Saline Infusion Sonohysterogram and Hysteroscopy

The thing about this fertility journey is every other day you learn a new acronym or procedure that is a part of this journey. Before going to my RE I had no idea a Saline Infusion Sonohysterogram or "SIS" was even a thing. I had heard of the hysterosalpingogram or "HSG" which my regular doctor had recommended but no idea a SIS was a thing.

What is it you ask...

It is just how it sounds. It is an transvaginal ultrasound with saline infused in through the cervix with a small catheter to detect abnormalities in the uterus. Normal transvaginal ultrasounds can detect some abnormalities but this gives a clearer picture and can detect smaller things such as fibroids, polyps, and scarring. 

This was one of the first things after bloodwork we had done after seeing my RE. Its done at a specific time in your cycle typically after your period but before ovulation, I can't remember the exact days. I was told to take some tylenol or advil before coming in as it can be uncomfortable. Being the hard headed tough person I am I didn't take any. 

I got to the office and was told to undress from the waist down and given a sheet to put over me. The NP did my procedure as my doctor was out that day. She cleansed the cervix with betadine I believe and then inserted the catheter. She then injected the saline and I was able to see on the tv infront of me the whole thing, which being in healthcare is cool to me! When she injected the saline it felt like a sudden bad period  cramp but it was not bad at all. I could tell their was something there on my uterus that wasn't suppose to be and I just felt defeated. ANOTHER hurdle to jump over. ANOTHER ultrasound that didn't bring good news! Every ultrasound is PTSD for me whether fertility related or thyroid related...its never good. The whole procedure didn't last maybe 5 minutes. The weird part is when you sit up all the saline rushes out of you into this like trash bag and it feels like you are peeing your pants haha. All in all wasn't a bad procedure at all. Pain was 1/10. 

Afterwards the NP came in and told me she did see something on the ultrasound but wasn't sure exactly what it was more then likely a polyp. Again defeated and angry at this point. We were ready to start trying again that month and due to ovulate soon. All of that would be put on hold. 

We had to wait for the RE to review  the results to know our next steps. Being the anxious person I am I send her a message in the portal to try and get some answers. She was super responsive and responded back quickly and at that point we knew I would need a hysteroscopy to remove whatever was in there. Through the grace of God my RE squeezed me in the following week! I couldn't thank her enough! I wanted this taken care of ASAP and didn't wait to have to delay trying again. She put me on Aygestin which is a birth control to control the lining of my uterus and to make sure I didn't start my period. Let me just tell you Aygestin is the DEVIL. That little pill made me sooooo hungry ALL THE TIME. Thank God I didn't have to be on it long! 

Thankfully Daniel was able to get off work for my procedure. He was on night shift that week so he ended up having to take 2 sick days. My hysteroscopy was done a UAB Highlands and we didn't have to be there super early which was nice. This isn't my first rodeo for a surgery so I knew the procedures. Get checked in, prep, IV, pregnancy test, vitals, and off to sleepy town you go. I may sound crazy but I love that feeling of anesthesia when they put you under hahah, best sleep ever...until I wake up usually nauseous. They had prescribed me a scopolamine patch to help with nausea as well. I don't remember much after the versed in my IV. The next thing I knew I was waking up in recovery, not nauseous, PRAISE JESUS! The procedure doesn't take long at all. I'm sure the majority of time I was under was positioning. I woke with what felt like a UTI soooo bad. The nurses said it was normal since the instruments were down there. When I finally saw Daniel the first thing I said was what did the doctor find lol. At that point he told me it was retained tissue from my prior losses. I was frustrated at that because I felt like I should have just had a d and c to begin with. I was frustrated my body didn't naturally miscarry or even fully miscarry with the cytotec! Gosh, come on body can you do something right please. I also had told Daniel when it was taking longer than expected to get a negative pregnancy test post miscarriage that I was worried about retained tissue and I thought I needed an ultrasound to make sure everything was gone. Apparently a regular transvaginal ultrasound may not have picked this up anyways. 

Recovery wasn't bad. The worst part was that night I had really bad pain with urination and the urge to urinate frequently. It felt like I was peeing razor blades. Daniel went out and got me the over the counter uti meds and that helped some. They also called me in an antibiotic which eventually took that away. The post anesthesia I felt very anxious and tired but I couldn't sleep well at all. I'm so grateful my doctor recommended taking off that Friday after and the weekend and going back to work Monday. I felt like a zombie. I guess with my age I don't bounce back from anesthesia as quickly. I ended up taking magnesium with melatonin and that helped a ton.

My virtual follow up was fine and confirmed that I had retained tissue and actually a small polyp as well. We were given the green light to try again this next cycle and start progesterone vaginal suppositories 2 days after peak. My next step is either pregnancy or if not pregnant by June 17th I have bloodwork to confirm my elevated cardiolipin. 

"You've got to wait till after 3 miscarriages before testing."

 After my second miscarriage I was determined to seek help and not wait for another miscarriage to happen. A lot of times in the medical community they tell you they do not do anything/begin testing until you have 3 consecutive miscarriages. Thats just crazy to me! I've got to go through 3 loses until they run a reoccurent loss panel...for which I am paying for? I wasn't okay with that. I asked my doctor to refer me to a fertility specialist. She stated she could run the reoccurent loss panel after the pregnancy hormones were out of my system and she would put a referral in but she didn't know if they would do anything since I've ONLY had two losses. My loses happened back to back with no cycle in between. We were 2 for 2. We tried 2 months and got pregnant immediately both times. Sure it could be a genetic abnormality with the embryo but I wasn't willing for that to be my only answer without further testing. 

I called around in Huntsville to the two fertility clinics but they did not accept our insurance so it would have been all out of pocket. I would have been fine paying out of pocket if I had to, we would have figured out a way to make it work but our insurance has infertility coverage so we just had to find where to go. Calling around and getting the run around we found out that UAB Reproductive Endocrinology and Infertility was where we needed to be. I called our insurance and surprisingly we actually have pretty good  fertility coverage we just have to go to UAB which is about an hour and a half from our house. When I called to schedule my appointment I was asked if I preferred a male or female provider which I preferred female but if it was going to get me in sooner I would go with a male. My appointment was scheduled for March 22 which was about 6 weeks away. At the time I thought that was so long and it was going to delay me getting pregnant again, as I didn't want to get pregnant before we got the testing done. In reality it came at a PERFECT time, which was a God thing...teaching me patience and helping me to heal not only physically but mentally as well. I literally, FINALLY, got a negative pregnancy test the weekend before my appointment and started my first period post miscarriage and first one since October, due to back to back pregnancies. 

Daniel had gotten the day off and we were headed up to Birmingham hopeful for some answers. It's pretty intimidating walking into a fertility clinic, its definitely not a place anyone chooses to go to. I always had a fear I wouldn't be able to get pregnant but the fear of miscarriage never crossed my mind. I had filled out all the paperwork prior to coming and made sure I was as accurate as possible and Daniel of course adding his little comments haha part of being married to a doctor. Everyone was super nice at the clinic. I felt very comfortable and in good hands.

The doctor was great and very thorough. We went over my history and were able to ask as many questions as we wanted. I never felt rushed or "just a number". It was great! We went over the plan and were given the okay to track ovulation and try for a pregnancy again. We got all the labs ordered including:

Hemoglobin A1C - assess for diabetes 

PRL - checks prolactin levels in blood

TSH/T4 - thyroid labs

TPO Ab - thyroid antibodies

APLS - antiphospholipid syndrome (clotting issues)

Parental karotyping - checks for balanced translocations for both Daniel and I

Urine test for mycoplasma and ureaplasma (Due to Daniel requesting...no signs I had this)

We were warned that everything could come back normal. I wasn't hopefully something would come back abnormal but at the same time I was so we would have an answer for our loses. 

We also scheduled a SIS - Saline Infusion Sonohysterography, which is where they do a transvaginal ultrasound and inject saline to look at the uterus for structural abnormalities. This was scheduled for a week later as I was currently on my cycle and it needed to be done at a specific time in my cycle. 

Our plan was to have timed intercourse and start baby aspirin as well as use vaginal progesterone suppositories in luteal phase.

I felt confident in the plan and was eager to get some answers and try again. My doctor was awesome and as soon as my results came back she communicated in the portal with me the results. Can I just say I LOVE patient portals in the medical community. They are so great and I love having access to my medical records with the click of a button! Really helps with the anxiety and having a super responsive doctor is AMAZING! Definitely feel like we made the right choice, guided by God. God placed us in the right hands! As much as it sucks to travel to Birmingham for every visit, it is completely worth it! 

One thing that came back abnormal was the APLS. It was slightly elevated and the plan is to get tested again in 12 weeks from original test to confirm it and if I get pregnant before then to start lovenox injections and aspirin.

Another thing that came back abnormal was the ureaplasma and I was given an antibiotics for it. Doctor did not think this contributed to my loses at all but since they found it they treated it.  

Everything else came back normal, well besides my thyroid but we already knew that and were working on that. Even our parental karyotyping came back normal which took FOREVER to come back and I was a ball of anxiety the entire time. I was asking for prayers from all my friends and small groups every week. 

Throughout this whole process God is teaching me patience and to let go and let God. 

Luke 12:25-26 Who of you by worrying can add a single hour to your life? Since you cannot do this very little thing, why do you worry about the rest?

Cytotec (Misoprostal) Experience

      After we found out baby number 2 had no heartbeat I had my HCG blood drawn to see what my levels were at. The results came back within the normal range of where I was suppose to be according to gestation. That gave me a little hope, maybe it was too early to see a heart beat. I was scheduled for a second HCG blood draw 48 hours later. That result came back with a decline in HCG of 2000. At that point we knew it was a miscarriage but still held out a little hope for the confirmation ultrasound one week later. God is in the business of performing miracles and I was praying this would be one. I just remember that weekend was just excruciatingly long. I had an appointment for Monday at 3pm and it couldn't come soon enough. We went in for the ultrasound and it was confirmed no heartbeat. Of course we were completely devastated. How could this happen 2x in a row! 2% chance of back to back miscarriages. We now joined the 1 in 100 statistic of reoccurring losses.

 We were given 3 options at this point.

1. Wait for a natural miscarriage to happen 

2. Take Cytotec to induce a miscarriage 

3. Have a D&C 

Waiting for the miscarriage to happen naturally wasn't really an option in my book. My HCG was dropping so slowly and it would be a long time before I may actually miscarry. I also was extremely nauseous and just wanted to feel better. Also, I just started a new job and wanted to have at least some control of the timing. 

Cytotec was highly suggested by both my doctor and my husband. I was hesitiant on taking it as I would have to go through the physical pain of the miscarriage and two it may not even work. The good thing about cytotec is it happens quickly after you start taking it and it avoids instruments in the uterus that can cause scar tissue to build up. 

The third option was a D&C which I was leaning towards. Its quick and easy and you are put under for it. You know all the tissue is taken out. Also the tissue can be tested for abnormalties. The risk is scar tissue forming in the uterus which could cause issues with implantation of another pregnancy. 

In the end we ended up choosing the cytotec. I had Friday of that week off of work due to low census so I had planned to induce the miscarriage Thursday night after work. How it worked was I was given 8 pills/tablets. I was too insert 4 pills vaginally close to the cervix and lay down for 30 minutes to and hour. The pills are suppose to start working within 6 hours. I inserted the pills around 2-230pm and anxiously awaited the pain/cramping to start. I didn't have any. It was getting close to the 6 hour mark and I still hadn't had any cramping or bleeding. Finally right at 6 hours I had some very minimal spotting but at this point it was not progressing like it should. I was frustrated. Not only was my body failing me with this pregnancy but also with cytotec now. 

So 830pm came and I had to insert 4 more pills. I laid down and put on a TV show. It was around 10-11 and still nothing was happening. I was so frustrated, why wasn't my body reacting the way it should? I finally just took an Ativan and fell asleep. Around 1-2am I woke up and I could tell I was bleeding. I went to the bathroom and as soon as I sat down I began to pass a ton of clots. I was having some minor cramping but not awful. I went to lay back down in bed and within 5 minutes the cramping got worse and worse. I then just made a bed on the bathroom floor. I continued to pass a ton of clots and BIG ones. 

Around 3am I'm laying on floor crying because I was in pain physically and mentally. Thankfully my doctor prescribed me some tramadol and I took one of those. About 10 minutes later I passed the baby and the sac entirely in one big
piece. Which was painful! We were told if I passed the baby we could save it and get it tested. I yelled for Daniel and we were able to collect it and store it properly. 

 After I passed the baby the cramping went down significantly. It was more emotional pain now. I was finally able to get some rest now too. 

The next morning I took the baby in to the doctors office to get tested. Testing would take 2-3 weeks. Now the emotionally healing began. A friend said it best, "Let's face it, you'll never be the same." I couldn't agree more. 

Would I choose the cytotec again if I had a missed miscarriage again? I'm not sure. The pain wasn't awful and the fact that I was in a little bit of control and was able to see everything be passed kinda helped. But in reality what we would learn a month in a half later is the cytotec didn't work completely and I ended up with a D&C anyways. So unfortunately it may have delayed the healing procress. I would say if my reproductive endorcrinologist recommended cytotec I would probably do it again but I would want an ultrasound done after to ensure the tissue was all cleared out. All in all it wasn't an awful experience.

Baby Krautter Take Two....is this real?

Days after miscarriage

After my miscarriage I struggled every day just to get out of bed. I knew miscarriage was common but I
guess I never knew how common or really even thought it would happen to me. My mom didn't struggle with pregnancy or miscarriage nor did Daniel's. I always had a fear that I would have a hard time getting pregnant or wouldn't be able to get pregnant. The thought of miscarriage never crossed my mind. I did not want to get back on my anxiety medications as I wanted to get pregnant again and didn't want to be on anything. I would literally do the bare minimum. Get up, go to work, come home and cry in bed. Every little thing would set me off crying. Daniel would try and cheer me up but every little thing I would cry. I know I was only 5.5-6 weeks along but I had envisioned the life we were going to have with this baby. It just hurt and still does honestly to have that ripped away.

My Joy

 Christmas was coming and I just could not get into the holiday spirit. It just didnt feel right. I was working at a PRN job which was more or less full time and I enjoyed it but I was between 3 different buildings at this point and I was just ready to go full time somewhere. I had been working nonstop since I moved to Huntsville and I knew God was telling me to just slow down. I offered to go full time status at the job but they did not need me full time until probably January. I kept my eye out for other opportunities and a full time home health job fell in my lap! I LOVE home health. It is probably my favorite setting to work in as a physical therapist assistant. I had interviewed with this company twice already in different cities but it just didn't work out as I didnt want to travel that far plus commute to patients homes for work. This position was in Huntsville so it was perfect. I had two interviews and ended up getting the job. My husband was slightly anxious about the interviews as I was an emotional mess. I guess I was able to mask it well and nailed the interviews. It was such a blessing to get this job and be able to have less work and WAY more flexibility. I was also grateful for something positive and something to keep my mind off everything.

Christmas came and honestly it was just depressing. Daniel worked and so it was just me and Ranger. We made the most of it but it just sucked to spend our first married Christmas apart but it is what it is and it is, part of being married to a doctor. I had not gotten my period back yet from my miscarriage but I had been tracking ovulation with OPKs. I knew I had ovulated so we had timed intercourse to try again. First let's back up a little bit, I went to MFM and was pretty much blown off. I had gone to get guidance for my thyroid during pregnancy. I had the appointment made prior to getting pregnant for preconception counseling but wasn't able to get in for several weeks. I did not go because I had had a miscarriage. The doctor told me miscarriages happen and my thyroid had nothing to do with it. I tried to explain that that was not why I was there but it was dismissed. She stated we did not need to wait to try again and I would just need my thyroid checked once a trimester. So armed with that, we decided to try again right away.

Christmas day I was 9-10 days pasted ovulation, DPO, so feeling depressed I decided to take a test knowing it would probably be negative or even too early to show a positive. I took a test and waited impatiently...it was a faint positive. I couldnt believe it. Was this real? This can't be real. I was excited and hopeful but also TERRIFIED! The next day I went and got some more tests. I got 3-5 different brands including a digital. I used all of them and they were all positive! I couldn't believe this was happening again this quick! I was so excited. The excitement quickly fated and the terror started. Instead of going to work and coming home to cry in bed. I would go to work and come home and sleep to check off another day until my first appointment. I was terrified EVERY SINGLE TIME I went to the bathroom. Every ache, pain, cramp, I was scared. I was scared I didn't have any symptoms yet. My last pregnancy I had a lot of breast tenderness this time I had none, was that bad? Why am I not nauseous? I analyzed every single feeling I had, every single bathroom trip was pure terror. My appointment was scheduled for January 31st. I just needed to make it till then.

Line Progression

 I began taking a pregnancy test each morning to see the line progression and make sure it was getting darker to show in my mind my HCG was rising. It helped to see it getting darker but in reality it meant nothing, I had some minor spotting early on and of course I was terrified but luckily it stopped pretty quickly. Around week 5 I began to experience nausea. I began taking unisom and b6 and it was working pretty well....for about a week. I believe the weekend of week 6 I did not leave my bed. I was so nauseous and I was vomitting. I felt awful but I was also happy I was having these symptoms because that meant the pregnancy was progressing right? I eventually was prescribed basically dramamine to help and as long as I took it around the clock I could get through work...barely. 

Weekends were spend in bed and any time I wasn't working was spend in bed. My diet was awful I was literally eating whatever I could get down. I ate a lot of carbs and a lot of chewy granola bars. My poor house was a disaster. I literally couldn't function much above going to work and coming home. The constant nausea helped ease my anxiety though which I was grateful for. 

The day of my appointment comes and I was the most nauseous I had been to this point. I remember getting home from work to pick up Daniel to go to our appointment and I open the car door and just throw up all over the front lawn. It is was rough. We get to the appointment and are going over a few things and then we go to the ultrasound room. I'm scared at this point as ultrasounds and I do not get along. From my thyroid diagnosis to this, ultrasounds are just not good for me and very triggering. We start with a abdominal ultrasound and she can't find a fetal pole so we move to a transvaginal ultrasound, it could still be early to see on abdominal. I felt like we did the ultrasound for hours but I knew it was not good. I can't believe this was happening again! How is this possible? 2% of people have back to back miscarriages. Why am I among the 2%.

Baby Krautter take one

 Wow! I can't believe it has been since 2017 since I last wrote in this blog! A lot has happened since 2017. I am now married and living in Alabama. Believe it or not my life is still leading me to the title of this blog, "Everything happens for a reason". I'm going to be honest, it has been really hard to believe that in the last few months. This blog will be turning to everything trying to conceive, TTC, and pregnancy. It is just another avenue to get things off my chest and to hopefully help others in the same situation as me. So lets get started...

Our avenue of TTC started in October 2020. Daniel, my husband, and I always knew we wanted to start a family shortly after getting married. We wanted to wait a year, then a year turned to 6 months, then 6 months turned to let's start trying now at about 4-5 months. So given my history of thyroid cancer I went to the doctor just to get check out and to make sure my thyroid was good for TTC. I was given a referral to maternal fetal medicine, MFM, just to get guidance on where my levels should be for pregnancy. It was over a month before I could get into MFM. We decided we were going to stop being "careful". I do not use birth control, I just naturally track my cycles with basal body temperature, BBT, and ovulation tests, OPK. It works well for us and avoids unnecessary hormones into my body. 

First pregnancy tests

As my November cycle was approaching I was eager to test to see if maybe we had gotten pregnant this cycle. I really wasn't expecting a positive as an OBGYN we knew told us it was taking her patients 6 months to a year to get pregnant. Which pushed us to start trying NOW! I remember I saw tests that could detect 6 days before your missed period so I was eager to test. I was off work that Friday because I was running a half marathon on Saturday and my friends were coming up. I went to Walmart to buy some tests after work on Thursday and I think that was 7 days before my missed period. I remember testing and seeing a negative but honestly it was probably a faint positive. I had never really taken a pregnancy test so I assumed it needed to be a darker line so I just shrugged it off. If you've been apart of the TTC journey for any amount of time you know how we study these tests, going back and forth checking to see if it "turned positive". I remember going back and looking again and looking back I know it was a positive but being my first ever pregnancy test, I thought it was a negative.

PREGNANT

1/2 marathon

Saturday comes and I run the half marathon with Daniel and my running crew. I was super nauseous after the race but I just assumed it was from being out of shape. I waited for my period to come and it was Wednesday the following week and I was either due to start that day or the next. I remember having cramps, like period cramps, that morning. I assumed my period was coming. That night I took a test and it was CLEARLY positive!! I still didn't believe it, I ran to the store and got a digital. It said PREGNANT!!!! I was sooooo excited!!! I couldn't believe we got pregnant so quick! Daniel was excited as well. I called the next day to make my first appointment. My first appointment was scheduled for December 1st and I was so excited! I could not wait to tell my family, especially my mom. I was already planning to go home the weekend after my appointment so I planned to wait until then to tell her in person. Best thing was I would be due around her birthday, how cool!

So a couple weeks go by, I really wasn't feeling any different. Maybe a little more tired but nothing awful Minimal nausea, which was AMAZING! Then the week of Thanksgiving comes around and I had systemic itching. I was so itchy all over. I thought it was weird but I wasn't too concerned. Then November 24th the day before Thanksgiving I woke up to some bleeding and I was terrified. Ive never been pregnant but I knew this wasn't good. The bleeding wasn't much and it stopped very quickly. Luckily I was able to get into the doctor that day. She assured me it could be normal but even if I was miscarrying there was nothing they could do at this point, I was too early on and 1 in 3 women have a miscarriage unfortunately. She offered me a transvaginal ultrasound but stated they may not be able to even see anything since its so early. We opted not to have the ultrasound as it could cause anxiety I didn't need. The bleeding had stopped so we assumed we were good.

5k

Thanksgiving day I woke up and no bleeding! I ran a 5k and felt great. Friday was fine as well. Saturday I was spotting a little but not a lot. Sunday I woke up to cramping and more spotting. I was terrified and I just knew deep down that this was the beginning of the end. I ended up talking with my heart sister Jeanie Gregory on the phone and was able to get myself up and go to church. I was giving it to Him. While I was in church I had horrible cramps and I just knew we had lost the baby. I get home from church and I beginning to pass clots and tissue. Daniel was a work at the time and it was rough to be going through this alone. Not only was it emotionally painful but physically it was a well. It was so hard to "know" what was happening but at the same time not know. I was hoping for the best but deep down I knew we had lost our baby.

Monday comes around and I was able to get into the doctor and get an ultrasound to confirm the nightmare was true. I had miscarried. I am 1 and 3. It was hard. I blamed myself. Maybe if I hadn't run that half marathon...maybe if I didn't work so much....maybe if I (fill in the blank). Not a lot of people share about their struggles with infertility and miscarriage so it was hard. I felt like I was alone. Not to mention we didn't have a huge support system or family around us. We were told these things happen and it doesn't mean anything is wrong. We could try again. Little did I know the adventure we were about to go on....