Hysteroscopy Friday

Back to regular (albeit private) scheduling, after a hiatus!

When you transfer a chromosomally normal embryo into a woman who has had no problems getting pregnant in the past, and both times result in a categorically Not Pregnant, there are really only two possible explanations: either there’s a problem with the embryos or there’s a problem with the uterus.

It’s possible that the embryos were damaged by the freezing process. However, that is so horrific a scenario I won’t spend much time thinking about it except to say that a) if they are all damaged, we are fucked; and, b) although possible, it’s unlikely; and, c) the clinic has given us a deal where we only have to pay for a bit less than two FETs and we can transfer all remaining embryos (five FETs in all). Plus, if it works the first time they will refund the difference, which means they are assuming all the risk, which I think speaks to their confidence that the next FET will work.

So that leaves my uterus as the thing to focus our attention on. With a history of placenta accreta, placenta previa, a succenturiate lobe, and villitis, the current theory is that I have endometritis (inflammation of the uterine lining). So I’m having a little surgery this Friday. I’ll be having a hysteroscopy (where a camera is inserted into your uterus so the doctor can look at it) and biopsy (to test for endometritis) under general anaesthetic.

The thing about endometritis is that the false negative rate is quite high—it’s possible to have inflammation in one area, but not all of, your uterus—so I will be treated empirically with a two-week course of antibiotics. If the results come back positive, I will continue the antibiotics for as long as my RE deems necessary, and will likely have a follow up biopsy in my Ob/Gyn’s office under light sedation. If the results come back negative, I will stop antibiotics after two weeks and jump right back into a new FET cycle.

The other theory I had is the possibility that, because I have endometriosis, I lack the beta-3 protein which is essential for implantation. However, instead of spending $600 on another biopsy which my insurance definitely won’t cover, we can, again, treat me empirically. The treatment is usually a months-long course of Lupron.

Now, the interesting thing about going on Lupron is that it’s the only medication I took with the cycle that resulted in V but did not take with either FET. So even though I only took Lupron for 12 days, maybe that’s the missing piece of the puzzle.

It might sound weird, but I’m hoping I have endometritis. If the results come back negative, even knowing the false negative rate is high, there’ll be a part of me that will worry that my uterus isn’t the problem. Which sounds great, but then that leaves us with the only other two things I can think of: damaged embryos (in which case, V will be an only child, and that will be another thing to process and grieve) or secondary infertility (is that even possible with my DNA removed from the equation?).

So, even though a positive result would likely delay things even more (sigh, my first FET was back in October), I think it would give me peace of mind to know there’s a definitive issue.

So, that’s where we’re at. With a bit of luck, we’ll do a transfer at the end of April. Onwards!