About Uterine Polyps

A new buddy of mine online just posted that she was diagnosed with a polyp. Here's what I shared with her:

Fibroids and polyps can change the microenvironment in your uterus by irritating the lining and causing a reaction akin to what an IUD does I believe. You end up with your body reacting to the "foreign" object but at the same time it's so hyper active from an immune standpoint that it disallows implantation. (some of this is sort of subjective on my part but I've read a lot about implantation, fibroid, etc.)

Do you like your ob/gyn? Don't they have a backup? If you are really feeling put off then maybe try finding help elsewhere -- though here in Seattle getting in to see an ob/gyn as a new patient takes 2 months plus.

Here are some links for you:



Emerging endometrial polyp during controlled ovarian
stimulation affects IVF/ICSI outcome

Results: In the patients with endometrial polyps, no pregnancy was achieved. Clinical pregnancy rates and implantation rates of the second group were 28.35% (55/194) and 13.05%, respectively. Fifteen of the pregnant women (27.27%) experienced miscarriages. In some of the patients, hysteroscopy was performed for removal of the endometrial polyp. In part of them, after the polyp resection, spontaneous pregnancy occurred.
Conclusion: Our results reveal that endometrial polyp <10 mm, appearing during COS is a rare complication and it may have a negative influence on the IVF/ICSI outcome. In order to improve embryo implantation, we need to remove the above mentioned endometrial polyp. Abnormalities at the endometrial level and abnormal embryo–endometrial dialogue may be responsible for some cases of implantation failure. Endometrial polyp may be an impediment to embryo implantation because it acts as space occupying lesion and/or disturbs the expression of various endometrial products such as pinopodes, integrins and cytokines. It is not clear whether the expression of such factor as the endometrial polyp is the reason for implantation failure or is just a reflection of other abnormalities taking place in complex cascade of events.
From: ESHRE Meeting, June 2006 - Implantation

Surgery is usually recommended for polyps, for several reasons:
To try to improve fertility. Polyps may interfere with implantation of a fertilised egg in the lining of the womb, so they're often removed to try to improve the chances of conceiving.
From: Uterine Polyps

Leiomyomas and polyps are growing tumours and thus produce significant plasma glycodelin levels. Uterine glycodelin flushings are elevated in patients with both polyps and leiomyomas. Elevated glycodelin levels in the follicular and peri-ovulatory period may impair fertilization and implantation.
From: Glycodelin levels in uterine flushings and in plasma of patients with leiomyomas and polyps: implications for implantation.

Endometrial polyps appear to be organized overgrowths of the uterine endometrium, although the precise mechanisms leading to their development are not clearly defined. The endometrial lining of the uterine cavity grows in response to estrogen and is architecturally restructured in response to progesterone. If the response to estrogen is excessive, either in the presence of unopposed estrogen (such as during periods of anovulation) or whenever the bioactivity of the circulating estrogen is increased (such as with increased numbers of estrogen receptors or with decreased metabolism of estrogen) overgrowth of the endometrium may occur. If these overgrowths organize and develop their own blood supply then they become polyps.

The mere presence of polypoid overgrowths in the uterine cavity may (at least theoretically) interfere with implantation and fertility. I have envisioned polyps as acting sort of like IUDs in the cavity, creating a hostile environment for embryo implantation. I remove endometrial polyps in women with reproductive problems and these women (anecdotally) seem to do remarkably well in subsequent fertility efforts. A well designed research project describing fertility outcome after treatment for different types of endometrial polyps would be valuable.

Endometrial polyps are not always benign. I removed one normal appearing endometrial polyp hysteroscopically and this was found to contain an endometrial adenocarcinoma (cancer) on pathology report. Therefore, in the presence of any atypical overgrowth of tissue it is always important to think about the possibility of cancer
From: Miscarriages - Causes and Treatments

Factor v Leiden & Pregnancy

I gathered these links this morning for my friend Bridget who just found out she was pregnant again. She's got this blood clotting disorder which is one factor in her having had three miscarriages since December 2004.

Bridget and I met up in Chicago in November when we just needed time to vent about our losses and hang out talking about it without judgement. We shared a hotel room and had a great time. I only knew her online before that. Other loss gals, you might want to try it -- it was an amazing experience and we're even stronger friends because of it.

Factor V Leiden and recurrent miscarriage—prospective outcome of untreated pregnancies
http://humrep.oxfordjournals.org/cgi/content/full/17/2/442

The effect of factor V Leiden carriage on maternal and fetal health
http://www.cmaj.ca/cgi/content/full/167/1/48

Gestational outcome in thrombophilic women with recurrent pregnancy loss treated by enoxaparin.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10823264&dopt=Abstract

Enoxaparin ( e-nox-a-PA-rin) is the generic name of Lovenox
http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202686.html

Pregnancy, Clotting, and Factor V Leiden: An Overview
http://www.naturalchildbirth.org/natural/resources/prebirth/prebirth35.htm

FVL-PG · Factor V Leiden and Pregnancy Issues (Yahoo Group)
http://health.groups.yahoo.com/group/FVL-PG/

Anticoagulation Forum -- click on the link on the left labelled Clinic Locations to find anticoagulation specialists in your area.
http://www.acforum.org/

Miscarriage Testing

This was posted with permission from my friend ozgal who did a lot of info gathering. It's a list of all the different types of testing that you can get done. My ob/gyn today suggested that I just get the IgG and IgM tests done -- as they more common blood clotting disorders. I'll get the results in a few days time.

Here's a list of suggested post-m/c tests (with resources below):

• Toxoplasmosis


• Antinuclear Antibody Titre (ANA)


• Anti dsDNA Antibody


• Anti ENA screen (ELISA)


• APA – Antiphospholipid Antibodies (Anticardiolipin antibodies)


• Lupus Anticoagulant


• Thrombotic Assays (for clotting factors):

-- Antithrombin III Activity
-- Protein C Assay (functional)
-- Protein S Assay (free)
-- Plasminogen Assay
-- Activated Protein C Resistance (Factor V Leiden)

• Serum Immunoglobulins (IgG, IgA, IgM)


• Fertility hormones: Progesterone, HcG, Prolactin


• RIP (Reproductive Immunophenotype – natural killer (NK) cell)


• NKA (NK cell assay)


• Antihistone Antibody


• Coagulation Assay


• DQ alpha HLA antigen (male and female)


• LAD (Lymphocyte Antibody Detection) (male and female)


• TNF alpha (Tumor Necrosis Factor)


• Antibodies to neurotransmitters


• ETA (embryotoxicity assay)


• Ratio of TH1 to TH2


• Genetic/karyotyping of male/female blood


• DNA Integrity Assay (this requires sperm analysis)

Sources:
Dr. Jonathan Scher and Carol Dix, Preventing Miscarriage, the Good News. New York: Harper Collins, 2005.
Jon Cohen, Coming to Term: Uncovering the Truth About Miscarriage. New York: Houghton Mifflin, 2005.
http://www.repro-med.net/info/cat1-5.php
http://www.haveababy.com/rpl/basics.asp
http://www.illinoisivf.com/recurrent-pregnancy-loss/post-implantation.html
http://www.inciid.org/article.php?cat=immunology&id=374&pagenumber=1
http://www.asklenore.info/miscarriage/immune_testing.html
http://www.rialab.com/miscarriages_prevented.php
http://sharedjourney.com/loss.html
http://www.infertilitytutorials.com/miscarriage_members/hormonal.cfm
http://news.bbc.co.uk/2/hi/health/4002539.stm
http://www.gentlebirth.org/archives/miscrg.html#Prevention
http://www.sefertility.com/patinfo_progesterone.html

Please send her some prayers as thank you for sharing. She'll need them as she works on TTC post loss.

Miscarriage Tips

I just wanted to write down a few things that might be helpful for people dealing with their first losses. Others feel free to add on your advice as well.

-- Unless your pg is dating more than a week behind in the 6-7 week range, you can't be sure about what's going on with your pg until you have waited a week and had a repeat scan unless you are already losing it and bleeding or have blood tests showing that your HCG level is dropping.

-- Don't just get a d&c after one bad u/s, wait a week just to confirm -- barring other situations that might preclude that such as ectopic, molar pg, etc. Sometimes things look badly and then it turns out to be just a bad scan. Not a majority of the time but you don't want to make a decision hastily and then feel guilt-ridden later that you hadn't given it a chance.

-- the medications that they use to knock women out during a d&c can have a side-effect that you might wake up crying. Doctors and anesthesiologists don't often tell women this and when you are dealing with the already emotionally traumatic experience of pg-loss this s/e can really make you feel worse and more out of control. (light sedation won't do this)

-- you usually have the option of doing a d&c under light sedation or under general. Ask your doctor about it. Some gals have had better experiences with light sedation. I've had both but only general during the d&c to remove retained tissue -- one didn't strike me as better than the other but each has it own benefits and drawbacks.

-- You can choose to m/c at home on your own. You need to know what to watch for (hemorrhaging and signs of infection) but lots of women do it. (see my miscarriage prescription)

-- Even if you have a d&c to end a failed pg more quickly you still might go into labor a few days later. (see my miscarriage prescription)

-- you might want to save the POC/baby if you miscarry at home. Some women here have planted it in their garden or even it potted plants. Some women feel guilt later if they have flushed it down the toilet. It's totally up to you what you want to do but don't feel like a freak if you feel the need to honor your loss in that way. And if you don't want to it's okay too.

-- if you have a full-time job it is hard to know how much time to take off and when. Miscarriages can be draw out affairs. Many women take at least a week off, some go back to work right away. I've alternated, going to work when I was up to it and stayed home on the days when I just couldn't cope at all. It's hard, and I think we've all had to deal with it. Know that others have struggled as you have and that it's okay. Just try to be gentle with yourself.

-- its easy to want to stop taking care of yourself after you learn of your baby's demise, wait to miscarry and recover physically afterwards. To go from being so careful about what you eat and taking all your vitamins to eating junk food and drinking wine. Try to do better than that, keep taking your prenatals as your body will need the extra nutrition as it reorganizes your hormones and body back to an unpregnant state. Drink lots of water, go for walks, and eat healthy meals. It's okay if you aren't perfect and can't manage to be super fabulous about it, just make an effort. Not taking care of yourself isn't going to make you feel better ultimately, it might make you feel worse.

-- If you have lost a lot of blood make sure to add in more iron into your diet and take iron supplements for a while. I think taking a separate supplement separately from my prenatals is easier for my body to absorb -- I take a chewable iron that doesn't disagree with my system.

-- bleeding more than two weeks after a d&c should be looked into via u/s or at least a beta draw.

-- you should have a beta draw a week after a d&c to help make sure you have no retained tissue

-- if you continue to have a dragging pregnant feeling after your miscarriage and your doctor hasn't done a f/u beta draw you might have retained tissue.if you have retained tissue that is still growing and engaged the progesterone produced post-O will make you feel more pg

-- your body can ovulate after the hcg level drops below 40-50 ng/ml.

-- you might ovulate a couple weeks later or your body might need more time to recoup and get things reset and restarted after your loss.

TTC After 35

Here are links to some articles I found when looking for info about my advanced maternal age.

Female Fertility After 35

36 and Over

How Aging Affects Fertility

Pregnancy After 35 - March of Dimes

Age Related Miscarriage


You might also appreciate:

How to increase your chances of conceiving and preventing miscarriages

The blood runs down
over my knees and ankles
large splashes of angry color
and mean pains.
The pool of crimson grows and grows
until it covers the earth;
there is nothing left in me,
I drown the world.

I am a flower pot that holds no soil
I poured out of me, so much
that which was meant to grow.
It all goes away and takes me;
there is less and even less of me;
a deficit really.
Call it hope if you must,
but to me it just feels like
I've been turned inside out.

Each baby is stolen from me
who are these witches?
They sneak up on you, like the fairies
and steal the babies
and not just their breath
like the cats can do.
They leave me empty and the emptiness only grows.

Or do they chase them away from me,
just as they were getting settled
like little birds flying in the November sky.

When I think of it
I made space in my life for
your coming, so many months.
You came, both of you
like fleeting sparks
Was that all?

In time
I can find a place
for the things I gathered to
welcome and warm you to the world
but never will there be
another place for
the indelible impression
you have left on my being.

There are grooves
running through me
like marks of a dogs teeth
on my bones
never totally healed

Memory remains in strands
of my hair, in my nails
the crevices on the back of my hands.

A little more worn, a little tired.

Some more miscarriage links

Check it out, lots of interesting information about early scans, percentage rates of various situations, etc.

Management of Early Pregnancy and Loss

Page of stats about miscarriage

First Trimester Miscarriage from Dr. Spoock

Dr Alan Beer is mentioned in the book Coming to Term as a repeat loss specialist. I took a quiz on the site and it said that it wasn't likely that I had an immunological reason for my losses. Probably pretty accurate for me, though the mention of retained tissue leading to an immune reaction (at link below) kinda freaked me out since I had retained tissue for so long with my first loss.

I found this page about RPL testing with posts from patients which is interesting

I'm CD 15 today and feeling heavy with achey ovaries. I started spotting yesterday and I can't wait until AF shows up as at least that will indicate that things will soon be better. I've got acu in the morning, hopefully that will help. I hope I feel better by the weekend when my MIL is in town.

Cortisol and Night Sweats

I'm onto something, a few things really but the one that has my attention right now is cortisol. I had really bad night sweats at the beginning of my pregnancy. Evidently panic attacks are associated with night sweats and I know from my partner who has panic anxiety that adrenal exhaustion triggers cortisol production. I came across a reference last week that mentioned that kidney yang deficiency was akin to adrenal exhaustion and I've been diagnosed with kidney yang deficiency -- boy doesn't it all come full circle with the night sweats.

ADRENAL FATIGUE

I found a couple of links about cortisol and pregnancy loss which I posted to the progesterone and miscarriage post, look towards the bottom of the links.

I've also been looking up about heparin and blood thinners to help stop immunological rejection of pregnancy. I posted a few weeks ago about some similar cases treated with chinese herbs that contained dongquai which is a blood thinner so I wonder if trying the blood thinner route might be worth it -- and then it is a matter of eastern or western medicine.

Progesterone and Miscarriage

I've found a few links that I've bookmarked about progesterone and I'll add to this post as I'm able to comb through more. I think that progesterone is part of my problem.

"I myself give progesterone. I'd rather take a chance on delaying a miscarriage than writing off a baby that just might make it..."

"Note: The normal level of progesterone is usually "15-20." If the progesterone level is ~13 or so, this is seen as salvageable. If the progesterone is <5, I've not really seen progesterone do any good."
From: Exercise in Early Pregnancy: Risk, Low Progesterone, and Miscarriage

Hormonal causes for recurrent pregnancy loss

Progesterone Therapy (PDF)

Luteal Phase Progesterone Level(s)

Also estrogen dominance can lead to prolactin excess and low progesterone production. Here's an article about elevated prolactin and miscarriage
High Prolactin Linked To Recurrent Miscarriage

Progesterone Therapy in Pregnancy

Possible Ways to Prevent Miscarriage

"The researchers found stress hormones such as cortisol are raised in the bloodstream, suppressing the production of progesterone - a hormone which is crucial to the maintenance of a healthy pregnancy."
From: Stress 'linked to miscarriages'

"Increased levels of cortisol are associated with pregnancy. Physical and emotional stress can also elevate cortisol levels."
from: Cortisol tests

A summer of last hurrahs

So last night I went out drinking and dancing with friends. I let my hair down, got all girlied up and boogied. It was a lot of fun. If I was pregnant or had a kid already then hanging out until 2 am would not really be an option. But since I'm not, I can have one last hurrah, actually a summer of last hurrahs. No babysitters for me, I can just throw on a cute, sexy outfit and hit the town.

It's really rather amazing. It's like getting that card in monopoly where you get to go ahead and get $200. I'm going to take it for the gift it is.

We're also thinking of going to Barcelona in September for 10 days. That would be so awesome. I'm going to help make it happen.

I'm still spotting a little but physically I'm feeling pretty okay. No big emotional stuff lurking or anything, I think it all went out the window during my dragon treatment on Thursday.

I'm off camping for the weekend. I hope you have a nice one too. Don't forget to celebrate what you do have.

Whoa.

I had acupuncture this morning and after reviewing more about my history (emotional as well as physical) she said she would like to try an acupuncture treatment called a Dragon treatment. It comes from Japan she told me and the points don't make sense in a traditional channel sense but they seem to unlock where we hold onto grief in the body. She wanted to clear out the grief from my body. I told her aside from the early weeks after this BFP where my mood lifted, that I had sadness for the better part of the past year.

She told me to ask my body to let it go, ask my mind to not fight it and if I could, to ask a higher power for help.The needle points were at the crown of my head, two just below my neck on either side of my spine, two in my lower back and two in my ankles. Then she opened the window and told me that was a part of the treatment.

She left the room and I started weeping. I lay face down on the treatment table and the room was silent. Everything was running, tears and my nose. I cried for having this happen to me. For my dead babies. For not being pregnant now. For having two, my twin angels, due within three weeks of one another. For both times being able to start planning for what was to come in my life and then to have it dashed away. I asked God to help me. Not in any particular way. Just to help me. I thought of the footprints in the sand. I thought about how my partner doesn't want to think of them as dead babies. I thought of how I had all the gushing surprise and expectancy last time though the baby seemed less real to me. This time I felt less gushing but since my fibroid was gone I felt more like there woudl be a baby at the end. I cried for having to manage my pregnancies and fertility to this degree. I didn't blame anyone though.

Next she will have me take an herbal formula but the one she wanted originally wasn't in the office so she wanted some more time to review my case and then try to come up with something that's a good fit. We're going to try to clear out any remaining stagnation from my abdomen, any blood stasis, etc. My tongue shows signs of digestive issues, I feel that as well. I'll be eating more blood building foods going forward, redoubling my efforts.

I can breathe a little better now.

Here's a link to a site showing ultrasound images of retained POC (products of conception)

Spontaneous abortion - Retained products of conception

Here's a link which explains how to read ultrasound images of the uterus.

My scan today showed something in the upper part of the uterus but my RE said it wasn't there last time so it is likely just some clots. I sure hope so. I'm ready to be done now.

Back from acupuncture

I went over and met with two women acupuncturists today who both took case notes and my pulse. Obviously we had a LOT of information to go over since I've been there and back over the past three years.

They were a bit amazed that we hadn't tried any fertility meds, not because they thought we ought to have but just because I had been seeing REs (4 total) and all I've had them do is provide consult, an HSG, some bloodwork, 2 d&cs and a myo.

After going over the here and now miscarriage stuff, then into my pregnancy a bit and then over my cycle history and the fibroid stuff finally we got to do some needlework. I was like a porcupine today with them all up and down my legs, on my hands and feet and across my belly. Two particularly painful areas were the palace of the uterus (down low near my bikini line) and my girdle (aka belt) meridian. The needles were fine but some of the movement they were trying to get to happen was fairly painful, not acute but really sore. Evidently my kidney channel was depleted, my lung qi was being drawn on heavily and it was depleted (channel associated with grief go figure) and my heart channel had some stuff as well. My spleen/stomach channel was doing its almost usual weirdness as well and of course, liver qi stagnation.

I feel much better now, not so entrapped by the changes my body has been going through. I'm going to sort out next steps with my REs office in the morning if the sac doesn't move out by tonight and then we'll see about medical management or herbs to try to move things. I'll have another acupuncture appointment next Thursday with them to follow up on getting my body out of this miscarriage phase and then we can start focusing on building me up again.

It sounds like a good plan to me.

This evening I'm feeling frustrated, just a little bit but it's there. How did this happen to me again? How is it that I was so close and then the whole project got called off. Why wasn't I consulted? I don't feel like I lost a baby, I feel like I lost a pregnancy. Next time, if I can sort it out so that we don't lose it I imagine people coming up and asking me "oh, is it your first?" and I will answer "No, it is my third pregnancy and no I don't have any children."

When I'm coming to and from the house I think of my neighbors and how they must perceive our life as this childless couple. Little do they know what has happened in their midst. Yet again.

I wish I could be even trying again but I'm still in the midst of getting rid of the remainder of this loss (still haven't passed the tissue -- I think I'm going to have to try drugs this weekend).

Still working on it

My ultrasound this morning showed that the gestational sac has moved down towards the area of the cervix but it has not passed yet. It still showed up as a dark blog on the screen so it still is fluid filled, though that doesn't have anything to do with it being still in there.

The nurse checked my cervix and boy did having that speculum opened feel like a treat. Everything is a little more sensitive down there right now, even the cotton swab she used to move blood away from the cervix opening was intense and ouchy.

My doctor, the nurse and I agreed that avoiding a d&c was worthwhile (see there is a reason I named my blog that) so I will just have to let my body do the remaining work to move the remaining tissue out of me which should happen within a few days but maybe a little longer. We'll reevaluate later on this week if nothing has happened by the end of day Thursday.

My head is foggy and my body still feels weird, unresolved as it was. Not as hormonally hung up as last time though but somewhere in between. I've realized that the hormonal changes your body goes through for a miscarriage somewhat impair the analytical part of the brain. Oh well, if I can just push through and focus on design work and not on any more proposals or client meetings I should be able to make it through the week.

It's 1:15 am and I can't sleep. I had a nap earlier this evening because I felt sleepy and heavy and then I woke up. I've been surfing around and not working on this proposal that is still hanging over my head.

I wish I felt tired. I feel like an insomniac.

I also wanted to thank you all for coming and lurking and posting and sending me prayers and good thoughts. It helps to make this seem less of a lonely time. I wish it was because we were all celebrating instead of worrying over this non-event.

Today I kept thinking of this song by Sarah McLachlan,"Out of the Shadows". It's from her first album. It's a pretty song but a bit moody. Reading the lyrics they hover around what I'm feeling, but I'm not going to let myself be depressed. Well okay a little. But not in a big self-indulgent way. Just a measured amount.