Category Archives: Procedures

Ask Me How I’m Doing

I went back to work last Monday. It was initially really hard walking in and getting the hugs and condolences, and then it was just normal. Normal is so nice, and I have been wanting to feel some sense of normalcy since Colton died. One of the doctors shared with me that she also suffered a stillbirth. She said no one at our workplace knows and she only shares when it happens to someone she knows. In some ways I think it would be easier to have no one know. But since they do know, I think it’s appropriate to ask me how I’m doing. It allows me to open up if I’m feeling up for it, and it shows that people care. Another doctor did this, saying welcome back and asking how I was both physically and emotionally (physically almost normal and emotionally is day by day in case you were curious). I was really grateful that he did this, as I wouldn’t have expected it from him.

In my personal life, only a few people have been asking me how I’m doing. To be fair, I sent an email when Colton died saying I needed time before discussing it, so maybe I need to open up. But it makes it so much easier if my friends and family would just ask me how I’m doing. It’s hard to bring it up but I want to talk about it. My sister in law sent an email saying she didn’t know how to act and asking how she should act. I told her I wanted her to ask me about him and still be in touch with pictures of her kids. She has been texting pictures of her kids like we normally do, but then this past weekend when she visited, she said nothing about Colton. I even tried to bring up the delivery in a conversation and she just changed the subject. It’s so frustrating.

I have a couple of friends who have been texting and calling frequently and I am so eternally grateful for their support. It’s eye opening when you suffer loss to see who really cares. I’m not surprised by who has been in touch, but there are a couple of people I would have expected to be more present that have been missing. That’s life I guess.

In other news, at my follow up doctor’s appointment I still had the retained placenta. My OB was able to get me in really quickly for a D&C, which I had yesterday. It’s really hard to feel done with the physical part of birth when you’re still bleeding and cramping everyday. I was so incredibly scared to have this procedure done that I insisted it be done in the OR where I could sleep through it. Luckily this was accommodated. The OB who did it was fabulous and I even continued to advocate for myself by asking that the resident did not perform the procedure. After everything I’ve been through, if this procedure screwed up my uterus I certainly want to know that it was messed up by someone very experienced and not someone still learning. What a weird thought to have, right?!

I was so relieved to have the procedure over and done with yesterday that I was in a fabulous mood (after I napped for 3 hours). I had to have general anesthesia and a breathing tube due to heartburn, which was not something I wanted but it went fine so I’m just going to be thankful there were no problems. I am also so thankful that I didn’t lose my uterus. Being in the medical field, I just know way too much and I was so freaked out this would happen even though the risk is incredibly low. I certainly hope there is no scar tissue either.

Today I have no cramping and just light pink spotting. It’s glorious! I feel normal and it’s just so incredible to have my body be getting back to normal. Now I have to lose the last 10lbs of baby weight, but I can at least squeeze into a good chunk of my pre-pregnancy clothes. I’ve been running, walking and doing exercise videos with my husband to slowly get back into shape. It makes me feel so good. My husband and I both have noticed how we are in such better moods when we exercise. The mind-body connection is incredible.

Not a day goes by where I don’t think of Colton but I am no longer crying everyday. I do randomly have tears well up in my eyes and I also cry sometimes, but it’s much less frequent. I know that grief ebbs and flows and I’m pretty sure hitting all the milestones like the due date and birthday will be hard for me, along with lots of other random things. This is a part of me finding my new normal. It sucks that I have to do this, and I hate that I have to do this. Life is just so unfair.

Next week I meet with maternal-fetal medicine to go over the results of the stillbirth and figure out where to go from here. I already know there is no obvious reason for his death based on all the tests that were performed. However, I’ve crafted a list of questions to ask and I’m hoping to get something new out of our conversation.

Another date with misoprostol

As if the universe hasn’t dealt me enough shit already…

I passed some half dollar sized clots at 3 weeks postpartum, and had an ultrasound to make sure nothing was amiss at that time. I did not see my regular OB. Nothing was noted except a heavy uterine lining, which was expected. Relief overwhelmed me, because the doctor had to manually extract my placenta during my delivery, and I was expecting bad news.

I had my 6 week postpartum appointment today. Based on the fact that my bleeding has not lightened much, and in fact has become heavier and redder, I knew something was up, but I was hoping I was just one of the unlucky ones who bleeds a long time after birth.

As I undressed, I managed to bleed all over my legs, socks, and the floor. Glorious. Apparently there was a huge clot just sitting in my vagina making a mess everywhere. She removed it and took a quick look. Everything looked normal, and my pelvic exam was normal as well. Then she followed up with my gazillionth vaginal ultrasound.

The ultrasound showed I have what looks like some retained placenta. I have no idea how that was missed 3 weeks ago, but my OB said she looked at the previous picture and agreed nothing looked amiss there. My options are D&C or try misoprostol in hopes that it’ll cause enough contractions to get everything else out. I opted for the misoprostol, since I am intimately familiar with the workings of my body with this medication. I do not want a D&C if I can avoid it. At this rate I’m willing to bet my left toe that at my follow up next Friday I’ll still have some placenta in my uterus and I will have to have one anyway.

I had a whole host of questions about my stillbirth but the exam took so much time that I elected to save them for my follow up next week. We scheduled a 30 min slot before lunch to do a recheck and chat about the results. She provided me with the full report today so I can read over it and re-formulate my questions based on what I read.

Basically, there is nothing obvious that caused Colton to be stillborn. Maybe a cord accident, maybe placenta problems or a fetal arrhythmia. I wish there was a better answer. The ambiguity makes the next steps much harder for me.

I’m giving a huge F-YOU to my uterus right now. Feels like it just can’t do anything right.

Saline sonogram 2.0

I had my saline sonogram yesterday on CD10. I found my last one in 2015 to be quite crampy and uncomfortable. It was (and still is) my most uncomfortable experience with fertility procedures. This time I took 300mg Motrin 1 hour before and what a difference! Although maybe it was the doctor’s technique that was better but I literally had no pain (although I was bracing myself for pain the entire time). (Edited to add that I apparently took 800mg of Motrin before my last procedure so it must have been my new doctor’s technique). It took less than 10 minutes.

Fortunately there is nothing in my uterus that shouldn’t be there. He also reiterated that if we didn’t know about my UU, he would never be able to tell based on ultrasound that I had one. Oddly enough I almost wished for a polyp so I could undergo another hysteroscopy. One of my theories is that baby A stuck around because of the hysteroscopy creating an area for her to burrow in deep, sort of like an endometrial scratch. Alas I will never know if that was the magic needed but it’s certainly possible.

I still have the same cyst on my left ovary so I hope it stays for several months so I can ovulate from my connected right ovary for awhile, hopefully increasing my chances to be pregnant for the 3rd time in a year…sigh. When we were on our journey toward baby A I had a cyst on my left ovary for a long time, around 6 months. Maybe that is a more cyst-y ovary, if that is even a thing.

I am so unsure that I will ever carry another pregnancy to term. While I now know my body is capable of doing it, I certainly have pretty terrible odds with pregnancy outcomes. What a weird and lonely journey to be on. Never in a million years would I have expected to have recurrent pregnancy loss. I didn’t even know this was a thing until after I had my first miscarriage. Oh to be blissfully ignorant again.

Kidney ultrasound

This is just a quick update mainly geared toward anyone who may have a unicornuate uterus who reads or finds my blog.

People with mulliarian anomalies are more likely to have kidney problems or be missing a kidney. Back in December 2015 I had an MRI to evaluate my uterus and make sure I didn’t have a communicating or functioning rudimentary horn (which I don’t, I literally only have the right side of my uterus). That test also showed that I have 2 kidneys but it couldn’t evaluate whether or not they are fully functional. My MFM told me I should have the kidney ultrasound done once I was no longer pregnant, which I promptly forgot about until I was reviewing all of my medical records prior to my appointment with the new RE. I asked him if he could order the test for me and he obliged.

Yesterday I had the ultrasound. I had to drink 24 oz of water 1 hour prior to the test and then hold it. The ultrasound tech was really nice and chatty. She scanned my right kidney first with no problems. She then did the left kidney and she had a harder time, even saying that the left kidney likes to hide. Of course I thought that meant something was wrong with it (since that is my “bad” side/on the side that is missing the uterus). Then she scanned my full bladder, had me pee, and then scanned my empty bladder. It went from looking like a huge rectangle to a tiny slit, starting with 500ml of water and ending up with 5ml. At least I know I can urinate well!

I was told I would get the results in 2 days. Well I was pleasantly surprised when 2 hours later my RE emailed to tell me everything looks normal. That is a huge relief!

So I wonder if my anatomy is not normally positioned on the left which is why she had trouble with the left side. Who knows!

The next steps

Just a quick update to say I finally got my referral to the new RE and they had a cancelation so I’ll be meeting him next week. Most of the RPL labs I did last time were ordered and to my knowledge they look normal. Except for my beta 2 glycoprotein 1 came back positive. I did not have this drawn last time and from my research this can cause blood clotting during pregnancy contributing to miscarriages. Apparently to be considered an issue the test needs to be positive twice with 3 months in between tests. So it’ll be interesting to see what he has to say about that. I also asked for my FSH, E2, LH and AMH to be run for comparison.

Honestly I am mostly interested in a thorough uterine cavity evaluation looking for polyps or anything else that could cause issues. But if anything else can help us that would be great too!

I ovulated on CD 13 this month, which is unheard of for me. My earliest ovulation date is CD 17. Now I’m wondering if this in a one-off or if it’s an indication of my declining fertility. I guess only time will tell.

I have basically cut out all refined carbohydrates, sugar and alcohol. And I’m about to wean off the caffeine too! It’s been easier than I thought it would be so I’ll be keeping it up for as long as I can. I figure it can’t hurt, right?!

Emotionally I’m doing well. It took a little time but I have been going about my life and have been feeling pretty happy, all things considered. I hope we will be able to have another baby but if that is not in the cards, I think I’ll be ok. My husband said to me recently if I wanted to stop trying he is ok with that, even though he does want another child. It really helped to hear that. So we shall see.

Hope everyone else is doing well.

I am a Unicorn

I had an HSG right after my SIS at the beginning of November. It was “optional” per my RE, as he felt the SIS had showed us the probable polyp and we were already going to remove it at the hysteroscopy. Of course, I am a glutton for all the information I can get regarding my fertility, so I went ahead with the procedure.

It was done by a nurse practitioner. She prepped me for the procedure, the radiologist joined us, and we got started. The x-ray machine was turned on and they injected the contrast.

Side note: the procedure didn’t hurt at all, and I like to think that as a nurse, she was more gentle than my doctor (I am a nurse also). She inflated the catheter balloon very slowly, as that was the worst part of my SIS, and it did the trick. So I’d recommend that you ask whoever does these two procedures inflate the catheter balloon slowly and it may help with some of the cramping and pain associated with these procedures.

They had a hard time visualizing my full uterus so I turned from side to side and did everything I could to help them get a full picture. Then the NP said it…

I think it’s unicornuate“. 

The first words out of my mouth were “Oh shit, that’s not fixable”. She said she’d talk with my RE as soon as she got back to the clinic, and I received an email later that night from Dr. N saying he agrees with the NP and he’d be able to tell more at the hysteroscopy.

For those of you that don’t know, a unicornuate uterus (UU for short) is a type of Mullerian anomaly (mis-formed uterus). Basically, I only have half a uterus that is connected to 1 Fallopian tube and 1 ovary. Something went wrong and the other half of my uterus did not form as I was developing. It happens very early on in embryo development. Apparently, it’s the most rare of all the uterine anomalies, occurring in 1/4000 women. Women with this anomaly have poorer pregnancy outcomes according to my research.

My RE confirmed that it’s a right UU at the hysteroscopy, and the tissue they removed did not show a polyp (although it showed some “necrotic” tissue, which he is unsure about and wonders if it’s left over from the last miscarriage). At our follow up he said this is no reason I can’t get pregnant and carry a baby to term. He still believes that the miscarriages are due to my egg quality and not my uterus. So apparently if we catch a good egg, then things should be good. However, now I only have a chance to get pregnant naturally if I ovulate from my right ovary, as the right side is actually connected to my uterus.

There are a whole host of other issues that come with a UU. The most notable for TTC are pre-term labor and IUGR because the baby runs out of room to grow since the uterus is not a normal size. So in the exciting event I can catch a healthy egg, I will have lots of other high risk pregnancy fun to deal with. And of course there are no guarantees that my uterus isn’t to blame for the miscarriages due to poor blood flow or something along those lines. Also, those with a UU also have a 50% chance of only having 1 kidney. I had an MRI that confirmed the UU and that I have 2 ovaries, 2 kidneys, and no rudimentary horn (meaning the remnants of the left side forming were not visible).

So what’s the plan? For now, my husband and I are continuing to try naturally since I have been getting pregnant. My RE suggested IVF with a single embryo transfer (as with my half uterus, the risks with multiples are very real and much more pronounced). I have a second opinion and two other IVF seminars in my area next month so I can pick a place for IVF that I am comfortable cycling with. IVF is completely out of pocket wherever we go, so I want to make sure the clinic is reasonably priced and puts its patients individual situations first.

Our first IVF consult was with Kai.ser and while I loved Dr. H, I am not wild about doing it there because they cycle their patients at the same time and only use 3 protocols. I’m worried with my DOR that I may need a more individualized approach and I am scared to go on birth control for the 2.5-3 months before the stims start. I took it just now for 6 weeks prior to my polyp removal and my ovulation this month is super delayed. I’m scared it’ll cause me to be a poor responder. Dr. H also confirmed that he believes my miscarriages are due to my egg quality, and he thinks I can have a successful pregnancy with the UU.

I am glad to have more answers as to why things are not going my way, as I believe more information will help us achieve our goal to have children. I was saying to a friend that I can make peace with donor eggs, surrogacy, or adoption, but I cannot imagine a life without children, so I’m on this roller coaster for the long hall. We are not done trying with my eggs or uterus yet.

Happy 2016 everyone. I hope we can all realize our dreams this year. Let me leave you with a sign I found. I am learning to embrace everything about my body, and since I now know about my UU, I have to learn to love it. 

False passage

I had a hysteroscopy on Wednesday to remove a possible polyp and to get a better look at my uterus. What an interesting experience. It’s done with conscious sedation, so while I was awake and watching what was going on on the camera, I felt nothing and I don’t really remember most of the procedure. It was pretty cool to watch and I wish I was more with it to comprehend!

Before it started, a resident Doctor came over to introduce herself. She was nice enough, but in the back of my mind I wanted to ask if my RE would be the one to do my procedure since we were also going to confirm if I had funky anatomy (more on that in another post). I am a nurse and I watch residents do procedures a lot, and while usually they go well, I’ve seen several end up in a less desirable manner. However, I did not speak up. Everything seemed to go fine but I was so out of it afterward.

So you can imagine my surprise when my husband and I went in for a “next steps” consult on Friday and the medical assistant put us in an exam room. I was confused and protested that it was just a follow up appointment. She insisted we were to be in there. Then my RE comes in and asks if I need an exam. I said no, and then he asks I’ve had foul, yellow discharge, unrelieved pain, or copious amounts of bleeding. I told him no and that I’d started my period since I had stopped the birth control pills. He said ok and we moved into his office.

He proceeds to tell us that his resident has dilated my cervix for the procedure and had poked a hole in an incorrect spot and then she tried to insert the camera, causing him to have to take over from her before she caused further damage (thank goodness). He informed me this is called a false passage and he was very glad I wasn’t having symptoms of an infection.

Suddenly it made sense why I was taking antibiotics post procedure when that normally doesn’t happen. Even the nurse that discharged me from the procedure was confused what “false passage” was and why I would go home on antibiotics. I was too out of it to ask intelligent questions. Apparently, aside from risk of infection, as long as they stopped poking early enough there should be no complications.

My husband was way more pissed than I was. I just kept kicking myself for not going with my gut and asking that the resident not perform the procedure. I will always speak up from now on and I encourage all of you to never let a resident do any procedure on you. Obviously they have to learn somewhere but it certainly won’t be on my body from now on.

I am gearing up for a big post about some additional diagnoses and recommendations but I’m still processing the information and trying to figure out the next steps.

I also want to say that I am so thankful for all of you out there in blog land. Your stories are so heartfelt and raw and I am honored that you are willing to share them with others. Thank you!