After 3 miserable rounds of IVF my husband and I implemented protocols from a great book called “It Starts with the Egg”, we had a break for four months then commenced our fourth round using ICSI. With much better results we transferred a fresh Embryo which stuck and with no complications our little boy arrived safely. From this fourth round we were beyond excited that one little embryo made it be PGD tested and to freeze as a day 5 blastocyst. Little did we know what it had in store for us.
When our son was 13 months old, we made the decision to transfer our final embryo in the hope of a sibling. 10 days later we had a positive blood test and a couple of weeks after that (7 weeks gestation) went for our heartbeat ultrasound. There it was a flickering heartbeat. My next call was to my clinic to find out the gender, being a PGD tested embryo that information was available. It was a girl, perfect! A pigeon pair, all we could have hoped for!
Finding out I was pregnant with twins
The next 5 weeks of pregnancy were standard I had a lot more intense nausea and morning sickness than with my first but assumed that’s because I was having a girl so thought nothing of it. At 13 weeks we went for our Nuchal bloods and scan.
The TV screen for the patient in the room wasn’t working on the day and the radiographer seemed to take forever to tell us what she saw. She sheepishly asked if wed had a scan previously, I assumed something was wrong. She turned the screen and said, “There are two in there”, I saw it immediately two little heads it was unmistakable. In utter shock and disbelief, I didn’t know what to think or feel, it was such a surreal feeling, and my blood was just rushing though me, heart pounding, anxiety kicked in and then you start to wonder “how did this happen”?
The odds of monochorionic monoamniotic twins
I knew immediately that they would be identical as we don’t take any risks while doing IVF rounds. Little did I know we were about to have a steep learning curve about monochorionic monoamniotic (MCMA) twins. These are twins that not only share a placenta but and amniotic sac as well. MCMA twins occur when the embryo splits between day 8 and day 12, making them very rare, only 1:35000 to 1:60000 pregnancies and represent only 1% of all twin pregnancies. The radiographer on the day told us what she could but as always, we needed to see our OB / Specialist, but this couldn’t happen for another 10 days as he was on leave, we were in the dark.
We told our families who were all ecstatic about the news of an extra little girl. Me on the other hand was scared and apprehensive. I joined every group I could find to try and gain as much knowledge as I could on how these pregnancies are managed, complications, success rates and what to expect. Management of MCMA pregnancy differs significantly around the world but there was one thing that was consistent was that these babies would be delivered at 32 weeks at the very latest.
Being pregnant with MCMA twins
We live in regional NSW a town of about 60,000 people, 5 hours away from our capital city that had the expertise to handle this type of pregnancy. Once we saw our OB he referred us straight to the MFM unit in a large hospital in our capital city.
From 16 weeks we commenced fortnightly scans, which I would fly to and from. The first of these visits was daunting. I’d been busy reading in groups and googling about complications. Hearing what we would monitor for and why every fortnight was overwhelming but also reassuring in a way that I knew I was in the best care now. We also discussed In-patient care V’s out-patient care at this point. My MFM shared her knowledge of both, and it’s been shown more recently that inpatient care doesn’t conclusively ensure better outcomes. Provided we followed the MFM units care instructions we were satisfied of a positive outcome with Outpatient care only.
16-24 weeks pregnant with MCMA twins
We talked though TTTS, TAPS, discordance in growth and cord entanglement, all out of my control of course. Our 16 week and first high def scanned showed there was no dividing membrane and that they were indeed MCMA, relived too that it also showed only a small discordance in growth and that everything else was tracking well at this point. Fortnightly scans continued up to 24 weeks with no concerns.
26 weeks pregnant with MCMA twins
At 26 weeks we found Twin 2 had a small VSD, which we investigated and were advised it may close on its own after birth. We were also passed the riskiest time knowing if we had to deliver earlier the girls had a very good chance of survival now. At around this point in the UK and USA, MCMA mums are usually admitted to hospital and put on bed rest with daily scanning and dopplers, I had selected to be outpatient in the end it was more suitable for us as I had my son to care for too and being admitted at 26 weeks wasn’t feasible for us as a family.
28 weeks pregnant with MCMA twins
At 28 weeks we all relocated to be closer to the hospital as we had made it to the third trimester and wanted to be in the best place if I went into preterm labour. Scans became weekly and our C-Section was scheduled. Every scan was an hour or more with so much to check and two babies to review I felt like I knew them already. As we got closer to the 32 week mark we were scanning every two days. We did our steroid injections in preparation. At 32 weeks we made the decision to push to 32+5 giving them just those few extra days was important to me, and we had no indication of any complications
Giving birth to monochorionic monoamniotic twins
The C-Section went smoothly with both girls being born in the same minute. Both girls were breathing on their own, no time for cuddles they had their checks and headed to ICU. No CPAP was needed, and they were on room air in their humidity cribs by the time I got to see them 5 hours later. Their cords were very entangled with a true knot in one section, we are very lucky to have had such a positive outcome. We had a few issues with Jaundice but other than that we were only in ICU for 2 days then off to special care for feeding and growing. Amazing really. At 20 days old we were flown back home by air ambulance and spent the next 10 days in our local hospital learning to feed.
We know we were extremely lucky to have an uneventful MCMA pregnancy, they don’t all go that way. The care from our MHM unit was of the highest level and gave me confidence the whole time I’d get to meet my little girls. Other than some pretty severe silent reflux as babies they are now two happy and healthy 2.5-year old’s.
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