On Friday I had a much anticipated appointment with Mr E (my consultant at ACU). The appointment was supposed to be in May, but after the awful gynaecology appointment earlier in April I couldn’t stand the anxiety and brought my fertility consult forward.
Since ACU is in the same NHS hospital I go to for gynaecology (I’m a self funding patient at an NHS ACU) Mr E had the pictures from the hysteroscopy and my hospital notes. After we’d exchanged pleasantries he immediately said that the hysteroscopy results concerned him…
The hysteroscopy showed a “healthy” uterus with the exception that the lining is very thin and white, despite my hormone levels being fine and ovulation being regular.
As I expected, the long and short of it is that an embryo can’t implant in the uterus lining if there practically isn’t one. To put it in context (biology time!!) the uterus lining needs to be thick and “juicy” ready for the embryo, so around the middle of your cycle it thickens up and then plumps up a bit more just after ovulation. It gets around 9-11mm thick. At the start of the cycle (just after the old lining is shed via your period) the lining is around 3mm.
On the day of my hysteroscopy (5 days after I’d ovulated) it was around 3mm. At my consultation just after my “period” it was only around 1mm. Seeing this Mr E had to give me the sad news that if things stay as they are there is very little hope for me to become pregnant. Not only that, but he also told me it would be difficult to stay pregnant.
I assumed he meant that there may be early miscarriage (a chemical pregnancy) if the egg gets fertilised but fails to implant properly, or implants but doesn’t get enough “nutrition” from the lining and the embryo stops developing (blighted ovum). He said yes to that, but he also said that:
• risk of miscarriage would stay high throughout the pregnancy
• there would be a high likelihood of having the baby prematurely
• there would be a high chance of the baby being Small for Gestational Age and/or having a low birth weight.
The pregnancy would be very high risk. He actually said that the uterus could get to the point where it “just couldn’t do anymore”.
I WAS DEVASTATED, and totally unprepared for that bleak a diagnosis. I thought he’d say it would be very difficult to get pregnant but I wasn’t expecting to hear that it would be hard to stay pregnant. He even mentioned surrogacy (if the uterus is the problem, use a different one) but he also mentioned that it’s very, very, very expensive [and single people currently can’t do surrogacy in the UK] so probably not an option.
Since the entire process of getting pregnant will be costly (from sperm to actually having the procedure) the doctor said I needed to have a think about what I want to do as he wouldn’t want me to go through with expensive procedures if there’s such a slim likelihood of them working. 😢
We talked some more and he decided to try using hormones to see if my lining would respond. So we’re going to do a monitored cycle (everything except put the sperm in) to see what happens. If that works then we could try a cycle of IUI (insemination) with a “try it and see” approach. But I’d have to bear in mind that the chance of it working is slim… I guess I’d have to try to not get my hopes up too much.
Of course implantation is the 2nd step in getting pregnant, the first step is the egg being fertilised. If IUI fails we wouldn’t know if it was because implantation failed, or if it’s just a case of the egg not getting fertilised (which would obviously have nothing to do with the thin lining). I asked what we could do about that, and he said that maybe we could try one cycle of IVF to know that we have given things the best shot (i.e. put an actual embryo in). He seemed to stress the “one”, I assume as a warning not to get caught up in multiple cycles throwing money down the drain. 😔 He also said that if the hormones don’t work then he’s struggling to think of a Plan B*.
So here we are. I feel so so so sad! And confused about what to do next. On the one hand I think “don’t lose hope, there is still a chance”. On the other hand I think “do I want to put myself through the potential disappointment of cycles of it not working?” (and if I do, how many? how much money am I willing to put into this?). Then, if it does “work” in terms of getting pregnant there’s the pregnancy… Do I want to put myself in the situation where I get pregnant but miscarry (possibly multiple times)? And would I be able to enjoy my pregnancy if I know there’s a high chance of miscarriage throughout? Surely I’d be stressed and anxious the whole time, which wouldn’t help. 😕
After having had a few days to mull this over I’ve concluded that the only thing I can do is go through with the monitored cycle and see what happens. I guess there’s no point in getting ahead of myself. If the hormones work then I will need to make the decision to go ahead with insemination; and if it doesn’t, then I’ll have to come to terms with the fact that I can’t carry a child.
*Sidebar: Just to cover off adoption. While single people can adopt in the UK, I am concerned that I wouldn’t get approved because of my health conditions. If I had a partner I feel there would be a better chance, since if I had an episode of illness there would be a second parent to care for the child. At the moment I have my mum, but adoption panels are really tough and I think they’d have concerns about her age (due to news stories of grandparents being refused long term care of grandchildren because they might not live until the child is 18).
However in future, if I get a partner then adoption or surrogacy (if we have money) come back on the table