9: Hydro. . . What?

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The following week I had both the hysterosalpingogram (HSG) and the sonohysterogram (SHG) done. I’ll describe what these tests involve from my own first hand experience.

The goal of both tests is to take a better look at the anatomy of the uterus, fallopian tubes, and ovaries as well as to check for patency of the tubes. The SHG was done in the fertility office by a nurse, or in my case four nurses. I got to be the guinea pig as the experienced nurse showed the new nurses how to do such a procedure. Awesome. Sterile saline is injected from a catheter through the cervix into the uterus while a transvaginal ultrasound is used to image the reproductive organs. Does it hurt? Yes. It felt like the worst menstrual cramp x10. In fact, I had to take a 15 minute breather prior to walking to my car. They tell you to take an ibuprofen prior to the study and I’m sure glad I did.

Two hours later I had the HSG appointment at the hospital I work at. I took some more ibuprofen and waddled in. This test is performed by a radiologist in an X-ray room. This time instead of sterile saline being injected, contrast dye is used. X-rays are taken as the uterine cavity fills with dye, going up through the tubes and spilling into the abdominal cavity. Thankfully, this test wasn’t painful.

With the initial round of testing complete, my husband and I met with Dr. B to go over  what had been found and what to do next. To be completely honest, I had hoped Dr. B might tell us that Matthew had the abnormal results or that he was at least a part of the reason why we were not conceiving. Would I be the only one at fault? Would it be my own body hindering our dream of becoming a family?

I’ve come to realize that this line of reasoning is absolutely wrong. Infertility is no ones fault. No partner is to blame. It is certainly hard not feeling guilty when you’re the one with anatomical or physiological abnormality. You feel as if you are unable to give your spouse something that you are supposed to be able to easily give them. This is something couples have to face whether they have male factor infertility, female factor infertility, or both. It is so important to discuss these feelings and be supportive of one another. I know this first hand. Because while my husband’s results came back normal, mine did not.

First, some of my hormone ratios and pelvic imaging seemed to indicate that I may have a “whiff” of PCOS (polycystic ovarian syndrome). For this, Metformin was prescribed. Metformin is a well known diabetic drug that has been proven to help with PCOS.

In reviewing my SHG and HSG, Dr. B was a little concerned that one of my tubes had a hydrosalpinx. This is essentially a blocked fallopian tube filled with fluid. This can leak back into the uterus and become toxic to a fetus. As no imaging modality is perfect, Dr. B gave me about a 50/50 chance of having a fluid filled tube.

We were given four options:

1. Do nothing
2. Laparoscopy
3. IUI (intrauterine insemination)
4. IVF ( In Vitro Fertilization)

We were ready to move forward with some type of medical intervention, so we crossed off option one. Option two allowed for the doctor to visualize my anatomy with a camera to see if I indeed had a hydrosalpinx. As for options three and four, I felt it would be useless to move on to other interventions if I had a blocked tube that would end up leaking toxic fluid potentially hindering any chance at a successful pregnancy. Dr. B left the room to give Matthew and I a chance to discuss things alone making sure we knew that there was no pressure to decide that day. We both agreed. Laparoscopy would be the next step.

I began to tear up, overwhelmed with the thought of having surgery and all the arrangements that would have to be made with my work schedule.

Dr. B came back in and reviewed every step of the surgery and the risks involved. We discussed what to do if he were to find a hydrosalpinx and agreed that he would remove the tube. I signed on the line and consented. Though I had walked patients through consents many times, it’s a lot different being on the other side of that form.

Though I wanted to feel at peace with my decision, deep down I was nervous. My mind tends to drift to the worst case scenario. What if there was some kind of emergency and they had to perform a total hysterectomy? Or what if my bowel was perforated and I had to have an emergency colostomy? What if I have a major reaction to anesthesia and arrest on the table? This is when I wish that I was not a nurse and am ever so thankful for a level headed husband who does not think the worst and who helped reassure me that we made the right decision.

The surgery was scheduled for several weeks away which gave us plenty of time to continue to pray and feel more secure with our decision.