Monthly Archives: February 2018

Delayed gratification

I used to think I was pretty good at delayed gratification.  I mean, I have a PhD, which means that after college I basically said, “You know what, 17 years of school isn’t enough.  Let’s sign up for more school, which gets harder and offers less and less specific feedback as you go, with no promise of success or a lucrative job in the field that you love at the end.”  I took that leap of faith, and there were times that were hard, but ultimately it has worked out pretty well.

I think the difference between doing a PhD and being in the long haul for fertility tests and treatments is that I really loved what I was doing when I was doing my PhD.  So, sure, there were setbacks and difficult times, but in the end, I knew that I was doing something that I found challenging, awe-inspiring, and worthwhile with my time.  The journey was worth it, even if I didn’t reach the destination I wanted to reach.  Having pregnancy-related issues is a horse of a very different color.

Or is it?  I mean, yes, it’s a slog.  Much more of a slog than grad school ever was.  I go from panicking about my ticking biological clock to the physical discomfort of tests and treatment to disappointment after disappointment as my period arrives or the next miscarriage starts.  Every positive pregnancy test brings a cocktail of elated hope and terror and resignation.  Every two week wait is an exercise in patience and acceptance.

But, would I choose anything different?  My options are either this, or giving up on adding another much-wanted member to our family, or pursuing a totally different mix of hope, terror, elation, stress, and cost to add another family member a different way.  And while this happens, I’m going on and living my life.  I’m working hard at a job I love.  I’m being the best wife and mother I know how to be.  I’m raising my one living child with all the joy and commitment and love that I’ve been saving up and bubbling over with.  It’s hard.  But it’s the path that feels authentic to me given the choices I have.

Cultivating acceptance, cultivating patience, cultivating cautious hope in the face of setback after setback.  This is the work of the current phase of my life.

What’s motivating these reflections this week, you might ask?  I was supposed to have my MRI tonight, which was supposed to let me move on to the next thing, the hysteroscopic surgery to remove the adhesions and possibly fibroids that my RE thinks might be contributing to my recurrent miscarriages.  But my RE neglected to mention that she was ordering contrast for the MRI, which you can’t have if there’s a possibility that you might be pregnant.  And since I last saw her the day after a positive OPK result, there’s a possibility (a remote one, to be sure) that I might be pregnant, but of course it’s too early to tell for sure (my period is due on Wednesday).  So I called her office today, trying to find out whether the MRI might still be worthwhile without the contrast.  But she was on an international flight, and the nurse wasn’t helpful, and ultimately I just wound up having to reschedule the MRI for next week.  Then I called to reschedule the follow-up appointment with the RE, which I need to do before we can move forward with the hysteroscopy, and she doesn’t have an opening for another three weeks!  So there goes another wasted month.

I felt so frustrated today.  I wanted to complain to someone, but there’s nobody I see on a daily basis other than my husband who knows what I’m going through, and I try not to complain too much to my husband because I hate to stress him out on my behalf.  So instead I’m trying to put my frustration into context.  It’s not really frustration with this one test being rescheduled.  It’s frustration with the entire process of five years of four pregnancies and three miscarriages.  It’s frustration with watching other women get pregnant around me with their second or third living child.  It’s frustration with a medical system that feels so impersonal, with the uncertainty of never being sure that what I’m doing is a necessary or sufficient approach to adding another living child to our family.  It’s frustration with my life not going the way I want it to despite my very best sustained efforts over a long period of time.  And today it just bubbled over during the string of multiple phone calls with my doctor’s office and the radiology line.

I may be good at delayed gratification, but this is straining my abilities.  I just hope that there is, ultimately, gratification to be had, and that this journey is worth it in the end.

More procedures

I met with the RE again today to go over the month of testing that turned into three months of testing, and it did not go quite as I’d expected.

From what the nurse practitioner told me after my SHG, I thought there were a few irregularities with lining thickness that showed up, and that was all.  From what the radiologist told me at my HSG last week, I thought there were some hints of synechiae, but that it didn’t look like a big deal.  Apparently, taken together, my RE thinks that these results are a big enough deal that now I need an MRI and a hysteroscopy, and that my husband and I should hold off on trying again until both of those procedures have been completed.

The MRI is to determine whether or not I have fibroids.  Apparently the shape of my uterus on the SHG was irregular enough that she thinks there’s a possibility of fibroids — but she also said that the irregular shape could be caused only by adhesions, which it’s pretty clear that I do have at some level.  I don’t need to do the MRI, strictly speaking, since they could probably figure everything out during the hysteroscopy — but it will determine whether or not the irregularities are due to fibroids before I have the hysteroscopy, which is important mostly so that I know what to expect going into the procedure (since fibroid removal is a bigger deal that adhesion removal).  Then, the hysteroscopy is supposed to go in and fix whatever adhesions are kicking around in there, plus the fibroids if they exist.  Since I have a history of adhesions, and since adhesions can cause RPL, and since I now have two tests results pointing to adhesions in my uterine cavity, she says she thinks we should definitely do the hysteroscopy to remove them before trying again.

In theory, this course of action makes practical sense.  In practice, I am bummed that this testing/treatment process is just dragging out indefinitely.  What I initially thought would be one month of testing (in December) will now be a minimum of four months of testing/treatment, and it sucks.  And I don’t even know when we’ll be able to start TTC after that — it depends on whether it’s fibroids or just adhesions.

One step forward, two steps back.

So, that’s where I am now.  I don’t know a whole lot about timing at this point — I have to call to find out about MRI scheduling tomorrow.  She said she could probably do the hysteroscopy on my next cycle, but only if they can do the MRI *and* schedule a pre-op appointment before then, which means during the next 2-3 weeks.  So, things are a little bit up in the air right now — I have a treatment plan, but I don’t know how long it’s going to take or what to expect in terms of recovery time afterwards.  Ugh.

Anyway, I’m mostly managing to be zen about it — I’m really just discouraged by the long, slow timeline, but it’s nothing I’m not used to at this point.  Mainly I’m sad that we aren’t supposed to TTC until this is over.  It just feels like so much wasted time that I don’t have. But, all of my other tests looked good, including ovarian reserve, so I’m trying to remind myself that a few months here or there are unlikely to make a difference in the long run and that this currently looks like the best route to a new healthy pregnancy.

I’ll keep y’all updated.

HSG #3

Well, folks, do I get a prize for surviving my third HSG today?  They are always super-fun, of course, but actually today’s was basically a non-event — catheter/balloon placement was not even a little bit painful.  Not sure whether the difference is due to having had a full-term delivery since my last one or whether I just had a magical doctor doing the placement, but hey, I’ll take it!

As for the results, they were very good — better than I thought I could expect, really.  Both sides spilled dye almost right away, and the radiologist told me there was really only a little bit of scarring noticeable and only slight dilation on the left.  I don’t know if it’s even possible, but this HSG seemed much better than the one three years ago, when the dye only partly spilled and they told me I had a partial hydrosalpinx on the left.  So, good news, I suppose!  Although also no magical interventions to help this process go faster, presumably.

There was one thing that came up on the HSG that I am interested in asking my doctor about when I see her next week to debrief about this 3-month testing ordeal.  The radiologist pointed out to me some synechiae on the fundus of my uterus.  They were pretty obvious — it looked like a little notch taken out of the top of my uterus with little fingers poking out on either side.  He said, “With a history like yours, I’d be surprised if there wasn’t a little scarring,” and seemed to mostly downplay it.  But scarring and uterine irregularities are some of the main known and treatable causes of RPL, so I’m wondering whether it’s significant enough that the RE might want to do something about it.  I’m also wondering why it didn’t show up on the SHG I had in December.  So, that’s something to bring up at my appointment on Tuesday.

And with that, I’m done with testing.  Hooray!  No obvious major problems, which is good in a way, but which also means no obvious solutions.  I’m sure I’ll update more after my follow-up appointment with the RE this coming Tuesday.  I’m expecting she’ll just tell me to go away and try on our own for six months or something, but who knows?  I am turning 35 this weekend, so maybe she’ll be more likely to want to intervene to step up the pace?

In other news, the semester is in full swing, I’ve got two big gen-ed classes and a seminar this semester with >100 students altogether, we just got back from a lovely weekend visiting dear friends in Boston, and next weekend we’re off to Texas for a conference, with kiddo in tow as we visit friends.  S is experimenting with two-word phrases, continuing his “hide and seek” obsession phase, and just generally getting ready to turn two in a couple of weeks.  I’m finally feeling like I’ve come out of the funk of last fall, when the weight of my dad’s death on top of two miscarriages in a row just put me over the edge.

As I’ve gone through all the heartbreak and waiting of the past 9 months, I often just take a step back and reflect on how fortunate I am to have S with me this time around.  He is the light of my life and the apple of my eye and all the cliches in one tiny little toddler-shaped body.  Whenever I am with him, I soak up the snuggles, knowing he’ll be too big too soon. There is never a moment that I take his existence for granted.  I continuously marvel at what a miracle he is.  And he gives me hope that someday this process just might work again and we might add a whole new layer of love to our beautiful family.  I have a lot to be thankful for, and a lot to hope for.