Sometimes it becomes necessary for surgery to be performed in the course of fertility treatment.
It's generally not considered good news by you, the patient.
Very few of us want to have surgery. There is fear about risks, complications and even outcomes.
When it comes to alleviating pain, however, or finding or confirming a diagnosis, sometimes surgery is a relief.
Here's an explanation on what a surgical hysteroscopy entails. This is straight from the Reproductive Medicine Associates of CT website, written and edited by our board certified reproductive endocrinologists:
A doctor performs a hysteroscopy to look at the lining of your uterus with a viewing tool called a hysteroscope. The procedure is done to find the cause of abnormal bleeding, to remove uterine growths like polyps and fibroids, and to examine the uterus to see if there’s a problem with its shape or size that’s preventing you from becoming pregnant or causing repeated miscarriages.
Operative Hysteroscopy Procedure
A hysteroscopy is usually done in an operating room of a hospital or surgery center, although in some cases it may be done in the doctor’s office. It is an outpatient procedure and takes about 30 minutes.
A local, regional, or general anes
thesia is given, depending on the doctor’s preference. The procedure begins like an internal gynecological exam. The doctor then places the hysteroscope at the entrance to the vagina, moving it gently through the cervix into the uterus. A gas or liquid is infused through the hysteroscope into the uterus to help the doctor see the lining more clearly. The hysteroscope is equipped with a light and a camera to provide a magnified view of the endometrium, or uterine lining, as well as the uterine openings of the fallopian tubes. All of this is can be viewed on a video screen.
During the exam, the doctor may take a small biopsy, or tissue sample, through the hysteroscope to examine under a microscope to help in a diagnosis. If infertility is a problem, a laparoscopy may also be performed.
Risks Associated with Hysteroscopy
1. Injury to the uterus or cervix
4. Puncture of uterus, bladder or bowel
5. Problems with anesthesia
6. Bloating, if fluid is used
7. Embolism (air bubble in blood vessel) or belly pain, if gas is used
Light vaginal bleeding is normal following a hysteroscopy. If it gets heavier, or if you experience fever, severe belly or pelvic pain or cramping, problems urinating, shortness of breath or vomiting, contact your doctor.
We know that surgery can be scary. If a hysteroscopy is in your future, please let us know if you have any questions.
We're here to help.
Often when patients come to the office for their first infertility visit
there is a lot of fear and apprehension. Some patients will even delay coming to see a reproductive endocrinologist
out of fear or anxiety. In talking to patients, it seems that this apprehension has two parts; the first is that we will find something terribly wrong with them, and the second is fear that they will have to endure a series of invasive procedures. These fears are normal; we all have a fear of the unknown, especially when it comes to our health.
There is good news, news that can help allay these fears. Almost all couples have a fertility diagnosis that is amenable to available treatments. In approximately 80% of new patients we will start with the simplest fertility treatment plan. In fact overall in our practice we do twice as many IUI (intrauterine insemination) cycles as IVF (in vitro fertilization) cycles. Very few patients need to utilize in-vitro fertilization as a first-line infertility treatment cycle.
Generally our first fertility treatment is utilizing clomid which involves taking a pill for 5 days, and having 2 ultrasounds with blood testing. Only one injection is needed to trigger ovulation, this is a small injection much like an insulin shot and is most often given in our office by a physician or nurse. In most cases we recommend an IUI in order to help increase the chance for a pregnancy to occur. This is a very simple fertility procedure with generally no more discomfort than a pap smear. It requires a ten minute office visit and patients are generally allowed to have normal activity that day.
If more extensive treatment is required, RMACT (Reproductive Medicine Associates of Connecticut) has many resources to help you. Extensive teaching is provided to guide you through the infertility process, including medications and appointments. Every patient has a primary nurse to walk them through every step of the process. We also have resources to help deal with fear and anxiety, such as yoga, acupuncture, and professionally led support groups. You will never be left out on your own.
If you are experiencing fertility problems, take that first step on your family building journey and make an appointment with a Reproductive Endocrinologist. Remember the phrase, "Nothing ventured, nothing gained" can apply here. While fear and anxiety can make that first step of infertility treatment difficult, we are here to help you reach your ultimate gain; a family of your own.
Dr. Cynthia Murdock is a staff physician and a fertility specialist in Reproductive Medicine at RMA. She is board-certified in Obstetrics and Gynecology and in Reproductive Endocrinology and Infertility.
Dr. Murdock earned a BA in biology at Cornell University and an MD at Creighton University School of Medicine where she graduated magna cum laude. She completed her residency at Creighton University Medical Center where she was named Berlex Best Teaching Resident. In 2003 she completed a fellowship in Reproductive Endocrinology and Infertility at the National Institutes of Health.
An experienced researcher, Dr. Murdock has contributed to numerous peer-reviewed studies and presented at several of the most prestigious conferences in the field of reproductive medicine. The focus of much of her research has been on estrogen receptors, hypothalamic neuron function, and precocious puberty.
Dr. Murdock is a member of the American Society for Reproductive Medicine and the Society for Reproductive Endocrinology and Infertility, as well as a Fellow of the American College of Obstetrics and Gynecology.
Dr. Murdock was previously an assistant clinical professor at Creighton University School of Medicine and a staff physician with Reproductive Health Specialists at Nebraska Methodist Hospital. She has also served as an Assistant Professor of OB-GYN at the National Naval Medical Center and Walter Reed Army Medical Center.
Savasana is final relaxation pose in a yoga
practice. A deeply quiet place where all the outer layers of who you are peel away. What you do for a living, how you spend your time, what you own, how much you weigh, even whether you are a parent; all melt away to reveal to you the essence of who you are.
You are not infertile. I am not infertile. I am Lisa. Some of you have been making your name known to me; none of you are "infertile". You each have your own name, and you are each a unique person. We are not our diagnoses. That's what a friend said to me today, as a response to yesterday's blog, "we are not our diagnoses". What a good reminder, thank you.
We will live in this space of trying to conceive for a time period. Sometimes it feels like it will last forever. Oh, like waiting those two weeks for the results after a cycle. Or getting blood drawn and knowing the phone call is coming with a "yes, you are" or "no, I'm sorry, you're not". Or yet another month of getting your period when you are so hoping not to.
It actually will not last forever. Life is not designed that way. One way or another, you will have resolution around becoming pregnant and having a baby. There are many different ways that resolution is reached. It may not be the way you expect or want. Already, it's been pretty tough, hasn't it? I love our practice, our doctors, nurses, clinicians. Still, not what you envisioned when you pictured creating a child. No matter where you are in treatment, it will have a time limit on it. And you will be in a different place. You will still be that essential you, separate than your diagnosis.
So spend some time with a spectacular person this holiday season. Yourself. Find a way to inhale deeply, coming into yourself. The season can be so busy, so full of things that must be done and need our attention. In yoga, we refer to that as our exhale. The inhale is necessary to replenish, refresh and renew. Similar to what the earth is doing. Bringing energy inward so that it can burst forth in the spring; the earths exhale.
You are worth it.Inhale.
When I speak to my Fertile Yoga students, (many of whom are patients in our practice) I am reminded again of how perspective is skewed by the observer. The old tale of "seeing" an elephant by touching his tail, foot, trunk or belly. Each of those body parts will give a vastly different idea of what the elephant truly is, physically.
Here's what happens in doctor's offices across the world. Yes, world. I will stick to the infertility arena since that's the one I know. A doctor gives a comprehensive explanation during a consultation about (infertility treatment, IVF, IUI, pregnancy success rates, third party reproduction, diagnosis, fertility test results, etc.) and feels satisfied that he/she has covered the information in an understandable way. They have taken the time to explain in a non-patronizing, well measured way.
Here's what the patient has heard. Blah, blah, blah...
If you are a patient in infertility treatment, you know what I mean. Your doctor tells you something that you perceive as bad news. Might not even be bad news, but it doesn't sound good. Even infertility words are scary- IVF failure, hostile mucous, diminishing ovarian reserve, poor or low responder. We hear these words and we shut down. Our physician has gone on to explain what they mean and we are stuck hearing the words reverberate in our head. We feel anxious and upset and can't even explain why. We heard something that sounded like bad news and were unable to follow the rest of the conversation. We may look like we are, we may ask questions as if we are hearing the information, but often, very often, we aren't.
How do we avoid this disconnect? Our doctors are doing just what they should. They need to be able to give us information and use the language of infertility, it makes things understandable. How do we hear past that possible bad news?
A few suggestions. Take a pad with you, write down the questions you have before your appointment. Leave space after the questions. Write down the answers while you're in the appointment. Ask your doctor to slow down or repeat something if you need to. While you're at it, take someone with you to your appointment. Someone who can either write down the answers or just be a second set of ears to guide you through a replay when you leave the office. During the appointment, write down questions as you have them. Write down the answers. After the appointment, write down questions that you may have missed. Email or call and get the answers.
Make sure that you understand what you are being told. Make sure that you ask the questions that you need to make things more clear if you do not understand. Keep in mind that this is what your doctor and nurse want for you. They want you to understand.
You see, I also get to speak to the doctors, the nurses and the patient coordinators at RMACT. They do want you to understand, it upsets them if they think they are being unclear. They care that you understand your fertility treatment, diagnosis and prognosis.
So whether you are touching the elephants' tail, trunk, leg or belly, there is still one whole elephant when you open your eyes. It helps to see even more when you walk around the elephant and put it all in perspective. So ask your questions, find your answers. Make sure that you are seeing the whole elephant.