Hydrosalpinx?!

Let me backtrack a bit...

• In early July I found out I had two cysts (one large on the right and one small on the left).  

• Last month I had one cyst (probably the large one getting smaller).  

• This month I have a small cyst on the right (the large cyst STILL isn't gone) AND a few smaller ones on the left side.

No bueno.  I was not happy when I left the ultrasound but wasn't too upset about it.  I was just a little frustrated that the cyst wasn't gone and that it looked like there were more small cysts.  I just don't understand.  I have never had problems with cysts before - even when I was taking clomid. 

I wasn't too concerned about the small cysts at the time because it was possible that they were antral follicles.  Antral follicles are small follicles (about 2-8 mm in diameter) that are 'on deck'.  They are the follicles that are waiting their turn to become a dominate follicle.  Sometimes these follicles can look like cysts on an ultrasound so I was not concerned.

This was not the greatest news but still isn't the worst news I received at my CD3 ultrasound.  The other information the nurse told me in a followup phone call with the results - I have fluid in my fallopian tube by the cyst and more endometrial lining than I ought to on CD3.  "So we are going to have to skip this cycle.  I am going to have your doctor look at these results and schedule you an appointment so he can talk to you about this"

Wait, what? 

"What was the name you used for the cyst again?" I asked. 

She said "It isn't a cyst.  It is fluid in your fallopian tube.  It's called hydrosalpinx"

"Umm, ok" Clearly I had no idea what this all meant but knew it couldn't be good if I now have to see the doctor.

I scheduled an appointment for Wednesday and then went back to work for a minute before Dr. Google began begging me to look into this fluid situation.

What I found was frightening.  

If you google 'fluid in fallopian tube' the only thing you get is "hydrosalpinx" so that HAD to be what the nurse said over the phone.

Here is a nice summary I found at the top of the search results:
http://www.pacificfertilitycenter.com/infertility-diagnosis/hydrosalpinx

According to the website:
A hydrosalpinx is the medical name for a fallopian tube that has become filled with fluid due to injury or infection.  
Injury or infection?  How did I injury it?  I haven't had an infection either.  WTF.

Hydrosalpinx usually affects both fallopian tubes, (even when only one tube is affected, there is usually some residual damage to the other)
Oh great.  Just great.

Hydrosalpinges (when both tubes are affected) is a very severe form of tubal damage and pregnancy is usually only achieved with In Vitro Fertilization.
Wait, what?!
Cue the tears.  There was no stopping the internet searches now.  I had to keep looking into this.  Could I really be forced into IVF because of this stupid fluid?

Hydrosalpinx commonly results from a long-untreated infection in the fallopian tubes. A number of situations may lead to fallopian tube infection, including:

• The residual effects of a prior sexually transmitted disease such as chlamydia or gonorrhea
• Prior ruptured appendix
• Excessive tissue buildup due to endometriosis

None of the above applies to me.  I've never had an STD - I've been tested throughout the years.  My appendix is fine and to my knowledge I don't have endometriosis.  This doesn't make sense.  Was it the IUI, the progesterone suppositories, the uterine polyp removal surgery?  I have lost track of the number of transvaginal ultrasounds I have had- its been so many.  Could it be from that?  How is this possible?

The inflammation and healing process resulting from such infection destroys the delicate finger-like fimbria, which extend from the end of the fallopian tube to the ovary. Fimbria are responsible for carrying the egg to waiting sperm and moving egg and sperm together for fertilization.
Wonderful.  That's not good.  That's really bad.

When injured, fimbria become fused together, thus closing off the tubes. Fluid then collects in the fallopian tubes, making it impossible for them to function.
Fused together.  Seriously.  Could this get any worse? 

In some cases, especially where the hydrosalpinx is small, this type of blockage can be repaired, allowing pregnancy to occur naturally.... A laparoscope is surgically inserted into the abdomen and an incision is made to open the blocked fallopian tube. Recovery from this procedure is relatively rapid and normal activity may be resumed within a few days. 
Oh good, MORE surgery.  REAL surgery.  Through my freaking belly button.

Because ovarian health and egg quality decline after the age of 35, reversal surgery is more viable for younger patients who can afford the additional wait time. 
hmmm, I'm 33, 34 in 4 months.  What is this additional wait time?  A couple of months?

Patients conceiving after tubal surgery must be monitored very closely for a possible ectopic pregnancy.
OMFG. It just got worse.  The fertilized egg may get stuck in there now?  Seriously.  I have enough problems with the recurrent miscarriage worries and concerns.  Now I have to worry about an ectopic?  sigh.

Because of the low chances of success with attempts at surgical reconstruction of the tubes (some studies have shown a 10% pregnancy rate in the year following neosalpingostomy for hydrosalpinges), and because of the increased risk of ectopic pregnancy, most women experiencing significant tubal damage are advised to move directly to IVF.
The final nail in the coffin.  A YEAR?!  Increased risk of ectopic and a 10% pregnancy rate. IVF it must be then.

In order to increase IVF success and a healthy pregnancy, it may be recommended that the damaged portion of the fallopian tube be removed entirely before treatment, as in some cases, fertility enhancing drugs may have the adverse effect of causing fluid buildup in the fallopian tubes. Blocked, fluid-filled tubes also can leak into the uterus, posing a risk of infection after embryo transfer.
Stick a fork in me - I'm done.  This is no quick fix.  Another disappointment another delay.  I'm no closer to holding a baby in my arms as I was 27 months ago when all of this began.

With that bombshell I had to leave work.  Once knowing this possible diagnosis I could not focus on anything else.  Thank goodness the nurse waited until the end of the day to call me back so I could work a little longer.

I am devastated.  I am heartbroken.  I am mad.  I am let down - yet again.  I cried on and off all night and didn't get much sleep.  I am in mourning.  I am mourning the loss of my fallopian tubes before they are even gone.  Let's get rid of them.  NOW!

This is so hard.  Never did I imagine it would be half this hard to have a baby.  Never did I think it would get this bad either.  No tubes now?  No possibility of having a baby naturally again.  No unplanned surprise baby.  No luck.

I realize that I am not yet diagnosed with this condition.  I know that.  My husband hates that I do this.  He hates that I am diagnosing myself.  He the optimist, I am the pessimist. 

I like to be prepared.  I like to know what I am up against.  I'd like to go into my appointment informed.  I also want to prepare myself so I do not fall apart when the doctor delivers the unpleasant news. 

This doesn't mean I cannot have a baby.  It's just another obstacle to overcome.  Another step to take.  I haven't gotten this far by being a wallflower in this path to parenthood.  I am an empower patient that has become my own advocate.  That is my biggest lesson thus far.  SPEAK UP.  DON'T LET THE DOCTOR WALK ALL OVER YOU.  If your gut tells you something is wrong than listen!

I am incredibly lucky in one regard.  My state requires insurance companies to have fertility coverage.  I can have IVF.  I have excellent insurance.  This is not the end of the road for me.  I may be taking the scenic route even though I started out on the highway but I WILL make it to my destination.

I am already thinking ahead...
1.  Doctor's Appointment                                                 September 4
2.  HSG to confirm the hydrosalpinx diagnosis               September 10 (CD 14)
3.  laparoscopic salpingectomy (removing the tubes)     October 17 (in a dream world)
4.  Recovery                                                                    October - November
5.  IVF                                                                             December (fingers crossed)
6.  Baby :)                                                                        September, 2014

Rainshower: My tubes aren't looking too good right now
Rainbow:      It's 2013.  I don't need tubes to get pregnant (although it is much easier if you do).

Another Month, Another Negative Test

I am preparing to go into my blood test Monday morning.  I hate these blood tests because I already know the answer. It's negative.

What is even worse is the awkward conversation with the nurse when she calls with the results.  They always seem surprised that I am not devastated by the news.  It's almost as if I am encouraging THEM to keep trying.

I test early so I can come to terms with the outcome and start a new cycle with a clear mind.  I treat it as a fresh start and am optimistic about next time.  Perhaps this is rare considering the astonishment of the nurses that I speak to.

Am I really that strange?  Is it really that uncommon to test early and already deal with my emotions and disappointment prior to being told by the nurse?  Apparently.

Why a blood test if I already know the results?  Well, most of the time it is required if you have had medication (Clomid, HCG shot, etc.).  

For me though it does provide a little peace of mind.  My third pregnancy and miscarriage was a complete surprise. I tested negative and then got what I thought was my period (but kept spotting for longer than usual).  When my spotting turned into bleeding mid cycle I called the doctor and had a blood test that confirmed I was pregnant and miscarrying.  This is exactly why 'light' periods make me paranoid now.

So our first, well timed, IUI was a bust.  No May baby for us.  I would have LOVED a May baby:(

It's JUST the Progesterone!

Repeat after me: It's just the progesterone!

So it's 6 DPO and I'm having symptoms. At 4 DPO I began to experience ongoing tender breasts.  At 5 DPO it was a tender breasts, headache, fatigue and irritability.  Today, at 6 DPO, it is a triphasic BBT chart, bloating, along with tender breasts (and maybe I'm a little queasy this afternoon?).

I have experienced all of these symptoms in both pregnancy and progesterone supplemented cycles.  What is a little unusual this month is the breast tenderness occurring so soon after ovulation.  Breast tenderness is very uncommon for me on a normal cycle and only common intermittently on progesterone supplemented cycles. On a normal progesterone supplemented cycle breast tenderness normally begins at 9 DPO, NOT 4 DPO.  

This cycle is a little different.

I repeat:  It's just the progesterone!

(I need to keep reminding myself of this)

Rainbow:      I have my sanity so far.

Rainshower: I'm reading into all of these symptoms but constantly need to remind myself that it could just be the hormones I am on.  At least I can tolerate these hormones better than birth control and Clomid.

What the Heck?! I ovulated on CD 12!

Holy moly. I ovulated on Cycle Day 12.  This never happens to me.  Only twice in the 2 years I have been charting my BBT have I ovulated on Day 14 let alone Day 12.  I am a Cycle Day 16 or 17 kinda gal.  This is nuts.

Even nuttier: I had EWCM on CD 10. Day 10!  That peaked my interest so on CD11 I took an OPK.  What do you know? It was POSITIVE.  It was as positive as positive gets which is rare for me (my 'positives' are never as 'positive' as the manufacture say they should be).  What the heck?!

So on CD11 I called the doctor.

My CD 12 follicle scan turned into an IUI!

Nuttier still: I actually ovulated on CD 12 so my LH surge was longer than normal. I'm the kinda gal that ovulates on the SAME day as I get a positive OPK on 90% of my cycles.  OPKs aren't helpful in the 'prediction' category.  It's more of a hurry up and get husband test (HUGH).  Or a huge stress inducer.

So the IUI was well timed.  

The questions I had/have:

Did my small residual cyst contribute to my extra positive OPK this cycle?

Did the cyst contribute to this early ovulation even though it only slightly moved up my ovulation last cycle to CD 15??

Did I even ovulate or is this cyst giving me a false positive on my LH surge???

Did I even ovulate a MATURE egg or did I just spit out something immature when my cyst caused an LH surge????

What is going on here????

Today I am 3 DPO.  Only time will tell. I am feeling hopeful but that is normal for 3 DPO.  By the time 8 DPO comes around I begin the unravel.  Sigh.

Rainbow:  I had a well timed IUI with 36 Million swimmers.

Rainshower: I wasn't able to be monitored so I don't know anything about the egg size and lining thickness. 

Catch 22 - Round 2

Almost EXACTLY one year ago I wrote the post to follow.  It is how I STILL feel.  It is so, so sad for me to still be in this holding pattern at my job.  This job is stealing my joy.  My will.  My soul.  I am close to being sucked dry by this blood-sucking-job.

What HAS changed is my will to get a new job.  I have had it.  I am defeated.  I am trapped in the daily drudgery and doldrums.  I surrender.

This the season of repeat feelings of self loathing about this job-o-mine.

…........................................................

Bare with me here:  I want a new job – I have tried for years to do just that with no luck.  I also want to get pregnant and quit my job.  I don’t want to get a new job, get pregnant right away, and then quit the new job so it might be best to stay at my current job.  But my current job sucks – there is no satisfaction in my role, no room for advancement and no recognition of my effort; it causes situational depression.  Then there is this whole uncertainty of WHEN and IF I’ll have a healthy pregnancy, which brings me back to the beginning of this paragraph.

My husband wants me to just quit, no new job, no backup plan and no income because he knows that it is adding to my misery.  It’s a scary thought but one I’m beginning to more and more wish was possible.  At the same time I am a very rational person and know this isn’t an option yet (financially).  

I’m a planner.  I have a Master Plan.  Keep working, get out of debt, save money by working through a pregnancy (or most of it at least), build up a savings to supplement the loss of my income after a baby comes and cross my fingers that husbands’ growing career will make up the difference by the time the savings run out.  Sounds great on paper, doesn’t it?  So quitting now doesn’t sit well with me because it interferes with the master plan even if it might be good for me right now.

The planner in me thinks it sounds like my Master Plan is a perfect plan.  Then reality sets in.  There are always unexpected expenses.  Being on a tight budget long term is quite difficult especially for Mr. Big Spender.  Then throw in all of this recurrent pregnancy loss grief, uncertainty and anger and all of a sudden this plan of mine is just ridiculous.  I’m planning for a future that is more uncertain than certain.  Another Catch 22, I guess.

Rainbow:          It could be worse.  I’m thankful I have a supportive husband that understands I am really struggling right now.  I’m thankful that he has suggested I quit.  I really shows me how supportive he is.

Rainshower:    I just feel trapped in every way (at my job and in this parenthood journey).  It would be nice to have an end in sight, a reason for the losses. 

On Some Days it is difficult to Hold It Together

I haven't written in awhile.  We are not pregnant despite my optimism early in the waiting period.  As I approached the end of the wait I just had a feeling the test would be negative.

I wasn't upset.  I was more focused on my husbands follow up SA.  

Those results came back fine as I hoped and expected.  

I had my CD3 ultrasound a couple of days ago.  I still have a small cyst BUT it is small enough that my doctor is going to let me do a trigger shot this cycle. Yippee?

Yesterday our IUI was approved by our insurance.  

These are all good things.

However today is not a good day.  There is no particular reason for my sadness today but it may have to do with me looking ahead, reflecting on the past and looking into the success rates of an IUI.  Honestly the success rates aren't all that great when you are going the unmediated route as we are.  I know that everyone is different and that WE probably have good odds of success but I am just feeling sad today that I am not pregnant.

It's days like today that I would like to be at home snuggling with a child. 

I told a coworker that we would probably do three IUIs before moving on to IVF (I imagine that my Doctor will recommend this route if we are unsuccessful after 3 IUIs).  Saying that to someone, out loud, rather than just constantly thinking it really affected me today.

The idea that we may still be at this 4 months from now is just so sad.  Then there are the thoughts about getting pregnant but not being able to stay pregnant.  

Notice my spiral of negative thoughts today? I do.  I cannot help it though.  I am a worst case scenario person.  Expect the worst and be pleasantly surprised seems to be the theme of 2013.

I have normalized my thyroid levels and had my polyp removed and am hopeful that these things will solve the recurrent miscarriage problem but there is no real way to tell until I actually get pregnant.

I am ready.  Very ready.  To be pregnant.  To stay pregnant.  

Ready.