Back Up and Ready for More Punches

Remember those punching bag inflatable things from when you were a kid? The bottom was filled with sand and the rest with air. I remember getting one for Easter one year. I think it was a bunny and I remember feeling bad hitting it too hard. I'm sure you can figure where I'm going with this. That punching bag that quickly pops back up? Yeah, that's what I feel like.

I've recently taken some harder hits than I threw as a kid. But, I'm back up and ready for some more abuse. I'm just hoping I don't pop anytime soon.

Today was an insanely long day. My appointment was at 7:30 and after I had to drop off paperwork at my boss' house. From there I saw 8 kids for therapy. There was a meeting thrown in there as well and a cancellation I wasn't informed of, so I still drove all the way to the daycare. I came home and took a nice nap on the couch.

My appointment was fine today. They drew blood and checked all of my levels: progesterone (0.6), estrogen (<20), LH (.47), TSH (2.45) FSH (4.1), and HCG (4.1). I asked about polyps and that being a possible factor in a chemical pregnancy. The NP said she didn't see any on ultrasound. I then informed her that I had them in the past and that they were only visible with the hysterosonogram. She asked if that was something I was interested in repeating and I said it was. 

I was given the all clear to start estrogen today since my HCG level was low enough. I am supposed to take it 3x's/day. With my last frozen transfer I took it once a day and remember it made me pretty nauseous. I hope it is better this time around. I also start back up on baby aspirin and dexamethasone. It was a nice 4 days off. 

I have another appointment this Thursday to recheck my HCG levels and to do the hysterosonogram. I am hoping I don't have any polyps, but I need to do this for my own peace of mind. I have another appointment for the following Wednesday where they will check my lining and I will do intralipids. It is an IV and takes about an hour and a half. W is requesting the afternoon off from work so he can be there to keep me company. From there, as long as everything looks good we can schedule the transfer. The NP today a possible day could be the 19th. Looks like I will be spending some of my 2WW in Mexico. Yes please!

Polypectomy

Polyp free is the way to be!! Surgery was Wednesday and everything went fine. This time it was at a surgery center instead of the hospital so I was there a much shorter amount of time. My doc said I started to shake and my body temperature dropped during the procedure, but it wasn't a big deal. I guess I will do anything for those heated blankets, conscious or not.

When Dr.S met the resident prior to the surgery and started to give my history he started with... "Elizabeth and I go way back." It seems his opinion about the miscarriage is that it was caused by low progesterone. Even though this is just an idea, it helps me feel more confident in preventing a miscarriage in the future.

I took Wednesday and Thursday off from work to stay home and relax. It was nice to not be working even though I didn't really feel like I needed the time off.

Dr. S removed at least 1 polyp, I can't remember if there are more. He took me off the BCP's and I need to go back for an appointment some time around 2 weeks. He mentioned doing another sonohysterogram before the FET to make sure everything looks good, but we will see.

He said it is unlikely the polyps would come back, but knowing me, this feels so much more likely. He said he is going to talk with his colleagues and do research to see if there is another recommended protocol. I'm nervous about the future but also feel so ready for another cycle.  

Really?

Nothing else unidentifiable has appeared, so that is good.

I went to my GYN for my annual this week. When she asked if anything had changed, I gave her the full run-down. I barely made it through without starting to cry. This makes me wonder whether I've reached a point where I really should see a counselor. She was very nice and everything was super quick. I mentioned the tissue thing to her and she didn't seem to think anything of it. I was still spotting at that time.

On Friday I started bleeding, like a period. I'm still on birth control pills and haven't missed any. That afternoon I called my RE's office and left a message for him to call me back.

When he called, another 45 minute conversation ensued. He offered me another sonohysterogram prior to the hysteroscopy but I said no. He said it was possible that I passed the polyps, but it was certainly unusual and without a tissue specimen it was impossible to tell. He left it as he planned to keep me on BCP's but to call Monday afternoon to let him know if the bleeding had stopped. 

I was bleeding all weekend, so no, it didn't stop. I will call this afternoon and see what he has to say. It's not quite as heavy as a period, but definitely not just spotting. 

He also said that we won't be able to do the FET until I have a cycle after the polypectomy. This means at least 6 weeks until CD 1 for FET.

We rejoined the Y this week so I am hoping to do some running/jogging more consistently. Wish me luck!

Conversation with RE this afternoon and pre-op appointment on Wednesday. 

Unidentified

TMI alert. You probably want to skip this entire post if you aren't interested about the inner-most workings of my effed up body.

I had some spotting yesterday. I think it was still a result of the sonohysterogram from Monday, so it didn't concern me. What concerned me was when I went to the bathroom to pee when I wiped a large piece of tissue was there. It was larger than a quarter but not rounded. I have no idea what the hell it was. It was almost like a membrane, but what the...???

When I went to flush I noticed there were two more pieces in the toilet. Then more spotting for the rest of the day. 

I called the nurse at my clinic just to let her know and perhaps find out what was going on, but she said she would tell me doc and possibly call me back. No phone call so I think I will survive. I guess I'm not dying. The nurse did tell me to save it if there were more, but there wasn't any more. 

She said she knew you can shed a fibroid because she's seen to happen with another patient, but she had no idea whether that was possible with polyps. I seriously doubt it, but I'm not gonna lie, if there aren't any polyps there when I have my hysteroscopy I am going to be pissed. 

In other exciting news I have my annual appointment with my GYN today. Two violations in one week? No wonder we haven't had any sex, I'm getting enough action without my hubby.

UPDATE: I just talked to the nurse from my clinic. She said without bringing the tissue in to be looked at by the lab, there is no way to tell what it was. She said it isn't likely that someone could shed a polyp unless it was barely hanging on. Mine didn't appear that way. In the future, I am supposed to save anything like that and bring it in so the lab can figure out what it is. It's just another mystery now. I said "So it was probably just some tissue that got dislodged from the sono?" Her reply, "There's shouldn't be any tissue there." Who the hell knows!

Hurdles

Why do the hurdles keep getting higher? Do you know how short my legs are? 

I had SHG #2 today. W was able to make it this time so it was nice to have him there. The procedure itself was uncomfortable, but it didn't take very long. The results....2 polyps. Just great.

So now I have surgical procedure involving anesthesia #4 with Dr. S scheduled. I had Lap #1 last Oct, Lap #2 with bonus D&C in Feb, and my egg retrieval in July.

My surgical hysteroscopy is scheduled for October 5th at noon. I have my pre-op appointment next Wednesday. The procedure itself is supposed to be quick, I just wish it could have been scheduled sooner. 

I can't say I was shocked or surprised about having polyps. At this point I have started to expect the worse, so I had kinda prepped myself to receive the news of polyps. The endometrial biopsy showed traces, so it's no huge surprise. My RE thinks they grew as a result of the high levels of estrogen during my IVF and pseudo-FET cycle. He wasn't able to say whether the poyps and the fluid were related. 

I will stay on the birth control pills until at least October 5th. My biggest question to Dr. S was when will we be able to do the FET after the hysteroscopy? He wasn't able to give me an answer, but said he would discuss it with the panel of doctors this Thursday in order to make the best decision. He said he would call me on Friday and let me know what the consensus is. 

Today was the closest I have come to breaking down in tears in Dr. S's office. Is this FET ever going to happen?

Becoming a more patient person

My doc called today while I was in the middle of a therapy session. As soon as my phone rang I excused myself. I felt bad just getting up and leaving for 15 minutes, but there was no way I was missing another call from him. He apologized for not calling back sooner as he was out sick Monday and Tuesday. 

Dr. S talked about the results of the biopsy. He first talked about the proliferative endometrium and said that although it was concerning, but there was nothing we were going to do about it at this time. When I told him I had only been on the progesterone one day he said that it may not have been enough time. I asked about how my progesterone levels got so high during the IVF cycle and he said that is in the blood and that my endometrium may be different. Without doing a biopsy the only thing you can do is measure the blood levels of progesterone and go by what you see on ultrasound. 

He then talked about the traces of the polyp that were found. He was surprised since he had done a sonohysterogram (SHG) in Dec and didn't see anything then. He said that they don't often pop up in a short amount of time and that there is no real reason why this would happen. He said if I had been on estrogen the entire time without exposure to progesterone, that could cause a polyp, but it isn't the case with me. The only thing that could explain why we didn't see anything with the first SHG was because it wasn't done on the high resolution ultrasound machine at their office. He wants to do another SHG on the high resolution machine and see whether we see something. He said it is rare to miss polyps on a SHG because they light right up. If we do find a polyp we will likely do a hysteroscopy. He didn't want to go there immediately because it means surgery and he doesn't want to subject me to unnecessary surgery.  

Doing another SHG means having to schedule with the ultrasound technician and my RE. He said he would try to do it before going out of town next week, but he wasn't sure about scheduling. 

The receptionist called me a few hours later to tell me they won't be able to get me in before Dr. S goes out of town next week. They will have the nurse call me next week to schedule. I was disappointed at first, but at least now we have a plan in place. I am hoping we will be able to schedule it for the Monday when he is back. Until then, I guess I just continue taking BCP's and crossing off the days on the calendar. 

We are looking at the week of the 12th for the HSG. If they find something, who knows when they would do the hysteroscopy. Looks like September is likely out for the FET. The hardest part about that is that my EDD for the miscarriage is September 30th. I really thought I was going to be pregnant again by the time that rolled around. 

Things haven't been easy the past couple of months. W said the other night that he wants a list of all the potential problems we could encounter and once we cross them all off then we know we will get pregnant. It really seems like one roadblock after another and that is something can go wrong it will. I'm starting to become more patient and understanding with this. There is really nothing I can do about it, and feeling badly about it all the time doesn't help. I'm tying to distract myself and focus on other things, but it is hard. 

I made a realization about friends lately as well. If we find a nice couple to hang out with (usually they are married), they are either pregnant or they already have a baby. As much as I like them, it is hard to spend tons of time gushing about their babies. There is no "safe" couple to spend time with these days. That means I am hanging out with younger people who are more at the partying stage of their lives. This isn't a great influence on being healthy and making good decisions. I feel like I just can't relate to any friends right now. 

A few months ago I made an appointment with the other RE in the area. I am happy with the care I receive with Dr. S. I am happy he knows who I am and takes the time to call me personally and talk for 45 minutes if needed. I am happy with the treatment as well as decisions made to this point, but at times I do feel like Dr. S is overly conservative about things. I'm not really displeased in any major way, but the price is a huge consideration. The other RE (Dr.K) has package deals, and they have one package deal I am considering. I have an appointment scheduled with him coming up in September. I never thought it would get here so quickly and I had previously hoped I wouldn't need it when I made it in June. Now I am faced with canceling the appointment and sticking with Dr. S for now until we at least complete an IVF cycle, or seeing the other doc and finding out what he has to say. I feel like my case has been so complicated it will be hard for the new doc to follow it all. Also, I have to get my file to the new doc and that means notifying my current office and making them think I'm not happy with the care I receive. Is there really any point in seeing another doc if we can't even get out of the starting blocks with my current doc?

Any advice? 

Biopsy Results

I have a new idea for any doctors. Never call your patients on Friday afternoon and leave a message.

On Friday I missed a call from my RE and he left a message. Really?? A message on at 4:50 on a Friday afternoon with no hope of any conversation until Monday. 

And then? He was out sick on Monday.

On the message he said he had the pathology results of the endometrial biopsy. The biopsy revealed a small fragment of benign polyp and a proliferative endometrium (no progesterone effect). He said we will have to address the polyp as it could interfere with implantation. He was also surprised that he was seeing no progesterone affect as he thought I had been on it at least 2 days. I had actually only done one shot and it was fewer than 24 prior to the biopsy. He said that I could be progesterone resistant as some women with PCOS are. He is not sure, but this is something he will have to look at. He ended the call by saying we would have a further discussion Monday over the phone about it. 

I left a message yesterday both at the clinic (the nurse is out this week) and on his "academic" line that is a direct line to his personal voicemail. I guess I will have to keep my phone glued to me today.

Upon consulting Dr. Google, it seems that removal of polyps usually entails a hysteroscopy and D&C. Any personal experiences from anyone out there with polyps?

I really just want to have a plan in place and hopefully be able to execute the plan prior to my RE leaving for 10 days on Sep 1st. In a sense I like to think that dealing with this issue will make the fluid no longer be an issue. I know it will mean more time before we are able to do the transfer. Why does it feel like I am the only one standing still on this journey lately?

Hopefully I will talk to Dr. S today and have some answers and a plan in place. I will update when I do.