Hysteroscopy, Endometrial Scratch and a big bag of drugs- Starting IVF2 (with IMSI & EEVA) August 2013.

Hysteroscopy

My new clinic had recommended a hysteroscopy before my cycle and this was scheduled for August 2nd. It was carried out in a private maternity hospital by referral rather than at the clinic itself. A few days beforehand I had to attend for an ultrasound scan at the hospital just to make sure there were no issues that would cause a surprise on the day. This was an abdominal rather than a transvaginal unltrasound which took me by surprise as I am so used to having the others now. No issues were detected.

On the day of the hysteroscopy I was dropped off at the hospital at 7.30am having fasted since midnight the night before. The only exception to this was one sip of water that morning in order to take the two Cytotec tablets I had been given to ‘loosen the cervix’. These tablets caused a bit of cramping but luckily nothing too bad. On arrival at the hospital I had to fill out some paperwork for my medical insurance and was then admitted and brought to a ward, there were 3 other girls in the ward but I wasn’t speaking to anyone as we were all curtained off from each other. I think we were all there for the same or similar procedures. I got dressed into the hospital gown and paper knickers provided and put on my own dressing gown and slippers. Various nurses and doctors came to see me to take blood pressure and to note other details and I ticked my preferences on a menu for a light meal later.

The consultant who would be doing the procedure came in to discuss it.  I had already signed  a consent form at a previous consultation with her a week before. She explained that a camera would be inserted and the inside of the uterus would be viewed to check for any issues such as fibroids, polyps, scarring, blockage of tubes etc and that she would do a light and very gentle D&C. I had some reservations about the D&C but she explained it would be very gentle and would be of benefit. After the consultant left there was quite a long period of waiting so I just read a book and tweeted. Eventually, around midday, a nurse came for me and brought me towards the theatre. I sat in an outside room initially where the anaesthetist and one of the surgical team came out to introduce themselves to me. Then I went in, handed over my dressing gown and slippers and lay flat on the bed. There was a lot of good humoured chatting, and the nurse said that a pain relieving pessary would be inserted while I was under anaesthetic. The canula was inserted in my right hand and a mask placed over my mouth, it felt a bit weird initially but 3 breaths and I was gone…

I woke up some time later in a recovery room with a mask still over my mouth. I wasn’t sure if I was alone but later noticed it was a very large room and there were 4 others there. One girl’s alarm kept beeping so there was a lot of activity around her. A nurse came over to me a couple of times, I started to cough and she removed the mask. She also brought a cup of water and straw so that I could take some painkillers as I had some cramping. After a while I was wheeled back to the ward and told to sleep for a couple of hours if I could. The girl opposite me was snoring quite loudly so I couldn’t sleep but put on my headphones and rested instead. A nurse came in to check every now and then and around 3.30pm I was brought some food which I gratefully accepted, brown toast, tea, cranberry juice and a bowl of icecream. The consultant came around and said that the procedure had gone well, no fibroids, polyps or other issues were detected inside the uterus, the bit of scar tissue on the cervix was unimportant. The only issue she had in fact was an excess of thick cervical mucus that made access difficult but which was cleared out. She said she would note this in her letter to the clinic consultant as any transfer I have should be by guided ultrasound (they usually are). After that I got up to use the bathroom and noticed I had a large wad of cotton wool, like a thick pad between my legs as I had some bleeding. My husband arrived soon after and before I was allowed leave I had to use the bathroom (where I changed into my own pad and underwear) and had a final blood pressure check.

The post procedure instructions were to take it easy for a few days, no heavy lifting. No sexual activity or tampon use for 2 weeks. I went home and went to bed for a while as the next day I was flying out to London for a few days. I had some spotting and bleeding like a light period with some clots for about 4 days after to varying degrees. Maybe this was because although I was on holiday, I was doing a huge amount of walking. An acupuncture treatment on my return seemed to help with this. I also had a sore throat for a few days, possibly following the insertion of a tube while under anaesthetic. Some lozenges helped.

Endometrial Scratch- the third one!

Next up was the endometrial scratch on August 8th. This was to be done by the clinic and without any sedation. I was dreading it as I had this procedure twice in my old clinic and found it very painful both times even though it is a quick procedure. I had an acupuncture session that morning and arrived at the clinic rather early for my allocated slot of 1.30pm. I sat in the waiting room with DH and considered when to take the painkillers I had brought, I was aiming for 20 minutes before the procedure. However, we were called in before I could decide so ended up taking them just minutes before the procedure. I explained to the nurse that I had been for a hysteroscopy a few days before. She instructed me to get ready and gave me a plastic squeezy toy to use when I explained my nerves about the procedure. She said squeezing  the toy would actually distract the brain from the procedure. I hadn’t tried this before but I think it definitely helped and having DH there did too. The doctor arrived in to do the procedure, I had not met this doctor before but she was very nice. She explained what she was doing and got down to business quickly. I felt the discomfort and used the squeezy toy but it never got unbearable. Next thing I saw her calling the nurse over and a ‘very good sample’ (her words) being put into a container, then she said I was done and that I could get ready, she advised I take one of the sanitary pads to put on in case of spotting. After that I got ready, was given some post procedure care instructions (no heavy lifting, strenuous activity for 24 hours, no sex or tampon use for 1-2 weeks, take the prescribed antibiotics). I settled my bill (this procedure was a separate cost at this clinic unlike my old one) and we left. I was given a prescription for 5 days of antibiotics, to prevent any infection, so we collected those. Once home I got into bed for a nap as I was feeling a bit queasy. I have a little spotting still, some days later, but it’s very little.

Collecting the Drugs

The day before my endometrial scratch, I had arranged with the pharmacy that I would collect my drugs. They had my prescription on file from the clinic so I was not entirely sure what I was going to be given. When I was handed a huge paper carrier bag filled with drugs I was quite taken aback! I was immediately glad I had both DH and the car with me as I wouldn’t have enjoyed trying to sneak these into work without being noticed! I signed some paperwork and paid the capped fee for the drugs of €144.

When I got home I spread the lot on the floor to have a look. Here’s what was in the bag (not including the Eltroxin for thyroid, Metformin and contraceptive pill which I got previously). The new clinic were not joking when they said that they were putting me on ‘everything’.

  • Suprecur- buserelin- nasal spray for down regulation.
  • Clexane- enoxaparin sodium- to prevent blood clotting.
  • Deltracortil- prednisolone- a steroid.
  • Folic acid 5mg tablets
  • B- Complex ( I opted not to take the pack as I already have a B complex supplement and it was just a general supplement not a specialised dose and it was an extra cost).
  • Puregon-  Follitropin beta- the FSH (follicle stimulating hormone) drug to grow follicles in stims, this drug stays in the fridge. The Puregon pen was also included in the pack.
  • Luveris- lutropin alfa- a hormone that supports FSH therapy, a gonadotrophin that contains LH or Luteinising hormone.
  • Cetrotide- cetrorelix acetate, a GnRH that prevents premature surge of LH.
  • Estrofem- estradiol, presumably to help with the lining or with the hormone levels of estradiol.
  • Pregynl- chorionic gonadotrophin or HCG, the trigger shot, also stays in the fridge.
  • Crinone- vaginal progesterone gel for luteal support (alas I know you well!).
  • Flagyl pessary and By-Mycin- these are antibiotics so might be used to prevent infection after perhaps EC or at transfer?
  • Solpadol- paracetamol and codeine- think may be used on EC day.
  • Hypnovel- this wasn’t in the bag but supplied directly to the clinic, it’s a sedative used for EC.
  • One pack of By-Mycin was also included for DH, no idea when he needs to take that.
  • Needles and swabs. Still have a sharps container from my old clinic so will use it but it is small so may need to come back for the one offered by the pharmacy.

I have to take all of these drugs to my appointment on 20th August when a nurse will explain everything to me and give instructions for the injections. From what I can see, Puregon, Luveris, Clexane, Cetrotide and Pregnyl are all injectable medications. So that’s going to be fun!  I have used Puregon before so am not worried about that one, but some of the others require mixing so am a little worried about that. The 20th August will also be my baseline scan to see if I have down regulated.

I started my down regulation spray on 10th August. On looking at an earlier blog post I noticed that I started the down regulation for my very first cycle last year also on 10th August. It feels a bit déjà vu. I really hope we have a happier outcome than we had after the same process (though much less drugs) this time last year. I hope somewhere in all of these extra drugs is something that makes the difference.

Time for another sniff of buserelin so better sign off….

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