Saturday, April 28, 2012

Surgery or no surgery?

This past two weeks have been a bit of a roller coaster with good news and bad news and confusion all around!

Last Tuesday I had my pre-op appointment with Dr. F to sign the consent for surgert and go over the risks etc.  With Dr. M, he tested my tubes last May and it showed they were open, then during the surgery he declared them both closed, but he did not perform another test. Dr. F is not really comfortable taking the word of Dr. M when his reports are conflicting so she ordered another test; a more accurate one than the one I did last May.  It's called a hysterosalpingogram (HSG).

During the HSG, a contrast dye is inserted into my uterus and forced through my tubes while images are recorded on an x-ray. As it turns out, my left fallopian tube is open! But my right is still blocked with nice fat hydro. The image below is NOT mine but it shows kinda what mine looked like.

Figure 2

Notice on the left side that the dye looks like smoke, but on the right it is more solid? That is because on the right the dry is being trapped and contained rather than being released into the abdomen. There was a slight anomalie with mine. At the base of the right one there was a small area that also looked like smoke. This meant that my right tube, while diseased, might possibly be open too. If both tubes are open, then I wouldn't need surgery!

Because the test on my right tube was ambiguous, Dr. F got a second opinion from one of the other RE's at the clinic. They agreed that the tube should be treated as closed because the area of 'smoke' was so small.

What does this mean?

Basically, since I have one open tube, I actually have a chance at a successful Intrauterine Insemination (IUI) which is much much cheaper and less invasive than IVF. If I choose to do IUI, then I don't need to do surgery.

With the blocked tube, there are studies that show IVF is more successfull if the tube is removed. However, there are no studies on IUI and blocked hydro tubes, so she can not say that removing the tube would be beneficial.

If we are going to do IVF, I should have the surgery. But if we would rather do IUI, then I would't need to have the surgery. However, if we try IUI and it doesn't work and we want to persue IVF, I would need to have the tube removed at that point. So, we need to make a decision.

IUI has only a 10-12% chance of success and a 5-10% chance of ectopic (pregnancy in the fallopian tube) whereas IVF has a 60-70% chance of success. And we can only do IUI on the months that I ovulate on the left side since that's the only tube that's open. And those percentages were before I asked her about D's SA results. OF course, he was out walking the dog when I was talking to her so she couldn't give me the numbers, but his count is low so our chances are probably a little lower than 10%. We figure we will likely end up doing IVF eventually, but it's really hard ignore the fact that IUI will cost $350, while IVF will cost $10,000.

I have decided to go ahead and do the surgery on May 9 as planned and we will have to think about whether we want to do an IUI or two before IVF. A successful IUI would be like winning the lottery, and you can't win if you don't play. We are thinking about buying one 'lottery ticket' before going all in with IVF. I keep second guessing that choice though.

Technically we have some time, I'm turning 32 next month and D is the same age. The only thing that puts us into a time crunch is that D is supposed to be on a drug to supress his immune system a little so that he doesn't develop a resistance to Remicade (the drug to treat his Crohn's Disease) but he's not taking it while we TTC. His GI says it's safe, but everything I've read says there is a risk of major birth defects if the male partner is taking it and both RE's that we've had say it's not safe. So he has not been taking it for 2.5 years now and I'm constantly worried that he will build up a resistance to his miracle drug. (You should have seen him before he got on this, he was sooo sick and in sooo much pain all the time I can't watch him go through that because my body is screwed up and can't have babies).

But really, what's another few months for a chance to "win the lottery"?