Hysteroscopy Post-op

I went in for my post-op yesterday. My appointment was scheduled for 2:50 pm and they ask that you arrive 15 min early to check in. I had already confirmed my information online so I didn't think I need to be there that early but I was hoping if I got there early maybe I'd get seen sooner.

On my way there, my gas light turned on and I debated whether I had enough time to get gas before the appointment. My gas light rarely goes on, it's not something I procrastinate because I have no interest in getting stuck anywhere. But recently I drove my husband's car and that needed gas so in my mind I had already gotten gas recently and kept forgetting to fill mine. I decided I didn't want to risk getting stuck without gas so went to the pumps near the office and ended up getting to the appointment by 2:40 pm. Plenty of time. Checking in took about 30 seconds because I had done everything online. Then I sat and waited. And waited. They were clearly running behind.

At 3:15 I got called back by the assistant to get vitals. She took bp, pulse, and temp. She asked me to get on the scale and I asked if I have to since I was just there. She retracted quickly saying, no no we don't have to it's just part of the protocol. Well eff protocol. I'm really quite done doing stuff "just because." I'm pretty much game to do anything that will be helpful but I'm not a puppet and if something isn't necessary then what's the point? I had also weighed myself earlier that morning and I know how much I weigh and just gave her that number which was good enough. I know when we start actual IVF or something then I'll have less of a choice and I'm ok with that. Honestly, I was wearing complicated sandals and didn't want to deal with taking them off if it wasn't necessary.

Nurse left and I waited some more. A medical student comes in and said she will get some information to tell the doctor and then the doctor will come in. At this point I was feeling annoyed. The wait didn't bother me until that very moment. When the medical student tried to explain why she's there instead of the doctor she said something like, "Well, because we can give you more time and get the information to the doctor." I'm paraphrasing but that's the gist. This upset me because I'm paying to see the doctor, I'm not paying for a med student's time nor did I schedule on the med student's calendar. Surely they will bill me with the doctor's fees. I'm not a case study or a charity case - I'm a paying customer and I didn't come here for a med student. This was all going through my mind as I tried to not get angry because when I get angry I cry. So I switched gears in my mind and said, fine let's do it. This is, after all, a "teaching hospital" and something else to get used to in a new clinic. Awesome.

So she started asking questions about my recovery - fever, chills, nausea. I told her that recovery took a while, in my opinion because of the general anesthesia. I told her about my cramping and spotting. She asked a few more questions and then went to the doc. The walls are pretty thin and I could hear the discussion in the doc's office. What I think happened was that the doc was running so behind schedule that she never had time to eat lunch and so instead of making me wait she sent in a med student to do the grunt paperwork before coming in. I'm on board with that. I would have been even more on board if the student had introduced herself by saying, "Hi I'm a med student and I know you've been waiting for the doc so in order to maximize your time here and get your appointment moving, I'll get some notes before the doctor comes in." That would have made me feel like even though they're running behind they're still respectful of my time and that my appointment isn't truncated with the doctor just because the schedule is messed up.

ANYWAY. Doctor comes in, says hi, and says she doesn't like that I'm still spotting. She asked if she could do an exam to check for infection. They left and I got undressed... the sandals had to come off afterall. She didn't see signs of infection. She took samples to look under the microscope and didn't see anything alarming there either. She recommended I stop the bc pills to get a period even though I'm not due to do that for another week. The thinking being that the procedure may have irritated the lining and it's off balance or something. If spotting and cramping continues after my period then she wants to put me on antibiotics. Ironically, in the quest of searching for inflammation, it's possible that the procedure triggered some inflammation.

Originally, the next step would have been the ERA. But since she wants to make sure there's no inflammation before testing the lining, her recommendation was to do IVF next. Moving up the timeline on the IVF is fine and this schedule lines up with when my husband's mandatory wait is over. It actually works out well to move up this period because then we're doing a retrieval as soon as he's ready. We're waiting for pathology results regarding the stain that the RPL specialist wanted to see. That's taking a little longer than expected and coupled with this newest unexplained spotting, she wanted to change the timeline a little bit.

In summary, here are the next steps:
- Initiate period asap
- Break cycle in July waiting for spotting to resolve and pathology results
- IVF cycle in August
- ERA cycle in September
- FET in October

There are a lot of ifs in that timeline and I know it's not set in stone. For example, depending on the timing after the retrieval we may push off the ERA/FET by a month due to the holidays. Also there will only be an FET if there are embryos from the IVF cycle, obviously.

The ERA is supposed to be a natural cycle, which means multiple days of monitoring, possibly on a daily basis. She asked if Saturdays are out completely and I said not necessarily. I'll come in for a procedure if I have to, especially for something like a retrieval or a very specifically timed FET because there's so much at stake. But for something like the elective ERA where I know there will be lots of days I have to go in, it's just not worth the hassle and stress to try to do it over the holiday season where there will be so many days that it will be a challenge to go in.

While I don't like the delay of the ERA, I'm happy with this switch. It means having the retrieval in the summer before things get hectic for me at work in the fall. It also means getting the heavy recovery procedure out of the way. I like the idea of possibly taking a break for the holidays before getting back into it for the ERA/FET. I know it's all going to work out how it's supposed to and I have no say over things I can't control, but for right now I'm content with this schedule and I'm trying not to worry about the spotting.

Recovery and July 4th

It's been a tough week for me. The recovery from this procedure really kicked my butt. Cramping lasted nearly a week; spotting lasted nearly as long; I had all kinds of side effects from the anesthesia like puffy and dry eyes, headaches, fatigue, nausea, and constipation. I tried to stay hydrated and eat right but I was barely making it awake through most days. I am so lucky my office was closed for the holiday week because I don't think I would have taken the time off to recover and I clearly needed it. It wasn't enough to warrant drugs, but taking it easy and staying hydrated were key. I don't know how much of my symptoms were because of the procedure and how much due to the weather; either way it sucked. It was definitely more of a recovery than my procedure in January.

 

Since I spent most of the week in bed or on the couch, I was on my phone for entertainment the majority of it. That's a bad idea and I don't recommend it. Social media is the devil and it will find your weak spots and exploit them. First of all, I was so disappointed to see how many complaints were being posted about the lack of camp on July 4th. No one wants to spend time with their children? No one wants to make childhood memories that last a lifetime? What is wrong with people? 

Second, there were the vacation photos. People are clearly posting their highlight reel, I know that. They're not posting the fight they had this morning with their spouse, or their regular day at work, or the broken washing machine, or the spoiled milk they put in their coffee, or the thousands of other daily life things that happen. They're posting pictures of beach vacations, pool parties, and exotic getaways. Smiling on a jetski, or posing with an icy cocktail on a boat in a cute summer dress with a floppy hat, or showing some ancient monument in Europe, or piling in big happy groups on the side of a pool with a bbq in the background. For someone who is already down because of what feels like a steaming pile of poo life has handed them, these pictures were a stab in the gut. It's the things I want but can't afford or don't have access to. 

I have a large group of acquaintances but not a big group of friends. I have people I can go out to lunch with one-on-one. But here is no cohesive group like on "Friends" the TV show where we default together. Usually the default group is family which I'm grateful and blessed to have, with all the politics and fun that comes with. Which means that on a day like July 4th when people post about potluck parties and large get-togethers, it makes me sad we're not invited to people's parties. My sister hosted a bbq which we went to but it was family and then their entire group of friends. I felt out of place and left after a couple of hours. I used to have really close friends but life took us on different paths and we're barely in touch. Geography is a big part of it. Being married to someone not as social is part of it. Spending all my mental energy on trying to build a family is a part of it. 

I don't know how people make close friends later in life, but I know it's not from doing what I'm doing. Something big needs to change, like moving to a new neighborhood or having a kid who has friends with parents, or starting a new job, or something similar that puts you in a position to spark new relationships.

Over my break I watched a documentary called "9/11 Faker," which talks about a person who pretended to have escaped the twin towers right before they fell. In the documentary, the real survivors of 9/11 talk about their experiences and how they started a support group for the survivors to get together, discuss their experiences, and lean on each other due to their shared experiences. Talking about the reason they started the group, and why he could no longer rely on his family for that support, one survivor said a phrase that stuck in my mind: "My need to talk is greater than their ability to listen." Even though his family loves him and wants to be there for him, they just don't understand. His story doesn't change and the horror replays in his mind all the time, so after a while people who weren't there just don't get the need to keep talking about it as a way to process. 

That phrase really touched me because it's how I feel with my support group. I call them my "out-of-network" group since they love me and want to be there for me but they just don't get it. My "in-network" support group are the people who have gone through it or are still going through it. I only have one non-online friend that we met recently who is still going through it and I often times find it easier to talk to her than some family members or even my oldest friends. 

At this point it's been three years since we started fertility treatment. I feel like I can't talk about it anymore to people who aren't in it. They're not as compassionate as they need to be, they're slightly dismissive without meaning to be, and they don't understand that asking "so what's next?" to get the timeline moving isn't going to make it move any faster. When I said I was having a hysteroscopy, one person responded with "oh you've had this already" as in ok so it's not a big deal. It's surgery. It's recovery. It's still scary and frustrating and painful. I don't need to hear that it's not a major surgery to make me feel better. I need sympathy and compassion and "Ugh I'm sorry you're going through that again; I hope you get some answers." When people downplay my procedures then I'm reluctant to share because it makes me feel like I have no right to talk about it, since it's no big deal right? I'm not asking to be coddled but I'm feeling dismissed. My best friend didn't check in. For 4 days. On Tuesday I texted her to make sure she's ok. I get that her job is very demanding and that my treatment is repetitive but still. A text. C'mon. 

One other thing contributing to my mood is the Handmaid's Tale. Anyone else watching it? I won't give away spoilers but during the latest episode my thoughts were "Omg, even SHE got a baby before me." It's a very intense show and I'm not sure why I watch it when it's so disturbing. 

Next week I go in for a post-op appointment and to discuss next steps. I can't believe summer is already half-way over. 

Hysteroscopy II

Last night before going to bed I reread the post about my first hysteroscopy and it made me feel better to remember that it's not a big deal procedure with minimal recovery. 

Our new clinic is very different than the old one as we discovered with my husband's surgery. Since the new clinic is part of a hospital, all OR procedures happen there. When I went in this morning, I was scheduled between a bone operation and a kidney surgery. 

Things were very different than the first procedure. It was very busy in pre-op. They took my vitals at least six times. They separated us until my IV was in. We waited for nearly two hours before being walked back. I saw at least 9 nurses throughout the day saying they're the ones going to take care of me. Contrary to old clinic where they have a cubby for your stuff and you go back to the same room after surgery, in the new clinic each part was a different location. I was told I should give anything valuable to my husband for safekeeping. This included my glasses. I was VERY uncomfortable giving up my glasses before needed since I cannot see without them, but I couldn't risk them getting damaged or lost for that very reason. 

Forty five min after my scheduled time, I gave up my glasses, said goodbye to my husband and walked semi-blindly with the nurse to the OR. They got me set up, hooked up a bunch of things, and started medication. As we waited for the doctor to come the nurses complimented my eyebrows and we had a whole conversation about the benefits of threading. The doctor came and everyone was ready to start but we had to wait for the anesthesiologist to come before the nurse could administer the dose that would put me to sleep. At that point my doctor complimented my eyelashes and everyone chuckled since she clearly missed the threading conversation. I joked with them to keep the compliments coming; the oxygen mask covering my face made talking difficult and my eyelids were getting heavy. 

The anesthesiology doc finally showed up and the nurse gave me the heads up that they're about to start. I felt a cold sensation in my IV arm and I was out. The next thing I knew they were trying to roll me onto a gurney but my body was totally dead weight. I fell asleep again and woke up in recovery sobbing, hearing someone telling me to take deep breaths. I don't even know why I was crying - relief? Pain? Drugs? Who knows. I feel like this is a common theme with me waking up from surgery. 

The doctor was telling me something ".... and we'll go over your results." By the time I opened my eyes again I wasn't sure how much time had passed but my doctor was gone. They told me they need a few more blood pressure readings before I can go to the next stage of recovery where my husband will get called. They gave me water and ginger ale and crackers and said I have to be able to go to the bathroom before they can take me to the next stage.  I sipped my water down and asked for another. I took a few swigs of the ginger ale. The crackers were ignored. 

At one point I was still disoriented and the nurse pulled the curtains back and said something like "....I'm just going to check..." - lifted my robe and peeked into my mesh undies. First of all, when did I acquire said mesh undies. And second, I know that while I was out they could do literally anything, but dude I'm awake and I'm right here!!!  I was still out of it enough not to make a stink about it but still. They likely do this every day; they're just doing their job; but a little courtesy and warning goes a long way. 

About 50 min after arriving at post op they asked if I was ready for the bathroom. We walked over and I did my business and as a reward I was allowed to level up to the next stage. They called my husband over. The nurse was about to give me something for the nausea but I declined -- I'd rather a day of nausea than a week of constipation, tyvm. Also, thanks for asking and giving me a choice rather than just shoving it in my IV. I already liked her better. I was about to get dressed when I asked if I was going to see my doctor. Apparently I had asked for her twice already and she was being paged. She called the nurses station and I walked over to talk on the phone. She said we'll talk at the post-op, remember? I said I had no memory of this but thanked her and hung up. Clearly I was not lucid when that conversation took place. 

They took out my IV, I got dressed, and they wheeled me out. I asked if I could walk and they said it's policy. Being in the chair made me so nauseous and I really preferred to walk, but I also knew that if I argued it would delay going home and that was my ultimate goal. 

I got home starving. It was nearly 3 pm and all I'd had was water and a little ginger ale since 6 pm last night. I had my prepared healthy lunch of roasted sweet potatoes, hard boiled eggs, and whipped cottage. I was no longer hungry but I was very dissatisfied. I had an intense need for cake. I. NEED. CAKE. I took to the freezer and found some ice cream. I also found some cheese curls hidden in one of the drawers. I had both and was still not happy. 

I paged my world and asked them to bring cake. One person brought babka; another brought an apple crumble. While it was greatly appreciated that people answered the call, they didn't bring the right cake. The babka was store bought and gross; and I don't like baked fruit. I couldn't direct them because I didn't even know what I wanted. I couldn't tell them they brought bad cake because even in my insanity I still felt protective of their feelings. My mom offered to make sponge cake. I declined, not wanting her to bother. I decided I need chocolate chip cookies and made a batch. They were heaven. I planned on eating the entire batch but I was satisfied and full after two cookies. They really hit the spot. 

At this point it's been over five hours since I woke up from the procedure. Cramping has subsided significantly. There's more bleeding than last time but I don't know what that means, if anything. Hopefully it will go away in time for mikva. Sex is allowed as soon as bleeding stops but that's not my concern right now. Even though cramping has gotten better and I'm not in physical pain, I'm really tired and feeling light headed. They did general anesthesia, not the twilight stuff I'm used to. I'm also really annoyed. Really, really annoyed. I don't know why, but I'm just mad at the world. I've limited visitors because I can't be trusted not to snap at someone or say something I might regret. My filter went for a hike and I don't know if it's coming back today. 

Shabbat food was already made last night so we're prepared; all I need to do is light. Going to shower, light, eat, and sleep for 15 hours. Shabbat shalom. Love and peace to all. 

Making the wait count

Things have fully transitioned to summer mode around here and the change has been nice. Things are slower at work, the weather is finally hot, and it seems like we're on our way to getting our summer projects started.

I'm still learning about insulin. I don't understand how my fasting and 2hr glucose are both well under the limits but my fasting/2hr insulin is high. I think I broke Google trying to come up with an answer because it doesn't seem to know. Beside that there are conflicting opinions about what to eat. Some say to strictly limit all forms of sugar while other opinions say that fruits are fine. Cutting out fruit entirely would be really hard for me so I'm not doing that yet. I have a call in to the Registered Dietician and in the meantime I'm working on cutting out white flour and refined sugar. I think that if I try to change too much too quickly then it will backfire so I'm focusing on small steps to help the changes stick.

This week's changes are to include at least 30 min of activity most days. That's up from 0-2 per week ever since the March loss. I'm also back to counting calories and, while not cutting it out entirely, limiting white flour and sugar. I found some recipes from an Instagram blogger that I'm excited to try. One is a lemon-garlic chicken and the other is a zoodles salad recipe. Very diet friendly and they both sound delicious.

The biggest challenges are going to be planning ahead and avoiding cereal. Planning ahead is crucial to having healthy food already in the house so that we don't resort to take-out which has been a major go-to in the past few months. Cereal is my food drug of choice in all forms and flavors. I can easily inhale two bowls for a snack, or instead of any meal of the day. It's not only a lot of processed sugar but there's also barely any nutritional value and it's a waste of calories. I'm not going to attempt to go cold turkey but it will have to be eaten sporadically and within small controlled portions.

In treatment news I'm getting ready for the hysteroscopy scheduled for the end of the month. I'm still on bcp so I can schedule my period around when it needs to be. The tricky part is with regard to mikvah since the procedure needs to be on a certain day of the cycle and will likely cause spotting. Hopefully the procedure will go smoothly with limited recovery which won't delay anything. After that I get a two week break while they get the results over to the RPL specialist and we all wait for the start of my next cycle.

If all looks good, we'll start an unmedicated ERA in that cycle. I've done two already but they were both with the medicated FET protocol. Per the medicated ERA results I need an extra day of progesterone for my lining to be receptive. The RPL specialist wants to see if I still need that extra day if I'm not on any meds. Obviously we don't want to miss the window if I do an unmedicated FET with an actual embryo, so we can't use data from a medicated ERA. I understand the reasoning, I just hate the idea of another uncomfortable biopsy.

I'm trying not to "bird view" the summer because thinking of all the things ahead makes me anxious, but it's helpful to think that if all goes well with the hysteroscopy and ERA then the next step is a retrieval. That finally feels like progress. It's also the biggest hurdle before a transfer, since we have nothing to transfer now. So while things are slowly moving forward, there are still a lot of steps to happen between now and a potential pregnancy.

In the meantime we're working on taking one day at a time. We also added a new project: enjoy the wait. The time will pass regardless of whether we're anxious or not, so we may as well do things that make us happy in the meantime. There's a time to be sad and anxious and worried, but it's not all the time. It's a gift to wake up every day and our time shouldn't be wasted harping on things we can't control. We'll work toward what we want and we'll put in everything we can in to it. But at some point it becomes up to Him and our job is to just wait. So why not enjoy the wait. It's easier some days than others but it's a mitzvah to be happy and it's worth the effort to prevent becoming depressed and bitter. We don't have money or PTO to do lavish trips around the globe but we can do outings and things on a smaller scale. Yesterday we went to see The Incredibles 2 (3D) and it was fun. Highly recommend.

One at a time

Patience isn't one of my strong suits. I work hard to suppress this personality trait in my every day life: when talking to people and they have boring stories I'm not interested in hearing; when dealing with slow clients on the phone; when coworkers come for a chat I'm not in the mood for; when people have solvable problems they're whining about; the list goes on. There are times my impatience wins but for the most part I'm able to function in society like a regularly patient person.

It's been difficult to keep my frustration at bay with how long everything takes in fertility treatment. I was frustrated when we needed to see the urology specialist who scheduled us for May but ended up having a cancellation in March. I was further frustrated when we discovered we'd need to do surgery which would delay any IVFs for three months, and then even more frustrated when the first available opening was at the end of May even though we were seen in March. I almost lost my marbles when I found out we'd have to  wait to see the RPL specialist in October but then it worked out that we were able to go sooner and got an appointment in May. That was nearly a miracle. And now I'm realizing how stressful May ended up being.

It doesn't end there. The RPL specialist wants me to repeat the hysteroscopy because the images sent from old clinic didn't have what he's looking for. I'm not thrilled about another surgery. I'm really unhappy about it, actually. But beside the fact that it needs to get scheduled around a period, they also need to do some work to figure out what the stain test is because it's not standard protocol. So I was able to schedule it only based on next month's estimated period, not this month. This pushes back everything else.

In addition to all the waiting, the RPL specialist recommended repeated the ERA, this time unmedicated. I'm really not thrilled about another unpleasant biopsy, especially since I already did this twice at $800 a pop out of pocket. Unmedicated means no FET drugs or birth control. He wants us to go straight from that to a retrieval cycle. The reasoning behind that is to take advantage of the cycle of not suppressing the ovaries with bc pills and possibly needing less medication to stimulate. From there he wants to go straight into an unmedicated FET in the third month. All this needs to be timed so that the retrieval month falls out after the necessary recovery period of the varicocele repair.

Looking at it all at once is very overwhelming. I'm seeing a very frustrating summer ahead and I get annoyed and upset and frustrated at everything that needs to happen, at just the right time, for us to even start thinking about a possible retrieval or transfer. All things considered, we're know we're so lucky we were able to get in to see the RPL specialist sooner rather than later for obvious reasons. But this is rough. It's really rough to just wait. It's really tough to see my friends starting to think about bar and bat mitzvah celebrations for their preteens. We're not even any closer to having an infant.

In the grand scheme of things it's only a few weeks. I know that logically and most of the time I'm ok with it. I've been able to shove down most of my frustration and impatience under the guise of "doing something" with these appointments. But every so often something pops up and I get reminded of how frustrating it all is. I'm upset today because the hysteroscopy was scheduled for end of June instead of next week. But the reality is that a few weeks don't make that big of a difference. I'm thinking of it compounding and if everything takes "just a few weeks" then it builds up to months and months of waiting.

I know I can't think like that. I just won't survive. My blood would boil in anger at the injustice and then they'll delay things even more to treat my sky rocketing blood pressure caused by all the impatience and frustration.

My husband made me feel better by saying we should just take it one day at a time. I can't think of a better way to tackle this. We really have no other choice. Every other year the summer seems to fly by. So maybe if I focus on one day at a time it won't seem so long. While I can't help but be impatient, I can try to incorporate fun summer aspects sprinkled throughout to help it go by faster.

When thinking about the difficult aspects of infertility, there are a lot. The first ones that come to mind are the devastating negative betas, or the traumatizing miscarriages, or the emotional roller coasters during stim days and embryo development. I'd rank these waiting days among the top five as well. Waiting for each procedure, each test, each surgery, each appointment one at a time with weeks in between trying not to scream in frustration while attempting to go about your daily life as though this is normal is pretty mind boggling.

So I had a cry. I got some hugs from people I love. I got in a good laugh and made some food for Shabbat. And now we just wait #oneatatime.

Latest happenings

It's been busy at work and I haven't had much time to think or process. Now that things are slowing down for the season, I wanted to update on what's been happening.

On Sunday I took advantage of my lab being open and knocked out the glucose/insulin test that the specialist recommended. It's a smallish lab -- only about 20 seats in the waiting room -- and they're only open until 11 am, so knowing I had at least a 2 hr wait, I had to make sure to be there early. I thought it would be a slow day, but the place was hopping the entire time I was there. I signed in and it took almost 30 min before they got me checked in and did the first blood draw. Then I had the gross drink and waited an hour for the second blood draw. At the two hour mark they took final blood. While I was waiting I was totally a backseat driver in the waiting room: telling people where to check in, showing them where they are in the queue on the screen, getting someone who had stepped out for a cig that it was their turn. At one point I overheard a clueless guy tell the receptionist that his doctor at [old clinic] didn't give him a lap slip so I helpfully suggested emailing his nurse. I was helpful all over the place. I hope results come back soon and that they're all normal. In the meantime have a beautiful purple-yellow bruise to remember my time there.

After bloodwork I went to get my nails done - it's been a while and I had a work event the next day. I went with a pale pink on my hands (business) and smokey red on toes (party).

I also had my follow up appointment with my endocrinologist. My TSH has finally reached normal levels: 1.24. Hooray!  That means I don't have to keep coming back every 4-6 weeks to check levels. Now we're at 6 months checkups. She got the latest about what's happening fertility-wise and told me to keep her posted if my RE takes any labs that include thyroid, and when the next transfer is in case I get pregnant and the meds need to be adjusted as well.

I sent over the images from my hysteroscopy to the specialist and he said he couldn't see what he needed and recommended a repeat. So I need to schedule that for sometime in the next few days.

A few weeks ago I noticed a new trick my body likes to do which is make my heart race. At one point it scared me so much I went to urgent care and they got an EKG. My heart was beating at 100 bpm and my blood pressure was elevated but other than that they couldn't see anything wrong. EKG came back normal. Physical came back normal. I wasn't out of breath and didn't have pain anywhere. It was the Friday before a 3 day yom tov and right before my husband's surgery so they diagnosed it as anxiety. Maybe it was. It hasn't gotten as bad since but I have noticed the racing every so often, weirdly when I'm at rest. It never lasts more than a min or two and then I forget about it. I take my pulse often now to see where it's at, which is usually somewhere in the 70s. Every so often I'll feel it go back hovering around the 90s when I'm at rest. At urgent care they said as long as it doesn't go above 100 or 110 then it's not a big deal, especially since they couldn't find anything wrong. I mentioned it to the endocrinologist who said that it's not a side effect of the thyroid meds or any of the meds I'm taking. But she did say to look out for shortness of breath combined with leg pain, which is a sign of the bc pills causing clots, and (rarely) causing clots in the lungs which makes getting oxygen to the heart an issue. She did say that if it persists or episodes get longer that I should go back to the cardiologist. Maybe I'll do that anyway. I don't want to keep being the kid who calls wolf but I'd rather look dumb than have an issue, especially with a potential pregnancy on the line.

My husband sent me a picture of a bug he found in the kitchen and I panicked and called the exterminator for a full workup against roaches, mice, and all pests.  I googled roaches and the internet said if there's one there's likely hundreds more. Ewww. The guy took a look at the bug and said it was a beetle, not a roach. He searched the house and found not much more than a few spiders in the basement and couple of ants outside.

The weather has been unseasonably frustrating with lots of fog, rain, and humidity. There are mild patches of sun when we remember that oh yeah it's summer. At some point our roof started leaking. We called the roofer and got an estimate for a repair ($800) or replacement ($8000). So far we're putting out bowls when it rains and hoping that before we need to make a decision it will either repair itself or get so bad that insurance needs to get involved.

Another summer project I want to take care of, other than ttc, is decluttering. Every year I say I want to go minimal and I think this year I want to make it real. There are drawers of stuff that we don't need; closets of stuff we're storing and never look at; a storage area full of things we never touch. Why should they collect dust, and apparently spiders, when someone else can make use of it? If we don't use it on a regular basis, or at all, it needs to go. If I only manage to make a small dent in what needs to be gotten rid of, it's still a win. The ultimate goal is to feel like if we were to move tomorrow, I'd have nothing that I need to throw out. I'm still unsure what to do about thinks I know I'll never use again but am unsure about giving away, like my wedding dress. I guess I can start with the non-sentimental stuff and work from there.

Summer is upon us and I want to take advantage of the longer daylight hours. I want to get into a routine that includes better workout schedule and better food planning. I know it's just a matter of starting and I'm mentally motivated but need to get my butt in gear. My husband is on board to join in so that can be a big help if we do it together. Let's start with 10 lbs. I decided I'd get myself a present at the end of the summer if I'm successful. Maybe a bosch mixer or a new hairstyle.

Our 11 year anniversary is coming up. My husband's birthday is also coming up. This past week we sponsored kiddush in memory of our grandmothers, who happened to have the same birthday and died within a year of each other.

Happy summer :)

Thyroid: continued

It has been a long and mentally exhausting week.

Ever since I got my TSH results back, I've been researching and discussing. I sent emails back and forth to my endocrinologist. I asked to speak to her over the phone but she prefers email or face to face, so I scheduled an appointment at her first available which is next Thursday. I asked to be on the cancellation list as well if anything sooner opens up. I also looped in my RE. His response was that it's not an issue. That didn't sit right with me. Why. Why is it not an issue. I sent him links to the articles keeping me up at night and asked him to call me. What was I expecting him to say? I don't know. I think he knows me enough to know he couldn't convince me with anything he said, so he sent me a study to read. I went over it with a fine tooth comb absorbing all the statistics and information it had to offer.

As I understand the study it basically says there's not enough evidence to really say one way or another about the 2.5 - 4.0 range. There is fair evidence that SCH, defined as a TSH level >4 mIU/L during pregnancy, is associated with miscarriage, but insufficient evidence that TSH levels between 2.5 and 4 mIU/L are associated with miscarriage. So if several studies have found that elevated TSH levels in pregnancy are associated with an increased risk of miscarriage in patients without a diagnosis of hypothyroidism (>4), and studies show improved pregnancy rates in cases of what's considered the ideal range (<2.5) then, all else being equal, wouldn't it provide a better chance at success if my TSH was closer to the 2.5 level instead of the current 3.54? I understand TSH numbers can vary greatly and it's an inexact science but I've been getting these 3ish readings consistently since the summer and even after starting medication (albeit very low starter dosage) it's still stubbornly at that range.

The other thing that caught my attention was that the studies in the article were done later in gestation and there's limited information about early miscarriages, or even TSH rates and implantation. My chemical pregnancies didn't make it past six weeks gestation and while it's impossible to know why, I can't help but wonder if TSH was a factor. If the Endocrine Society recommends 2.5 as the upper limit of normal in the first trimester, and it's known that TSH tends to go up during pregnancy, I'm not understanding why a level at 3.54 is not an issue.

When I asked if 3.54 is as good as having a number in an ideal range or if there's a benefit to waiting to get my TSH number closer to "ideal" of under 2.5, this was his response:  "We in the practice have gone both ways in the past. I cannot argue with your goal. Different societies can read things differently."  Basically, he has no answer but also has no objection to trying to bring TSH lower to under 2.5. He doesn't believe that it will make a difference, but if it makes me feel better he's not opposed. There's certainly no harm to it.

So RE says it's not a problem. Endocrinologist says it's not a problem. My mind is stuck wanting to give the transfer the best chance but I'm willing to accept that it's my own hangup and can be convinced to move past it.

Enter new factor for consideration: I forgot about the endo scratch. The hysteroscopy was done on 1/26 and counts as having similar benefits of an endo scratch as long as a transfer is done within 60 days of the procedure. If I wait to lower my TSH to "ideal" then I lose the benefits, if any, of whatever the endo scratch did. There's no way I'm interested in doing a hysteroscopy voluntarily again, so if we want the benefits of it then transfer can't be delayed.

I reached out to the doctor we saw in the summer for our second opinion back in the summer. I really liked her and thought she had some good ideas. I decided to see if she has time to chat with me and get her take on it. If she also says that it's not an issue then I can comfortably proceed with peace of mind. She heard me out, got all the dates and numbers and basically said that if my thyroid anti-bodies are normal (negative) then she would recommend to proceed. In her opinion, getting the benefits of the hysteroscopy endo scratch were better than trying to get the TSH down to ideal, especially considering I'm already on meds and have already increased the dosage.

So there we have it. It's one thing to get the opinion of a doctor and disagree with it, but here there are three. Three medical professionals, trained endocrinologists, are all saying it's a go. I can't argue with that. Whatever will be will be, and hopefully this is the time it's supposed to stick.

I feel completely drained from all the anxiety and worry and questioning everything about this issue. But at the same time I feel satisfied that I left no rock unturned and no question unanswered. At the end of the day, my husband and I need to live with this decision and I needed to make sure I'm at peace with what we chose.

Shabbat Shalom!

Hysteroscopy plus

On Friday I went in for the hysteroscopy. Compared to all the other procedures I've had, this ranks as the least uncomfortable. The most painful part was that they had to poke me four times to get a vein for the IV. It took three tries pre-surgery and once during the surgery the anesthesiologist didn't like the positioning of it so he moved it to a new location. It didn't help that they had told me not to eat or drink in prep for surgery so I was dehydrated and all my veins were flat.

Speaking of dehydrated, no one told me to expect to give a urine sample (for a pee stick test) so I went right before checking in. When it was time to give a sample, luckily I was able to squeeze out a few drops. A heads up would've been nice.

It was a slow surgery day. So much so that they weren't so concerned with time because they didn't have to keep a tight schedule, especially with me since there was no trigger so no deadline. They requested that we show up 90 min before our scheduled procedure but there was no need for that this time. We waited in the waiting room over half an hour before getting called back, then it was another 30 min before anyone came to start my IV. Usually it's started right away. The nurses and docs were more relaxed and jokey. I already know everyone by name by now and they know us.

The only other part of this was that in prep for the surgery, on Tuesday I got a call from my nurse that they need to update my vitals in prep for the hysteroscopy since it's surgery and my weight was a little borderline when I went in for the HSG early Jan. At the time it was right after a retrieval and Chanukah so I had definitely put on a few holiday pounds. This week I was worried I'd still be bloated from the flight and our trip but early Wed morning I got to the clinic for weight and height check and it was fine.

The procedure itself was uneventful. The doc gave me copies of the pictures they got. He said he took a sample biopsy to be thorough so we'll get results from that next week but for the most part they didn't find anything, as expected.

One thing different this time was that when I woke up I felt an extreme case of annoyance. I was so irritated. When my husband got to the room he was on his phone checking for reception to order an uber and I snapped at him for being on his phone. When he argued back (mistake) I yelled at him that I'm once again on a stretcher and the least he could do was put away his f***ing phone. Later on in the day my sister drove me around to do errands and I criticized her driving. To be fair I was right, but I could have been nicer about it. The annoyance came and went throughout the day and was nearly all gone when I woke up this morning. I don't know what it was about, or if it was related, but it was significant enough for me to remember through the post-anesthesia fog.

I was alert almost immediately after the surgery. From there we went to Rite Aid because I wanted to buy snacks. While there we also got flu shots. We walked to a grocery store to get the snacks and then walked home. It was totally fine. Throughout the day I had a slight headache (may have been due to the sugar rush from the snacks) but for the most part I felt like myself. On Friday night I had a great night's sleep for the first time in a while. I slept solidly for 10 hours straight.

Overall it was a very simple procedure with a straightforward and easy recovery. I was nervous leading up to it, much more so than I needed to be, knowing what I know now. Bonus is that if we do a transfer within 60 days then it counts as an endo scratch.

Hysteroscopy

It looks like we're leaning toward doing the hysteroscopy. I asked my doctor why they choose that procedure over say an MRI to get really good images with a less invasive procedure. His answer was that the hysteroscopy is the golden standard and other imaging techniques such as an MRI would not pick up minor things. So basically either do it right or not at all.

The main reason we're going to do it is because I have to feel like we've done everything possible to help the transfer succeed. I don't expect them to find anything. If they do I would be surprised but hopeful that maybe that's the answer to why our transfers weren't sticking. When a transfer fails it's impossible to not feel responsible. It' would be even worse if there's something I could have done that didn't. So for peace of mind we're doing the procedure.

The other reason is because of insurance coverage. I was told that even though I'm keeping my same insurance, they still need to officially verify it before they can send preauthorization. All together it may take 4-6 weeks to get an answer back from insurance. Which means that Jan will basically be a dead month anyway with regard to treatment. I don't believe it will take that long to get preauthorization, it was really quick last year, but I would still rather plan for something else in the meantime so as not to lose the time.

I've given my nurse two dates: my first choice and a backup. Since this is an elective procedure it gets prioritized after egg retrievals and D&Cs, since those are both time sensitive. I understand completely. It's just annoying to not be able to plan with work.

As for my own calendar, since I'll be on birth control I was told I can do it at any time during my cycle. So I'm still trying to understand what that means with regard to a transfer. Does that mean if I schedule it toward the end of my bc pack, I can then do the procedure then have a period, then start meds for a transfer right after? Waiting to hear back from doc about that but we have time to figure out details.

Before a transfer

After speaking to my doctor today, we decided to nix the prednisone and lovenox for the next transfer. It was an easy decision. In my mind, it did more harm than good even though we'll never really know for sure.

He also confirmed that he recommends an updated HSG since the last one is 3 years old and there was miscarriage in the meantime, so I scheduled it for next week.

Now for the complicated decision: whether or not to do a hysteroscopy before a transfer. It would be under anesthesia. Not only so that they can get better pictures but also if there's actually something there they can remove it right then and there. I would have to take a day off and then there's the recovery. It would also mean delaying a transfer by a cycle because it irritates the lining too much. I asked if that's basically an endo scratch and the doc answered that it's way more irritating plus there's water that goes into the tubes plus risk of infection - long story short he wouldn't do a transfer the same cycle. He doesn't feel strongly that it's necessary. He said it was up to me if I wanted to feel like I'm leaving "no stone unturned" before another transfer. On a scale of 1-10, 10 being that it was absolutely necessary, he said he'd rank it as a 4. 

On one hand I really don't want to leave any stone unturned, especially when it comes to transferring embryos of which we have precious few. I also remember our second opinion doctor recommended it, but then again some docs do just because it's a profitable procedure that gets them interesting data. On the other hand it's surgery. It's not necessary, I'd be opting in. So I'm trying to use logic. The reason we did the ERA procedures is because it was unpleasant but I knew I wouldn't stop thinking about whether we're transferring on the wrong day if we didn't do them. It wasn't an easy decision but it was justified when we discovered we did indeed need an additional day of progesterone to get a "receptive" lining.

I don't think the decision here is as simple. Putting aside the fact that we'd be transferring a month later, which I hate but am willing to swallow, I'm worried about doing more harm than good. Obviously if they find something and remove it then I'll feel wonderful and vindicated. But there's a slim chance they feel there's anything there to find. The risks are pretty high: a tear in the uterus? Infection? Who knows what else. The month wait would be the least of my problems.

My gut instinct is to reject this procedure. Logic is trying to convince me otherwise because if the transfer fails this is where my mind will go -- regret that we didn't take this step before transferring. We have a bit of time to decide so I know which thought will be permanently set up in my mind for the next few weeks.

What would you do?