Hysteroscopy
by T

Why Would You be Doing a Hysteroscopy?

Hysteroscopy, when your cervix is dilated and a small set of surgical tools is inserted into the uterus, is usually recommended when your doctor has noticed something strange during an HSG or saline sonogram. Sometimes both these tests are normal, but other issues (pregnancy loss, bleeding, IVF failure) may indicate hysteroscopy. Hysteroscopy allows your doctor to envision the uterine lining using fiber optics, after pumping the womb full of sterile air or fluid. She can then easily detect any irregularities. Septums, uterine polyps (benign overgrowths of the lining), and some fibroids can be carefully removed. Hysteroscopy is considered the gold-standard treatment for growths like polyps, which are too often missed during blind D & Cs.

What You Can Expect

Depending on where the procedure falls in your cycle and why it’s being done, you may be prescribed birth control pills to keep your lining thin and make it easier for your doctor to figure out what’s going on. I was able to schedule mine for early enough in my cycle to avoid this.

Most hysteroscopies are performed as outpatient surgeries under general anesthesia. This means you will need someone to take you to and from the surgery, and you will have to fast. Make sure you understand exactly what’s expected by the particular surgical center, as they often have varying protocols.

If, like me, you are scheduled for an afternoon slot, chug as much water as you can right up to the midnight cut off. Also, it’s good to avoid any anesthesia-related regularity issues by taking a stool softener and/or eating ample fiber in advance. The cramping post-procedure can make constipation a real downer, to put it mildly.

Once you’ve arrived at the surgical center, you’ll have an IV started and may be given a pregnancy test. After your doctor and anesthesiologist have spoken to you briefly to review what’s about to happen, you’ll be taken into the operating room. A few seconds after the anesthesiologist administered a drug into my IV, I was out like Rip van Winkle. Depending on the timing, your doctor might speak with you or your companion about the results of the procedure. In my case, my husband got the report, as I was still down for the count. If you think you’ll have questions that your companion won’t think to ask, write them down.

Though hysteroscopies do not involve any incisions, the dilation and activity in the uterus do lead to unpleasant cramping, pain, and bleeding. I was given naproxen (Aleve) to take for the cramping, as well as hydrocodone for pain. Even if you think you won’t need them, fill these prescriptions ahead of time if possible. The cramping may not start right away, but it will come and you’ll welcome the relief.

Though you’ll likely get a pad from the center to deal with the bleeding, I brought along my favorite kind, just for comfort’s sake. You may also want to wear comfy clothing like a loose dress or sweats and take a cardigan, hoodie, or other cozy wrap to keep you warm before and after surgery. Bring your favorite pillow to keep the pressure of the seat belt off your belly for the ride home, and snacks for the trip home like juice, yogurt, and water. Stock up beforehand on some tasty, nourishing, fairly bland and soft comfort foods for the evening after surgery. Some gals even suggest throwing a little get together, though I personally was content to sprawl on my pillows and watch DVDs.

After a few days, you’ll likely be feeling pretty good, if not completely back to normal. If you can manage it, take it easy the day of and the day after the procedure. Get some good books, good movies, treats, and take really good care of yourself. You may have some spotting or bleeding for a few days afterward.

Ask your doctor before you go under about post-op follow up, signs that you need additional medical assistance, and how long you should avoid tampons, sex, and any other cervical annoyances. Though I can’t recall getting specific instructions, some online research showed that two to three weeks of pelvic rest was best. Anything removed from your lining will likely be sent to a pathologist for testing, though malignant growths are extremely rare in pre-menopausal women. Though some women have mentioned that they’ve had unusual periods following the procedure, I only noticed that mine was a little later and lighter than usual.

Personal Tips

We discovered that I had polyps thanks to a saline sonogram, after a normal HSG. Polyps were suspected in my case because of luteal phase spotting. If you have persistent, regular spotting but a normal HSG, get a saline sonogram just in case. It may give you additional information, and it’s basically painless compared to the HSG.

I combined my hysteroscopy with a laparoscopy, an increasingly common diagnostic combo in infertility. This two-birds-one-stone approach seemed to work very well: I was already out cold, and my doctor could give us the full picture of my pelvic and uterine health, thus increasing my peace of mind. In the end, three small benign polyps were removed, and two spots of endometriosis blasted with a laser. The entire procedure took less than an hour, all told.

With the addition of the lap, I had more pain than you normally would with hysteroscopy alone, due to the incisions and the gas used to inflate the abdomen.

Rest is the most important part of recovery. I slept and lounged my way through two days, when I started to feel much better and no longer needed the pain medications. Any friends or family willing to contribute meals and keep you resting should be heartily encouraged. The more you sleep now, the better you’ll feel in the long run.

Written by Carolyn

Why Would You Be Doing Acupuncture?

In general terms, the purpose of acupuncture is to reconnect the flow of chi through the meridians of the body. When part of the body becomes blocked, chi builds up and is unable to flow to other areas of the body. The needles used in acupuncture can help unblock these chi stoppages and reconnect the flow of energy all over the body. Acupuncture has been practiced in Asia for over 2,000 years and is practiced all over the world today to help treat a variety of medical conditions including infertility.

Specifically, acupuncture is believed to help stimulate blood flow to the reproductive organs (in women and men) and aid in balancing hormone levels. Thus, acupuncture is more helpful for patients with functional fertility problems (such as hormone imbalances) than structural problems (such as blocked fallopian tubes). Regardless, acupuncture can also help as a relaxation aid, especially when a patient is going through a stressful medical procedure such as IVF.

Acupuncture can be done in conjunction with other infertility treatments or alone, and is frequently accompanied by herbal treatments prescribed by the acupuncturist.

What You Can Expect

**This is my experience with one acupuncturist. I didn’t have many appointments, and I’m sure that other acupuncturists will do slightly different things than mine did. I don’t have experience using Chinese herbs, which many acupuncturists instruct their patients to take. Nonetheless, I hope this and any comments that follow will give you a reasonably good idea of what to expect when doing acupuncture to help with fertility.**

Your first acupuncture appointment should be on the longer side—mine was around 90 minutes. The first 20-30 minutes were spent filling out a medical history form and talking with my acupuncturist about what I wanted to achieve during our sessions. After that, the acupuncture itself lasted 45-60 minutes. Later sessions should also be around an hour.
Your acupuncturist will ask you to remove your pants/skirt and possibly your top. If you’re uncomfortable removing your shirt, I suggest wearing a loose tank top or cap-sleeved blouse. Comfort is essential—the chi can’t flow if you’re too tense. Ask for a blanket or sheet if you’re cold.

If you’re squeamish about needles, close your eyes as the acupuncturist puts them in. Each needle is sterile and for single-use only. Some you may not even feel, others can be uncomfortable for a minute or two. Try to relax. Your acupuncturist should tell you where he/she is inserting the needles and what each is intended to do. Each needle is tiny and very, very thin. These aren’t like the needles you use to do an injection!

Depending on your body and energy, the needles may hurt, tingle, or give you a “swirling” sensation at the insertion site. If they hurt, make sure the acupuncturist knows, so he/she can reposition the needle more comfortably. I typically had one needle in my forehead, one in each arm, two on each hand, one or two in my belly, and several on my legs and feet.

After the needles are inserted, the acupuncturist typically puts on some soothing music and leaves the room for 15-20 minutes. This is a good time to focus on your mantra or some inspirational quote/imagery that will help you to relax and focus on your chi. I found that doing a body scan was very helpful in determining where I still had chi blockages and where the needles were really working.

The acupuncturist should come in again and shift the position of the needles to “stir” the chi before leaving you alone for another 15 minutes. Again, try to meditate or use your mantra/imagery. After 15 minutes are up, the acupuncturist will remove the needles and talk to you for a minute about how you’re feeling. Get up as slowly as you need—I was usually a little dizzy after a session and needed a minute to re-orient myself.

Reactions to acupuncture really vary depending on the person. I found that immediately my periods became heavier and shorter. I was also more energized and focused in the days after a session and was more relaxed during medical procedures.

Here Are Some Problems That Might Arise

Quite a few doctors still don’t believe that acupuncture is a valid way to assist in treating infertility. You may encounter resistance from your RE, but it’s important to tell all of your doctors that you’re doing acupuncture. Some acupuncturists also prescribe Chinese herbs to assist in conception. Mine didn’t, but I would strongly advise you to research these herbs on your own and speak with your physician before taking them.

On a random note, blood banks treat acupuncture the same way they treat tattoos and piercings. If you’ve had a session in the last 12 months, you can’t donate blood. This isn’t a problem for most people, but something I discovered when I went to donate blood a few months after my last acupuncture appointment. Some blood banks will allow acupuncture patients to donate blood if the acupuncture has been performed by a licensed doctor.

Personal Tips

Ask questions, ask questions, ask questions! Finding the right acupuncturist is the most important step. Get referrals from anyone you know who has used acupuncture for fertility. Search Internet message boards if you don’t personally know anyone who has done it. Finding an acupuncturist is easy, but finding one who specializes in helping infertile patients conceive can be difficult. Do your homework. Once you’ve found an acupuncturist, “interview” them during your first appointment. Make sure that your personalities click. This is a person you’re trusting with your reproductive health, so make sure that you trust them as much as you trust your doctor. Like your doctor, your acupuncturist should know all medications you’re taking, medical procedures you’re undergoing, and have emergency contact information for you in case something unexpected happens.

Operation Heads Up is series of write ups about common procedures, medications, tests, and diagnoses associated with infertility. These entries were written by those who have been on the receiving end of the needle or catheter–they are not doctors, just fellow stirrup queens or sperm palace jesters like you. These write ups are meant to give you a heads up before your own experience and provide tips that have worked for other stirrup queens or sperm palace jesters before you. The information should never be used in lieu of medical advice from a doctor.

DIAGNOSES
1. Diagnosis: Anovulation
2. Diagnosis: Endometriosis
3. Diagnosis: Infertility Caused By Scar Tissue
4. Diagnosis: Luteal Phase Defect or Low Progesterone
5. Diagnosis: Male Factor Infertility
6. Diagnosis: Unexplained Infertility
7. Diagnosis: Uterine Anomalies
8. Diagnosis: PCOS

9. Hormone Level Chart (off-blog link)

TESTS OR SURGERY
10. Endometrial Biopsy
11. HSG (Hysterosalpingogram)
12. Hysteroscopy
13. Laparoscopic Surgery (for Endometriosis)
14. Postcoital Exam
15. Semen Analysis
16. Sonohystogram
17. Varicocelectomy

MEDICATIONS
18. Clomid
19. IM Injections
20. Metformin (Glucophage)
21. Progesterone Supplements (oral and vaginal)
22. Sub-Cue Injections

HOW TO VIDEOS FOR INJECTIONS (all videos are off-site)
23. Medications for IVF
24. Videos Galore–IVF Shoot ‘Em Up
25. Ganirelix Injections
26. Gonal-F Injections
27. Menopur Injections 1
27. Menopur Injections 2
27. Menopur Injections 3
28. PIO Injections

TREATMENTS AND COMPLICATIONS
29. IUI (Natural or Medicated)
30. IVF (Fresh Cycle)
31. IVF (FET or Frozen Embryo Transfer)
32. OHSS

THIRD PARTY REPRODUCTION
33. Choosing an Egg Donor
34. Choosing a Sperm Donor
35. Egg Donor Agency List (off-blog link)
36. Gestational Surrogacy
37. How to Tell Children About Third Party Reproduction

ADOPTION
38. International Adoption: China
39. International Adoption: Guatemala
40. Questions for Choosing an Adoption Agency

PREGNANCY LOSS
41. D&C or D&E After a Pregnancy Loss
42. Natural Miscarriage
43. Medical Management of Miscarriage (using medication to control a miscarriage)
44. Testing for Recurrent Pregnancy Loss

MISCELLANEOUS
45. Acupuncture for Fertility
46. Basal Body Temperature (BBT) and Charting
47. Infertility Counseling (Therapy)
48. Ovulation Predictor Kits (OPK)
49. Prenatal Screening and Diagnostic Testing

50. Beta Chart (off-blog link)

LISTS OF QUESTIONS, BLOGGING ABBREVIATIONS, AND SPREADSHEETS
51. Questions When Choosing a Reproductive Endocrinologist (RE)
52. Questions for a High-Risk OB (Maternal Fetal Medicine or MFM/high-risk OB)
53. Treatment Spreadsheet
54. Common Blogging Abbreviations (for the IF/pg loss/adoption community)

Please come back and add your own experience in the comments section for an entry after you have tried the medication or completed the procedure.

If you see a topic missing, propose a new write up.

Each entry follows the same format:

1. Why you would be doing the procedure, taking the medication, or having the test (the reason and common uses).

2. What you can expect (for example, the ins and outs of the procedure or how to give the injection).

3. Problems that may arise and ways to troubleshoot.

4. Personal tips.

If there is a write up missing from the list that you can complete, please email me at thetowncriers@gmail.com. We’re always looking to add information to the list.

If you still have questions after reading an entry, check the Peer Infertility Counselor List and write the person in the proper category directly. Make sure you mention the Peer Infertility Counselor List in the subject line of your email.

You can also search for stories similar to your own through the blogroll.

So…now that the blogroll is growing and growing (keep sending in those links to your blogs!) it’s on to the next part of the Infertility Crusade…

Operation Heads Up.

So, my idea is that this blog–in addition to addressing the emotional side of infertility AND figuring out the things that are helpful/hurtful to the community (a tour book to the Land of If)–could be a friend’s guide to infertility. Not the whole sterile, medical, look-at-my-shiny-speculum side, but the this-is-how-I-got-through-it side.

I received more information about IF from the bulletin boards and chat rooms than I ever did from my OB. And my RE was fantastic when explaining things, but he never told me how to make the injection as painless as possible. He just showed me how to do the injections (without having gone through them himself–so he couldn’t give me insider information). The bulletin boards was where I turned before a procedure or before I tried a new medication.

But then there were the times when I realized I had a question five minutes before I was due to give an injection. And I wished there was one place where the advice was written in an easy-to-read form. Where I didn’t have to wade through a google search. Enter Operation Heads Up.

I want to compile a list of the most common procedures, treatments, and medications and give tips and a “heads up” from veterans to newbies. I’ve already written one as an example–how to give sub-cue injections. The post is below. I will then add a link on the side bar so that people can easily click and find this information in the future. But the best part–since it’s a blog, people can add their feedback. Sort of like the Epicurious of Infertility, where people are talking about their own experience with the procedure instead of commenting on a recipe for Tandoori chicken. So a person can read the original write-up as well as all the comments and be prepared for anything IF throws their way.

Just some comments on my write-up: there are four categories. (1) Why would you be doing… (fill in the blank). (2) What you can expect (either the details of the procedure or how to do something). (3) Problems that might arise and ways to troubleshoot (this section may be blank in some cases). (4) My personal tips (this section was redundant for me because I added my personal tips into section two, but in other cases, you may list things you brought with you to a treatment or things you’re happy you asked for in advance–like a sonogram picture). Obviously, with some topics, the categories may need to be tweaked.

I’ve been compiling a list, but it’s hardly even scratched the surface of A.R.T., surgery, or drugs.

Basal Body Temperature (how to take it)
IM injections
HSG
IUI
IVF (transfer/retrieval)
Hysteroscopy
Laparotomy
Semen analysis
Post-coital exam
D & C
Testicular biopsy
Vasography
Varicocelectomy
Oral (Clomid) and vaginal (Prometrium) medications

What else? Write in with things to add to the list. Should we include common side effects like OHSS? What about things like an ectopic? There are also things that could probably be listed together under one umbrella topic.

Write me directly (thetowncriers@gmail.com) if you want to take a stab at one of these. I’ll coordinate it so that we have one person working on each topic (also feel free to write and suggest a topic AND offer to write it). As they come in, we’ll post it to the list, create a link on the side panel, and people can add their comments.

Ideas? Thoughts? Comments on my own small-mindedness for leaving something important off this starter list?

Why you would be doing a sub-cue injection

There is a wide range of fertility drugs that use subcutaneous (usually abbreviated to sub-cue) injections. These include Gonal F, Follistim, hcG, Lupron, and Antagon. While some people will do unmedicated cycles, more people doing IUI or IVF will use injectible medications.

What you can expect

I always gave myself my injections. I was very squeamish about needles and I came to this decision because (1) I didn’t want to associate my husband with pain and (2) I thought I’d handle it better if I was in control. Know yourself. If you think you would be the best person to give the shot, do it yourself. If you think you’d rather have it out of your hands, pass on the task to someone else. You can have more than one person learn how to give the injection in case your primary person isn’t available on a day when you need a shot. For the sake of clarity, I wrote these instructions as if you are giving yourself the shot. But know that someone else can do all these steps as well.

Get everything together before you begin—maybe ten minutes beforehand. Unless you’re used to giving yourself injections (or having others do it), you don’t want to start preparing things too early or you’ll build a lot of anxiety. In order to do the Stirrup Queens-Giddyup-and-Inject-Yourself method, you’ll need a few alcohol wipes, a sterile gauze pad, an ice cube in a cup, a hot water bottle filled with…hot water, the needles, and a totally mindless half hour of television on tape.

The sub-cue injections I experienced (Follistim and hcG) were both prepared as a powder in one vial with an accompanying vial of sterile water. Mix them according to your doctor’s instructions after swabbing the top of each vial with an alcohol wipe. Take your time. Hold the needle upright and flick it a few times to get the bubbles to rise to the surface. Push them out. Gently (don’t waste any of that expensive medication!).

Pop the tape in the VCR. Why did I tell you that it had to be on the television? Because you need to distract, distract, distract. I always had the bright idea to tape reruns of E.R. Why did I do this? It didn’t distract. It only made me more anxious. Stick to sitcoms, favourite dramas, mindless cartoons.

When the time comes to give yourself the shot, take the ice cube out of the cup and rub it on the area being injected. Rub it for at least one full minute. You really want to numb the area. But don’t do this step until your ready to give yourself the shot. There’s nothing worse than going through freezer burn only to have to do it again and again because you don’t feel prepared for the shot.

When your belly (I always did the shots in my belly) is numb, wipe it off with a final medicated pad. Then take the needle and line it up so it is lightly touching your belly. Pull back your hand at least an inch, look away (distract, distract, distract), and plunge down. You’ll need to glance down and check that the needle is in. Then look away again and slowly depress the plunger. Pull out and immediately cover the site with the gauze pad (there may be a spot of blood). Press the hot water bottle to the site and hold it there for a half hour or so. The heat will help (specifically, the wet heat will help) minimize pain. Follistim is sometimes nicknamed Follisting because it has a burn afterwards. I’m sure there are other comments below giving you a heads-up on the specifics of other drugs.

Watch your television show and relax. You did it. You got through the first shot. Or maybe it’s your second or third shot. Or maybe you return here every time you need to do an injection. That’s okay too. You’re amazing and you’re already a fantastic mother doing so much to bring a baby into the world. Hang in there. The injections are terrible, but they’re worth it if they bring you closer to your family.

Here are some problems that might arise (and ways to troubleshoot)

Sometimes you’ll get bruising. I was never sure what caused the bruises and why they sometimes occurred and sometimes didn’t. There’s not a lot you can do for buising—the body just needs time to heal. You can alternate sides of your belly button each shot and ask your doctor if there are other locations on the body for your sub-cue injections.

Here are my personal tips

Look above—that’s about all I can say about sub-cue shots. Oh, except be really nice to yourself on injection days and get yourself a special treat. Better yet, make someone else get you a special treat—you’re the one enduring the shot!