Cycle 50....CD 2

I'm CD 2 today so I just called to schedule my baseline sonogram for this cycle. I'll be going in tomorrow at 730am (right after I get off work). Dear God, please let this be the last cycle we have to struggle with and bless us with a healthy little bean growing into the New Year.

Follow Up

I had my post-surgery follow up with the Dr today. Incisions look good and no pain (I still have a slight tugging/pulling sensation on one side of my abdomen when I stand up from a sitting position though). Dr N went over the official results from the laparoscopy....she removed 3 polyps--all of which came back clear (ie no cancer or abnormal looking cells) from the pathologist, checked tube patency by pushing dye through--all clear with good flow, and checking the possibly damaged left sided fimbria--which cleared up with a little extra pressure of dye, no repairing needed!! Thank God! There are two main problems for conceiving after a TL/TR: tube lengths--shorter tubes make conceiving harder--mine are still a good length, and proximity of tube to the ovaries--mine are "very good" she said. Dr N said based on what she saw in there, she doesn't know why I haven't gotten pregnant yet! The polyps could be a "possible" reason why, since they can impede implantation, but she said she has seen uteruses with more and/or larger polyps still conceive.

Dr N then went over our options. We discussed what we tried at the other RE's office and what we feel comfortable with doing over here. IUI/IVF is still off the table, so we are going to try another Clomid + TI cycle. Plan is to call on CD 1/2 and schedule baseline sono, start meds on CD 3-5 or 5-7, follow up with u/s until O is near, BD at home when its times, and confirm O with another u/s. The good thing, since we have meet our out-of-pocket max for the year, most of this cycle will be covered by insurance depending on when AF arrives and we get started!

So now we just wait for AF to arrive...which should have been here already, but surgery delayed it a little.

Latest Update

Little recap: So back in Feb 2014, I was going to have surgery but that's when our lawsuit stuff (DSS) started and we had to take the 5K that was for the surgery and put it toward the attorney. Last Oct was when DH started his new job, his new insurance would cover part of the surgery, but it was still going to cost around 2-3K out of pocket. We didn't do it then because we still had some other financial stuff to pay off first.

Fast forward to now....We had meet our deductible for the year several months ago, but with me starting a new job, DH didn't want me to have surgery just yet. Plus is looked like it was still going to be at least 1K+ out of pocket so we figured we'd just have to wait until next year and unfortunately have to pay more because our deductible would reset. After I got home from work this morning and was trying to sleep, something told me to go ahead and call the dr's office. (The likelihood of getting it done before the year was over seemed impossible since its already mid Nov). I left a message for the surgery coordinator and she responded a few hours later. Turns out because we are almost to our max out of pocket for the year, the max we would have to pay is $442.78 if we do it before Jan 1!!!!! They want me to come in for a visit with the dr and a sono (which I want anyway) and redo labs to make sure its even worth proceeding. So my visit is Nov 30 and surgery (assuming everything is still ok with my levels) is Dec 10!!


Such happy news, esp considering AF arrived today and started cycle #49.

Followup

Today, I had a TR post op appointment with Dr K. Right after surgery he said my tube lengths were 3.5 and 4.5 cm, but today he said they were both 5 cm. Not sure why the change (I was actually fully awake when he said that after surgery so I don't think I misunderstood him), but I'm happy since the longer the tubes the better! He then reviewed the protocol on what will happen when I get pregnant. I'll have to go get betas drawn every 48 hours and then have an US to confirm placement once my numbers reach 1500. This is to catch an ectopic (10% chance of happening) as early as possible, so as to avoid any major complications such as needing my tube taken out or worse, my death. Once a pregnancy has been confirmed in my uterus, then I will be released to my OB/GYN for routine pregnancy care.

I'm on CD 12 today, so I should O in a few days.

Fingers crossed this will be the only TTC cycle I need!!

Two weeks....

since my surgery and I feel great! Its amazing how many more of my PTLS symptoms have gone away (Yay!!) since the TR. My incision has healed up nicely and while in the recovery room, Dr K said we could start ttc as soon as I felt up to it. Today is only CD 7 so I still have another week or so before ovulation.

I am SO glad we decided to go through with the TR (and even more excited that it ended up being cheaper than we were originally quoted.) I'm relieved that the huge weight that I've been carrying around for 2.5 years (yes, I have regretted the TL pretty much since the day I got it done) has finally been lifted off of my shoulders. A huge part of that probably has to do with my Catholic upbringing.

I got a Carter's catalog in the mail the other day....ohmygoodness....so many cute clothes that I would just love to buy. Even the boy clothes have gotten so much better since the last time I've had to buy baby clothes. I even refrained myself from buying a gender neutral ensemble. Can't say that might not happen once I get a BFP though. :-)

It's dooonnneee!!

Ok, so yesterday I didn't wake up after surgery so well. I was in a lot of pain, crying, so they ended up giving me 4 different kinds of pain meds (and 2 differet nausea meds because I was so nauseated too) I remember hearing DH telling the nurse that I don't even take something as simple as tylenol since I hate taking meds, but that I must been in horrible pain for it to make me cry like I was and he said I kept apologizing for acting like a baby. Once we finally got home, I took some more pain meds and went to sleep. I'd wake up every so often in pain because it hurt to change positions or I had to go pee. Got up for a little bit and tried eating even though I was still nauseated. Ate something soft, then took a phenergan for nausea. Then did a cyle of sleep, take meds, go potty, sleep, etc all night.

Woke up this morning and my right side feels a WHOLE lot better. My left side still hurts, esp when I have to stand/sit, but funny thats the same side that took longer to heal with my 2 c/s. Maybe once I take my bandage off this afternoon, it'll feel even better.

My tubes are approx 3.5cm and 4.5cm (not sure which length for which side) and on an interesting note, I've noticed some of my PTLS symptoms are already better!

I AM TIED NO MORE!!!!

Thanks and Glory be to God and to my wonderful surgeon, Dr K!

Tomorrow is the big day!

I have to be at the surgical center by 11am and surgery is supposed to start at noon. I can't believe its really here!!!! I'm so excited, yet the nerves have kicked in too. I just hope I'm able to get a little more sleep than I have had the last two night.

Random Thoughts

The hardest part of this journey so far is the lack of family support (well, that $6,500 check wasn't exactly so easy to part with either :-P). The only people that know about the impending TR are my in laws, a wonderfully supportive group of ladies that I have known for four years now at Womb and Beyond, one real life friend and now some new ladies I have found in an online TR/TTC group.

The main reason we haven't told my family goes back to the fact that they made nasty comments when we announced I was pregnant with DD. They certainly wouldn't hold back voicing their surely negative opinions about the TR and subsequent TTC. Probably along the lines of "why would you want to reverse something you did in the first place" or "you already have three kids, why do you want/need another?"As little as we see/talk to them we totally could have another baby and they would not even realize it was a new family member. And this is my immediate family I'm talking about!! Sad huh? But hey, who needs that kind of negativity around them anyways, right?!

Our kids don't know either (DSS knows I will be having surgery, but he doesn't know what for) and we won't say anything until I'm actually pregnant. All of the kids will be super excited to have another sibling though. The boys make comments every so often about how they wish they had another sibling to play with. (They both wish for another sister. How sweet is that!) The only one that may have a problem is DD, especially if we have another girl. She would either be VERY excited or VERY territorial about having to share her clothes and toys, but based on how we made sure the boys adjusted well when she came along, I think we'll be just fine. :-)

Our Story

Guess you are wondering who we are huh? Well, here is goes....

First of all, my name is Brandy and I love to use (parentheses) as you will soon find out. LOL.

DH and I got married in 2007 (I also became a step mom to a WONDERFUL boy whom I love as my own) and we conceived our DS that first month! I had horrible N/V the entire nine months and also ended up developing pre-eclampsia. I was placed on medication to help with the N/V, but I would take it sparingly since I was afraid it would hurt the baby. Two weeks after my pre-e diagnosis, I was induced due to severe hyptertension. During induction, DS heart rate started deceleration and had to be delivered via emergency c-section at 38w5d. I then developed complications (I went into hypovolemic shock and ended up needing 2 units of blood transfused). Needless to say, his pregnancy and birth were not what I expected.

Fast forward 11 months. We became pregnant with DD on our 7th cycle of trying. Her pregnancy mimicked DS and this time I was placed on two medications to try and combat the morning sickness. Even with the medications, I still had trouble keeping anything down. People thought I was crazy for having another baby after everything I went through with our son and I admit, there were days I thought so myself. After all, who loves the thought of having to carry baggies everywhere with them for nine months to throw up in because you can't make it to the bathroom in time?? Since I had to have an emergency c-section with DS (I was not a candidate for a VBAC) we had a scheduled c-section date for DD. Long story short, she decided to come a few days earlier than that, at 38w3d.

After two complicated pregnancies, DH and I decided we were done having kids and for me to get a tubal ligation since they'd "already be in there" during the c-section. I wasn't 100% on board, but at the time, I knew it was the best thing for us to do. (I don't believe in birth control....I know, I know, tubal ligation is a form of birth control.) I felt different almost immediately after the TL and I just figured it was due to the fact that I just had a baby, plus a toddler and an older boy at home.

About 1.5 years later, I thought I was pregnant. (Which I was secretly hoping I was because by this point I was just sick to my stomach knowing that I had permanently altered my reproductive system.) I told DH about it and he verbalized his regret of getting the TL done too and hoped I was pregnant. Turns out I wasn't pregnant and that my thyroid levels were just off (I had gotten diagnosed with hypothyroidism about a month prior, plus I was developing PTLS). While at the Dr, DH brings up questions about a tubal reversal. He was really excited about the prospect of having another baby!! So after we got home, we had a good, long discussion about the thought of getting the TR done. I researched it and narrowed it down to two Drs. Of course, we had to save up the money for it since insurance doesn't cover it.

So here we are 14 months later, about to get the TR done! Our surgery is scheduled for May 30, 2012. I decided to start this blog to document our (hopefully short) journey in hopes to give women contemplating a TL to strongly reconsider it before they do it. I just wish I knew then what I know now. :-(

Tubal Reversal FAQ's

FAQ's about Tubal Reversal and Trying to Conceive After a Tubal Reversal

Q: What is a tubal ligation?
A: Tubal ligation is a commonly performed sterilization procedure. Also called "tying your tubes" or "getting your tubes tied". There are a variety of ways in which the procedure can be performed (clips or rings to occlude portion of the tubes, small segments of the fallopian tube is cut off or electrocautery). Sometimes a tubal ligation is performed at the same time as a cesarean section and is called a Pomeroy procedure. During this procedure, a small section of the tube is actually cut out and the ends are tied off with suture material. A less commonly performed procedure is a fimbriectomy. During this procedure, the ends of the tube are completely removed. Because the fimbria is an essential part of the tube, this procedure is irreversible.

Q: What is a tubal reversal?
A: Most tubal reversals are done using an open technique. This means making a 2-3 inch incision in the abdomen in a bikini-like fashion. The abdomen is opened and using a microscope the ends of the tubes are reconnected (tube-to-tube reanastomosis). The procedure normally takes 2 hours and after the procedure you will spend a couple of hours in the recovery room and will be sent home that day. In some less common cases, you may decide to spend the night in the hospital.

Q: Are tubal reversals covered by insurance?
A: You will need to verify with your particular insurance company, but 95% of the time it is not a covered procedure and you will have to pay the entire amount out of pocket. Tubal reversals can range from as little as $5,000 to as much at $8,000 depending on physician charges, facility charges and any additional tests (such as lab work or other tests).

Q: What are the steps for a tubal reversal?
A: You must obtain copies of all the post operative and pathology reports from the doctor who performed the tubal ligation and send them to prospective doctors who perform tubal reversals for review. Once you have chosen a doctor that you feel comfortable with, follow his/her advice. Sometimes the doctor will require the male to have a semen analysis before performing the tubal reversal. (This is to prevent the female from undergoing surgery if there is a problem with the male until the problem is corrected.)

Q: What kind of doctor do I look for?
A: You want a doctor who performs micro reproductive surgery. OB/GYN F.A.C.O.G or a Reproductive Endocrinologist.

Q: What tests should I expect to have prior to tubal reversal?
A: The basic tests performed include a pelvic exam, a check of basal body temperature (BBT) charts and the monitoring of some baseline hormone levels, such as prolactin and progesterone levels during the luteal phase. In addition, a postcoital test (PCT) or diagnostic laparoscopy may be performed. Some doctors may require a complete CBC and hormone panel to rule out menopause. Depending on the type of ligation you had, you may also have to undergo an HSG to determine if you have enough tube left.

Q: How long is the hospital stay?
A: This depends upon inpatient or outpatient surgery and your doctor. Most tubal reversals are performed outpatient and are home the same day.

Q: What is the recovery time for a tubal reversal?
A: This depends upon the patient's tolerance for pain and possibly unforeseen complications. Most women are fully recovered in 3-4 weeks. Your activity will be restricted for at least the first week.

Q: Does the procedure hurt?
A: Some women compare the pain to that of a c-section and some experience little or no pain at all.

Q: How big is the incision?
A: Generally 3-5 inches across the abdomen. If you have had a previous c-section, they will go in through the same incision.

Q: How will the incision be closed?
A: Normally staples, stitches, surgical glue, or an adhesive are used to close the incision.

Q: What can I expect the incision to look like?
A: The first time you look, it may be red or pink in color. It may even appear to be puffy. As long as it isn't bleeding and you don't have a fever, you should be fine.

Q: Is it normal for the incision to become numb?
A: It is very normal.

Q: What can I expect my cycles to be like after the tubal reversal?
A: Most women do not see a change in their cycles from pre-TR to post-TR. Some women experience shorter and lighter cycles and vice versa.

Q: When can I return to work?
A: Generally within one to two weeks when no heavy lifting is involved. Otherwise expect 4-6 weeks.

Q: When can we begin trying to conceive?
A: Some doctors say as soon as you feel like it and others say wait 4-6 weeks. Ask the opinion of your doctor.

Q: Is it okay to become pregnant the first or second month after the reversal?
A: Yes. There is no relation between miscarriages and tubal reversals. Most miscarriages in tubal reversal women is due to a hormonal deficiency.

Q:What is the normal length of the fallopian tubes before a tubal ligation?
A: 10-12 centimeters (some women may have longer or shorter tubes)

Q: What is the length of tube needed to conceive?
A: Most doctors say at least 4cm, but there have been successful full term pregnancies with less.

Q: What are the success rates of a tubal reversal?
A: Factors that can determine how successful a reversal can be include the length of the fallopian tubes after repair, patient age and method that was used for the ligation. There must be three to four centimeters of fallopian tube for pregnancy to occur. If the patient had no problems becoming pregnant prior to tubal ligation, and the reversal is successful, the patient should be able to conceive. At your consultation, the Dr will attempt to give you a better idea of what to expect regarding your chances of conception after your reversal.

Q: Will I need to do anything special after I get pregnant?
A: Yes. After a tubal reversal, the chance of ectopic pregnancy is higher so your Dr will want to know right away of any positive pregnancy test. They will then have you come in for blood tests to check your HCG levels every 2-3 days until your levels reach 1500 IU where they can then do a transvaginal sonogram to identify a (hopefully) uterine pregnancy.

This information is not intended to be used as medical advice. Use only as a reference.

Abbrevations

Here is a list of common abbrevations you will see me use in posts.

2ww-2 week wait

AF-Aunt Flo (period)
BBS-Boobs
BBT-Basal Body Temperature
BD-Baby Dancing (making love/having sex)
BFP-Big Fat Positive (on pregnancy test)
BFN-Big Fat Negative (on pregnancy test)
CD-Cycle Day
CM-Cervical Mucus
DD-Dear Daughter
DH-Dear Husband
DPO-Days Post Ovulation
DS-Dear Son

DSS-Dear Step Son
EDD-Estimated due date
EWCM-Egg White Cervical Mucus
FF-Fertility Friend
FMU-First Morning Urine
FRER-First Response Early Result (HPT)
HCG-Human Chorionic Gonadotropin (what a pregnancy test tests)
HPT-Home Pregnancy Test
IC-Internet Cheapie (HPT)
LMP-Last Menstrual Period (start date)
LOL-Laugh Out Loud
LH- Luteinizing Hormone (Hormone detected by the OPK)
LP-Luteal Phase
N/V-Nausea/Vomitting (morning sickness)

O-Ovulation (Variants-Oed, Oing)
OB-Obstetrician/Gynecologist
OPK-Ovulation Predictor Kit
PG-Pregnant
POAS-Pee On a Stick

PTLS-Post Tubal Ligation Syndrome (collection of symptoms many women develop after a TL. Some drs don't think this is a 'real' disease.)
SMU-Second Morning Urine
SX-Symptoms
TMI-Too Much Info
TL-Tubal Ligation

TR-Tubal Reversal
TTA-Trying To Avoid

TTC-Trying To Conceive
U/S-Ultrasound