Introducing my new fibroid

I just had my RE appointment this afternoon and it was an interesting experience. My partner basically laid it out there for her, that we were feeling that it was worse to get pregnant than to not get pregnant -- since losing the pregnancies was far worse than not having them. She suggested that we try using Femara to induce ovulation for a few cycles, in the hopes of promoting a stronger ovulation. After a few cycles we could then move on to trying IUI. She said that really, in spite of my partner's poor morphology, that getting pregnant on our own really was the ultimate test of his fertility.

We also discussed and scheduled a HSG for next week, to check for adhesions, any damage to the lining from the two d&cs and make sure the tubes are open. Sounds reasonable, and its what I wanted.

I brought up again that I had read that low ferritin had been linked by some doctors in Britain to lower fertility and increased miscarriage rates and she dismissed me and said that she had never heard that and it wasn't something that she would check for on her own. If I pressed she would do the bloodwork but whatever.

Then she suggested that we do an ultrasound right then and there to see about any new fibroids. Sure I thought, but there weren't any when I had my ultrasounds around the last miscarriage. Low and behold, there was a brand new 2.5 x 3.5 cm intramural fibroid, but away from the uterine lining and towards the outer wall of my uterus. I was in total disbelief. I just went through major abdominal surgery just 14 months before, and there wasn't anything on the scan last June. How could this happen so fast, and in the same are of my uterus?

She said it seemed to be pushing the right ovary out of the way a bit, distorting it on the scan. How nice eh? She said she doesn't think it is causing me any problems right now. She also checked my lining via ultrasound and said that it didn't appear inconsistent which can sometimes be an indicator of adhesions. I'm going to have an HSG on Tuesday next week to check my tubes. If that all looks okay then we'll try for a few cycles using Femara/Letrozole to see if maybe there is an ovulation dysfunction that we can override.

As my doctor was leaving the operatory I said dryly, "well at least I've been growing something in there," and she totally didn't know what to say but then she laughed (my twisted sense of humor overwhelms them you see).

So what should we name this new little interloper?


Some of the lovely things you find in the RE's office.

Hysterosalpingogram (HSG)

An HSG is a hysterosalpingogram, an x-ray of the interior space of the uterus and fallopian tubes using a contrast dye. It can be used to look for uterine abnormalities and adhesions, determine how much infringement fibroids are making into the interior of the uterus (to some degree), and identify if your tubes are open (referred to by docs as "patent"). Some docs do it standard a few months after a myomectomy, mine did not. The dye does have what my RE referred to as a "voodoo effect", where there is some slight increase in pregnancies after the procedure, speculated to be caused by the dye perhaps causing the little hairs (cilia) in the tubes to function better.

It can be done by your doctor in a radiology facility or by a radiologist -- mine was done by my RE and she was a lot more comfortable with the procedure than the radiologist I could tell.

They insert a catheter to insert the contrast dye through your cervix; a good cough evidently will open up the cervix so it is less painful. The dye feels like pressure going in, and it can cause a drop in blood pressure. It's generally uncomfortable and causes some cramping. My RE tried to manipulate my uterus for the xray shots using the special speculum and I found that to be very uncomfortable with my 6-7cm (at the time) fibroid.

Here is an link detailing Guidelines for the Performance of HSG - it advises taking 1000 mg of NSAIDs prior to the procedure.

Rarely it can cause infection, and some people are allergic to the contrast medium. Some docs give antibiotics preventatively ahead of time, they also might have you take a heavy dose of Tylenol an hour beforehand.

Here are some links to sites showing images from HSGs:

HSG Link 1

HSG Link 2
HSG Link 3

I should go pick up my x-ray film from the University of Washington Radiology Department, where I brought it when I consulted about UAE a couple years ago. I'd like to scan it and and post it here so you can see what my distorted uterus looked like.

Pelvic Adhesions

Adhesions are really common after pelvic surgery but they don't necessarily have to cause you problems or impact your fertility. Some doctors will perform an HSG (hysterosalpingogram) a few months after a myo for women wanting to try to conceive but mine thought we should just see what happened for a few cycle on our own. We were able to conceive and have implantation in my uterus so no problems there for me.

Adhesions & Pelvic Pain
What Women Need To Know About Prevention and Treatment

Pelvic Adhesions

Pelvic Adhesions - Their Role in Infertility and How to Prevent Them
PDF brochure from RESOLVE

Reduction of Adhesions

Asherman's Syndrome

Pelvic Abnormalities: Pelvic Adhesions (photos)

International Adhesions Society
(they are also conducting a survey of patients regarding informed
consent forms with regards to mention of adhesions)

Adhesion Related Disorders

Chronic Pelvic Pain
(includes some info about how to minimize adhesion formation)

Pelvic Adhesions
(fairly clinical and scientific information about adhesion formation and prevention in a Powerpoint presentation)

Pelvic Pain Needing Treatment

Wound Healing and Scarring - Sutures

Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.
(there are other media that can be used to prevent adhesion formation as well, if you are interested continue searching on these terms:
"pelvic adhesions barrier agents")

Other Causes of Pelvic Pain Besides Fibroid Degeneration

A common complain of women with fibroids is abdominal Pain. This pelvic pain can come from from fibroid degeneration, when the fibroid outgrows its blood supply and dies, but that's fairly rare and there are other possible causes of pelvic pain including (an incomplete list):

Appendicitis

Constipation

Adenomyosis -- endometrial tissue grows into the wall of the uterus and can form pockets that bleed each month

Endometriosis -- endometrial tissue grows on other pelvic structures outside of the interior of the uterus and swell and bleed with the hormones produced as a part of your menstrual cycle

Ovarian Cysts -- mature follicle that does not rupture and can grow pretty large, if they rupture they can be quite painful. Some cysts are normal and most of the time they are just reabsorbed. There are other forms of cyst which require medical intervention such as dermoid cysts, endometrioma, and sometimes chocolate cysts.

Ovulation -- mittelshmerz is pain that is felt around ovulation, perhaps from the release of the egg or perhaps from irritation from fluid released from the follicle

Pelvic Inflammatory Disease -- bacterial vaginosis, gonorrhea, and chlamidia can all cause infections in the pelvic cavity

Pelvic Adhesions from prior abdominal surgery or infection -- a d&c or IUD can sometime result in an infection as well

Fibroid Pressing on blood vessels or other abdominal structure

Cystitis -- bladder infection

Kidney infection

There is also a diagnosis in traditional chinese medicine/acupuncture called blood stagnation which can cause pelvic pain and is generally associated with gynecological conditions such as fibroids. Liver stagnation is usually part of the diagnosis as well, the liver being the major detox organ in the body and one that is also associated with emotion and grief in chinese medicine. I've found acupuncture to be helpful in managing my pelvic pain, as well as breathing exercises that promote movement in the abdomen. Here's a link about blood stagnation that you might find useful.

All About Blood Stagnation
http://www.acupuncture.com/Herbology/bloodstag.htm

If your doctor checks you out and you are still having problems then
you might consider the blood stagnation possibility.

My Reasons for Not Wanting a Myo

Here are my reasons for not wanting a myomectomy:

1. major abdominal surgery
2. risk of adhesions
3. length of recovery period
4. fact that with multiple factors there isn't a documented increase
in fertility
5. they would require me to deliver by c-section if I did get pregnant post myo
6. that I'm largely asymptomatic except for slightly heavier periods and some pelvic pain for a few days prior to ovulation and at the start of my period

We don't even know if we want to do any assisted reproductive therapy anyway, we went to the reproductive endocrinologists (RE) to get their opinion on our situation (my partner had a vasectomy reversal and has an issue with sperm morphology -- morphology refers to shape of the sperm). It was just kind of intense having the head of reproductive endocrinology at a leading university tell you that he consulted with all of the other REs and they've decided they don't want to be my friend.

I've always wanted to go the natural way -- I was never on birth control pills, don't eat junk food really, stay fit. I don't like it when the medical establishment says (in its Terminator voice) "you are infertile. we will cut you open and remove that fibroid. take these drugs and we will harvest your eggs and MAKE you pregnant."

Now I don't know how the rest of you feel but I'm not feeling like I want to go out on a limb with any procedure since I would feel worse if I didn't feel like my care providers were on my side. I guess I will continue doing my watch and wait routine and in the meantime at least take advantage of the MRI order from the RE so I can learn more about what's inside of me. Maybe God or the Universe will intervene in the meantime.