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MONDAY, MARCH 2, 2009

I am set today for my Saline Sonogram. From what I have read, it should be a really easy, painless procedure. In fact, so much so, that I told hubbo not to cancel his important meetings and that I could take myself. And, to be honest, the HSG was SO painful, I can’t see how this will be painful. Instead of dye, this is simply saline injected for contrast. The saline sonogram is used to evaluate the inner cavity of the uterus (endometrial cavity). It can also be used to discover whether either of the fallopian tubes is open. This test does not reveal any abnormalities on the outside of the uterus or on the ovaries, such as adhesions or endometriosis. From what was explained to me, I was told they would be looking for polyps, fibroids, or any “foreign matter.”

This is what we hope the sonogram looks like…dark with no light streaks or spots!

Normal Saline Sonogram

Normal Saline Sonogram

Okay, off to the procedure! More later…

Hey gang, it’s the next day, last night was ROUGH, to say the least. I am coming to learn that I am incredibly sensitive—and that my retroverted uterus makes it tough to get up in there.

The procedure was performed by Dr. Sohn, who couldn’t have been more kind, knowledgeable and gentle. In the practice they rotate docs, so this was my time to meet Dr. Sohn. Unlike many, he talked me through the entire procedure, which I appreciated. The procedure is performed as follows:

  • The procedure is performed in the office
  • A speculum is inserted into the vagina.
  • The cervix is swabbed with an antiseptic to help avoid infection that can be caused by insertion of a small, balloon-tipped catheter through the cervix.
  • The speculum is removed and a transvaginal ultrasound probe is inserted into the uterus, providing a picture on a monitor.
  • A warm saline solution is injected through the catheter, expanding the fallopian tubes to allow for better visualization.

The doctor and nurse will tell you to expect mild cramping, and to take 800mg ibuprofen an hour before the procedure. If there is any pain, it should go away after the probe is removed.

THAT IS THE EXPECTATION. I, of course, could not be the norm, and had to be in dire pain. It wasn’t as bad as the HSG, but we ran into a few issues that created more pain than anticipated. Due to my retroverted uterus, Dr. Sohn had to manipulate the cervix in several ways to insert the catheter. My opinion is that the balloon on the end of that sucker is what hurts. Following that, there was some resistance flushing in the saline. When it did flush through, it felt like the most incredible menstrual cramp where you would expect an enormous flow to exit. I felt the cramp swirl from the bottom of the right of my uterus and flow up around the top around to the bottom of the left. I visualized a large marble in there. Then I started thinking about roulette. Then I started thinking about the movie Casino Royale…then I wondered if I would ever design anything as amazing as the opening credits for that movie. ANYTHING to distract, I suppose. I laid back on that table crying silent tears down the sides of my face.

Very Cool. I pulled it together. I got to watch the whole thing on the video monitor. I didn’t actually know what I was looking at. Kind of like Rachel on Friends when she can’t see the baby on the ultra sound. At that moment, Dr. Sohn showed me a bright white spot on the monitor. It kind of looked like a AA battery. Maybe an air bubble? He asked, Have you ever had an IUD? Uh, no. Are you sure? I laughed. He said, yes, you would likely know better than I would. So he, in his words, rooted around in there for a while to see if he could change the size, shape, position…an air bubble shouldn’t remain that long.

After about 45 minutes he removed the probe, sat me up and said, I think you have a “foreign body” lodged in the lining of your uterus. Uh, EXCUSE ME? He suggested I have a hysteroscopy to determine what it was. This is where they insert a camera into the vagina to get a better look. Want to know something funny? THE FIRST THING I ASKED? Do I get any pain medication for that procedure? I was not doing one more thing that was going to hurt that much. He said he would discuss with Dr. F and they would call me later.

I WILL TRY TO GET THE IMAGES OF MY SONOGRAM SO YOU CAN SEE WHAT IT LOOKED LIKE.

MY TIPS FOR THE SALINE SONOGRAM

Procedure Time. 20-45 minutes depending on size, shape and position of uterus. Additionally, any findings can increase time to take additional images. It seemed to pass quickly for me.

Ask for meds. If you had a hard time with anything else, get a valium or vicodin or something more than advil.

Wear granny panties. I don’t know about you, but I am a thong wearer! I have found that for these appointments I need to wear full undies to wear a sanitary napkin.

Wear loose clothing. They shoot you up with TONS of saline/water. You will be bloated for about 24 hours. Since it is not in your bladder, it will need to be absorbed or leak out, so fun.

Sanitary napkin! They gave me one, but it was short. When I took a few steps, I GUSHED saline and blood. I had to stop in the lobby and change out. Be prepared.

Recovery Time. Take it easy. AS ALWAYS…I say take it easy that day, and don’t over-exert the next. The doctor will tell you that you can resume normal activities within 3 hours. Having had it done, IF you can, relax. Let someone take care of you. My hubbo made me really fresh swordfish, cous-cous and my all-time favorite SO bad for you dessert of vanilla ice cream with magic shell chocolate. He is the best.

IMPORTANT NOTE: I was completely ok to drive myself home. I had terrible cramps, but nothing worse than a very bad period by the time I left.

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WEEK OF FEBRUARY 9, 2009

It is so interesting…we got home and said, Okay, let’s take the week to determine what to do, IVF or IUI. But I think we both knew right away that IVF was the way to go. Like I said, I tend to get all the info and have the ability to make a decision immediately. The hubby? He ruminates. I get it. And then I don’t get it. At the same time, it did feel a little strange to meet one time with a doctor and then make a major life altering decision. We decided to do the following:

  • Talk it over with our parents
  • Review the financial ramifications of trying IUI first, then moving on to IVF if IUI was unsuccessful.
  • Complete a list of unanswered questions to email to Dr. F.

IUI

To begin, we learned more about the IUI process. Most people we know call it “The Turkey Baster.” I guess this is the way they can make is comfortable to talk about. {Maybe this is something I’ll talk about later, how much people DON’T want to talk about this, even your closest friends.}

IUI is defined as the process by which sperm is deposited in a woman’s uterus through artificial means. From what I have read, many IUI candidates are those who have male fertility issues and can use assistance getting the “good” sperm separated and inserted past the cervical mucous.

Process

TheAdvanced Fertility Center of Chicago has a good description of the process in my opinion:

  1. The woman usually is stimulated with medication to stimulate multiple egg development and the insemination is timed to coincide with ovulation – release of the eggs from the follicles.
  2. A semen specimen is either produced at home or in the office by masturbation after 2-5 days of abstinence from ejaculation.
  3. The semen is “washed” in the laboratory (called sperm processing or sperm washing). By this process, the sperm is separated from the other components of the semen and concentrated in a much smaller volume. Various media and techniques can be used to perform the washing and separation, depending on the specifics of the individual case and preferences of the fertility doctor and laboratory. The sperm processing takes about 20-60 minutes, depending on the technique utilized.
  4. A speculum is placed in the vagina and the cervical area is gently cleaned.
  5. Then the separated and washed specimen consisting of a purified fraction of highly motile sperm is placed either in the cervix (intracervical insemination, ICI) or higher in to the uterine cavity (intrauterine insemination, IUI) using a sterile, thin and soft catheter. Intrauterine insemination has a better success rate than intracervical insemination. Therefore, it is the preferred method at the large majority of fertility specialist centers.
IUI Insertion Example

IUI Insertion Example

After reviewing this option, my husband is REALLY, REALLY wanting to do this. He feels like it is more natural, in so much as those procedures that need assistance. He is getting pretty upset that our baby may be made in a petrie dish. I keep joking we can name the baby Pete. Apparently, not so funny. I think it is. The other consideration here, this is MUCH LESS invasive and emotionally and physically demanding on the woman. My husband did not want to see me go through this.

IVF

I thought I knew a lot about this process. You take some hormones, they harvest your eggs, they fertilize them, re-implant them and you are pregnant. Yippee! I DID NOT KNOW. I JUST DID NOT KNOW. Every situation is quite personalized For us, we were starting from a poor baseline. Let me take you through the process of IVF, later I’ll talk about follicles, eggs, etc.

IVF has many steps, and is much more complicated to explain than IUI. In short, the goal of IVF is to stimulate more than multiple follicles {as opposed to one} into multiple eggs for retrieval and fertilization in a lab. These fertilized embryos will be implanted into the woman’s uterus anytime between 2-5 days after fertilization. Two weeks after implantation you will know if you are pregnant. I will go into MUCH greater detail the IVF process in a later post.

TALKING TO OUR PARENTS

This just didn’t go so well. My hubbo isn’t that close to his, so we went to talk to mine. I just started to cry. I startled myself with this. They just didn’t think it was as “bad off” as we said. My dad, the doctor, was convinced that our test results were wrong. Bless them, they just didn’t want to see us in pain.

OUR LIST OF QUESTIONS

  • You quoted us possible success rate of 35-40% with IVF. Is this per embryo implantation per cycle, or per cycle only? And, is this rate based on our specific case?
  • How many eggs will you aim to retrieve? What is a normal retrieval?
  • How many eggs do you recommend implanting per cycle?
  • What is the increased percentage of multiple births?
  • What is the risk for miscarriage?
  • What are the common complications we need be aware of?
  • Is it possible that our future bloodwork and/or tests could change our eligibility for IVF treatments? Are there key tests we need to be aware of?
  • Are there any genetic defects and/or development disorders that have been associated with / attributed to IVF?
  • Given our inclination to move straight to IVF, do I need the laparoscopy, or can we wait?
  • I have recently gained about 15 pounds (normal weight is 160-165lbs). Is there benefit to waiting a couple of months to lose the weight prior to starting treatment? I am concerned about being too heavy during my pregnancy.
  • Is there weight gain associated with the fertility drugs I will be taking?
  • Are there any lifestyle modifications that might help my condition and increase my chances of getting pregnant? What role do the following play in getting pregnant: weight, exercise, prescription drugs, stress, acupuncture, etc?
  • What is the full array of programs/services the Center for Reproductive Health offers?
  • Will any of our fertility conditions worsen over time, improve, or remain constant?
  • What further tests do you recommend? Are there any risks associated with the testing? Does my hubby need additional testing?
  • Follow up: In your practice, how often does this/these treatment(s) result in pregnancy? How many of these pregnancies result in live births, miscarriages, etc. (percentages?)
  • How many cycles of treatment on average does it take to see positive results?
  • Can we begin treatment immediately? Do you tailor treatment to individual couples, or is there a set protocol?
  • What type of monitoring and interaction can I expect from the center? Ultrasounds, blood work, general communication? How available are people for consultation and questions via telephone?
  • What are the benefits to IUI v. IVF? What makes a good candidate for each treatment? Can we improve our candidacy for IUI?
  • At what point do either or both of us need to consult a reproductive endocrinologist? Does your center offer that service?
  • Do you provide fertility and ob/gyn, or fertility only? Do I need separate ob/gyn?
  • What does treatment cost? Does my insurance cover any of the medications, hospital charges, or doctor’s visits? If I must pay out-of-pocket, do you offer any special payment plans?
  • What is the procedure for getting questions answered between appointments? Can I call, fax, or e-mail and expect a prompt reply?
  • What is the standard callback time, and does it vary depending on the urgency of the call?
  • I understand that many of my questions can be answered with a callback from a nurse, but if I need to speak with a doctor how do I make that clear?
  • What do I need to know about scheduling weekend procedures?
  • What is the phone number for off-hours problems?
  • Is there a directory of phone numbers for office staff and doctors? (numbers for contacting a nurse, getting lab results, discussing billing issues, etc)

THE DECISION

By default, we decided to just go to the upcoming IVF orientation. We were pretty clear that IUI was not going to work for us. Had it simply been an issue of my husband’s sperm motility, it may have made sense. However, with my follicle count and FSH levels “drifting upward” we knew we needed additional help. At this point, I think it was really more a question of whether or not IVF would work for us.