i survived my HSG

It turned out to be not too bad.

I had heard such a range of stories and experiences of the HSG, ranging from the worst pain imaginable, to it was no big deal. I definitely felt jitters not knowing what to expect or which side I would fall on. I also read that if you are too anxious or tense your tubes could spasm causing severe pain, and making it look like your tubes were blocked when they weren’t. I had no idea if that was true, but nevertheless I then became anxious about being anxious.

But it turned out to be ok. I spent the entire procedure focusing on breathing, staring at the weird floral lighting on the ceiling, and relaxing as many muscles as I could under the conditions. The nurse’s last name was the same as my maiden name, so we joked about that, and the doctor proceeded to call us half-sisters for the rest of the exam. It helped to keep me relaxed.

I definitely felt cramping, but the cramping was tolerable. The whole procedure was similar to my saline ultrasound, but with the cramps turned up a notch. The doctor was not my regular RE, which made me nervous, but was personable and gentle. He told me that everything looked good – my tubes were clear and there was no sign of scarring. “She did a great job,” he said once the procedure was done. I just looked at him, not knowing did he mean me? The nurse? “Your doctor,” he clarified, “She did a great job with your surgery. No signs of your septum at all.” He sounded impressed, and that gave me comfort.

I feel so relieved to have done this and have it over with. The peace of mind has helped me feel so much calmer this cycle. Everything is looking good, and now I just need to work on that elusive thing called patience.

As the doctor was leaving, he said to me, “Your story is mighty familiar…my daughter had the same surgery and I’m now the grandfather to an adorable redhead. I know it will happen for you too.”

I thanked him as my eyes filled with tears. I know he’s right. I hope he’s right. 

To read more about the gritty details of the procedure, click here.

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it’s time

A long 39 day cycle later, it was finally time to return to my RE’s office to see if my cyst was gone, and check how my uterus had healed after my hysteroscopy. I had been anxiously waiting for this day after the setback last month when I learned of the cyst and was told to delay trying. Every day, as I would count my cycle days, analyze my temps, and try to guess when I would get my period again, I would also do a silent tally of the number of months since the last miscarriage. Seven. Seven months of doctors appointments, testing, surgeries, and perhaps worst of all, waiting. Seven months, after experiencing a particularly arduous year, felt excruciating. 

When I finally scheduled the return visit to the RE I hung up the phone and quickly returned to my day, as I was in the middle of a deep house clean preparing for my mother’s visit the next day. In the middle of a particularly rigorous Swiffer session, I felt a sudden swell of emotions build up inside of me, and I fell short of breath. My body was having a reaction independent of my own positive mind frame. My body remembered. My body remembered that I never seem to get good news at these appointments. My body remembered that this journey is like swimming against the current, the baby continually just out of our grasp, as we keep fighting for air and to stay above water.  My body was bracing for another setback, and started grieving the setback before it actually happened.

All I could do was cry, feeling completely overwhelmed by it all. Even if I were to get good news, I knew what that meant also. Time to throw myself back into what had caused all this devastation in the first place.

I showed up at my appointment the next morning already deflated, ready for disappointment. I had felt anxious all morning, which had slowly morphed into a disinterested hopelessness by the time I reached the ultrasound room. Go ahead and give me the bad news. Tell me that we have to wait longer. That I’m still not ready. That this baby thing just is not going to happen now. I already know what’s coming.

“Left ovary looks good…..Right ovary looks great!”

My cyst was gone. I was healed. My uterus was septum-free and ready.

The rest of the day I felt different, like we had entered a new era. After putting a baby on hold for seven months, I had settled into that reality. But those seven months are officially over. And I could finally revel in a little bit of cautious hope.

I’ve become so familiar with the emotional ups and downs that sync with our cycles. The hope, the anxiety, the disappointment, the despair, and then the hope again. I had been on my own giant seven month cycle, and experienced this same spectrum of emotions. But finally, I had entered the moment of optimism. That just maybe this will be our month. That just maybe this could actually happen.

My mom arrived that day, to stay for a week to help my brother and sister-in-law with their new baby. After my doctor appointment we drove to their home, and I watched as my mother teared up as she nuzzled her first grandchild for the very first time. We all sat around, watching this tiny newborn’s every move, as all the mothers talked birthing and babies.

I sat there, safe in my own bubble of hope, giving silent thanks for my good news that morning. Knowing it would have been a heart-wrenching day had I been told anything other than what I had received. 

Despite the fear, anxiety, and uncertain expectations, it’s time to try again.

the dreaded ultrasound room

I walked into my RE’s office this morning thinking we would finally get the ok to start trying again. I actually felt a little excited. Six long months since our last miscarriage, and six long weeks since my uterine resection. My RE wanted to do an ultrasound to see how my uterus was healing.

She told me we shouldn’t try this month and we needed to wait.

And then I remembered that ultrasounds only bring me bad news.

Apparently, all the hormones I was taking to help expedite the healing process had left my cycle a little wonky. And she found a small cyst on my left ovary. She thought it would be better if I had one more “natural” cycle and then take a look again. Hopefully the cyst would be gone by then, and my uterus would be clean and ready. 

I had been conflicted about starting to try this month anyway, and on one hand it was relieving to have my RE make the decision for me. I knew it would be better to give both my husband and me another month to heal from our surgeries. We would be that much stronger. I also realized that if we got pregnant this month it would coincide perfectly with our first pregnancy one year ago. We conceived Memorial Day weekend. Found out we were pregnant a few weeks later on our one year wedding anniversary. And then we miscarried in early July, on the exact day my brother’s baby is due this year. 

I couldn’t help but feel I wanted to shake off those tainted dates, and have our next pregnancy claim its own fresh timeline. 

But despite that, my appointment today left me completely deflated. Ultrasounds make me sad, that cursed, grey screen a constant messenger of bad news. On those screens I’ve seen a tiny embryo, its lagging measurement a harbinger of its inevitable death. I’ve seen an empty gestational sac, and then another empty gestational sac a few weeks later. I’ve seen that I have a malformed uterus, and learned I was unlikely to carry a pregnancy to term without surgery. And now, once again, I’ve seen an empty uterus, still not properly prepped for pregnancy. I realized that the ultrasound screen is a trigger for me, and after not hearing exactly what I wanted to hear today, it took me back to grieving all the bad news that its heartless monitor has ever shown me.

I laid in the room today staring at the screen wondering how I would ever face it once I got pregnant again.

And now another month of waiting. Throughout the process of getting tested and the procedures we’ve needed, I’ve felt like pregnancy was slipping further and further from my grip. Every test required time, every procedure required prepping and healing. It took us six weeks to even schedule my husband’s varicocele repair, which on top of the 3 – 6 months of healing time afterwards added to a feeling of utter despair. Every time I hear we need to wait even longer I feel completely, and utterly helpless.

I have no control. Even after all this, it is still just so hard to accept. 

my hysteroscopy

At my saline ultrasound, my fertility doctor saw what she suspected to be a uterine septum (an upside-down, triangular shaped piece of tissue which divides all or part of the uterine cavity in two). The septum does not have proper blood supply, so if an embryo were to implant over the septum it would likely result in miscarriage. A likely cause of our pregnancy losses. I would need a hysteroscopy, a straightforward outpatient procedure, to have it removed. First, a camera (hysteroscope) is inserted into the uterus through the cervix. A wire loop with electrical current is extended through the camera and applied to the septum tissue. As the septum is incised, the tissue springs back in the uterine wall, creating a normal uterine cavity.

I was ready. My RE started me on birth control pills two weeks before the surgery, to thin the lining of my uterus and keep me from ovulating and getting pregnant. The morning of the procedure I was to take misoprostol, to help soften the cervix. I took the pills four hours before the surgery and laid down until it was time to go to the hospital. I had been warned the misoprostol could cause cramping. Which it did. Subtle at first, but once I arrived at the hospital two hours later they started to intensify. As I was getting prepped for surgery I I became quite uncomfortable, and started counting down until the anesthesiologist arrived to give me some pain meds. My husband stayed by my side.

The surgeon (my RE), her resident, the anesthesiologist, and a few nurses scurried around me. I was given pain meds and some valium, and after a quick goodbye to my husband, was wheeled into the OR. They continued prepping for surgery, and I was soon asleep.

I woke up 2 hour later. I vaguely remember the nurses saying I had a fever, but that it was normal. I felt quite sleepy and woozy, but tried my best to talk to my RE about how the surgery went. She told me I had a sizable septum, and because of that she put in a balloon catheter into my uterus, which would stay in for five days while my uterus healed. This would prevent the walls of the uterus from touching to prevent scarring or a re emergence of another septum. She warned me it could cause more cramping.

I stayed in the recovery room for four hours, much longer than what was usual, the nurses noted often. I had become horribly nauseous, probably from a combination of the pain meds and anesthesia. They also would not let me go home without urinating. Which was not happening. Two bags of IV fluid, 3 juice cups, 2 glasses of water and 4 hours later, I finally went. After a couple “way to go!”’s and some cheers from the nurses, they let me go home.

I was very tired for about 3 days after the surgery, and it took close to a week to really feel like myself again. I had some cramping for a few days, but generally felt ok. My RE prescribed me 2mg of Estradiol to take twice a day for 28 days, and 200 mg of Progesterone to be taken for the last 12 days of the Estradiol. Five days after the surgery I went to my RE’s office for a follow up and to have the balloon removed (a little uncomfortable and weird, but not painful). Once I get my next period I’ll return to her office for an ultrasound to see how my uterus is healing. If all is well, we can start trying again next cycle.

Please don’t fail me now, uterus.

the first doctor i could trust

“You’ve been through a lot,” were the first words she said to us. Despite hearing over and over from respected Los Angeles doctors that all we needed to do was just try again, I had decided to see a fertility specialist. Her response to us was soothing. She understood, as opposed to the shrug we received from the perinatologist, followed by his telling us there was nothing else we could do. Making us feel silly for even asking.

We went over all the testing that we should do. My regular OBGYN had tested us for basic chromosomal problems and blood clotting disorders, but our fertility doctor would fill in all the holes and do a full fertility workup. She decided I needed a saline ultrasound, so she could check for uterine abnormalities. I had asked my OBGYN just a few weeks prior if I should have something like that done. She told me no. The likelihood was low that we would find anything wrong. I had hesitantly believed her. But when my fertility doctor suggested it I eagerly agreed. I wanted to test everything.

While performing the saline ultrasound she discovered I had a uterine septum. A uterine septum causes infertility and miscarriage, she explained. An embryo has trouble implanting on a septum, and if it does, it will not get proper blood supply and you will miscarry. And even if you don’t miscarry and the pregnancy progresses, the fetus is likely to run out of room to grow, and in that case you will have preterm labor. In other words, it needed to be out, and I needed surgery to make that happen.

When she gave me the news I felt an overwhelming urge to cry. Not because I needed surgery. I didn’t care. I knew it was a good thing that they found a likely culprit. No, I wanted to cry because I had been told by 4 doctors already to just try again. Told not to see a fertility specialist. Told that there was no more testing we needed to do. Had I listened, I realized in that moment, we would have been staring straight in the face of loss #3.

I had felt so alone after my second loss. Alone in the research I was trying to do, alone in trying to solve the medical mysteries that so often define recurrent pregnancy loss. I could never trust my doctors, feeling like they were basing their recommendations on probabilities and likelihoods, rather than the thorough, thoughtful approach I was hoping for. Antiquated medical advice based on limited research. I was looking for someone to help me do everything in my power to avoid another loss. But I was constantly skeptical of every doctor, and the generic advice I constantly received.

In working with my fertility doctor, for the first time I stopped feeling alone. I started to trust. I knew she couldn’t predict the future, and I knew there was always a chance of more losses, but she was my advocate. She wanted me to succeed. I finally felt like I could put down Google.