Today was my early ultrasound at 6w3d, and sure enough, we have twins. Twins! My doctor even had me guess before he started the ultrasound, and although I had strongly suspected it ever since the first HPT, for some reason I was the most confident yet when I told him there were twins in there. Five seconds later he confirmed it, and about five seconds after that, he confirmed that both had heartbeats. He was actually going so quickly that I was having troubles keeping up, which was probably for the best, since I didn't want to start crying or anything and miss everything he was doing. So he measured Baby A first (the smaller of the two), which measured at 6w1d with a heartbeat of 121bpm, which are apparently both perfectly normal measurements (although of course I'm worried that it measured 2 days behind where it should be). He also measured Baby B, which I think he said came in at 6.4mm (but didn't mention the weeks/days measurement), and he didn't do the heartbeat. Everything looked good, although my doctor did point out that although there are two currently, it's not uncommon for one to be absorbed. Which may sound harsh, and I hope it's not because he saw cause for concern due to Baby A's size (although he also said that's normal for there to be a disparity in sizes - even this early - in multiples), but I feel like I'm being fairly pragmatic about this so far and so I appreciated the same from him, as I am not going to be naive enough again to think that just because we saw the heartbeat that everything is guaranteed to turn out fine.
The other exciting development from today (besides the confirmation of twins!) is that my daily PIO injections are over! Yay! My back is a mess of bruises and welts right now, so that came not a moment too soon. So now I have to take Endometrin, which has its own set of issues, but at least it doesn't involve sticking a 1.5" needle in my back. I also got the okay to switch from the every-three-days estrogen shot to a twice-a-day pill, which is great except for I don't think I have enough pills left to last me until 12/19, when I'll be done with both the progesterone and estrogen. Since I'm pretty sure we're out of pocket at this point (whenever our insurance finally catches up and lets me know how much we have left for our infertility cap would be awesome - I haven't heard anything from them since our copay bill for the second IUI in July), I'm being a bit more careful about refilling prescriptions if I have other options. At some point this week, I'll count out how many of the estrace pills I have to work backwards to when I can stop with the estrogen injections, and then I'll just have to hack it with those until that point. Which hopefully having a couple days in between injections will give my back a little time to heal.
My doctor also kind of told me I could continue riding - he wasn't too thrilled about it, but he didn't flat out tell me to stop, which is more what I was expecting. He was more worried about the up-down motion (which they apparently usually recommend against using a treadmill, etc., for the same reason), but said that it shouldn't be a problem if I'm careful - although he did want me to hold off on riding until after my spotting stopped. Internet research has pointed to PIO as sometimes being linked to spotting, so I'm really, really hoping that it will go away soon now that I'm off that.
One of my concerns about having twins has already struck though. I'm going back to my doctor in 10 days for another ultrasound, and then if everything looks good, he'll release me to my OB... the only problem is, I normally see a midwife, and it turns out they won't take on "high-risk" pregnancies, which I apparently am with twins. That was a pretty big disappointment, because we really wanted to do things more naturally (yes, despite the fact that we went the high-tech route to get to this point) and I was hoping to have a med-free birth. Although one of my friends was able to do that with twins a couple of years ago, I think that's pretty rare and it stings a bit to have to come to grips with our decision of putting two embryos back has essentially made it much more difficult to do something that was very important to us. I also don't want to endanger the babies in any way, though, so while I have some more research ahead of me to see what kind of options I have, I'm also well aware that two babies + a c-section is still far more preferable than no babies + the idyllic natural birth that may never have been anyway.
So I've been a little subdued today, just thinking about all this stuff (and with some more light-headedness and nausea than normal) and trying to come to terms with the fact that my plans have likely changed, and also acknowledging my role in this decision. That was such a hard part of the IVF process anyway, since it's hard to make decisions that can have lasting, lifetime impacts (ranging from how many embryos we should transfer - since multiples tend to be born prematurely - to whether we should use ICSI to fertilize the embryos - since there are some linkages with ICSI/IVF and increased genetic defects), that will affect both Ryan and me, and any child(ren) we have. But we had weighed the risks at the time, and made what we believed was the best decision based on all of the information we had, so I also have to comfort myself with that rather than focus on the "what ifs".