Uterine Septum Surgery

Hello friends, I know I've owed you this post for a while... As you could probably tell from my previous post, we've been walking through and trying to deal with some unexpected strife. Here I am, back with you, more determined than ever to get through this so I can become a tool to help those of you that may be struggling as well. 

In December I underwent hysteroscopy to remove a previously misdiagnosed uterine septum. You can imagine our delight that our yearly deductible was met, hence the rush to get it done before the year's end. This journey is far from cheap, so any part of it being covered helps tremendously and is definitely an answered prayer!

As previously stated, a uterine septum may be a reason for past complications and miscarriages, though there is no way to absolutely know for sure. Our reproductive specialist explained that this septum is not composed of normal uterine tissue. The tissue is dense and fibrous with scant blood vessels. Therefore, if a placenta tried to attach and grow in this area, it would not generate proper blood flow, and eventually would clot and cause the baby to die. Since there is no way to determine what part of the uterine lining this will attach to, we made the decision to have the surgery in hopes that future pregnancies (God willing) would have a better chance of survival. 

A hysteroscopy is performed using a lighted tube (hysteroscope) inserted through the cervix and into the uterus. Gas is then released inside the uterine cavity to inflate the area and give the doctor some room to work. (I was completely asleep during the procedure.) In my case, a laser was used to cut away the septum, removing the fibrous tissue. (Other tools that may be used are special scissors or electrical currents.) 

The procedure itself was quick and I rather enjoyed the nap. (I'm normally a troubled sleeper so I will take what I can get!) I remember waking up groggy then experienced terrible cramping. The nurse brought me a ginger ale that I didn't even have to ask for and medication for the pain. You know you've been to a surgery center too often when they no longer have to ask your post-op drink preference. The cramping I experienced was expected, however it took more pain medicine than they normally anticipate to alleviate the pain. Sometimes I feel as if my body is rebelling against me for all I've put it through. Hubby was there to hold my hand of course, as always... And quite often my dad just happens to show up at the surgery center to wish me well before hand, how comforting compassionate family members can be. I can't say enough good things about the staff at the East Memphis Surgery Center. Having worked in the medical profession for years, I know how burnt out nurses and doctors can get in their daily routine. I must say that I have never received anything but excellent service and empathy from the entire staff. That is such an important aspect, especially if you get pre-procedure anxiety like I do. Something about any procedure just makes me anxious. It's not that I am afraid of not waking up afterwards, if that were to happen I'd simply wake up in Heaven, with my Heavenly Father and my three children... How amazing would that be? I think it's more anxiety of pain afterwards that gets to me. 

By the time the nurse got my pain under control, Mike was already back with me in recovery. Not long after that, we were discharged with more medication just in case. I slept a good bit of that afternoon, cramping on and off. I was pleasantly suprised that the post-op bleeding was very light. (The doctor said that is due to the fact that the tissue removed didn't have much vascularity.) I was sore for a few days following, but nothing too bad. The surgery was done on a Friday and I was able to return to work the following Monday, so no time lost there thankfully. 

One important thing I would encourage you to do if you find yourself dealing with presurgical anxiety like I experience, is to have your spouse pray with and for you. I can't even describe the level of comfort and love that I feel when I hear my spouse speaking to God on my behalf. If the anxiety is intolerable, the staff at such centers also have anti anxiety medication available to you. I haven't partaken in this part, but they still offer it every time. I can usually stay calm enough knowing that it won't be too long before I'm sedated anyways, and I always have Mike there to make me laugh in the pre-op area... Boy the things you hear in pre-op can be entertaining!!!

Our doctor appreciates my curious nature and medical background so he even supplied us with pictures from the actual procedure. I won't post them here because I know many of my readers are pretty squeamish, but if you're as curious as I am, I don't mind sharing them with you. 

Never underestimate the things a mother is willing to endure for her children, even for the ones that don't exist yet... Even just to keep the dream of having children alive... Even if this has no future benefits to us, I will not regret haviing it done, just knowing thereis even a possibility of it helping with future pregnancies is encouragement enough to know it was worth it. Like I've said before, this is the path God is leading us down, there's no way I can ever regret following Him.

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Stay tuned for posts about a scary post-op emergency, another post-op procedure and a new addition to our family (of the 4 legged variety). For today I'll leave you with this bit of infertility humor: 

If it's broken... fix it!

Hello everybody. Did you miss me?

Mike and I took a much needed vacation. For his birthday, a few weeks ago, I gave him tickets to see his beloved Buckeyes take on Penn State in Columbus, Ohio. We made a long weekend of it, since I am off on Fridays and got back LATE last night. It was amazing... exactly what we needed... to get AWAY!! We had an amazing time, and hubby especially loved seeing his Bucks win, by a landslide!

Now it's back to work... and back to reality.

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We had a follow-up appointment the past Wednesday, the week of our trip. I decided to put it out of my mind until we got back. But like I said, now it's back to reality. So... Here is what we discovered. After having some shaky looking labs in the beginning, with a scary increased prolactin lab result... the repeat labs were all normal. Our doctor is chalking that up to the retained products that I had after our D&C surgery. His is cautious, however, and will watch my labs even closer in the future. In other news, I had no clotting factors or antibodies towards the pregnancy. Good news.

Now the bad news. I had a repeat sonohysterogram, the details of the first time we had this done at my OBGYN's office, including details about the procedure itself can be found here, or you can go to the post entitled "An Interesting Case" written in March. These new results came out abnormal. So... either the measurements were inaccurate the first time, or the tissue that they first thought could be a septum has enlarged and become more of a septum.

This is the shape of a normal uterus:

This is the shape that they first thought my uterus was:

This is how my uterus looks now (or did before but just got a good plane of measurement):

So what to do... ... ...

My septum is a little over 1cm in measurement. By radiological definition a septum can only be called a septum if it is at least 1cm. My doctor says, that by itself, this is not too impressive. He likely would have gone on with the first IVF procedure even if he had known this from the beginning. Now that he has seen me pregnant, however, he thinks that it needs to be surgically removed.

Here is the problem with a septum: it is composed of fibrous tissue. Fibrous tissue does not have the normal extensive blood supply that the rest of the uterus has running through it. When you get pregnant and the egg implants, you cannot control what wall of the uterus that the egg implants into. So if the egg implants into the fibrous part of the uterus, after the placenta is forming (which is around the time of our loss) it cannot get enough blood supply and will die... and there's nothing that can be done. This is what our doctor thinks happened. You can see where a placenta will form by visualized where the yolk sac is located in the gestational sac, and little baby b... that yolk sac was in the area right along the area where the septum begins. Baby A... completely at the septum (we will never know if this is why baby A stopped developing or if there was some other abnormality) but it is very likely that this is what happened with our little butterbean (baby b). Had either baby attached to any of the healthy walls, this may not have ended in miscarriage. But that is only for God to know. He is the only one with any true answers... we can just give the best guesses that our scientific minds can wrap their ideas around.

Surgery here I come. It will be on November 8th, which is a Friday, my off day. It will be done on an outpatient basis at East Memphis Surgery Center. I'm nervous about it, but know that I will be in good hands. This is the center that all of my procedures have been done at so I know the staff is awesome!! I also will not have any abdominal incisions, it will be done via hysteroscopy.

Hysteroscopy is preformed by inserting a flexible lighted tube into the vagina, through the cervix and into the uterine cavity. I will be under general anesthesia (asleep) for the procedure. My uterus will then be inflated with either saline or gas for better visualization of the septum. Then they will slowly cut away the fibrous tissue until they get to the normal tissue,and ultimately will give me a normal shaped uterine cavity. There is the possibility that a laparoscopy will be preformed at the same time if there are any complications. (A small incision is made into the abdominal cavity with an inserted lit tube to visualize the outside of my pelvic structures). The recovery will be similar to a D&C recovery... several weeks of bleeding and cramps, the worst of which will be the first few days after the procedure. I hope to be able to return to work the following Monday after the surgery. Please pray for that.

The hope is that, with the septum removed, I will be able to have a normal pregnancy. Now that I have had recurrent miscarriages... I feel like this is the right thing to do.

We ask for your prayer during this time for a successful surgery and a fast recovery, and that it may increase our future success!

God has led us so far in this journey... we know that He will be with us through every moment of this! Thank you for letting us share the good and bad with you.

"The joy of the Lord is my strength!" Nehemiah 8:10

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Please feel free to come with us with any questions you may have... and if you find yourself in our shoes... we would be HONORED to pray with you and for you! We can be reached any time at thejewells319@gmail.com

Witnessing a Miracle

How many times in your life do you realize that you are witnessing a miracle as it is happening? Often times it is realized after we looked back... we don't even know it is happening, often it is too hard to see the big picture as you are living through the difficulty.

My friends.... we are living through a time of miracles. And you all are our witnesses.

When we went through our injection training, Mike asked the nurse how many good mature eggs was our doctor hoping to retrieve from me. Her answer? 8. His hope for us, to give us a good chance of success... with everything that is "wrong" with my ovaries... their answer was 8 good healthy mature eggs.

Yesterday was our retrieval. I didn't feel nervous, although my heart rate of 115 gave me away... honestly I felt excited. Most importantly, I felt in peace. We didn't speak much on our way to the surgery center. I spent the entire time, in my head, in prayer. I prayed for peace and I immediately felt it. I felt all of your prayers being lifted up for us. My mother met us there... and I was ready to go! I was still hurting from my full ovaries but I knew that was a good sign that they were so full.

The nurses of East Memphis Surgery Center were amazing. Everyone went out of their way to be nice and encouraging. Everyone we met was great, the anesthesia doctor and nurse, the pre and post op nurses... and our new doctor. Our regular doctor had a very valid reason for being out of town... his daughter was graduating college. HELLO of course he had to be there! Dr. Brezina would be our doctor for this procedure and possibly for our transfer depending on the date. I know people who see him so this change in plans did not worry me at all. He was well up to date on our case. He was kind and open... just what you want from someone who is about to do a surgical procedure on me. He told us the ins and outs one more time, the risks (of course) and made us feel completely comfortable. As we walked to the surgery room and I said goodbye to my husband and my mother... he even laughed at my silly joke to my husband... He was off to give his sample upstairs, to which I replied "Do me proud Mister." The doctor burst into laughter and I immediately liked him even more for thinking I was funny. ; )

I remember being strapped down to the table (just my legs, it was not uncomfortable). I remember an oxygen mask being put on my face... and I remember the nurse anesthetist saying "this may burn a little." It did not... and I was out. I felt nothing from the procedure, I don't even remember them moving me from the surgical table to the recovery stretcher. Next thing I knew, I was just awake. I felt like I had a really good night's sleep... but I was VERY sore and VERY thirsty. I downed the glass of ginger ale they gave me in about 20 seconds. I was given some pain meds after asking about my pain level. Dr. Brezina came around the corner next smiling from ear to ear... I knew this had to be good. "We got 30 eggs," he said. Wait... what?? 30?!? "These are amazing results," he said. I'll say they are.

Keep in mind that on Tuesday we had 25 good sized follicles... and it goes like this... Not all follicles contain an egg... not all eggs will be mature... not all mature eggs will fertilize and not all fertilized eggs will mature. Keep this in mind from here on out. I wonder how many follicles matured in the day and a half before our surgery! Amazing, amazing results... based solely on God's blessing and power. I think he likes showing off sometimes. ; )

My mother and husband were given my discharge instructions. From there Mom took me home to babysit me and hubby went to work. She made one of my favorite meals... eating was thankfully not a problem. I was comfortable when I got home, slept in bed for a while. Mom went to get my pain meds. I woke up starving while she was gone and moved to the couch. I ate and passed out about 5 minutes afterwards. I slept for hours but was unfortunately awoken in bad pain. We had inadvertently let the medicine wear off. It wasn't too bad if I laid still with a heating pad. Really the worst part is moving around or going to the bathroom. The filling and emptying of my bladder moves my ovaries around, so it's a before and after pain. The bleeding hasn't been too bad, it gets less and less as time goes by... exactly as it is supposed to.

Last night wasn't too great. I'm so overly emotional. I don't know if it is the hormones or withdrawals from all the shots or the discomfort... or if the emotional impact of all of this is catching up with me. I'm crying a lot. But all in all I feel okay... just that my body is going crazy lol. I take that as a natural response. The doctor says my level of pain is not abnormal, due to the fact that "he stabbed my ovary over 30 times". His words...

I have read and re-read all of the retrieval letters that were given in our basket of love from our friends. The love you guys have for us is just overwhelming.

Now for the news you all are waiting on. I spoke to the embryologist this morning.

Out of the 30 eggs that were retrieved, 22 were mature enough to use.

Out of the 22 eggs that were mature enough to use, 21 fertilized!

Now, keep in mind, not all fertilized eggs will keep growing and developing into embryos...

All we can do, and all we ask of you, is to keep praying. This is the power of prayer! This is a time for miracles. Watch it unfold before your eyes as we are!

Praising God continually! To God ALONE be the glory!

.... for now... I'm going back to bed. : )

We love you all!

We should hear more tomorrow from the embryologist, they will decide whether to do a 3 day transfer (on Sunday)  or a 5 day transfer (on Tuesday). Today is counted as day 1. Retrieval day was counted as day 0. The transfer date depends on how healthy the embryos look and how they are developing. We will transfer 2 embryos at that time. We hope for a 5 day transfer, because our doctor believes there is a greater chance of healthy implantation on day 5... but we know that God is the one in control... it will happen in His time, on His terms. We are okay with wherever and however He leads us.

Stay tuned...