Amniocentesis and another 2WW.

From: http://www.webmd.com/baby/twin-pregnancy-types

Thursday we had our amniocentesis. What a nightmare. It was really important for us to have one, but holy crap that stuff is scary.

The doctor certainly didn't help. It was that same irritating douchey specialist from the other week.

I guess I should back up a bit since I've been MIA.

The cell-free DNA test ended up coming back inconclusive. That's right, the test that the doctor recommended and then we found out afterwards that the manufacturing company doesn't always recommend for multiples or donor eggs (and since this is surrogacy, my eggs are considered donor) - came back inconclusive. Shocking. They wanted my SIL (our surrogate) to come back in for another. She called me and gave me the update. The nurse was really pressuring my SIL to come back in for another try at this test that is only partially covered by insurance.

After thinking about it, I told my SIL not to get it. It didn't make sense. Why should she have to take extra time off from work for a test that was not going to tell us anything different than the amniocentesis that we had already decided we were doing. Why should we pay even MORE money for a test that didn't give us anything different? Why should we put her through an unnecessary poking that could very well end up being inaccurate or inconclusive. I told her to not worry about going back for the test.

And then she called back. The nurse was EXTREMELY insistent that she come back for this test. At this point I because very irritated (not at my SIL, but at this Dr.'s office.) It was clear that they wanted us to do this test to try and convince us against the amnio. I told my SIL not to stress about it and I would straighten everything out with the Dr.'s office.

Ready to rage war, I started making phone calls. First I called our old fertility clinic ACRM. Our nurse that took over our case when our original nurse was promoted was nothing short of awesome, and I wanted to ping her for her advice. Then I walked outside my office, took a deep breath, and called the specialist's office.

The nurse that spoke to my SIL was not available, but another person in the office was able to call me back fairly quick. That conversation did not go as expected. Actually - it went quite well. The nurse (I think she was a nurse - but we will call her one anyway) was awesome. She is similar in age to me and she confided that she would consider the amnio if she was in the same situation. She explained why the other test was inconclusive and agreed that if we were going with the amnio, then it was not necessary to get the cell-free DNA test - especially so close together. We talked for quite awhile and she restored my faith in this part of the process.

Hubby and I decided that maybe it would be better to have the amnio done at an office closer to us. Maybe staff at a Decatur/Atlanta office would be more professional that some of our previous encounters at the Fayetteville office (like the bad nurse my SIL talked to). Heck, I'll bet the Fayetteville office, even though quite modern and large, has never even seen a mixed Indian/Caucasian couple, much less one using surrogacy. It would be the same doctor (groan), but hopefully no sight of other staff members with similar issues. (Atlanta is completely different than most of the rest of GA.) We would still do the regular appointments closer to where my SIL lives, but we felt safer with the amnio in a more diverse setting.

Fast forward to Thursday: amnio test day. Meep.

We knew that my hubby would be about 15 minutes late due to work constraints, but we really wanted the time to be more convenient for our SIL and let her set it. So when the doctor came in after the initial ultrasound, hubby had not arrived yet. The doctor started off with "are you sure you still want to do this?" and I had to resist the urge of having a fit. Both SIL and I answered in the affirmative.

The doctor then explained that since there were twins, the first injection would have an add-on of dye. The barrel part of the syringe is interchangeable and thus one needle can be used to insert dye, screwed off, and another barrel placed on to gather the amniotic fluid. This insures that you are hitting the same place and that you don't have to puncture multiple times. The purpose of the dye is when they go to do the second amnio on twin B, they make sure they get the fluid from twin b and not twin a again. Apparently the sacs can be all over the place.

Guess what happened? 

Removing fluid for the second amnio showed blue dye. The doctor stopped and asked us if we wanted to continue. By now my husband has arrived and we have to explain what the blue dye is and what it means. It also, all of a sudden, occurs to me that 2 punctures to the same sac means we have just doubled that baby's chance of miscarriage. And the doctor says that if he hits it a third time it will triple it. And if one miscarries, then it can make the second one miscarry.

I sat shaking. Oh - and I haven't even MENTIONED how horrible this looked for my SIL. The first one didn't look painful until they removed the needle, but the second one definitely looked painful. What to do what to do? I felt paralyzed. Secretly I wished my husband would make the decision for us, but I knew that wasn't fair. My SIL turned to us and said she was fine if we wanted to continue. She continuously amazes me.

While the doctor started rambling on about some of our other options, I quietly thought to myself. There was a pause and I explained to my husband again, because I felt it had been glossed over, that the second puncture had increased the chances of miscarriage and a third would triple it. I stated it again to make sure my understanding was correct. The doctor said it was and my husband started asking more questions. Again I reach internally and quietly thought to myself.

What I realized was that my initial fears of chromosomal abnormality had not changed. I still couldn't deal with certain outcomes, but now I was increasing the chance of making a good outcome bad. And I didn't have my comforting statistics on hand to let me know what was optimal. Ultimately I internally decided that I felt we should continue. And to nut punch the doctor if he pierced the wrong sac again. My SIL reiterated she was fine to continue today.

I overheard the doctor saying we could try again in a week or two. This made ZERO sense because then you would definitely be piercing the twin A 3x (because you would have to do the dye again) and the timing would be off if we had to make other decisions. My husband turned stonecold at this point and told him "Just do it now." Hubby looked at me and I nodded my head yes.

The doctor found another area that he sounded more confident with injecting. Complete opposite side that had not been available (baby moved) previously. My husband asked him "between 0 and 100% what it your confidence rate that you won't hit Twin A a third time?" The doctor replied "Oh you can never be 100%" and didn't answer the question. Hubby repeated the question again and doctor replied "I'm very confident". Which of course we followed up with "how much is VERY???" His reply: "At LEAST 50%." Facepalm.

The doctor had to get into a weird hand position to access the third location. The dye check occurred and this time it was clear. We all breathed a big sigh, but the room was still incredibly tense. I could tell it was painful for our SIL. I watched as the doctor withdrew the amniotic fluid and saw his hands visibly shake the entire time. I have no idea if it was because he was old, nervous, or just because his hands were in a really awkward position. I decided that it would make the situation worse to announce "WTF is wrong with your hands?!?" mid-withdraw, so I stayed silent. (I did tell hubby, mommy, and SIL later.)

It was over. We were done. We asked SIL if she was ok. She said she was. Hubby ran downstairs to pharmacy because the doctors office didn't provide any after pain medicine and we didn't want her hurting on the long drive home. Tylenol was fine the staff said. SIL said she was fine, but hubby ran to get some Tylenol anyway.

My mother was waiting in the lobby when we were done. She had graciously volunteered to drive my SIL when we realized the night before that she shouldn't drive herself. Doctor's office failed to mention this. Hubby ran back downstairs and got drinks and Reese's peanut butter cups for everyone. We talked for about an hour to make sure SIL was feeling ok, before the long drive home.

At the end, we scheduled our appointment for the next ultrasound. We decided that Fridays would work best for everyone, rather than Thursdays. The front desk lady informed us that we would have a different doctor if we went on Fridays. Without getting mad, or causing a scene, I simply replied "GOOD" and she made the appointment.