HSG Results: The Plan Is In

Thursday went pretty well, all things considered. Even though the valium script was for the lowest dose, 5mg, it did its job and I felt my edges filed to a decently smooth surface, which is hard when you're naked from the waist down climbing up on a cold hard metal table to have catheters threaded through your cervix and x-rays taken in real time of your uterus being slowly filled with dye. In hopes that your uterus is a similarly smooth surface, devoid of sharp scarry edges.

It hurt, of course it hurt. But our doctor took it slow and deflated the balloon a bit at the end to relieve pressure. The worst part for me is when the catheter goes into my uterus, because it pretty much clamps down and screams: "INTRUDER ALERT! GET OUT OUT OUT!" which I guess is a good reflex to have, as usually little flexible tubes with balloons (which feels vaguely to me like fishing equipment) aren't supposed to be in your uterus. I just hope it's not doing the same thing with all our embryos. The valium helped, and the advil helped, and then after, some percocet helped. I felt pretty fine afterwards, once I was sitting in the car and everything kicked in.

During the test, I saw nice smooth uterus at the bottom. Bryce was actually able to be in there with me, in a little room with a radiation shield and its own screen for viewing my innards. He made the joke, "What, are you afraid I'll become sterile?" which I thought was kinda funny but no one else did. A little infertility humor never hurt anyone (as long as it's an infertile person doing the joking of course). As the dye made its way up to the top of my uterus, the controversial part, things looked less smooth. Not asteroid-surface (when picturing what this would look like, all I could see in my head were scenes from Armageddon), but more like pleasant scalloping, like on country curtains. Which is lovely and decorative when not in your womb. I hoped it was just the gentle dye release causing that effect, but I knew the truth.

Two things: The scar tissue is still there, in some form. That scalloped edge is caused by areas where the dye isn't, because of the surface being all wonky. However, the area was relatively small and it is not where embryos typically implant. They typically implant in the front and back of the uterus, and that's just fine. The second thing...the dye didn't spill over. I only have one tube, so that's to be expected on one side. Somehow I expected that to create more spillage out the other one since there's only one exit point, so it would be like a geyser with the pressure, but that didn't happen. Nothing happened. Which means my left tube is blocked. Hmmmm, what could be blocking the tube? SCAR TISSUE. I don't need no stinking fallopian tubes with IVF, so this is not tragic (although it definitely puts the final nail in the coffin of our supposed "miracle baby when we're not thinking about it" that will happen on our own some romantic evening...how people can still say this to me after everything we've been through is just astonishing). However, it worries me because it's further evidence that scar tissue remains and it's the same as it was before the last hysteroscopy. My doctor half joked, half seriously stated, "Well, we know you can't have a recurrence of an ectopic pregnancy, so that's kind of like a good insurance." Which was funny, but also true, since thanks to my first freakshow IVF ectopic I am more likely to have a second one, but NO MORE since there is a shut and locked door covering that hole. I guess the scar tissue can be somewhat benevolent.

I asked about risks, and with my amount of scarring they are minimal, as long as the embryo implants in the right place. If the embryo implanted at the top it would be problematic anyway, so we are not so worried. I asked about expansion, and was returned with, "Great question. Nope, not a concern. The adhesions are not so severe that they wouldn't easily break up during normal uterine expansion to accommodate a pregnancy." Which is great news, but also sounds just a tad painful, doesn't it?

So on we go. My plan is in, and it makes me a bit nervous with the timing. The timing is pretty awful, actually. On a couple of counts.

One is logistical. The clinic closes its embryology lab for two weeks around the holidays (right around Christmas) for cleaning and further fancy-pants-ing. My cycle, without finagling, lands us right in that period, and there are absolutely NO transfers or retrievals during that time. But, they want to strike while the HSG/hysteroscopy is hot, and before there's a chance abnormalities could a) return or b) worsen. Why, uterus, why do you hate me so? SO, I have a shortened Pill duration. Down to two weeks. Then I call with my period, have a baseline on Day 2 or Day 3, and start the Femara on Day 3 and continue through Day 7. This brings us to Thanksgiving. I start the Follistim on Day 8 (which, according to the anticipated timeline, puts us right ON Thanksgiving), and I can be thankful for injections. The Follistim goes for 8-10 days, which seems crazy to me given that this is not at all for eggs but for good lining, but whatever, I'm not the expert here. Supposedly the Femara limits egg recruitment and then the Follistim takes that handful of eggs and develops them to maturity, while giving me a lovely Goldilocks level of estrogen and a plush, thick, naturally derived (if derived by shots can be considered natural) lining. Then trigger, then a week later, transfer. Which sounds a little squished to me, because I thought we'd be doing transfer ten days later to mimic the timing of a 5-day transfer, but I think I remember something that was said about finagling the timing of the transfer for optimal lining and moving it earlier. The embryos honestly won't know. Maybe my lining will hold nicely for implantation this way. WHO KNOWS.

If you have a calendar out and have been counting, you'll see that this puts monitoring around Thanksgiving, and transfer the week of December 8th. So now count 14 days from December 8th. Or from any day that week. When does our test likely fall? Care to make a guess?

CHRISTMAS.

Which could make for an awesome Christmas, except for the fact that we've had two positives before and a positive test does happy us make, but also brings a level of anxiety... WILL IT DOUBLE APPROPRIATELY? Will everything look great until one day, inexplicably, I START TO BLEED, DURING THE HOLIDAYS? So, while it would be excellent and amazing to have a positive pregnancy test, not to sound ungrateful in advance, but it would come with a fair amount of fear. And a negative test? It's a little tempered by our plan to start adoption as soon as we are done with both FETs we have available to us, but it would still be devastating. Especially at that miracle-baby holiday full of family traditions that we share with...our cats.

Also, family functions and travel plans. We were already planning to be home for Thanksgiving and spending the Friday after Thanksgiving with my family here in Rochester and my sister and her family who come in from Potsdam. So when the nurse asked, "Are you traveling for Thanksgiving?" I could honestly say "No," which was good because she let out an incredibly audible sigh of relief. They were apparently holding their breath, since I will most definitely need to come to Buffalo at some point during the holiday. But, we were making Christmas plans. We had planned to go to Maine for Christmas proper, since we've never spent Christmas up there with Bryce's mom and stepdad, and then on our way home hit our favorite holiday/winter vacation spot, Grafton Vermont, between Christmas and New Years. So, fulfilling family visit time, and also taking our relaxing vacation and NOT right on Christmas because last year that made us a little sad. It would be a shorter stay, but special nonetheless.

Now the question is, can we do it? If my test falls before Christmas, we could drive up after and just wait for the results in the car (man that sounds like a crappy way to spend the drive). BUT, if it's positive... how do I get my subsequent beta draws? Do I find a place in Maine to do it and have them send the results to Buffalo? Do I do the same in Vermont (good luck on that one, since there is very little actually near Grafton, which is part of the appeal for us)? Are our travel plans shot?

Some anxiety is hanging over us. Things like, what if it takes me longer to stim, like it seems always to do? Will we miss our window for transfer? Will we be in any shape to see anyone at Christmastime after this experience, for good or for sad? Will it make for the best Christmas ever, or will it effectively RUIN THE HOLIDAY SEASON?

Tricky tricky. I guess the main thing I should be thinking is that I'm just grateful that our journey didn't end on the X-ray table on Thursday, that we are ok to proceed, just not with optimal conditions. But not cycle-ending conditions, either. I should be grateful that we have this opportunity, that we have another set of two blasts to transfer. Bryce thinks maybe our doctor is trying to give us a baby for Christmas, and while that's an interesting theory I don't think it's true. I actually kind of hope it's not true, because I would like my medical team to be logical and thinking of the best possible way to get us pregnant, not doing crazy calculations to do it for a holiday (which is something I would totally do). I am happy that we have the go ahead, but I am also strangely sad. Or maybe not-so-strangely sad. We feel close to the end, and the sense of hope and wonder that used to overwhelmingly accompany a new cycle is being eclipsed by fear and anxiety and a sense of impending disaster. I will do a better job of feeling more positive once we're in it, but right now, looking at my calendar and counting out days, all I feel is an overwhelming weight hanging over me, a sense of "oh dear, now we have to drive out to Buffalo in potential snowy/windy conditions and what happens if they close the Thruway?" Because that happens, with more regularity than you'd think. It's a tundra in some spots between Rochester and Buffalo. There's white-out conditions. In addition to purchasing more fish oil and Vitamin E, I will need to be sure to have a deluxe emergency kit for my car. We may need to think about watching the weather and staying overnight to try to avoid snow issues possibly. This is all planning way out in advance, but that's kind of what we do. Or what I do. Let the obsessing begin.

Slowly I will make the transition from dread to hope, from a sense of fear of what-could-go-wrong to a sense of hope of what-could-go-right. And I so hope for things to go right, for this new protocol to work, for my ticket off this hellish ride. Because here we go, again, for better or for worse. Or for better. Let's hope better this time. Tenth time's the charm, we hope.