Follow Up Dr Appointment

Today was my follow up from my HSG that was done yesterday. It took about 45 minutes to actually see my doctor, but I didn't expect different. It was a Friday in the afternoon, they were bound to be behind.

Upon talking to Dr. H she said that she was hoping that I had a septate uterus that the septum was down close to the cervix, and the cath when inserted for the HSG had to pick a side to go up. That would be the ideal situation. Because a septate uterus can have surgery to be fixed, a cornuate uterus? Not so much.

Yet, we had to face potential reality and also talk about what our plan of action would be and what complications I could face.

First plan of action: find out if kidneys are functioning.

If you have a unicornuate uterus 40% of the time women have one functioning kidney or horseshoe kidneys that never separate. So to diagnose this we need to do an IVP (Intravenous Pyelogram), in order to do this I needed a Comprehensive Metabolic Panel (CMP).

So today I sat in the lab and waited after the appointment. Four hours later,  I called the lab and got the CMP results. My creatine level needed to be 1.4 or less to do the IVP, it was 0.7 so it is a go!

Further Plan of action: Do an IVP & MRI

The IVP is where a dye is injected into my vein and x-rays are taken to watch the dye flow through my kidneys, down to my ureters, into my urethra and finally into my bladder. It will watch how well my kidneys are functioning for filtering and the structure of my urinary tract. I have stopped taking my metformin to help be able to move up the test date.

The MRI is our choice over the laparoscopy simply because the laparoscopy would be invasive, and the doctor wouldn't know what exactly she would be facing. With the MRI we can know exactly where the kidneys, ovaries, and fallopian tubes are located. AND we would know 100% what is going on with my uterus, if it has a rudimentary horn, if it is a unicornuate (half) uterus, or if I have a large septum that caused the HSG cath to go only to the left  (praying for this!).

After the IVP and MRI we will have a clearer vision of where we are to head next. If indeed I do have a unicoruate uterus there isn't anything we can do about it except for hope and pray.

I did bring up the fact that we have never done a cycle day 3 estrogen check along with my FSH and LH then to check for Premature Ovarian Failure (POF) or Diminished Ovarian Reserve (DOR). When I first got diagnosed with PCOS they checked my FSH to LH value, with normal women it is 1. Mine was 3 or 4. Which can show PCOS (but they usually do not go by that anymore, it is more old school) OR it could show poor egg quality/less eggs. High FSH means that the follicles are being stimulated but none of them are mature enough to sustain a healthy pregnancy.

Dr. H said she wanted to wait to talk about that until we had the complete diagnosis. She did say she would be willing to do six more cycles of clomid if all checked out, and after that I would be moved onto a Reproductive Endocrinologist (RE). Honestly, it probably will be before that. I would like to be checked for more less common issues so we can do all possible to avoid miscarriage if and when another pregnancy happens.

The doctor had to be honest and give me the facts. She herself had to look up the stats, because a unicornuate uterus isn't that common. Here are some stats:

For women miscarriages happen 13-26% of time out of ALL pregnancies. She also broke it down by age
20-30 years 9-17%
>35 years 20%
>40 years 40%
>45 years 45%

 After 1 Spontaneous Miscarriage (SAB) - 20%, 2 SAB - 28%, 3+ SAB - 43%

With a unicornuate uterus (UU) ...first of all 10% of uterine defects are a UU, or 1 in 4,020 women.
On to the scarier facts...
2.7% chance of ectopic pregnancy (2% is normal)
24.3% 1st trimester miscarriage
9.7% 2nd trimester miscarriage
20.1% chance of pre-term labor
10.5% Intra-Uterine Fetal Demise (Stillborn)
40% chance of kidney abnormalities

49.9% chance for a live birth.

I have less than a 50% chance of having a living healthy baby in my arms with each pregnancy.
Really? WTH?


So here I am facing all of this. And pondering the fact that things are not 100% horrible, but know we have a rocky road ahead of us. Yesterday I didn't know how many more pregnancy losses I could face before it would be enough to break me. But, I have to question if my heart will be more broken facing miscarriage or not experiencing holding my own baby in my arms. Should we skip trying and go right to adoption? Or should we face hardship and believe in our God to give us a baby that would be a reflection of James and I.

I have to say, I was a pretty darn cute little kid. I would love to see one of me living and breathing here on earth. Regardless, our children...whether biological or adopted will be so immensely loved it is ridiculous.