The Cooter-Rooter

In my last post, I introduced you to the wonderful Dr. Paul Zarutskie at the Texas Children’s Pavilion for Women Family Fertility Center. He correctly diagnosed me with a septate uterus and suggested surgery to resect the septum that divided my uterus.

This would be my first surgery ever. I’d never even had so much as a wisdom tooth pulled up until this point! Dr. Zarutskie was confident that he could adequately resect my uterus and hopefully increase my chances of carrying a pregnancy to term. I was immediately put on birth control to manage my menstrual cycles until my surgery.

I had hoped that we would be able to do the surgery within a few weeks, but instead my surgery was scheduled for almost two months later. This was the first of many “hurry up and wait” instances that I endured over the following year. Waiting is the worst!

Finally, the surgery was scheduled for December 16, 2015.

(The following paragraph contains descriptions of a medical procedure, and reader discretion is advised. The story continues below the next paragraph.)

Resecting a uterine septum is a minor surgery, and patients typically go home after a few hours of recovery. It is performed under general anesthesia. During the surgery, a hysteroscope is inserted into the uterus through the vagina, and a laparoscope is inserted into the abdomen. The surgeon then begins cauterising and removing the septum, bit by bit. As the septum is removed, he watches the laparoscope, which is trained at the top of the outside of the uterus. At some point during the resection, the uterus will literally open up, regaining its full and proper shape. The surgeon will also use the laparoscope to monitor that the uterus is not perforated during the procedure.

(Squeamish readers return here!)

Finally, it was the night before the surgery. In my meeting with pre-op, I was told to shower before bed and then wipe myself down with some wipes in order to help cleanse my body for the surgery. The wipes made my skin itch. All night. I had to wipe myself again from head to toe before we left for the hospital.

My mom met Chad and I at the hospital at 6am. We got a primo parking spot for once since the parking garage was nearly empty!

We took the elevator to the 5th floor, and I was quickly taken back to pre-op. The nurse asked me questions like: “Do you know the surgery you are having today? Is anyone forcing you to proceed with this procedure?” and finally, “Do you want your mother and husband here with you today?” Apparently this is standard procedure, but I’m glad that it’s done to protect patients! It’s scary to think about a woman answering these questions differently than I did.

The nurse then started an IV (something I’d never had before). Chad and my mom were allowed back into the pre-op room and we began to make jokes as we waited for me to be taken back for surgery.

At about 7:30, Dr. Zarutskie, his fellow, his assistant, the anesthesiologist, and two or three nurses all crowded into my pre-op room for a meeting before they took me back. I was again asked, “Do you know what surgery you are having today?”

This time I responded with a grin: “Yes, sir. It’s a cooter rootering!” Nervous glances shot around the room from the surgical team. Dr Zarutskie asked, “Did my fellow say that?”

I laughed and said, “No, my husband did! If you can’t laugh about this stuff, it sure gets awkward quickly!” Everyone began laughing. Then I gave the scary science name for the surgery I was having: resection of a uterine septum performed via hysteroscopic procedure with laparoscopy to obtain visualization.

The anesthesiologist's assistant took my glasses from me, gave them to Chad (no contacts or glasses allowed), and then injected a fun little cocktail into my IV. I was wheeled to the OR.

Dr. Zarutskie was walking next to my gurney, and I began crying. He held my hand, his cold hands enough to provide warm comfort as we entered the OR.

I cried because I was terrified. I’d never heard of needing surgery to have a baby (even a minor day surgery).

Dr. Zarutskie left my side, and the nurses helped me onto the bed. I struggled to take in every detail of the room, but without my glasses and with the cocktail starting to work its magic I couldn’t get very much. I did notice that the OR was huge, and that there were people and machines everywhere. I saw two screens next to the table, which I assumed were the screens for the laparoscope and hysteroscope.

I lay down on the table; it was soft and squishy. Dr. Zarutskie returned to my side, and I felt his cold fingers grip my hands again. I could smell his aftershave. These memories of the day are still strong, since my special cocktail and lack of glasses meant I was relying on my other senses.

A mask was placed over my face, and just like in the movies (but with tears in my eyes), I started counting down: 10, 9...then nothing.

A Second Opinion

In my last blog entry, I talked about my experience with an OB/GYN and a drug called Clomid that was used to encourage ovulation. I also threw a bunch of medical terms your way. To keep up with the growing list, I’ve created a new FAQ section that includes all the definitions and descriptions of the medical terms you will encounter throughout my blog.

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After being less than thrilled with my experience at the OB, I felt like I needed a second opinion. During the Clomid cycle, I had already made up my mind that if I were to become pregnant, I would be seeking a different OB anyway.

A good friend of mine had given me the contact info for her doula, so I decided to give her a call and see if she had any recommendations for OB/GYNs. One of the things I talked about with the doula was my desire to have as natural of a birth experience as possible. During our discussion, I found out that Texas Children's Pavilion for Women has a midwife program! This would allow me to give birth in the hands of a midwife, but in a hospital setting in case something were to go wrong.

While spending a bit of time on Texas Children's Pavilion for Women website, I noticed the hospital also had a fertility clinic. Since I was still not sure if I was pregnant, I figured having a backup plan wasn't a bad idea, so I made myself an appointment to be seen by a fertility specialist.

Once we found out that I was in fact not pregnant, I was relieved to have made that appointment at the fertility clinic. The wait time was almost 4 weeks (which is actually quite fast) before I could be seen by Dr. Paul Zarutskie. I’m a planner to a fault, so having this appointment already scheduled actually made the disappointment of not being pregnant more bearable.

Tuesday, September 29, 2015

The day of our first appointment finally arrived, and I was optimistic. At the beginning of our appointment, one of Dr. Zarutskie’s fellows carefully took my complete medical history. She asked a lot of questions, and did not seem as phased by my 90+ day period as my prior doctors had. She was compassionate and patient as I detailed everything.

Dr. Zarutskie joined us, reviewed the fellow's notes, and asked more questions. Then, it was into an exam room for a complete physical and the first of many transvaginal ultrasounds.

We finally left the clinic and were sent upstairs to the lab for a battery of blood draws for the both of us. They took about 8 tubes of blood from me to perform a total of 13 different blood tests. I nearly passed out! I was also asked to come back later that week for a glucose response test.

Chad was asked to make a "deposit" for a semenaisis.

Finally, the doctor asked for copies of my medical history from my old OB's office, including copies of my abdominal MRI from August 2014.

I was scheduled to see Dr. Zarutskie again about a week later to go over our lab results. Chad passed his test with flying color, and my blood work also looked good...except the glucose response test. It showed I was borderline insulin resistant, and I was scheduled to see a dietitian to make changes to my diet so I could avoid any medication.

The last item of interest was my MRI from August 2014. Dr Zarutskie asked if he could send my MRI images to another radiologist to be re-read, which was of course fine with us.

This appointment concluded with a the doctor telling us that he was pretty hopeful about our prospects of getting pregnant, but that it seemed like I was going to need a little bit of help given my medical history. I laughed when his fellow told me I could throw away my home pregnancy test, since they would be managing that process for us going forward.

About a week after that appointment, I got a phone call from the nurse. She said the doctor wanted me to come back in for another ultrasound, and asked if I was available the following morning. When you get a call asking if you can come in the next day for a test, the answer is yes. So of course, I dropped everything and made the appointment.

The next morning, Dr. Zarutskie did another transvaginal ultrasound. Then Chad and I went next door to the consult room. Dr. Zarustkie explained that he suspected I did not in fact have a bicornuate uterus. I say “suspect” because he ended up sending my MRI images to 4 other radiologists, all with conflicting reports. Dr. Zarutskie explained that he had a good level of certainty that I had a septate uterus instead. Luckily, this is something that is reparable via surgery.

From the time I first met Dr. Zarutskie to the time that he presented me with this surgical option was about 45 days. Dr. Zarutskie gained my trust in this short period of time by being compassionate, and fully understanding me as a person (not just a chart of data). For these reasons, I went ahead and scheduled a hysteroscopy and laparoscopic procedure to explore my abdomen and hopefully correct my septate uterus.

FAQs, Definitions, and References

Click here for a link to the timeline of our journey!

Throughout my blog, I reference some big, scary medical terms. I wanted to create a section of definitions and FAQs just for you, my readers, so you don’t have to run off to Dr. Google every time you encounter something unfamiliar.

Friends and family: PLEASE do not consult with Dr. Google. I promise I will provide everything you need to know here as it relates to MY journey. If you feel I have left something out, let me know before you consult with Dr. Google. Just like these medical terms, he can be big, scary, and mean. Without knowing what you’re looking for, chances are you will be misinformed.

Infertility patients (those of you embarking on this journey as an individual or a couple sticking yourselves with needles): I encourage you to speak with your doctor before you begin consulting with Dr. Google. They will help you understand YOUR particular situation so you can identify which information is helpful and relevant while you’re wading through it. You need to read it all so that you can ask the right questions during your appointments.

Why do I make two very different recommendations regarding Dr. Google? Each infertility journey is different. What you’re reading here is mine. These definitions relate to my story, and are relevant to my particular situation. Misinformation is a huge problem in medicine (and in society as a whole), and the last thing I want is to misinform you any further.

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Bicornuate uterus - A type of uterine malformation also known as a "heart shaped" uterus. Bicornuate uterus literally means that the uterus has two “horns,” and is often marked by an inversion on the top of the uterus. Since room for baby to grow is drastically reduced, this malformation can make it harder to carry a baby to term and usually results in a C-section delivery. Bicornuate uterus is detected by ultrasound or MRI, and occurs when the mother’s uterus is formed but does not properly fuse together during the embryonic stage of development.

Charting - This is where a woman tracks her menstrual cycles in order to predict ovulation. Tracking can include observing cervical mucus, cervical position, basal body temperature, and of course menstruation itself.

PCOS - Polycystic ovarian syndrome (PCOS) is a hormone disorder typically characterized by the appearance of cysts on the ovaries. These cysts cause the ovaries to malfunction, which grows the hormones out of whack and ultimately leads to issues with ovulation. The patient will usually present with multiple distinct symptoms caused by the hormonal imbalance, including facial hair, acne, menstrual irregularity, and obesity.

Chemical pregnancy - A chemical pregnancy occurs when there is enough hCG (the pregnancy hormone) for the test to detect a pregnancy, but the pregnancy fails to develop further and is lost shortly after. No, this is NOT a "false positive." The likelihood of a false positive is extremely low, since modern home pregnancy tests are extremely accurate. You are more likely to get a false negative (where you are actually pregnant but the test does not detect hCG) than to get a false positive.

Clomid - Clomid is a drug that is used to help produce follicles, which eventually lead to ovulation. The use of Clomid can often lead to pregnancies of high order multiples. This is because the ovaries will often produce multiple eggs, which are then fertilized and implant into the uterus. Many, many, many of the families of multiples you see on TV were formed by the use of Clomid.

Follicle - A follicle is found on the ovaries. One egg develops inside each follicle.

Glucose response test - This test determines if you have diabetes. First, your blood is drawn to get a baseline. Then, you are asked to drink a nasty bottle of liquid (basically the sweetest and flattest Sprite ever) and sent into the waiting room. You are not allowed to leave, eat, or drink anything during the test. You are called back to have your blood re-drawn one hour later, and again after two hours. (This blood draw schedule can vary). Each blood draw measures your blood insulin and your glucose levels. This test is often given to women at the beginning of their pregnancies to determine if they are diabetic or at risk of developing gestational diabetes.

Ovulation - During ovulation, a follicle releases an egg into the fallopian tube where the egg is hopefully met by sperm. If the egg is fertilized, it continues to travel down the fallopian tube into the uterus to implant and grow into a baby.

Follicular ultrasound - This is an ultrasound performed via a transvaginal wand. The ultrasound technician will count the follicles on the ovaries, measure the volume of the ovaries, and measure the lining of the uterus.

Ovulation test - This is an at-home test with moderate reliability. The test is performed on a urine sample over multiple days, and is supposed to measure the increase of luteinizing hormone (LH). A spike in LH triggers ovulation.

Septate uterus - a type of uterine malformation where a cartilage-like wedge of flesh divides the uterus. Depending on the size and location of the wedge, it is usually corrected via surgery. Generally, pregnancies after the wedge is removed proceed normally. Without removing the wedge, the embryo can implant along the wedge (if it does implant at all), which will almost certainly result in a miscarriage before the end of the first trimester. A septate uterus occurs when the mother’s uterus is formed but does not fully fuse together during the embryonic stage of development.

Transvaginal ultrasound - This is an ultrasound performed through the vagina as opposed to being done over the abdomen like you often see in TV and movies. I tend to refer to this sort of ultrasound as “a meeting with Wandy.”

Two week wait - It takes two weeks from the time a woman ovulates to the time that a pregnancy test can reliably detect a pregnancy. This time period is otherwise known as the longest two weeks of your life. You must go about as if you are pregnant, but in reality you have no idea if you are in fact pregnant just yet.

My Medical Team & Other Infertility Resources

Texas Children's Pavilion for Women

women.texaschildrens.org

Dr. Paul Zarutskie

Eastern Harmony Clinic (Acupuncture)

www.easternharmonyclinic.com

The National Infertility Organization

www.resolve.org