Bob and I had our surgery consultation with Dr. Gentle. We got many of our questions answered, but in no way is our path clear from this point on.
Bob usually does not go to medical appointments with me because my doctor is an hour away from his work. But this time, I felt that this particular appointment was important for us to attend together. The information we get would potentially be the foundation of our path moving forward.
Dr. Gentle was as caring and gentle as always. She really has the best bedside manner. She was pleasant, matter-of-fact, patient, and clear with everything that she told us. She is extremely experienced and knowledgeable. She backed things up with study findings.
Right off the bat, Dr. Gentle told us that my uterus is not the best environment to grow a baby. She showed us the images from the MRI scan. The left side was my belly and the right side was my back. I could see the uterus and the big mass that was hanging behind it. It was bigger than the uterus itself. And its pattern showed that it was not quite a fibroid. Dr. Gentle said that it could be adenomyosis. It could be growth from scar tissues due to the abdominal myomectomy back in 2011. Her guess was that it might not be adenomyosis if the biopsy back then showed that it was all fibroids. To her, ademonoysis does not grow that rapidly to that size in four years if it was absent before. To her, it didn’t really matter what it was. Having that hanging in the uterus is not going to be the best for one to carry a baby. She said that with my age and the condition of my uterus, it would be best for us to use a gestational carrier. She called the uterus “diseased”.
This was not news to me. Having heard the same news two weeks ago, my heart had been prepared for the possibility that Dr. Gentle would give the same diagnosis as Dr. E. I had enough time to let the news sink in. If I had come alone not knowing about the potential of needing a surrogate and expecting to talk about surgery but instead getting this shocking news, I would have sobbed non-stop right then and there. However, it was still a difficult moment as it is hard to wrap my mind around my previously “perfect” uterus not being the best environment for growing my own baby. The beliefs that I had before are now all altered.
As I listened to her, my mind went far far away thinking about the reality of never carrying a baby. Never feeling the pregnancy-related sickness, the kicks, the heartbeat, the amazing moments of feeling something alive growing inside of you. The natural desire of being a mother includes all of this. A few weeks ago, I still believed that having a good embryo would be all it’d take for me to achieve that dream. How quickly things changed.
If we decide to carry a baby, there is a much higher chance of complications even if I get pregnant. Higher chance of gestational diabetes, pre-eclampsia, placenta previa, placenta accreta, late-term loss, so on and so forth. The growth could interfere with the blood flow of the uterus for the baby. The placenta could grow into any scar tissues that I may have. And if that happens, the placenta cannot be separated from the scar tissues, and the risk is severe hemorrhaging during birth and the potential of a hysterectomy at birth. The picture that she painted is not pretty.
Dr. Gentle asked us to think about our end goal. Do we want a healthy baby with the healthiest uterine environment for growth? She wants me to ask myself why I want to carry a baby and to ask myself what is more important: to experience pregnancy or to have a healthy baby in the end.
With all of that said, it is actually not impossible for me to carry a baby. We don’t have to worry as much about genetic anomalies of the embryos because of the use of donor eggs and the possibility of using pre-implantation genetic screening. The complications that she talked about are all potential risks. Does that mean that anything is going to happen to me if I get pregnant? She said nobody knows. As a medical professional giving us advice, it is the requirement for her to go over all the potential risks. But ultimately, the responsibility of choosing the path rests on us. She predicts that most likely I will carry to term. A C-section a couple of weeks prior to due date is definitely required to prevent uterine rupture. Each time a surgery or C-section has been done on the uterus, the uterine wall is weakened a bit more, and the risks are a higher and higher. With that said, plenty of people decide to do surgeries or C-sections. She herself has had 5 C-sections in the past. A nurse friend of her had 7 C-sections, and lost her uterus at the 7th one.
Basically, it is totally up to us to evaluate what is worth doing. Is it worth it to find a gestational carrier and not worry about the potential risks? Is it worth it to risk having a potentially complicated pregnancy? Is it worth it to forget all this and go the adoption route?
We find ourselves once again at this crossroad, needing to make a very important decision of what to do.
If we indeed want to try to carry a baby on our own, then we have to think about the uterine condition. We will definitely have to do something about the growth in my uterus. There are a few ways to go about it:
- Laparoscopic surgery to remove all the masses. Dr. Gentle showed us pictures of how it is done. She said that for big masses, she’d break it down first and then take them out of the incisions. She’d suture the uterus. If the big mass is also adenomyosis, then she most likely will have to leave some in there because it is coming very close to the cavity/lining. She’d put tapes on the sutures to protect them from scar tissue. It takes three whole months for the sutures to blend in with the uterine muscles. Therefore, it is recommended that one wait three months before cycling again. She said that the uterus is a flexible organ. After the removal, the uterus should pretty much return to its normal size immediately. And because the uterus heals well, she said that she wouldn’t be able to see the sutures from the previous surgery. However, it doesn’t mean that the uterine wall is strong. The areas of the suture are still weaker and have the potential of rupturing. The more the uterus is operated on, the weaker the walls become. She said that even with that big mass I have, surgery is still safe and the sutures are still going to be okay. I will have a choice of either doing a traditional laparoscopy or one with robot assistance. Robot assistance is apparently better for sutures. If we decide to do a surgery, a potential date could be June 3rd.
- Lupron Depot for three to six months to shrink the growth. If the masses can be shrunk, transfer after that. Disadvantage is the side effects of the drug, and the potential rebound effect that once the drug is stopped, the fibroids may grow bigger and stronger than before. The drug is only effective during the course of treatment. Once stopped, the growth will come back. We can do monthly injections for three months, a one-time injection that lasts three months, or monthly injections for six months. It is not advised to have Lupron Depot for more than six months because of the danger to bone density loss. The only problem with this approach is that there is an endometrial component of the mass meaning it has grown into the cavity. If the Lupron doesn’t shrink the endometrial component, I’d still need a surgery to remove the big mass. Lupron is covered by my insurance and the shots can be done at the injection clinic.
- Lupron Depot to shrink the masses and a laparoscopic surgery to remove the remaining masses. This will take the longest as it takes time to do the injections, get an MRI, schedule a surgery, and three months to recover. But this will possibly be the safest way since shrinking the masses will help the surgery be easier to remove smaller masses and to suture better with smaller masses.
Studies showed that pregnancy outcome is higher with the removal of fibroids and adenomyosis. However, if we decide to use a gestational carrier, no surgery is needed as I don’t show any symptoms from any of these growths. I don’t have pelvic pains, cramps, or excessive bleeding associated with my menstrual cycle. I am asymptomatic other than infertility. These growths are not going to affect my health. Dr. Gentle said that they will likely disappear during menopause because of the lack of estrogen produced in my body.
Dr. Gentle said that the IUD Mirena has shown to reduce these growths. When she mentioned about this birth control method, I asked if we should prevent pregnancy. If it’s so high risk for me to carry a baby, shouldn’t we be careful not to get pregnant naturally? (Not that it is highly likely that I’d get pregnant, but it is a possibility as long as I have eggs and a uterus left.) She chuckled and said, “If you get pregnant naturally, we’ll say Congratulations to you and monitor you closely.” At that point, I know that it is a possibility for us to try to carry a baby. If my doctor is not insistent on us preventing a pregnancy, it means that my situation is not that dire. She said that over 50% of women (I think that’s what she said) who have babies over the age of 40 have fibroids and other growths. However, she did mention that carrying a pregnancy over 40 is not a walk in the park. Because of our aging body, we will have a higher chance of having aches and pains than younger ladies. So again, think about if it’s worth it to put ourselves and the baby in a potentially risky situation.
Bob and I are letting all this information sink in first. We haven’t really talked about what we want to do as we had to rush back to work after the appointment. Originally he had set his mind on using a gestational carrier as he didn’t want to put me in any risky position. Just watching his reaction throughout the whole one-hour consultation, I could see that he may be changing his mind. I think he saw that those are just potential risks and doesn’t mean that they will happen to me. I think he thinks that the Lupron Depot is not such a bad idea, although Dr. Gentle did warn of the side effects of mood swings. My take is if we don’t have to put anyone in the position of carrying baby for us, I don’t want to do that to anyone, be it a friend or a hired surrogate.
I just happened to have scheduled my visit with my therapist that same afternoon. She told me that this is a huge news to digest and consider and we don’t have to make a decision today. One thing she mentioned about is that none of the doctors have outright told us not to carry. She said it speaks volume. Risks are risks, but nobody knows what will happen in the future. She said that we should think about it separately, continue our dialogues, and listen to each other’s take on things. Having a gestational carrier is the ultimate relinquishment of one’s control as we can’t control what the other person does with her body. And a gestational carrier is not a guarantee to a baby. The timeline is also a factor. Do we wait for my body to get better to accept an embryo, or do we just want to go directly to a gestational carrier so things move faster? What about the potential costs? Is the genetic link with my husband a must or are we okay with embryo adoption or traditional adoption? Many questions we have to ask ourselves, but we don’t have to have answers today.
The last thing she said was that, some people may choose to stop trying for a baby at this point, but she thinks that we are still going strong with this path. She is right that although I have doubts at times, my heart still yearns for a child I can call my own. Bob is the same way too. I pray that as Bob and I continue to discuss and pray about this, God will eventually show us our path to parenthood. Whichever path He shows us, I hope that we surrender all of our will to His.