By Royalyne

Why would you be having laparoscopic surgery?

Laparoscopic surgery (often referred to as “lap”) is the only real way to diagnose endometriosis. Your gynecologist or even family doctor may have made an assumptive diagnoses based on your symptoms, but a true diagnoses can only be made when the endometrial adhesions are seen. The description of the surgery (-scopic) suggests that the doctor intends to merely look and see if adhesions are present, but once adhesions are found they are removed during the same procedure. Endometrial adhesions are most frequently found on the ovaries and fallopian tubes, but may be present anywhere in the abdomen. Endometriosis on the ovaries can form cysts, called endometrioma.

What you can expect

You will need somebody with you, whom must remain at the hospital throughout your procedure to drive you home.

Each hospital will have its own standard operating procedures (SOP), I can only write from my experience, using the SOP of my hospital. Your lap will be performed in a hospital by a gynecologist as an outpatient surgery. You will be placed under general anesthesia for the procedure. You will be asked to follow their standard pre-op procedures, such as fasting the night before. Beforehand you will have an IV started and provide a urine sample for a pregnancy test. The doctor will brief you on his/her plan for the surgery and what will be done if adhesions are found. The anesthesiologist will also speak to you about the anesthesia that will be used and the endotracheal tube (the breathing tube they put in). A few minutes prior to being moved to the operating room you will be given a shot of a medication in the category benzodiazepines, most likely midazolam (brand name- Versed). This medication is a relaxant and also an amnesic (reduces your memory of events while on the medication). You may begin to feel drowsy and “stoned,” which is normal for this medication. Once you are in the operating room and transferred to the operating table, additional medications will be administered and once you are completely unconscious a breathing tube will be placed in your throat.

A small incision is made in your abdomen to facilitate the insertion of the laparoscope. There is a camera on the laparoscope that allows the doctor to see your internal organs without making a large incision. Another incision, this one much smaller, is made to allow a tube to be inserted. Sterile air is pushed through this tube into your abdomen. Once your abdomen is inflated, the doctor can see the entire area much easier and access areas that would have otherwise been blocked from view. The doctor will basically look around for anything out of the ordinary. Endometrial lesions and endometrioma will be removed with a laser, but also shifted ovaries can be returned to the correct position and anchored, and likely many other beneficial procedures. The doctor will take many pictures, both before and after shots, for your patient file.

Once the surgery is complete, the air is released and your abdomen deflates. The incisions are sealed externally with glue, probably stitches internally, but for the life of me I can’t remember what they said (that darn Versed). The breathing tube is removed and a medication is administered to slightly reverse the affects of the anesthesia. You will be moved to the recovery area until you become more fully conscious, and then returned to the outpatient area that you started in. The doctor will then come speak to you about the surgery: what was found, what was done to treat it, your prognosis, etc. You will be given a prescription for painkillers, and if you are in pain (anesthesia is very much different from painkillers) you will be given a dose of the medication prescribed. Once you are able to sit up and feel ready to leave, you will be taken by wheelchair to the car.

You will be under restrictions for 2 weeks following your surgery. Abdominal surgery requires cutting abdominal muscles, and the abdomen is your core, it is used when moving almost any part of your body. The restrictions are in your best interests, and in the best interests of your healing body.

Problems that may arise and ways to troubleshoot

You may notice pain or cramping in your neck, shoulders, or upper arms for a few days following surgery. This pain is a result of the trapped air from the inflation of your abdomen. Some air gets trapped and is not released when your abdomen deflates. This air “floats” in your body, moving to the highest part of your body. Lying as flat as possible, or with your legs elevated will disperse this trapped air, spreading it out and not allowing it to concentrate in one area. The air is gradually absorbed into your blood stream and released within a few days. A way to encourage that absorption is a heating pad and/or massage. When the area has a greater blood flow the trapped air is absorbed faster.

As with all surgeries, your incisions are very important. If they become more painful, red, swollen, or begin producing a discharge, see your doctor immediately.

My personal tips

My procedure took an incredibly long time due to the amount of adhesions I had and where they were located (one ovary was ripped from its proper location with an endometrioma, minor adhesions on the bladder, lots of adhesions everywhere), but was not difficult at all. When I was awake, though, I did notice an odd taste in my mouth (from the breathing tube) and my mouth felt incredibly dry. Be sure to have a nice cool bottle of water nearby once you get home (or for the drive if it’ll last longer than 10-15 minutes).

The person who drives you should be somebody you trust enough to have with you when the doctor comes to give you the post-op report. You will likely be very groggy (I don’t remember seeing my doctor afterwards, but I’m told he was around for 10-15 minutes telling my husband about everything). This person should also be taking notes, because you will want every detail and their memory may not be perfect enough for your liking if they don’t write it all down.
The trapped air was my biggest complaint afterwards, and the painkillers I got (darvocet) did nothing for that pain. Apparently the main use of darvocet is for incision pain, of which I had almost none. Needing darvocet was my downfall, but I’m allergic to vicodin (apparently their drug of choice post-surgery). I ended up taking either Tylenol or Advil liquigels for the air bubble pain, whichever was closest to the couch. My husband was nice enough to give me twice-daily shoulder rubs and keep my microwavable heat pad nice and warm for me. The pain lasted 3 days, including the day of surgery, but after the second day it was more like the pain of an overworked muscle.

My main incision was less than an inch long, inside the bottom of my belly button. It felt like a cat scratch, and within a week I didn’t feel anything at all. The second incision was un-located for 2 entire days, as it was located below the pubic hair line and caused absolutely no discomfort. The only time I had any pain in my main incision was during the process of changing positions (i.e. sitting to standing and its inverse, rolling over, etc.).

Don’t wear a belt for a while, especially one with a big, cute buckle. Pressure on that navel incision is not a good idea; it hurts. All of my pants are low-rise, but sitting down or bending over with a belt on pushes the buckle right into that incision.

Restrictions exist for a reason. You use your stomach to wiggle your toes and pick up your head off the pillow, and just about everything else. The 20lb lifting restriction extends to the vacuum cleaner, even if you’re just pushing and pulling it across the carpet. Take advantage of your restrictions, they really are in your best interests. I was back to basically my normal routine about
4-5 days after my surgery, except for strictly following the restrictions. Once my restrictions were lifted I had no problem going back to that routine, including shoveling 2 feet of snow in my driveway. You know your body best, you know how slowly to ease into things once the restrictions are lifted. But don’t rush the restrictions, they were put in place by somebody who has seen your insides, and if you trust them enough to let them cut you open you need to trust their judgment on restrictions as well.

Metformin (or Glucophage) for polycystic ovararian symdrome (PCOS)
by Kelly

Why would you be taking metformin or glucophage (metformin is the generic for glucophage)

Metformin is a diabetes medicine used for lowering insulin and blood sugar levels in women with polycystic ovary syndrome (PCOS). This helps regulate menstrual cycles, start ovulation, and lower the risk of miscarriage in women with PCOS. It is generally used in conjuction with clomid.
The most common side effects of metformin

Nausea.
Loss of appetite.
Diarrhea.
Increased abdominal gas.
A metallic taste.
Tiredness.

Problems that might arise and ways to troubleshoot

I have always had pretty strong side effects (lots of nausea and always very tired) while taking metformin. It does get better as time goes on but working myself up to the maximum dosage has always been hard.

I’ve been to a number of different doctors who have all suggested different ways to work up to my maximum dosage (1500 mg). It is generally suggested that you start with the lowest dose and keep increasing it as you get used to it (or as the side effects start to go away). The first time I took it, I took 500 mg for about three weeks (1 pill in the morning). Then added a second pill at lunch time (so I took 1000 mg for 3 weeks). And, then I added a third pill at dinner time.

The second time that I took metformin, I increased the dosage from 500 mg to 1500 mg over the course of three weeks. I was sick a lot but I feel like I got the worst part over with faster.

My personal experience has been that it usually takes me about 1 month for the side effects to start to lessen. I will still have bouts of nausea, but after about 2 months that starts to happen less often.

My personal tips

Always take with food or a glass of milk – I always take my metformin when I am eating either breakfast, lunch or dinner.
I have heard from others that following a low carb diet helps with the side effects (I personally haven’t found this to be true – or maybe I just couldn’t follow the low carb life).
When increasing your dosage, just increase it as you feel ready.

Amniocentesis
by Edenland

Why Would you be Doing an Amniocentesis?

Amniocentesis is a medical procedure performed on a pregnant woman to withdraw a small amount of amniotic fluid from the sac surrounding the foetus. By about the 16th week of pregnancy, the developing baby is suspended in around 130ml of amniotic fluid, which the baby constantly swallows and excretes. The goal of amniocentesis is to examine a tiny amount of this fluid to obtain information about the baby – including its sex – and to detect physical abnormalities such as Down’s syndrome or spina bifida. Amniocentesis is only performed on women thought to be at higher risk of delivering a child with a birth defect.

What You Can Expect

I got talked into having a nuchal test, when I was 12 weeks pregnant. I didn’t want to, but the midwife looked up at me and said, “If I were your age, I would do it.” I was thirty-frickin-five, but you’d think I was 90, the way she carried on. So I did it, and the initial scan looked fine. I thought nothing more of it.

I had done IVF/ICSI to get pregnant, due to my husband having a vasectomy after the birth of our first child. This was a long pined for, long awaited for, pregnancy. I had JUST started to get happy about it when the phone rang a few days after my nuchal …..

1 in 173 chance my baby had Downs Syndrome.

My bloodwork alone came back at 1 in 30 chance. I tried to not let it worry me, but it WORRIED ME. I had to wait a few weeks, to do an amnio. I knew I had to do an amnio, because I could not panic like this for the rest of my pregnancy. I was so so petrified of the actual procedure, the needle puncturing the sac. It was wrong. Sometimes, we have TOO many tests available to us. Sometimes, ignorance is bliss.

I took a friend down with me, to hold my hand. She had gone to the same doctor for her amnio a year before. Her baby was in the pram, and gave me hope that all might turn out ok. The doctor had a thick Scottish accent and called me “lass”, in such a tender way that it killed me. The doctor likened doing an amnio procedure to “trying to stab a fish in a bucket with a blunt stick”. I found this disturbing, until I realised he was trying to reassure me that it doesn’t hurt the baby … the needle won’t poke it.

It was awful, but over very quickly. It took two tries, as he had to get enough fluid for the test. Some women I spoke to beforehand didn’t bat an eye about doing an amnio, some had huge concerns, like me. The needlemark in the amniotic sac closes over and heals, we would have definitive results, and all shall be well in the world. I limped around, so scared of miscarrying until about a week afterwards.

I paid a couple of hundred bucks to get the results fast-tracked and the doctor rang me back the next day, telling me that everything was fine with the baby and there were no signs of Down’s Syndrome. As soon as he said this, I realised I had known this all along, but I had gone against my instincts and got a bit bullied into tests and procedures I didn’t really want to do. I was angry for a long time, which was useless really. The baby was fine and that was the most important thing.

I urge anyone to trust their own instincts. It’s hard to say if I would have my nuchal test over again. If anyone is reading this and facing their own decision about whether to have an amnio, only you can decide. It was a great feeling, to know that the baby was fine, but it caused me a lot of angst. If the baby had Down’s syndrome, I would want to know. I might have chosen to not go ahead with the pregnancy, I might not have. I’ll never know.

Personal Tips

Take someone with you during the procedure, as it’s not a good idea to drive afterwards. Talk to other women who have had an amnio. Try to go home and go straight to bed.

All the numbers and odds and statistics can be quite confusing. Remember that you – and your baby, are more than a number. Before the baby was born, my husband got diagnosed with cancer, a mass of extremely aggressive tumours were found in his stomach, courtesy of Non-Hodgkin’s Lymphoma. He had to go through six months of intensive, soul-destroying chemotherapy. He is now in remission. His chances of the cancer coming back is 1 in 4. We think those odds are fantastic.

Hysteroscopy
by T

Why Would You be Doing a Hysteroscopy?

Hysteroscopy, when your cervix is dilated and a small set of surgical tools is inserted into the uterus, is usually recommended when your doctor has noticed something strange during an HSG or saline sonogram. Sometimes both these tests are normal, but other issues (pregnancy loss, bleeding, IVF failure) may indicate hysteroscopy. Hysteroscopy allows your doctor to envision the uterine lining using fiber optics, after pumping the womb full of sterile air or fluid. She can then easily detect any irregularities. Septums, uterine polyps (benign overgrowths of the lining), and some fibroids can be carefully removed. Hysteroscopy is considered the gold-standard treatment for growths like polyps, which are too often missed during blind D & Cs.

What You Can Expect

Depending on where the procedure falls in your cycle and why it’s being done, you may be prescribed birth control pills to keep your lining thin and make it easier for your doctor to figure out what’s going on. I was able to schedule mine for early enough in my cycle to avoid this.

Most hysteroscopies are performed as outpatient surgeries under general anesthesia. This means you will need someone to take you to and from the surgery, and you will have to fast. Make sure you understand exactly what’s expected by the particular surgical center, as they often have varying protocols.

If, like me, you are scheduled for an afternoon slot, chug as much water as you can right up to the midnight cut off. Also, it’s good to avoid any anesthesia-related regularity issues by taking a stool softener and/or eating ample fiber in advance. The cramping post-procedure can make constipation a real downer, to put it mildly.

Once you’ve arrived at the surgical center, you’ll have an IV started and may be given a pregnancy test. After your doctor and anesthesiologist have spoken to you briefly to review what’s about to happen, you’ll be taken into the operating room. A few seconds after the anesthesiologist administered a drug into my IV, I was out like Rip van Winkle. Depending on the timing, your doctor might speak with you or your companion about the results of the procedure. In my case, my husband got the report, as I was still down for the count. If you think you’ll have questions that your companion won’t think to ask, write them down.

Though hysteroscopies do not involve any incisions, the dilation and activity in the uterus do lead to unpleasant cramping, pain, and bleeding. I was given naproxen (Aleve) to take for the cramping, as well as hydrocodone for pain. Even if you think you won’t need them, fill these prescriptions ahead of time if possible. The cramping may not start right away, but it will come and you’ll welcome the relief.

Though you’ll likely get a pad from the center to deal with the bleeding, I brought along my favorite kind, just for comfort’s sake. You may also want to wear comfy clothing like a loose dress or sweats and take a cardigan, hoodie, or other cozy wrap to keep you warm before and after surgery. Bring your favorite pillow to keep the pressure of the seat belt off your belly for the ride home, and snacks for the trip home like juice, yogurt, and water. Stock up beforehand on some tasty, nourishing, fairly bland and soft comfort foods for the evening after surgery. Some gals even suggest throwing a little get together, though I personally was content to sprawl on my pillows and watch DVDs.

After a few days, you’ll likely be feeling pretty good, if not completely back to normal. If you can manage it, take it easy the day of and the day after the procedure. Get some good books, good movies, treats, and take really good care of yourself. You may have some spotting or bleeding for a few days afterward.

Ask your doctor before you go under about post-op follow up, signs that you need additional medical assistance, and how long you should avoid tampons, sex, and any other cervical annoyances. Though I can’t recall getting specific instructions, some online research showed that two to three weeks of pelvic rest was best. Anything removed from your lining will likely be sent to a pathologist for testing, though malignant growths are extremely rare in pre-menopausal women. Though some women have mentioned that they’ve had unusual periods following the procedure, I only noticed that mine was a little later and lighter than usual.

Personal Tips

We discovered that I had polyps thanks to a saline sonogram, after a normal HSG. Polyps were suspected in my case because of luteal phase spotting. If you have persistent, regular spotting but a normal HSG, get a saline sonogram just in case. It may give you additional information, and it’s basically painless compared to the HSG.

I combined my hysteroscopy with a laparoscopy, an increasingly common diagnostic combo in infertility. This two-birds-one-stone approach seemed to work very well: I was already out cold, and my doctor could give us the full picture of my pelvic and uterine health, thus increasing my peace of mind. In the end, three small benign polyps were removed, and two spots of endometriosis blasted with a laser. The entire procedure took less than an hour, all told.

With the addition of the lap, I had more pain than you normally would with hysteroscopy alone, due to the incisions and the gas used to inflate the abdomen.

Rest is the most important part of recovery. I slept and lounged my way through two days, when I started to feel much better and no longer needed the pain medications. Any friends or family willing to contribute meals and keep you resting should be heartily encouraged. The more you sleep now, the better you’ll feel in the long run.

Written by Carolyn

Why Would You Be Doing Acupuncture?

In general terms, the purpose of acupuncture is to reconnect the flow of chi through the meridians of the body. When part of the body becomes blocked, chi builds up and is unable to flow to other areas of the body. The needles used in acupuncture can help unblock these chi stoppages and reconnect the flow of energy all over the body. Acupuncture has been practiced in Asia for over 2,000 years and is practiced all over the world today to help treat a variety of medical conditions including infertility.

Specifically, acupuncture is believed to help stimulate blood flow to the reproductive organs (in women and men) and aid in balancing hormone levels. Thus, acupuncture is more helpful for patients with functional fertility problems (such as hormone imbalances) than structural problems (such as blocked fallopian tubes). Regardless, acupuncture can also help as a relaxation aid, especially when a patient is going through a stressful medical procedure such as IVF.

Acupuncture can be done in conjunction with other infertility treatments or alone, and is frequently accompanied by herbal treatments prescribed by the acupuncturist.

What You Can Expect

**This is my experience with one acupuncturist. I didn’t have many appointments, and I’m sure that other acupuncturists will do slightly different things than mine did. I don’t have experience using Chinese herbs, which many acupuncturists instruct their patients to take. Nonetheless, I hope this and any comments that follow will give you a reasonably good idea of what to expect when doing acupuncture to help with fertility.**

Your first acupuncture appointment should be on the longer side—mine was around 90 minutes. The first 20-30 minutes were spent filling out a medical history form and talking with my acupuncturist about what I wanted to achieve during our sessions. After that, the acupuncture itself lasted 45-60 minutes. Later sessions should also be around an hour.
Your acupuncturist will ask you to remove your pants/skirt and possibly your top. If you’re uncomfortable removing your shirt, I suggest wearing a loose tank top or cap-sleeved blouse. Comfort is essential—the chi can’t flow if you’re too tense. Ask for a blanket or sheet if you’re cold.

If you’re squeamish about needles, close your eyes as the acupuncturist puts them in. Each needle is sterile and for single-use only. Some you may not even feel, others can be uncomfortable for a minute or two. Try to relax. Your acupuncturist should tell you where he/she is inserting the needles and what each is intended to do. Each needle is tiny and very, very thin. These aren’t like the needles you use to do an injection!

Depending on your body and energy, the needles may hurt, tingle, or give you a “swirling” sensation at the insertion site. If they hurt, make sure the acupuncturist knows, so he/she can reposition the needle more comfortably. I typically had one needle in my forehead, one in each arm, two on each hand, one or two in my belly, and several on my legs and feet.

After the needles are inserted, the acupuncturist typically puts on some soothing music and leaves the room for 15-20 minutes. This is a good time to focus on your mantra or some inspirational quote/imagery that will help you to relax and focus on your chi. I found that doing a body scan was very helpful in determining where I still had chi blockages and where the needles were really working.

The acupuncturist should come in again and shift the position of the needles to “stir” the chi before leaving you alone for another 15 minutes. Again, try to meditate or use your mantra/imagery. After 15 minutes are up, the acupuncturist will remove the needles and talk to you for a minute about how you’re feeling. Get up as slowly as you need—I was usually a little dizzy after a session and needed a minute to re-orient myself.

Reactions to acupuncture really vary depending on the person. I found that immediately my periods became heavier and shorter. I was also more energized and focused in the days after a session and was more relaxed during medical procedures.

Here Are Some Problems That Might Arise

Quite a few doctors still don’t believe that acupuncture is a valid way to assist in treating infertility. You may encounter resistance from your RE, but it’s important to tell all of your doctors that you’re doing acupuncture. Some acupuncturists also prescribe Chinese herbs to assist in conception. Mine didn’t, but I would strongly advise you to research these herbs on your own and speak with your physician before taking them.

On a random note, blood banks treat acupuncture the same way they treat tattoos and piercings. If you’ve had a session in the last 12 months, you can’t donate blood. This isn’t a problem for most people, but something I discovered when I went to donate blood a few months after my last acupuncture appointment. Some blood banks will allow acupuncture patients to donate blood if the acupuncture has been performed by a licensed doctor.

Personal Tips

Ask questions, ask questions, ask questions! Finding the right acupuncturist is the most important step. Get referrals from anyone you know who has used acupuncture for fertility. Search Internet message boards if you don’t personally know anyone who has done it. Finding an acupuncturist is easy, but finding one who specializes in helping infertile patients conceive can be difficult. Do your homework. Once you’ve found an acupuncturist, “interview” them during your first appointment. Make sure that your personalities click. This is a person you’re trusting with your reproductive health, so make sure that you trust them as much as you trust your doctor. Like your doctor, your acupuncturist should know all medications you’re taking, medical procedures you’re undergoing, and have emergency contact information for you in case something unexpected happens.