Tag: laparoscopy
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.

 

Aside

Soliciting Laparoscopy Info…

Hey friends!

My laparoscopy is a month from tomorrow, and my pre-op appointment with Dr. F, who will be performing the surgery, is on Thursday.

I don’t know what to expect from this appointment, honestly. 

I also don’t know what questions I should ask…

So I’m throwing it out to youse guys!

 

What should someone scheduled for a laparoscopy expect from a pre-op appointment?

What kind of questions should the patient ask the doctor?

Do you have any pre- or post-surgical tips you’d like to share?

Please comment below!  🙂

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The Western Front

Tuesday, June 18th, 2013.  CD11.

Howdy, friends.

All’s quiet here… No surprise, I’m sure.

I wish I had more to report on these days, but I really don’t.

And you know what?

I’m okay with that.

As for reproductive updates, I have few, but here they are:

I just wrapped up five days of Femara, complete with the lovely letrozole headaches to prove it.

I have a teensy amount of Gonal F left in the fridge from last cycle that expires liiiiiike… today.  I’m probably going to take it tonight, because hey – why not?

I’m not having any medical monitoring – blood work, ultrasound, or otherwise – this cycle.  Just good ol’ fashioned temping and OPKs for me.

I don’t have a whole ton of hope that five little pills and a miniscule amount of FSH are going to help me conceive, but for what it’s worth, the taking of the pills has done what I hoped and helped me to feel like I’m doing something to further my cause.

Unrealistic though that thought may be, it works for me right now.

I’m having some trouble with my diet lately, and therefore I’m also having some trouble taking the Metformin as I should be.  Some days I skip my lunch dose because I forget, or some days I skip my dinner dose because I eat too late at night.  It’s not healthy, but I’m working on getting back on track.

I’m also doing that self-defeating thing again where I forget to take my vitamins.  It’s not that I don’t want to, it’s just that sometimes I don’t see the point.  Sometimes I forget.  And yeah… sometimes I just don’t want to.

I’m working on that, too.

Other than that, it’s been a fairly laid back week since I last updated.  Work has been keeping me extremely busy, I got my hair cut and colored last night (some people go blonde for summer… I go ginger!), my garden is in and prospering, and the husband and I are traveling out to my homeland this weekend to have family photos taken with my side of the fam.

 

The only thing stressing me out a bit is that I’m waiting on pins and needles for my doctor to call me.  She is the only one who can schedule my laparoscopic surgery to look for endometriosis, and once I have a date in hand, I’ll be able to start planning around my recovery.

Speaking of lap recovery, I’ve heard anything from two days to two weeks… Does anyone here have any insight?  I’d really like to not be laid up for a fortnight (Ha!  I’ve always wanted to use that word!), but if I can plan my work around a tentative recovery time frame, I might be able to swing it.

Also, can anyone provide input on what cycle day(s) your doctor/surgeon recommended having the surgery?  Mine is recommending before cycle day twelve, but after the bleeding stops.  For me, that leaves probably around five days to work with, likely the second week of July.

I’ve heard that others have had their surgery during the very start of their cycle, and have gone on to have a normal ovulatory cycle that month.  I suppose it would make the most sense to me to have the surgery done as close to Aunt Flo’s arrival as possible, as that would be when any suspected escaped endometrial tissues would be the most inflamed…

Then again, I’m not a doctor.

I just play one on the internet.  🙂

Do you have any advice or insight on having laparoscopic surgery?  Please comment below – I’m all ears!

 

Status

Drifting Forward

Apologies, again, for yesterday’s heap of venting.  Sometimes you just need to put it all out there, read it over a few times, and become accountable for your own life.

And sometimes you just need to pick yourself up, dust yourself off, put on your big girl panties, and deal with things.

Which I am now doing, thankyouverymuch.

My doctor is on vacation, which I know isn’t easy for her to do… I would hate leaving my patients in the hands of others; luckily, she works in a large practice with several other very competent physicians, and they are helping me work through all of the WTF?, NOW WHAT?!, WHERE DO I GO FROM HERE?!! crap I’m currently spewing into the universe.

More accurately, the lovely nursing staff at the University of Michigan Center for Reproductive Medicine is fielding my emails, running around and asking doctors to make decisions for me, and generally just patting my hand and giving me virtual hugs to make me feel better about being a crazy person with busted junk.

I love them.  I need to send them flowers or a fruit basket or something.

Anyway, they talked another of the doctors there into letting me continue on with a Femara-only cycle.  No monitoring, no trigger – just pills and OPKs and old-fashioned mattress-dancin’.

(And shhhhhhhh… don’t tell, but I have a teensy bit of Gonal F left in the fridge that will spoil if I don’t use it.  So I probably will.  It’s too small an amount to make much of a difference, but hey… why not, right?)

Based on past results, I have very little faith that this will be my miracle cycle.  About that much, I am realistic.  I’m not doing this because I think it will get me a baby…

I’m doing it because it feels like doing something, and I  need that right now.  It’s something to hold onto, and a way to feel like I’m less drifty and floaty in the miasma of space and time.  It gives me a bit of an anchor, and something to obsess over for the next month.

Next  month is going to be a whole different story…

July will be my laparoscopy month.  When my doc gets back from vacay, she will call to schedule my surgery for me.  I estimate that it will be scheduled for around July 12th, but I’ll know more in a couple of weeks.

I’m super nervous about having surgery.  I haven’t had to be put under for anything since I was like four, and that freaks me out.  I have faith in the doctors, though, and know that this is one step I have to make, regardless of where I’m headed next.

Worst case scenario – they find nothing, and the surgery was a waste.  At least I will have gotten it out of the way, as most  docs require it before moving forward with IVF.

Best case scenario – and I know this sounds twisted – they find some serious endometriosis in there.  I don’t want to have endo, believe me, but if they find it, they can remove it.  If they remove it, there’s a good chance that I will feel so much better physically.  Maybe my periods won’t leave me gasping and sobbing on the floor for the first three days of each cycle, and maybe – just maybe – removing the potential escaped endometrial cells will help my hormones shift back to normal and let me go on with the business of making babies.

Maybe.  It’s a gamble, but there’s no way to know until I try.

I suppose that’s why they call it an “exploratory surgery”.

So that’s where I am.  Not so much adrift as I was yesterday, because now at least I have a distant shore in sight.  I don’t know what I might find there, but it’s the only bearing I have, and I’m taking it.

Ahoy, bitches!

I know how you feel, Tom. One day at a time.

Status

Adrift: A Novel

Monday, June 10th, 2013.  CD3.

Warning:  Word Dump to Follow…

Business first, I guess…

If you follow the blog’s Facebook page then you probably already know this, but my last-ditch effort IUI hybrid injects/Femara cycle was a bust.

If you’re keeping tabs, that’s five IUIs, four inject cycles, 15 medicated cycles, and Godknowshowmany natural cycles that have failed.

That all comes to fifty months of failure under my belt.  That means that if my baby-making efforts had been successful at the start, I’d have a preschooler at this time.

My infertile journey is a walking, talking, potty-trained small person with a personality at this point.  Beat that, suckers!

Aside from the high levels of crazy I’m currently emitting, I’m also reasonably devastated.  I had a lot of hope for the countless changes in diet, lifestyle, and medication to make enough of a difference for this to have worked.

Maybe it’s too soon for all that change to have kicked in…

Or maybe it just won’t ever make a difference.

As the husband and I laid in bed on Saturday night talking about how shitty it is that we’re in our fifth year of progeny non-production, I could hear the frustration in his voice as he asked “When do you think these doctors will figure out why this isn’t happening?”

Oh sweetie.  I wish I knew.  And it breaks my heart that you’re now feeling what I’ve felt for so long…

I don’t know where to go from here.  I still haven’t heard back from the nurses on what Dr. F would like me to do now, whether that be further testing (which I’ve requested) or more medicated cycles (which I doubt, considering my track record).

I’m adrift.  No direction, no solutions, no options.

Well, not exactly NO options…

I’ll tell you what I told the husband:

At this point, every test I’ve had in the past four years has pointed to me being the problem.  For most of that four years, we didn’t know why.  At least now we have a vague idea, but thus far we haven’t been able to resolve anything.

In my mind, this all comes down to an egg quality issue.

No matter what the cause, something is happening with my eggs that’s causing them to either develop poorly, release weakly – or not at all, be of a quality so poor that fertilization doesn’t occur, or be of a quality so poor that when they do fertilize, they don’t develop properly into healthy embryos.

The basis for this hypothesis comes from a few things I’ve picked up through the years.

First, during natural cycles, I tend to ovulate weakly, if at all.  That has been proven with a combination of temping, varied OPK results, and ultrasound monitoring.  For this, we use a trigger to help force the mature follicles release the eggs, resulting in a stronger ovulation.  As to why I am not ovulating in a normal, healthy fashion… Well, that points to some sort of hormonal imbalance, and likely a poor quality egg that’s not triggering the body to ovulate on its own.

Second, even during medicated cycles wherein I am monitored closely and respond perfectly, pregnancy does not occur.  It stands to reason that the odds of anyone getting pregnant in any given month are between 20 and 25%, but considering the number of good-response medicated cycles I’ve completed, I should have seen some results by now given those odds.  That leads me to believe that the healthy sperm are just not finding anything worth fertilizing, or that there’s something wrong with the egg itself that causes it to not be able to be fertilized at all.

Third, I have had one cycle that resulted in pregnancy, but also ended in miscarriage.  During this hybrid Femara/Menopur cycle, I didn’t respond as well as expected, taking twice as long with the injects as I was led to believe would be necessary.  It’s true that not everyone responds the same way in every cycle, but that month felt a great deal like forcing my body to do something it was patently against.

Now, in that cycle, I spent five days taking Femara, ten days taking 75IU shots of Menopur, triggered with one decent-looking follicle and one just-okay follicle, and managed to get pregnant with the good ol’ mattress-dancin’ method.  Aha!  The swimmers can swim, and they can do what they’re meant to!  Check one unresolved question off the list.

My first beta was very low, which was a warning sign in retrospect, but I was told not to be terribly concerned.  Second beta was also low, but had doubled in the appropriate timeframe.  Then, at just before six weeks, I had some minor spotting that lasted only a few hours.  Again, I was told this was no big deal, and all was well.

A few days after that, I had what I can only realistically describe as a panic attack.  I don’t know what brought it on, I just knew that something was wrong and that I felt… off.  The doctor saw me right away, and found that my heart rate was high.  I was sent into the ultrasound room for a quick peak with directions to stay hydrated.  The ultrasound didn’t show much… that was the third warning sign.  By six weeks, a heartbeat is usually visible, but at 5wks6days, there wasn’t really even a definable embryo there, only a black spot where it should be.  I was sent home with instructions to come back in a week for my regular ultrasound, and not to worry, as my uterus is tilted in such a way that I might have some trouble with early ultrasounds.

Everyone knows how this story ends – the next two ultrasounds show little, if any, growth.  Development was not on track, and eventually started to revert.  No heartbeat was ever seen, let alone a fetal pole.  I miscarried, given the diagnosis of a missed miscarriage.  I think, to this day, that it may have been more accurately diagnosed as a blighted ovum, though I suppose a missed miscarriage can BE a blighted ovum.

Basically, a blighted ovum occurs when a fertilized egg implants, but development is slow, stops, or never starts due to a chromosomal abnormality.  This typically occurs in either the sperm or the egg, and since we know that the husband has super-swimmers, we can reasonably assume that this is the fault of my shitty eggs.

In order to prove this hypothesis, we need to complete an IVF cycle.  In order to examine my eggs closely, we would have to go through the whole process of stimming, retreiving, fertilizing, and observing the growth of the embryos.  If I have truly shitty eggs, they may not even progress into viable embryos, but there’s no way to tell until we’re fully invested.  It’s a big risk, both emotionally and financially.  To dump nearly $15K into something that has only a 50 to 60% chance of working is like savings account Russian roulette.  And that 50 to 60% is only if my eggs manage to fertilize properly, develop appropriately, survive a few days in a petri dish, and then implant in my uterine lining they way they’re meant to.

That’s a whole lotta really pricey ifs.

And so, that’s where we are today.  I have great sperm at my disposal, we know that my body is hospitable enough to carry a pregnancy, at least in the very early stages, and I respond well to medications.

I also have a mystery hormonal issue that is causing my eggs to stew in an imbalanced mixture of stuff that’s causing them to mutate into worthless cells that kill my chances at pregnancy month after month.

I’m doing everything I can to help my body make better eggs.  I’ve improved my diet, I take like thirty vitamins a day, and I regulate my insulin levels with dietary changes and medication to help balance my hormones as best I can.  I get plenty of rest, I stay hydrated, I relax as much as possible.  I am proactive with my health, and make sacrifices left and right to get my body into fighting shape.

I realize that most of what I’m doing takes time to make a real difference in egg quality.  Studies show that Metformin itself takes four months or more to see a noticeable improvement in quality, and I’ve only been taking that for 2.5 months – and at that, I have only been taking the full dosage of the original formula Met for one month.  I may not see improvement in my eggs until early July at the earliest, realistically sometime in August or September… Or possibly even later.

Another concern I’ve had is with my recent estradiol numbers around ovulation.  They were rather low, and I have heard that can be an indicator of low egg quality.  Would I be a good candidate for estrogen priming?  Maybe.  Do I want to bring this up to my doctor and sound like a crazy person so early in our relationship?  …Maybe not.

Anyway, I’m obviously spinning out of control here, which we have all learned happens when I have no set plan in place.

This is why I am attempting to get my freaking doctor on the phone – I need a plan.  I need details, and a schedule, and a PLAN.

Here’s what I have so far:

Laparoscopy – I need to have one.  More and more, I think that this pain gets worse each month, and even if they find nothing amiss in there, I will likely need to have had a lap to start the IVF process anyway.  Might as well get it out of the way during the summer months.

DNA Karyotyping – The husband and I both need to do this.  I don’t know whether insurance will pay for the testing, but it’s getting done one way or another.

Genetic Screening – I especially want to have this done to find out whether I have some form of MTHFR.  That, and I probably need to do the CF screening to move forward with IVF, despite the fact that there’s no family history.

Autoimmune Testing – I’d like to have this done locally, but I know that most doctors don’t want to touch immune issue infertility with a ten foot pole.  I’m going to ask my current RE, however, if she can run the basics at least.  From there, I can at least get an idea whether I need to pursue further testing or treatment with one of the immunology bigwigs.

So that’s where I am.  I have very little information at hand, but I do have a lead.  I’m going to continue to take care of myself, and to press my doctors for more information and more testing.  I’m going to keep trying, month after month, whether it’s with IVF, plain old Femara, or just the good old fashioned bump n’ grind method.

Apologies for the giant word dump.  Sometimes you just need to take one.

 

 

 

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