Status

Back To the Drawing Board…

Yesterday was my pre-op consultation for the diagnostic laparoscopy I have scheduled for late August.

Err… HAD scheduled for late August, I should say.

Yeah.  My doctor and her bulldog assistant effectively talked me out of having the lap.

Well, they talked me out of having the lap with them, for sure.  I haven’t made up my mind about the rest yet.

Before any of you get upset or start to demonize the good doctor, I can tell you that she’s coming from a place of honesty and realism.  She talked to me for a long, loooooong time yesterday, listening as I rattled off the finer points of multiple studies on laparoscopies in women with unexplained infertility, and gently explaining to me that no matter the outcome of the procedure, the next logical step in our journey is IVF.

It seems as though there are only two choices with this doctor performing the surgery:

One, she finds mild endometriosis, and removes anything that isn’t attached to important bits of my anatomy, such as the bowel, ovary, uterus, or fallopian tube.  Post surgery, the suggested treatment would be IVF if I didn’t manage to get pregnant on my own, which, let’s be honest, is not likely considering all of the other treatments I’ve tried that have failed, despite a good response.

Two, she finds moderate to severe endo, and leaves it alone.  Removal of endometrial adhesions that are more deeply attached to organs and tissues is more dangerous than it’s worth, and she won’t risk my organs to remove something that is, in the grand scheme of things, not causing me a terrible amount of discomfort.  Post surgery, the suggested treatment would also be IVF.

Hmmpph.

I feel cornered.

I really thought I was going into that consult yesterday to find out the gory details about the surgery, and to plan ahead for recovery.

I feel a little blindsided, and more than a little disappointed.

The thing I expected the least, though, was to feel relieved.

And I do feel that.  Relief.

I really don’t want to have surgery.  I don’t know if I want to have surgery more or less than I want answers, however…

Basically, Dr. F brought me gently to a realization that I’ve been avoiding for a very long time.

I may never know what’s causing my infertility, and I may have to move on to IVF without that knowledge.  I may have to take the gamble, when all I want is to calculate odds and create the most level playing field possible.

I may have to just take the plunge.

Those, however, are decisions for another day.

Today, I’m going to relax.  I have permission to stop taking Metformin, as long as my cycle doesn’t start getting wonky, which means that I can eat what I want, have a beer now and again, and gain some weight back that I lost during the Metformin Bowel-Voiding Frenzy that accompanied that first two months on the drug.

Today, I’m going to order some Maca Root and Royal Jelly, overhaul my diet and eat well, but healthfully, and give my body a break from drugs.  I’m going to schedule a few massages, and maybe get back to acupuncture.

Today, I’m going to set up a dedicated bank account for IVF funds, and make sure that money makes it’s way in there every week.

Today, I’m going to keep in mind that my doctor, and every single other doctor I’ve ever seen, has told me that the broad majority of women with true unexplained infertility tend to get pregnant at some point… It just never seems to happen as quickly as they would like, and it oftentimes happens when they are not in an active medicated cycle.

Thankfully she didn’t tell me outright to “just stop trying”

I may revisit the idea of the lap… I will probably send my medical file over to another doctor or surgeon to review for a second opinion – not because I don’t trust my doctor, because I do trust her – but because I think it’s always smart to have more than one set of eyes looking at your case.

I feel a little adrift today, but also a little relieved.  I know that I don’t have all the time in the world to conceive, and that my eggs are probably getting crappier by the day, but today…?

Today I’m taking back my sanity.

At least for a little while.

 

11 comments on “Back To the Drawing Board…

  1. lydiaseeks
    July 26, 2013 at 10:05 am #

    My doctor is also really anti-lap too. His reasons are similar, at least for my case. He thinks that whatever it tells us most likely won’t change the needed course of treatment, but it does put you through a surgery just to gain a little more information. Or not! Sometimes they find nothing. We are also on the cusp of IVF for this reason. I do sort of feel that if my husband and I just lived our lives and had unprotected sex, sure I might get pregnant at some point in the next 5 years. I’m just not willing to take the gamble that that won’t happen. I’d also like to have more than 1 kid (I know, so greedy) so we gotta get this show on the road.

    It sounds like you’ve got an empowering plan laid for the coming weeks. I think that’s important to take back some of the control you lose while going through this.

    Like

    • Tracy
      July 26, 2013 at 1:55 pm #

      I haven’t entirely given up on having the lap, I just think that maybe she has some good points in that regardless, the next logical step would be IVF… For now, I might as well just live my life, right? 😛

      Like

  2. ~kboo
    July 26, 2013 at 11:29 am #

    Sounds like this doctor isn’t specially trained in laparoscopies. Endo can and should be removed from all those places you mentioned, if present. Go to a specialist.
    Stay on the met. It helps with egg quality for IVF and takes months for the full effect.

    Like

    • Tracy
      July 26, 2013 at 2:06 pm #

      My doc is an experienced RE, but I know she’s also a big stickler for the big studies that are out there. She brought a lot of facts to the table, I think because she knew that I’d be bringing my own facts, studies, and stats to the table…

      I haven’t given up on the lap, and am still looking around for specialists in this area. I think Cleveland is the closest. The issue is that much of what I’m seeing is directed toward women who already KNOW they have endo and wish to have a lap to remove endo or correct structural issues.

      I don’t appear to have any structural issues at ALL, which is part of why my doc is hesitant to perform the lap, and she says that much of what I think to be symptoms of endo are either indicative of dysmennorhea, or severe endo that involves the bowel, neither of which, according to her, having surgery with this clinic will be able to correct.

      So yes, I do need to see a specialist if I want my symptoms to be considered as an indicator of endo, but I know that it will take time to get that second opinion in the works.

      As for the Met… I’ve lost over 10lbs since starting it, which is not healthy. I can’t imagine that egg quality is improving while my body is wasting away, either, so I’m going to look for other ways to regulate hormones. I’m still taking Pregnitude, and will be starting Maca and Royal Jelly. All I can hope for is that one of these combinations can help me conceive without making me sick!

      Like

  3. Kitten
    July 26, 2013 at 11:52 am #

    I understand where your doctor is coming from. My lap was done because I had a large cyst on my ovary. While my OB was in there, he found severe endo and cleaned me out the best he could. Had I not had the cyst, I probably wouldn’t have had a lap at all, as there was no reason to suspect endo. Besides, according to my RE, it wouldn’t have mattered: looking at everything in my history and lab work, she would have recommended the same course of action, endo or not.

    I think you’re approaching this the right way: thinking on what your doctor told you and planning to seek a second opinion – that’s the responsible thing to do before deciding to undergo surgery that may or may not be helpful to you.

    Like

  4. nonsequiturchica
    July 26, 2013 at 11:59 am #

    I agree with kboo- endo should be removed if you do have it. It sounds like you may want to see another dr to get this done.

    This is from the American society of Reproductive Medicine (http://www.asrm.org/Endometriosis_booklet/):

    Surgery for Infertility

    Laparoscopic treatment of minimal and mild endometriosis has been associated with a small but significant improvement in pregnancy rates. In the largest study to date, 29% of women who had their endometriosis treated conceived within nine months, in contrast to only 17% of women whose endometriosis was diagnosed but not treated during laparoscopy. Although this is a modest treatment benefit, it suggests that there is a period of enhanced fertility after laparoscopic treatment of endometriosis. Treatment of moderate and severe endometriosis by laparoscopy and/or laparotomy increases pregnancy rates for women in whom no other causes of infertility have been found. There is no evidence that the outcome is improved by any specific method used to treat endometriosis, such as electrosurgery, laser, excision, or ablation.

    Like

  5. nonsequiturchica
    July 26, 2013 at 12:01 pm #

    Oh and I was in the same boat as Kitten- my dr didn’t suspect endo, but I had a large fibroid that had to get removed. When the dr opened me up he also found Stage 2 endo and removed it.

    Like

  6. A Morning Grouch
    July 26, 2013 at 1:18 pm #

    We also chose not to do the laproscopy for the same reasons. We were lucy enough to get preggo with the injections alone, but not too much before we were ready to move to IVF.. Good luck to you.

    Like

  7. notwhenbutif
    July 26, 2013 at 2:27 pm #

    Ultimately, you have to make the decision that is right for you, and you are already asking yourself all the right questions and thinking about all the obvious alternate ways you can handle this news.

    All *I’m* able to offer is my own perspective, and that is 100% the perspective that kboo proposes above. I had no clue I had endo before my lap, and I remember walking into the surgical suite thinking to myself, “Oh goodness, what if this was all totally pointless!?!” I beat myself up about it because I demanded the lap even though my doctor said it wasn’t his “first line” course of treatment. I was so ashamed that I might have guessed wrong.

    You know what happened? A diagnosis of severe endo with adhesions attaching my bowel to my abdomen, encasing my right ovary, and blocking both my tubes. My doctor removed it all (as he SHOULD have removed it all) and I woke up a few hours later not suffering from constipation for the first time in over 15 years. I believed what doctors had told me year after year about my constipation – that is was “probably IBS,” that I needed to drink more water, eat more fiber, have a colonoscopy, etc. I downed gallons of water, went through jugs of metamucil each month, and was so ashamed and embarrassed. 2 hours post-op (at a time when I was supposed to be in pain and miserable) I had the first normal bowel movement of my adult life. I wasn’t remotely surprised when, at my appointment to review the surgical findings a few weeks later, I was told my worst endo was on my bowel. I felt human for the first time in over a decade.

    I was certain I didn’t have endo, and blamed my own inherent weakness or bad pain tolerance or poor diet for all my issues. Having lived after the excision of endo, I can tell you that pain tolerance wasn’t my issue.

    In the past months my symptoms – which I now fully recognize as SYMPTOMS not mild inconveniences – have returned, so I’m going back in for lap#2 on August 20. First, because I want to know what’s going on in there, but second because my RE insists on my having another lap before we move forward with IVF this fall.

    As I said, these are my thoughts and my beliefs. We are all entitled to our own. I just know what I felt like then, and know what I feel like now, and know I’ll always recommend a lap to friends and family that are curious (and it is totally up to them whether they accept my advice or tell me to mind my own beeswax!)

    Like

  8. Susy_Sama
    July 26, 2013 at 2:36 pm #

    Taking back your sanity sounds wise So does taking a step back to think of your options Each story, each body is unique Whatever you decide will be fine; only you can see the cards on your table I believe in the lap because it did change my story but I’m aware it could have resulted in nothing. Wish you all the best!

    Like

  9. jlynny
    July 30, 2013 at 10:35 pm #

    I have been reading your blog for awhile and have recently done IVF myself. It was a hard decision because it seems like such an investment and like you’re giving up hope on other options. However, it worked for me and several friends I have made through this journey. You have tried so many things but don’t give up! IVF is a very hopeful option and no matter what you choose you will and can have a happy, healthy baby! I am so glad i made the choice to do ivf. Good luck with whatever decision you make! And good luck with your proposal at work!

    Like

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