life, love, and maybe babies

Wednesday, August 13, 2014

Inside Out: My Super Awesome Experience with an Endometrial Biopsy

Warning: this post is a little graphic.

Getting poked and prodded and tested and evaluated is an annoyance and necessity that infertile and sub-fertile women endure. We put up with it and allow it because it is a means to an end that we so desperately want - but that doesn't mean it's fun.

As a woman who began testing for potential issues during the last year, I'm pretty far into the procedures. For those of you who haven't gone down this path just yet, allow me to enlighten you on a few of the joys you might get to experience.

1. Blood work: Lots of it. Lots and lots and lots of it. Get used to your arms looking like they belong to a recovering heroin user.

2. Transvag ultrasounds: A penile-looking device goes up in your lady parts while the nurse looks around for your ovaries, uterus and her lost car keys. You'll watch it on a screen and it won't make any sense. The tech will say, "See? That's your uterus." And you'll be like, "Ummm. Where? It looks like blankness."

3. HSG - Basically the doc shoots some weird purple dye up your vajayjay to see if anything is blocking your Fallopian tubes. Oh look! There's a blockage! Let's increase the velocity and speed of the dye to see if we can get that puppy out of there. It's basically like when you dump Drain-O down your bathroom sink. Except in your vagina...

4. Hysteroscopy: This is just a bundle of fun. Doc puts a thingamajig (also called a hysteroscope) way up through your cervix and into your uterus. He then shoots some gas up there to expand the uterus so he can look for polyps, fybroids, etc. After a few seconds he pulls everything out and you're done. But remember the gas he used? It needs to escape. So it slides up into your shoulder like a sadistic snake and you feel like you're having a heart attack for about 20 minutes. Wheeee!!

5. Endometiral Biopsy - This one requires a more in depth explanation. Mostly because I just had mine last week. My hands are shaking just thinking about it. Let me tell you what happened.

We recently began infertility treatments at a clinic in Colorado. Most of you probably know which one I'm talking about. (I don't know if I should say their name, so I won't. Even though they're awesome thus far.) Hubs and I went in for our one day workup, which consists of a round of baseline testing. Once completed, we did have a small list of tests that we needed to have performed back home. One of those tests was called an E-tegrity test. In plain terminology, this is a uterine biopsy. The biopsy is sent to a lab and the lab then looks at your sample to see if your body is producing a certain protein that helps the fertilized egg implant. If you don't have this particular protein present, it could be one of the reasons pregnancy isn't happening.

The hardest thing about this test was finding someone who would actually do it. I called my OB, I called my prior infertility one knew what the hell an E-tegrity test was and refused to do it. After I made about 20 calls, I discovered that I was asking for the wrong thing. All your doc needs to do is an endometrial biopsy (which is a relatively standard procedure) and the E-tegrity part is just the test the lab does on the sample.

Are you following? It's okay, it doesn't matter anyway.

The long and short of it is, I finally found a doc who agreed to do it. I scheduled the appointment and that was that. Hubs asked if he needed to be present and I seriously considered asking him to come. However, I had done my homework. I read up on endometrial biopsy and the general consensus was, if you can tolerate some mild cramping (similar to an HSG) for about 10 minutes, you're golden. Incidentally my HSG was minorly awful, but I survived it, so I knew I could handle this solo. I told Hubs to skip it.

The day of the test arrived. I checked in and was led back to an examination room. A moment later, the nurse practitioner arrived and basically said, "Okay, what exactly are we doing again? I'm confused."

I re-explained that I just needed a uterine biopsy and the sample would then be sent to a lab where the test would be performed. She looked confused but ultimately seemed to understand. And so we began.

I assumed my favorite position and waited. The nurse informed me there would be some cramping as she got that little catheter through my cervix. No biggie, I'd had this done several times. I waited for the cramping and it showed up quickly. And then it got more intense. And more intense. 

I teared up a bit.

Thankfully, a moment later it was over. Until the nurse hit me with, "Um, don't get excited. I didn't get through. I only made it about half-way through your uterine wall...I need to get all the way through. Let me try again."

So she did. Three times. Pain pain pain. No luck.

At this point she enlisted the help of an actual doctor. When he came in, he explained that there could be an issue with the way my uterus was sitting. Would I mind if he kind of twisted it around and moved it?

Sure. Play tinker toys with my insides, doc.

He pulled, he clamped he yanked. I prayed to any God that would listen to make it end. Eventually he said he thought he had a better angle to get where he needed to get and do what he needed to do. So it was time to try again.

He tried 5 times without success. At this point, I heard the nurse say, "Okay, honey, we're going to try and stop the bleeding and then come up with a game plan to see what we might try next."

By all means, please stop the bleeding before anything else.

I sat up and doc told me in no uncertain terms, he couldn't get through the uterine wall. Would I consider returning tomorrow or Friday? He may as well have said, "A serrated knife doesn't seem to be working for removing your head. Could you come back on Friday and we'll try the guillotine?" 

Here's what I knew in my heart. If I left that office without the test being completed, I was never going to come back and I might possibly even burn the building to tiny little ashes and wee wee on them. It had to happen now or never. The doc and nurse quietly consulted with each other, used a bunch of terms I didn't understand, and finally came up with something.

"How about this?" Doc sighed, running his hands through his hair. "If we take you over to a room where we can do a sonogram, I might actually be able to see what I'm doing, and it could help. Would you be willing to do that?"

At this point, I was willing to do anything if it meant this awful process could be over. I got dressed and the nurse led me down the hall to the sonogram room. Same drill. Bottoms off, assume the position.

Doc came in and informed he would begin by clamping my cervix so he could hold it still. 

"I'm sorry, did you say CLAMP?" I asked, incredulous. I hadn't heard the word clamp since my 9th grade shop class.

"Yes, I know," he replied. "But if I can hold it still, it will help me out."

Fine. Whatever. Do it. 

The sonographer put the goop on my stomach and suddenly,up on the TV were my insides in all their HD glory. I felt him reach up and grab my friggin' cervix and I felt the clamp. So fun. Then on the screen, I saw the little catheter appear and I watched as he tried to get it to the correct spot in my uterus. With the help of the sonogram, he was able to very quickly determine where he was being blocked and bent the catheter around the trouble area. Bingo. He was in.

I thought that was it. I thought it was over. No no. Not even close.

If you read this website, it will give you a clinical explanation of what has to happen next. I'll give you layman's terms: he puts a friggin' wire through your uterine wall, roots around for a few seconds, rips out a sample of the LINING OF YOUR UTERUS, then pulls the sample out.

I didn't know what to expect, but when that wire went in...I swear I can feel it right now all over again.  All I saw was light and stars and red and blue and green and pain. The kind of pain where you can't even make noise. You just gurgle and basically have a full body seizure. I might have kicked the doctor in the face. I know I practically broke the sonographer's hand.

I felt the wire retreat and the pain began to subside. Through tears, I sniffled, "Please tell me that was it. Please." 

I didn't get an answer. I know now it was because the doctor didn't get a large enough sample. He needed to go back in but didn't want to tell me.

And so he did. 

The pain hit again and this time I really thought I saw the other side. The light everyone talks about in near-death experiences. I think I saw my grandfather. He was smiling. 

Actually, turns out it was just the doctor standing over me and telling me it was all over. He patted my hand and apologized for going back in, but thought it would be better to ask forgiveness than permission.

I won't like to you, I wanted to rip his man parts off. But I didn't, because I can't get pregnant if I'm in jail. Besides, it wasn't his fault. He did what he had to do...but I still kind of hate him.

The nurse gave me a pad to catch the inevitable blood that was going to occur, told me I was a brave girl and sent me on my way.

I made it all the way to the car before I had my meltdown, and for anyone in the parking lot that day, I'm sure it was quite a show. I couldn't help it. The physical pain was gone, but I was mentally and emotionally exhausted. I just couldn't take it. I cried for at least 10 minutes before I had the strength to dial Hubs' number and tell him everything. Of course, he felt terrible for not being there for me. Personally, I'm glad he wasn't there. No one wants to watch their spouse go through pain and suffering, even if it is only for a few minutes.

From the hospital, I drove straight to my favorite Mexican food place and got the largest cheese dip they offered, complete with a huge vat of Dr. Pepper. I came home, crawled under the comforter and didn't move for the rest of the day. 

I'm not telling this story to scare you. I could have been a rare case. I've talked to other ladies who just experienced that "mild cramping" the internet promised me. I've heard other women say their doctor let them have VALIUM before the procedure. (I want that doctor next time.) More than anything, I want you to know that I take pride in my experience. As women, we're often told we're wimps, whiners, not tough. Well, I challenge any man to have a needle stuck up his swizzle stick over 9 times and just "tough it out." Ladies, we are unbelievably strong. We are emotional and physical warriors to put ourselves through all of this for the CHANCE that we might get a baby out of it. There are no guarantees and it might not all work out. But that fact that we are willing to try is amazing and it should be celebrated. With lots of presents. :-)

Don't be afraid to say it hurts. If you need to cry, cry. If you need to yell, yell. Don't try and tough it out. That causes wrinkles and constipation anyway. This isn't easy. And just a hunch, but I don't think it's going to get easier for me anytime soon. IVF doesn't sound like it's going to be a walk on the beach with a mimosa in my hand. It's going to be hard. But dammit, I can do it. I will do it.

And it's so going to be worth it.

PS- I still don't have the results back on my biopsy...stay tuned


The Purple Guru said...

Wow - I thought my HSG experience was horrific! You don't say how bad yours was but I had a similar amount of faffing around up there and a lot of pain. And I felt exactly the same about my hubby, he'd wanted to come in the room when I had my HSG done and I thought about it and ultimately decided I didn't want him in there. Initially because I thought I'd be fine, but afterwards because I was glad he hadn't seen me in so much pain. I will keep everything crossed I don't need a biopsy at some point as well. Thank you for yet another brilliant post.

Kim said...

Don't get me wrong, my HSG was awful as well! I certainly don't want to repeat it anytime soon. But yes, this was vastly worse.

Thank you for following along with my story. I'm glad you enjoy it!

goddessoflubbock said...

OMG I cried reading this! I was supposed to have the same thing done just the other day. (For different reasons, I'm 52!) The dr ended up being unable to find my cervix (oh yeah I have issues...) so it's getting done under general next week.

In the attempt however there was up to 6 people in the room, some holding my legs airborn, others manipulating my uterus through my belly.

I regret making my husband come in with me. He's been to everything as I'm disabled and he helps me but this was too much. Ugh. The stuff we deal with.

Much luck on your journey.

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