I’ve had a fertility update written for several weeks now, but have been too lazy to upload the photos which is why you have yet to see it! And then yesterday I found myself in stirrups waiting for my 10th+ (I’m starting to lose track) transvaginal ultrasound and now the entire update has changed!
Let’s do a little recap. I had a hysteroscopy in December in preparation for IVF in January/February. We weren’t expecting to find anything other than some potential inflammation and to our surprise my Dr. discovered a very small septum (see photos below) and no inflammation which completely changed our IVF plans. IVF was put on hold and we were able to start trying on our own again this month. The plan was to track my ovulation via blood draws (home ovulation tests don’t work for me) and start vaginal progesterone suppositories following ovulation. I’m still on baby aspirin too. Now for some septum photos before I continue with the rest of the story. So…I realize it’s a bit weird to share pictures of the inside of my uterus with you all BUT it’s the only real answer we’ve gotten and I’m pretty excited about it. And I’m a nurse and think stuff like this is kind of cool.
And now…the rest of the story. I was supposed to be ovulating on/around Tuesday this week so I went in to check my labs on Sunday. My LH was 13…not ovulating in the next 36 hours. Progesterone <0.050…haven’t already ovulated. Estradiol 33.4…what does that mean? I only had Clomid cycles (where my estradiol was 300, 600, 900) to compare these labs to so I wasn’t sure what my estradiol should be on an unstimulated cycle but I knew 33 wasn’t right. I knew it was low. I was FREAKING out thinking I was going to ovulate late and we were going to “miss” ovulation due to conflicting work schedules. The next day my Dr. confirmed that my estradiol was way too low only it didn’t mean I was going to ovulate late…it meant I wasn’t going to ovulate at all. I lost it. Lots of tears were shed. We finally found a problem and “fixed” it and were finally getting to try on our own again and suddenly I was experiencing another issue that had never been an issue before. Why is this happening? What is going on? Complete frustration. There’s a lot more to this story like more freaking out, talking with people who’ve been through it and calling my Dr. for more answers but let’s fast forward to what this an-ovulatory state really means for us!
This an-ovulatory state may just work in our favor! My body decided it’s not going to ovulate on its own so we’re going to pump it full of drugs to mature some eggs, then we’re going to make it ovulate and then we’re going to place D’s sperm right inside my uterus. Intrauterine insemination. My ultrasound yesterday revealed lots of immature follicles so I started on a lower dose of gonal-f last night to start maturing some eggs! We have to make sure too many eggs don’t mature because then we’d have to cancel the procedure due to the risk of multiples. I’ll give myself a shot in the fat on my abdomen for the next 12-14 days and be closely monitored by ultrasound and labs until I have a couple of mature eggs. Then D will have to give me a different shot to trigger ovulation (this is a one-time intramuscular shot which is why D will have to do it)! A day (or two- not sure on the timing here) later we’ll go in to have his sperm placed in my uterus and then the dreaded 2 week wait will begin and hopefully the even more dreaded first trimester of pregnancy will begin after that!
The stakes seem a little higher now since I’m putting medications into my body, but I’m really not too worried about getting pregnant. Our next pregnancy will kind of be the moment of truth and if we have one more miscarriage we’ll go right back to IVF. The hardest times in this journey are all of the times I’m sitting around and waiting so it actually feels really good to be proactively working toward a baby. I (strangely) look forward to my shots because I’m actively doing something to move this journey along. I look forward to blood draws and ultrasounds and love all of the information they provide. All of these things make me feel a little bit more in control of a process I truly have no control over. Here’s to hoping IUI works and that the septum has been the problem all along!
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MORE ON THE SEPTUM…I don’t think they can ever say with complete assurance that something was the cause of a miscarriage and while the septum is the first (& only) answer we’ve gotten it was still a very small septum. My Dr. said it’s about 50/50 whether (or not) the septum has been the cause of all of our miscarriages. Not really the answer I was hoping for (I’d like more than 50/50), but still thankful we did the surgery and found a septum. My Dr. said miscarriages usually occur later (after the placenta really takes over) if it’s due to a septum, but that doesn’t mean our embryos weren’t implanting on the septum and still resulting in miscarriage. It just means we can’t be real sure the septum has actually been the cause. I asked if we should consider trying to conceive post septum removal like we’re starting over again. I asked if we have another miscarriage should we think maybe it’s just one of those chromosomal “flukes” that happens to a lot of people and try again or default back to IVF. He said yes, it is possible for the first 5 miscarriages to have been caused by the septum and a 6th (future) pregnancy to be caused by a chromosomal fluke but you can only be dealt so many bad hands before you get a good one. If we have a 6th miscarriage it will be worth moving on to IVF to do the genetic testing to ensure we’re implanting normal embryos and hopefully spare us from any more miscarriages.