A Positive Regroup

We had a very interesting regroup with Dr. B Thursday. I had a list of questions, and we wound up somewhere I'm really happy with, but didn't necessarily expect.

Question 1. What's your take on why this keeps happening? Lining? Aneuploidy? Something else?
A: Most likely aneuploidy. She'd like to see my lining get to at least 7, and there's no way to rule it out for sure, but everything suggests it's an egg issue for these last two CPs, not a lining issue, while the Dec and 2016 CPs were probably lining.

2. Let's talk prednisone again.
A: If I want an immune protocol, CCRM isn't the right clinic. She will put me on low dose prednisone for my next cycle. (I brought a list of six peer reviewed journal articles supporting this. I also acknowledge that I could find just as many that show no result.)

3. Lining was thicker in May. Does that suggest it could improve or give us ideas on what to do to improve it?
A: It could improve. It's most likely that having more days of estrogen exposure due to the long stim was what helped it. As a result, we'll take the following approach: 1 estrace/day vaginally until the dominant follicle hits 14, then increase to 2. We'll keep using the viagra. Estrogen is what makes the lining trilaminar, nothing else can change the pattern, so there's no way to help that.

4. Do my lining issues indicate I need a repeat hysteropscopy?
A: Not yet. We've seen it trilaminar since my last surgery, and we've seen it up to 6.7. I've also been through a lot of "instrumentation", no reason at this time to repeat. We looked at my u/s from trigger day, and there is no clear pattern. When I asked why, she noted that it's probably because things were thicker in some spots than in others. At this point we really just have to hope for the best in future cycles.

5. Ovaries didn't respond until we backed off the estrogen. Thoughts?
A: Largely addressed this with #3. We'll reduce the estrogen and aim to stim for ~12 days - longer than many of my cycles, but shorter than this most recent one.

6. We ordered cetrotide after our August '17 regroup. When would I use it?
A: Only if your LH was rising indicating ovulation. The estrogen seems to be supressing that really well for you, so there's been no need. That might change if we try to stim you for 12 days, so hang on to it.

7. Best guess on our chance of pregnancy if we continue this approach? Where's the tipping point when we should move to IVF, either OE or DE?
A: Impossible to say. She noted that we clearly have fertilization and embryos that reach 12-14 days every time, so she would expect that even if we only retrieved 2-3 eggs, we'd get a blast or two. It's a numbers game as to whether those would be euploid or not. Obviously, changing to donor eggs makes the numbers more likely to fall in our favor. The advantage of IVF is it would allow us to rule out aneuploidy as a problem, and eliminate many of the worries about a late first-tri loss. The disadvantage is that we'd probably only get 2-3 eggs. Also, even euploid blasts don't implant and do miscarry, so IVF would really be diagnostic.

8. If we moved to IVF, is it possible to get a better lining if we don't care about ovulation?
A: Maybe. My OI protocol is their 'poor lining kitchen sink' protocol, so it might give us our best chance. We could try delestrogen injections plus vaginal estrace and vaginal viargra in a mock FET to see what my lining did, and that might get better. Hard to predict. She'd really like to see me at 7 before a FET, and I have gotten to 7 before.

9. If we did IVF, is there any way to improve ovarianresponse?
A: We could do a clomid/FSH cycle if it's IVF and we don't care about lining. That might get us another follicle or two. Still, don't expect more than 2-3 embryos.

10. If we did OE IVF, is there anything we could do to improve egg quality?
A: We could add in HGH. In fact, we could add that now. So, Saizen goes into my current protocol.

11. Do I retake doxy for a future cycle?
A: Yes, unless it's making me really sick.

12. Is a plan of ~3 more OI/TI cycles, followed by a mock FET to test lining, then OE/DE IVF if lining is good enough, reasonable?
A: Yes. Probably wise to test lining before investing in IVF of any sort.

I'm really happy with this. If we throw my current meds, plus prednisone, plus HGH into the mix for 3 attempts and I'm still not pregnant with a baby that can reach the second tri, I'll feel pretty good that we're not going to find the 'gold egg' from my ovaries via IVF, and we can move to DE or DINK. That's a different decision point.

Past and Future

Today marks two weeks until surgery. Only a few days until my next biopsy. If all goes well, it's less than 30 days until I'm cycling again. I am suspicious that getting pregnant again is going to be somewhere between 'a lot more difficult' and 'impossible'. Why? Because even though I took estrogen this cycle, my period was 2 days of what could barely be classified as more than spotting. I'm worried my lining is totally and irrecoverably shot.

I am oddly zen about it all. Yes, the surgery is unnecessary if my lining 'can't get it up' as it were. But since we won't know about my lining until we cycle, and I absolutely will not cycle without the surgery, well, it all falls into the category of 'it will be what it will be.'

Tuesday was three months since we lost Quinn. The twins' first birthday is coming up. I don't feel right calling it a birthday, but there isn't another term I like better. Others just feel too cutesy (angelversary) or too harsh (stillbirthday). Let's just say that it's almost a year since we met and lost them. In some ways, it seems like it was yesterday. In other ways I can tell that I'm doing better than I was, even a month ago. I am having fewer bad days. The seasonal triggers produce moments or hours of memories and pain, not days. While medical stuff is on my mind a lot, when I think about my babies it's with love and longing, not the overwhelming grief I've felt recently. The only thing that makes me not zen is remembering that Quinn should have been born, at term, a month from now. Remembering that breaks my heart in a completely un-zen-like fashion.

At this moment, with the future still unknown, I'm ready to move forward even if moving forward doesn't bring us another pregnancy. I think that's the zen talking. I hope I can hang on to this zen in the coming months.

Infectious Diseases Specialist Visit

With the crappy news of another operative hysteroscopy, I got distracted and never posted about our appointment with the Infectious Disease Specialist at the U. Overall, it was a good experience. The TL;DR version: the initial CE finding was probably due to retained POC. It's probably unnecessary, but I can do 14 days of doxy and repeat the biopsy.

Here's the long version: The doctor (who was very pregnant herself) was extremely thorough. She spent well over an hour with us and walking through my complete medical history, going back to childhood. She even sent a follow up note to me asking if I'd had blood clots in the past, because she'd spoken to a colleague who is a rheumatologist, to see if my history of juvenile arthritis (JRA) might be playing a role.

The downside of such a long conversation and discussing so much history is that the conversation was a bit meandering. It's hard to tell the red herrings (JRA, recurrent sinus infections, 12+ years of incurable infection in two of my toes) from the relevant (chronic endometritis, recurrent UTIs). She mentioned something that I thought was really interesting, if frightening: in a proportion of women with recurrent UTIs, there seems to be a chicken and egg issue, where the surface of the bladder is inflamed, and that inflammation makes it more prone to bacterial growth/infection. No one is sure which comes first: the inflammation, or the infection. It can be really hard to break the cycle. This could be what's happening with my uterus, but there's no clear treatment approach if so.

She thought the CE from the biopsy might simply be because of the amount of debris that was in my uterus - retained placenta. She wanted, partly for research, partly for me, to have me do another biopsy before starting antibiotics. Our initial discussion was that we would do the biopsy, and if the CE is gone, I wouldn't do any antibiotics. However, I realized that with the FemVue, I would have to take a few days of antibiotics. Once we discussed that, the doctor agreed that if we were going to be on 4 days of doxy, we might as well do the 14 days of doxy that would be the normal first line treatment for CE. So, the plan was: biopsy and Femvue on 10/4. 14 days of doxy starting on 10/14. Repeat biopsy when my next cycle starts.

Of course, we didn't account for the repeat hysteroscopy in the plan, but it doesn't really change anything. I finished my doxy yesterday morning, and I'm now booked for what I really hope will be my last biopsy on the 30th. The pathology from this last hysteroscopy came back with no evidence of CE (YIPPEE!), and also no retained placenta. It appeared there was just a bit of scar tissue.

Lessons from Surgery

I realized last night that having had seven surgeries in less than two years, I might have some advice that's helpful to anyone else preparing to go through gynecological surgery. Thus, here are my "credentials" and also my experiences/advice.

Surgeries since 1/18/16:

1. D&C for missed miscarriage - Jan 16
2. Operative hysteroscopy to remove scar tissue and retained POC from missed miscarriage - May 16
3. Emergency D&C due to postpartum hemorrhage - Nov 16. To be fair, they did two of these, since I Started to hemorrhage again while in recovery before regaining consciousness.
4. Operative hysteroscopy to remove scar tissue and retained POC from losing the twins - Feb 17
5. Rescue cerclage placement - July 17
6. Operative hysteroscopy to remove scar tissue and retained POC from losing Quinn - Sept 17
7. Operative hysteroscopy to remove scar tissue and retained POC from losing Quinn - Oct 17

Things I have learned throughout this process. These may only apply to me, but I thought it was worth sharing:

• If you can, get a morning surgery. Going without food until an afternoon time slot makes an unpleasant day worse.
• Be aware that even though you're groggy, you'll have awful insomnia starting around midnight the night of/after the anesthesia (this applies only to the general anesthesia and not the spinal)
• Be aware that you'll stay groggy the day AFTER surgery.
• Know that it's ok to ask to have the IV placed in your arm, not your hand - often that hurts less. Either way, plan on about a week of bruising from it.
• Expect 2-3 days of sore throat from the anesthesia. How sore will depend on how long you were under. 
• If you're allowed, plan on a shower as soon as you get home - different hospitals do a better or worse job of cleaning up the betadine they use on you, expect that you'll still be orange in a few places until you can shower. 
• If you're outpatient, be aware that the doctor will tell the person you came with the outcome of the surgery. This means that if you have specific questions you want answered, make sure to tell that person. I expect my DH to know what's going on and ask the right questions, but in reality, all he's able to process without specific guidance is, "It went well."
• Wear comfy clothes and a bra that are easy to get back on. At the hospital, a nurse dressed me while I was in post-op. At the surgical center, I had to dress myself in the tiny pre-op/recovery room. In either situation, you want easy to doff/don clothing. 
• If you get cold easily, bring a jacket you can throw over your shoulders while waiting. Yes, hospitals and surgical centers have warm blankets, but they're often about 2" by 2", so it's tough to really bundle up! My local hospital offers a warming gown, but the surgical center doesn't, so having a jacket over my shoulders while waiting to be taken back for surgery was awesome.
• Have a pain management discussion with your doctor before you go under. My first two surgeries, I was given narcotic painkillers and rx strength ibuprofen. I never needed the narcotics, I did appreciate the rx strength ibuprofen. Surgeries 4, 6 and 7 we never discussed pain management, and since I can't take NSAIDs, I went without once home. That's ok by me, but if it's not ok with you, be sure to discuss with your Dr.  
• Have a plan for what to do when you get home. My plan is Netflix under a blanket on the sofa, but figure out what low-energy thing will be a treat for you, and have it ready.  

Most of all, my advice is that you CAN get through this, no matter how scary it seems. 

Still Not 1/18

I spent quite some time trying to come up with an appropriate title for this post. A few I tried on:
You've Got To Be Kidding Me
Really, Uterus?
Again!?!
Motherf*cker!!

That last one still feels the most appropriate.

Today was the repeat endometrial biopsy and FemVue. The FemVue's goal was to check my tubes and make sure nothing was left in my uterus. Tubes looked great. Uterus? Not so much. Don't know if it's placenta or adhesions, but up near the fundus something remains. It was obvious enough I could pick it out on ultrasound, and I suck at reading u/s.

I'm not surprised - my period has been unusual, and there was fluid in my uterus before they started the FemVue, which didn't bode well. Alas, this means another operative hysteroscopy. If it means another week with a stent . . . if it means another week with a stent I'm thinking very hard about canceling the surgery and giving up. Because a uterine catheter is hell. Just hell. No better description. Surgery is booked for Friday, and if I think too long about it, I'll back out because I'm just not up for that hell again.

So I won't think about it, I'll just do it.

Oh, and for the record, today's biopsy hurt a lot more than last month's. The FemVue didn't hurt at all during, but I still have odd abdominal tenderness afterward. Fun times.  

Same Bat Channel, New Bat Time

Wednesday's surgery went ahead as scheduled. When I came out of surgery, I was told that my doctor had removed some scar tissue, and quite a bit of retained placenta. They gave me the photos from the hysteroscope, which I've included below, along with a comparison photo of my own uterus, in a "clean" state after my very first operative hysteroscopy. If you don't want to see the inside of my uterus, look away now!

Clean uterus in 2016

Here are two from yesterday:

Left uterus -retained POC & scar tissue

Right uterus -retained POC & scar tissue

This leads me to ask my body: "What is up why you, hmmm? How is it that you hold on to placentas for so long, but you can't hold on to the babies in them long enough? What the heck did I do or not do to you to make this happen every time? WFT, body?"

Probably not the most helpful conversation I've ever had. I'm trying really hard to be hopeful that this worked and will be worthwhile.

I'm not sure if it was because this surgery was more extensive, or because my body is just tired, but I'm in more pain this time that usual. I've been really lucky that with all my past surgeries, I've had some cramping, and I've felt like someone used a serrated-edged, 8" diameter speculum to access my cervix/uterus, but I haven't had much pain beyond that. This time is different. My vagina is really raw and unhappy, my cervix burns, and my uterus keeps sending off stabbing pains and gnarly cramps. I guess that's to be expected and I should be really happy that it wasn't the case before!

Next steps: follow up visit and removal of the stent on Tuesday. We'll need to discuss the pathology for what was found in my uterus, the cultures from the biopsy last week, tubal patency, and what comes next. Exciting, no?

Oh and one final note to the surgery center: If you give patients specimen cups with their name, age, and gender, and have them give samples in the bathroom so you can confirm there is no pregnancy, it's probably unwise to throw the empty but labeled cup and the test stick into the open trashcan next to the sink in the bathroom. Because I looked down while washing my hands, I now know more than I want to about the other woman getting a hysteroscopy that day.

Rainbow-spotted Unicorns

In my utter dismay last week over the need for another operative hysteroscopy and stent, I overlooked something really important that happened. Something that makes me breathe a sigh of relief for the first time in months.

What could that be, you ask? Winning lotto tickets? Calorie-free chocolate? A more functional uterus? The ability to write a post without at least one egregious typo? Alas, none of those. Rather, the MFM called me back. She left me a voicemail and told me she'd try me at home that night if I wasn't able to reach her during the day.

When I got in touch with her, she told me she'd gone back and done a lit search on chronic endometritis (CE). She wanted to find the most up to date info. She noted it was mostly associated with early losses (like my first miscarriages), but that it was also associated with losses up to 20 weeks. She said that she'd recommend we add a few other things to the biopsy being done, and noted that the literature reflects the use of hysteroscopy for CE diagnosis. She wasn't sure it was worthwhile to do the hysteroscopy, but wanted to discuss that option with me.

I told her I was getting the biopsy done later that day, and unless I got really lucky, there was a good chance we'd see adhesions and need a hysteroscopy anyway. Further, even if we didn't see adhesions, my RE encouraged a diagnostic hysteroscopy before a COH cycle, so I was likely to proceed with one. Dr. N told me she'd call my OB right away and let her know what other tests needed to be done on the biopsy sample, and that she'd provide her with information/images on what to look for during the hystreroscopy, to detect CE.

I ended that call with such a feeling of relief. What I have hoped for, what I have felt I needed since the beginning, was a doctor who would take me seriously. A doctor who would be willing to look into the newest research on relevant topics, rather than dismissing me based on previous knowledge or assumptions. A doctor who might normally practice "when you hear hoof beats, think horses," but who would acknowledge that give my history, thinking rainbow-spotted unicorns might be necessary. I will always wonder if things might have been different for Quinn had I found a rainbow-spotted unicorn doctor before getting pregnant with her, or during those first 12 weeks when I asked about cervical monitoring, but at least I'll know that any future pregnancy has the best shot possible.

BFP - But Not That Kind

Big Fucking Positive. Not the good kind that you dream about and hope for. My OB called me to inform me that the first of the endometrial biopsies is back, and it's positive. Do not pass go. Do not collect $200. Proceed directly to the pharmacy for antibiotics in advance of Wednesday's surgery, because your uterus shows histological signs of chronic infection and inflammation.

How many doctors have told me that chronic infection isn't possible because the uterus is like a "self cleaning oven?" How many have dismissed my concerns? Getting to say "I told you so" has never felt shittier.

In case you've ever wondered, here's the diagnostic criteria for endometritis:

• Acute endometritis is characterised by the presence of more than five neutrophils in a 400 power field in the endometrial glands.
• Chronic endometritis is characterised by the presence of more than one plasma cell, (and lymphocytes) in a 120 power field in the endometrial stroma.

We're still waiting on the culture to see what's growing in there. For now, I'm on oral clindamycin three times a day. I'm guessing they'll run clindamycin and gentamycin during surgery on Wednesday as well, if they haven't yet gotten the culture back, but I'll confirm with my OB. I had both of those via IV for 48+ hours after losing the twins, and then for ~12 hours after the cerclage was placed. In retrospect, that may have been what got us nearly 3 weeks with Quinn, as opposed to only a single week past pPROM with Alexis and Zoe. That said, I don't really have faith it's enough, and it's not the standard of care for true chronic endometritis. 

Some treatment recommendations on CE, from the literature:

• 100 mg of doxycycline twice per day for 14 days (My RE's office does Doxy standard for a few days on all IVF cycles.)
• CDC's PID recommendations:
• Ceftriaxone 250 mg IM in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH* or WITHOUT Metronidazole 500 mg orally twice a day for 14 days
• OR Cefoxitin 2 g IM in a single dose and Probenecid, 1 g orally administered concurrently in a single dose PLUS Doxycycline 100 mg orally twice a day for 14 days WITH or WITHOUT Metronidazole 500 mg orally twice a day for 14 days
• OR Other parenteral third-generation cephalosporin (e.g., ceftizoxime or cefotaxime) PLUS Doxycycline 100 mg orally twice a day for 14 days WITH* or WITHOUT Metronidazole 500 mg orally twice a day for 14 days

If you're interested in a few good articles on chronic endometritis and RPL or Infertility, here are some links:

Chronic endometritis due to common bacteria is prevalent in women with recurrent miscarriage.

Chronic endometritis and infertility. 

At Least it won't be 1/18

There's scar tissue. Near the fundus and again near the cervix. I go in for surgery on Wednesday, and get another week with a balloon stent. I cried in the ultrasound room. Hysteroscopy #3, here I come. I knew better, I have Ashermans, so I knew I should expect it, but it's still one more blow and one more thing I'm dreading. At least this surgery won't be on 1/18.

It Wasn't Mylar

Surgery took place as planned back on the 18th. Being back at the hospital was indeed hard. I might have cried a bit in the waiting room. I might have cried again post-op.

Surgery itself went well. During the follow-up appointment, my OB told me, and pathology confirmed, I had scar tissue and embedded retained placenta in my uterus. I suppose it's no surprise with what happened.

My OB cleaned everything out. Due to the nature of the scarring (Asherman's), she left behind a balloon catheter for a week. It looked like this:

It was the most miserable thing I've dealt with in this entire journey. In my mind, I'd assumed that everything would stay inside me. I know that sometimes IUDs are used for Asherman's patients, and I've had an IUD that only had a tiny string in my vagina. I just assumed this would be similar.

Nope. Wrong on all counts. First off, that tubing is just slightly smaller than a quarter of an inch. Not at all like the string on an IUD. Having a string the width of a thread coming out of your cervix is a very different experience than having a .25" tube coming out.

Second, the tubing was long. Long enough to go through my cervix, and vagina, and hang a good few inches outside my body. From a practical perspective, that meant that anytime I moved, stood up, sat down, or rolled over, the tubing got pulled on a bit. Tubing that was going through my cervix and into my uterus. Imagine what that might feel like. On second thought, don't. It sucked, no one should deal with that.

Third, there was a hard plastic connector on the end of the tubing. It allows the balloon to be filled with saline. That's great. Except from a practical perspective. From that perspective, no matter which way the tubing points, that hard plastic connector is going to be jabbing you in a sensitive spot of your anatomy.

Finally, surgery made my digestive system unhappy. Consider the logistics of trying to keep a dangling tube and connector out of the way as you deal with what you have to deal with when your digestive system is unhappy. This is especially fun in my case, since I know the bacterial infection that took my girls and led me to this point in my life was largely comprised of bacteria found in the digestive tract. And here was a fucking superhighway going right into my ute.

It sucked. But it's out, and it's over, and now we move on to the next hurdle: figuring out if the surgery worked and if  my tubes are clear. More on that to come.

Full Circle

My journey to parenthood started December of 2015. That was when I got the first positive test. That was when I experienced the first rush of utter elation that I was pregnant and DH and I were going to be parents. January 15, 2016 was the end of the elation. I was 10 weeks, and there was no heartbeat on the ultrasound. I was scheduled for a d&c the following work day, January 18.

Two chemical pregnancies later, I had a saline sonogram done. It found scarring, caused by the d&c. I went through an operative hysteroscopy to remove the scar tissue, and then went on to conceive the girls with the help of a great RE.

After losing the girls, and knowing my history of scarring, I went in for a saline sonogram in late December. I wanted to be sure my uterus was clear to try again in March of '17. Alas, this SIS made the last saline sono look like the "good" version. This time around, there are adhesions all over. I suppose it's to be expected, in light of the infection and the fact that it took two rounds of emergency surgery to stop the bleeding after delivering Zoe. I've gotten an official diagnosis of Asherman's.

Thus, I've been scheduled for another operative hysteroscopy. On January 18. It has to happen then, because of the timing of my cycle and the fact that my OB only operates on Wednesdays. I won't lie, I'm hurting at the thought of being back in the same hospital on the same day one year later, with only heartbreak to show for the intervening year. I've come full circle, and yet instead of progress or joy, there's only pain and loss. I'm terrified at the thought of waking up in the same post op facility that I last woke up in the night I lost the girls. Those are memories I don't want to re-live.

I'm just hurting. I'm hurting because I miss my girls. I'm hurting because everything for the last year has been so damn hard. I'm hurting because I don't know if this will work, if we'll even be able to try again, or if our road will end here. I'm hurting because I know if it does work, and I do get pregnant again, I'll never be able to simply enjoy it - I'll worry until the moment I'm holding a living, breathing baby in my arms. I'll say it again, I'm hurting because I miss my girls.

Now I just hold out the hope that this surgery will work and the scarring will stay at bay long enough for us to conceive again. I hold out the hope that my ovaries can pull off one more pregnancy. I hold out the hope that this time, my uterus can keep my babies safe. None of this may come to pass, but I'll pray that January of 2018 sees my DH and I somewhere better than here.

Verdict is. . . .

There are times when I feel truly bad for medical professionals. They spend years, decades even, studying and training. They continue learning as they practice and complete CE. Still, the human body is an amazingly complex system, and not every human's complexities follow an expected pattern. That means there are times when the best explanation a medical professional can give is, "I don't know" or "It doesn't make sense."

So, what was the outcome of my follow up appointment? Well, the saline sono, taken in early May, and the HSG from last Friday both suggest a horrendous case of Asherman's syndrome. But both of those are imaging techniques that don't directly visualize the uterus. The hysteroscopy, with photos taken after the saline sono but before the HSG, shows a normal uterus. The surgical notes written by the doctor who performed it didn't indicate any evidence of Asherman's, or anything other than mild scarring. The actual pictures should be the gold standard, but they are completely inconsistent with the sono and HSG. So the verdict? "It doesn't make sense."

Where does that leave us? Well, we could keep doing tests. Maybe we'd start getting consistent results, maybe not. Either way, we've now done all the tests that can be done, so we'd have to start repeating things. Verdict: probably not enough incremental value to be worth the drawbacks. Alternately, we can go back to the original plan: an injectable cycle in July, with monitoring of lining and follicles. Verdict: This approach will should tell us how my lining responds, which is a critical part of the question. The risk is that it won't tell us if both tubes are open. We could spend the money and the time on the cycle, and ovulate on the left side, where we don't know if my tube is open.

Total cost of more testing versus an injectable cycle will probably be similar. If they run multiple tests, that would be more expensive. It all comes down to a question of what really matters? And what really matters is: can I grow a lining that will support an embryo? Going the injectable route should answer that, because if I do have severe Asherman's syndrome, I won't grow sufficient lining no matter what medications they throw at me. If my uterus is healthy enough to grow a lining, it probably means the HSG was flawed, and I'm not as worried about tubal patency.

So, we will try the old fashioned way this cycle. We'll pray for a healthy, fully implanted embryo out of that. If I do get a positive test, we'll monitor the hell out of it! I am not optimistic, since I've had continued spotting since the HSG, but hey, I'm not going to turn down the excuse to spend some quality time with DH. ;) If this cycle doesn't work out, I call C.CRM on Day 1 and go in for Day 2 or 3 labs and an ultrasound, and then we start drugs and see what happens.

How will it all work out? Well, I'll give the most common answer from my own profession, which also deals with human beings and their irregularities: "It depends!"

Before and After

So, I love me a good before & after picture. Home reno before and after? Yes! Haircut before and after? Check! Recipe ingredients before to beautiful meal after? Bring it on! Today's before and after might not be for everyone. Today's before is my uterus at the start of the operative hysteroscopy. The after is my uterus after the scar tissue was cleaned up. If you don't enjoy viewing pictures of people's internal organs, don't scroll down.


So, here's the before photo. It looks rather like a tunnel, no? To the left and right are the ostia, or the openings to the fallopian tubes. From what the doctor explained, some of the white patches are scar tissue. Overall, there isn't much white where it shouldn't be, which means there wasn't much scar tissue from the January d&c.

Now for the after photo. In this photo, you can see everything is smooth and pink. There's less scar tissue, and the pink suggests that my endometrium is healthy and should be capable of a pregnancy.

There are two layers of endometrium in a healthy uterus, a basal layer, which remains at all time, and a functional layer, which is shed monthly. We're pretty sure I have trouble with my functional layer not getting thick enough, or having the correct pattern, to support a pregnancy. However, based on these photos, which were taken May 23rd, there shouldn't be anything blocking my uterus. This is what makes Friday's HSG so inexplicable.

At this point, I'm praying for an answer that isn't the end of our journey, and I'm focusing on the after picture, because it looks like it should.

It Went Well (Sorta)

Monday was hysteroscopy day. Surgery was scheduled for 1:50 pm, so I got to enjoy the fun of no food or liquid for most of the day, along with the anticipation of someone getting up close and personal with my reproductive system. Since Dr. S could only guess based on the ultrasound that I had scarring or fibroids, I was very interested in knowing what Dr. C (who performed the surgery) found. Thus, after surgery, I asked my husband what the doctor had told him. The only thing DH could remember was “it went well.” GAH!

On that front, it did go well. I was done and on my way home by 4:30, and other than a really sore throat, some mild cramping, a bit of bleeding, and the occasional shooting pain coming from the direction of my uterus, things are normal. Compared to the d&c in January, I was much more hungover from the anesthesia this time.

While DH didn't know much, Dr. C did, and he called me at home Tuesday night to check on me and follow up. He told me he found only minor scarring by one of my tubes and he took care of it. He doesn’t expect there to be any new scar tissue that forms, so he didn’t use a balloon catheter. He’s bumped up my follow up appointment to June 7, and we’ll talk about next steps then. The down side of “minor” scarring is that it’s unlikely to be an explanation for the repeated losses. So we’re not much farther along than where we started.

So, what’s ahead? I should be getting my cycle day (CD) 3 blood work back. That will tell me how close to diminished ovarian reserve I am. If the answer is that I’m very close, I lean toward more aggressive treatment now. If my numbers are ok for my age, hopefully we can try less costly and less aggressive options first. I’ll also be discussing my thin uterine lining with Dr. C. He said it’s probably not a factor, but a lining under 5 on the day before ovulation is not promising, and I have the research studies to back that up. So, we’ll see. Wish me luck?