Friday, 30 October 2009

IUI #1

Today is Day 2 in our very first IUI cycle.

The lab tests from the laparoscopy came back clear, so I do not have endometriosis. However, with only my left tube completely clear, the odds of pregnancy are slightly lower. The professor estimated that we have a 10-20% chance of success per cycle, with a 40% chance of success over three IUI cycles. Interestingly, he recommends a rest cycle in between each IUI cycle for both psychological and biological reasons.

I have joined the university's head-to-head randomised trial comparing Clomid with Menopur for IUI. Now no matter what the outcome of this cycle, I am increasing scientific knowledge that will help subsequent people with infertility make more informed decisions. They gave me a selection of brown envelopes to choose from, and I chose one that means I will be taking Menopur this cycle. This is my protocol:

CD2-CD7: 75 IU Menopur
CD8: Ultrasound and bloodwork - Menopur dose as advised
CD9-17: Possible ultrasounds and bloodwork - Menopur dose as advised

Once the follicles look ripe:

Day -2: Trigger with Pregnyl
Day 0: IUI
Days 0-15: Progesterone suppositories
Day 15: Blood pregnancy test #1
Day 27: Blood pregnancy test #2 and ultrasound, if #1 positive

I am very thankful that I have my dear husband to do my injections. He is an expert at these things, while I can't even bear to watch the instructional video. I am also very glad that I only have one injection per day, it is subcutaneous, and the post-IUI progesterone is not an injection.

The hardest thing will be to try to keep everything in perspective. I am a very goal-oriented person, so if this IUI doesn't end in pregnancy I will feel as if I have personally failed. So my main mission this cycle is to focus on staying happy, to enjoy my time doing the things I love, and to remember that I already have a wonderful life.

Sunday, 4 October 2009

Laparoscopy / hysteroscopy

It has now been one week since my laporoscopy / hysteroscopy. I am recovering well, and they found a cause of our subfertility. I had intrapelvic adhesions between my uterus and abdominal wall, as well as on my fallopean tubes and ovaries. The methyl blue test showed that my left tube is unblocked, but my right tube is partly blocked. The doctor thinks that the adhesions will return in about six months, so we have a few months to try IUI, then on to IVF. The adhesions should not affect our chances of success with IVF.

The surgery really wasn't as bad as I thought it would be. For the previous five days I was on a low-fibre diet, with a bowel prep the night before. On day day of surgery I wore a dress and felt strange without my wedding ring. All the staff were great, especially the nurse who looked after me all day. My husband and I checked in at 8:30, and we had our own private room by 9:30. I got changed into a dashing blue gown with press-studs, sad that they wouldn't let me keep my socks on. I hunkered down under the blanket and started watching TV on my iPhone to distract me. The nurse could see that I was a bit nervous, and offered me "something for the pain" and "something for the anxiety". She looked at my belly and told me it was "good". The nurse took my blood pressure, and did a pregnancy test. At 7 days post ovulation it seemed a bit pointless, especially as abstinence was ordered by the doctor. The funny thing was, I was a bit afraid that it would come up positive, and I would be sent home in disgrace for wasting their time. However, it was negative.

In no time at all it was time for surgery. They even let me hold my toy dog that I had brought with me for moral support (yes, I am 29 years old). The wheeled me until just outside the doors of the operating room. There was a small boy of about 10 who was being wheeled through too, crying and vomiting and sounding terrified. I, on the other hand, was feeling quite mellow. Exactly like myself, but not at all worried or nervous. Yay for tranquilizers. A while later, they had me get off my bed and walk into the operating room.

I lay down, and started to shake. My mind might not have been nervous, but my body was cold and apprehensive. One nurse started sticking all these heart rate monitors all over me, while the anesthesiologist was prepping my drip, strangely in my wrist and not in my hand like in the movies. Everyone was moving very quickly, and they all seemed to know exactly what they were doing. The drip was in quickly, and the anesthesiologist told me that I would feel a bit of discomfort when the medication started flowing. The nurse held an oxygen mask above my nose. I asked them if they wanted me to count backwards from 100, and they said no. The infusion started, felt unpleasant, and within seconds I was feeling very sleepy. I wanted to tell them that I wasn't completely asleep, because I could still hear the beeping, but after that I fell completely asleep.

The doctor's notes say that they first conducted a hysteroscopy, and that my uterus looked normal from the inside. It measures 7 cm. A small biopsy was taken to double-check for endometriosis.

For the laparoscopy, a 12 mm incision was made just underneath my belly-button, and my abdomen was inflated. Three more incisions of 5 mm were then made lower down. From the outside, the uterus looked normal. There were adhesions in the vesico-uterine fold, in the pouch of Douglas between the sigmoid and peritoneum, on the right fossa ovarica (depression that lodges the ovary), and on end of the left fallopian tube. The adhesions were blocking the fimbriae that collect the egg from the ovary and pull it into the fallopian tubes. My corpus luteum was still bleeding. It was coagulated, and a cystectomy was conducted and sent off for further tests.

Methyl blue die flowed quickly through my left tube, but very slowly through my right fallopian tube. The adhesions were removed, my abdomen is deflated, and my catheter and breathing tube were removed.

I remember dreaming about wandering through the cobblestone streets of the city, but the next thing I new two hours had passed, and I was in the recovery room, with my toy dog on my pillow. I was so worried that I would never wake up again that I was just so thankful to be conscious. I started shaking, and the forced warm air under my blanket. I told them I was in pain, and they added something to my drip.

They wheeled me back into my room, and there was my wonderful husband, who hadn't left the room for even an instant. My throat was sore, and they wouldn't let me use my soothers because they had lidocaine in them. But they gave me something else to suck on to relieve my throat. I spent the afternoon dozing and recovering, getting some more infusion of "something for the pain" in my drip, and after that "something for the pain" to put under my tongue. The doctor came over in the afternoon to tell us the results. She said that the adhesions are most likely due to "an infection in the pelvis", which the internet tells me is most likely clamydia, which is very surprising.

I have taken the next week off work. The first 24 hours were difficult. It hurt every time I moved, and I could not lie on my side or sit up without intense pain in my shoulder, due to the residual gas pressing on a nerve. But I was still able to lay on the couch and have a Mad Men marathon, so it wasn't so bad. Every day got easier, and I am surprised how quickly I am recovering. The incisions are tiny, and the stitches are going to be removed tomorrow.

I am so glad that we now have an answer, and I have some neat photos of my uterus to boot. So now that the cobwebs have been cleared away, I am hoping for some good news in the next twelve months.