hydrosonogram – The Great Pudding Club Hunt

I have been told by several doctors that I have a beautiful cervix, and today I discovered that my uterus is just as “gorgeous”. Well these were the exact words of my Reproductive Endocrinologist (RE)!!!

Today was my hydrosonogram (also known as a Saline Infusion Sonogram). This procedure was the final test I required prior to our IVF treatment. The hydrosonogram is a procedure where the doctor inserts a catheter into the uterus and injects saline into the uterine cavity whilst performing a transvaginal ultrasound. The water shows up as dark black on the ultrasound against the white endometrial lining. This allows the doctor to look for smooth edges of the uterine cavity. If the ultrasound shows an edge that is not smooth then these rough and lumpy edges maybe polyps, fibroids or scar tissue which could be a possible problem for embryo implantation.

The procedure in itself was an interesting experience. Greedily, I had three doctors in the room as well as the nurse! The three doctors were: my RE, the doctor whose name I can’t pronounce and performed two of my IUIs, and one of the male student doctors Chris conversed with at our last IUI. I wasn’t quite sure if my RE was overseeing the procedure, or she had called in the other doctor because she was more familiar with my cervix and therefore inserting the catheter. Either way, there were a lot of people clambering around my vagina in this one tiny examination room. It was rather amusing.

First the doctor with the unpronounceable name inserted the speculum, and then peered up from between my legs and showed me the ‘flexible’ catheter and said, “remember this? Was it this one we used before?”. Ummmm….. “I think so??!!!” I replied. How am I supposed to know these things???! When she inserted the catheter I could hardly feel it at all. The speculum was removed with the catheter still in, and then she inserted the vaginal ultrasound ‘wand’. We could see the catheter on the screen, there was a lot of excitement amongst the doctors. The nurse was tying to hold something in whilst the two female doctors discussed tactics of why it wasn’t distending with the saline, perhaps the catheter was up against something, my uterus wall…or perhaps it was bent somehow. Either way, when they removed the magic wand, the catheter came out. They apologised and said they would try again. So back in the speculum went (this was only the painful part, no different to a pap smear), the catheter went back in, speculum was removed, magic wand went back in. And there was a gaggle of excitement as this time it had clearly succeeded; the saline filled the uterine cavity and I could quickly see there was a nice oval shape, with no rough edges on the screen. My RE told me my uterus was “gorgeous!”. She took a few shots on the screen, and showed me in 3D my uterus. With this image it actually looked more like a normal shaped uterus that you see in biology books rather than what I saw on the screen during my HSG x-ray. You can see from the image from my HSG below that it was upside down. Today’s ultrasound, it was the right way round and looked almost perfect. Text book.

My HSG X-ray with my retroverted uterus (it’s hard to see because it’s hiding behind the catheter)

I don’t have a copy of images from my ultrasound from today, but I have found a link that shows the difference between a normal and abnormal result from a hydrosonogram.

After all the excitement and the nurse had cleared everything up, suddenly my RE exclaimed! “Wait! I need to see her ovaries so I can calculate her dosages!” So back in the stirrups I went and the nurse re-prepared everything for another peek inside using the magic wand. We had a very quick look at my ovaries to count the number of follicles. As today is Cycle Day 7 I had about 5 or 6 follicles in the right ovary and then a dominant one in my left. She seemed pleased with this. I mentioned that I knew it was going to ovulate from the left his month because I could feel it. I can always feel pain in my ovary on the left side when I’m ovulating from this side. I’m not sure why. The doctor who’s name I cannot pronounce seemed very interested in this fact. I left wondering why.

All in all, I left with a sense of relief. But my feelings were mixed. I was relieved that we can still proceed with IVF and there was nothing seriously wrong that would require surgery, but I had the feeling of frustration. In the back of my mind, we still don’t have an explanation for why we have not been successful in conceiving so far. Unexplained infertility can really niggle away at your mind.

On a side note, today I have experienced two more pregnancy ‘announcements’. One whilst I was at the fertility clinic, a lady found out she was being released from the fertility clinic to her OB/GYN. She kept asking the nurse if she was sure, then she cried a lot (tears of happiness of course) which made pretty much everyone else around cry too. Including myself. And secondly another of my colleagues who recently married is pregnant. Soooo all I’m thinking is – who is the third? They usually come in threes, right??!

Well my blog post title has given the game away, so in summary…our next step will be In-Vitro Fertilisation!

This morning we met with our RE who reviewed our progress so far, or lack there of. Our tests were all normal, the three IUIs all went according to plan (except of course for the pregnancy part), I responded well to the letrozole with 2-3 follicles, Chris had awesome sperm. We remain unexplained, but she does still suspect endometriosis. If my period pains were so bad that they affected my life and I wanted that to change then she would recommend a laparoscopy. This surgical procedure comes with risk, side effects and can take several months to return to normal, so if my periods were so bad this would be the way forward, however, in my case the benefits are unlikely to outweigh the downsides. So she recommends we move straight to IVF. She explained the overall process:

Week 1 to 2 – after menstruation I start birth control pills for about 14 days, these help to control my hormones

Week 3 – start injectable medications to control ovulation and stimulate follicles to grow – many many more than the 2-3 that were stimulated with letrozole in order to get the best chance of retrieving some ‘good eggs’.

Week 4 – continue injectable medications…have ultrasounds every other day to monitor follicle growth, along with blood work to monitor hormone levels. When the follicles are ready, we will inject the hCG Ovidrel trigger and 36 hours later I go for egg retrieval surgery. Under sedation my eggs are extracted from my ovaries. Chris provides his sperm and my eggs are fertilised in-vitro. After the eggs have been fertilised, the embryos grow for a few days under close watch. Then if they survive, one or two embryos are transferred directly into my uterus.

Week 5-6 – start injectable progesterone until the big pregnancy test either says – “woohoo you are preggers”! then I stay on progesterone, or…”booooo it’s a BFN my friend”, then we will…..well, let’s not go there right now.

This is everything I expected her to say, except for two things slightly different.

First, I need to go for a hydrosonogram. This procedure will produce a 3D ultrasound of my uterus. I will have this last test because I have a severely retroverted uterus they could not see it very well on the HSG X-ray, they want to double check that there is nothing preventing the implantation stage.
My HSG X-ray with my retroverted uterus (it’s hard to see because it’s hiding behind the catheter)

I have been promised this does not hurt quite as bad as the HSG. THANKFULLY!!!!
Secondly, she thinks it would be a good idea to do Intra-Cytoplasmic Sperm Injection (ICSI) because we are ‘unexplained’. This is a procedure where a single sperm is selected and injected directly into the egg rather than normal IVF where the sperm is placed near the egg. This procedure is an extra $2,420 so we need to check whether our insurance would cover this or not.

Talking of costs….it is going to cost $9,075 for the IVF which includes office visits, endocrine monitoring, ultrasounds, retrieval, transfer and first pregnancy test. Plus, it is an additional $400 for the anaesthesia. Medication will be approximately $4,000 to $6,000. Then the ICSI procedure is $2,420. Cryopreservation is $1000 then $60 a month for any embryos frozen. Yikes!!!! But we roughly knew this anyway, it’s just a bit scary seeing it listed out like this.

So for now, we start the negotiating with our insurance and the diary planning. It’s looking like a late June start.

Ultimately, today I walked away with this one key figure she gave: for us – a 50% chance of success. In my mind that is pretty amazing. I’ll take that. I’ve always been a glass half full kind of girl, lately it’s been half empty, today I think I’ve been topped back up 🙂

Thank you for all your support and kind thoughts so far, I’m feeling pretty encouraged this will work!