Next Steps

Today we had our long-anticipated consult with the RE to go over everything that’s happened since our baby died eight months ago and talk about next steps.

This morning I organized my thoughts into three concerns I wanted to discuss, and one question (the big “what next” question).  My three concerns were (in order of biggest to smallest concern):

1) During the hysteroscopy when my intrauterine adhesions were treated, one of my tubal ostia was never visualized.  Should I be worried?  Is it possible that I could have tubal scarring in addition to endometrial scarring?
2) My periods have been noticeably lighter since the D&C.  Should I be worried about the quality of my endometrium?
3) Every time I have an ultrasound (and I’ve had a LOT of those!), I’m told that I have a cyst on my ovary and that they’ll “keep an eye on it.”  They never do.  Should I be worried?

Here are the RE’s responses, condensed:

1) Tubal scarring is possible, and now is a good time to check on it.  Given my history, it’s not clear exactly when the scarring of my uterus occurred, and I had enough wacky interventions (like manual removal of the placenta) that infection at some point is a distinct possibility — if infection was involved, it very well might have affected the tubes.
2) In essence, no, I should not be worried about my endometrium since I have full-color hysteroscopic images of the inside of my uterus and it’s clearly nice and vascular/glandular.  She pointed out some good spots and bad spots on the images, and said that it seems clear from the images that most of the endometrium is just fine.  So, while she would normally be concerned by lighter periods given my history, she said that this is good evidence that there’s no need for concern just now.
3) She basically said that the sort of cysts they’ve seen in the past were no big deal, but that she plans to do another ultrasound in the near future if I don’t get pregnant in the next couple of months (or if I do, for that matter) and we’ll check then.

As for next steps… I get to do a repeat HSG and some bloodwork next week (woohoo!) unless I’m miraculously pregnant this cycle which I’m pretty sure I’m not (10dpo today and no implantation bleeding again).  If that comes back normal, she sends us off to keep trying on our own for 2-3 more cycles with the same sort of digital OPK timing we’ve been doing, and after that we start escalating with other treatments — probably superovulation with timed intercourse at first.  On the HSG they’ll be looking both at tubal patency and at cavity regularity, and if any hint of irregularity is seen in the cavity she’ll do either another sonohysterogram or another hysteroscopy to check the lining before doing extra-stimulatey ovulation.  (I’m hoping for hysteroscopy, assuming they can do it in-office like my last one — that procedure was a cakewalk compared to the others!)  If both tubes are closed, we go straight to IVF.  If one tube is closed, we discuss, and maybe go to superovulation quicker.

So that’s the story.  I’m very comfortable with the RE’s suggested balance of trying naturally vs. being proactive, and I felt reassured after our conversation with her.  She emphasized that now that we know about the clotting mutation they uncovered after our baby died, my chances of carrying a baby to term eventually (with the help of daily injections of blood thinners, which she was very positive about) are “excellent.”  So that was nice to hear.  I can’t say I really trust probabilities much at this point, even vague probabilities like “excellent,” and I’ll believe it when I see it, but I’m allowing myself at least a little bit of optimism as a result.  I have to say, though, it’s a mark of how my “normal” has shifted that I left the consultation thinking “yay, another HSG, and then a few more months of trying, and then more treatment!”  Yay, another HSG?  What sort of alien creature have I become?!  But at this point, anything to assuage my fears that there’s something (else) wrong and that our attempts are just more wasted time is far more valuable to me than worrying about the pain and discomfort of one more invasive test.  After all, I’ve had all these tests before, and they really weren’t so bad… bring it on!

8 thoughts on “Next Steps

    1. lyra211 Post author

      Yes, my RE was great. Honestly, in the past I’ve sometimes felt that she talked over me and was on a script, but today she was very responsive and sensitive to our loss. Part of me wonders if it’s because I was just a “normal” infertile patient before, and now that I’m really weird she’s paying more attention…? 🙂

      Anyway, yes, I’m very happy that we have a plan, and that my RE is working with us to think about the future.

  1. theskyandback

    This sounds like a great plan to me! Hopefully you can breathe easier these next couple of months knowing that there’s a backup option if you don’t get pregnant. But hopefully you will!

    1. lyra211 Post author

      Thank you! Yes, indeed, it makes it so much easier to keep going, knowing that it’s only a few more months (which felt like FOREVER when we had to stop trying after our daughter was born, but now feels like nothing). It would be nice to get pregnant naturally (as long as I can stay pregnant this time), so I’m happy to keep trying for a while. 🙂

  2. Wifey

    I’m glad your appointment went well and that the RE was able to give you some reassurance and develop a plan you are comfortable with. Hoping things go really well for you over the next few weeks!

    1. lyra211 Post author

      Thanks so much! We’ll see how things go. Nice to see your Mother’s Day post — this was my first Mother’s Day without my grandmother as well, so between the loss of my grandmother and the loss of my daughter, it was a sad one. Hoping that things go well for you in the next few weeks as well!

  3. Ulrike Ingram

    I agree. Having a plan is a good thing. I am personally struggling because we don’t yet have a plan. The results of one of the last blood tests was indeterminate (meaning slightly elevated), all the others were negative. We have an appointment with a specialist next week and are hoping for some answers. Such a test of patience.

    1. lyra211 Post author

      Ulrike, it’s so nice to see you back again, although I’m sorry that you’re also struggling. I really hope your appointment with the specialist goes well. Would love to hear more about it.

      And yes, a test of patience. Sometimes I feel like I didn’t truly understand the meaning of the word before all this happened. It’s not a test that I think I am doing particularly well on. 🙂 But then again, what choice do we have but to take whatever steps we can and keep hoping?


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