Intro, Pos NT screen

iVillage Member
Registered: 10-19-2004
Intro, Pos NT screen
12
Tue, 03-02-2010 - 8:35pm

*warning termination ment.*

Hello ladies,

My name is Jenna and we are 14w2d pg with what we hope will become our first living child. After 4 fresh IVF's and 11 IUI's our last IUI was, so far, successful. We have had many losses so I am still cautious.

I know many women here have probably had the 1T screen. We had this screen and got a positive result for DS, though it was only 1 in 97, which is lower than the average risk for my age. A bit over a year ago we lost our twin pregnancy, one twin to unknown causes at about 9-10 weeks. The with the second twin, we did the 1T screen and got a high risk of 1 in 4. In that case all of our numbers were normal except for incredibly low PAPP-A (really low, like .07 or something). We did amnio and had PROM after amnio, which did not reseal, which made the fetus nonviable and the pregnancy very dangerous (potentially fatal) for me, due to very high rates of infection in these cases. We found out the fetus had T21 the same day we found out the membranes did not re-seal, and were told the T21 was the likely cause of the PROM...that the fetus makes the membranes, and when the fetus is abnormal the sac often is as well...and in fact they said there's a good chance the membranes probably would have ruptured in a few weeks even without the amnio. We scheduled an emergency D & E at 16w, and thankfully infection did not set in before that (despite a close call at the emergency room with possible elevated temp), so my fertility was preserved and I was able to try again.

In this pg, when I asked about my risk of PROM again, my doc told me that the deceased twin I was carrying last time was also a risk factor for PROM, along with the T21. But they can't say for sure 100% why the PROM happened, or that it wouldn't happen again. I also have a submucous fibroid that has been growing rapidly, about 3mm the last time I checked, which I think can increase the risk of PROM. My doctor told me that the risk you see for amnio and CVS are averages, but an individual's risk could be higher or lower. She felt my risk was likely higher, especially for CVS, and that my risk may be higher for amnio as well, but it was the safest choice if I needed invasive testing, and if our screening results came back good enough that we felt comfortable avoiding, that would best.

Anyway, here I am again, with much better but still positive and not reassuring results. We have decided to wait for the 2T screen and see what that says, and then possibly the 18w ultrasound before making a decision about amnio. Because I know that PROM makes even a genetically normal fetus nonviable if it happens before the lungs develop, and it happened to me before, I'm really terrified of amnio and am hoping to avoid.

Anyway, I am anxious during this wait and I'm wondering if anyone else here has had these lower-positive levels on your 1T screen, and if so, what happened (either in your 2T screening, U/S, amnio, or birth). If you had the 2T screen, did your odds get better, or worse, and by how much? Any soft markers on the u/s? If you had an amnio, what was the result?

This time around, we didn't have any drastically abnormal readings, it was more a combination of readings that gave us a positive result.

Our numbers were
NT: 2.5 (MoM 1.33)
PAPP-A: MoM .78
Hcg: MoM 1.14

u/s done at 12w5d, CRL gestational age 13w2d
Anticipated maternal age at delivery: 42
T21 risk 1 in 97
Risk for T18 1 in 3,200.

They did visualize a nasal bone in the U/S btw, though we had one in our T21 pg as well so that is not greatly reassuring.

Would be interested in hearing results of other ladies 1T tests and subsequent tests/birth/outcome.

Kind and non-judgemental responses only.


- Jenna, 41, DH 38 TTC since September '06 with MFI. 3 failed unmedicated IUI's with DH sperm, 1 failed IUI with injects with DH sperm, IVF #1 BFN, FET BFP but M/c week 5, IVF#2 BFP m/c week 7, IUI with injects and donor sperm: probable chemical pg. 1 failed unmedicated DS/IUI. Started BCP's 7/30 for IVF #3, ER 9/10, ET 9/15, Beta 9/24 results 9/25. BFP, Twins. Lost 1st twin at 9-10 weeks, lost second twin at 16 weeks 12/17/08. Attempted IUI #4 converted to DS/DH IUI April 09 at my request, BFP and M/c. IVF #4 June 09 BFN. DS-IUI w/injects 7/6/09, BFN. Hysteroscopic myomectomy to remove fibroid 7/29/09.Unmedicated DS-IUI 9/09, BFN. DS-IUI with injects, 10/09, BFP and M/C. DH/DS-IUI with injects and HGH, 12/6. BFP! Betas: 12dpo 12/18 58, 14 dpo 12/20 157, 16dpo 12/22 379, 22 dpo 12/28 4,002



pregnancy
- Jenna

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iVillage Member
Registered: 01-23-2010
Tue, 03-02-2010 - 9:20pm

Hi Jenna,


This is my first time trying to have a baby, so all this screening/testing business is new to me. I had the ultrascreen done three weeks ago and I'm STILL waiting for the results of the blood test portion- I'm kind of pissed off too. The NT scan looked good, and I'm planning to try to carry the baby even if the full results put me/the baby at higher risk for a genetic abnormality, but there's no reason it should take this long.

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iVillage Member
Registered: 03-05-2008
Wed, 03-03-2010 - 12:19am
Hello, Jenna. Welcome and congratulations. I hope you get some responses from the ladies here that give you the details you're looking for. I'm not familiar with what PROM is so I apologize that I can't speak to that. With our oldest daughter, we opted for 1T screening, including the NT scan and blood work. This was about six years ago (I was 36 at the time). I can't recall what the exact odds were they gave us then, but I do know definitively that my age alone resulted in the results being positive for DS. That was despite the fact that our blood work, NT scan, and nasal bone scan all came back within "normal" ranges. With our second daughter, who just turned two, I by-passed all screening and opted to go for the amnio. With that pregnancy (I was 40 when I delivered her), based on my age and our genetic histories, the odds of her having any chromosomal abnormality were quoted to be 1:62 and for having DS, 1:87. The amnio confirmed she did not have any chromosomal defects. With this baby, (I'm now 42), I again opted for the amnio and by-passed all other screenings. I forget the exact numbers for DS and other chromosomal abnormalities but I think it was something like 1:42 for the baby having any chromosomal abnormalities and 1:62 for DS. The amnio again confirmed this baby is free of any chromosomal abnormalities. So although I can't speak directly to the measurements you received, I can offer you the odds I was given and tell you that I think the odds you received are pretty darn good. I hope you'll keep us posted on your journey with this little bean and I look forward to seeing you posting here. Best wishes to you and be well.

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iVillage Member
Registered: 12-08-2009
Thu, 03-04-2010 - 5:40am

Hi Jenna.

First, Congratulations on this most recent pregnancy. I know your scared and anxious...b/c I have literally walked in your shoes. I am a fellow IUI/IVF mom...although my IUI did not work and I was told to either use donor sperm (moderately-severe male-factor infertility) or go straight to IVF. We opted to go straight to IVF and did have success on our first try. I was 35 at delivery and today have a very precocious 5 1/2 year old daughter.

Our 2nd baby was a "bonus" baby...no medical intervention necessary.

We also have 5 little souls in heaven due to early miscarriage. Our most recent loss was in December of 2008. I carried until 10w5d, but baby's growth was only measured at 6w5d. No pathology was performed and it was just assumed to be a trisomy loss, but one never knows when dealing with infertility. It could have been another sperm issue.

Anyway, I did the 1T NT screen and did come back with elevated/positive results for T21. I've been trying to go thru old emails and or IVillage posts b/c now I can't remember my exact numbers...except for a couple. Like you, I did not have overly terrible numbers (yours are actually better than mine), but when we went to the perinatologist for follow-up it was explained that it was the ratio or combination (as you mentioned) that gave me the odds it did.

I never got the hCG reading...my peri said that number is really the least of his concerns and variable from woman to woman and pregnancy to pregnancy. I know mines gotta be pretty high considering how darn sick I was until about 14 weeks! Ironic isn't it...all of my m/c had abnormally LOW hCG levels and now its too darn high...I can't win for losing!

My NT was lower than yours...(1.88), but then so was my PAPP-A (.38)

Interestingly, Dr. Ridgway shared with me some info about the PAPP-A score...I think this was the biggest red flag on my readings (although I find it interesting that the cut-off for normal, albeit low-normal is .40). Apparently, PAPP-A isn't just an indicator of chromosomal abnormality, but also of late-term pregnancy induced problems such as IUGR (growth restriction), pregnancy-induced hypertension, pre-term delivery, etc. For some reason, I'm almost more concerned about these things than the thought of having a DS baby!

Anyway, Chris and I are not opting to do amnio at this time. My risk for T-18 and Spina Bifida came back totally normal (they didn't even give me the results...I should have asked). My fear is that I will be that 1:250 odds that goes on to miscarry a totally normal-chromosomal fetus b/c I did amnio. We have so much dang trouble getting a healthy embryo into the right place to begin with that I am terrified of messing with nature...this early in the game. BTW...could you tell me what PROM is? I have no idea, but it doesn't sound good!

My RISK for DS came back at 1:17, but that still means I have a 95% chance of having a normal kiddo. I may be in denial, but I'm really just trying to think positive and enjoy this last pregnancy of mine.

We are scheduled for a return visit to the peri at 21 weeks (end of March) to look for soft-tissue markers, but you're not really going to know until delivery (or amnio results).

Wishing you all the best of luck and continued success in carrying this most recent pregnancy. You'll be in my prayers,

Valerie

Just some history (Male Factor Infertility)
Age 30: Chemical Pregnancy
Age 31: Ectopic Pregnancy; less than 6w; methotrxate termination
Age 32: Blighted Ovum: D&C
Age 33: Failed IUI
Age 33: Natural Conception while waiting to start IVF; ectopic 2X
Age 34: IVF; 1 round; success; Mary; delivered 3-weeks shy of 35
Age 37: Natural Conception: Benjamin Paul; age 3
Age 39: Miscarriage at 10Weeks; weak heart rate at 7weeks
Age 40: BFP in November 2009!

iVillage Member
Registered: 01-11-2010
Fri, 03-05-2010 - 10:11am

Hi Jenna,


Welcome to the board and congratulations on this pregnancy! It's moving to read your story

 

iVillage Member
Registered: 10-19-2004
Mon, 03-08-2010 - 5:01pm
Karen, Thanks for your response. You've been waiting 3 weeks for your test results? Ugh! I know where I live the State does the blood testing and that's why it takes so long. If it makes you feel any better my doc said that they prioritize the positive results so if your results are taking a long time to come back they are usually negative (good). Good luck and keep me posted!
- Jenna, 41, DH 38 TTC since September '06 with MFI. 3 failed unmedicated IUI's with DH sperm, 1 failed IUI with injects with DH sperm, IVF #1 BFN, FET BFP but M/c week 5, IVF#2 BFP m/c week 7, IUI with injects and donor sperm: probable chemical pg. 1 failed unmedicated DS/IUI. Started BCP's 7/30 for IVF #3, ER 9/10, ET 9/15, Beta 9/24 results 9/25. BFP, Twins. Lost 1st twin at 9-10 weeks, lost second twin at 16 weeks 12/17/08. Attempted IUI #4 converted to DS/DH IUI April 09 at my request, BFP and M/c. IVF #4 June 09 BFN. DS-IUI w/injects 7/6/09, BFN. Hysteroscopic myomectomy to remove fibroid 7/29/09.Unmedicated DS-IUI 9/09, BFN. DS-IUI with injects, 10/09, BFP and M/C. DH/DS-IUI with injects and HGH, 12/6. BFP! Betas: 12dpo 12/18 58, 14 dpo 12/20 157, 16dpo 12/22 379, 22 dpo 12/28 4,002



pregnancy
- Jenna
iVillage Member
Registered: 10-19-2004
Mon, 03-08-2010 - 5:06pm
Hi Joan, Thanks for the welcome and encouragement. I am trying to take this a good news, because my risk is lower than my risk by age, but it's hard after what we've been through. PROM is premature rupture of mebranes. It's when your water breaks too early. When people lose their babies due to amnio it is generally due to PROM.
- Jenna, 41, DH 38 TTC since September '06 with MFI. 3 failed unmedicated IUI's with DH sperm, 1 failed IUI with injects with DH sperm, IVF #1 BFN, FET BFP but M/c week 5, IVF#2 BFP m/c week 7, IUI with injects and donor sperm: probable chemical pg. 1 failed unmedicated DS/IUI. Started BCP's 7/30 for IVF #3, ER 9/10, ET 9/15, Beta 9/24 results 9/25. BFP, Twins. Lost 1st twin at 9-10 weeks, lost second twin at 16 weeks 12/17/08. Attempted IUI #4 converted to DS/DH IUI April 09 at my request, BFP and M/c. IVF #4 June 09 BFN. DS-IUI w/injects 7/6/09, BFN. Hysteroscopic myomectomy to remove fibroid 7/29/09.Unmedicated DS-IUI 9/09, BFN. DS-IUI with injects, 10/09, BFP and M/C. DH/DS-IUI with injects and HGH, 12/6. BFP! Betas: 12dpo 12/18 58, 14 dpo 12/20 157, 16dpo 12/22 379, 22 dpo 12/28 4,002



pregnancy
- Jenna
iVillage Member
Registered: 10-19-2004
Mon, 03-08-2010 - 5:52pm

Hi Valerie,

I saw your earlier posts when I was lurking here and I was hoping you would respond. I am sorry for your losses. Our stories are similar in many ways. We also have male factor, in fact on this latest IUI we used both my DH's sperm (first) and then donor sperm an hour later as back up, so we don't know for sure where the paternal DNA came from ( we will do a dna test when the baby is born or from amnio sample, if we do amnio). In our case paternal factors were also highly suspected as a contributing factor in our losses and trisomy. However on our last IUI my DH's sperm was sudenly much better than on all previous tries.

I am familiar with all the other (scary) causes of low PAPP-A from last time. In my last 2T pg, I was in total denial afetr the pos screening results, I had myself convinced before we got the amnio results that there was no trisomy, but that we had placental issues and may have some of these other complications...that it might be a difficult pg with month of bedrest but still give us a healthy baby. That my 1 in 4 risk meant a 75% the baby was fine, which I figured was probably closer to 80% because they saw the nasal bone. Now I realize it doesn't get much worse than 1 in 4. This time though not ideal my PAPP-A is so much higher at .78 MoM I hadn't considered those other risks...but as a matter of fact they've been telling me my blood pressure is a bit elevated already and they are watching that, and instructing me to eat a low sodium diet. I wonder if that could be related?

I can so identify with your fears of miscarrying a healthy fetus due to amnio after going through so much to get this far. When you lose a baby due to to amnio it is generally due to PROM, premature rupture of membranes. It means your water breaks. Having had that happen before I am very afraid of it happening again, though my OB reassured me today that there were specific reasons (primarily trisomy, but also the dead twin I was carrying) last time why I was at high risk for that, and I would not be at higher risk with a healthy baby because it had happened before. Psychologically though, it is hard to get over that fear. With a risk level of 1 in 97, I am more afraid of losing a healthy baby to PROM from amnio than I am of having a DS baby (especially if the DS was not severe). After what we've been through I just don't think I could stand that. On the other hand a late term loss or still birth (very common with DS), or a very sick baby that dies early or is severely disabled with no quality of life possible would also be unbearable. I don't really like playing that "what is worse" game...there are too many awful scenarios to imagine.

Good luck with your u/s, I hope everything looks healthy and normal with your baby, and you don't have any complications from the low PAPP-A. Yours isn't that far below normal, if the cut off is .40 MoM.

I was supposed to get a u/s at 19w1d, but I moved it up today to 17w5d. I am just too anxious after the positive screen to wait that long.

On another note I'm encouraged you were able to conceive naturally despite MFI issues. We would ideally want 2 kids but after all we've been through we'll feel so lucky to get even one healthy baby. But it's still nice to think we might have a chance at another.

Anyway I wish you good luck with everything and I hope you'll keep me posted on how everything goes.

- Jenna, 41, DH 38 TTC since September '06 with MFI. 3 failed unmedicated IUI's with DH sperm, 1 failed IUI with injects with DH sperm, IVF #1 BFN, FET BFP but M/c week 5, IVF#2 BFP m/c week 7, IUI with injects and donor sperm: probable chemical pg. 1 failed unmedicated DS/IUI. Started BCP's 7/30 for IVF #3, ER 9/10, ET 9/15, Beta 9/24 results 9/25. BFP, Twins. Lost 1st twin at 9-10 weeks, lost second twin at 16 weeks 12/17/08. Attempted IUI #4 converted to DS/DH IUI April 09 at my request, BFP and M/c. IVF #4 June 09 BFN. DS-IUI w/injects 7/6/09, BFN. Hysteroscopic myomectomy to remove fibroid 7/29/09.Unmedicated DS-IUI 9/09, BFN. DS-IUI with injects, 10/09, BFP and M/C. DH/DS-IUI with injects and HGH, 12/6. BFP! Betas: 12dpo 12/18 58, 14 dpo 12/20 157, 16dpo 12/22 379, 22 dpo 12/28 4,002



pregnancy
- Jenna
iVillage Member
Registered: 10-19-2004
Mon, 03-08-2010 - 6:10pm

Thank Melinda,

It's good for me to remember the high rate of false positives with screening tests after 40. I hope you have great results at your 20 week u/s!

Glad to know you have found this board non-judgemental, I've run into some other types on the TTC 40+ board, which is the main reason I've waited so long to post here, and the reason for my note on the subject. I cl'd another board for a long time (TTCYFC 6+ months) and we had very firm guidelines to keep the board a kind, welcoming and non-judgemental place all of the time. But not all boards share that ideology or maintain that standard of conduct, so it's hard to know what to expect on a new-to-me board. My apologies if that reminder is unnecessary here.

- Jenna, 41, DH 38 TTC since September '06 with MFI. 3 failed unmedicated IUI's with DH sperm, 1 failed IUI with injects with DH sperm, IVF #1 BFN, FET BFP but M/c week 5, IVF#2 BFP m/c week 7, IUI with injects and donor sperm: probable chemical pg. 1 failed unmedicated DS/IUI. Started BCP's 7/30 for IVF #3, ER 9/10, ET 9/15, Beta 9/24 results 9/25. BFP, Twins. Lost 1st twin at 9-10 weeks, lost second twin at 16 weeks 12/17/08. Attempted IUI #4 converted to DS/DH IUI April 09 at my request, BFP and M/c. IVF #4 June 09 BFN. DS-IUI w/injects 7/6/09, BFN. Hysteroscopic myomectomy to remove fibroid 7/29/09.Unmedicated DS-IUI 9/09, BFN. DS-IUI with injects, 10/09, BFP and M/C. DH/DS-IUI with injects and HGH, 12/6. BFP! Betas: 12dpo 12/18 58, 14 dpo 12/20 157, 16dpo 12/22 379, 22 dpo 12/28 4,002



pregnancy
- Jenna
iVillage Member
Registered: 12-08-2009
Mon, 03-08-2010 - 6:40pm

Wow, Jenna...our stories really are similar.

I know how you feel...while multiple children would be wonderful, 1 healthy baby is certainly a blessing. We never expected to have 2...let alone 3 children. At 35, we were just so very grateful to have Mary Catherine!

I was wondering...is a trisomy defect always the result of a "bad" egg or are trisomy defects also passed along via sperm?

Oh, the PROM thing sounds horrible. I don't know if you were around yet or even just lurking, when Jack and Noah's Mom (Marissa) was posting here. Just a few weeks back, we both got our NT screening results. Her's came back elevated for T-18 (1:17) while mine came back elevated for T-21 (1:17). Marissa then went on to do the amnio.

Her last post was worrisome. She woke up on the middle of the night feeling wet and went to either her doc or the ER to find that she was leaking amniotic fluid...she had lost about 1/2 (I think that's what she said) due to an infection. She never posted again.

I'm afraid that in this case, no news is not good news...

The infection/leakage occurred AFTER she had an amnio done...is this an example of PROM?

I'm so glad that we have met thru this forum. Sometimes, I feel like the odd man out b/c most of the other gals, although the same age, haven't had the significant loss history and or infertility journey that I've experienced. I feel down-right neurotic some days!!! LOL

Best wishes as you continue this journey. I look forward to your updates and hope and pray that all goes well. Isn't it miraculous what medical science can do for those of us "infertile" ones!

Blessings,
Valerie

iVillage Member
Registered: 10-19-2004
Mon, 03-08-2010 - 8:05pm

Valerie,

Trisomies can be from either the sperm or the egg. In either case it can be either inherited or random. Usually it is from the egg unless your DH has MFI, a small percent of men with MFI have what is called sperm aneuploidy. There are some new tests that can point to sperm aneuploidy. After our T21 pregnancy we did some more testing on DH's sperm and we found out that 40% of the very small percentage of sperm that looked normal and swam normally (was selected for ICSI) was likely aneuploid (did not bind to hyaluronan plate). My RE told me that in our case the T21 could have just as likely been from wither of us. Our hope is that the natural selection of IUI (natural fert) will help protect from sperm aneuploidy, if the egg was fertilized by my DH's sperm. There's no data on this, in fact the whole discovery of sperm aneuploidy is relatively new...they used to think it was always the woman unless it was a genetic predisposition.

I was not lurking to see Marissa's story. It sound like me, she had PROM after amnio. In my case it happened within hours of the amnio. I was just lying in bed and felt a big gush. I reached down and my underwear were soaked. When I went to urinate there was another big gush. I called the doc and they said that it was amniotic fluid leaking but in most cases the membranes would re-seal within 48 hours. I went on STRICT bed rest, I even had DH get some adult diapers so I didn't have to get up to pee (terrified more fluid would leak out). After 3 days of anxious terror they brought me in for an u/s to see how much fluid was left. There was little to none visible in the sac with the living baby (dead baby's sac was full of fluid still). Then I got the news about the T21. That night I had more leaking and they told me that meant my membranes had not and would not re-seal, and the pg would not be viable, and I needed a D & E ASAP, though I might m/c at anytime before they could get me in. Once the membranes rupture there is a high risk of infection, so I had to take my temp 2x an day, and told to go to ER if any sign of fever. I ended up in the emergency room late one night thinking I may have a fever (turned out the therm must have been off because temp was normal at ER).

I was told the risk of PROM after amnio is MUCH higher when there is a chromosomal abnormality...that may have been what happened to Marissa. If it was due to an infection in the uterus (I know there are some low grade chronic infections like mycoplasma and ureaplasma that can raise risk of PROM with or without amnio) I think she would have needed a D & E and may have m/c'd before then. I was told infections of the uterus due to ruptured membranes always result in m/c and requires an immediate emergency D & E if detected before M/c. I'm not sure if that is also true when the PROM is triggered by an infection or not. I was told the uterine infections in PG with ruptured membranes are very dangerous because the placenta can pump the infection straight into the mother's bloodstream, so it can kill you in as little as 48 hours if not treated. Hopefully Marissa is OK, like you I'm afraid no news may be bad news. It sounds like in her case she may have had PROM even without the amnio, though the amnio may have made it happen sooner. I was told there is good chance I would have had PROM in a few weeks even w/o the amnio. We'll never know.

Anyway, I don't want to freak you or anyone out about amnio excessively...it sounds like these were both very specific cases where something was already very wrong with the pg to begin with. I think in healthy pg's the risk is quite low.

I know what you mean about feeling neurotic and anxious after a history of IF and loss. I think I have post traumatic pregnancy syndrome. It is great to connect with someone with a similar history and concerns.

- Jenna, 41, DH 38 TTC since September '06 with MFI. 3 failed unmedicated IUI's with DH sperm, 1 failed IUI with injects with DH sperm, IVF #1 BFN, FET BFP but M/c week 5, IVF#2 BFP m/c week 7, IUI with injects and donor sperm: probable chemical pg. 1 failed unmedicated DS/IUI. Started BCP's 7/30 for IVF #3, ER 9/10, ET 9/15, Beta 9/24 results 9/25. BFP, Twins. Lost 1st twin at 9-10 weeks, lost second twin at 16 weeks 12/17/08. Attempted IUI #4 converted to DS/DH IUI April 09 at my request, BFP and M/c. IVF #4 June 09 BFN. DS-IUI w/injects 7/6/09, BFN. Hysteroscopic myomectomy to remove fibroid 7/29/09.Unmedicated DS-IUI 9/09, BFN. DS-IUI with injects, 10/09, BFP and M/C. DH/DS-IUI with injects and HGH, 12/6. BFP! Betas: 12dpo 12/18 58, 14 dpo 12/20 157, 16dpo 12/22 379, 22 dpo 12/28 4,002



pregnancy
- Jenna

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