Thursday, February 20, 2014

The state of the U

The state of my uterus, that is. Not the Union (because we don't have a state of the union here in the great north, and because I don't want to talk about politics, I want to talk about my uterus. I majored in Infertility, and not political science).

I went back to the fertility clinic a few weeks ago. Same waiting room. Except that this time I was all alone. No Mr. A. No Gummy. Nobody else, in fact. My appointment for the sonohysterogram was at 10:15, after the morning blood work and u/s rush.

The last sono I had at my clinic was on the painful side of uncomfortable. It felt like about 6 litres of saline was inserted inside my tiny, pre-baby, never stimulated uterus, causing a shitload of pressure. I had another sono at the US clinic, and that one was more like going to the spa. My uterus was soaked ever so gently with a small amount of green tea and lemongrass infused saline while I reclined and watched it all on my personal screen. Oh, the beautiful mild arcuate.

Since this was at my north of the border clinic, I was expecting the 6-litre treatment. However, I think they've revised their practices OR my uterus can now handle its liquor, so to speak, because it wasn't so bad. But of course, I was anticipating PAIN and so had the accompanying mucho anxiety.

Dr. RE somehow didn't get the message that I was in with the nurse and so we waited for him for a while, me in my bedlinen skirt, she in her scrubs, busying herself with tasks. We chit chatted. And then she asked about the birth. "WELL, you might want to sit down for this". Turns out she had been an ER nurse before starting at the Fertility Clinic and found my whole story quite fascinating. Because we were talking about a different hospital, she was at (greater) liberty to say what she thought. She agreed that errors had been made and encouraged me to write to the hospital* She also thought this should be a teaching case because the retained products should have been suspected given that my blood pressure kept climbing after the birth. But when you show up at the ER in hypertensive crisis and the OB on call is an asshole, that gets missed. I appreciated being able to debrief this story with her, and appreciated her encouragement to do something about it.

Interesting outcomes of the sono included:

  • My uterus is in excellent shape**. Dr. RE actually admitted that he was expecting I had Asherman's Syndrome, hence why he mentioned I probably would need a couple hysteroscopies during my last appointment. But no, that won't be necessary. Augusta's uterus takes a bow.
  • There was a tiny bit of what he called 'debris' and he cleared it all out with the saline. 

I asked him the same question I asked my OB at 6 weeks postpartum: what's the likelihood I would die if I have another baby? He basically told me what I knew already, but it was comforting to hear from someone who actually knows:

  • I'm at risk for experiencing placental disorder with any subsequent pregnancy. 
  • (I actually have multiple risk factors: previous D&Cs, IVF, previous placental disorder, c-section scar. 
  • I know this and so would be alerting any medical professional following me during pregnancy to the facts. 
  • Hence, if the placenta is burrowing into my uterus (or beyond), this could potentially be diagnosed before the birth (although Dr. RE didn't express any confidence in diagnostic tests for placental disorders). 
  • Regardless of pre-birth diagnosis, this would be an expected possibility, and I would most likely deliver at Large University Hospital instead of Pleasantville General Hospital. 
  • Dr. RE paid me a huge compliment and said that because I am who I am, this could not get missed*** 
  • Death would most likely occur if the placental disorder came as a surprise, and our small regional hospital was suddenly unprepared deal with a post-partum hemorrhage (and the need for an emergency hysterectomy) 
  • While he seemed to think death was unlikely, I gathered that a hysterectomy was much more likely. Fun. 
Aside from that lighthearted line of conversation, we also talked about HRT. He's been highlighting that he doesn't want me to take extra.ce orally as a long term strategy. The effects on the liver is concerning. So, he's trying to sell me on patches. Mmmmm, estrogen patches. What fun. Not only do I have to shove prometrium up my hooha for 11 days per month every month, now I will also need to stick patches on fleshy parts of my rump and backside. Looking forward. He also expressed the worry that too much estra.ce could negatively impact my cardiovascular system. I told him that my blood pressure problems were unique to my pregnant state, and that I normally have normal to low bp. "take it right now," I said "you'll see." 

Famous last words

My blood pressure was HIGH. 

Except that OF COURSE my blood pressure was high: I had just talked at length about Gummy's birth and ensuing circus, which, as you know, REALLY rattles me. And then I had a procedure which made me anxious. All that on a tiny breakfast (as per instructions) and without pain meds (contrary to instructions). So, this made Dr. RE nervous. I took my bp later that day and it was back to normal.  

The two conclusions from that appointment are:  

1) I'll have a follow-up appointment in March to finalize our long term HRT plan. The plan will include patches. Bleurgh. 

2) The ball is officially in our court in terms of transferring the second blastocyst from our DE cycle in June 2012. My uterus is ready to host and grow another embryo/fetus. 

The only thing with point number 2 is that I cannot begin to fathom having another child. And that would be another post altogether. 


*I've started that letter, but it's a hard one to write.

** Considering what its been through. 

*** I think he said "You're a psychologist, so you can judge character. If an OB is not taking you seriously, you would go to someone else." 


  1. I think my BP would be through the roof going back to the clinic alone.

    But glad your uterus looks good. And glad you have choices to make...

  2. Oh for the glorious days of when I could be on hormonal birth control (yes, there was a period when that was a good thing...developing (thankfully minor) clots in the leg prompted a "no hormonal birth control for you" mandate from the dr.), I loveloveloveloveloved the patch. So much more convenient than pills, didn't hurt peeling off, only very rarely come off on its own, and when it did, it could be stuck back on. I have no idea if the extrace patches are similar, but if they are, give them a try -- you might be impressed.

    1. I'm glad to read that you love the patches. That brings me hope and confidence. Thanks for letting me know

  3. Glad your uterus looks good. yay! Thinking of you - you have a very full plate!

  4. Glad you're appointment went smoother than you anticipated and that you were able to vent some frustrations with the nurse. I'm sure your blood pressure would be normally good. They had to take my little girls BP (for the first time at 3 yr check up) I think 3 different times before she calmed down about it and didn't send it skyrocketing with her nerves of what the heck they were doing to her. Also I used the vivelle patch for about a year and like it also...only dropped it because my insurance stopped covering it. Wish I could back to it...maybe someday. I will be asking about liver concerns for long term HRT and thyroid combined...good point so thanks for mentioning that.

  5. Heavy load but we have all learned there are many roads to get to that Mighty Crib. Love to you.

  6. I'm glad you are getting some of the difficult topics sorted out now. And that your doctor is supportive but frank. And that the sono was less uncomfortable and showed good results.
    Take your time. Maybe some more skiing with Gummy first?
    Also, patches aren't so bad, in my experience.

  7. Oh YAY, nurse, for validating our Augusta's obviously already totally valid but still it doesn't hurt to validate them some more, with the voice of experience, feelings. I'm really happy to hear about the condition of your excellent uterus. Whatever you choose to do with it, nice to know it's in prime condition.

    Sounds like a lot to internalize and contemplate. A hysterectomy is a terrifying prospect. I think you owe your faithful readers some estimate of that probability. More likely than death, but a serious concern? A real but unlikely risk?

    In case any part of you is longing to take the chance but stuck on the "can't fathom" angle, here's my conclusion, which I've doubtless shared with you many times because I am the BORINGEST...I couldn't imagine what it would be like to have one child. It was harder and easier and way more natural than I could have imagined. The same is true of having two.

    1. I'm mainly with Bunny on the can't-fathomingness of children in general.

  8. Validation is such a key component to sorting out these things. I found huge solace in the kind words and acknowledgement of difficult feelings after finally sharing my first birth story AND the crazy ass details of my crazy ass dealings with a crazy ass relative. (I am obviously new here and don't know all the particulars just yet, but I *did* write a letter to the College regarding my asshole GYN. And while "nothing" ever came of it, knowing someone read that Dr. WORST is, in fact, a horrible asshole made me feel better. So, work on the letter, even if you never send it.)

  9. Can your uterus come have a little chitty-chat with my uterus?!?! A cup of tea perhaps? No seriously, so happy that all things are looking good for your uterus. That's a win. A big one! Your nurse sounds kind and knowledgeable. Glad you were able to have that talk with her.

    The risks involved with another pregnancy, I'm sure sound daunting. But based on your doctor's feedback, you can just focus on when you're ready to get pregnant again with all the information that's available to you, with a doctor that's going to watch you like a hawk. All good things.

    Other than the sticky goo that comes along with the patches, they aren't so bad. Pills in the hooha are much worse. ;)

  10. Disconcerting on risks. Joy on having a chance to decide (against those hefty risks) on baking a wee Augusta II. Sorry so short. Catching up on everything.