Challenges of Fertility and how to overcome to achieve parenthood-Part 6

So we still hadn't conceived using Clomid or Femara. The doctor recommended IUI with injectables. We did three rounds of IUI with injectables and still no success. The first round was unsuccessful because the dosage was too low, the second round resulted in hypersimulation and resulted in cancellation of IUI. The third round of IUI was performed hastily because my hormone measurements jumped rapidly to our doctor's surprise. This is when endometriosis was suspected and hence we were recommended laparascopic surgery.

Laparoscopy is the most common procedure used to diagnose and remove mild to moderate endometriosis.

[Endometriosis is a condition where tissue similar to the lining of the uterus (the endometrial stroma and glands, which should only be located inside the uterus) is found elsewhere in the body. Tissue and blood that is shed into the body can cause inflammation, scar tissue, and pain. As the misplaced tissue grows, it can cover or grow into the ovaries and block the fallopian tubes. This can make it hard for women with endometriosis to get pregnant. The growths can also cause problems in the intestines and bladder. Another result of endometriosis is the ormation of ovarian cysts called endometrioma that may also interfere
with ovulation. It is estimated that 30-40% of women with endometriosis may not be able to have children as easily as women in general. ]

If your doctor recommends a laparoscopy, it will be to:

View the internal organs to look for signs of endometriosis and other possible problems like large uterine fibroids, ovarian cysts, scar tissue, hydrosalpinges and other abnormalities in the uterus like septate uterus etc. An exhaustive evaluation of the pelvis and abdomen is then performed. If ovarian cysts are present, the cyst wall is removed in its entirety thereby lowering the chance that it will ever recur. All endometriotic implants are identified and completely destroyed either through the use of electricity (bipolar current), or a carbon dioxide laser,
or by surgical excision. The appendix and upper abdomen are also evaluated. In cases of more extensive laparoscopic surgery, it is not uncommon that three small incisions are made just above the pubic hairline. Dissolving stitches are used to close the incisions.

For a laparoscopy, the abdomen is inflated with gas (carbon dioxide or nitrous oxide). The gas, which is injected with a needle, pushes the abdominal wall away from the organs so that the surgeon can see them clearly. The surgeon then inserts a laparoscope through a small incision and examines the internal organs. Additional incisions may be used to insert instruments to move internal organs and structures for better viewing. The procedure usually takes one to four hours.

It is usually performed as an outpatient procedure and the patient is discharged the same day with oral painkillers prescribed for 4-7 days. Expect some degree of shoulder pain following a laparoscopy because of the carbon dioxide gas that they use to visualize the internal pelvis.
It can be a sharp shooting pain that comes and goes on it's own.

Laparoscopy is as much an art as it is science. It not only involves deft maneuvering of the probe and instruments, but also judgement and skill in deciding what to look for and what to correct surgically. The key issue here is to choose a doctor who has a lot of experience with performing these procedures. The doctor who performed my surgery had done over 5000 ( yes - five thousand!) laparoscopic surgeries alone apart from other procedures, and he performs this procedure atleast several times a week over the past two decades.

In my case, the following three issues were discovered:

a. Severe endometriosis around the ovaries and surrounding tissue.

b. Closed fallopian tubes (FYI; even though my HSG report showed them as open, the doctor found during laparoscopy that they were almost closed and could have been a factor in infertility. Therefore he opened them and put a cuff around the ends so they stay open.)

c. Septate Uterus (Again, the HSG X-Ray showed a normal uterus, however my doctor found that anatomically it was a septate uterus, and since he was already in the middle of the procedure, he decided to take the initiative and reshape the uterus to resemble a more normal form. In my case, this might have been a crucial factor of the success of not just the IVF, but in carrying the twins to full term).

Though the doctors say that normal activities can be resumed within a week, the key is to be cautious and get plenty of rest. I resumed driving and normal activities in two weeks. Avoid gas inducing foods, and drink plenty of fluids.

Overall, pregnancy rates are highest in the 6 to 18 months after surgery.

Even though laparoscopy might cause a 3-4 month delay in embarking on your treatment again, it is a very prudent thing to do before you start IVF because it gives a much greater chance of success. If your doctor wants to do IVF without a laparoscopy take it as a warning sign, because this procedure will discover issues that cannot be viewed through a HSG, hysteroscopy or an ultrasound.

Next comes my experience with the biggest advance in fertility treatment - In vitro fertilization (IVF).

 

Dear Malar,

The doctor decides that the dosage is low by the blood work done every day from 9th day to the day of ovulation. I had both blood work and Ultrasound done everyday from day 9 to day 15/day 17.

Getting AF soon could be an issue ( Luteal Phase Defect). I was on oral progesterone supplements and the doctor suspected that the progesterone is not absorbed well orally. Therefore my doctor had me take Progesterone in Oil injections. Also, does your doctor do a blood work 7 days after Ovulation to check your progesterone levels? This test can determine if you have enough progesterone to sustain the endometrial lining.

Let me know if you have more questions.

Good luck!
Vidya