this isn't directly related to fertility, i suppose, but since i'm providing such helpful medical information on this blog i figured i'd also describe my afternoon getting a cardiac MRI.

it sucked.

i've had one MRI before, for both of my knees a few years ago when i blew them out with too much exercise. (i now maintain a much safer regimen of anti-exercise.) i went to a "stand-up MRI" place for that one, and essentially i dozed off while comfortably propped up in a piece of machinery akin to a heavy-duty plastic recliner. 45 minutes later, it was over. today was not so a) comfortable, b) easy, or c) short.

to refresh your memory, due to my childhood history of funny heart issues, the fertility doc sent me to a cardiologist to make sure that my ticker is all set for both the upcoming surgery and, potentially, pregnancy and childbirth. i had an echocardiogram and an EKG about a month ago, both of which revealed nothing. however, the cardiologist maintains that i have an irregular heartbeat, and since neither of those standard procedures showed any reason for this, he wanted me to have a cardiac MRI to see if we could learn anything more.

turns out that cardiac MRI technology is fairly new -- really only in use in the past five years or so -- and that my cardiologist is some sort of a leader in the field. they are still doing studies on the procedure and its results, which i am now a part of. the cardiologist insisted that he be present for the procedure today, and he was... along with two other doctors, a technician, a nurse, and possibly a couple of other people that i couldn't see because i was inside a huge tube.

so, yeah. the huge tube. it's like you've seen on TV (and like the photo i've included above, from karachidigest.com). you lay down, they push you inside, and they put headphones on you so that the whirring and whooshing and thumping noises that the crazyass giant magnet machine makes don't make you deaf. i expected all of that. what i didn't know was exactly how long it takes to get images of all of the valves of one's heart (since he couldn't isolate which ones might be problematic) and also that i would have an IV that would be shooting contrast dye into my system so that they could see better. oh, i also didn't realize it would be about 40 degrees in the room while i laid there in just a hospital gown for TWO HOURS.

the technician could have been the brother of Top Chef's Mike Isabella. seriously, his voice was identical. and he was a big italian guy from brooklyn who laughed way too loud at his own jokes and bragged about his skills. ("i've been here since the place opened. i know the deal here. these residents... we get a new crop every year." rolls eyes) this was all very comforting to me somehow. he gave me the rundown of the procedure beforehand, and it was he who looked close enough at my file to realize, "oh... 'evaluate ALL valves!' oh, this'll be a long one." i was happy for the heads-up, but he still told me the "long" side was an hour and a half. this was not true.

in the beginning it wasn't that bad. the nurse put the IV in my arm and then they stuck me into the tube. the room had a huge skylight and the tube was open at both the top and bottom, so it wasn't dark and it wasn't too terribly cramped in there. the doctor gave me directions in the headphones: "take a deep breath," "hold your breath," "breathe normally," etc. in between commands i was dozing off... it was such a nice quiet little cave. while i was still comfortable.

then i started losing track of time. it's hard to keep on top of that sort of thing when you're staring at nothing and mindlessly following doctor's orders in between little naps. but eventually i started to get really cold, which eliminated the possibility of napping. i was SO cold that i was shaking, which isn't okay when you're having an MRI. you have to stay super still. staying still was also problematic because i starting losing feeling in my limbs. that began with my right arm, the arm with the IV in it. they warned me when they were injecting the dye through the IV and said my arm would probably feel cold. in fact, i could feel the liquid going into my veins (or at least i imagined i could) and my whole arm started tingling. and yes, got cold. very cold. anyway, by the end i was getting delirious, trying not to cry, and was convinced i'd never be able to move my limbs again. eventually they pulled me out, and i saw the smiling face of a lovely russian nurse who helped me sit up and took out the IV. then she gave me some advice:

nurse: you should drink lots of water to flush out the dye.
me: ok.
nurse: or whatever you like to drink.
me: ok. how long does it take?
nurse: it take 48 hours. just drink a lot. but you drink too much, you'll spit it up. (a pause.) but that's ok, too. just flush it out.

comforting advice.

the doctors and technician -- the many voices i had heard in the background over the headphones -- were gone... they'd all disappeared into an adjacent screening room where they were poring over the many photos of my heart. the nurse said the results would be ready in 3-5 days. i'm not sure what to think about the fact that i had a marathon session, even longer than the longest estimate Top Technician All-Star given me. maybe they found something weird. or maybe they didn't find anything, so they kept taking more pictures to try to find something. who knows.

i felt super light-headed and a bit woozy for awhile afterwards, but i walked home slowly and picked up a smoothie on the way. this was followed by several glasses of wine with dinner, to continue the flushing process. and i feel fine now.

next week i have a pre-surgery appointment for bloodwork and whatnot. and, assuming all is normal, that's the last hurdle before the surgery. i can't wait for it to be over. i have spent far too much time in a hospital these past couple of months.

surgery deets

after a month or so of what feels like almost constant traveling, i am home for the foreseeable future and therefore finally went back to the doctor today to schedule the surgery. at first i was annoyed that i had to physically visit the office just to plan the procedure, but after spending a half hour with the doc and the nurse practitioner going over all the details, i understood why we couldn't just have a short phone chat.

i'm going in on tuesday, may 3, which works out well for a friend's wedding at the end of the month but not so much for my choir performances in early may. ah, well. priorities, i suppose. my mom has offered to fly down to stay and help out around the house, which i thought was overkill when she first offered... but after hearing the details today i think it will be a great help. the hubby is wonderful in many ways, but picking up the slack around the house when i'm incapacitated is not one of those ways.

since i'll be totally knocked out under general anesthesia, there is a lot of preparation. and since they will be making three incisions in my pelvic region AND they won't really know the situation down there until they get inside, it's hard to say how much pain and discomfort i will experience. the doc did tell me that i definitely won't be able to return to work that week after the surgery on tuesday. but hopefully by the following monday i'll be able to be up and around more normally.

about a week prior to the surgery, i'll have to go in for a pre-op check-in to make sure all of my bloodwork and everything is still normal. then two days before the surgery i have to eat an all-carbohydrate diet, eliminating fruits, veggies, proteins, and dairy. the day prior to the procedure i will be on an entirely liquid diet, with nothing at all (even water!) after midnight the night before. i also have a prescription pill to take four times per day the day before the surgery (simethicone) which will help to reduce bloating and gas. fun, fun.

i'll go into the hospital that morning (they'll call me the day before to go over details and tell me exactly what time to arrive) and will get knocked out so i don't have to know about any of the gory details until afterwards. basically, they will make three incisions, each about a centimeter long. one will be in my belly button, where they'll insert the laparascope to peek around in there and see what's going on. then there will be two other incisions somewhere along my pubic bone that will allow them to insert other tools like scissors and lasers and scrapers and who knows what else. they'll scrape out the uterine lining to get rid of the polyp(s) and the "dysynchrony" of its composition, and they'll move my tubes around to see what's going on behind and around them. if they find endometriosis, they'll zap it out as much as they can. then they'll either staple or glue me up.

i will have to hang out in recovery for a couple of hours afterwards to come out of the anesthesia and all, but then i can retire to the couch for some good (and hopefully not too agonizing) relaxing time. i should start thinking about movies and TV shows to watch that week... hmmm...

all in all, i feel ok (if a little nervous) and just want to get this over with. i am so grateful that i work with such supportive and understanding people, and that i will have friends and family here to lend a hand. it really shouldn't be a big deal at all, and hopefully the end result will be worth all of it!

my heart

just hours after arriving home from a whirlwind international trip, i found myself back at the hospital -- this time in the cardiology department. thanks to my doctor's direct call to the cardiologist, i was easily able to schedule the pre-op procedures he wanted me to have done as soon as i arrived home, and they promised he would get the results the following day, which means i can schedule my surgery as soon as possible.

i had an EKG, which i've had done before... no big deal. it takes all of two minutes to print out the wavy lines that somehow indicate how your heart works once they stick the little thingies all over your body to attach the electrical wires to. the EKG looks for abnormal rhythms in the heart. i also had an echocardiogram, which i don't think i've had done before. that one took a bit longer. it's sort of just a sonogram, with the wand and the gel, but you also have to be hooked up to some of the electrical connections like with the EKG. the doctor asked me to do a lot of different breathing activities while she took about 50 different pictures of my heart. i could see it beating on the screen, and there were a lot of colors overlaid that i think indicated the flow of blood. this procedure obviously looks for physical issues with the heart and with the flow of the blood. it took about 20 minutes or so.

after i wandered around barnes & noble for awhile, i went back for my appointment with the cardiologist, to go over the results. (same day results -- i told you i had superstar service!) the doctor said that the two procedures showed that everything seems to be working fine with my heart, and that there's no reason to worry in terms of the surgery. which is good! but... there's still something up with my heart.

the cardiologist seemed more fascinated with the situation than concerned, so i am not worried. basically he just kept saying that my heartbeat has an irregular sound, and nothing in the echo indicated any reasons for that. in fact, he seemed to think i was misdiagnosed as a kid, when the pediatric cardiology department at the world-renowned hospital in my hometown told my parents that the tricuspid valve of my heart was actually a bicuspid, causing an incomplete seal when it closed and leading to an odd heartbeat. he said that the echo showed that all of my valves are normal and that my heart is contracting normally, but there is still a "strange" sound that he can't explain. so he wants me to have a cardiac MRI so that we can learn more. he specifically instructed the scheduling desk to make sure he was able to be present for the procedure, so it seems like he's really interested in my freak heart. i had to call the hospital in my hometown and request my records... from 1987. crazy.

but in any case, it seems like i'm good to go for the surgery. my ovulation monitor did not much enjoy me traveling to another time zone, and it didn't actually give me a reading this cycle. i'm not sure exactly wen i ovulated... for once i wasn't paying attention! but today is day 22, so i expect to get my period sometime in the next five days or so regardless. that means the surgery will be the end of april or beginning of may. yippee. i emailed my choir director today to tell her that i'm not sure i can continue performing with the group this semester, since our concerts are the first two weeks of may. sucks. but what can you do? in the end, i hope it will all be worth it.

and now, what you've all been waiting for: the results

we had our appointment with the fertility doc today to go over the zillion and one results from all of the procedures and tests. and, i have to say, the outcome is probably ideal. i honestly would have been miserable if he'd said, "you're perfect in every way and we have no idea why you're not getting pregnant! just go home and keep trying!" but, obviously, i didn't want to get terrible news about my health. thus, my perfect scenario was realized: there are some things going on that could very likely be impacting our fertility, BUT they should be easy to fix.

we were there for 45 minutes and i still love the doctor so much. he went through every single test result in detail, including each and every blood test that they ran with the huge vat of my blood they collected over three visits. he had looked over everything, including the records sent from my regular doc, and prepared a huge detailed and organized file with multi-colored tabs to document everything. it was very satisfying.

RESULTS
overall, i am in very good health. the results were negative for all of the bad genetic stuff like sickle cell anemia and cystic fibrosis as well as for all of the infections and STDs and whatnot; not only do i not have any of them now, i never have. that was the most interesting thing i learned from the conversation, actually, that your blood is a record of your body throughout your life. it showed that i had chicken pox, and that i have been immunized against hepatitis B, and also that i had parvo (fifths disease) at some point in my life, although neither i nor my parents realized it. fascinating stuff.

but i digress. in addition to being clear of nasty stuff i also had normal results for the hormone tests. my ovaries have lots of healthy eggs and are producing them normally, and my estrogen and testosterone levels and whatever else are rising and falling as they should throughout my cycle. i am also totally normal in most of my other body functions, such as liver, thyroid, etc. my cholesterol was slightly high but nothing terrible (and i didn't fast before the test, so it may not even be accurate). the only thing that came out of the blood tests that is important to note is that i carry two genetic mutations that have to do with blood clotting. for normal, healthy nonchild-bearing folks, this is mostly irrelevant and doesn't impact their lives in any way. for normal, healthy pregnant women, they just need to take medication to make sure they don't develop blood clots. but it may be a bigger deal for me... more to follow.

the other thing that the tests showed was that there is something not quite right with my uterine lining. there are two parts of the lining (endometrium): the glandular lining and the endometrial stroma, which is connective tissue. these two parts have to be formed together in a particular way in order for a fertilized egg to implant and thrive. right now, mine probably won't allow that to happen. the doc said that even if an egg did manage to implant, this condition causes repeated spontaneous abortions. but he also said that scraping out the lining and letting it start from scratch will hopefully fix that, and also remove any polyps that are there. he said the one we saw in the sonogram photo may or may not actually be a polyp, but if it is one it needs to go. so that's something that will need to be done.

the third thing that the doc shared with us is that he's pretty convinced that i have endometriosis, which is a condition in which endometrial-type cells develop in other parts of the body, usually around the ovaries, causing lesions and sometimes scar tissue. these cells respond to hormonal changes as the regular endometrium does, which can wreak havoc with your periods and fertility. if it's bad enough, there's a chance that the tubes can actually become deformed from scar tissue so that the eggs don't ever make it out. the doc said that almost always when he sees a woman under 35 with otherwise normal test results, awful periods (which i have developed over the past couple of years), and a partner with decent sperm counts (which he insists the hubby's are) that endometriosis is the cause of the infertility. once they remove the cells, pregnancy is often very simple.

but in order to do that they have to do a surgical procedure. it's called a laparoscopy, and it consists of inserting a scope through my belly button and something else through the bottom of my pelvic region in order to get a closer look at what's happening down there. this allows them to see around and behind the ovaries and tubes to really be certain that everything is working correctly. while they're in there, they can laser away any endometriosis that they find. they can also, in my case, scrape out the uterine lining. it's like two surgeries for the price of one! aren't i lucky.

but before any of this happens, i have to see a cardiologist. when i was younger, my pediatrician discovered an abnormality in my heart that they kept a very close eye on throughout my teenage years. one of the valves that is supposed to be a tri-cuspid (meaning it has three flaps to let blood through) is only a bi-cuspid. for years they thought this might cause me problems, but eventually they stopped monitoring it because it seemed to be rather harmless. however, in pregnancy when the demands on the body increase tremendously, this could be an issue. add to that the blood test results that showed i may have issues with blood clotting, and we could have a serious problem. the doc insisted that i see a cardiologist before we take any other steps, to make sure that i'm healthy enough to handle a) surgery and b) a possible pregnancy. in fact, he called a reputable one at the hospital and talked to him this afternoon, so all i need to do is call and make an appointment.

NEXT STEPS
so, to recap concisely, here are the issues at hand:
1) blood clotting/possible heart issue
2) uterine lining problem
3) possible endometriosis

the first thing i need to do is see the cardiologist. as soon as he clears me for surgery (assuming he does), i schedule the laparoscopy. the doc wants this to happen in the beginning of my cycle, after my period has stopped but before ovulation -- so i'll need to look at my calendar and figure out how that works. after the surgery (and the 5 days or so he says i'll need to recover) we will hopefully be good to go. as long as the surgery doesn't reveal any bizarro issues with my tubes, the doc said he'd probably advise us to keep trying on our own for a couple months, possibly with the aid of injections that would up my ovulation rate (giving us a better chance of conceiving). if that's still unsuccessful, we'd probably try IUI. but, again, this assumes that my tubes are totally functional.

if the laparoscopy reveals problems with my tubes, in vitro will be our only option. the doc said -- in light of our financial concerns about dropping the $10k this costs and the fact that my insurance only gives us $5k per calendar year toward any fertility assistance procedures -- that we'd be sure to save that whole $5k to put toward in vitro, if that's the case, rather than wasting time with IUI when it won't be useful. but we're hoping it won't come to that. (although my inlaws have already offered to pick up the tab for the $5k our insurance wouldn't cover if that's the only way they'll get a grandchild.)

so for right now, it's the cardiologist and then hopefully the surgery. and then we'll know even more and will be able to plan for the next (and hopefully last) step. the doc is very optimistic. he said his job is made easier by people in our situation. and so i am also optimistic. this is the best i've felt about this matter in months, even though i'm staring down a not-so-fun surgery. if it leads to us finally having a baby, it will be worth far more than that discomfort.

and the best part? there's absolutely nothing i can do until i get back from my trip in two weeks. i can't even wonder or worry right now, really. so i can hop on a plane and leave the stupid ovulation monitor at home (i can't figure out how to deal with the time zone change anyway) and just enjoy life and love and vacation for awhile. won't that be grand?

perspective

while it was hard to pinpoint exactly when it started as i never stopped spotting after the biposy, i definitely have my period. and while i am, of course, disappointed, i am not surprised and also not very bothered by it this cycle. this was our 13th try, i think, though i'm losing count. it's a mere five days until our results appointment, and i'm really looking forward to hopefully hearing something definitive, something to change the course of the past year and my outlook on the future.

and in the meantime, i think i can honestly say that i've developed some perspective on this, finally. there has been so much stuff happening in lives parallel to mine that has made me think about how very lucky i am to be at this point of my life and to have almost everything i ever could have wanted. i know it sounds cliched, but it's really true. in the past year i got my doctorate, bought a house, and landed my dream job (which has, unbelievably, actually continued to be my dream job even after doing it for nearly a year). the hubby and i are happier than we've ever been. and yet, on the periphery of my rosy life, i have friends and acquaintances who can't find jobs, relatives going through divorces, friends fighting cancer, a friend whose mother is dying of cancer, a friend who has had a student die in recent weeks, and a fellow chorus member whose life partner suddenly passed away -- leaving her financially and legally very bad off. i recently learned that a colleague -- one of the people i'm closest to at work -- has been trying to get pregnant on her own for over a year. she's been inseminated 14 times and they can't figure out why it's not working. she's 37 and desperately wants kids so, although she's single, she finally triumphantly decided to go it alone and had every reason to believe it would happen easily... and here she is, shelling out big bucks for hormone meds and procedures every month, to no avail. she's spending her nest egg trying to make a baby and they can't figure out why it's not working and she just doesn't know what to do next.

i'm not going to say "it could be worse;" of course it could be, and that's not the important thing here. the important thing is that i am, in every other facet of my life aside from my un-parenthood, incredibly happy. and i'm not going to sacrifice that for want of this one elusive thing. i do want a baby... so much. so much that it makes me cry both in happiness when i imagine it and in misery when i think it won't ever happen. but no matter what we find out on wednesday, i think we're in good shape to deal with this with perspective. we know what we will and won't pursue in terms of fertility assistance, and any information we get will hopefully help us to make a plan going forward. if there's nothing conclusive, we'll give ourselves a time limit for how much longer we'll try before we switch routes. and that's that. i don't think we're going to let this crush us. i really don't. and while i've claimed that in the past, i am pretty sure now that i actually mean it.

phase 2, part 4

this morning was the last test of the fertility workup: the endometrial biopsy. this is, as it sounds, a procedure that is done in order to examine a sample of the uterine lining for any abnormalities, cancerous cells, etc. i made the hubby come with me for this one, because i knew it would likely be the most uncomfortable part of the process. in actuality, it wasn't as bad as i expected. the cervical biopsies i've had in the past seem worse in my memory... but maybe i've just toughened up. :)

we had a different doctor again for this test, but she was great: an older russian woman with a great bedside manner. she first did a regular ultrasound to, once again, check things out in there and take more photos of my ovaries and whatever else. then she explained the procedure to me very simply: after inserting the speculum, she'd swab me with some betadine, then put in the catheter and use a tube to suck out some of the lining for 15 seconds. she told me those 15 seconds would be the worst part but that was it. i figured i can handle anything for 15 seconds. and it all happened so fast, i didn't even realize the 15 seconds were happening until she told me we were halfway done. she made me keep talking to her, and totally distracted me. excellent technique.

then the nurse took some more blood. you know, as if i have any left in my body after the past couple of weeks. they're going to check the hormone levels again to make sure they've dropped, now that it's a week after ovulation. i asked her to take it from right arm since my left one is still bruised... now i definitely looks like the reason i've missed so much school lately is due to my crack habit.

afterwards i stayed lying down for a few minutes until the cramping subsided. it hasn't been much of anything since then, though she did tell me i'd probably have some spotting for the next day or so, and NO SEX today or tomorrow. then we had to make our appointment for the results discussion with the doctor. we had a moment of panic when we thought we might not be able to schedule it prior to our trip to turkey in two weeks, but finally we were able to get an appointment for the wednesday before we leave, march 9. that still seems like a long time away to me, but by then at least i'll know for sure if i got pregnant this try, and we'll know what's up before our vacation... for better or worse.

then the hubby took me out for a lovely brooklyn diner breakfast, and now i'm spending the rest of this rainy day on the couch, catching up on work, reading, and probably napping. not a bad friday. and there's nothing else for me to think about or do at this point other than try to ignore the two-week wait. today is day 20, so in a week or so i'll either get my period... or not.

phase 2, part 3

if you want to know the secret to making sure that sex-on-demand happens as it needs to, i'll tell you: be sick for a week beforehand (coming off of your period) so your husband is severely deprived. we had no issues last night, other than him refusing to kiss me because i have been feeling so crappy and he didn't want to be exposed to more of my germs than necessary. also yesterday and today were my ovulation days, so we had double the incentive... hopefully i will be feeling well enough for the rest of the weekend to maximize these peak fertility days!

this morning i went in for the post-coital exam, which was the easiest part of this process yet. it was even less involved than a pap smear. all they needed to do was collect some mucus. speculum in, mucus sucked up, and done! for a pop culture reference on the subject, this is where things went wrong for charlotte on "sex and the city." her cervical mucus was attacking trey's sperm. hopefully this is not the case for me.

today's doctor was much more chatty and helpful than tuesday's, so i asked her something that i'd been wondering about about next week's biopsy. on the off-chance that i do get pregnant, would it be safe for them to be poking around in there and removing part of the uterine lining? she said that people ask that question a lot, but that yes, it is safe. she also told me that she had recently read a study that showed that in cases of early pregnancy when a biopsy is done it may actually cause the embryo to form an even stronger bond during implantation. go figure! she said that a lot of women end up getting pregnant during the fertility work-up, which i've heard and read before. who knows exactly why, but it's something to stay optimistic about, i suppose.

after that i went to a lab to have the additional bloodwork done. these were tests that have to be submitted as frozen samples for whatever reason, and the doctor's office doesn't have the technology to do that. i couldn't decipher anything on the form other than figuring out that one of the tests was for lupus. so i'm guessing these are just more of the same hormonal and genetic tests that they were collecting for last week. it was another 10 vials, not terrible.

so that's it until a week from today: the biopsy. that's the last stage of this process other than the results meeting with the doctor. hopefully we won't have to wait too long to schedule that. this has felt like a long process already.