The Nightmare Begins Again

We're back from the ultrasound. No heartbeat. No baby, actually. Just an empty gestational sac and a yolk sac measuring around six weeks. That would explain the low progesterone. And now there's no hope left for this one. D&C is tomorrow.

Merry f***ing Christmas.

Bump in the Road

I got up to a very strange voicemail today: it was nurse Laurie from the doctors' office. She said something about how my blood work results came in and she was "really confused" about something and that I need to call her back right away. So I did.

She informed me that my progesterone is low and needs to be supplemented. I tried not to go into panic mode as the questions flooded my mind. Low progesterone is not good, but if it were a problem, I'd already know about it, right? I'd have spotting and cramping and I'd know that I were losing the pregnancy, right? The reason Laurie was confused was because according to my chart I was already 11 weeks along and I had only just now had my progesterone tested, even though I had had a miscarriage and should have come in for a progesterone check within a week after my missed period. OH, NOW YOU TELL ME. Bugger. Okay, does it help that I'm actually not quite nine weeks along? Hmmm. It was hard to ask her many questions, as she seemed to be semi-frantically trying to figure out my situation. I would only be on progesterone for two more weeks! Well, at least until my next appointment. Yes, I could come in for a sample right away and fill my prescription right away and that will help.

At this point, I had to cut in with questions. I was still stuck on, "It's low?" It just would not compute in my layperson's brain. How could it be low? So I asked what's normal. She told me normal is around 20, and mine was 8.72. YIKES. That just didn't sound good. But I keep telling myself that if it were a big problem, I would already know about it. And as soon as we see that heartbeat on Monday, we'll be in the clear, right? RIGHT??

Laurie urged me to come in immediately for a sample to use right away and for my prescription to fill, again, right away. I still hadn't showered. Erich was home for a snow day. While I showered and struggled to remain clear headed, Erich googled progesterone levels during pregnancy. When I came downstairs again, he showed me a chart that said normal for the first trimester was 9-42. Quite the range, and I was just below the low end. And progesterone levels can fluctuate. I'm probably fine...probably, hopefully.

I fishtailed through four inches of slush to the doctors' office. I picked up my sample and prescription and asked to talked to a doctor or nurse about this. She managed to pull Laurie away from the phone and I asked her some more questions. I can't even remember what all I asked, but I wanted to know how much I should worry. "Not at all," she assured me. Well, her words assured me, but her face and manner were so serious! I asked what kind of signs I would have that something was already going wrong. She answered, "Cramping and spotting." I remembered some crampy feelings I had had the other night. They weren't painful, but they gave me pause. "Some cramping can be normal," she said. Gee, thanks. She told me again to use the sample right away and fill the prescription TODAY. Yes, ma'am. And if I get pregnant again, come in right away for a blood test. Thanks for all the hope you're showing in THIS pregnancy.

I filled my prescription. I'm now on Crinone vaginal cream inserts. We'll see how this goes.

The First Appointment

I had my first appointment today and it went really well! It really made feel excited about this pregnancy, and that I should actually expect to have a baby next July.

Erich was able to go with me, which was awesome. We had to wait a while, as usual, and then I was called in for a weight/BP/urine check with a nurse. She used the little useless wheel calendar to determine my due date based on my LMP: July 11. Not gonna happen, but she wasn't allowed to go by anything other than LMP. She gave me an order for standard blood work, and I went back to wait. Even though I hadn't been looking forward to returning to this office for the first time since my D&C follow-up, the more I sat there, the better I felt about everything. I'm pregnant, it's early, and I was there for my first appointment. One day at a time. Big whoop.

Before too long, Erich and I were called back to wait in an exam room for Dr. P. On our way, the nurse stopped me to reclaim my blood work order and cross out the cystic fibrosis screening since I've already had it done.

In the exam room, I undressed and prepared to be examined for the first time in a long time, relatively speaking. When Dr. P burst into the room with a huge smile and a "Congratulations!" I couldn't help but feel happy and excited. "And you're ten weeks already! Wow!" I told her that wasn't accurate since I'm a late ovulator and she automatically responded, "Oh, that's okay, we can just do an ultrasound." I did a little happy dance. :) She immediately wanted to know what happened with me after she finally referred me to Dr. M. She seemed really pleased and proud of herself that it was a uterine septum, which I believe was her original theory. After a medical history questionnaire, she did a quick pap and then felt my uterus. She had to search a little since I'm retroverted, but when she found it, she said, "Oh yes, getting bigger!" This was a contrast to my first appointment last time: I was about a week further along, but when Dr. D went to find my uterus, she frowned and said, "You're not twelve weeks," which I knew, but then she went on to say, "You did get a positive home pregnancy test, right?" I guess my little septate uterus wasn't stretching at all.

Once the exam part was over, Dr. P assured us again that we would come in for an ultrasound as soon as possible, and we should be able to see a heartbeat on the ultrasound. The thought of seeing a heartbeat within a few days just made me sigh with relief and happiness. I know Dr. P appreciated that. She also said that by my next appointment they'd probably be able to hear a heartbeat with a doppler. And the next appointment feels so close since I'm doing such a great job of taking this one day at a time! On our way out of the exam room, Dr. P told the receptionist to schedule me for another appointment in four weeks and for the first available ultrasound. she emphasized again: "FIRST AVAILABLE." Then she asked for my blood work order again to add progesterone. She and I both know that low progesterone wasn't the cause of my miscarriage, but she said that since I had one they should test for it and they can always supplement if it's low. Okay, whatever! Since we had time, I went ahead and got my blood drawn right away after the appointment.

Second appointment is for 1/14 with Dr. D. And the first available ultrasound isn't until Monday at 10:30. Booo. But at least we're getting one before Christmas so that we have a visual aid when we tell people!

I Had a Dream!

Okay, I dream pretty much nonstop when pregnant--vivid dreams that I remember upon waking. But something I never dreamed about with my last pregnancy was either being pregnant or having a baby. I didn't find that significant before the loss, though I was anxious to finally have a baby dream, but afterward it made me think. Maybe my subconscious knew it wasn't meant to be, and that's why I never had a baby or pregnancy dream? Or maybe it meant nothing.

Of all my crazy vivid dreams this time, there have been three of note:

1. About a week before my BFP, I had a dream of five positive pregnancy tests lined up on the bathroom counter. They were VERY positive and one of them was actually saturated with pink dye. In fact, it was a picture similar to this real one:

I like to think that the middle one where I smudged my sharpie was the saturated-dye test of the dream.

2. The weekend after Thanksgiving, I had a dream that I was spotting at 6 weeks. I kept checking with my finger and coming back with a little spot of thin red blood. Just so you know, that's not realistic at all. In my dream, it was my knowledge that 6 weeks pregnant+blood=bad that made me freak out, but the emotion of the dream was not actually scary at all. I knew I was dreaming, and this was just a manifestation of an incident the day before involving a chapped but mostly healed cold sore that split a little bit and left tiny drops of blood on my fingertip.

3. This very afternoon, I had a dream that I was caring for a little infant boy--MY newborn baby. Now, I'm pretty sure this dream was due to the fact that I fell asleep in the living room while watching Bringing Home Baby on TLC, but I still enjoyed the dream. I was about to start breastfeeding the baby, and my dad handed me a pink afghan that I had made (but not specifically for myself) so that I could cover myself up. Throughout the dream I either held the baby or sat him in a carseat, and he was smiling the whole time. Sometime he let out a really relieved and satisfied sigh as only a dreambaby newborn can.

I wouldn't call that last dream particularly realistic, and therefore it can't have been prophetic, but I'm still taking it as a good sign nonetheless. And I'm almost seven weeks pregnant! Halfway through the first trimester, 12 days until my first appointment (and then the real worrying begins, but we won't ponder that right now).

Thanksgiving

Tomorrow, I get to the six week mark! This pregnancy is moving slowly because I'm anxious to get out of the first trimester, but I really can't complain. I'm happy it's still going. Plus, WOW, did my symptoms suddenly show up! I wasn't worried about the mildness of my pregnancy symptoms earlier because I knew it was still very early. In my first pregnancy, I had nothing that made me feel far out of the normal range until about 5.5 weeks.

Well, as of Thanksgiving Day, I was 5w4d and started to notice a major onset of symptoms. My yucky bloat turned into major bloat--certainly helped by the large meal. My tiredness has turned into major fatigue. And I'm pretty sure I've grown at least half a cup size in just a few days. I FEEL pregnant, and it's wonderful.

But, Erich and I, the receptionist at my doctor's office, and the girls on thebump.com are still the only ones who know I'm in the family way. We got together with Erich's entire extended family for Thanksgiving--36 people in all. We knew we wouldn't be announcing any news at this gathering. I know the family will be so excited, but I can't imagine that everyone would be able to hide their apprehension. Heck, I'm still nervous. So we enjoyed having our little secret, though I was surprised at the number of times I had to suppress little urges to exclaim, "We're pregnant!!"

Anyway, I wish I would be further along than 9.5 weeks at Christmas, but nonetheless, that's when we've decided to tell our families. I just hope it's at a time when everyone, including me, can be purely excited and not too worried that this one will end the same way as the last. I mean, I know it CAN'T end the exact same way, i.e. baby getting choked out by uterine septum, but this is a touchy subject now, thanks to all my reproductive baggage.

There is just no erasing my happiness, above all. I love that my current worries are of the somewhat trivial nature, compared to worries as to whether I would ever get pregnant again or have kids. And I LOVE the fact that I'm virtually six weeks along with no signs of anything but a healthy, normal pregnancy. Praise the Lord!

The Mantras

On the nest thebump.com, the ladies at the Success After a Loss message board have list of mantras, which I shall repost here (cleaned up for grammar and structure, because that's the kind of girl I am):

Today I am pregnant and I love my baby.

I am pregnant until someone tells me otherwise.

My past does not dictate my future. A previous loss does not mean I will have another loss.

Just because something sad is happening to someone else, does not mean it will happen to me. Miscarriage and complications are not contagious!

Hope does not make bad things happen. I cannot "jinx" my pregnancy by creating a ticker, getting excited, or telling someone. Live in the positive!

And this is the hardest one: There is nothing I can do to prevent a miscarriage from happening. Worrying myself sick won't prevent a miscarriage. And if, God forbid, it were to happen again, I know I will survive.

Intuition or Impatience?

Still pregnant! I took a third test in as many days this morning, and the second line was much, much darker. I'll still breathe easier when my period is actually late, but for now I can definitely say I'm knocked up!

It's funny how different I feel with this BFP compared to last January. Last January, I was definitely happy, but I was just so confused for the first three weeks. I couldn't figure out how far along I was. Actually, I thought I knew, but I turned out to be wrong--I had been pregnant for at least three weeks longer than I had thought. While I was happy to learn I was already nine weeks along and the time of greatest miscarriage risk was behind me, I still had trepidation. I couldn't bring myself to buy any maternity clothes or start registering for shower gifts. It just felt too soon. I was so glad I hadn't done those things when I did eventually find out about the miscarriage.

Did I know, deep down, my baby wouldn't live? Perhaps. But I think my trepidations were mostly a result of how new I was to the whole baby-making game. My second cycle off the pill had confused me greatly, and it resulted in a baby without my knowledge. In retrospect, I wish I had charted, but at the time I thought it would make me too obsessive. I can't say whether I really knew that pregnancy wasn't meant to be or whether I was just being cautious. It's too difficult not to view the past through the lens of the miscarriage.

Fast forward to today, and while the doubts and cautions are sneaking in, I am very excited. I believe that I will have a baby in July or early August. I found myself thinking in the past few days about how I want to get a onesie or a maternity shirt. I'm barely four weeks pregnant! Is this my intuition telling me that everything is going to be okay, or is it just that I'm so prepared and so ready to be pregnant that I'm not worrying too much about anything else? Either way, that's a good thing.

So it's going to be hard to keep this a secret. I feel like shouting it from the rooftops. But whenever I think about actually doing that, I do come to my senses. I wasn't sure before if we'd even tell family as early as ten weeks, but that's how far along I'll be at Christmas, and what a perfect time to announce. But we will not tell our larger circle of friends or the general public until well into 2009. I don't really want to wait that long, but from where I stand that wait looks a lot easier than the waiting I faced last February.

For now, I'm doing a pretty good job of taking this one day at a time. Now that my septum is fixed, I'm at no increased risk for miscarriage. And since I made it past nine weeks last time, I have no reason to believe I have any condition that might cause an early miscarriage. So I'll just keep taking this day by day while I stare at my three (and counting, to be sure) positive pregnancy tests!

Here We Go Again

It's been nine months to the day since I found out about my miscarriage. This is not sad for me, because I got my first positive pregnancy test this morning! I cannot contain my excitement. I thought I wouldn't blog about it, but I can't help myself. Therefore, this blog has become private for the time being.

Anyway, how about a story? This is our third cycle TTC since my septum resection surgery. I had a lot of hopes riding on the first cycle, as it was my only chance at a BFP before my original EDD. I was not pregnant. This was sad, but I got over it. However, I was a bit annoyed that I did not ovulate until CD28.

Cycle number two was even worse. CD28 came and went and I still hadn't ovulated! I was really depressed. I felt like my body didn't work, that I would never get pregnant. I made the decision to stop charting for a while and try to put it out of my head. I knew that trying to predict when I was going to ovulate is probably what delayed it. Sure enough, I started to feel PMS symptoms, and my best guess led me to figure that I had ovulated on CD32. Oh, and I was still not pregnant.

Luckily, I had a plan. I had done some reading about soy isoflavones, and how, when taken for five days at the beginning of the cycle, they would help stimulate my hormones to make me ovulate earlier. So when I got my period at the beginning of TTC Cycle #3, I already had the supplement on hand, which I took daily CD3-7. And to help predict ovulation and help reduce stress, I bought a pack of ovulation predictor kits. I knew Erich had a few business trips planned, so I really hoped that I wouldn't ovulate in the middle of him being away.

In mid-October, Erich and I visited his family down in southern Indiana. On our way home, we decided to do some shopping in Terra Haute. We wanted to buy Rock Band 2, which had just come out. And I knew there was a Dollar Tree store there, and I've heard lots about their pregnancy tests. So we stopped by, and I picked up five. No, six. And, of course, a bottle of water and some paper plates. I wasn't JUST buying pregnancy tests, no sirree.

Anyway, I ran out of the first pack of OPKs and decided to buy cheap ones in bulk from the internet. That was a good plan. Because I had to use a LOT of those puppies. Even though the OPKs continued to be negative, I started to be hopeful that I would ovulate around CD21. And then... spotting?!? WTF. Was this my period? What was wrong with me? I felt really horrible for about half a day. Luckily, though the spotting lasted a full 48 hours, it was never heavy and it did cease. My cycle was still in progress.

Halloween day I got my first positive OPK. I was readying the house for our Halloween party, and Erich had just gotten home from work. I was so happy about this, because if it weren't for the positive OPK, I would have had no idea that ovulation was imminent. Even though we both got pretty sauced that night, we made sure to give it the ol' college try. I got another positive the next day, and a few more days of high temperatures indicated that I ovulated on Sunday, CD29. [So I guess the soy did basically nothing but make me spot. I only took the smallest dosage, though, and was planning on upping it the next cycle if needed.]

I worried about the chances of conception based on when we "tried," but all-in-all I felt rather at peace. I felt really good knowing that I could see ovulation coming and that we did our part to make a baby. The "two-week-wait" was not too bad for the first eight days or so. But then the questions started flooding my head like they always do. "Is this PMS or pregnancy? Was that a menstrual cramp or implantation?" Tuesday I felt a few cramps, and I really thought it could have been implantation. Yesterday, after registering my highest temperature ever, I was feeling super curious. But I scolded myself not to test early. I hated getting BFNs that first cycle, and if I had just waited a few days, I wouldn't have wasted the tests because my period arrived right on time. But THIS time I had cheap tests on hand.

I told Erich my notion of testing on Thursday or Friday, thinking my good rational husband would talk me out of it, but he was actually in support of testing early. See, he's going on a big hunting trip with the men of my extended family this weekend (my period is due Sunday), and he didn't like the thought of me testing and getting a positive without him there. And plus, even if it were BFN, I still have five other cheap tests, so it's barely a waste. So with his permission, I got up this morning after another record-high temp, peed in my special pee mug (which says "I <3 Jim Halpert"), took out the test, used the dropper to carefully drop four drops of pee in the proper place, and we watched the line of pink move across the test. The control line came up right away and no second line, but it had only been about 90 seconds. Erich walked away, but I kept staring, fully prepared for a BFN. But then... it started to appear. It was faint but undeniable. I could see it without squinting or holding it up next to my face or tilting it just right. It was there.


Erich's reaction took me right back to my original BFP back on January 5th. His logical, rational brain just cannot equate the faintest of faint lines on a cheap little object to a baby. As for me, I am excited already. It's a bit daunting that I'm only 3 weeks and 4 days along, but getting pregnant at all is a big first step. And this time, I was expecting it. I already know I'm pregnant; there's none of the confusion or wondering "When did this happen?" that I had last time. And my uterus is remodeled and, as far as I know, totally baby-ready.

Barring any unforeseen difficulties, I'm due July 26. Yippee!!!

Another Septum Resection

Thursday night I managed to procure three pumpkins for carving. Actually, I really just wanted the seeds, but if you're going to cut open pumpkins, you may as well make jack-o-lanterns, right?

Why am I telling you this? Because one of the pumpkins had a definite septum! It was broad and three-pronged near the base and extended up into the cavity of the gourd. I successfully resected it by hacking away at it with a steak knife.

Happy Halloween!

Pregnancy and Infant Loss Remembrance Day

Today, October 15th, is Pregnancy and Infant Loss Remembrance day, for all those who have had a miscarriage, stillbirth, or who lost an infant due to illness or SIDS.

The loss of a pregnancy is the loss of a life, a unique individual with his or her own DNA and fingerprints. When parents mourn the loss of a pregnancy or an infant, they mourn not only the loss of the life but the loss of that individual's future and what could and should have been. Every single human life has value, and every single loss is felt deeply.

Please show you support by visiting this website, www.october15th.com, reading the information there, and, if you wish, join others in lighting a candle this evening at 7pm in honor of those who have lost a child through miscarriage, stillbirth and other complications.

The EDD

Today was the estimated due date for our baby.

I didn't expect today to be emotionally difficult. When we first learned our baby's due date on January 24, I was excited that I was already nine weeks along, and I earmarked August 27th in my mind as the general time of year that our baby would be born. I knew it wouldn't happen on that day. That day is already taken by my sister. :) Only 5% of women deliver on their due date, so I knew I would have a baby anywhere from mid-August to early September. August 27th was a ballpark figure, an idea, not a SUPER SPECIAL DAY.

So as this day approached, I was aware of it looming in the distance, but I didn't give it much thought because I thought I hadn't attached much importance to it. But really, I had. I had thought about how I would be gigantically pregnant in the dog days of summer. I thought about the kinds of clothes I would wear and what the baby would wear. I thought about how I would still have a few months to be able to go outside with the baby without bundling up. Because I had heard that glorious heartbeat, I assumed that by August 27th I would either be big as a house, in labor, or caring for a newborn for the first time.

That dream, as we know, was dashed to pieces only three weeks later. I went to the hospital six months too soon and the pregnancy was over, the baby gone. August 27 went from the symbolic day back to only my sister's birthday. But in the back of my mind, I kept it earmarked. Before I knew about the septum, I hoped, prayed, and even assumed that I would be pregnant again before that day. After everything I went through in five months, I still saw August 27th as the deadline for maximum possible joy. Luckily, I realized I'd have to be extremely fortunate to be blessed again already. (I'm not.)

So, yes, today has been difficult. I tortured myself by reading through chats and emails from before and after the miscarriage. I can't stop thinking about where I should be. Today has been a flood of memories, and while it feels healthy, it certainly doesn't feel good.

I had a chilling moment the other day. I was doing something insignificant and I thought of myself in the future, and I couldn't imagine myself pregnant. I had thoughts like that before I got pregnant the first time. "Other people have babies, but I can't possibly be worthy of something so wonderful," I thought. Even when I found out I was pregnant, I found it hard to believe. After my surgery, I found optimism and hope: I was certain that I would be pregnant again soon and that I would have a baby. But now I feel like that view has fizzled. Pregnancy is for other people; I'm not so lucky.

I know it will happen, but sometimes I don't believe it. Funny how that works.

But enough about me. Today is a day to remember our baby, the baby we will meet in heaven. We love you and we miss you, dear Keiki.

Comparison

I don't know why I was thinking about this the other day, but this is a post I had composed in my head shortly after my last surgery that I never got around to writing. But now I feel compelled, so here it is.

This is D&C and Septum Resection: A Comparison

Time of year
D&C: February 18, cold and blustery dead of winter
SR: June 27, gloriously sunny ideal summer day

Time of day
D&C: 6am, dark
SR: 8am, warm promise of a new day

Location
D&C: large hospital, parking garage, multiple wings, etc.
SR: Center for Surgery, not intimidating at all

Nature of Surgery
D&C: general anesthesia, performed via cervix, altering inside of the uterus
SR: same

Surgery preparation
D&C: no food or drink after midnight the night before, IV, pushed around in wheelchair/bed
SR: no food or drink after midnight the night before, IV, walked around myself when awake

Physical effects
D&C: pain, grogginess, feeling of rawness in the womb
SR: same, with slightly more pain

Psychological approach
D&C: sad, end of pregnancy, feeling of necessity to go through with it
SR: happy, joyful, beginning of hope for future pregnancy, spring in my step in the days leading up to it

Psychological effects
D&C: even more sadness in facing the loss, feeling of being thrown into a state of confusion and doubting ability to have children
SR: smile plastered to face, a sense of returning to normal and feeling completely renewed hope in having children


I really feel as though I've returned to normal in many ways. I am forever changed by my experiences, but they haven't destroyed me in any way. A few days ago, something compelled me to pick up and read the journal I wrote in right after my loss. The tears sprang up anew, which was okay because it reminded me that I'm human and will always be affected by my loss. But reading the confusion and doubt that I expressed in that long, cold winter reinforced my hope for the future.

Truth be told, I'm getting a little bit obsessed with TTC, but not in a totally crazy way. I'm enjoying learning about my body yet hoping not to have to wait too long before I'm expecting again. But, TTC is not the topic of this blog, so I'll leave you here. I just wanted to say, now that it's been six weeks since my surgery, that I am very happy and hopeful!

*BIG GIANT HINT*

Someone posted this on the Nest, and I need it. I've been saying for a while that I need a stuffed uterus, and this one seems cute. So, someone should buy me this:

Mission Accomplished

It's not my intention to let this blog die, but at the same time, I don't really have much to say anymore.

According to my drop in temperature today and my spotting yesterday, today starts the first full cycle with my newly remodeled uterus. [I have no idea whether to expect a normal period--can any former septum-ites give me some insight?] I no longer feel compelled to share the nitty-gritty details, since I'm now "normal." And given my history and as I've discussed earlier, we won't be quick to announce to the world when we get a BFP. Part of me doesn't want to tell anyone until it's really obvious to the naked eye, but my family may rest assured that they'll probably hear of it before that. :)

I'm also unsure whether I'll start posting in this blog again with updates down the road or whether I'll start a new one and let this one remain archival. Decisions, decisions. I'm glad they're some of the toughest decisions I'm facing right now!

I don't think this blog will die. But it may be pretty quiet for a while. Thanks for reading.

The Photos

I've alluded to the fact that Google and I are friends again. That is, of course, because Google doesn't have to try to figure out what kind of uterus I have. I finally know for sure! And I've got the pictures to prove it. Get ready for these; they're not for the faint of heart.

Here we go:

Consider this the "Before" picture. When I first looked at this (I was still heavily drugged) I thought the black things were shellfish eyes. But no! Those are the two sides of my uterine cavity. Our little Keiki grew in one of those sides till s/he ran out of room. :(

This is right after Dr. M started cutting the septum away. You can see the top and bottom starting to pull apart.

And now we shed light on the black holes. Here's one tube...

And here's the other.

And here's where the septum once was! All cauterized away. Erich described it as looking like cooked chicken. I believe that description is apt.

Consider this the "After" picture. I believe the hysteroscope is in the same position as in the first view. Big difference, no?

And for the cheap cartoon version:

Dr. M did this illustration to describe the procedure to Erich while I was still flying high. It's pretty self-explanatory. :)


P.S.: I've had on and off pain and bleeding since Friday, but I think the worst is behind me now. I shall patiently wait for AF (piece of cake!) then it's TTC, here we come!

The Septum Resection

My life is filled with hope again.

Yesterday morning, Erich and I arose around 7am after I had bad dreams that I was eating and drinking in the morning when I was not supposed to. I was glad to wake up and realize that I did not disobey the rules for anesthesia. :) We arrived at the Center for Surgery around 8:20--10 minutes early. I got called back about 20 minutes later, gave a urine specimen (giggle), changed into the oh-so-flattering hospital gown and got an IV. The nurses at this surgery center are very skilled. I could barely feel the IV in my hand! I appreciated that. I also had my blood pressure checked a few times, and the cuff totally squeezed too hard the first time, and I have streaks of broken capillaries on my upper arm. Yay, battle wounds!

Erich got to sit with me for the last 30 minutes while I waited to go in for my 9:30 procedure. The nurses were more anxious for Dr. M to arrive than I was. They seemed a little uptight, but I'll take that over careless any day. Then again, he did kinda swoop in at the last minute. He explained the procedure again and told me what to expect afterwards then went to get ready. I was walked to the OR and got on the table. Soon after the anesthesiologist told me she was putting the sleepy-time drug in my IV, my arm felt that familiar tingly discomfort, and that's the last thing I remember.

Before I was aware of anything, Dr. M went out to show Erich pictures of the procedure and described how everything went. (I scanned these pictures already, but I'm going to tease you, Scheherezade-style, and post them later. ;) Shortly after I came to, a nurse brought Erich to the recovery room. Remembering that first half-hour or so is like remembering a dream. Last night, I kept saying things to Erich like, "I had a tube in my nose!" and "You fed me ice chips!" [ETA: "I ate crackers!"] I thought I was awake, but MAN was I drugged.

During the procedure, saline was pumped into my uterus to keep it inflated (for lack of a better word) to give Dr. M room to work. My body absorbed that saline, and a catheter drained it out through my urinary tract. The nurses would not release me until I had passed enough fluid. So while we were waiting, my recovery nurse went on lunch, and I got another one, who was very concerned about sending me home with written recovery instructions. She went out to go find Dr. M and I heard her say to him, "Susan K---- has a few questions for you." And I was like, "huh?" So when he came in and looked at me expectantly, I explained that the nurses just wanted him to give me instructions again. He nodded and said, "My instructions are to go home." Heh heh. But he reminded me of what he had said earlier while the nurse wrote it down on my discharge sheet. Basically, I can't take a bath for a few days. Whatever.

We got home a little before 1pm. I pretty much relaxed on our La-Z-Boy loveseat, watching Pride & Prejudice (BBC version) and the Cubs (who LOST, boooo) while Erich tried to remember that I was recovering and not just being lazy. Kidding; he did a great job. There was moderate bleeding, but I'm pleased to report that there is now next to none! Last night, I stepped on the scale (I weigh myself far too often) and was horrified to see that I gained six pounds in a day. Then Erich reminded me, "Baby, you drank saltwater through your uterus!" Oh yeah. That's why my eyes are half-closed from puffiness. :)

Today I'm less puffy, but I've had more pain as the anesthesia has entirely worn off, and I'm afraid I may have overdone it a bit when Erich and I went out to run a few errands. But I have some Darvocet which they had already called in for me (and which I definitely WON'T be taking more than I need to--I hate that drugged feeling), and after relaxing for the rest of the afternoon, I'm feeling generally pretty good.

So I believe we can now consider my womb improved. I started reading Mayo Clinic Guide to a Healthy Pregnancy again today. I want to get a good start for our next baby! :)

A Letter

Dear Septum,

You don't know how long I've been waiting to tell you my feelings. See, even though you've been with me all my life, I never really understood what you meant to me until recently.

You've been pretty quiet all this time. No offense, but I didn't even know you existed. In fact, I found out from Google that you were supposed to disappear before I was born. I won't say I'm offended that you wanted to stick around and make a home in my uterus; it's just that you weren't really invited, were you? Kudos to you for some Grade A squatting. You basically lived rent-free for 25 years, and that's no small feat.

I understand you might have felt a bit threatened when you got a roommate in the uterus. But, Septum, you need to realize that you had overstayed your welcome. The uterus is supposed to be a place for a baby, and you just couldn't let go. You refused to budge and the roommate had no choice but to leave. Was that right? In your heart of inadequately vascularized fibrous hearts, you knew that was not the best choice.

You had one chance, Septum, and you blew it. That's why I invited a surgeon to slice and vaporize you into oblivion. So this is my farewell to you, O Uterine Septum. I hardly knew you, yet you made an impression on my life that will never go away. I won't miss you.

Sincerely,

Your Former Landlady

The Next Biggest Viral Video

....NOT. I tried to make Erich watch this, and he just couldn't quite stomach it. Me? I found it fascinating. That's a little weird because I'm the one who can't watch a needle go into my skin.

Thanks to Google (we're friends again after our love/hate relationship), I found these totally awesome videos of real, live septum resections. It's what they're going to do to me tomorrow!

Enjoy:

http://www.layyous.com/root%20folder/hysteroscopy_videoclips.htm



Also, Dr. M still rocks my world. I had a few questions for him, so I sent them to him electronically through his really cool website, and he called me back yesterday evening and cheerfully answered them all in detail. I think he may be the best doctor I've ever had for anything. :)

The Hysterosonogram

Thank you to everyone who left me a comment, both here and on Facebook. It's humbling to have so many people pulling for me and my little ute!

I feel compelled to post in detail about my experience, as in days of yore.

As you've probably gathered from my preceding posts, I was not feeling particularly excited about my saline u/s. I was annoyed that my last cycle was so long, which delayed scheduling the test that I was absolutely certain would tell me what I already knew. And then, I was sure I would have to wait another cycle to schedule surgery, and just to tease me, my body would come up with an even longer cycle to make me wait through. All I saw was more waiting, so it was definitely difficult to muster up excitement for one short and possibly painful stirrup experience.

But by Sunday night, I was excited. Dr. M just exudes knowledge and experience, and I was so glad that he was finally going to be the one looking at my insides. The procedure was all I had on my schedule for Monday, and I was finally looking forward to it.

I showed up a few minutes early, and promptly had to wait another 20 minutes before getting into the exam room. But hey, what's 20 minutes after four months? A nice assistant who didn't tell me her name escorted me to the bathroom, where I emptied my bladder, and then to the exam room, where I was glad I hadn't brought along Erich or my mom. There would have been no room for anyone else! I hopped up on the table and covered my lower half with the paper sheet. Now, as much as my modesty has gradually flown out the window since I found out I was pregnant, it's still difficult to greet people wearing nothing below the waist--and then have those same people do things like visualize my cervix and insert instruments. Just makes me feel like I deserve some flowers or something; that's all I'm saying.

The catheterization was no picnic, but it was nothing compared to my HSG. I think the radiologist had a "get it over with" style whereas Dr. M was "steady as she goes." Much better for pain management. Within minutes, he was performing the internal ultrasound and I could watch on a little screen right by my face. Before he injected the fluid, he gave his prediction that I have a uterine septum and not bicornuate. Very little after that surprised me.

The saline felt weird, a little like peeing in reverse. On the ultrasound, the saline showed up as bright white and the walls of my uterus were dark. Dr. M very skillfully moved the probe and pointed out to me the division in my uterus. As he moved the image upward he pointed out how the two sides of the cavity get narrower and further apart as the septum broadens near the top. Then he slowed down at the point where the fundus of the uterus filled the screen. He had me note how it was solid and dark from one side to the other and told me that if it were bicornuate, there would be some open space across the middle. He told me that the two sides join at the bottom and I have only one cervix. It just seemed so clear and so simple. I know from my research that I have every reason to be extremely grateful that Dr. M is so knowledgeable and experienced, yet it seemed like any doctor should know this. Knowing that so many other women go through much more just to get a simple diagnosis like mine... well, let's just say I'm very grateful.

And just like that, it was over. I sat up and Dr. M mentioned the hysteroscopy and I was like, "sign me up!" so he asked where I was in my cycle. I told him day 12, and while he thought about that I told him that I take my temperature every morning, and even though I know that's not the best way to pinpoint ovulation, I think it's pretty clear that I ovulate late. "How late?" he asked. I told him Fertility Friend put it at day 25 last cycle. He said, "Oh that would be fine. Let's see if I have any openings this Friday." I was delighted and just a teensy bit incredulous. I had no idea it would all happen this fast! He gave me that professional smile that seemed to say, "I know how much of a difference this makes to you to have this done so soon." I was so excited but not yet getting my hopes up for surgery this week.

But after I reclothed myself and walked out to the common area, the nice nameless assistant gave me the same knowing smile and told me they would call me to let me know what time my procedure would be this Friday. It was all I could do to keep from clicking my heels. I got a bunch of PNV samples and went on my way. About half an hour later, they called me to confirm surgery for 9:30am this Friday.

I'm still just so happy I don't know what to do with myself. In less than two days my septum may be completely gone! We could be TTC by next month!

And I have learned through all this that God's time is best. Thanks to my long cycles, I can have surgery this week. Thanks to my last cycle ending when it did, I could schedule the test for just the right time to be free for surgery before it's too late in this cycle. And I'm glad I take my temperature and know that I ovulate late, and I'm glad Dr. M is a great doctor who took me at my word. And best of all, I have learned the extremely important virtue of patience.

Hysterosonogram: Done

Bad news: I have an abnormal uterus. (But we already knew that!)


Okay news: the abnormality is definitely a uterine septum, and not bicornuate. (We were pretty sure of that.)


Absolutely fantastic news, deserving all-caps:

I AM GOING TO HAVE SURGERY THIS FRIDAY TO FIX MY UTERUS!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!


Patience, my friends. Patience pays off. After more than four long months of waiting, waiting, and more waiting, I'm finally, officially, on my way. I feel so grateful (thank you, God!), relieved (aaahhhhh), happy (HOORAY!!), and if you looked those words up in a thesaurus I'd feel all those other words too.

I don't think anything could spoil my day now. :)

Excitement

Okay, I'm starting to get pretty excited. Less than 18 hours until my hysterosonogram/hsg/sonohysterogram/shg/saline ultrasound/whatever you wanna call it.

Bring on the saline and tell me what I want to hear!

A Decision

My hysterosonogram is getting closer, and I'm trying to muster up some excitement. It's difficult, though, because I don't expect to get a lot of new information and I'll certainly have to do more waiting afterward. It will be nice to have a final word (I hope) from Dr. M and to find out whether/when I may have surgery this summer. Beyond that, this is yet another step, and I don't expect to feel much different after the procedure than I do now.

My moods and feelings have evolved in interesting ways in the last four months. Right after the miscarriage, I was so anxious to try again. It felt like I had to make up for lost time. I no longer feel that way: I now want to be pregnant again because of my pure desire to be a mother. It felt good to turn over that leaf, as though my grief had come to completion. I still get sad and cry over the baby I lost, but I can function again, and it feels good.

Another way my feelings have evolved is in regards to transparency. Having been active on thenestbaby.com, where perfect strangers share all, I got into a mindset that I'll be open and up front about our TTC journey on this blog. Last time, we cautiously waited to tell family and friends about our BFP, but it was still too soon. On the other hand, I was glad people knew, as we received so much support from said family and friends. We felt bolstered by their thoughts and prayers, and for that we are still grateful. So, I thought we wouldn't wait at all to tell at least our families next time we get that BFP. The more people we had praying for us and our baby, the better, I thought.

Erich has been of a different mind all along, and now I fully agree with him. We are jaded. We have lost the innocence that goes along with being first-time parents. Not only do I worry that it will be difficult to get pregnant again, I also dread that second pink line. It signifies so much that could be and so much that could be lost. We had no choice but to share our grief last time, but if, God forbid, there should be another loss, we would prefer to limit the number of people who know about it.

So the decision is this: if and when my uterus is ready for pregnancy, this blog will have served its purpose. Posting won't necessarily stop, but it will probably slow as we move on to the next stage. I plan to resume posting when I'm pregnant again, but only after we feel comfortable announcing it to our family and friends, which may be after I'm out of the first trimester.

As soon as we're TTC, I'm going to stop drinking, I'll cut back on caffeine, and I'm going to eat and behave as though I'm pregnant so that no one IRL will actually know if I am. We don't wish to be secretive or anything, but we have learned that "being pregnant" and "expecting a baby" are two very different things.

I'll let you know when we are expecting a baby.

CD 2

This has been a rough cycle, folks. Very long--38 days. But at long last, my favorite auntie has come to town and today I scheduled my hysterosonogram.

June 23 at 1:15.

Time to wait!

OMG, Cyanide and Happiness

I like this comic. Sometimes it flies over my head, but most times it just puts me in stitches. I read today's and first said, "Whaaaa?" and then I was like, "Oh I get it, people can be rude in insensitive. I know what that's like!"

Enjoy. (You'll have to click on it, which will take you to the site so that you can actually read it.)


Cyanide & Happiness @ Explosm.net

ETA: Tim helped clarify the genesis of this comic for me in his comment. Still funny, I think. :)

All I ever do is wait

The day after I made my last post, Fertility Friend decided that I ovulated on CD23, so at least I'm in the latter part of my cycle now. So AF is due around Monday, which puts the CD6-12 window for the saline ultrasound... (drum roll)... simultaneous with my trip to Galena, IL! Hooray! (NOT.) But, I know I'll be able to work around it. At the very least, I can beg them to let me do it the next week, since I ovulate so freaking late. On the other hand, I want this done ASAP. I guess I'll just see when dear auntie rears her ugly head.

In other news, I recently read about someone (whose screen name will go unmentioned) who just had an MRI to diagnose an MA. She is, get this, hoping for bicornuate because, GET THIS, she doesn't want surgery! I'm having trouble wrapping my head around this. For a recap:

Septum:

• up to 90% miscarriage rate
• easily treated with simple, non-invasive surgery and short recovery time
  
• normal post-op miscarriage rate with no other increased pregnancy risks

Bicornuate:

• miscarriage rate 40-60%
• only surgery to treat is horribly invasive and not usually ordered (and when it is, you sit and cross your fingers, hoping scar tissue won't make you infertile)
  
• heightened risks of preterm labor, intrauterine growth restriction, cervical incompetence, and breech presentation, necessitating c-section

Everyone has a right to want what they want out of their own bodies. But as for me and my uterus, I pray for septum.

Still Waiting!

For the record, I'm still just sitting around, waiting for AF so I can schedule (then wait for) my saline u/s, which will be performed to confirm what I am 90% sure is true.

CD25 and I haven't even ovulated.

I hope there's an extra special reward in heaven or on earth for patient waiters like me.

Here's some inspirational quotes posted by a gal on the MA Yahoo! Group:


I've started to realize that waiting is an art, that waiting achieves
things. Waiting can be very, very powerful. Time is a valuable thing.
If you can wait two years, you can sometimes achieve something that
you could not achieve today, however hard you worked, however much
money you threw up in the air, however many times you banged your
head against the wall. . .

--"The Courage to Change" by Dennis Wholey

The people who are most successful at living and loving are those who
can learn to wait successfully. Not many people enjoy waiting or
learning patience. Yet, waiting can be a powerful tool that will help
us accomplish much good.

We cannot always have what we want when we want it. For different
reasons, what we want to do, have, be, or accomplish is not available
to us now. But there are things we could not do or have today, no
matter what, that we can have in the future. Today, we would make
ourselves crazy trying to accomplish what will come naturally and
with ease later.

We can trust that all is on schedule. Waiting time is not wasted
time. Something is being worked out - in us, in someone else, in the
Universe.

We don't have to put our life on hold while we wait. We can direct
our attention elsewhere; we can practice acceptance and gratitude in
the interim; we can trust that we do have a life to live while we are
waiting - then we go about living it.

Deal with your frustration and impatience, but learn how to wait. The
old saying, "You can't always get what you want" isn't entirely true.
Often, in life, we can get what we want - especially the desires of
our heart - if we can learn to wait.

Today, I am willing to learn the art of patience. If I am feeling
powerless because I am waiting for something to happen and I am not
in control of timing, I will focus on the power available to me by
learning to wait.

--"The Language of Letting Go" by Melody Beattie



That said, I'm trying my darnedest to just live my life. I have plenty going on to keep me busy. I am calm; I am patient.

Birthday Today

I was supposed to have a baby when I was 25. I hope that can still be true!




That is all.

New Theory

MAYBE during the HSG, the pressure of the dye from the catheter pushed my septum to the side, mimicking a blockage. That HSG sure did hurt. I renew my supposition that the HSG will eventually be disregarded, and I find myself wishing that Dr. M had been in on all this from the beginning.


I told you it was going to be a long month before the next test. Stuff like this goes through my head NON. STOP.

My Crazy Uterus!

My uterus is strange. My uterus is a mystery, a shape-changing enigma just waiting to be figured out by the medical professional who endeavors to study it.

I got a call back from Dr. M today. There's good news and weird news. (No bad news!) I'm liking lists lately, so here's the good news:

• He's already looked at my HSG and U/S, only three days after our appointment, two days after I dropped them off.
• Based on the U/S, he thinks it looks pretty clearly like a uterine septum with maybe (MAYBE) a little bicornuate-ish (his words) split on the outside.

Weird news:

• Paraphrase from voicemail: if both CDs didn't have my name on them, he would have thought they came from two different patients.
• Based on the HSG, he would not have called my uterus abnormal: not bicornuate, not unicornuate, no septum. He would have called it a normal uterus with a fallopian tube blockage.
  
• "Looking at the ultrasound, there is nothing that looks at all like the HSG."

He mentioned the possibility that films got mixed up. If I hadn't witnessed both tests myself and already known how different they were, I'd agree with that as a possibility. I still vote for disregarding the HSG, but I know all things should be taken into account for now. And that's why Dr. M will perform a saline u/s, which I will schedule when AF comes to town again, in about three weeks.

So for the timeline update, it looks like I'll have a saline u/s around mid-June, and I'll most likely have a septum resection, probably in July. That would mean being able to try again by August! That would help keep with my goal of being able to try again before the EDD of my first pregnancy.

Even though this is going to be a long month before the next test, and even though I wish things could be moved along a little faster, I'm in a good mood right now. It won't be long before my "Womb for Improvement" is cleared for renovations! Then I can hang an imaginary "room for rent" sign on my cervix.

(That was a little crass. I don't apologize.)

:)

Back from RE

I like Dr. M. He knows what he's doing, so I don't have to, and that is a great relief. We have a plan! And he confirmed the plan by sending me a letter via the patient portal on their website within minutes after our appointment. I like that.

The one frustrating thing is that due to HIPAA stuff, he has not yet been able to look at the images from my HSG or U/S, so I will have to obtain those and give them to him. If I had known that already, I would have gotten them ahead of time. But luckily, I don't have to worry too much about wasting more time. Without further ado, I present to you Our Plan, which I will transcribe/paraphrase from the letter.

From this point, there will be one of three outcomes:

1. If I have a definite bicornuate or unicornuate uterus, then he will not do surgery now but instead have me attempt pregnancy.
2. If I have a uterine septum, he will discuss hysteroscopy further for septum resection.
3. If he can't say with certainty what I have, he will perform a hysterosonogram [saline ultrasound].

Whatever the outcome, we can expect to be able to try again within a few months. Hooray! I'm still putting all my hopes into SU, since pregnancies can be so complicated and uncertain with BU or UU. (Even though my HSG report says UU, that's extremely unlikely, so I can pretty much not worry about that one.)

Some other things of note which Dr. M shared:

• 1 in 200 women has a bicornuate uterus.
• Surgery is not usually done right away for BU, but is considered if it is determined to be the cause of multiple miscarriages.
• He has performed surgery on BU, but only about once a year or less. (That sounded like a lot to me, which means he's experienced!)
• He can usually tell from hysterosonogram the difference between SU and BU, and if it's SU, he does the resection via hysteroscopy. He said there would be no incision, so I guess he does not feel the laparascopy is usually necessary.
• He performs septum resections several times per month. (Yes! Yes! Yes!)
• He saw no reason to do any other kind of infertility work-up, blood work, semen analysis, etc. I love that he's not ordering all kinds of unnecessary tests!

So, by tomorrow I should be able to have obtained digital images from my HSG and U/S. I'll drop them off at Dr. M's office (which is less than 10 minutes from where I live!), hope he has time to review them soon, and find out what happens next!

Hopeful Mother's Day

My MIL wished me a hopeful Mother's Day. Her wish is coming true! Turns out, I'm just not bothered at all. Though I honor all mothers this day, I realize that it is kind of a made-up holiday to sell cards and flowers. Just saying.

But anyway, Erich FTW!

I came home to this yesterday afternoon. Here's the note:

It's perfect!

I love these reminders that it's all about him and me. We want children badly, but it starts with us and our love for each other. Pardon my mushiness, but it's true!

To all mothers: Happy Mothers Day!
To all mothers of lost babies: Hopeful Mothers Day!

To all women: You are special on this and every day!

Mother's Day

Talk about a hairy subject. I still don't even know what to think about it. Prior to 2/13 I was kind of looking forward to it--my first Mother's Day! Now I feel as if it's been taken away from me. Sure, I'm a mother, but the world doesn't see me that way, and even if they did, the fact remains: Mother's Day is not a happy occasion for a mother like me.

So now, as usual, I'm torn between wanting to be acknowledged and hoping to be overlooked while focusing on mothers around me who have been blessed with the ability to hold their children. As the day draws closer, the more I realize I wish it didn't exist at all.

I've also noticed another trend: my fertility journey has been defined by small incremental steps. Between each step, I go through a particular emotional process:

Part 1: Frantically try to process newly learned information.
Duration: ~1 day

Part 2: Experience relief that another step has been completed.
Duration: ~2 days

Part 3: Wait patiently with hopes that the next step will be progressive.
Duration: however long it takes to get to Part 4

Part 4: Worry that the next step will not be productive, nothing new will be learned, and/or I'll have to tell the doctor what to do or find a new doctor.
Duration: 5-7 days preceding next step

Part 5: Depression. Preparing myself for the worst: total and hopeless infertility.
Duration: concurrent with the final days of Part 4

Guess which part I'm experiencing right now? Yes, part 4. And Mother's Day comes just two days before my RE consult, so I'll probably be in the depths of part 5 just when all of America gets gooey about new and expectant moms. I'm not trying to be pessimistic, but I can't help it that my excitement wanes as my worries resurface.

So I'll cling to something totally arbitrary and choose to call it a good sign: my RE appointment is May 13, exactly three months after I failed to hear my baby's heartbeat.

Baby Mama

Erich and I went to see Baby Mama last night, the new movie with Tina Fey and Amy Poehler. I knew I wanted to see this movie because it looked pretty good and both those women CRACK ME UP. But I knew I HAD to see it when I found out that Tina Fey's character has a t-shaped uterus.

Did you know that a t-shaped uterus is a Müllerian Anomaly? If all your info on MAs has come from this blog alone, you probably didn't. I haven't discussed it since it doesn't apply to me. It's one of the rarest MAs, and it usually can be traced to the mother's ingestion of diethylstilbestrol, or DES. Sometimes prescribed to mothers between the 1950s and early 1970s, DES was thought to help prevent miscarriages. Despite insufficient study data, doctors continued to prescribe it through the '50s. In the '60s, data suggested that miscarriage rates for mothers prescribed DES were no lower than the general population, but doctors continued to prescribe it. And finally, in the '70s, scientists began to discover all the bad side effects of DES. In addition to uterine malformations (sometimes lacking a uterus entirely), the so-called "DES Daughters" were also more prone to various cancers, including cancer of the vagina and cervix.

In the movie, Tina Fey's character is 37 and trying to get pregnant via a sperm donor. All her attempts fail, which a doctor finally blames on her t-shaped uterus. (The line often featured in promos: "I just don't like your uterus.") In reality, a t-shaped uterus doesn't necessarily effect fertility. Like other MAs, it's associated with higher miscarriage rates as well as heightened risk of preterm labor, incompetent cervix, and fetal malposition. Also, her mother claims to have taken DES (though I don't think they name the drug in the film) to cure liver spots. I don't want to give any spoilers, so I'll just say that in sum, the movie has several inaccuracies.

Did these inaccuracies bother me? Not in the least! Anyone would be crazy to go into a comedic film hoping for a science-based anatomy lesson. Her uterine anomaly is simply a device to get to the main plot of the movie, which is the rocky friendship between Tina Fey's character and her hired surrogate mother, played by Amy Poehler. I really liked this movie. It was very funny and sweet in the right places without being sappy. And it is quite refreshing to see a real comedy with substance headlined by two female leads. My verdict: thumbs up.

Infertility Blog

There is a certain Dr. Licciardi who specializes in infertility and keeps a blog. As blogs go, I wouldn't say this is an absolute gem, but he does give good information for those struggling with infertility. Back when I was googling up a storm, I came across a few posts of his, which touched upon septate/bicornuate uteri. Thanks in part to his info, I am not ready to believe my uterus is bicornuate.

In this post, he describes the difference between SU and BU in a straight-forward manner:

This is an issue I have been dealing with since the start of my practice. It’s the identical story over and over again. I came across the same thing 2 times this month. The issue is far from trivial because the proper diagnosis will change the method of treatment. Delayed diagnosis (sometimes for years) will delay and sometimes prevent pregnancy.

OK, what’s a bicornuate uterus? A bicornuate uters is an abnormality in the way the uterus is shaped. It does not develop; some women are born with them. Uterine and/or vaginal abnormalities that are present from birth are lumped into a category of Mullerian Abnormalities. There are many different varieties, and all are rare.
In a girl embryo, the uterus starts as 2 tubes that merge together to form a larger hollow structure. If the 2 tubes do not completely come together, a bicornuate uterus develops. It is a uterus with 2 horns , one going out to the left and one going out to the right.

This is a very general description. There are tons of variations. Some bicornuate uteri have larger horns and are not connected in the middle, and others are mostly connected in the middle with just a small amount sticking out as horns.
Here's the rub. I have seen many patients who were told they have bicornuate uteri but their real diagnosis was a septum. This mistake has happened even if the patient had a HSG, 3-d ultrasound, 3-d sonohysterogram, MRI or even hysteroscopy.

So what? It’s a big what. The uterus with the septum is smooth over the top. The bicornuate dips at the top, sometimes considerably.

So one nurse telling me it's "bi-corny-it" doesn't do it for me. I expect my RE to know the difference and properly diagnose me.

Dr. Licciardi describes the implications of different diagnoses in this post:

The reason it is vital to know your diagnosis has to do with treatment. If you have a septum, most (not all) doctors would recommend treatment. This is because an experienced reproductive surgeon can fix a septum relatively easily. It’s done through the vagina using a hysteroscope. The doctor looks in, then slides a tiny scissors through the scope and makes small cuts at the septum until it is gone, making the uterus normally shaped. Some doctors will recommend a laparoscopy at the same time to guide themselves through the surgery. Others will perform the surgery using the hysteroscope and an intra-operative ultrasound to guide them, avoiding the laparoscopy portion. In either case, patients go home the same day.
A bicornuate uterus is a whole different story. To fix this a doctor needs to perform a laparotomy (an incision into your abdomen), then slice the uterus wide open, then sew it up in such a way that the 2 sides come together to make one round uterus. As you can imagine, this has a much higher complication rate, and has a higher rate of infertility due to post-op scar tissue. Hospitalization can be 2-3 days. Full recovery is 6 weeks. Because this procedure is more difficult and has a higher complication rate, it is rarely performed.

This gets us back to the very beginning. If you have a septum, but your doctor calls it a bicornuate, you probably will not be offered treatment and be faced with continued increased odds of infertility and miscarriage. If the correct diagnosis of a septum is made originally, you could have a more simple procedure that may increase your odds of reaching your goal.

Many patients have come to me with a diagnosis of a bicornuate uterus. Told surgery was not a good option, they ask me what else can be done to help them get pregnant or reduce their odds of miscarriage. Some actually have a bicornuate uterus. Some are very surprised when I tell them they really have a septum and should revisit the surgical option.

If it turns out it is BU, so be it. But I won't believe it till I hear it from a specialist. Oh, and have I mentioned that SU is twice as common as BU? According to this study (PDF document; scroll to the second page for a chart), SU occurred in 1.4% of the population, and BU in only 0.7%. Now, we all know how I feel about the odds, but now that I'm much, MUCH more hopeful and optimistic (I WILL have babies), I feel comfortable with hoping for the most common of the MAs.

"ABNORMOL"

At the imaging center when I was checking in for my ultrasound, I peeked at the chart, and I saw the above written in big letters. I had to grin. "Abby someone. Abby Normal." That's me!

Just now, I asked Erich, "Why do I have to be the one with an abnormal uterus?"

His answer, with his signature dimple and eye-sparkle: "Because I don't have a uterus!"

Love that man.

The Next Step

I'm so glad I didn't have to wait too long to get to this point: I have been referred to an RE. Though I was expecting an MRI (and may still have one), I find myself very relieved that no more time is being wasted on tests ordered by someone who just doesn't have enough knowledge about my problem. So, goodbye for now, Dr. P and hello, Dr. M!

The person who called me this morning (another office monkey, I don't know if it was a nurse or what), said my uterus is bicornuate. She pronounced it "bi-corny-it." I still refuse to believe that's the final answer. I know for a fact that the ONLY 100% reliable diagnosis is the "gold standard" laparascopy/hysteroscopy combination. Unless surgery confirms complete bicornuate, I choose to believe I have a treatable problem. I'm so happy that I'll be able to make a list of all my questions and have a hope of getting them all answered by a person who specializes in uterine abnormalities and surgery!

My appointment is May 13, three weeks from today. Again, I wait patiently. I realized after my last post that I have reached some kind of mental equilibrium. I find I worry less and less about what's going to happen as I gently oscillate between waiting with mild depression and waiting with patience and optimism. I feel pretty confident right now that I'll be able to wait out the next three weeks with optimism.

Three weeks really isn't long to wait to see an RE. I have a lot to keep me busy in the meantime. I can stay positive.

Waiting

Always, always waiting.

Life is going on: everyday activities are not on hold. But right now, my life seems to be a series of waiting for the next thing. Waiting for my stupid period, waiting for a test, waiting for test results, waiting for another test, waiting for more test results and waiting to hear what test I'll have next.

Hope has been a constant ebb and flow. Every fresh surge of hope starts to fade before I'm done waiting for the next thing. I'm hoping for the hope surge that lasts nine months and is only the beginning.

I'm getting used to this process. I've come to assume lots of things. For one thing, I assumed I would not get straight answers quickly. I still assume straight answers will be hard to come by for a few months. I assume I'll have to ask questions and be insistent about what I know in order to keep moving forward. I assume I'll be put through more diagnostic tests before the word "surgery" is even mentioned by the medical professionals. And, of course and above all, I assume there will be much more waiting.

I'm waiting for my doctor to call me with results from the ultrasound. I hope she calls me soon and that she is knowledgeable about my problem. I assume that MRI is up next. I'll wait for that test. I hope it shows that I have only a septum and an otherwise normal uterus. I assume that no matter the outcome, I'll have to wait several weeks or months for treatment/surgery. I hope diagnosis/treatment/surgery is successful. I assume that I'll be able to have kids in the future. I hope I don't lose any more babies....

It doesn't end.

Optimism Returns!

Just as I had feared: the HSG was almost a complete waste of time. It was such an uncomfortable procedure, it yielded unexpected results, and the cramping and need to wear pads afterwards brought back some really painful memories from my m/c and D&C. Up until last Thursday, I was thinking, Okay, I have either SU or BU. The HSG had me thinking I either had a unicornuate uterus (do not want!) or a normal uterus tipped to the side for some reason. It took the wind out of my sails and left me quite depressed for a week, though I didn't realize how much it directly affected my mood until...

I had my ultrasound today, and it was a very good experience! I cannot express how much better I feel now. All the people at this imaging center were extremely nice, including the tech who answered all of our (my mom went with me) questions to the best of her ability. Compared to the HSG, this test was downright pleasant. Without going into all the particulars, I am happy to report that I do indeed have two ovaries, and a normal-sized uterus. There is a definite division inside--the tech guessed that the septum goes all the way down to my cervix or near it. We were unable to get a good picture of the outside contour, so I'll probably have an MRI next to determine whether it's normal on the outside (totally fixable) or heart-shaped (partially fixable).

Granted, this is only what I learned from the tech today. The radiologist at this facility will look over the images and make his/her report to my doctor, at which point I'll learn the official findings. But I feel confident now that it is only a matter of time before my uterus becomes "good enough" to support a pregnancy. Please keep the prayers and well-wishes coming that everything will continue promisingly.

And pardon me while I go frolic in the beautiful spring sunshine! :D

HSG Follow-up

Just a quick post today.

I finally got a call from Dr. P's office today. They basically confirmed everything I had suspected. The left tube didn't open, so they will do a pelvic ultrasound to determine whether it's a simple blockage or not. If it is, I'll be referred to another doctor who will "take care of it and [I] can become pregnant." If not? ...I don't know. If it's not a simple blockage, does that mean it doesn't exist? I suppose that's a "wait and see" item.

The lady on the phone also talked about uteruses that are shaped "differently" and they're called "bicornuate." Mmmhmm. I refrained from the urge to explain MAs to her. I had been warned that doctors use "bicornuate" as a catch-all term. Anywho, I asked about the shape of my uterus itself (I'm not as concerned about the tube since I know I have one that works well) and she said "it's bicornuate," then hedged and said the ultrasound will show everything that's going on. I hope that's true.

Here's the absolute best news: I already talked to the imaging center who will do the ultrasound (the staff were really nice!) and they had available appointments for TOMORROW! Hooray. I can't say I'm actually excited to learn more; I'm still a little bit afraid at each step in this journey, but I'm really glad that I won't have more than one night to sit and dissect everything I found out from Dr. P.

10:30 tomorrow. Here's hoping everything looks normal on the outside (two ovaries, two tubes and a normal-shaped uterus). I can deal with things that aren't normal on the inside.

Let Me Off

I've changed my mind. I don't want miscarriage. Who do I see to get my baby back? I'd be cool if we could just pick up where we left off, really.

After two months, it hasn't gotten any easier. If anything, it's gotten more difficult. Every time I see a pregnant belly, there's a squeezing sensation in my chest. It's a picture of what my life would be right now if it had continued to be easy. But alas, it feels like my days of getting through life easily are over.

I have a lot of things I want to call my doctor about right now. But I'm still waiting for HSG results. So I'm stuck in limbo again, unable to decide whether to just go ahead and call or wait another day or two for them to call me.

This will probably turn out to be an inaccurate perception, but I feel like I'm waiting for a phone call that will tell me whether I still have hope of having my own children. I do realize it's more complicated than that and at best, there will be more testing to figure out what, if anything (grr), is wrong. But I need something new to look forward to. I need to be told that the next test will give a really clear picture of what's going on and treatment (or cure!) will be right around the corner. I'm losing hope that it will be that relatively simple.

I'm running out of hope on my own; I need someone else to give me some.

I should be finding out if it's a boy or girl right now, not waiting to find out what's wrong with my uterus. So, it would just be much better if I could get my baby back. Please.

Progress

I've been really depressed all week. I know much of it was due to jetlag, being away from Erich, and apprehension about the HSG. As thrilled as I was to schedule it, once it sank in that it was so close, I started getting very nervous about the next step. I realized that there was still a chance that my uterus could be normal, or there would be a clear problem (like a clearly divided uterus indicating SU or BU), or much worse, inconclusive. And lo and behold, I've got a big fat inconclusive as of immediately after the test.

So I felt really down about it all day. And even though the initial cramping went away when the liquid drained out (thank you, leftover extra-huge miscarriage maxi pads), a general feeling of crampiness and gassiness returned and did nothing to help my mental state. (And neither did the dark and rain that persisted outside!) I let the feeling of hopelessness wash over me. Though I still officially didn't know anything, I started thinking my uterus is just inhospitable to pregnancy and always will be. Not a happy thought at all.

My best option was to consult Google, with whom I have a love/hate relationship. It's good for finding out about things about which I have no knowledge, and it's abysmal at personal diagnosis. But I needed something--anything--to grab onto. And I'm glad I did. I googled "uterus tipped side" and got results, enough to know it does happen. That fact was enough to remind me that I'm not a health professional, and even though I've gotten to be pretty knowledgeable about MAs, there are plenty of other possibilities as to what my problem may be (if anything).

As Erich helped articulate for me, it's a fine line between being an advocate for my own care and trusting the professionals to come up with real answers. Luckily, I have to wait only 3-5 days for results. I believe that's short enough for me to be able to stave off excessive googling and speculation. After all, there's still a chance that I'm normal.




(But if I'm normal, why did I have a miscarriage??)

My HSG

Here's what I know: not much.

But I should start a little closer to the beginning. I got to the hospital, registered, and got called in pretty quickly. I got to wear two hospital gowns, so no embarrassing openings (bonus!). A very nice nurse walked me through the procedure before the radiologist came in and offered reassurance.

Then the radiologist came in, a pleasant enough man. He echoed much of what the nurse had already told me: this procedure was not going to be fun and there would be pain, but most people do okay with it. So now that I was totally excited about the HSG, he asked a bit about my history and why I was there. He also asked if I'd ever been told my uterus was abnormal before, and I casually mentioned that I had been told it was tipped during my first ultrasound. Then it was down to business!

Let me reiterate: absolutely nothing about an HSG is pleasant. First there was the dreaded speculum, then he cleaned my cervix, then the catheter went through my cervix and my uterus was flooded with an iodine solution. Sounds simple, but let me tell you: It. Hurt. But once everything was in place there was some relief.

The large x-ray machine hovered over my midsection and started taking pictures. Luckily, I could see the screen and watched it with apprehension. The radiologist removed the speculum (more pain relief, thank goodness) and had me move from one side to another and then all the way over on my right side then to my back again. It seemed like only one side filled up with the dye, and I could see only one tube. Could it be unicornuate? I wondered.

Afterwards the Dr. confirmed that the dye didn't go into my left tube, which he shrugged off as one of those things that happens sometimes. He asked me whether I was told to which side my uterus was tipped. I replied that I assumed it was tipped back, not to one side. He proceeded to tell me that it looked like it was tipped a bit to the right, and he was not ready to call it abnormal yet. He would look at the images more closely and then send a report to my doctor. He told me he would recommend some follow-up ultrasounds to get a better look at everything.

[In retrospect, that's pretty annoying: ultrasound can be done at any point in the cycle, and I wouldn't have had to wait this long to get going on diagnosis. It's been 8 weeks and 1 day since my m/c!]

Dr. Radiologist will send a report to my doctor, and I'll hear back in 3-5 days.

Optimism Continues

Spain was wonderful. The first weekend was especially grand, as we spent Saturday in San Sebastien, a beautiful tourist town with a beach, and it was gloriously sunny and warm, a wonderful contrast to the snow and wind we left in Chicago!

By Sunday night, though, I started to return to reality. The distractions of culture shock had completely separated me from my physical troubles and memories, which was nice at first. And then I discovered that emotional pain is like a toxic substance that needs to be constantly vented. The toxic substance built up until it all burst out at once, and I hit a low point. I went from the happy traveler to a miscarriage sufferer in a matter of moments. The PMS and nasty yeast infection with no hope of treatment for over a week made matters much, much worse. I forgot my optimism and felt some despair, compounded by the stresses of jet lag and being in a new country where I didn't speak the local language.

[By the way, this post is about menstruation. If this doesn't interest you, you may want to just skip to the last paragraph.]

But then, the flicker of hope. That twinge of pain in the lower abdomen which grew into definite, obvious menstrual cramps. I know those and remember those; there was no more guesswork as to whether it was just ovulation or my uterus simply changing size and shape (like when I was pregnant and afterwards). The pain was the worst on Wednesday morning. I had forgotten just how bad my cramps could be before I ever went on BCP. And I absolutely reveled in it. And, indeed, AF arrived that morning. Despite my fatigue, cramps, and bloating, I had a big spring in my step when I went out to explore Bilbao that day. The thought of tampons put a huge smile on my face. I knew I was looking forward to AF, but I was even more relieved and delighted than I thought I would be. This signified not only moving toward the next step but also moving away from the past. My body had done the most obvious thing it could do to prove it could behave normally; it cleansed itself of its own accord and I felt the last physical remnants of the miscarriage leave. The sense of relief was palpable.

When Erich got back to the hotel room that evening, I told him my good news, and he helped me make that wonderful phone call. I have scheduled my HSG for this coming Thursday. I'm hoping that I will either be able to look at the screen during the test (I've gotten a good idea of what septate/bicornuate uteri look like on an HSG by now!) or that I will at least have results soon after the test. The fact that I won't get a full diagnosis from this test no longer concerns me in the least: it will be a valuable first step, and when all is said and done, I really didn't have to wait that long. I'm feeling good about this. Thank you, Optimism!

Optimism

I'm going to try something new. I'm going to try thinking/assuming that everything is going to work out just fine, at least in the short term.

The bad news is that AF did not show last week, but the good news is that she is not here yet! We're leaving for Spain today and I'll be gone for 9 days. So if she holds off till at least Saturday, I will definitely be home for the HSG window. I'm thinking my chances are good. Plus, based on what I've read, it's not taking abnormally long to get AF after a m/c.

(Here's the thing, though: I've been having phantom pregnancy symptoms for the past few days! Nothing major, and nothing that couldn't possibly be PMS, but it's still a little freaky. Examples: when I was pregnant, I was fatigued like crazy, I had vivid dreams, and I got tonsil stones constantly. [I won't link to the Wikipedia article on tonsil stones: search at your own risk. They're very gross.] So I've been pretty darn fatigued lately, I've had a few vivid dreams, and I woke up Sunday morning coughing up a tonsil stone. Oh, and I've had to pee waaaay more than average lately. I've tested three times, all BFN, though one turned positive outside the time window. I have one test left, which I'm taking to Spain to use when I feel necessary. Pregnancy would be extremely unlikely right now, but see this post for my views on the odds. "Very unlikely" doesn't mean as much to me any more. I'm 99% sure I'm not pregnant, which is a great relief, but it sure is hard not to want to be pregnant. That is the goal, right?)

Yes, optimism. Patience. Going with the flow (hahahaha, pun!). I'm all over it.

Patience

CD 30 and no AF in sight. I've been having PMS symptoms on and off, but all I can really gather from my body's signals is that my hormones are still completely messed up and I have no idea what to expect. But while two weeks ago I was very anxious to get AF by 3/17 (or 3/19 at the very latest), at this point I'm just rolling with it. What will be, will be.

Patience is probably the strongest theme on this blog and in my life right now. Each time I have a tiny sliver of new information about this whole ordeal, I get very worked up and eager to have answers NOW. Finding out that the HSG requires a very specific situation in order to take place only made matters worse. I told myself to be patient; others reminded me that I would have to be patient. Well, patience is not a switch I can turn on and off. Patience must be practiced. In the past month, I have found patience through the turning of the earth, through the simple fact that life can and must go on. In the past few weeks, I have gradually become more calm, more peaceful, and I attribute that to increasing numbness, forgetting what it's like to go through what I've been through this year. And, happily, I've had distractions. I'm a church musician and it's Holy Week, so obviously I'm keeping myself busy. As far as taking care of my anatomical problems is concerned, patience is the only option. And that's okay.

Now as my "AF Deadline" is imminent, I am trying to wake myself up from this numb, sleepy patience. I'm trying to remind myself that I mean to take charge of my own care; I need to be my own advocate in the medical world. Unless AF arrives tomorrow (not likely), I intend to call my doctor on Thursday to see if she can order an MRI. It is not outside the realm of possibility that she doesn't know that MRI is better for diagnosing MAs. (It's also possible that it's not feasible to have an MRI before HSG. I don't know--but there's no harm in asking.) And I think as soon as I finally have a period, I'm going to start charting my basal body temperatures daily so that I can have some clues for myself, or a doctor if necessary, as to what is really going on in my crazy body.

Can I remain patient while arming myself with as much information and knowledge as I can? That remains to be seen. But I don't doubt that patience will find me when it becomes the only option, and I'll be okay.

Müllerian Anomalies Explained

I am not a doctor. But if I were, I probably wouldn't know much about Müllerian anomalies, so I don't mind sounding like I know what I'm talking about. As a reminder: my doctor told me immediately after my D&C that I have something in my uterus that may have caused my miscarriage. It could be a septum or I may have a bicornuate uterus. At the follow-up appointment, she did not say the words "septum" or "bicornuate," but when I mentioned a septum, she hinted that that's what she thinks it is. I await further diagnosis through HSG.

Someone on the Nest pointed me to this Yahoo! Health Group: Müllerian Anomalies. It has, by far the most comprehensive information on the web on MAs. Rather than putting it all into my own words, I've decided to copy/paste from their FAQ page, and put in bold the statements I find to be important.

1. What does müllerian mean?

The uterus, fallopian tubes and upper vagina are made up of two partially fused tubes, which, in the embryo, are known as müllerian ducts, named for physiologist Johannes Peter Müller, who first described them in 1830. They are also known as the paramesonephric ducts, and are at first present in embryos of both sexes.
Normally, these ducts run down vertically from flank to pelvic floor in the young embryo and eventually fuse into a double-barreled tube with two loose ends, known as the uterovaginal primordium, or UVP. The double UVP will eventually merge into a single-barreled uterus, cervix and upper vagina, while the loose ends develop into the fallopian tubes. In adulthood, these organs are referred to as the müllerian tract and congenital malformations of this tract are called müllerian anomalies, or MAs, as we call them on this list.

2. What are the different types of müllerian anomalies?

d. Bicornuate uterus (BU): The uterine fundus fails to fuse and a myometrial division extends down to the cervix in a complete bicornuate uterus, or part way to the cervix in a partial bicornuate uterus. The division is visible on the outside of the uterus, evidenced by a groove or cleft in the uterine dome exceeding 1.5 centimeters. Cervix and vagina are usually single but may be septate or duplicate. BU has relatively few pregnancy complications when compared to SU or UU, with breech presentation being one of the most common.

e. Septate uterus (SU): The müllerian tract has fused properly and the uterus looks single from the outside, but the inner duct wall (i.e. the median septum) has failed to dissolve around 20 weeks of gestation, and the uterus retains a double cavity. There may or may not be a shallow groove of 1.5 centimeters or less on the outer uterine dome, and sometimes even a whitish triangle of tissue, the septum itself, is visible. The somewhat fibrous inner septum extends to the internal cervical opening or beyond in a complete septate uterus, and extends only part of the way down in a partial septate or subseptate uterus. The inadequate blood supply and progesterone receptors of the median septum may cause problems in pregnancy, giving the SU the worst pregnancy outcomes of all the MAs.

Obviously, there are other types of MA, such as unicornuate, arcuate, and didelphys, but SU and BU are the most common and seem to be the most relevant to me at this point.

7. Is HSG alone good enough for diagnosis?

First of all, in an infertility work-up, a hysterosalpingogram (HSG) should be done to either rule out or assess the presence of a two-chambered uterus, the depth of the division, as well as tubal patency. But an HSG alone cannot differentiate between septate and bicornuate uterus. Misdiagnoses of BU by HSG are very common.

Other methods have better levels of reliability:

• Transvaginal ultrasound is nearly 100% successful in detecting a bifid uterus, but only 80% successful in differentiating between SU and BU. It can be a helpful tool in the diagnostic process, but should not be relied upon alone.
• Three-dimensional ultrasound (3DUS), is 92% accurate in differentiation of BU from SU, according to one 1997 study, but not widely available at the time of this writing. It should not be relied upon alone, with an 8% margin of error.
• According to two studies done in 1994 and 1995, MRI can reliably differentiate between BU from SU, with an accuracy of 100% in comparison with laparoscopy/hysteroscopy. More recent studies cast some doubt on this. Proceed with caution after an MRI.
• Concurrent laparoscopy and hysteroscopy are considered the "gold standard” of BU/SU differentiation. This test is invasive, but if needed, corrective hysteroscopic metroplasty can be done at the same time.

8. Should I have my uterus surgically repaired?
Hysteroscopic metroplasty, abdominal metroplasty, hemihysterectomy, vaginoplasty

The quick, reflexive party line here is that if you have a septate uterus, yes, you should have it fixed. Studies tend to show a poor pregnancy outcome in the uncorrected SU, but a near-normal pregnancy outcome in the surgically corrected SU. Of course there are exceptions, and we should not forget that most women with a septate uterus are never diagnosed, and may indeed have no trouble with reproduction.

Bicornuate, arcuate and didelphic uteri are generally thought to do well in pregnancy, but some studies show correlation to miscarriage and other problems. Again, take your history into account, first and foremost, and weigh the benefits versus the risks. Surgical correction of a bicornuate uterus involves an open (laparotomy) procedure in which the surgeon cuts through the uterine wall of each horn and then sews them together. Unlike most septum surgeries, abdominal metroplasty is a major procedure and carries greater risks of bleeding, infection, adhesions, infertility and rupture during pregnancy. Recuperation takes at least twice as long, and greater pain control is required.

The FAQ page continues with details about surgeries and diagnostic tests as well as success stories. In the past few days, I've also been reading the huge backlog of posts on the message boards. It's refreshing to see so many people who live and deal with these problems, most of them able to have children. I'm finally to the state, emotionally, where I can deal with reading so much information, accepting the risk of getting very worried about the type of care I will receive. Will my doctors be familiar with these problems? Why am I wasting time waiting for an HSG when it doesn't even show the outside of the uterus? How long will I have to wait to see a specialist, if indeed I will have to see one? How long will it be before I can have the surgery, if I have a SU? Is it realistic to hope I can get pregnant again before the end of the year?

It's frustrating that no one can answer my questions, though I am tempted to call my doctor and share my concerns about the HSG. If my safe window for HSG falls while I'm overseas in a few weeks, it will be very hard to wait another month. I will still know nothing! On the other hand, I may be premenstrual right now and don't yet have reason to give up hope that I will be able to have the HSG done in the next few weeks, in which case I can be patient. I suppose.

For the first time, I feel like God is trying to tell me something. Maybe this wasn't the right time to have a baby, and from this experience I will learn the very great importance of patience.