HSG (Hysterosalpingogram)
by Carolyn (otherwise known as the Heads Up Queen–not to be confused with the Heads Off Queen from Alice in Wonderland)

Why Would You be Having an HSG?

The HSG is one of the first diagnostic tests an RE runs when you’re having trouble conceiving. It is usually given shortly after the first infertility appointment, no later than CD 12 of your latest cycle.

Common problems that can be diagnosed with an HSG include: blocked fallopian tubes, uterine polyps, fibroids, and uterine defects such as a septum or a bicornate uterus.

What You Can Expect

The HSG is performed in the radiology department and is usually administered by a radiologist and an RE. You’ll lie down on the table underneath an x-ray machine, and the RE will insert a speculum as if you were having a PAP smear. The RE will then insert a catheter into your cervix and inject a clear dye into your uterus. For most women, this is the most uncomfortable part of the procedure. To me, the dye felt like sharp, strong menstrual cramps that lasted for a little over a minute. After that, I felt no pain at all.

While the RE is injecting the dye, the radiologist will take pictures of your uterus and tubes. Most of the time you should be able to see what’s happening on a screen somewhere in the room. You’ll be able to see the shape of your uterus, and if your tubes are clear you should be able to see each tube and then the dye as it spills out into your abdominal cavity.

If your tubes aren’t clear, the procedure may be more painful since the dye can’t spill out. The RE may try to force a closed tube open by injecting more dye, and this sometimes works.
After the test is over, you’ll be able to get dressed again and may go over your test results with the RE immediately. If not, your RE should schedule an appointment with you fairly soon to discuss the results. If your appointment isn’t for several days, try to get at least a preliminary report from the RE or radiologist while you’re still in the room.

Make sure to bring your own pad to the hospital or clinic because the dye is very messy and will be leaking out of you for several days. Dye that remains in the abdominal cavity is absorbed into the body. You may also experience some spotting after the procedure, but not heavier than a period.

There is some evidence that suggests that there is an uptick in fertility for the three cycles after the HSG.

Problems That Might Arise

Pain is the most common problem associated with the HSG. Some women experience only mild discomfort, while others experience severe pain. If you have a tight cervix the insertion of the catheter will be very uncomfortable. Occasionally, if you are experiencing severe pain your fallopian tubes may close even though they’re usually open.

If you are allergic to iodine, make sure you tell your RE before the procedure, since the most commonly used oil-based dye contains iodine and can cause an allergic reaction. There is also a water-based dye that can be used if you have an iodine allergy.

There is also a small chance of infection associated with the HSG, so your doctor should place you on antibiotics for several days before and after the procedure. If you feel more pain or experience heavy bleeding after the HSG, contact your doctor immediately.

Personal Tips

Since the HSG is usually the first invasive fertility procedure most women go through when they’re having trouble conceiving, it can be overwhelming and emotional. I did an acupuncture session the morning before my HSG, which was a wonderful way to stay calm and focused during the procedure.

Talk to your doctor before the HSG if you can. Ask them to tell you what they’re doing as they’re doing it, and don’t be afraid to tell them when something hurts. In my experience, REs seem to think that an HSG isn’t a very big deal. It’s a VERY big deal to the woman who is lying on the table, both physically and psychologically. Anything you can do to remind your doctor that this isn’t just “business as usual” for you will help.

Endometrial Biopsy
by Carolyn

Why Would You be Doing an Endometrial Biopsy?

An endometrial biopsy is typically done when (not surprisingly) your doctor suspects you have a problem with your endometrium. Such problems can include endometrial hyperplasia, low estrogen or progesterone, and endometrial cancer. Blood tests are a more common (and less painful) way of detecting progesterone and estrogen problems. Endometrial hyperplasia and cancer are very rare in women under 40. Nonetheless, if you have problems with LP spotting and your progesterone levels are normal, an endometrial biopsy might be a good idea.

What You Can Expect

The biopsy is an outpatient procedure that only takes 10-15 minutes to complete. Before the biopsy you should take something for the pain, since the procedure isn’t performed under sedation. My doctor gave me the option to take 2 Percosets an hour beforehand. Two or three tablets of Motrin is an option if you don’t want to (or can’t) take something stronger.
The first stage of the biopsy is very similar to a normal PAP smear. After you get comfortable in the stirrups, your doctor will insert a speculum. If your cervix isn’t at the right angle, your doctor will need to use a tenaculum to move it into position. This does hurt, because the tenaculum has pincers that grip your cervix and usually cause some bleeding. After that, your doctor will dilate your cervix and insert a Pipelle aspirator, which uses suction to collect the sample. You’ll feel cramping and then a pulling as the aspirator gathers its sample. If you’ve had an HSG, this part of the biopsy will feel very familiar.

After the doctor has collected a large enough sample, he/she will remove the instruments, and you’re done! If the doctor needed to use a tenaculum, they will probably use some silver nitrate to stop the bleeding on your cervix.

Post-biopsy, you may have some cramping and tenderness, and your doctor will probably recommend that you take more pain medication that night. For what it’s worth, I felt absolutely no pain after getting home and didn’t need to take more painkillers. You’ll probably experience some spotting, possibly as heavy as a period. If you start bleeding more than that, or the bleeding lasts longer than a day or two, call your doctor.

Lab results should be available within a week. Before you leave, ask your doctor when you can schedule a follow-up appointment to discuss them.

Problems That Might Arise

The main problems you can encounter when doing an endometrial biopsy are pain and bleeding after the procedure. For the pain, my doctor recommended Motrin, but also gave me two extra Percosets just in case I needed them.

If you experience heavy bleeding (heavier than your period) or the bleeding continues for more than a day or two, call your doctor. It’s unusual, but it does happen. Also, try to refrain from any strenuous physical activity for a few days after the procedure. See below for my personal story about why this is a good idea.

Personal Tips

Anything you can do to relax while you’re on the table will help make the procedure less uncomfortable. I did deep breathing exercises until after the sample had been collected. DEFINITELY take some kind of pain medication beforehand.

One of the things I really appreciated before the biopsy started was having my doctor explain to me which instruments she would be using and why. She also told me what she was going to do before she used each instrument. If your doctor doesn’t take a minute to walk you through the procedure before starting it, I recommend that you ask them to do so. Relaxing was much easier when I knew what she was doing and why.

Take it easy for a few days after the procedure. You don’t have to go on bedrest or anything, but try to refrain from any strenuous physical activity. I made the mistake of hauling some heavy things up and down stairs the day after my biopsy and spent the following day regretting it from the couch because it felt like someone had kicked me in the gut every time I moved. Be ye not so stupid.

As a final note, if you take Percoset or other narcotic painkiller beforehand, be sure to have someone at the clinic with you to drive you home. Not only can these painkillers impair your ability to operate a car, but they can also make you extremely nauseated. Let’s face it, no one wants to drive when all they really want to do is throw up.

By Royalyne

Why would you be having laparoscopic surgery?

Laparoscopic surgery (often referred to as “lap”) is the only real way to diagnose endometriosis. Your gynecologist or even family doctor may have made an assumptive diagnoses based on your symptoms, but a true diagnoses can only be made when the endometrial adhesions are seen. The description of the surgery (-scopic) suggests that the doctor intends to merely look and see if adhesions are present, but once adhesions are found they are removed during the same procedure. Endometrial adhesions are most frequently found on the ovaries and fallopian tubes, but may be present anywhere in the abdomen. Endometriosis on the ovaries can form cysts, called endometrioma.

What you can expect

You will need somebody with you, whom must remain at the hospital throughout your procedure to drive you home.

Each hospital will have its own standard operating procedures (SOP), I can only write from my experience, using the SOP of my hospital. Your lap will be performed in a hospital by a gynecologist as an outpatient surgery. You will be placed under general anesthesia for the procedure. You will be asked to follow their standard pre-op procedures, such as fasting the night before. Beforehand you will have an IV started and provide a urine sample for a pregnancy test. The doctor will brief you on his/her plan for the surgery and what will be done if adhesions are found. The anesthesiologist will also speak to you about the anesthesia that will be used and the endotracheal tube (the breathing tube they put in). A few minutes prior to being moved to the operating room you will be given a shot of a medication in the category benzodiazepines, most likely midazolam (brand name- Versed). This medication is a relaxant and also an amnesic (reduces your memory of events while on the medication). You may begin to feel drowsy and “stoned,” which is normal for this medication. Once you are in the operating room and transferred to the operating table, additional medications will be administered and once you are completely unconscious a breathing tube will be placed in your throat.

A small incision is made in your abdomen to facilitate the insertion of the laparoscope. There is a camera on the laparoscope that allows the doctor to see your internal organs without making a large incision. Another incision, this one much smaller, is made to allow a tube to be inserted. Sterile air is pushed through this tube into your abdomen. Once your abdomen is inflated, the doctor can see the entire area much easier and access areas that would have otherwise been blocked from view. The doctor will basically look around for anything out of the ordinary. Endometrial lesions and endometrioma will be removed with a laser, but also shifted ovaries can be returned to the correct position and anchored, and likely many other beneficial procedures. The doctor will take many pictures, both before and after shots, for your patient file.

Once the surgery is complete, the air is released and your abdomen deflates. The incisions are sealed externally with glue, probably stitches internally, but for the life of me I can’t remember what they said (that darn Versed). The breathing tube is removed and a medication is administered to slightly reverse the affects of the anesthesia. You will be moved to the recovery area until you become more fully conscious, and then returned to the outpatient area that you started in. The doctor will then come speak to you about the surgery: what was found, what was done to treat it, your prognosis, etc. You will be given a prescription for painkillers, and if you are in pain (anesthesia is very much different from painkillers) you will be given a dose of the medication prescribed. Once you are able to sit up and feel ready to leave, you will be taken by wheelchair to the car.

You will be under restrictions for 2 weeks following your surgery. Abdominal surgery requires cutting abdominal muscles, and the abdomen is your core, it is used when moving almost any part of your body. The restrictions are in your best interests, and in the best interests of your healing body.

Problems that may arise and ways to troubleshoot

You may notice pain or cramping in your neck, shoulders, or upper arms for a few days following surgery. This pain is a result of the trapped air from the inflation of your abdomen. Some air gets trapped and is not released when your abdomen deflates. This air “floats” in your body, moving to the highest part of your body. Lying as flat as possible, or with your legs elevated will disperse this trapped air, spreading it out and not allowing it to concentrate in one area. The air is gradually absorbed into your blood stream and released within a few days. A way to encourage that absorption is a heating pad and/or massage. When the area has a greater blood flow the trapped air is absorbed faster.

As with all surgeries, your incisions are very important. If they become more painful, red, swollen, or begin producing a discharge, see your doctor immediately.

My personal tips

My procedure took an incredibly long time due to the amount of adhesions I had and where they were located (one ovary was ripped from its proper location with an endometrioma, minor adhesions on the bladder, lots of adhesions everywhere), but was not difficult at all. When I was awake, though, I did notice an odd taste in my mouth (from the breathing tube) and my mouth felt incredibly dry. Be sure to have a nice cool bottle of water nearby once you get home (or for the drive if it’ll last longer than 10-15 minutes).

The person who drives you should be somebody you trust enough to have with you when the doctor comes to give you the post-op report. You will likely be very groggy (I don’t remember seeing my doctor afterwards, but I’m told he was around for 10-15 minutes telling my husband about everything). This person should also be taking notes, because you will want every detail and their memory may not be perfect enough for your liking if they don’t write it all down.
The trapped air was my biggest complaint afterwards, and the painkillers I got (darvocet) did nothing for that pain. Apparently the main use of darvocet is for incision pain, of which I had almost none. Needing darvocet was my downfall, but I’m allergic to vicodin (apparently their drug of choice post-surgery). I ended up taking either Tylenol or Advil liquigels for the air bubble pain, whichever was closest to the couch. My husband was nice enough to give me twice-daily shoulder rubs and keep my microwavable heat pad nice and warm for me. The pain lasted 3 days, including the day of surgery, but after the second day it was more like the pain of an overworked muscle.

My main incision was less than an inch long, inside the bottom of my belly button. It felt like a cat scratch, and within a week I didn’t feel anything at all. The second incision was un-located for 2 entire days, as it was located below the pubic hair line and caused absolutely no discomfort. The only time I had any pain in my main incision was during the process of changing positions (i.e. sitting to standing and its inverse, rolling over, etc.).

Don’t wear a belt for a while, especially one with a big, cute buckle. Pressure on that navel incision is not a good idea; it hurts. All of my pants are low-rise, but sitting down or bending over with a belt on pushes the buckle right into that incision.

Restrictions exist for a reason. You use your stomach to wiggle your toes and pick up your head off the pillow, and just about everything else. The 20lb lifting restriction extends to the vacuum cleaner, even if you’re just pushing and pulling it across the carpet. Take advantage of your restrictions, they really are in your best interests. I was back to basically my normal routine about
4-5 days after my surgery, except for strictly following the restrictions. Once my restrictions were lifted I had no problem going back to that routine, including shoveling 2 feet of snow in my driveway. You know your body best, you know how slowly to ease into things once the restrictions are lifted. But don’t rush the restrictions, they were put in place by somebody who has seen your insides, and if you trust them enough to let them cut you open you need to trust their judgment on restrictions as well.

Metformin (or Glucophage) for polycystic ovararian symdrome (PCOS)
by Kelly

Why would you be taking metformin or glucophage (metformin is the generic for glucophage)

Metformin is a diabetes medicine used for lowering insulin and blood sugar levels in women with polycystic ovary syndrome (PCOS). This helps regulate menstrual cycles, start ovulation, and lower the risk of miscarriage in women with PCOS. It is generally used in conjuction with clomid.
The most common side effects of metformin

Nausea.
Loss of appetite.
Diarrhea.
Increased abdominal gas.
A metallic taste.
Tiredness.

Problems that might arise and ways to troubleshoot

I have always had pretty strong side effects (lots of nausea and always very tired) while taking metformin. It does get better as time goes on but working myself up to the maximum dosage has always been hard.

I’ve been to a number of different doctors who have all suggested different ways to work up to my maximum dosage (1500 mg). It is generally suggested that you start with the lowest dose and keep increasing it as you get used to it (or as the side effects start to go away). The first time I took it, I took 500 mg for about three weeks (1 pill in the morning). Then added a second pill at lunch time (so I took 1000 mg for 3 weeks). And, then I added a third pill at dinner time.

The second time that I took metformin, I increased the dosage from 500 mg to 1500 mg over the course of three weeks. I was sick a lot but I feel like I got the worst part over with faster.

My personal experience has been that it usually takes me about 1 month for the side effects to start to lessen. I will still have bouts of nausea, but after about 2 months that starts to happen less often.

My personal tips

Always take with food or a glass of milk – I always take my metformin when I am eating either breakfast, lunch or dinner.
I have heard from others that following a low carb diet helps with the side effects (I personally haven’t found this to be true – or maybe I just couldn’t follow the low carb life).
When increasing your dosage, just increase it as you feel ready.

Amniocentesis
by Edenland

Why Would you be Doing an Amniocentesis?

Amniocentesis is a medical procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus. By about the 16th week of pregnancy, the developing baby is suspended in around 130ml of amniotic fluid, which the baby constantly swallows and excretes. The goal of amniocentesis is to examine a tiny amount of this fluid to obtain information about the baby – including its sex – and to detect physical abnormalities such as Down’s syndrome or spina bifida. Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.

What You Can Expect

I got talked into having a nuchal test, when I was 12 weeks pregnant. I didn’t want to, but the midwife looked up at me and said, “If I were your age, I would do it.” I was thirty-frickin-five, but you’d think I was 90, the way she carried on. So I did it, and the initial scan looked fine. I thought nothing more of it.

I had done IVF/ICSI to get pregnant, due to my husband having a vasectomy after the birth of our first child. This was a long pined for, long awaited for, pregnancy. I had JUST started to get happy about it when the phone rang a few days after my nuchal …..

1 in 173 chance my baby had Downs Syndrome.

My bloodwork alone came back at 1 in 30 chance. I tried to not let it worry me, but it WORRIED ME. I had to wait a few weeks, to do an amnio. I knew I had to do an amnio, because I could not panic like this for the rest of my pregnancy. I was so so petrified of the actual procedure, the needle puncturing the sac. It was wrong. Sometimes, we have TOO many tests available to us. Sometimes, ignorance is bliss.

I took a friend down with me, to hold my hand. She had gone to the same doctor for her amnio a year before. Her baby was in the pram, and gave me hope that all might turn out ok. The doctor had a thick Scottish accent and called me “lass”, in such a tender way that it killed me. The doctor likened doing an amnio procedure to “trying to stab a fish in a bucket with a blunt stick”. I found this disturbing, until I realised he was trying to reassure me that it doesn’t hurt the baby … the needle won’t poke it.

It was awful, but over very quickly. It took two tries, as he had to get enough fluid for the test. Some women I spoke to beforehand didn’t bat an eye about doing an amnio, some had huge concerns, like me. The needlemark in the amniotic sac closes over and heals, we would have definitive results, and all shall be well in the world. I limped around, so scared of miscarrying until about a week afterwards.

I paid a couple of hundred bucks to get the results fast-tracked and the doctor rang me back the next day, telling me that everything was fine with the baby and there were no signs of Down’s Syndrome. As soon as he said this, I realised I had known this all along, but I had gone against my instincts and got a bit bullied into tests and procedures I didn’t really want to do. I was angry for a long time, which was useless really. The baby was fine and that was the most important thing.

I urge anyone to trust their own instincts. It’s hard to say if I would have my nuchal test over again. If anyone is reading this and facing their own decision about whether to have an amnio, only you can decide. It was a great feeling, to know that the baby was fine, but it caused me a lot of angst. If the baby had Down’s syndrome, I would want to know. I might have chosen to not go ahead with the pregnancy, I might not have. I’ll never know.

Personal Tips

Take someone with you during the procedure, as it’s not a good idea to drive afterwards. Talk to other women who have had an amnio. Try to go home and go straight to bed.

All the numbers and odds and statistics can be quite confusing. Remember that you – and your baby, are more than a number. Before the baby was born, my husband got diagnosed with cancer, a mass of extremely aggressive tumours were found in his stomach, courtesy of Non-Hodgkin’s Lymphoma. He had to go through six months of intensive, soul-destroying chemotherapy. He is now in remission. His chances of the cancer coming back is 1 in 4. We think those odds are fantastic.