Second Ultrasound at 8 weeks 5 days

My second and last US with my RE at 8.5 weeks was Monday.  A heartbeat of 165 bpm was heard and a fetus was actually visualised that looked somewhat like a baby!  I got to see the flickering heart, spine, legs, arms, umbilical cord and even fingers!

I have flipped the US picture upside so you can see the baby right side up.  At top is the head and bottom are the legs, an arm is to the left and the umbilical cord is going off to the right towards the yolk sac.

Here is a video of the heartbeat!  My RE said that there is now less than a 3% chance of SAB/miscarriage after hearing the heartbeat for a second time.  Yay!

Honestly, I am still in shock.  Overjoyed and excited, but still in a bit of disbelief.  I just cannot believe it worked on the first round.  I really thought we were going to be like many couples who have to go through heaps of rounds before we met with success.  What faith, hey?  My RE was thrilled though for us, and I am happy for them as well as my data will help their success rate go up in the women over 35 category.

Sadly, I am graduating from my RE office.  I am 9 weeks today and will stop daily progesterone at 10 weeks.  I will then see my midwife (also my preceptor) on 4 January for a new OB appointment where I will be scheduling first trimester screenings at that point due to my age.

I am excited about going forward and am trying to have loads of faith that all will work out fine.  I am thankful for all my friends' and family's support and prayers.  It really means the world to me (and us!).

Friday's News - HSG

I had a hysterosalpingogram (HSG) with saline in my doctor's office on Friday. The procedure is initiated with a small catheter that is inserted through the cervix, then a small balloon is inflated to keep the catheter in place within the uterus and to prevent the saline from leaking out. It is similar to a foley balloon used for dilation of the cervix and induction in labor, but much smaller.

Saline (100 cc or more) is then injected via the catheter into the uterine cavity in order to examine the uterus and surrounding structures via ultrasound.

The procedure itself is not painful - felt like a typical pelvic exam. However, upon first insertion, the catheter was not staying in place and they had to use a tenaculum on my cervix in order to insert the catheter further inside the uterus.

While medicine and science say there are no nerve endings in the cervix, the pain experienced when the tenaculum was placed was intense (you can see here it pierces the cervix in order to hold on to it). It was a searing, tugging pain that felt like my whole uterus was going to be pulled out. I became overly hot, sweaty and nauseous. At one point I even thought I was going to pass out. The nurse gave me a magazine to fan myself, and I began to feel better. Thankfully the tenaculum was only in place for a few minutes until the catheter was inserted further and the balloon was re-inflated. Then they proceeded with injecting the saline.

As an aside: Even though the tenaculum was only in place for mere minutes, I am still having cramping, soreness and an achy discomfort in my uterus a day later. Many practitioners use tenaculums to place IUDs, but after yesterday's experience, I am definitely going to ensure I learn how to insert them without a tenaculum. Hands down, that was the worst gynaecological experience of my life.

My US revealed a few nabothian cysts on my cervix, but nothing to be concerned about there. They are small and benign and typically disappear on their own.

The spot in my myometrium was reviewed. Last time it was fluid filled, possibly blood, but this time it was empty. A second area was also noted with this US. Both appear to be adenomyosis. On one hand, this is a relief as it is not cancer, but on the other, it is still somewhat concerning for me due to the possible effects on fertility and the increasing menstrual cycle pain I have been experiencing. I am also quite stressed by the fact that this has shown up only after commencing with fertility treatments.

Adenomyosis is when endometrial tissue that lines the uterine cavity grows into and within the myometrial (muscle) tissue of the uterus. This endometrial tissue is a glandular tissue that secretes essential nutrients for implantation and growth, as well as blood during menses thereby essentially causing bleeding within the walls of the uterine muscle. This is what causes the extreme pain during the menstrual cycle.

My two spots on US, however, appear to be isolated islets (like these spots on far right) instead of endometrial tissue growing into the muscle (as seen by the arrows here). This is why my RE is not 100% sure of the diagnosis, although she says she is quite confident that what she is seeing is not going to affect our chances of conceiving.

Adenomyosis can cause menorrhagia - heavy or prolonged menstrual bleeding (yes to heavy, no to prolonged), dysmenorrhea - severe cramping or sharp, knife-like pelvic pain during menstruation (yes, definitely - began with fertility treatments and became increasingly worse with each month), menstrual cramps that last throughout period and worsen as one ages (no, only first 2 days), pain during intercourse (no, thankfully), bleeding between periods (no, hopefully never), and passing blood clots during menses (yes - has increased with fertility treatments). The uterus can also increase to double or triple its normal size (don't know yet). Adenomyosis can cause a bearing down feeling (yes) along with pressure on the bladder (no).

I have not asked for my measurements of my uterus, but plan to at my MRI. I have been feeling rectal pressure and lower back pain more and more frequently of late and am wondering if this is due to the increasing size of my uterus. Previously my RE told me my uterus was anteflexed, but I have always been told previously that it was retroverted. We shall see and confirm on both counts with the MRI.

Adenomyosis is mostly found in women over the age 35 (that's me!), typically between ages 40-50. Adenomyosis is dependent on estrogen and grows with an increase in unopposed estrogen or in the presence of an estrogen imbalance. Due to this, adenomyosis often goes away with menopause.

I did not know this before, but someone experiencing uterine surgery, i.e., cesarean section, is at higher risk for adenomyosis due to the cutting through the uterine layers of myometrium and endometrium. However, I have had no uterine surgeries, and am not sure why I would be predisposed to this.

Treatment for adenomyosis is via hormone suppression and balance with oral contractive pills, IUD with progesterone (Mirena), or Depo-Provera. I have also read online about the use of natural progesterone cream as a way to balance the estrogen dominance. Heavy menstrual flow and pain can be controlled with around the clock ibuprofen (decreases blood flow by 25-30% and cramping pain due to anti-prostaglandin action). Lupron can also be used, but it causes a menopausal state with complete cessation of ovarian function and menses, eliciting many menopausal type side effects like hot flashes and can only be used for 6 months. Typically all symptoms of adenomyosis resume after medication cessation. Sadly, at this point in medicine, an hysterectomy is the only permanent cure outside of menopause.

Next Friday, I will have a pelvic MRI to determine a definitive diagnosis as well as to see if the adenomyosis is diffuse - throughout the myometrium - or only localised to the two spots seen on US. I will have the results a week from next Friday. I am hoping my RE is right and that this will cause no impediment to our chances of conceiving and having a healthy baby. I definitely do not want to have a hysterectomy.

My theory is that I have an estrogen dominance issue due to:

1. Drastic increase in weight gain since moving back to US (up 9 kg/20# in 10 months).
2. Fertility treatments.
3. Not practicing Ashtanga/working out regularly.
4. Age - over age 35 estrogen levels rise and progesterone levels fall, progesterone levels are lower due to less consistent ovulation and short luteal phases, the latter which I have. Unopposed estrogen (without progesterone) leads to estrogen dominance symptoms and diseases.

So my personal plan now is to:

1. Return to my acupuncturist (I stopped going when I found out that our fertility issues were due to my husband's low sperm count).
2. Make an enquiry to the acupuncturist regarding DIM and Myomin - I read online both can reduce and balance excess estrogen thereby reducing adenomyosis symptoms.
3. Add supplementation - vitamin E 600 IU at bedtime, magnesium 300 mg/day and B6 50 mg/day - along with my prenatal vitamins.
4. Take a month break from fertility medications to clean out my system.
5. Do a juice fast for 20 days to detox, rebalance and lose the excess weight - I will be following the Reboot plan.
6. Return to practicing Ashtanga 5-6x a week for de-stressing, fitness, health, detoxing and re-balancing. Many asanas in Ashtanga also work to increase blood flow (prana) to the reproductive organs and mula bandha helps strengthen the pelvic floor.
7. Feel better in 30 days!

An Auspicious Round 3

Thursday, 9 June -

Day 1 of cycle. Called clinic and my Clomid and hCG were called in for me. I pick up Clomid at my local neighbourhood pharmacy (only $3 with insurance) and the hCG is sent via FedEx by Walgreens to my front door (also only $3 with my insurance).

Saturday-Wednesday, 11-15 June -

Taking Clomid 50 mg 1 x a day for days 3-7.

Saturday, 18 June -

US to check my follicles. Sadly, I only have 2, maybe 3 that have developed (previously I have had 4-6), but my RE still has hope. There is a spot of concern though - a fluid filled sac in the wall of my uterine muscle. It does not appear to be ominous, but it is peculiar as it was not there in the beginning, showed up in my diagnostic US, was gone for my HSG and round 2, and now has resurfaced. If this IUI does not take, then I will undergo a hysteroscopy and biopsy to find out what it is, but in the meantime, per my RE, I am not to worry about it. Since it is not of immediate concern, the IUI will continue as planned.

Monday, 20 June -

0700 My husband drops off his sample. I do not have much hope as I just had a dream that night that the clinic called us and told us not to bother coming in as his sample was too small.

1030 rolls around and there is no call, so I head into the city to the clinic.

1120 we are shown to our room and I am asked to undress from the waist down. I always like to wear tunics or dresses so I do not have to feel so naked. I take my capri leggings off and sit in the chair chatting with my husband. I do not want to hop up yet on exam table as I never know how long I will have to wait and I hate feeling like a patient.

1125 My doctor pops in just 5 minutes later and asks if I am ready. The nurse and doctor verify with us that the sperm sample is my husband's (what a nightmare it would be to be injected with someone else's sperm!). We confirm that it is. They then give us the good news that the sperm count today was over 10 million - our best count yet! Woo hoo!

1130 I get into position - lithotomy, stir ups, the whole lot (although my midwifery preceptor likes to call them footies - she says that is less threatening). So I am up in the footies preparing myself for a very long and uncomfortable ordeal as it has been before, but it was amazingly super quick this round. Speculum was inserted, sperm was drawn up into a syringe, catheter with syringe attached was inserted through the cervical os via US guidance and voilà!

1132 In under 2 minutes 10 million + sperm were injected into the top of my uterus. We were all surprised. There was no bending, turning and readjusting the catheter or filling up my bladder more. My RE said, "I am taking this as a good sign!" She said she did not know what was different except that my bladder was not as full, but it was quite a different experience and visit. An very auspicious round 3.

1145 After a 10 minute 'psychological' rest and paying our $300 IUI bill, we are out the door, arms around each other, both exceedingly happy.

I told myself before I went into round 3 that I was not going to get my hopes up. The previous 2 times I had such high hopes and was über stressed during the procedure and throughout the 2 week wait (maybe that is why the previous IUIs did not go very well!). Both times ended in a day or two of prone position depression and heaps of crying. This time I did not want it to be like that. I have read The Secret and do believe in positive thinking, but this time I did not want to have such high hopes that could be so disastrously dashed. So I have taken up a nonchalant attitude. I want it to happen, I hope it happens, I am thinking positively that it WILL happen for us eventually, but if it is does not happen this time, I am okay with that. Due to this attitude, I was happier and more relaxed at my visit and am now going to go on with my life for the next two weeks without the obsession and worry that consumed me for the previous 2 rounds. I am hoping things will be different this round, but it will not be the end of the world if they are not.

Now, I am off to spend the week with my husband doing renovations to our home in hope of having it all done very soon. All of these home projects will surely keep my mind active and occupied. My uterus and right ovary (where all my eggs were again - I do not think at this point that my left ovary is working at all) are a bit sore and crampy, but I am hoping that will dissipate later today. No time for bed rest though when there are so many projects still left to complete!