Follow Up and IVF Talk

We met with Dr. M this afternoon. I decided I wanted to talk about what I thought to be positive info first-the SA results. So last cycle we had 9.5 mil sperm and this time around 14 mil. Great! Then last time we had 31% motile sperm, this time 42%. Great! However, of the washed sperm, only 1% were motile- 500,000. I can't remember what it was last time but he said it was less this time than it had been previously. He would consider these SA results perhaps slightly better than last time. So perhaps not as positive info as I thought!!!

Then we moved onto the elephant in the room-the stupid hydrosalpinx. I always thought our little boy was a miracle. Now I know it! I pulled up research articles that had been published and with a hydro, chances of pregnancy are cut in half and that is with IVF, and if you consider that the fact that anyone gets pregnant on any given month, that's crap. Dr. M hit the nail on the head when we were discussing whether or not to correct this problem before proceeding with our cycle when he said, "If you don't fix it and the cycle doesn't work, you will think it was because of this." Damn if that isn't right! Sure, it could just be a failed cycle, happens all the time. But if I didn't have the hydro corrected I KNOW that I would think it must have been that, and even if I wasn't totally convinced of that irrational thought, I would always wonder "what if?"

So, the decision has been made and Dr. M is completely backing us. I will call my OB/GYN in the AM and try to get a surgery date set up ASAP to have this thing either removed or at least have that tube tied. Which brings me to my next issue to deal with emotionally and physically. The consequences of taking care of this issue. I asked about something I had read online on a forum about hydros where multiple people said that they not only had to have their tube removed but the corresponding ovary as well. This is a problem! So we discussed that and Dr. M didn't really feel that that was a necessary evil, but he did bring up something I had not considered. I figured if they had to remove the ovary then obviously I would have less eggs to retrieve when it came down to it. I just sort of figured that if the ovary was left in we would have those eggs as well. Not necessarily. The fallopian tube and ovary share a blood supply, so if we clamp the tube, we may be risking any follicles and resulting eggs from that ovary. It is an unfortunate situation, but I think I'd rather risk losing the response from that ovary than having fluid leak into my uterus and giving us dismal odds at pregnancy.

I will have the surgery, and per Dr. M request that Dr. A or whoever ends up doing my surgery try to preserve my right ovary as best as possible. Dr. M said that we could contact him as early as a month post-op to setup our mock transfer appointment and begin an IVF cycle. He tends to be a little more aggressive than some docs, he said that others would recommend waiting at least 8 weeks post-op to see if you get pregnant on your own. But given our male factor infertility issues, I think getting pregnant on our own may not be very feasible.

Please pray that we can get scheduled quickly and that the surgery is as atraumatic as possible!

HSG results

Hydrosalpinx (big ugly dilated looking thing on the left side of the screen) on the patient's right side, and an occluded tube on the left (my left tube is patent and resembles the tubes on the picture below).


Normal HSG with both tubes patent

I had my HSG this morning. It was not painful initially until they injected the dye, and then it was very painful. Alot of cramping which persisted until about an hour and a half after the procedure and oddly enough radiating down my leg. I didn't freak out about that too much since I used to have extremely painful periods and would have that same leg pain, it was more of an annoyance than anything really. I came home, put my heating pad on my belly and took some motrin. I laid there wishing I would just throw up since the doxycycline is not sitting well on my stomach and unfortunately I still have alot of doses left to take!

Last time I had an HSG (2006) it showed my right side was blocked or a hydrosalpinx. I was sent for an ultrasound which didn't show much so we continued on with my cycle. It was explained to me at that time that they believed it was a blocked tube or they would have expected to see more of a dilated tube on ultrasound. If it had been a hydrosalpinx, there would be a lower chance of pregnancy, and a higher risk of miscarriage if pregnancy did occur. This was because in a hydrosalpinx there is fluid that leaks from it which can make it hard for an embryo to implant, and could contain debris or other harmful things which could be detrimental to a fetus. Luckily, I got pregnant, and delivered Jack at 37 6/7 weeks. No complaints here!

So today when I went in, I prayed that our HSG would be no different than it had been last time. Well, I could see on the screen that my right tube looked bigger. Uh oh. I heard Dr. M and the radiologist talking about a hydro. Great. I got dressed, went out to meet Dr. M and he showed me my pictures which indeed showed a hydrosalpinx on the right. He said they are sure it is a hydrosalpinx. I asked what that meant for us and he reiterated the things we already know about a lower chance of pregnancy, higher risk of miscarriage, and then added, "but you've gotten pregnant with it before and had a full term baby." So he thinks I should be ok. I felt torn leaving him because I could in theory be ok, but what if I'm not. Our plan was that we weren't going to do this again if this cycle fails. Do I want to risk it on this problem tube?

I came home and looked up a few things on it, specifically pregnancy rates, etc in some studies. 40% in the control group vs. 19.65% in the hydrosalpinx group...50% less chance. If you think about it, we did get pregnant before, but would I have allowed them to try a cycle on me if I knew it was for sure a hydrosalpinx???? Probably not, I probably would have elected to have it removed or ligated. Archie and I were discussing it when I got home, and he doesn't want to delay our cycle further, if we do, we'll be looking at procedures around Christmas this year and that's no good. I understand his thought process for sure, I don't want to delay it either, I'm excited and ready to go now! But I also don't want to waste what might be our last cycle.

After obsessing over this quite a bit, I called our IVF nurse (Sonya) and told her I was sorry to bother her with the thoughts in my mind, but I just don't know what to do or think about this. She asked if Archie had done his analysis and I told her he was going to do it tomorrow (appt in the AM). She told me that we have to have a follow up appointment anyway, so to call and schedule the appointment for next week, and we could discuss it further with Dr. M then and if we still didn't feel good about proceeding with our cycle we could decide about how to take care of it at that point. There are a few different ways to "take care of it" including tying the tubes, ligating or removal of the tube completely. Some of it can be done laparoscopically (sp?) and we could probably proceed with our cycle in December.

If you remember, I had planned this whole thing with the thought of using the last part of my maternity leave for a Disney vacation for Jack. If we don't do this until January, I will be pregnant when we go to Disney or we'll be going at Thanksgiving time (my holiday to work next year). I know we shouldn't plan like that, but I was planning like that because I am an infertile and since I can't get pregnant on my own, it is a perk to knowing when you may or may not be getting pregnant. So sue me!

I guess we'll see what Dr. M has to say next week. I'm a little depressed about it definitely being a hydrosalpinx, but I'm trying not to let it put a damper on things.