A trip to the RE

Tomorrow I go for my MRI. You would think I would have had one already to find out if I have two kidneys or not, or to get a better shape of my uterus. My OB/GYN’s office told me my insurance wouldn’t approve an MRI unless I had the ultrasound first.

Remember that my OB/GYN’s response to my ultrasound images was, “Everything looks normal.  Proceed as usual.” She assumed I would get pregnant before we had to meet again. But we’ve had two follow-ups since and still nothing.

So last week I had my first appointment at an RE, at one of the fertility clinics nearby. Having tried some of the holistic services at a competing fertility clinic (which is both a clinic and a mind/body center), I only had an image of clinics as being moneymaking houses reeking of excess.  My OB/GYN recommended the one that I went to, which made me a little trepidatious given her previous judgement of my treatment. But in my hour-long appointment with Mr. Hope I actually felt a little relieved, that maybe I was actually in good, capable, knowledgeable hands.

This place was not as flashy as the other clinic – it certainly didn’t have travertine tile floors, a Keurig, and a fireplace in the waiting area. Instead, it’s a brand new building with modest decorations, comfortable couches, and a no-fragrance policy. Once inside, our vitals were checked and then we met with a physician’s assistant. The main doctor of the practice is booked until mid-April, but because I’m new the nurses made sure I had an appointment with the PA sooner rather than later. She went over our histories and the images of my HSG, and what she told me brought me right back to square one, where I had been in September.

Among my short-term recommendations: to stop using clomid, to get an MRI to make sure I have both kidneys and to get a better picture of the uterus, to get initial bloodwork and a month of monitoring to see how my ovaries function on their own, and then to wait to meet with the doctor. Before we left, Mr. Hope gave 3 vials of blood. I have already been warned I will give much, much more than that.

Haven’t I given enough?

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The diagnosis

“Well, it’s not what we were expecting.  It appears from the HSG that you have what is called a unicornuate uterus.  You see, when we are born all of our organs have already formed and sometimes, very rarely, they don’t form completely.  It’s called a Mullerian anomaly, and it’s a congenital defect, meaning you’re born with it.  The uterus is formed by two cells fusing together to make one large uterine cavity and two fallopian tubes, and two ovaries.  In those people who have a unicornuate uterus, for whatever reason one side isn’t there.  This will make getting pregnant very difficult.  And this is also important for your overall health because sometimes people with Mullerian anomalies are found to only have one kidney.  The kidneys form at the same time as the uterus, we think, so somehow they are connected.  So we need to know a little more information.  We could do an ultrasound, we could do an MRI.  But you should know that getting pregnant, while it’s happened, is not going to be easy for you.”

Thank God I was sitting down.  “Should I keep taking clomid?  I just started my first round two days ago.” It was the only thing I could think to say.

“Yes, for now, let’s proceed as usual until we know more.  There could just be a blockage, but we won’t know until we do more tests.  My office will be in touch with you to schedule those tests.”  With that, she gave a little smile, stood up and exited stage left.

The nurse and the nursing student peeked in at me.  “Are you here with someone?” the nurse asked as they walked me down the hallway.  I shook my head and started to tear up.  “Are you okay?” She was holding my arm and the concern in her voice made me turn and hug her.  I hugged the nursing student, too, and tried to sound coherent through tears.  “Thank you both so much.  You were both so kind and warm.  Thank you.”  I squeezed their hands, then turned and walked away.  I couldn’t say any more.  I didn’t want to ruin their day with my emotions, which had already been wreaking havoc with me thanks to the clomid factor.  But I wanted them to know that it meant the world to me to have their support during this first glimpse of infertility.

I swiftly left the hospital in my sunglasses and my head down, made a bee-line to my car, threw myself into the driver’s seat, and cried.

The exam

September 9, 2011
“Can you shift a little to the left?  We need to get a better look.”

Easier said than done when sandwiched between a flat, cold steel table and an x-ray machine, your legs spread open and your OB/GYN pushing dye into your uterus through a catheter.  I moved, and felt another excruciating pain shoot up my side.  I tightened my fists and drew in short, sharp breaths trying to keep my composure in this cold basement hospital room, with four people staring intently up at a black and white screen.

When they asked me to move again, the doctor and the x-ray technician talking in strange words – “Septate?”  “Maybe unicornuate,” I started to worry.  I stole a glance over my shoulder to the right though the rest of my body was twisted to the left, and saw my spine, my hip bones, and what looked like a dark deflated balloon with air spilling out of it.  There was only one tube but that didn’t register at the time.  They just kept shifting me, and the pain kept waving over me.  Then, in deafening silence, it was over.  My doctor patted my legs and said to get dressed and she’d talk with me in the next room.

The nurse helped me to the bathroom to change, where she had laid out a large sanitary pad, wipes, and towels for me to clean up.  So thoughtful, as had been the warm towels she had laid over my legs when I first got up onto the table.  I changed and sat waiting for my doctor.