Showing posts with label hysteroscopy. Show all posts
Showing posts with label hysteroscopy. Show all posts
Apr 3, 2012
surgery tomorrow
Wish me luck - this thing is supposed to come out tomorrow. We did a doppler ultrasound yesterday that showed this thing is taking up most of my uterus and has a fantastic blood supply. I think it is the blood supply that suggests my uterus is a ticking hemorrhage time bomb and is encouraging them to move before Passover. They actually won't be 100% sure it is placenta until they biopsy it - it could also be degenerating fibroid or something else. I learned something interesting and freaky today - you can have a molar pregnancy that coexists with normal fetus(es). One doctor proposed the possibility that this could be my case, but thankfully we've ruled that out. I hope I will have a good report tomorrow. It is very disappointing that tomorrow is when we were supposed to fly to the states.
Mar 31, 2012
a gray cloud
The last week has been tough. I have been feeling very frustrated and angry since my appointment with the surgeon on Thursday. I have so much I want to say not about me, but about my babies, and I have been having a very hard time concentrating and getting it out, which in of itself is very frustrating - it makes me feel like I am not honoring them properly. Disappointingly, this post is probably going to be mostly about me and my appointment last week.
When I left off last time, we were beginning to consider the advantages and disadvantages of the myomectomy, the fibroid surgery (which, for reasons I will not get into right now, does seem like something we will likely pursue before returning to IVF).
On Thursday we had the diagnostic hysteroscopy with one of the two doctors who does endoscopic gynecological surgery to see what the fibroids look like now and in order to make a decision about the surgery and to hypothetically schedule it. Instead, we found out that my uterus is full of retained placenta and it was impossible to visualize the fibroids.
This was really surprising to us since it was a potential complication that no one discussed with us and because I had actually already had a D&C for retained placenta immediately following delivery. Apparently, vaginal birth between ~20-26 weeks is a risk factor for retained placenta and the risk with multiples is even greater. Add in the fibroid, the placental abruption, and my failure to deliver Aminadav's placenta, and in retrospect, this complication is not terribly shocking, but it still really really sucks.
The plan now is to do an operative hysteroscopy to remove the retained placenta on April 22. Unfortunately, they can't also do the myomectomy at the same time, so we will need to wait for my uterus to heal from this first procedure and then do the fibroid surgery later on. And then heal from that. Remember that crazy idea my RE had about starting a new IVF after Passover? I am wondering if the joke is on me - perhaps we're talking about Passover 2013.
There is a small possibility that the retained placenta will come out with my next period. The doctor seems to think this is not terribly likely, or at least not terribly likely that it will all come out (this is actually really disgusting to be writing about, and probably pretty disgusting to be reading about, so I apologize). What is more likely it seems is that I will get a period and the tissue will become more "organized" as they say and as a result, take up less surface area of my uterus, which will hypothetically make it an easier procedure with lower risk of causing significant scarring or adhesions. This is apparently why we are waiting until April 22 (that and socialized medicine, which I actually have few complaints about).
Unfortunately, for as long as I am walking around with retained placenta there is the risk of hemorrhage. I have been reassured this risk isn't terribly high since I am not actively bleeding at the moment, but high enough that air travel, specifically transatlantic air travel of the variety we had planned for most of the month of April, is not particularly wise. There is also the secondary issue that no travel health insurance plan will cover us abroad (i.e in the United States) because of my current condition. (It is worth mentioning that one doctor said air travel would be fine, one doctor said not a good risk to take, and a third implicated it's a bad idea but said it's up to us.)
The one immediate thing I was looking forward to was traveling with Y to the states to spend Passover with his family in Miami and then our trip out to California and up the Pacific Coast Highway. We were both really looking forward to the change of scenery and alone time together. The plane tickets were purchased, the arrangements made, and we thought this trip was a done deal. We literally planned the trip in the recovery room after my D&C, which was just a couple hours after I delivered the babies.
This was supposed to be our escape from all of this horribleness and I am so sad that now it seems we can't even take this trip, or at least the California component is in great jeopardy - no consensus on Miami yet. It is really hard to keep my chin up - stuff just keeps going wrong and it is increasingly hard to believe anything will change. When the doctor mentioned the risk of hemorrhage all I could think was "Hemorrhage? Why not? Sounds like something that would happen to me." I hate being this downtrodden and negative about everything. Still waiting for this big gray cloud to lift.
When I left off last time, we were beginning to consider the advantages and disadvantages of the myomectomy, the fibroid surgery (which, for reasons I will not get into right now, does seem like something we will likely pursue before returning to IVF).
On Thursday we had the diagnostic hysteroscopy with one of the two doctors who does endoscopic gynecological surgery to see what the fibroids look like now and in order to make a decision about the surgery and to hypothetically schedule it. Instead, we found out that my uterus is full of retained placenta and it was impossible to visualize the fibroids.
This was really surprising to us since it was a potential complication that no one discussed with us and because I had actually already had a D&C for retained placenta immediately following delivery. Apparently, vaginal birth between ~20-26 weeks is a risk factor for retained placenta and the risk with multiples is even greater. Add in the fibroid, the placental abruption, and my failure to deliver Aminadav's placenta, and in retrospect, this complication is not terribly shocking, but it still really really sucks.
The plan now is to do an operative hysteroscopy to remove the retained placenta on April 22. Unfortunately, they can't also do the myomectomy at the same time, so we will need to wait for my uterus to heal from this first procedure and then do the fibroid surgery later on. And then heal from that. Remember that crazy idea my RE had about starting a new IVF after Passover? I am wondering if the joke is on me - perhaps we're talking about Passover 2013.
There is a small possibility that the retained placenta will come out with my next period. The doctor seems to think this is not terribly likely, or at least not terribly likely that it will all come out (this is actually really disgusting to be writing about, and probably pretty disgusting to be reading about, so I apologize). What is more likely it seems is that I will get a period and the tissue will become more "organized" as they say and as a result, take up less surface area of my uterus, which will hypothetically make it an easier procedure with lower risk of causing significant scarring or adhesions. This is apparently why we are waiting until April 22 (that and socialized medicine, which I actually have few complaints about).
Unfortunately, for as long as I am walking around with retained placenta there is the risk of hemorrhage. I have been reassured this risk isn't terribly high since I am not actively bleeding at the moment, but high enough that air travel, specifically transatlantic air travel of the variety we had planned for most of the month of April, is not particularly wise. There is also the secondary issue that no travel health insurance plan will cover us abroad (i.e in the United States) because of my current condition. (It is worth mentioning that one doctor said air travel would be fine, one doctor said not a good risk to take, and a third implicated it's a bad idea but said it's up to us.)
The one immediate thing I was looking forward to was traveling with Y to the states to spend Passover with his family in Miami and then our trip out to California and up the Pacific Coast Highway. We were both really looking forward to the change of scenery and alone time together. The plane tickets were purchased, the arrangements made, and we thought this trip was a done deal. We literally planned the trip in the recovery room after my D&C, which was just a couple hours after I delivered the babies.
This was supposed to be our escape from all of this horribleness and I am so sad that now it seems we can't even take this trip, or at least the California component is in great jeopardy - no consensus on Miami yet. It is really hard to keep my chin up - stuff just keeps going wrong and it is increasingly hard to believe anything will change. When the doctor mentioned the risk of hemorrhage all I could think was "Hemorrhage? Why not? Sounds like something that would happen to me." I hate being this downtrodden and negative about everything. Still waiting for this big gray cloud to lift.
Mar 25, 2012
what next?
First, thank you for all the love & support. I know I have been totally flaky about responding to comments, but know that I read and re-read your comments and they help me through the day.
Today we went back to the RE for a 2 week follow-up appointment. The big decision we need to make over the next week is whether we want to do a myomectomy to remove my jerk fibroids or not. I was a bit shocked - when we asked how soon I might start a fresh IVF cycle if we do not do the surgery, Dr. T. said we could start right after Passover. (Passover begins April 6.) We will actually be away for most of the month of April, so we wouldn't be able to start until the last week of April, but that is still much sooner than I was anticipating.
On Thursday I will have another diagnostic hysteroscopy to get a better handle on the current fibroid situation. There definitely seems to be a consensus that one of my fibroids likely played some role (how much of a role is very debatable) in my problems with Aminadav's sac and placenta. While all of my fibroids grew with the pregnancy, none of them are objectively huge.
The two bad guys are the ones that bulge into the uterus. If we elect to remove them, they will need to be removed from the inside of the uterus. The problem when operating inside of the uterus of course is the potential to create scar tissue, adhesions, and other various types of damage which could cover more surface area than the original fibroids themselves.
Dr. T seems to think that I just had exceptionally bad luck with where Aminadav implanted in relation to one of the two problem fibroids and that it's better not to mess with my uterus any more then strictly necessary, though the doctors during my hospitalization seemed to be more in favor of getting the fibroids out before we attempt another pregnancy. We'll see what the surgeon says on Thursday and then we'll have to make some sort of decision.
I am unsure of what I want to do re: the fibroids and also quite unsure of on what type of time scale I want to pursue IVF moving forward, but before really delving into that I think we need to reach some sort of consensus on the surgery. Any folks out there that have done a myomectomy via surgical hysteroscopy or considered doing it? Any wisdom or thoughts?
Today we went back to the RE for a 2 week follow-up appointment. The big decision we need to make over the next week is whether we want to do a myomectomy to remove my jerk fibroids or not. I was a bit shocked - when we asked how soon I might start a fresh IVF cycle if we do not do the surgery, Dr. T. said we could start right after Passover. (Passover begins April 6.) We will actually be away for most of the month of April, so we wouldn't be able to start until the last week of April, but that is still much sooner than I was anticipating.
On Thursday I will have another diagnostic hysteroscopy to get a better handle on the current fibroid situation. There definitely seems to be a consensus that one of my fibroids likely played some role (how much of a role is very debatable) in my problems with Aminadav's sac and placenta. While all of my fibroids grew with the pregnancy, none of them are objectively huge.
The two bad guys are the ones that bulge into the uterus. If we elect to remove them, they will need to be removed from the inside of the uterus. The problem when operating inside of the uterus of course is the potential to create scar tissue, adhesions, and other various types of damage which could cover more surface area than the original fibroids themselves.
Dr. T seems to think that I just had exceptionally bad luck with where Aminadav implanted in relation to one of the two problem fibroids and that it's better not to mess with my uterus any more then strictly necessary, though the doctors during my hospitalization seemed to be more in favor of getting the fibroids out before we attempt another pregnancy. We'll see what the surgeon says on Thursday and then we'll have to make some sort of decision.
I am unsure of what I want to do re: the fibroids and also quite unsure of on what type of time scale I want to pursue IVF moving forward, but before really delving into that I think we need to reach some sort of consensus on the surgery. Any folks out there that have done a myomectomy via surgical hysteroscopy or considered doing it? Any wisdom or thoughts?
Feb 9, 2011
my surprise hysteroscopy (there are better types of surprises)
As predicted, AF came right on time yesterday. I went in this morning, expecting to just find out my dosages and instructions for IUI #5 and then be on my merry way, but IF World (it reminds me of this giant toy store "Child World" that we had near us growing up) had other plans for me today. Back when we started doing monitored cycles, the ultrasound technician told me I had a myoma. Since the ultrasound technicians regularly measure it, I knew that it had been growing slowly. However, a few months ago when I asked RE 1 about it, he said not to worry about it.
Today RE 2 decided we should do a hysteroscopy to see whether the myoma had penetrated through the uterine wall. The hysteroscopy itself wasn't so bad (and I was shocked they squeezed me in right away, as well as grateful since it gave me less time to be anxious), but it was just slightly awkward given 1) I am bleeding because I am, you know, in the middle of my period and 2) the crowd of 4 that convened around the circus attraction that is my uterus. RE #2 felt the compulsion to make casual conversation with the resident and med student who had assembled around him about my famous PhD advisor (also in the same medical school as the teaching hospital where the fertility clinic is located) lest I retain any anonymity.
The grand conclusion was that they could in fact see the myoma on the inside of the uterine cavity meaning that it had invaded through the wall, but only minimally. RE 2 said that it probably needs to come out eventually, but that I can wait until a failed IVF or successful pregnancy (whichever comes first) before surgery.
I expressed my disappointment about only having one lousy follicle last cycle, but he recommended that we stay with same (low) dose of FSH for this cycle, since from my experience with Clomid he knows I am very easy to over-stimulate. I am feeling pretty sad and despondent in general lately. I guess by IUI #5 I feel like I am hanging around in IUI purgatory biding my time this cycle and next until our health fund will fully cover IVF, if that makes any sense. Obviously it would be amazing if I got pregnant in the meantime, but I don't know how realistic it is, especially since they aren't willing to get any more aggressive with the FSH until we move on to IVF.
I have a lot more to say, but I think I have already gone on at too great length, so I will continue these thoughts soon...In the meantime, lots of congratulations and good vibes for a sticky baby and a happy & healthy 9 months to those who recently got good news, and many thoughts and prayers to everyone who is struggling and waiting.
Today RE 2 decided we should do a hysteroscopy to see whether the myoma had penetrated through the uterine wall. The hysteroscopy itself wasn't so bad (and I was shocked they squeezed me in right away, as well as grateful since it gave me less time to be anxious), but it was just slightly awkward given 1) I am bleeding because I am, you know, in the middle of my period and 2) the crowd of 4 that convened around the circus attraction that is my uterus. RE #2 felt the compulsion to make casual conversation with the resident and med student who had assembled around him about my famous PhD advisor (also in the same medical school as the teaching hospital where the fertility clinic is located) lest I retain any anonymity.
The grand conclusion was that they could in fact see the myoma on the inside of the uterine cavity meaning that it had invaded through the wall, but only minimally. RE 2 said that it probably needs to come out eventually, but that I can wait until a failed IVF or successful pregnancy (whichever comes first) before surgery.
I expressed my disappointment about only having one lousy follicle last cycle, but he recommended that we stay with same (low) dose of FSH for this cycle, since from my experience with Clomid he knows I am very easy to over-stimulate. I am feeling pretty sad and despondent in general lately. I guess by IUI #5 I feel like I am hanging around in IUI purgatory biding my time this cycle and next until our health fund will fully cover IVF, if that makes any sense. Obviously it would be amazing if I got pregnant in the meantime, but I don't know how realistic it is, especially since they aren't willing to get any more aggressive with the FSH until we move on to IVF.
I have a lot more to say, but I think I have already gone on at too great length, so I will continue these thoughts soon...In the meantime, lots of congratulations and good vibes for a sticky baby and a happy & healthy 9 months to those who recently got good news, and many thoughts and prayers to everyone who is struggling and waiting.
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