Wednesday, December 31, 2008

RE suggests IVF after ultrasound reveals scar tissue

Our appointment with Dr. Peter Ahlering, our RE, yesterday went better than I expected in the sense that my fluid ultrasound (FUS), which I also think is called a sonohystogram, didn't hurt one bit. I had taken a pain killer I had left over from when I got my wisdom teeth removed, figuring it was a good precautionary since I read some women seem to experience a decent amount of pain, but I don't think I even needed it. Basically, once they had the speculum in, I must have been distracted enough to not even notice when they put the catheter in, which was nice. I also didn't have a problem with cramping afterwards, so all in all the actual procedure itself went well.

Ok, so that's pretty much where the good news ends. Honestly, going in I didn't think we'd actually learn all that much from the ultrasound. I knew he was going to count follicles and all, but I thought that it would pretty much just be a confirmation that I had a PCO ovary. Which I did, and I guess in the case of considering IUI or IVF, that is a good thing because each will have the potential to mature into a large, viable follicule.

The big news was that my left ovary, my only one, is right on top of my uterus, rather than off to the side with it's own breathing room. He said he tried to use the ultrasound wand to poke it a little, trying to move it, and that typically he would be able to do so, however, in my case, my ovary didn't really move, which means there is probably some sort of scar tissue that is now bonding my ovary to my uterus... much like super glue I guess. He said that he's not that surprised to see that, considering my history. He asked again the nature of my incesion (mine is vertical and stretches from my belly button down to my pelvic bone) and said that it's pretty common when the pelvis area is opened up so much to have some adhesion occur (from the surgery, and I suppose also from the large, grapefruit sized ovarian cyst that was in me for a short time). Whenever there is adhesion, there is some amount of scarring upon healing. That scarring, or new tissue, can occur on or around organs.

So what does this all mean? Well, he said that this more than likely means that my ovary won't behave in a normal manor. He still thinks they can get me to stimulate and produce viable follicles, however since we're probably seeing signs of scarring, there is more than likely scarring or an irregularity to my only remaining tube on that same side, therefore, it will not work properly. His words were, and I quote, "I'm going to be so bold as to say I would recommend skipping the laparoscopy surgery (and therfore also skipping IUI) and going straight to IVF". The reason for this is because the laparoscopy would only be a diagnostic surgery designed to determine if there is actually scarring or damage to my tube. In his opinion, since this already seems to be the situation as shown in this recent ultrasound, there isn't much reason to do it, other than to confirm that what he believes to be true is in fact true. I did ask if this also meant I would have a problem carrying a baby to term, if I did ever get pregnant, and he said that no he doesn't believe it will have any bearing on that. That, at least, is a bit of good news.

As you might guess, we didn't expect to hear IVF is our only real option at this point in time. I have mixed feelings about the whole situation. On one hand it's nice to know, plain and simple, what we're really most likely dealing with so that going forward we are making decisions that are sound. I mean, why waste our time with things that most likely won't work. On the other hand, I had begun to have a glimmer of hope after hearing how much an IUI was. Before this appointment, we were feeling like we could financially swing 3 or 4 rounds of IUI without it taking too much of a toll on our savings. IVF is different - in fact so different, we could do about 5 rounds of IUI for what it will cost us to do one round of IVF.

I am honestly not sure where we'll go from here. Next Wednesday we have a follow-up appointment with the RE to go over the results from all of our tests - my bloodwork, the semen analysis and my ultrasound. Depending on what the findings there are, it could change things slightly. If the SA comes back normal and my bloodwork isn't too out of whack, it might be worth geting a second opinion on my scar tissue situation before deciding to completely rule out IUI as an option. Even with that said, knowing my ovary has issues, and knowing that PCOS women tend to have problems with producing good, viable eggs (PCOS women apparently produce lots of follicles but generally are of poorer quality), that might be another reason to opt for IVF, since it's the only way to really watch the egg during the fertilization process to see if it's maturing properly. After the follow-up appointment, we will most likely sit down with one of their financial coordinators to get an idea of what our financing options would be, should we decide to move foward at that clinic.

Obviously we have a lot of thinking to do about where we will go from here. At this point, I really feel like in my heart IVF or adoption will be our only way to have a child. I know that both of those will require a lot of time, money and potentially emotional strain on us and our relationship. I also know that ultimately it will mean our family will grow not only larger, but hopefully closer and stronger in the process, and that is what I truely hope and dream for.

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