Got Quads?

Five weeks into my pregnancy I found out I was having quadruplets. Since we transferred three embryos during our IVF procedure it appears all the embryos “took” and one split, creating a set of identicals. But who are the identicals?

Everyone wants to know who the “twins” are. I don’t have twins. I have quadruplets. Because Tortilla and Cakes are the only two with the same blood type, I have always presumed they are the identicals. Identicals, not twins. You see even though they are identical to one another they are fraternal to Roo and Sue-Sue, so you can’t call them twins. Some people have commented that I have two sets of twins… one fraternal and one identical. That categorization still doesn’t work because, again, four babies at the same time. 

Now, let’s get back to the topic at hand. How do I tell Tortilla and Cakes apart. Oh, it can be tricky. From day one there have been subtle differences. For the first year or so Tortilla’s face was slightly rounder. Cakes was more vocal (as in she cried loud and hard when she wanted something). Call it a mother’s instinct… I could usually tell them apart, even as infants, but sometimes I would have to put them side by side to figure out who was who. When our volunteers came over I would put Tortilla and Cakes in different colored clothing. Looking at pictures from a few years ago I now have trouble distinguishing between the two. Thank goodness I was good about cataloging those photos and putting names and dates on the back!

Cakes and Tortilla, as identicals, clearly have pretty similar features, but they have different personalities and different tastes. Tortilla is extremely sensitive. If she knows she hurt your feelings, she’ll start to cry. Cakes is up for adventure and is the one most likely to be dancing on the coffee table (or encouraging her sisters to do it). They both would like to live in party dresses and party shoes, but Tortilla prefers pink… Cakes likes yellow and orange. Cakes loves vegetables. Tortilla would rather eat candy. 

They have quite a strong bond. When we moved in to our new house their beds ended up being together. Often times Hubby and I would check on the girls at night and find Cakes and Tortilla sound asleep with their feet sticking through the slats of their cribs so their feet were touching one another. I still find Cakes near the bottom of her bed most nights so she can be near Tortilla.

Their bond has affected the bond between Roo and Sue-Sue. Since Cakes and Tortilla often pair up, Roo and Sue-Sue pair up as well. If Sue-Sue is sad and needs her blankie it’s usually Roo who brings it to her. Yet all four of them are close and have a bond very few will be able to immerse themselves in.

Stephanie at Ask Me Anything wants you to, well, ask her anything. Among her credentials she’s a scientist, an engineer, a rocket scientist and a mathematician. So I took her up on her ask me anything philosophy and posed these questions: how identical are identical twins (ok, I called them twins in this question but I didn’t want to make it complicated)? Do they share the same blood type and fingerprints? She confirmed Tortilla and Cakes are the identicals. Want to know what makes them identical? Well, I think I’ll have to direct you to Ask Me Anything .

When people find out I have quadruplets, one of the more popular questions (after “Was it natural?” and “Do you watch Jon and Kate Plus 8?”) is: “What did you say when you found out?” I wish I had a good answer.

About a week after we did IVF I found out I was pregnant. Maybe it was two weeks, but it was a blood test and it was fast. The phone call went something like this:

Nurse: Your blood test came back and you’re pregnant. Congratulations.

Me: What? That’s great. 

Nurse: (continued to talk about HCG levels, etc… vaguely remember her saying something about “high levels,” but didn’t pay attention because:)

Me: (in my head: Thank you, God! Thank you!!!!)

Then we scheduled a five-week follow-up for our first ultrasound. The day before the ultrasound I felt terrible. I was exhausted and the thought of food made me ill. Since I had sent Hubby on a “healthy shopping spree” that week, I thought my new diet was overloading my body. I was determined to eat everything recommended in What to Expect When You’re Expecting. We went to the ultrasound and the technician wouldn’t turn the monitor toward me. In fact, she left the room without saying a word. The Reproductive Endocrinologist came in, looked at the screen and asked me how many embryos we had transferred. Three, I responded meekly. I was sure there had been a mistake and I wasn’t actually pregnant. OK, he said, well, there are four heartbeats. Now this is the point in the story where everyone expects me to say I bawled with either happiness or fear or that Hubby fainted. Nope. I looked at Hubby and said something along the lines of “Four? Well, now I know why I’ve been so sick!” The tears came later, days later and were both tears of happiness and terror. Come to think of it, Hubby didn’t have much to say. Hmmm… maybe he was on the verge of fainting.

I think when there is a lot of attention placed on a higher order multiple (HOM) birth, people tend to forget that these births aren’t common. When you watch Jon and Kate Plus 8, read about Nadya Suleman and her octuplets or watch your local news and see a segment on a triplet (or more) family, it can make you think these births happen all the time. According to the Centers for Disease Control (CDC), HOM births in the U.S. are decreasing.

The latest statistics, which were recently made public, are from 2006. According to these numbers, which have been broken down by Mothers of SuperTwins there were:

• 137,085 twin births
• 6,118 triplet births
• 355 quadruplet births
• 67 quintuplet (or more) births

What does this all mean? Well, it means, in my opinion, most fertility clinics are being more responsible than we may have given them credit for in light of the recent octuplet birth. The American Society of Reproductive Medicine published guidelines in the 1990’s aimed at reducing the number of HOM births by limiting the number of embryos transferred during assisted reproductive technology (ART) procedures. The studies indicate this is working.

Why make an effort to reduce HOM pregnancies/births? The goal of any type of ART is to have one baby. Yes, four is a blessing. Four healthy girls born at 28 weeks and 2 days is a miracle. Not everyone in the same situation has as successful a pregnancy. A woman with a HOM pregnancy is at serious risk of complications such as pre-term labor, hypertension related complications (pregnancy-induced hypertension, toxemia, preeclampsia), and even carpal tunnel syndrome. The babies themselves face various risks, depending on their gestational age. Common problems for babies born at 28 weeks and earlier include sucking and swallowing issues, which may lead to a feeding tube, jaundice, lung development and blood transfusions. The NICU is a scary place when you have one, let alone multiple infants, requiring round the clock treatment.

Am I hypocrite? Here I am with four beautiful children, yet I wouldn’t wish a HOM pregnancy on anyone. It was the roughest, most stressful 28 weeks and 2 days of my life. The outcome has been wonderful, but not every family has this outcome.

The point I want to make from this post is this: I would hate to see more restrictions placed on ART simply because one doctor got too big for his britches and wanted to make history. The majority of reproductive endocrinologists out there approach ART with thought, care and responsibility. The majority of people who go through fertility treatments do so because they’ve thought long and hard about how to start a family and feel this is the best option for them. I know I’ve rambled a bit here and there and tomorrow I’ll get back to some of the wackier times with quadruplets, but for today I just wanted to break down HOM births a little to show you it’s not a common as the media sometime make it seem. Some of the high profile HOM births (you know which one I’m talking about) make it seem like we go in to a clinic, order up how many babies we want and boom here we come with x amount of babies. In reality, we’re a little more responsible than that. Now I’ll get off my soapbox.