For the longest time, I haven’t know what I wanted our family size to be. I knew I was super happy to hit the 2 kid mark, and very happy to hit 3. Not that I was less happy to hit 3, but because of all the infertility and loss between #1 and #2, it was just different. After Jude was born, I was absolutely, positively certain that if I ever wound up pregnant again I’d want to go jump off the nearest tall cliff, but as time went on and he grew (and, quite honestly, as he cried less, although he still cries a lot), my views softened. Maybe, I fantasized. Maybe 4 is a good number…
A few months ago, I said I was pretty sure we were moving in the direction of being done. And then a funny thing happened. So says I. My husband might view it as less funny and more terrifying…
I’d been having strangeness with my cycle each month, so I set up a few appointments to investigate. (Aside: no, this story is not going to end with a surprise pregnancy announcement.) At one of those, a fancy ultrasound, I asked the tech if she’d mind just swinging by my ovaries to count how many antral follicles I had.
For the uninitiated, antral follicles are basically eggs in your ovaries that are resting for a few months before possibly being used. In what is a gross oversimplification, resting antral follicles are eventually recruited to be developed to potentially ovulate, and of the eggs that are ready to potentially be ovulated, one is chosen as the winner.
Sort of like the Biblical story of Esther, except on a cellular level.
The long and short of it is that the more antral follicles you have, the more eggs your ovaries are likely to contain, and, therefore, the more fertile you probably are. Declining antral follicle counts have been an excellent predictor of many fertility-related issues, including things such as poor response to ovarian stimulation medications and decreased likelihood of pregnancy.
When I did ivf, I had 14 antral follicles. This was considered borderline, and I wasn’t eligible for cost-sharing opportunities because my antrals were on the low side. After I miscarried, my antrals had dropped to 8 or 9, and they told me if I wanted to do ivf again with my own eggs, I needed to move on it asap, because my window for using my own eggs would probably be closed within about 6 months.
Of course, in 6 months, I actually defied the odds and got pregnant on my own, and when I had an ultrasound after Isla was born, my antrals were counted to be in the mid-20s. This is completely and totally crazy; antrals don’t typically go up. It was also one reason I felt good about trying for baby #3. Somehow, my body had rebounded a bit, and I hoped everything would run smoothly one more time. Thankfully, it did. We got pregnant with Jude within about 6 months.
Back to the funny thing.
The sonographer, the same one who’d found my 20+ antrals after Isla was born, obliged and did a quick antral count. There were 7 on the right, and I started panicking a little. Seven? That’s not a ton. Maybe the left will be better. She headed over in that direction to a whopping 2. Two antral follicles. That was it.
So, apparently, I have a grand total of 9, which is a remarkably poor predictor for future fertility potential. Of course, I got pregnant with Isla with this many so it’s certainly not out of the realm of possibility. But it’s not as promising as it was after I had her and had so many. It’s much less likely.
The funny thing? How I reacted when I felt like the choice was being taken away from me due to apparent decreased fertility. It was very much an anxious NOOOooo! I wanted this to happen! Honestly, it caught me off guard. I mulled it over for several days, and realized that yes, in fact, I do want another baby. Huh. It’s nice to know what I really want.
However, even though it’s what I want, I still haven’t decided if it’s a risk worth taking. Preeclampsia was no picnic, and with the increased risks to me and my health, I’m not sure it’s fair to the rest of my children to put myself in that position. I have more thinking to do in light of those potential issues. I spent a good deal of time talking to the doctor about them.
The good news is that if we were to decide to go for a #4 and successfully got pregnant, the doctor said I’d be eligible to attempt a vbac. This is contrary to what I’d been told earlier, when a different doctor told me I wouldn’t even be eligible for a trial of labor. I’m not opposed to either option, actually, but, again, I like having all my options open. So that was a reassuring bit of information.