Frankenuterus

Last Friday I went in for my post-op appointment and to have the uterine balloon/stint removed and, as always, it was ... interesting.

When my Dr tried to remove the saline from the balloon he wasn't able to get anything out of it, so he went ahead and removed it (which hurt like a {fill in your favorite explitive here}) and it was completely empty! Obviously, I was a bit frustrated that I suffered with mild cramping and other unpleasantries throughout the week, basically for nothing, since the balloon wasn't fully inflated while the lining was healing/regrowing. 

Perplexed, Dr. K filled the balloon with saline to see if he could identify the leak and we finally determined that it was the valve at the end of the catheter; each time it got bumped a drop or two of saline came out. However, Dr. K did say he felt like the balloon still helped, even though it wasn't fully inflated b/c it created a physical barrier to keep the uterine walls from touching while they healed. We are going to do another SIS in a few weeks to make sure everything healed up properly. Yay (said with dripping sarcasm). 

We also reviewed the pictures that he took during the procedure where he identified and removed some scar tissue that was creating a "wall like" structure at the top of the uterus near the opening to the right fallopian tube. We looked back at the pics from my previous hysteroscopy in Jan 2010 and an SIS I had done in July 2010 and nothing like that appeared, so it is baffling as to where the tissue came from. He told me that he can't explain it and if he hadn't seen it with his own eyes he would think it was two different uteruses! OF COURSE it would be my luck to have the most unique uterus known to modern science. As I told the Dr, apparently I have a Frankenuterus! Grrrr. For what it's worth, Dr. K. didn't agree that it is a Frankenuterus but he did admit that what he found was strange.

Oh well, onward and upward, hopefully this is just the remodeling my uterus needed to create the perfect habitat for a thriving embryo!

IVF Here We Come ... Not so Fast!

In April 2011 I began taking birth control pills (BCPs), which is the first step in the IVF protocol that Dr. K prescribed for me. There's also a variety of blood tests and exams that have to be conducted as part of the IVF checklist prior to starting fertility drugs. One of these procedures is a saline infused sonogram (SIS) to check the uterine cavity and make sure everything looks alright prior to doing the IVF. I had the requisite SIS done a few weeks ago and, surprise, surprise an "unidentified" uterine mass of some sort was discovered and much to both my and Dr. K's chagrin, I had to have yet another hysteroscopy (this is hysteroscopy number 4, for those who are counting).

This past Friday (May 6) was the procedure and we were anticipating that it would be pretty simple. I was even expecting to be able to attend a friend's birthday celebration later that evening. Since it was "just" a hysteroscopy I anticipated that I shouldn't have too much discomfort. I guess that's what I get for making assumptions!

What was supposed to be a fairly simple, routine 30 - 45 minute procedure turned into an almost 2 hour, extensive, uterine "cleaning". Dr. K ended up finding a lot of polyps (he said there were many more than what he was expecting based on the SIS) as well as some more scar tissue at the top of my uterus (similar location to where it had previously been removed during the June 2009 procedure)! He said he probably went a bit above and beyond what was necessary but he wanted to be sure that he got everything and that the uterine environment will be as clean and hospitable as possible. Also, since the procedure was so much more extensive than expected, he went ahead and inserted a stint/balloon to allow the lining to re-grow and the uterine walls to heal without touching and hopefully avoid any opportunity for additional scar tissue to develop. Needless to say, I ended up spending the rest of that day and night laying on the couch, catching up on the shows I have been DVRing over the past several months!

We now have to wait for the uterine lining to heal and re-grow and then I start BCPs again.

2011 Re-Cap

It is now clear to us that conception will not be achieved through conventional methods and the less invasive, less costly forms of fertility treatment will not get us to the goal of parenthood. Therefore, we have both maxed out our health/flex savings accounts for 2011 in order to come up with the approximately $12,000 it is going to cost to do IVF. This is the last option for having a child of our own and given the expense, realistically we only have one shot at it!

2010 Re-Cap

In January 2010 my new RE, Dr. Shar Kavoussi, performed another laprascopy and hysteroscopy. The results revealed some additional, minor, endometriosis and, more significantly, quite a number of uterine polyps (again!). It was now clear that I had an issue with polyps and we needed to try and get pregnant as quickly as possible before any more developed.

Dr. K switched me from clomid to Femara because my uterine lining had become very thin and we were concerned it was a side effect of the clomid (which is fairly common). I responded well to Femara but unfortunately I continued to have trouble growing a lining that was thick enough to support a pregnancy. I also began to see a mayan abdominal masage therapist and consulted with a couple of midwives/doulas. Despite our best efforts, the year 2010, four more IUIs (eventually graduating to injectable fertility drugs to assist with ovarian stimulation and lining growth) and several thousand dollars slipped away, still with no success.

2009 Re-Cap

The next step was to try ovarian stimulation via clomid and IUI, to the tune of approximately $700/cycle (all out of pocket since insurance does not cover fertility treatments).  We tried our first IUI cycle in February 2009 with no luck but our second attempt, in March 2009, resulted in the faintest possible positive line on a home pregnancy test. We were cautiously hopeful that this might be it!

My first beta HCG (blood pregnancy test) came back later that day at 19 but it should have been around 100. Immediately, my Dr's nurse was warning me that things didn't look good. I continued to get betas taken every other day or every 3-4 days and, surprisingly, the levels continued to rise at a good rate but they were still well below where they "should" be. However, we were trying to stay positive and starting to get excited b/c the numbers were increasing really well and there are plenty of stories of perfectly healthy babies that had low rising beta numbers to begin with.

At 6 wks 2 days we had our first ultrasound (u/s) but there was nothing in the uterus. So, the Dr. determined that it was most likely ectopic. I was devastated ... I just couldn't wrap my brain around the idea. I had no risk factors what so ever and had absolutely NO typical symptoms. I went in for a second opinion u/s the following day at an independent imaging center but it showed the same thing, an empty uterus. However, they did not see anything in the tubes either. This was strange because my beta numbers were high enough at this point that a mass should have been visible SOMEWHERE. Two days later we went in for another follow-up u/s with the Dr. I was expecting/prepared (but not happy about it) to receive a methotrexate shot to terminate the, presumably, ectopic pregnancy. Shockingly though, during the u/s not one but TWO gestational sacs showed up in the uterus. It was a miracle (just happened to be Good Friday)! So we were back in the hope boat.

The following week my beta numbers started to really slow down but they were well in the 20,000s range so that's not totally out of the ordinary. That week's u/s showed that both sacs had grown in size but it appeared there was still nothing in them. So, we had to wait another week wondering if we were really "preggers" (it's amazing how LOOOOOONG a week can seem). The next u/s appt finally rolled around (I was 8 wks 3 days at this point) and sadly the results showed that the larger sac had barely grown at all and the smaller one was getting smaller and they were both still empty. The Dr informed us that it was not a viable pregnancy and I ended up having a D&C two days later, which was Friday, April 24, 2009.  It was an incredibly hard month of waiting and not knowing, being handed a spoonful of hope and then a bucket full of disappointment.

Unfortunatley, as if we hadn't already been through enough, the universe was not finished toying with us. On May 28 I had a follow-up appointment  b/c the hormone (hcg) levels in my body were not decreasing as rapidly as they should have been. The Dr. did another u/s and found a mass of pregnancy tissue ("remnants" is the lovely term they use to describe this) still remaining. Therefore, I had to have yet another D&C, making me the lucky recipient of not ONE but TWO D&Cs for the same failed pregnancy! It was a pretty awesome couple of months to be sure (note sarcasm and eye rolls)!

My Dr. called the day after the procedure to discuss what he found. It turned out, I had an 'atypical' shaped uterus (we already knew this from the previous HSG), which is shaped more like a "T" than an upside down triangle (normal shape). As it turns out, there were these two small 'pockets' on the outer edges of my uterus (i.e. at the ends of the top cross bar on the "T") and the residual tissue mass was lodged in one of those pockets. The Dr said it was also 'unusually adherent' tissue, therefore that's why my body couldn't pass it by itself. He indicated that he did "some work in there" to try and reshape the uterus a bit. I'm not exactly sure what he meant by that but we were hoping that might explain our otherwise unexplained fertility issues and help with future attempts! On Friday, June 19, 2009 I got my last blood test and the results FINALLY came back as negative (almost 3 months after we got that initial positive home pregnancy test)!

The next two IUIs we tried both resulted in pregnancies as well (August 2009 and October 2009) but sadly, they too failed (luckily though no more D&Cs were necessary). We did one more IUI in November 2009 without success. At this point I was beyond frustrated and decided to consult another RE to get a second opinion and see if there was something we may have missed, meanwhile I also started seeing an acupuncturist on a regular basis.

2007 - 2008 Re-Cap

We started trying to conceive (TTC) by  "not avoiding" in early 2007 (I was 33 at the time and Brian was 37). After several months of no success it was time to get our butts into gear and actively started  TTC in Sept 2007. I quickly realized something wasn't right when:

a.) we weren't having any success and

b.) I was consistently experiencing spotting in the middle of my cycles, which seemed odd.

Off to the ob/gyn I went and she ordered the usual battery of fertility testing (both his and hers). The results indicated everything seemed pretty normal for both of us except the results of an HSG ; it appeared I might have a slightly atypical shaped uterus and the radiologist that interpreted the test results thought that one of my tubes may have been partially blocked. This landed us at an initial consultation with a reproductive endocrinologist (RE) in Feb 2008.  The RE didn't seem to think there was anything terribly wrong with my uterus and that my tubes appeared to be fine. The options he layed out were:
1.) go straight to fertility treatments and try intrauterine insemination (IUI),
2.) surgery consisting of a laparoscopy and hysteroscopy,
3.) do nothing and continue trying on our own.
At this point we were still very much in denial that we couldn't do what everyone else around us was doing so easily and get pregnant on our own, so we chose to wait a while longer and see what happened. Well, nothing happened, so in June 2008 we decided to move forward with the surgery.

As a side note, the vast majority of health insurance in this country does not cover fertility treatments, however, most insurance policies do cover "the diagnosis and treatment of an underlying cause of infertility". Our insurance, being consistent with the norm, would cover the diagnostic procedures and surgery but wouldn't cover any kind of "treatment" (i.e. IUI), so we opted to try the surgery and see if we could figure out the problem and fix it. The results of the surgery revealed some mild endometrioses, several uterine polyps and one fibroid, all of which the doctor removed/corrected during the procedure. He also tested my fallopian tubes and confirmed that they were clear. We were hopeful that this was the cause of our baby making challenges and continued TTC as soon as we got the "all clear" after the surgery. Disappointingly, the surgical "clean up" didn't do the trick and by the end of 2008 we were still babyless.

Let's Catch - Up

The past four years have gone by in a flash as we have been busy trying to start a family ... along with Brian finishing grad school, starting a new job, both of us working full time, remodeling our house, travelling, and me returning to school for my MBA. I will attempt to briefly re-cap the trials and tribulations that have characterized our journey and will organize it as separate posts listed by year (it's pretty sad when you can quantify the attempt to start a family in terms of years).