a giant atom bomb. I worry about how Q. would react to the financial pressure of being the sole provider, while at the same time becoming a father of three. I worry about how we would both cope with the sleep deprivation- that was one of our biggest sources of tension when E. was little and he could have been so much worse. I worry about how I would find the support that I would need, when we have almost no family in the city.
Plus there is the impact on E. He is such a sweet, gentle, sensitive soul. I worry endlessly about disrupting his ordered little existence with the arrival of one baby, let alone two.
Etc. etc. etc.
I don’t think thinking these things makes me a bad or a selfish person. I have the right to feel anxiety about the possibility of such an unexpected (and enormous) change in our lives. I’d be worried about some of the same things even if there was only one baby on the way.
I kept reaching a stalemate: the fact that E., the only transfer that worked, was a two embryo transfer, vs. my abject terror at the thought of a twin pregnancy.
And then my birth club had a post one morning from a mum who was ready to try for a second, but her partner wasn’t on board, and she was asking the other mums how they knew if they wanted another. At first the conversation just pissed me off, because I’m pretty sensitive to pregnancy/baby talk on there right now, given some days it feels like EVERYONE else is either pregnant, has already had a baby since our May 2011 littlies, or their May 2011 baby was their last one. But then a couple of posts really hit home. One mum, when describing how her husband felt, really highlighted how I felt about the prospect of twins- the chaos of infancy, the extra financial costs- but then described how she viewed it: more love, more cuddles, more of life to share. And then two mums said they visualized what they wanted their dining room table to look like in twenty years.
THAT got me.
In the short term- pregnancy and birth and the first year- I cannot face the idea of twins. Even in the medium term the idea freaks me out. I’ve basically decided that the first four years would largely be an exercise in survival and if we made it out the other side with our marriage still intact and all three children healthy with no one suffering pyschological damage, I’ll call it a win.
But when push comes to shove, when I picture us sitting at our table two decades hence, and it’s a choice between dear sweet E. sitting there by himself, or the happy chaos that comes with three, it’s a no brainer.
I don’t want E. to be solely responsible for us when we hit our dotage.
I don’t want E. to be by himself if we don’t make it to our dotage.
I don’t want E. to miss out on having nieces or nephews of his own.
He will spend the rest of his life only seeing half of his family every two years (if that). I have no idea if he will ever have cousins who live close enough for him to count them as real friends.
I still have to talk to Q., but I know now how I feel about the situation.
If we’re lucky enough to be given the choice, I’m voting for two.