It all started with infertility
I’ve lived most of my womanhood with the diagnosis of Polycystic Ovarian Syndrome (PCOS) piggybacking on episodes of abdominal or pelvic pain, a cyst rupture making me feel like I was near death, and abnormal cycles. This can be a confusing diagnosis which left most of my doctors, especially endocrinologists, puzzled, questioning whether or not I really have PCOS or multiple cysts planted on my ovaries. This is something they usually determine through bloodwork which mine have shown slightly abnormal hormone levels, but all my ultrasounds have consistently shown its present. My self-treatment regimen typically involves Ibuprofen and a heating pad. Pain that I’ve adapted to and pushed through thinking this was all just part of being a female. Surgery 2 was set and scheduled 1.5 weeks after my breast surgery (as mentioned in previous post) and all started with the topic of infertility.
Disclaimer or fair warning: This a sensitive topic for some; however, this LENGTHY series of personal posts includes information I have decided to share for readers and/or their loved ones who may be at the start of discussion wondering where to begin. In addition, this isn’t just for those facing infertility, several issues unfolded as we gradually entered this topic. This message is written with hopes of helping others facing any unknown or questionable issues that are hard to define or diagnose. Please do not use this information to self-diagnose or make any presumptions. Links are provided for additional information and always talk to your doctor about any medical questions.
Things I didn’t know…
Women are infertile for most of their monthly cycles. Infertility is defined as the inability to achieve pregnancy or conceive for at least one year. According to the CDC, 6% of married women from the ages of 15-44 (didn’t know teenagers were getting married!) are unable to conceive after 1 year of unprotected sex. My new fertility/ob/gyn doctor mentioned to me that if pregnancy or conception isn’t achieved in 2 years, the chances of never achieving pregnancy rises. While some couples may have unexplained answers to infertility, there are a number of factors that could affect fertility. This is where our story unfolds.
My husband and I didn’t know where to start when talking about infertility early 2016 after a few rounds of “trying” with medications in 2015. Every couple responds differently to this topic. For us, this has been a prayerful journey. We didn’t want to force things to happen nor did we want to rush into the fertility clinic. Therefore, we have purposely avoided getting too emotionally involved to the point of desperation. We are rather seeking God’s Will and plans for our lives and therefore, willing to “try” with minimal fertility treatments as possible.
Our decision to move forward with a specialist began in April. This involved a consult, extensive check-ups, and small procedures (one sending me to the ER due to my heart rate and blood pressure plummeting to the 30s!). While lying in Trendelenburg position on the table recovering from a vasovagal response during what I thought was supposed to be a simple procedure, a hysterosalpingogram (HSG), an x-ray procedure to check the patency of my tubes, I said, “I may need to rethink about having kids.” The doctors giggled while I was trying to have some sense of humor to lighten the pain. I had a vasovagal response that plummeted my heart rate and blood pressure requiring IV fluids to bring everything back to my normal. I was emotional when they told me I needed to be evaluated in the ER, questioning this fertility route feeling somewhat guilty as if I was “forcing” things to happen. With spiritual guidance from family and friends, I was reminded that God is the author of all human talent gifting each of us with special skills such as medicine to take care of special cases.
After a couple months of testing, everything was normal and we were cleared to start our first treatment. It was too soon and we were still uneasy about it all. Therefore, we decided to move forward with our first IUI (intrauterine insemination) treatment later in the summer.
The last-minute switch: New doctor new discovery
Days before we were about to start IUI, I heard about a more natural approach to fertility through the science of NaproTechnology using the Creighton Model (CM). In fact, this method can also be used to avoid pregnancy (even during breastfeeding) which is nearly 99% effective (click to view effectiveness of CM). So far, we are very pleased with our new doctor and the bi-weekly follow ups with the nurse using the CM. Regardless of the outcomes, this new journey alone has been very informative for the both of us and intriguing! There is a lot of evidence based research behind it all. For starters, chances of getting pregnant with CM is significantly higher than IUI alone. And, the likelihood of success with using CM and a doctor is about 83%. During my consult with our new fertility/ob/gyn doctor, he suspected endometriosis given my medical history and having polycystic ovaries or PCOS. A very high percentage of women with PCOS also have endometriosis. These are all facts my previous fertility or ob/gyn doctors did not mention.
The cause of endometriosis, PCOS, and sometimes infertility are all unknown leaving doctors and women with many questions. However, studies do show somewhat consistent percentages of women who have PCOS and/or endometriosis also face infertility. When endometriosis is removed inside the uterus, the percentage of achieving pregnancy goes up but it’s not guaranteed. In addition, endometriosis is typically unraveled when infertility comes into play. Here is a website by Mayo Clinic that is easy to read and understand about endometriosis. Please note, all symptoms, treatments, etc. vary from person to person (click here for Mayo Clinic definition).
The result of this new visit left me with 2 options: 1) treat more conservative with another 6 months of trying a different form of medication to help with ovulation or 2) proceed with surgery (the only way to diagnose and excise endometriosis is via laparoscopic surgery). Again, I looked to my husband and questioned the fertility route. I wondered what goes through the minds of women in this situation. Do women actually choose to endure all this just for a small dose of a chance? My husband has been so supportive through all of this and provided me great words of wisdom. Yes, it’s hard for a guy to understand but he has been my voice of reasoning. He was right, this is my health and regardless of the outcomes, at least I’ll feel better.
I slowly accepted the idea of laparoscopic surgery and removing possible endometriosis and set a surgery date. I’ve heard of this term but never really explored the diagnosis or symptoms or even questioned any doctor about this issue. After an ultrasound of the pelvic, I received a phone call to add another step in the surgical procedure. Due to the size of my ovaries and number of follicles on them, he would like to perform a wedge resection (removing a pie shape) of each ovary. Well, good grief…I was just accepting the idea of excising possible endometriosis and now, this sounds a bit much! I’ve had PCOS for as long as I can remember, so I suppose this was another confirmation to move forward. Evidently, it’s a pretty clear picture that I DO have PCOS and now should remove parts of it to make my ovaries more normal (too many follicles and large ovaries can interfere with fertility). Wedge resections have been done for many years but recent studies have shown an increase of pregnancy rates because of the procedure. This isn’t life threatening, but goodness, it’s a lot to absorb.
After an easy breast surgery, I wasn’t sure what to expect before, during, and after this surgery. I was scared about a number of things and one being, not waking up due to my sensitive, vasovagal response. Secondly, I thought I could go back to work on Monday after surgery on a Friday. Two weeks prior, I found out, the doctor ordered 2 weeks off work! Wow, this must be a BIG deal!
They set up this type of surgery hoping to perform it days after a woman’s menstrual cycle starts. Needless to say, I had forgotten about the possibility of starting that week with the pre-op instructions reminding me to avoid Ibuprofen 1 week prior to surgery. Oh why did I forget to prepare?! Three days before surgery, I started cramping in the morning and because I’m so used to popping Ibuprofen I couldn’t prepare well for what was to come.
On my way to a meeting for one of my jobs, I stopped by Walgreens to find extra strength Tylenol and a heating pack for my belly. The pain was bad but tolerable. Minutes after my stop while driving, I felt trouble coming on. The pain was worsening and the onset symptoms of fainting were creeping in. It was rush hour traffic so finding a place to pull over was quite challenging. I finally swerved into an empty lot, jumped out of my car to crawl into the back seat to get my legs elevated. The pain was so unbearable the thought of calling or texting someone or even waiting wasn’t an option and I simply wanted to be alone. After 15-20 minutes, I decided to attempt to turn around and get back home. That wasn’t such a good idea. Traffic was notorious and the short few miles back it took close to an hour! I had to pull into a side street to park and climb into the back seat, again. This time to curl in a ball and pray. I begged God to give me the strength to get home safely. After 15 minutes, I was alert enough to sit in a little bit more traffic and barely made it through the door of our condo before I got sick. Ironically, I had a pre-op appointment a couple hours later and curled up with my heating pad until then.
For a girl who was nervous about general anesthesia and having surgery, this painful episode switched my emotions to being more excited to have this surgery! All this time I thought my pain was related to PCOS, but during my pre-op appointment, my doctor said he would be shocked if he didn’t find endometriosis. At that point, I was hoping and praying he would find it, otherwise, he’d have to problem solve where the pain is coming from. I asked if this was related to PCOS and he said no, but no matter the stage of endometriosis, there can be significant pain whether stage 1 or 4. In fact, some women never know they have endometriosis.
Two days before surgery, my husband fell ill with a virus sending me to sleep on the couch and sanitizing the condo! Neither of us wanted to delay this surgery. The day before surgery was a busy day filled with pre-op blood work, post-op appointment from breast surgery, and last minute work projects. Thankfully, one of my mother-in-laws who is also a nurse flew in that evening. Laparoscopic surgery requires bowel prep, too (YIKES). What I didn’t realize is that CO2 is pumped into the abdomen to expand and make room for the surgeons to see and navigate. In addition, going under general anesthesia meant being intubated and drawing blood in case of need for blood transfusion. My head was spinning.
Surgery morning, I said a prayer. Then my mother-n-law said a prayer before we left (almost the exact words I used in my prayer!). Another one of my gracious friends who lived close by, dropped my mother-n-law and I off at the surgery center. As we entered the whirlwind, busy, factory-like atmosphere, my body, soul, and mind went numb. I suppose I was ready to tackle this. Shortly after check-in, they handed my mother-n-law a pager, a card with my ID to track my progress on the screen and I crawled into the hospital bed with a paper gown. Traffic of nurses were coming in and out of the room with everyone asking me the same questions: what are you having done? What is your name? What is your birthdate? Are you going home? etc. Finally, when the anesthesiologist entered and asked me “are you going home today or staying overnight?” I responded, “well now I don’t know, I’m supposed to go home but am I?” He laughed and said it was protocol to ask questions several times. My doctor came into the room to review the multiple parts of the procedure again and begging me to take it easy after surgery and no working out. He also said a prayer with us which gave me quite some comfort. My husband arrived shortly before I was wheeled off. I remember seeing him at my right side, and he warned me the drug is going to make me feel funny. I said, “oooh, I feel so tipsy.” I was so happy he got there in time…his face and contagious laugh was the last thing I remember as I dozed off into a deep sleep.
Stay tuned for the continuation of this series…
Quote of the day: You gain strength, courage, and confidence by every experience in which you really stop to look fear in the face. ~ Eleanor Roosevelt
Bible verse of the day: Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God. And the peace of God, which transcends all understanding, will guard your hearts and your minds in Christ Jesus.
~ Philippians 4:6-7
(a special and perfect verse sent to me by my mother the morning of surgery)
*A special thank you to my mother who also works 2+ jobs and squeezed in time to edit my post.