29 September 2011
A new diagnosis ...It was actually a difficult challenge believing this new doctor we had just met. I really wanted her to be right and to get the problom corrected. But the challenge came from 7 years of living with a wrong diagnosis. It was hard to get it in my mind that my uterine problem was correctable, and that I would be able to schedule surgery.
Because I was having a hard time accepting that the new diagnosis was correct, I was afraid of the surgery. The way the surgery would work is that the doctor would enter my uterus with a camera, called a hysteroscope, and an instrument that would cauterize the extra tissue inside the uterus that was dividing it in two. In a septate uterus, that tissue gets no bloodflow, in most cases, so the surgery wouldn't cause much blood loss at all ....unless the new diagnosis was not correct, in which case, I could end up with a ruptured uterine wall or a hysterectomy. The doctor was confident though, and she also planned to do a laparoscopy as well, to make sure the top of my uterus was flat, thus verifying her diagnosis.
Most women with a uterine septum as large as mine suffered multiple miscarriages before diagnosis, and for that reason, I decided it was worth the risk. And, although there is no proof, there are a lot of people who have connected infertility with uterine septums. In truth, there is a good possibility we have had several eggs fertilized that never implanted because the septum made it impossible.
So, now came time for scheduling ... My doctor told me she could schedule me for some time in February or March, but I told her I would talk to my husband and call the office to schedule. We decided to definitely do the surgery, so I called the nurse, and practically begged for her to schedule the surgery as quickly as possible. She was SO wonderful! She actually got me scheduled for just over 2 weeks later in late January 2011.
My mother was gracious enough to come down from Pennsylvania to take care of Abi and me during my recovery from surgery, and actually missed spending her anniversary with my dad. I was so glad she was there, because I was so afraid the day of surgery ....not for my life, but for my reproductive ability. Having her there really helped me stay calmer.
I don't remember waking up from that surgery, but I do remember my husband telling me that everything went really well, and that we could start trying after a couple of months and a good HSG confirming that my uterus was in much better condition. I was so grateful, hopeful, and anxious to get started trying again.
In February, my husband accepted a new position with a new company in the Lafayette, Louisiana area, and we were starting to plan another move. My hope was that we would have enough time to do one fertility cycle before moving to Louisiana and that we would move pregnant (again).
Then in March, I had an HSG, which showed that a small part of the septum had grown back ...sigh. My doctor recommended that we do a repeat of the surgery, but left it entirely up to me. She was willing to do a fertility cycle with me if we decided not to have the surgery again.
Decision time ...
27 September 2011
From my first meeting with the new doctor, we discussed the possibility that I had been misdiagnosed with bicornuate uterus, and that the doctor suspected it may really be a septum, or septate uterus. The major differences were that Septate is reparable, and can cause miscarriage and other complications, while bicornuate is irreparable, and only causes preterm labor. On my first visit with the new doctor, she recommended an investigative ultrasound to see if she could identify which condition I had.
Within 30 seconds of the start of the ultrasound, she told me that she was positive that it was indeed not bicornuate. It was actually a complete septum that split my uterus into two halves. This should be good news, right? It was a reparable issue. A reparable problem that causes miscarriage, preterm labor, and can contribute to pre-eclampsia...
Miscarriage - check
Preterm labor - check
pre-eclampsia - check
So basically, I had been misdiagnosed years ago, long before I started trying to have babies. It took me a couple of days to realize that if I had been correctly diagnosed from the start, my uterus could have been repaired, and I may not have lost Angel. I may not have had Abigail at 33 weeks, and we may not have had to spend 37 days in the NICU. I was beyond livid. I mean, I know doctors make mistakes too, but this one affected 4 lives, my entire family. And I had insisted multiple times that they double check to see if there was any possibility that I really had a septate uterus rather than bicornuate.
I remember exactly where Angel had implanted in my uterus, and it was right on the septum. The difference between a septum and the lowered fundus of a bicornuate uterus is that in the bicornuate uterus, there is blood flow. So, even though we saw a heartbeat at 6 weeks with Angel, my poor baby hadn't received the appropriate level of blood flow to stay alive in my uterus.
Besides anger, there were a lot of other feelings I had:
- Regret - I should have gotten a 2nd, 3rd, or even 4th opinion when I was originally diagnosed. I should have been more vigilant until I felt confident in the diagnosis myself. Maybe Angel would have survived.
- Guilt - My body was deformed in a way that killed my child. My baby didn't survive because he or she didn't get enough bloodflow to support life. And I had even more guilt that Abi had to struggle so much early on, also probably because of my deformed uterus.
- Frustration - Now I would have to have surgery ...Yet another delay. I knew God had a plan, but it was so far from my plan! Sometimes I think God allowed these delays just to show us how much better His plan is.
- Gratefulness - This is what I felt with the greatest intensity. Once I saw how little space there was in my uterus, I was again reminded of what a miracle Abigail is. We were so fortunate that she made it until 33 weeks gestation. It was a miracle any baby could have survived my uterus. But God knows the plans He has laid out for Abigail, and He brought her into this world miraculously. Since that realization, I have had several doctors remind me just how much of a miracle she is when they see my HSG from December 2010 and realize that she was born BEFORE my uterus was fixed.
14 September 2011
So after trying to get pregnant again with my OBGYN'S and Clomid's help for almost 6 months, I was referred to a Reproductive Endocrinologist (RE), otherwise known as a fertility specialist. I really struggled with the decision to go to the RE. I really believed that we shouldn't have to seek the help of a specialist because we had been pregnant two times already.
It was more though... I didn't want to acknowledge that our infertility was as much of a problem as it was. There are so many other women out there who are dealing with infertility far worse than ours. We were not so bad off that we required a specialist. Were we?
I had to let go of my pride.
My doctor had just gone on maternity leave though, and since I was not excited about seeing her partners, I decided to go ahead and see the RE. They had recommended one of the best-known REs in the Houston area, and I called to get an appointment. The earliest they could see me would be late March. That was almost FIVE months! I was also just not terribly comfortable with the doctor in question, and I am not sure why. I just didn't feel settled.
So I went to a wonderful RE that a good friend recommended. It took us a month to get in to see her, and we had our 1st appointment in December 2010. I talked to her about my previous diagnoses of Polycystic Ovarian Syndrome (PCOS) and Bicornuate Uterus and about our miscarriage and preterm birth with Abigail. I also told her that I had initially suspected that my Bicornate uterus diagnosis may not have been correct, but that it had been confirmed during my D&C after we lost Angel. When I told her that, she looked at me like I was a little crazy and told me that the doctor performing my D&C should not have been able to confirm a diagnosis like that during a D&C. She also told me that she would like to take a look to confirm that diagnosis herself.
After ordering a battery of tests, including labs and a HSG (which is a dye test and Xray of the uterus to determine how open my uterus and tubes are), she asked if I would like for her to take a look at my uterus via ultrasound to see if she could determine anything about the deformation (more on that later). She also offered to do some labs on my husband, but we declined the semen analysis. It just didn't seem necessary. He had managed to get me pregnant pretty successfully considering I was barely ever ovulating.
And so our journey with a fertility specialist began. I was excited, a little nervous, and definitely annoyed at the delay this was all causing. I had no idea what was in store for us over the next few months.
06 September 2011
When Abi was 6 months old, I stopped breastfeeding so that I could start taking Clomid again in hopes of having another child close in age. My body had already returned to normal operation for a women, and in fact, was actually closer to normal operation than before giving birth ...at least for the first few months. I was also considering that I was 33, and it took about 4 years to bring Abi into our lives. That was in July 2010.
The doctor who delivered Abi started me on 50mg of Clomid. She was very cautious and monitored me through each cycle by doing several ultrasounds to determine if I was going to ovulate. The first Clomid cycle was very disappointing. No follicles matured, which means I wouldn't ovulate and there were not going to be any eggs to get fertilized. Then, since I didn't ovulate, I didn't start a period. So, in my mind, no period means that I could be pregnant! I began to have hope that God had done another miracle, and we would be welcoming another child to our family soon.
Every month for a women trying to conceive is like a dramatic ride. It is kind of like those swinging ship rides at an amusement park. You know... the ones that start slowly swinging and build up to the point where your hanging upside down for a few seconds? Well, that's what a cycle (or month) of trying to conceive is like. At first, you start getting hopeful, but you tell yourself not to get too emotionally involved. But as the month goes on, you have moments of confidence that you're pregnant and then moments when you are convinced that you aren't. And by the end of that two week wait between ovulation and expected period start date, you have days where you feel like you are hanging upside down.
So I took pregnancy tests ....lots and lots of them. Thank goodness for Dollar Tree tests, or we'd have spent hundreds each month on tests. Seven days and probably 10 hpts after my period should have started, my doctor started me on progesterone for 10 days to jump start my next cycle. A few days after I finished the prescription, my period started. I was so disappointed, but excited to get started on the next cycle.
The second cycle was slightly more optimistic because there was a follicle that had grown to about 15mm. Ideally, they want them to be between 17 and 23 for a good healthy egg to develop, so the doc gave it a few more days to grow and then triggered ovulation with an hcg injection. But again, there was no positive, and along came my period two weeks after the injection.
The third cycle was similar to the 1st and was also long and drawn out. Then the 4th cycle was similar to the 2nd despite using 100mg of Clomid.
So after 5 months and 4 cycles, my OBGYN gave up and referred me to specialist.
02 September 2011
In previous posts, I told the stories of pregnancy loss and Abigail's premature birth. To continue...
Before Abigail was born, while I was still in the hospital, I was visited by the proactive lactation consultants from the NICU. They reaffirmed what I already knew about how great breast milk is for babies - especially premature babies. But they also let me know that it may not be the easiest process because of the prematurity and my hypothyroidism, blood pressure, and breast reduction.
The day Abi was born, I started pumping, and I pumped and pumped and pumped. Every 2-3 hours around the clock without exception. There was nothing happening. 6 days after she was born, the pumping hadn't produced anything. But I kept doing it. I had so many people praying for my breasts, it was ridiculous.
On Abi's seventh day, her doctor started letting me try to nurse despite the fact that she was still being fed by a tube up her nose. That day, I made a few drops, and the next day, almost 0.1oz, and within a week, a few ounces. I actually got to the point at around 2 months, where I was producing enough in a day to feed Abi without having to supplement with formula. According to the lactation consultants, the amount I maxed out was was more than double what they had thought possible for me.
The whole time I was pumping, I was also trying to nurse Abi. We were on a 3 hour cycle: nurse, feed breastmilk by bottle, supplement formula, pump, wash all equipment, relax for 5-10 minutes, repeat. The nursing part was by far the most difficult. Needless to say, there are some sizing issues for a baby that small to latch properly. The lactation consultants provided a latex 'adapter' of sorts, and we still struggled with the latch ...for four months.
Another thing I never knew about nursing was how bad it can hurt if you're having latching issues like we did. There was a LOT of pain, and I had to used a lot of salves and ointment.
Finally, at 6 months, I stopped nursing and pumping, so we could start trying to get pregnant again.