Last week in part 1, I went through the procedure itself (diagnostic laparoscopy and hysteroscopy with D&C) and my recovery. In this post, I am going to review the results of the procedure and what they mean for our next steps.
Before I dive in, I think it’s important to do a quick review on why we decided to have this procedure in the first place. After our third frozen embryo transfer failed we were at a loss. Our third transfer had a different protocol due to the results of my endometrial biopsy. We really thought we had found the right protocol this time so we were all dumbfounded when we got another BFN (big fat negative). The transfer didn’t even work...not even a little bit.
We knew we couldn’t go into another transfer unless we could find some answers or somehow find a way to regain some confidence…..confidence in my body, in the process, in the medicine protocol we are going to use. And unfortunately, infertility doesn’t always give us answers. There are only so many tests our doctors can run to pinpoint what is happening. During our WTF appointment after the third transfer, I asked my doctor about having a diagnostic laparoscopy along with her recommended hysteroscopy. She said she wouldn’t recommend doing it since it was very unlikely that we would find anything (specifically endometriosis), but I could if I wanted to. So we left that appointment having to make the decision whether we were going to choose to have the surgery.
After speaking with my husband, family, therapist, OBGYN, my support group and the amazing infertility community I have through social media, we decided to move forward with both procedures. I was going to be put under for the hysteroscopy anyways so we might as well have the laparoscopy too. Maybe they wouldn’t find anything, but then at least it would be peace of mind.
SURGERY RESULTS
The hysteroscopy with D&C showed all positive results. There didn’t appear to be any inflammation (unfortunately the nurse ordered the wrong biopsy test so we weren’t able to test whether the endometritis was gone) and all other samples were benign or consistent with the time of my menstrual cycle I was in. For example, my uterine lining was nice and “fluffy” which is consistent for being about a week about from my period starting (this is when your lining is at its thickest, of fluffiest, before it is shed during the period).
Well it turns out the diagnostic laparoscopy wasn’t just for peace of mind after all. My OBGYN ended up finding and removing mild endometriosis on my uterus by my bladder. This was surprising as I really haven’t had any symptoms of endometriosis before and my last endometrial biopsy showed a decrease in the protein marker that may show the presence of endometriosis. She got all that she could see off my uterus and confirmed it hadn’t spread anywhere else.
Quick side note before we move on to the next steps...some people may not know what endometriosis is. Endometriosis is a condition where the tissue that normally lines the inside of the uterus grows outside of it. The tissue that grows outside of the uterus acts the same as it would inside the uterus - it thickens throughout the menstrual cycle, but instead of being shed like it would inside the uterus (a period), it gets trapped which can cause ovarian cysts, scarring, irritation and infertility.
OUR NEXT STEPS
The week after surgery we had 2 post-op appointments - one with my OBGYN and one with our fertility doctor (RE).
The appointment with my OBGYN was super quick. She checked that both of my incisions were healing nicely and she pulled off some of the glue on them that had started to peel off (ouch!). One thing we did ask her about was the 4 small scabs I had around my belly button. I knew they weren’t incisions but wasn’t sure what had cut me during the procedure. She said that as a part of the procedure, they use clamps to pinch the stomach skin and pull it up. This helps the skin to not lay on top of the organs they are moving around during the procedure. At the end of the appointment I asked for her opinion on whether the endometriosis could have caused our infertility. She explained that there really isn’t a correlation between endometriosis and infertility. Someone like me, with mild endometriosis, could have infertility, but someone with severe endometriosis can get pregnant naturally the first month they try. So then what now doc? Well if I was a “normal” person (a.k.a. presumably fertile) and was just diagnosed and treated for endometriosis, she would recommend 6 months of Lupron Depot to put my body into menopause (more on that later) and then after the 6th month the “test” if it all had worked (the endometriosis was “gone”) was to see if that person was able to get pregnant within a few months. 1) There is no way I am delaying things for 6 months and 2) we don’t know if I can actually get pregnant naturally so the “test” may not even work for us anyways. We left the appointment with our OBGYN’s recommendation to do whatever our fertility doctor told us to because she knows more than she does. Not the most confidence-inducing statement, but we understood so we got ready to meet with our RE the next day.
Time for post-op appointment #2 with our RE. As we sat down in her office and she asked how the surgery went, we shared with her news and her response was “well then it’s a good thing you went through with the surgery.'' This just reaffirmed something I have come to learn on our infertility journey and that is being your own advocate is one of the most important things you can do. Who knows whether the endometriosis being treated and removed is the answer to all of our problems, but I am sure glad we did the surgery. It’s a small step to regaining some confidence before our next transfer.
So, where do we go from here now that the surgery is over and the results are in? Our RE has recommended we do 2 months of Lupron Depot and put my body into menopause. We will use this monthly injection to shut down my reproductive system which will decrease the level of estrogen in my body (estrogen is one of the causes for endometriosis to flare up). While my OBGYN removed all the endometriosis she saw, the Lupron Depot and subsequent menopause will help to eliminate any remaining elements of it. So once a month for 2 months I will have the Lupron Depot injection given to me by my OBGYN office. From there we will move into the “kitchen sink” transfer protocol throwing any and all beneficial meds and treatments into my body in hopes that this will finally be our time.
I will share more about our new protocol once it is confirmed. For now, we are waiting to hear from our insurance if the Lupron Depot is covered and getting the first shot scheduled. And then it’s menopause time!
**This is not meant to be medical advice. Be sure to consult your doctor with any medical concerns. This is the account of my personal journey through infertility**
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