Tuesday, May 21, 2013

The Hysterosalpingogram

On Thursday afternoon, I'm having a hysterosalpingogram, or HSG. An HSG is a technique in which a dye is injected into the uterine cavity so that the uterus and fallopian tubes can be seen by x-rays. Dr. M, the reproductive endocrinologist that I've been seeing, recommended that we start with this procedure before we determine whether or not we should move forward with laparoscopic surgery. This way, if I have any issues we can discuss the options and procedures before the actual surgery. He said it would suck to wake me up from surgery and say "Surprise! You had tons of scarring and I removed both of your fallopian tubes". I totally agree.
During the HSG, dye is injected into the uterus through a catheter. The dye should
spill from the uterus into the fallopian tubes. 

Dr. M explained to me that there are basically three possible outcomes or conclusions to be reached from the HSG:

1) My tubes are completely clear and free of scarring or blockages,

2) My tubes have scarring or blockages that are removed by the pressure of the dye injection,

3) My tubes have scarring or blockages that may or may not be removed by surgery or medicinal treatment (such as hormonal birth control).

Of course, there are some other scenarios as well. Dr. M will also be able to see whether there is any scarring or abnormalities with my uterus. These, hopefully, would be able to be corrected with surgery as well, but who knows.

In my mind, only one of those outcomes sounds positive - #2. I think I will feel best if that is the scenario I'm dealing with. In that case, it's entirely possible that the only thing keeping me from getting pregnant was the blockages and once they're removed we should have no trouble getting pregnant without additional help.

Scenario #1 seems great on the surface, but if I never had any blockages then there must be some other reason that I'm subfertile. If this case turns out to be true, we'll have to discuss whether or not we want to move right to laparoscopic surgery or take some time to consider other treatment options.

Outcome #3 is too scary to think about right now, so we're not going to worry about that unless we have to.

Right now, I'm a mix emotions. I'm nervous, excited, scared, hopeful, and impatient. I just want to get this over with. I just want to know if there's anything wrong. I'm excited because I feel like we're finally trying something new - we've done everything we can for 11 months and we've had no luck. Maybe we're finally on the right track. I'm hopeful because Dr. M said that there is some evidence that women have an increased chance of getting pregnant for three months after an HSG (as long as there are no blockages). I'm terrified that I'm setting myself up for disappoint.

In a way, I also feel kind of fortunate. Obviously, in a perfect world I would be pregnant already and wouldn't even be thinking about this, but that's not how life happened. The reason I feel fortunate is that some people, regardless of the severity of the endometriosis, have no symptoms (other than infertility, which is defined as trying to conceive for 12 months without success). They have no reason to believe anything is wrong and so they wait a full year before they can pursue treatments, which they typically have to pay for out-of-pocket. Since I've had a pelvic pain for over a year, my doctor was able to suspect that there was a problem sooner - and endometriosis is a real problem whether you're trying to get pregnant or not. So not only am I able to seek help to diagnose the problem sooner than I would have if I wasn't experiencing  pain, but I also will have insurance coverage for the HSG! I've heard people pay up to $1200 for an HSG. Mine will cost $40. There's the silver lining that I'm going to focus on. It's complete bullshit that infertility testing and treatment is considered a "luxury" by insurance companies, but that's another story for another day. For now, I'm just going to be grateful that we're able to take these necessary steps without blowing through our savings. Fingers crossed for a positive outcome on Thursday!

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