Consult with CCRM

Well, I have some good news and bad news. I learned from CCRM (Colorado Center for Reproductive Medicine) that all fertility patients must undergo a Hysterosalpingogram. This is a test whereby they insert a catheter into your uterus (yeah, it gets better, watch...) and push dye through the cath, which then fills the uterus and gets pushed out of the only avenue it can - the fallopian tubes. If the dye doesn't go through, that means the tube(s) is blocked.

Of course, this begged the question of Doctor Success (DS), "But DS, why would I need fallopian tubes? In fact, this will be a donor egg cycle - I wouldn't even need my ovaries." Then he educates me. Me! Of all people, I pride myself on knowing what's going on in advance. Heck, I would say the other 28 minutes of our conversation were great, but taught me nothing I didn't already know. But he tells me this: There are studies that draw a clear link between blocked fallopian tubes and significantly reduced IVF rates. Apparently, if your fallopian tube is blocked at the end closest to the uterus, you're fine. If, however, the fallopian tube is blocked at the end closest to the ovary (the most common blockage called a "hydrosalpinx"), it leaves a tube open and available for collecting fluid (a cavity). Well, what happens is that the fluid that collects becomes toxic and when it spills into the uterus, it kills attached embryos.

How do they know this? Because a study was done over a dozen years ago showing a drastically reduced rate in women with a hydrosalpinx vs. women with clear fallopian tubes undergoing IVF. They quickly theorized the fluid in the hydrosalpinx was the culprit but wondered if that fluid was also causing a permanent problem in the uterine lining or if it was a remedy as simple as removing the fallopian tubes. So they followed up by removing the fallopian tubes of the women with a hydrosalpinx and followed them through IVF. And their numbers shot up to the same success rate as women with unblocked tubes. So refusing to remove a hydrosalpinx can present you with an IVF success rate of around 6-8% vs. the going average for women your age at your particular fertility clinic.

I was pleased to hear that blocked fallopian tubes do have a remedy.

And the really great news is that I know this now. The bad news is that I did NOT know this previously and I'm ticked off at my current RE for never having even suggested this test. It could be completely irrelevant but I just had a chemical pregnancy and I was patently clear with my RE that I would submit to any and all tests IN ADVANCE of an embryo transfer if it gave us some learnings that could help. If I have this painful test done and I have a blocked tube, I will be in more pain wondering if that had any impact on my early miscarriage. Fuck, fuck, fuck!

Hey, I would never volunteer for this test, all things being equal. I personally know two women who've had it and both said they couldn't believe this is done without sedation - that it's excruciating. I know in my 2nd saline sonogram this year, I cried when the doctor left the room. I was in such pain. So I definitely do not look forward to this test, no way. But if it provides the opportunity to save me the heartache of another failed pregnancy, I'll consider taking a bullet for that peace of mind.

Well, next steps:
Day 1 of next cycle I am to call CCRM for scheduling a "Work-up" between day 5 and 13 of my cycle. I understand that is the ONLY time I'll have to fly to Colorado before the embryo transfer. That's one good thing. :)

During the 1 day work-up, I'll have a fiberoptic hysteroscope (sounds oh so painful!), meet with a counselor (just a way to bilk me for cash - 'cause I've had 3 mandatory counseling sessions with current RE this year so far - I think, by now, I know this is right for me!), meet nurses and submit to a slew of blood tests for infectious diseases - never mind that I've been screened for every infectious and genetic disease on the planet this year on 3 separate occasions and that before this year, I donated blood every 3 months. One thing is clear, if I have HIV, trust me, it's my RE's office that gave it to me!

But this is a mandatory step - and I'm going for it! Wish me luck!

1 comment:

Anonymous said...

Don't worry... The test isn't that bad at all if you have any tolerance for pain... I've been through IT ALL! My suggestion for you is to really push CCRM to run ALL tests available... Including immune system and blood clotting tests.. Even if you have to pay out-of-pocket for them! These are tests Drs. rarely order UNTIL you've had a miscarriage. But, in the end it could save you precious time, money, and sanity! It took me 4 years: HSG, Laparoscopy, IUIs, IVFs, donors, so many injections I can't even count and lots of $$$ to find out I simply needed to be on a drug called Lovenox to make my tiniest of blood vessels not clot. And I finally have a pregnancy that so far so good seems to be sticking (knock on wood). This may not be an issue for you, but ruling it out could save you a lot of extra heartache!