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

Share the Sacrifice

If you're a close follower, you've noticed I haven't posted too much since our miscarriage. I have been in a battle with myself. A battle against negativity... a battle against depression and thoughts of worthlessness and sorrow and guilt. Thoughts that you know aren't true but you feel them sometimes anyways. This has not been an every day battle, this has been a "kick you when you don't expect it", "trip you when you're looking up kind" of battle. Overall I would say I was doing well with this... but for some reason the last few days have been hard. Part of this may be due to the fact that I had my first period since our D&C (surgery to remove our miscarried babies). Part of this may be due to the fact that several people have made pregnancy and gender announcements... people that I love and care for and am so very happy for (people that know the pain of loss and people that know the pain of infertility). The happiness for them is genuine, they are in my constant prayers. But it leaves a twinge of selfish pain behind. The sorrow of our own children not being with us. The sorrow of not being able to have a shower or a gender reveal... the sorrow of having to start over.

So these thoughts... they would pop in my head mostly when my mind went unoccupied by other things. For instance, I was vacuuming and thinking about the blog, how I should write something... then I began to wonder, does it really even matter? How would putting my pain into words benefit the world? Do I really have to keep doing this? Then I began to talk to God... God, do I really have to keep doing this? You know I didn't want to do it to begin with, and although it was fun when we had good news to share... do I really have to tell them these things? Do I have to share my pain? Can't I just dwell in it and hide in my bed and cry it out like normal people??... The answer was a resounding YES you have to keep doing this, was I not the one who told you to?? And in my head it sounded like Do you really have the nerve to not follow what I called you to do? So I (sullenly) wrote out The Letdown even though it was the last thing I wanted to do.

Obviously I haven't been writing as much as I should, and I think God has shown me some grace in that area, letting me work a few things out before I was mentally ready to resume the routine. So here I am. Back into the world of the living. Life has just seemed so hard lately. I feel like so many bad things have happened over the years in my personal life and in the lives around me, I just would find myself asking, when is it all going to end already? Can't I just catch a break? Yeah, a lot of these prayers were selfish. A lot of irritation was taken out on my poor, and forgiving, husband. My first period was wretched, so very painful. The doctor said that is basically normal for a cycle after a D&C, so I knew to expect it... but nothing really prepares you to be in pain. So I became snappy and sad and depressed.

Then today happened.

Today was not a great day. I was mulling over the fact that I have to have a repeat sonohystogram (see An Interesting Case for explanation) (to see if maybe I really DO have more of a septum in my uterus and may need surgery to remove it) on Thursday and a repeat of a ton of lab work that I have to be fasting for and won't be drawn until that afternoon. On top of those things, I hurt my neck this weekend and have had a horrible headache and pain shooting through my neck... and did not sleep well last night after going to bed later than normal for a Monday night. I was so moody. There was not enough coffee in the world to make me happy this morning. The work day was fine, until the end of the day. It is always the end of the day when doctors want to work people in for tests, and I get it, the patient is there so yeah let's just do it. I stayed late knowing I will be taking off a couple of hours early on Thursday for my testing... so that part didn't bother me, it's just that my neck was hurting so bad. And all of the patients actually had things wrong with them so the reports took longer to write and consulting with the doctors... and so on. Luckily, I work at the same office as my nurse practitioner and she was able to work me up and get some help (thank you Lord for that).

After a long drive home in traffic and waiting what felt like forever at Walgreens (but was really only about 15 minutes) I was so so so relieved to be home. As I pull into the driveway I see a package on my doorstep... then I began thinking (ugh what did we spend money on that we shouldn't have)... I picked it up, came in the house to let the doggies outside and then noticed the return address. My friend. It was a gift from my friend. A smile immediately arose out of my frustration.

Then I opened the package.

Then I read the letter.

I began to cry.

Then I saw the gifts. ( A book called Footprints, A book called You Changed My Life by Max Lucado... and the elusive darkside skittles, where lime skittles have now made their home) : )

And I cried some more.

This person (who shall remain nameless for theirs is not my story to tell) has become a dear friend to me over the last few months, we have gone through our battle through infertility and miscarriage (her first) almost hand in hand. We were only a few days apart on our schedule and, unfortunately, on our losses as well.

I know she will be reading this and I want to say: You have no idea but those words validated everything I have needed to hear and squashed all of my doubts about sharing our story. You, my dear friend, are an answered prayer to me just as you said that I was for you. She shared with me how sharing our story, our struggle, touched her and caused her to focus more on her faith. I read the letter through the tears in my eyes, I couldn't believe the words. The words written in front of me that I so desperately needed to hear. It's likely, my dear friend, that I will read your letter a thousand times... and thank you and God each time.

Sharing the intimate details of your life to the world is a sacrifice. It makes you vulnerable... it shows your weaknesses... your faults. Part of our human nature is to guard our experiences (at least the bad ones) and keep them to ourselves, to not let the world know we are not feeling 'okay'.

So, my dear friends, I encourage you to share your stories... your pain, your sacrifices... if it helps only one person, doesn't that make telling your story worth the pain of it?

As I re-read her letter something came into my thoughts, a fleeting thought that I have had before but brushed off, unable to fully acknowledge it. If I hadn't miscarried these babies when I had, would I have been able to walk with her through her loss as I did? Would I have been as sensitive? Would I have been as helpful? I would like to think I would have been but there is nothing quite like walking through sorrow and loss together. If the reason for this timing was so that my dear friend did not have to be alone, I am okay with that. Maybe that isn't the reason, but it was an opportunity for God to use me, if I was willing, to help. I am grateful for anything that made her hurt less... or that made the load a little easier to carry. As she was facing her own realities (at a time when I was still facing mine) I felt so sad for her. I didn't want this for her. I wanted to be able to take all of her pain away, but I knew I couldn't. So, I did what I was able. I was there for her... and she's been there for me too. Now we are bonded not only by our pain but by our faith in a loving and merciful God. A God who makes it clear that He can use every situation for good.

 And we know that for those who love God all things work together for good, for those who are called according to his purpose. Romans 8:28

 

How beautifully amazing is that? God's words... coming to pass just as He said. I was called to share my story, that is my sacrifice... being vulnerable, putting my heart out there for the world to examine and judge and react however they see fit... just in the hopes that it would help one person. I know that it has. I pray that it continues to help others as well. I am thankful once again for those that reached out to me during our first loss when I didn't know how to deal with it (Thank you again and again, you know who you are).

 

God made the ultimate sacrifice for us, giving His Son to die on the cross so that we may live. We are forgiven... we are loved beyond measure. That is the most beautiful thing I've ever heard. That is the most amazing gift that I have ever received. So, shouldn't we be more willing to sacrifice to help those around us when we can?

 

So today I pray... a prayer of thanks for my dear friend and her kind words that came at a time that I exactly needed... a prayer of forgiveness for any time that I doubt God's callings and timing... and a prayer for strength, that as I continue this journey I keep my eyes on the only One who leads me on a straight and narrow path (no matter how curvy it may feel at times.) Thank you Lord for these blessings.

 



An Interesting Case

I had just started my first round of fertility medication. I was taking 25mg of clomid for five days. Right after I started the medication I would have my first test, a sonohysterogram (also can be called a sonohys, or a sonohystogram). The reason this test was ordered was that there was a defect in my uterus on a prior ultrasound that my new doctor wanted to see the degree of. I knew this defect was there only because my friend who had done my ultrasound at the previous office showed it to me. Those doctors never even mentioned it, much less that it could cause a problem with me conceiving in the future. But my new doctor was way more thorough... and cautious.

Initially the test was scheduled with the nurse practitioner at my new office who performed these tests quite a bit. When I arrived at the office, I was immediately taken to the secondary waiting room while the sonographer set up the room for my procedure. She took me back, I got undressed and she did a transvaginal ultrasound before the procedure began. I was only slightly nervous about this exam, I had learned about it in school, I knew how things would go... and everyone made me really comfortable there.

A few minutes later the nurse practitioner walked in and said "I'm sorry but I won't be doing your exam today," --oh that's weird, I thought-- she continued "Dr. Williams was able to be here today after all and she would prefer to do the test and see everything herself." I was caught off guard, but in a good way. Oh! Well, great!!

The doctor came in and explained the procedure to me. I wasn't prepared for what she said next. "We have a student studying to be a nurse practitioner here today and I was wondering if you would mind if she and our NP watched?" "No, that's fine, I was a student once too, I understand." So there I was.... in stirrups, spread eagle on this table when the two walked in. "Thank you so much for letting us watch Mrs. Jewell... it's just that you're such an interesting case, we don't get to see cases like this too often." Great... I remember being a student... getting excited about the "interesting" cases. NO ONE wants to be an interesting case however. An "interesting" case means you have something wrong with you that most people don't. I never realized until that moment just how uncomfortable it felt to be that "interesting" case. Especially on a gynecology table where they were face to face with my goodies... But it was what it was. I really didn't particularly mind being the subject their learning experience, however I wished I didn't have to go through any of it. Honestly, I just didn't want anything else to be wrong with me.

Based on previous ultrasounds, they thought I had a partially septated uterus. A septate uterus is a congenital malformation, where the endometrium is split to some degree, this can range from a mild septation to a complete septation. In some cases this causes no problems... but in others it can cause implantation issues, miscarriages, preterm labor, etc...

Initially I was told that this procedure might be a little uncomfortable. Whoever said that has never had this procedure done. It HURT. It was not your normal pap smear speculum. This thing felt like a 16th century torture device. Then the catheter was inserted through my cervix. "You might feel a little pinch"... yeah, I almost came off the table. Tears ran down my cheeks... I wasn't crying, it was just a reaction from the pain. She was so sweet about it though when I told her it hurt. She talked me down and I was OK. The speculum was out and the fluid was about to be inserted. She warned me that I could feel heavy cramping as my uterus filled with saline. Oh boy... I did. They let me watch the screen though, and that occupied my curious mind enough to finish the procedure. All in all, the procedure didn't take too long. When I was done, I was SO uncomfortable. She gave me some Advil and a sprite.... and I waited for a diagnosis. At that point, I wished I had taken Mike up on his offer to take me to this appointment. I was not prepared for how uncomfortable I would be... and I was not looking forward to the 30-45 minute drive home.

After she looked over everything, she brought me into her office to talk to me about a diagnosis. I actually had an arcuate uterus. This was good news. An arcuate uterus is an anomaly where there is only a mild indention in the endometrium, and not a septation.

More good news... I was told this type of mild defect is not commonly associated with reproductive issues, although she warned me that although it is not common, it could become a problem. If it was to be a problem in the future she said it could be surgically repaired. The risk in that instance is that scar tissue can form in its place and theoretically cause the same kind of problem that the arcuate uterus could possibly cause in the first place. So which is the lesser of two evils? We would move on as planned from here on out. I was praising God for this not being as bad as she initially thought. More good news? I had follicles forming within my ovaries on both sides... she said this was a good sign that they were being stimulated by the clomid.

I left very achy... very ready to be home and called Mike and told him (once again) "you were right... I should've let you drive me... that was awful!" But we were both happy for the good news. We were cautiously hopeful that this would not become a future problem. I was exhausted. I went home... took some pain meds, a bubble bath and waited for a new day.

A New Start... and a Plan

Beginning of June 2012

Believe it or not, finding a doctor was an easy task. When my sister in law had her baby, I was amazed at how her doctor treated her as not only as a patient but as a caring friend, offering "suggestions" to her instead of telling her how she thought everything should go. She had urged me to go to this doctor before but I didn't want to change at that time. Now? I was ready... I was MORE than ready. I never wanted to step foot back in my regular doctor's office again! And I haven't! (well except to pick up my medical records)

So, I called her doctor... got the nicest receptionist I have ever spoken to on the phone... "I would like to make an appointment with Dr. So and So please."... "Oh, Absolutely! Have you seen her before?" "No, ma'am." "Okay well it might be a couple of weeks before we can get you in as a new patient, is that okay with you sweetie?" "Yes!" if I had anything it was time right? I got an appointment just in time to start medication for my next cycle, if that's what she wanted to do.

In the meantime, I went on a trip. A much needed trip with my mother to the beach. A few days in the sand and sun and outlet malls. I thought of our baby so much on that trip, I spent a lot of time deep in thought, scared of what was to come, going over and over what had brought us here in the first place... but by the end of it I was really missing my husband and ready to start our "infertility journey"

 

 



My first appointment at the new office had finally arrived. I was ready. Scared but ready. I waited all of about 10 minutes before I was taken back to a room. Already an improvement from the hour and a half long waits at the previous office. Once they did my vitals, I waited for the doctor, who was in the room before I knew it. She introduced herself then asked me a few questions... then suddenly she stopped and looked at me and said "you look so familiar, have we met?" Wow yeah once. "We met when you delivered my nephew, 'the mom' is my sister in law." "Yes! I knew I recognized you!" Even more progress. Talking to her was like talking to a friend I had known forever. There was no intimidation, there was no talking down to me, there was only her talking me like I was a person that she cared about!! Talk about PROGRESS!! We went over everything that had been done so far. What my labs were, what they should be, what isn't working. The she asked how I wanted to go about this.

She gave me a list of options:

• We could keep trying naturally for a while.
• We could try clomid.
• We could try naturally and then add progesterone later.
• We could try clomid and progesterone supplements together.

Then she gave me her recommendation... first she asked how badly we were ready to get pregnant? I had told her about her first pregnancy and all my feelings, etc. I told her we were ready to be parents yesterday. She giggled and then said, "okay then. If we are going to do this, I think we should give it all we've got! Here's what I think we should do to give you your best shot..." So there was a plan. I would take clomid on days 5-9 of my cycle. We would start taking ovulation tests on day 9 until I got a positive one and then a negative one. We would start progesterone supplements 3 days after a positive ovulation test and continue them until I either started my period or through the first trimester if we were to be pregnant. She also recommended that we continue charting using the basal body temperature thermometer. She also wanted me to have a sonohysterogram (an ultrasound guided test where your uterus is filled with saline and the interior of the uterus- the endometrial cavity- is evaluated). I left feeling confident... confident about our plan and confident that she REALLY wanted to help us. Just the fact that she cared brought me so much comfort. I was so grateful that she had come into our lives! I remember thinking on the way home... "Okay God, I'm ready... let's do this!" I'm always comforted when there is a plan of action, a direction to head that I can focus on.

I was not prepared for how my body would react to that first round of medication...
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If you are starting your infertility journey, the first thing I would ask you is... How do you feel about your doctor? If you have a good relationship, fantastic! If you are iffy... LOOK AROUND! So many doctors these days treat you like just another patient. This is a journey where you need your doctor to be an advocate for you! If you feel like you aren't being treated as well as you should... then that very well might be the case. I know it can be hard making a transition to a different doctor, especially if you have been going to the same one forever. Find someone who has been in your situation, ask them about their doctor, the tests they've done etc... Do research on what should or should not be done in your situation, ask questions... LOTS of questions. Write them down so you don't forget them. Don't be afraid to asks for tests to be done. BE YOUR OWN ADVOCATE TOO.

Second... This process is overwhelming! You are going to need a 'sister' to lean on through this that completely understands what you are going through. Find a support group or someone you can call, text or e-mail when you have questions or thoughts or just need to vent! I understand no one wants to be a member of the 'sisterhood' of women who have lost babies and/or are infertile, but I can tell you that you won't find a better friend than someone who has walked in your shoes. If you are in need of a support group I can recommend one to you. If you need a friend... I'll be your friend. I am here to answer anything you want. thejewells319@gmail.com

You always think the only thing you need to get pregnant is a man... but in our case, we need a doctor too... and a WHOLE lot of faith... and a WHOLE lot of support!!