What's next

Had my post-MRI follow-up today with Dr. S. My husband came along, and met Dr. S. for the first time. Apparently it was “bring our husbands to the RE” day today; every single woman in there had her hubs along.

So we got off to a bad start. Time of appointment: 12:45. Time we actually saw the doctor: 2:20. I appreciate that he spends as much time as you need and doesn’t hustle you out the door, but I left my office at 12:30 and didn’t get back until 3:15, and still hadn’t had lunch.

Dr. S. clearly hadn’t looked at the MRI report beforehand, so we sat there for a couple minutes while he read through it. (It was just a typed up report, no films. I was disappointed; I wanted to see my freaky uterus in all its glory.) Diagnosis of unicornuate uterus is confirmed; no indication of a rudimentary left horn, which is a good thing—a rudimentary horn that contains an endometrium (some don’t) but no outlet to the vagina can build up excess blood and tissue (=painful), for one thing. And I also knew from my Googling that a rudimentary horn also carries the risk of an embryo implanting in there (=bad)—apparently even if the horn isn’t connected to the main uterus, it is possible for sperm to migrate THROUGH THE PELVIC CAVITY to the rudimentary horn side, fertilize an egg on that side, and if there’s a tube, get sucked into the mini-uterus. But I have no rudimentary uterus and no left tube, so that’s fine. Apparently it also appeared that I have a cyst on the left ovary “consistent with endometrioma” (which resulted in Dr. S. explaining to my husband in great detail what endo is, not that he particularly cared to know). But Dr. S. wasn’t too concerned about that—he said it’s very hard to tell exactly what any given cyst-like thing is, even with MRI.

Then he gave us the lowdown on UU. No one knows exactly how common it is, he said—some say 1 in 10,000, some say 1 in 80,000, some say 1 in 500. He explained what it is, and that no one knows right now what causes it (which I knew from Google U.), and told us about all the risks, which I also already knew about—miscarriage, pre-term labor, incompetent cervix, abnormal presentation. He doesn’t think it should have any effect on my ability to get pregnant, only on my ability to stay pregnant. He has had patients with UU before, and none have gone full-term, but some have gone as late as 33 weeks. (Which, yikes. Still pretty scary.) Once I do get pregnant, my OB (who he knows) will want to monitor me very closely and work with a high-risk specialist.

Dr. S. was very adamant that we should avoid my getting pregnant with multiples if at all possible. The risks are bad enough with just one, he said. In fact, he said, if despite our efforts I do end up pregnant with multiples, he would strongly urge that we consider reduction—“of course, that decision would be up to you.”

Because of this, he thought we should continue with a few more Letrozole cycles for now—it’s a good protocol if you don’t want to overstimulate the ovaries, he said. Normally he’d only want to do 3-6 months of Letrozole, but in my case he said it would be worth doing longer if we wanted. (Though hopefully we would only need one cycle, he said, with that bright song-and-dance confidence they must teach during RE fellowships.) Ordinarily the next step after Letrozole or Clomid would be injectibles, but because we want to avoid the chance of multiples, if the Letrozole cycles don’t work he would recommend going straight to IVF, with single embryo transfer.

I asked, what happens if on a given cycle I only develop a follicle on the left side? Dr. S. wasn’t too concerned about that happening—he said that often with UU, there is decreased blood flow to the ovary without a tube, since a lot of the blood vessels supplying the ovary run along the fallopian tube. So chances are I will tend to ovulate more on the right side anyway. Not sure about that one—I will have to do some Googling.

I asked about my husband’s semen analysis, which he had done back in early November but we’d never heard anything about from Dr. S. The report wasn’t even in my file—he had to go out and ask one of the nurses to unearth it from somewhere. Volume, count, and motility all normal. Morphology is so-so, but he said, “We like to see at least 1/3 of the sperm with normal appearance, and you have about that, so it’s fine. A solid B-plus,” he joked.

Finally, I asked about kidney issues—I’d read online that women with UU often have a single kidney or weird kidneys, because the fetal tissue that forms the uterus also forms the kidneys. Dr. S. said, “Oh, I’m glad you mentioned that, I should have told you about that, normally I’m so OCD, but I guess I forgot. I’m glad you’re more OCD than I am today.” Ha ha. He checked the MRI report to see if they had looked at my kidneys—they hadn’t. “Normally they would call me with unicornuate uterus and ask if they should check out the kidneys, and I would say yes, but they didn’t. I should have asked them to do that.” Okay then. So I have to go to another office for a special renal ultrasound to make sure I have both kidneys and to check for horseshoe kidney (both kidneys fused together) or pelvic kidney (uh, one kidney down in the pelvis, which is useful to know about in case I need a c-section).

And that was basically that. I had written out all this other stuff to say about how I was disappointed in how my last cycle had gone, how his office fucked up the MRI precert, but I didn’t say any of it, of course. It’s hard enough having an “I’m disappointed in you” talk with someone you love, let alone your RE. Should I have said something? I don’t know.

My husband and I haven’t really talked about the appointment in depth yet—I had to run back to the office, and he has class tonight. We both need a little time to process it—he especially usually needs a couple days to process things before he can talk about them. The one thing we did talk about as I was walking him to the subway was that he is really uncomfortable with the idea of selective reduction. Born and raised Catholic, 12 years of Catholic school—even though he’s lapsed now, that doesn’t come out easily. Abortion and reduction are still difficult issues for him. I personally have no problem with reduction, but he says he just doesn’t know how we could decide which one to reduce. (I said I thought the decision was probably made based on medical criteria, but…) Anyway, I’m dead set against the idea of having twins—I was always a little apprehensive about the idea, given that I’m very very thin (5’9” and size 2—okay, feel free to hate me) and small-boned, but was resigned to the fact that ART comes with risk of multiples. But knowing what I know now, especially the things Dr.S. didn’t talk about, like the risk of uterine rupture—I just won’t risk it. And if my husband is uncomfortable with the idea of reduction, then we will have to talk to Dr. S. about not taking even the slightest risk that I will get pregnant with multiples, even if that means canceling an IUI if there are multiple follicles.

The other thing I need to contemplate is whether to stick with Dr. S. It’s getting late, so I’ll have to write more later, but as you can see and as I’ve written about already, I’m not totally happy with the organization/communication aspects of my care so far. Part of the reason I’m with this RE in the first place is because he was referred to me by (and is affiliated with the same hospital as) my ob/gyn, who I chose 2.5 years ago (when my previous ob/gyn stopped accepting insurance) primarily because she was affiliated with a hospital best known here in Big City for having a beautiful midwife-friendly birthing center. And my ob/gyn supports deliveries in the birthing center for low-risk pregnancies. I wasn’t wedded to the idea of a natural/low-intervention childbirth, but I liked knowing that the option was there, and that I might be able to have a say in how my birth experience unfolded. Now that I know that any pregnancy I have will be high-risk, and therefore that the birthing-center option is pretty much closed, why even bother staying with this hospital? It’s blocks away from my office, but maybe I’d be better off with the hospital right near my house, which is a Regional NICU center.

Anyway, food for thought. Hubs is home now, got to go be wifely.