Well, so much for “One month of testing and you’ll be done!” I haven’t yet seen the RE for a follow-up appointment, but apparently after reviewing my SHG and endometrial biopsy results, she wants to also do an HSG. But since she didn’t realize it until a week into my current cycle, I have to wait another cycle to get it done. I guess technically we can try to get pregnant this cycle, and if it works, great… but I’m not optimistic. At least the HSG doesn’t prevent us from trying next month, so it’s not as though we really lose time, but I was just hoping to be done with testing and ready to move on to planning.
Here’s the recap on the testing results that are in so far: apparently everything is pretty much normal. The endometrial biopsy was negative, all my blood tests were normal, the SHG showed nothing weird except for a slight thickening of the lining on the anterior wall, which I already wrote about — and if it were anything serious, the endometrial biopsy should have picked it up. So no answers, but also no identified problems.
So then, what triggered the HSG, you might ask? I’m not actually sure, since I didn’t get a chance to talk directly to my RE (I was supposed to have an appointment this coming Tuesday, which she suggested over electronic messaging that I cancel and reschedule for after my HSG). But here’s the story as I see it:
Before the HSG, the APRN doing the test did a baseline ultrasound. Everything looked just as expected, but she did point out an odd cyst-like thing near but not on my right ovary. She said it might be a paratubal cyst, and that it looked like it was in the location of my right fallopian tube, but didn’t seem too concerned. After the test, I mulled it over and remembered that during the 6w ultrasound where we found out I was miscarrying my last pregnancy, the ultrasound tech had seen the same thing, although she didn’t mention that it might be tubal — she just told me that it was a cyst-like thing that wasn’t on my ovary. Just to back up a step, these two ultrasounds were actually pretty close together in time — we found out I was miscarrying the first week of November, and then the testing cycle and SHG took place right after I had my first post-miscarriage period in December. So it’s clearly the same cyst-like thing, which was not there in June when I was going through my second miscarriage, but was there immediately after my third (most recent) miscarriage.
Now, combine this with the fact that I had high hCG levels in my most recent pregnancy — the last measurement at 5w was 2700 with a doubling time of less than two days. At those levels, you’re supposed to be able to see a gestational sac on ultrasound. But at my 6w ultrasound, there was no gestational sac… just two small irregular lumps in my uterus that the tech said might be bleeds. And I know that the right side is the side I ovulated on for the pregnancy, and it’s also the side that this possible tubal cyst is on. So, after remembering all of this, I wondered… is there any possibility that my most recent pregnancy could have been an undiagnosed ectopic, and the thing on my right tube is not a cyst but rather the missing gestational sac? Obviously I wasn’t in any danger, since the RE did follow my hCG levels back down to zero, so if it was ectopic it resolved on its own (like 80% of ectopics, apparently). But it seems like it would be an important thing to know to figure out how to proceed — and I already knew I had elevated risk for an ectopic since my second HSG showed scarring of both tubes. Since I’d been seeing my local OB for the miscarriage, and then went back to the RE for RPL testing, nobody had all of the information, so it makes sense that the RE wouldn’t have considered it.
Anyway, I wrote a message to the RE’s office containing this question, and asking whether I should have the records from my most recent two pregnancies sent to the office. The RE replied that an ectopic pregnancy was plausible, though difficult to know for sure, and that I should have the records sent over… and that’s when she suggested an HSG to assess tubal patency. If you’ve been reading my blog for a while, you already know that my tubes were somewhat damaged during my first pregnancy, which we found out during my second HSG. But since I then proceeded to get pregnant three times on the right side, it’s pretty clear that at least my right tube was still functional. However, apparently now this cyst thing (or possible gestational sac?) is weird enough that she wants to make sure it’s not blocking my right-side tube.
I’m not actually sure what to hope for in this case. Part of me is just sick of endless trying to get pregnant and miscarrying, and as I’m turning 35 I’m sort of thinking… I kind of hope it’s blocked, because then we can just do IVF already, and then they’ll do PGD and make sure they’re implanting chromosomally normal embryos and maybe it’ll finally work. Of course, I’m not exactly excited about doing IVF, so in that sense I hope my right tube looks no worse than the last time they did and HSG and I can just get pregnant the old-fashioned way again. I’m also just generally feeling grumpy about doing a THIRD freaking HSG, right after I’ve just done an SHG and an endometrial biopsy. Enough messing around in my uterus, already!
Anyway, much as I’m not wild about the idea of another HSG, I am a sucker for information, and I do want to know whether my tubes have gotten worse or not. So, I’ll go along with it, and wait for my next period, and do the HSG, and see what happens. But that means I probably won’t have the results of the HSG and meet with my RE until, like, late February or even March. UGH. I hate the slowness with which this sort of testing and treatment moves.
And in other news, I’m currently away for three days at a conference (in Washington, DC), and I miss my little guy something fierce. I felt so guilty leaving him, especially since he had a fever the day before I left and was super clingy and only wanted his mommy. I hope he doesn’t think I abandoned him! I cannot wait to snuggle that little munchkin tomorrow afternoon.
So, that’s where we are now. I hope all y’all’s new years are off to a better start!