Wednesday, January 27, 2010

The Results - Part 2

There wasn't much time to really talk with the doctor after she did the hysterosalpingogram (HSG) the second time, so we went to her office the following week to discuss game-plan.  She more or less repeated what she had said during the exam, which was that my left tube was completely blocked, and my right tube was partially blocked.  Without corrective action, she estimated that our chances of conceiving were about five percent.  FIVE. PERCENT.  Which, okay, to be fair, isn't zero percent.  But really, five percent is just about zero.

The good news was that she could do surgery to remove the blocked portions of my fallopian tubes.  It was good news, because we had assumed that if we needed this type of surgery, we'd have to go to the Pope Paul VI Institute in Omaha to have it done.  So being able to have the surgery within a couple hours of home was definitely good news.  She also said that my fallopian tubes had enough length that she would be able to remove a section without impacting their function.  

There was plenty of bad news too, or at least news that made the decision a lot more gray for us.  For couples that have this type of surgery, the success rate (in terms of couples who go on to conceive) is between 40% and 50%.  Those certainly aren't stellar odds, but it's better than 5%.  Having the surgery increases your risk of having an ectopic pregnancy, so you have to be examined really early on in your pregnancy to make sure the egg implanted in the uterus.  OMG, I just cannot imagine what would happen to me if we actually finally (FINALLY) managed to conceive, only to have it be an ectopic pregnancy.  And finally, while my insurance covers costs related to the diagnosis of infertility, it doesn't cover any sort of treatment.  So this surgery (inpatient, with 2 to 3 day hospital stay), would have to be paid for out of pocket.  Yikes.  Since my laparoscopy cost multiple tens of thousands of dollars, and that was outpatient, I knew this more extensive surgery was going to cost much more than that, and would probably at least wipe out our savings.

Darren and I had said before beginning any of these fertility treatments that we would pursue them only until they became so cost-prohibitive that they might prevent us from adopting.  So the prospect of wiping out our savings (for a surgery with a 40-50% success rate) and not being able to adopt (not to mention buy a house) gave us serious pause.  We left the doctor's office that night telling her that we would need to think about this before making any decisions.

All of these appointments happened back before Christmas.  We took a lot of time thinking and talking with friends and family about what they thought we should do.  It's just impossible for us to be objective about things at this point, and not that friends and family are able to be truly objective either, but it really helped to talk with people that have a little more distance from our situation.

After Christmas, we met again with our primary fertility doctor.  We told him about my laparoscopy, and the repeat of the HSG and those results, and he was completely mystified.  He had never had a patient have a normal HSG followed by an abnormal one, and didn't really know what to make of it.  Obviously, THIS IS NOT COMFORTING.  We eventually decided that it might be a good idea to have the HSG done one more time, this time by the medical group who did the test initially in 2008 (and where my tubes tested normally).  I asked the doctor if he thought there was value in doing the test a 4th time, or if it was just wishful thinking, and he said he thought it was 50-50.

Gah, is this boring?  There's a whole emotional/faith component to this that I'm completely leaving out, for now at least.  That might need to be a different post.

HSG number four was on Monday, this past Monday.  As each radiology tech and doctor asked if I'd this done before, I explained how this was my fourth test, and how I'd gotten conflicting results.  They even pulled out my results from a year ago and confirmed that, as I remembered, my first HSG showed normally functioning tubes.

The neat thing about the HSGs is that I can see the same thing the doctor sees on the x-ray screen.  So I get to find out the results right then and there.  I lay down on the table, and they place the catheter, and then begin to fill my uterus with dye.  The dye in my uterus makes the shape of a little triangle, and the little fallopian tubes look like squiggly little lines coming from two corners of the triangle.  I lay there, and I can see the little squiggly lines, and I think, "I can see squiggly lines. Are there two squiggly lines?" I remember from the very first exam that the dye spilling out the ends of the fallopian tubes looks like wispy clouds.  I look at the screen, and I think "Those look like wispy clouds - are there two wispy clouds?"  Pretty soon, the doctor says that he's taking out the catheter and that I can sit up.  And then he says the words that I absolutely did not expect him to say: "The test was normal.  Both of your fallopian tubes are open."

And then everyone is smiling, and telling me what good news this is, and I'm just kind of smiling and flabbergasted because this is just the last thing I expected.  I was so prepared to have this test reinforce the last two.  But no, now I'm batting 500 with these test results.  So I smile, too, and say that yes, it's good news.  But it would also be good to have some clear answers.

There seems to be three possibilities: 1) The imaging group that did tests 1 and 4 is incompetent; 2) The surgeon that did tests 2 and 3 is incompetent, or; 3) Something about my physiology is changing, either from cycle to cycle, or within each cycle.  We have an appointment next week to talk with the doctor about what all of this means, but for now, I'm feeling a lot more hopeful.  For now, I feel encouraged that my tubes aren't always closed.  That's more than we had a week ago.  I feel like my hope has been renewed, just a little bit.  It's enough, for now.

The Results - Part 1

So, uh, it's been awhile since I had surgery, huh?  I've needed to do an update here for a long time, and I'm sure you've been waiting on the edge of your seat!  Shall we?

The last few months have been a bit of an adventure.  My surgeon didn't find any endometriosis, and that's a good thing.  During the procedure, she also performs a hysteroscopy (using a scope to look for inflammation inside the uterus) and a hysterosalpingogram (injecting dye inside the uterus to see if it flows out the fallopian tubes).  I had a hysterosalpingogram done in November of 2008, and everything looked normal.  However, the test during my surgery showed that my left fallopian tube was completely blocked, and the right tube was only partially open.

This was a huge, huge shock to me since I had gotten a normal test result just a year ago.  Afterward, the doctor explained that the test results could be the result of where I was in my cycle when the surgery was done.  She said that the lining of my uterus was very "thick and fluffy" and it's possible that the lining could have interfered with the dye flowing down the tubes.  Her recommendation was to repeat that portion of the test on my next cycle, at a time when my uterine lining was less thick and fluffy.

We repeated the test in early December and got identical results.  Hearing that news was just . . . crushing.  When I had the test done in 2008, and it came back normal, it felt like that was one less thing we had to worry about.  Physically, I was normal, and so we just needed to figure out the hormonal aspect.  After addressing the hormonal stuff for a year with no success, finding out that something was now physically wrong was just too much.  I was in tears before I even left the x-ray room that day.

To be continued (shortly) . . .