More Roadblocks – Unsuccessful Hysteroscopy

There has been so many roadblocks in our quest to pursue egg donation.  It has almost become comical.

Yesterday was actually a sunny day.  Since I had to fast four hours prior to surgery time, Bob took me out to breakfast early so I could be full before the time limit.  Usually there are plenty of metered parking spots in front of the clinic’s building.  However, on a baseball game day (since the new clinic is very close to AT&T Park), these metered parking spaces are easily all taken.  We fortunately pulled into the last available spot before a bunch of drivers drove by asking if we were leaving.  Once we arrived at the clinic, we paid up and I was taken to the back for a physical exam.  The nurse took my blood pressure, which was slightly high.  And she also checked my weight in a convoluted way: after seating me on the exam table, the nurse raised the table and pointed a hand-held device at me.  The weight was registered on the device.  That was a weird experience.  Why they couldn’t just have the old-fashioned scale is beyond me.  Anyhow, a doctor came in and explained the procedure to me.  Since I was still bleeding even after being on the birth control pill for two weeks, I was worried that the blood would obstruct the view of the uterus.  The doctor thought that a little bit of bleeding would be okay.  As she explained it, I knew that it was going to be a simple procedure with minimal invasion.  Basically, Dr. No Nonsense was going to put a scope in my uterus, check on the scar tissue, and use scissors to remove it.  Okay.  I got that.

After the physical exam, Bob and I were taken to the other wing of the clinic.  This new clinic is like a maze.  The procedure side of the clinic had this open view of the bay with a few barges parked there in the water.  That was Bob’s work place for the next 1.5 hours.  I was led to a recovery room to get ready.  This is actually where the clinic currently does all the retrievals and transfers.  It looks really nice, clean, and modern.  All the recovery rooms are separated and all with a view of the bay.  I changed into my gown.  Both nurses were super nice.  They administered two pills of Ativan and one Norco to me.  The petite nurse told me that she only works here one day a week.  While she was doing that, she commented on my nice juicy veins.  Well, I think because she was not used to the IV catheter provided by this clinic, she kept on maneuvering the catheter needle and could not get it to go through my vein.  I usually tolerate pain really well.  Her maneuver was making it very uncomfortable for me.  She apologized, took out the needle from my wrist area, and tried my arm.  Same thing.  No luck.  She mumbled something like it rarely happens to her.  I reassured her that it was okay.  The tall nurse, a regular nurse at this clinic, came to the rescue.  She tried my right wrist and got it in on the first try.  Thank goodness.  I think the Ativan and the Norco were really calming me down because I was just sitting there smiling.  The tall nurse suggested to bring Bob back to say good bye before I went in.  He came in smiling, saying that he bumped into Dr. NN in the waiting room and showed him the electronic medical device that he was working on for work.  Dr. NN was super interested in it because his wife is a physician with a discipline related to the body part for which the device is intended.  Bob and I chatted for a little and kissed before I was wheeled into the operating room.

In the OR, I was positioned on the table before Dr. NN showed up later.  As usual, I asked for extra blankets.  The nurses were so nice.  They kept telling me that the most important thing was my comfort level.  They would give me the minimum amount of Fentanyl to keep me comfortable.  I could ask for it any time my pain level would go higher than five.  They really took very good care of me.  When Dr. NN came in, the first thing he said was how enamored he was of Bob’s new toy out there.  So I said, Yes, Bob said that since Dr. NN was going to cut up his wife, it was only fair for Dr. NN’s wife to purchase a device from Bob.  Too funny.  🙂  For the next 20 minutes, Dr. NN was trying to get the computer to log off from someone else’s account so he could log onto his own account.  I lay there with my legs wide open waiting for him to do so.  Sometimes technology is very frustrating.

Finally, Dr. NN was ready to get started.  He exclaimed and said, You are not just spotting, you are really bleeding.  When he started to put in the speculum, I felt the pulling and the tugging.  The nurse was right next to me explaining what Dr. NN was doing.  She was gentle and reassuring.  I was lying there watching the screen while he was doing his thing.  I was watching and watching, and my heart sank a little.  I had seen a hysteroscopy done before at my OB/GYN’s office.  I knew what it should look like. Although no one was telling me what was going on, I could tell that things weren’t going well.  I saw on the screen what looked like the inside of me.  But I didn’t know what part of my body it was.  Was it still in the cervical area?  Was it already in my uterus?  It was hard to tell.  I could see narrow passages and some blood attached to the wall of some sort.  I could see what looked like torn cotton balls blown by wind.  After struggling for a while, Dr. NN mumbled something under his breath and took the scope out.  He told me that my cervix’s opening was too wide, so the water that was pumped inside me that was intended to be used to expand the uterus kept on leaking out from the cervix.  He had a plastic bag underneath the table that was filled with the water that was supposed to remain inside me.  Because the uterus could not be expanded, he could not get a good look at the cavity in order to find the scar tissue.  He said he wished that he could do this in the real operating room when I am put under, so that he could use a bigger scope and maneuver things around inside me without making it painful for me.

With me lying on the table with my legs wide open, I listened to him and was thinking, This can’t be happening.   I told him that I cannot get the other surgery done with general anesthesia at UCSF because of the cost ($18,000 out of pocket, which I can’t afford).  I paid for this current procedure out of pocket hoping that the scar tissue would be cleared.  In order to get the other surgery done, I would have to go back to Kaiser, using my own insurance.  Kaiser insurance does not cover for a procedure done at UCSF.  Dr. NN told me that he wanted to write an email and refer me to another reproductive endocrinologist at Kaiser.  I mentioned that I actually did have an appointment scheduled with the surgical team doctor at Kaiser for June 9th.  I intended to cancel the appointment but was too lazy to do so.  So I currently still have the appointment scheduled for next Tuesday.  He said that whoever is going to do my surgery at Kaiser could contact him via email so they could touch base and talk about what to do next.  Dr. NN looked at my face, and said, you are disappointed.  I said, of course I am.  I just want to get it done and be done with it.  So he said, Okay, let’s try to do this one more time.

Dr. NN pushed the scope through one more time.  Same scene on the screen.  Some blood spots, fleshy looking walls, and some torn cotton ball like material being blown by the wind.  And liquid that kept on leaking back out of my body.  He couldn’t expand the uterus.  He pulled everything out, and showed me the big plastic pouch full of bloody water that came out of my body.  I lay there, looking at him.  I was speechless.  What can I say?  We tried.  So I asked a few things.  I asked about the fees that we had already paid for.  Dr. NN said he would see what he could do about it.  Also, I was wondering what code would be used for the procedure at Kaiser.  If a fertility code rather than a medical code is used, then the procedure will not be covered.  He really didn’t know the answer to that.  It is left for me to figure it out with Kaiser.  Dr. NN finished up with me, then exited the OR to go talk to my husband.  Before he left, he said, “I know the procedure in the future will be simple so we will get you ready to have your babies.”  The nurses remained inside the OR with me and explained the whole thing all over again to me about what happened just now.  I really appreciate their kindness and thoroughness with me.  When I was ready, I got up and was wheeled back to the recovery room.

Bob came in with a big smile on his face.  I really appreciate him being calm.  Dr. NN had explained to him what happened.  Bob looked at me and asked if I was worried about the money.  He told me that it was just money, so don’t worry about it.  The good thing is, we can get it done, and we will.  It is just a minor setback.  Because of his calmness, I was calm as well.  I sat there sipping my ginger ale and eating my crackers.  After the nurses made sure that I was fine, they removed the IV catheter from my wrist so I could change and go home.

It was still sunny when we walked out of the clinic.  Sitting in the car, I started feeling a little nauseous.  It could have been from the meds that were given to me.  When we arrived home, I had to lie down because the discomfort in my stomach was becoming a bit too much to tolerate.  I fell asleep.  My mom, who came home later, applied herbal ointment on my chest to make me feel better.  She and my dad also bought us dinner so we didn’t have to worry about food.  It is very nice to be taken care of while my physical being was recovering from the experience during the day.

How about my emotional wellbeing?  Like I said, it has been one roadblock after another.  I never anticipated a problem with the saline sonogram.  And I never expected a failed hysteroscopy because it is really actually a very simple procedure.  I shouldn’t be surprised that things are not going the way we want because… really, things haven’t gone the way we want for quite a few years now.  There is always a surprise when we turn a corner.  What is important is our attitude towards these roadblocks.  Frankly, it still bugs me a little at this moment that the simple procedure could not be done successfully.  But I can’t help but think that there is a reason why this road is so bumpy.  We are doing everything we can.  But we are not in control.  I think we have really learned that nothing is in our control, or our doctors’ control.  I prayed and cried out to God to just take me down the path He wants and help me to have the strength and peace to go through with it.  And I feel fortunate that my laziness paid off as I still have an appointment with Kaiser really soon.

Some days are harder than others.  When times are tough, I am learning to be extra nice to myself.  Today I still took a day off as planned although the procedure was canceled.  I felt that some down time is good for my wellbeing.  I got up early and spent some cuddle time with Bob.  I went for a walk with my father.  Breathing in the fresh air in the park, bathing myself in the sunshine, and chatting about whatever with my own father, those two hours were well spent and good for my soul.  I need to learn to embrace the good moments, and this morning’s moments with my father were the perfect example of something simple and extraordinary.

Friends, I am trying.  I feel that I am going to stay in the pit for a little longer.  But it’s okay.  I am figuring out a way, with God’s help, to climb out of it.  Hopefully I will find the way out very soon.

Hysteroscopy Needed

One more hurdle to overcome.

I totally thought that once we decided on egg donation, all we had to do was to choose an egg donor.  Other things would fall into places.  This is so not the case.

Dr. No Nonsense didn’t call me until Thursday.  The saline sonogram was on Monday.  So it took a whole three days for that phone call.  The “no-news-is-good-news” theory didn’t really work here.  Fortunately I actually was available to answer his phone call on the day when I had back-to-back clients.  As usual, he put me on speaker phone, which I really dislike because I feel like I can never have a decent conversation with him.  He asked if the saline sonogram was painful.  Actually it wasn’t.  I have pretty high pain tolerance for these things.  My previous saline sonogram or diagnostic hysteroscopy all did not hurt at all.  Even the hysterosalpingogram (HSG) didn’t hurt either.  Anyways, Dr. NN said that it looked like there is scar tissue.  No one knows how much there is.  So he said that he would need to go in and clean out any scar tissue that I may have.  He would prefer to do it when I am awake vs. me being totally sedated so that I can look at the procedure being done.   He hoped that we could clear all of it out using this procedure.

I just remember my heart racing fast and my mind going wild.  I just don’t want any sort of surgery if I don’t need it.  I was really hoping that we didn’t have to go down this route.  I just wanted Dr. Director to be wrong and for Dr. NN to say that the images from the saline sonogram were fine.  I always pride myself for having a good lining because it has never been a problem.  The fact that there is scar tissue that needs to be cleaned out is enough to make me want to puke.  But I held myself together and started asking questions about logistics.  I have Kai.ser insurance, which means that whatever procedure I do at UC.SF will not be covered by my insurance.  I reminded Dr. NN that fact.  I could hear him go Ugh.  He didn’t know the cost of the surgery.  So I asked him, “Is it a hysteroscopy that you wanted?” since he never told me what the procedure was called.  He said Yes.  And he said that I could get it done at Kai.ser, but that means that it will most likely be done under general anesthesia in the operating room.  If that’s the route I want to take, he would want to talk to my doctor at Kai.ser.  He told me to give my nurse’s email to my Kai.ser doctor to contact him.  And if I prefer to have the procedure done at UC.SF, the financial coordinator can contact me.

We hung up.  I really was not feeling good that a procedure has become a reality for me.  I could have felt sad, or mad.  However, I didn’t have time to analyze my feelings because my problem solving mode was turned on.  In the short 10 minutes that I had left before I saw my next client, I emailed my Kai.ser doctor, updated Bob about the situation, and emailed my own nurse to get some questions answered, including my bleeding problem that I was too flustered to remember to ask Dr. NN.  Bob was sad and frustrated.  He was mainly mad at himself for quitting his big corporation job and losing the fantastic health insurance that came with it.  He was mad that this could all have been covered at UC.SF had I continued to use his big corporation insurance rather than having to sign up with Kai.ser through my own work.  Nobody could have predicted what might happen in the future.   So it’s really not helpful to blame oneself.  I told him that we can’t worry about what has been done already.  We have to look ahead.  He said that he wanted to scream out of frustration, but he would try to persevere, like I was doing at that point.  He felt so sorry that it has been so tough on me.

I went on to see my next three kids.  It was really tough to get myself together.  But I did it anyways.  I really had no choice.  I tried as best as I could be to focus on the kids, but at times, my mind drifted back to the reality of having to do a hysteroscopy and possibly delaying our egg donation process.  My mind again went to a dark place: the fear of not being able to carry a child to term because of whatever problem I have in my uterus.  Again, I know this is not logical.  But that’s what fear is.  Not logical.  My mind went far.  The possibility of losing the egg donor. The possibility of scar tissue that is too serious and needing a gestational carrier.  It was scary to let my mind go so far.

One great thing about Kai.ser doctors is the accessibility to the doctors themselves.  My OB/GYN, whom I have never met in person before, returned my email right away.  She said that this kind of procedure is usually done in the operating room by the Kai.ser surgical team. She could make a referral for me if I would like.  I wrote her back asking for a referral. I also wrote again, gave her my background of my IVF cycle, and asked her if my 15 days of bleeding was a concern.  She said that it is most likely the extra hormones in my system that cause the vaginal bleeding, because scar tissue doesn’t usually cause that.  She also said that the surgical team will call me in a week to schedule an appointment, and at that time my questions regarding diagnostic code and procedure code will be answered.

The whole night on Thursday, while I was still waiting for the quote from UC.SF on the procedure, I became more and more calm about this new development.  Like I said, I have turned to problem solving mode.  Things may get delayed for a little.  But I would rather get this done first than to risk having implantation problems because of scar tissue.  At the same time, I feel like one day I may just explode.  There just has been one twist after another in our quest of a baby.  It has been really tough.

God really spoke to me that night.  The several daily reading plans that I read all helped me refocus my eye gaze back on Jesus.  One says, “But there is one thing that will never change, even through the ups and the downs of infertility.  Jesus Christ is the same yesterday and today and forever.” (from Infertility Encouragement from Sarah’s Laughter)

Another passage says, “When it comes to hardships in life, it is common to feel as though you are stuck…… When bad things happen, it’s understandable to feel continually defeated in your heart and spirit.  We can be tempted to think that we will always stay stuck….. One of the best gifts God has given to use is free will……. We have free of choice… we can CHOOSE joy.  We can CHOOSE to run to God. We can CHOOSE to do something about life from this day forward.  We can CHOOSE to pick up the pieces and create the best life possible with God’s direction.” (from Grief Bites: Finding Treasure in Hardships)

With these reminders to put my focus back on God, I fell asleep.  I woke up feeling mostly at peace.

My nurse returned my email saying that 1) the financial coordinator will contact me, 2) the bleeding could be a sign of perimenopause and I could be put on birth control pills to stop the bleeding.  I was taken aback a little by the word “perimenopause”.  But I guess, we have already chosen this route of egg donation.  So whether on perimenopause or not, I should be okay.

About an hour later, a surgical coordinator from UC.SF contacted me informing of the cost of a hysteroscopy in the office with sedation.  The total of facility fees and professional fees for scar tissue removal is about $2600.  If Dr. NN finds more than just scar tissue to remove, the professional fee may increase with the maximum of $500.  I was to contact her when I would like to proceed.  Dr. NN would most likely start me on birth control pills or Aygestin on cycle day two and schedule the procedure 15 days or more after I have been on the medications.  I asked if I could chat with the doctor one more time to learn about why I should get it done at UC.SF instead of Kai.ser.  The coordinator said that since Dr. NN has been following me, he knows how much to remove.  I asked about the cost of the procedure done at an operation room with general anesthesia because that will most likely be the procedure done at Kai.ser.  I was shocked to learn that it would cost $18,000 at UC.SF.  Uh no thank you.

So currently this is what we are facing.  A choice between paying out of pocket at my own clinic with my own reproductive endocrinologist or possible insurance coverage for the procedure at Kai.ser.  I haven’t called Kai.ser to learn about the cost.  I have a high deductive insurance plan so I will need to pay out of pocket up to a certain amount before insurance starts to cover for health-related cost.  The cost of the hysteroscopy at UC.SF is actually well within my expectation.  I will contact Kai.ser this weekend or on Monday to get a quote.  Another thing is that, I don’t know what code will be used at Kai.ser.  If an infertility diagnostic code is used, then the procedure will definitely not be covered.  So that’s something I have to look into.  Plus if it’s not covered, the cost of doing the procedure with general anesthesia in an operating room at Kai.ser is going to be really high.  I may as well just get it done at a clinic with which I am familiar.  Then I’ll just have to put on my big girl panties and do it with sedation in an office.  Hopefully it won’t hurt too badly.

Yes.  One more hurdle.  But I think we are in good hands: both God’s and the doctor’s.  I just pray that Bob and I will continue to remain calm and get over this hurdle with the peace and strength that only come from God.