XP from TTCAL: Calling All Ute Crew Members

BookishMomma · November 2014

Hello PGALers. You might remember me because I just left you lovely ladies last week. I'm coming back to see if anyone with structural uterine issues can give me some insight into some new information I just got.

I got the report from my ultrasound at the ER on Monday night, which confirmed that I had miscarried. I have to hand it to that radiology tech. He spent a LOT of time looking at my ute. In looking over his report, I found out some potentially new (!) information that could maybe give insight into my RPL. I might have a septum!

I have a note in to my RE and am waiting to hear back as well as set up an appointment, but my head is seriously spinning over here. I'd love to hear from any of you who have knowledge or experience with any of this stuff. If you have a septum, how was it discovered?

ULTRASOUND FINDINGS:

The uterus is anteverted and anteflexed, and has a septate morphology. [WHAT? No one has ever mentioned a septum to me.]

No fibroids are detected. Moreover, the small fibroid noted previously could not be identified. [More news! No one has previously told me I had a fibroid].

Intrauterine gestation identified previously is no longer seen. A nonspecific area of irregularity is seen at the endometrial myometrial junction at the fundus, which shows no increased color Doppler flow. [WTF does this mean?] The endometrium has an normal otherwise appearance and thickness with a
combined endometrial thickness measuring 3 mm. No clear evidence of retained products of conception are seen.

KMW08 · November 2014

My septum was seen on a saline infused ultrasound (SHG/SIS) and on a hysteroscopy. It was NOT seen on a plain US or on MRI.

I'm glad you have a call in to your RE and for an appointment to be made. Those findings definitely need to be discussed.

The nonspecific area at the junction---I'm not really for sure why they want increased doppler flow there, maybe it's an area that usually has a stronger blood flow than what yours was showing? My only other thought is if you really do have a septum or scar tissue, maybe it's at that junction? Scar tissue and septums generally have no blood flow and that is why miscarriages typically happen as the embryo implants on the "dead" area and can't get enough blood and nutrients to sustain.

This is the link to the ute thread that was made back in February on ttcal:

https://forums.thebump.com/discussion/12256369/uterine-anomolies-other-structural-issues-share-your-experience#latest

BookishMomma · November 2014

@KMW08 thanks, I was thinking along the same lines... that the lack of Doppler flow might indicate that that's where the (suspected?) septum is. Or scar tissue or... who knows? My doctor needs to call me back.

chicagojackie · November 2014

No answers just glad you're getting some information

Miss you! xoxox

ToriGirl2014 · November 2014

@bookishmomma - I'm so sorry.

My septum was first noticed on MRI. I can't speak to your medical description because my septum was complete so there wasn't much to wonder about whether it was septum or scar tissue.

However, when I was finally referred to an RE, they wouldn't just accept the MRI results and I went to have an HSG where the septum and other structural issues were confirmed.

My understanding is the same as @kmw08 - if the embryo were to implant on a septum or scar tissue, it might grow a bit at first, but eventually the lack of blood flow would cause M/C. I still have a very small area of septum/thickness left at the top of my ute even after three surgeries (I refused to let them cut me a fourth time) and that was definitely a concern that our doctors fully apprised us about prior to TTC.

Septums can also cause 2T M/C issues if they impede the uterus from stretching properly (fetal growth restriction or spontaneous M/C) so it's something you should definitely address seriously if they determine that's what you have.

Hopefully your doctor gets back to you soon and schedules more diagnostic testing.

Drgn30 · November 2014

hi bookish - first and foremost, ((hugs)) it looks like they suspect you have a septum, though it isn't clear that they've connected it to your losses.

my septum was first suspected at the ER during an ultrasound. based on my conversations with my doctors, you cannot conclusively diagnose a septum via ultrasound. you need to move on to the big dog tests for that.

i had a follow-up MRI and HSG with my RE to confirm my septate uterus. it took about a month and a half to meet with the RE, get the appts set up, and have the tests. from there, we scheduled my resection surgery. that took another two months. i had to prep by taking loads of ibuprofen (i believe it was that and not aspirin...). after the resection, i had a SIS to confirm everything looked ok in my ute. It was onto IUI from there (i have PCOS) and I was pregnant about a month and a half after my resection surgery.

while i'm sorry you're facing this potential diagnosis, i'm so glad that you may be getting answers regarding your losses. please feel free to pm me anytime if you have questions.

BookishMomma · November 2014

@drgn30 My RE called me back and said basically what you did-- that in order to definitively diagnose a septum, he recommends MRI. So it looks I will be doing an MRI at some point in the near future and we'll go from there.

Drgn30 · November 2014

BookishMomma said:

@drgn30 My RE called me back and said basically what you did-- that in order to definitively diagnose a septum, he recommends MRI. So it looks I will be doing an MRI at some point in the near future and we'll go from there.

good. the MRI is no big deal. i took valium and practically slept through the entire thing. if you get the diagnosis and move on to a resection - check out snedge's link. in it i give a detailed explanation of how i had to prepare for my resection surgery.

((hugs)) thinking about you as we head into december...

alleycat39 · November 2014

So sorry for my late response here….First, sending you (hugs) for the craptastic last few weeks you've had. Wishing the situation were different.

My septum was first suspected during my D&C for my first loss. I then went to a RE who did a hysteroscopy which determined that I did indeed have a septum. He was going to operate without doing an MRI to confirm. I switched RE offices and the next office had a MRI done- which confirmed my septum went the length of my uterus. I had it resected to the point at which my RE could determine there was blood flow (so if baby implanted there, there would be adequate blood flow).

I believe the Doppler comment refers to the fact of limited blood flow to the area, which would possibly be indicative of a septum. Also, fundus of the uterus means top of the uterus, which is where the septum is usually visualized. So from the looks of the report, it seems that it is very possible that a septum exists…..and would possibly be resolved with a resection/surgery.

That is pretty amazing that the radiology tech picked up on all of this. I think this information will give your RE a good place to start in regards to complete RPL work-up. If you have any specific questions, I'm happy to talk further!

jlworden710 · November 2014

First I'm sorry for the face slap of information! I hated having everything thrown at me right after a loss.

My septum was first thought to be a bicornate uterus during my first d&c, but they didnt move forward with anythung because they thought it wouldnt affect having a baby. Then during the second d&c my ob felt things might be more severe then she forst thought and sent me for an mri with contrast. Apparently that did the trick and showed I had a complete septum. She passed me to the RE and they took it up to the point of blood flow which was pretty much the whole way.

Lots of hugs lady. I hope the mri sheds some light and moves you forward with a plan!

jap618 · November 2014

(((Hugs))) lady. I don't have a septum but my scar tissue was discovered via sis and then I had an operative hysteroscopy to remove it! I'm sorry you're dealing with this but I'm glad you may have an answer!

BookishMomma · November 2014

@drgn30 said: thinking about you as we head into december...

Aw, thank you, this means a lot

edit - stuck in quote box

KMW08 · November 2014

Drgn30 said:

BookishMomma said:

@drgn30 My RE called me back and said basically what you did-- that in order to definitively diagnose a septum, he recommends MRI. So it looks I will be doing an MRI at some point in the near future and we'll go from there.
good. the MRI is no big deal. i took valium and practically slept through the entire thing. if you get the diagnosis and move on to a resection - check out snedge's link. in it i give a detailed explanation of how i had to prepare for my resection surgery.

((hugs)) thinking about you as we head into december...

I'm glad your RE called back. My RE also said MRI was the best diagnostic test to confirm a septum. If yours doesn't show up on MRI (mine didn't & had us baffled) or if nothing else is found, please continue to be an advocate for yourself and get other testing done like a hysteroscopy and/or a sonohysterogram(shg/sis).

BookishMomma · November 2014

KMW08 said:
I'm glad your RE called back. My RE also said MRI was the best diagnostic test to confirm a septum. If yours doesn't show up on MRI (mine didn't & had us baffled) or if nothing else is found, please continue to be an advocate for yourself and get other testing done like a hysteroscopy and/or a sonohysterogram(shg/sis).

@KMW08 @alleycat39 The crazy thing is that I've had 3 hysteroscopies with my RE in the last 4 months. The first one was in July as part of my initial fertility work-up to check for structural issues. That was when the RE saw retained tissue from my May D&C. He scheduled an operative hysteroscopy in August to get the tissue out, so got a look inside my ute again. Then in September, I went in for another hysteroscopy to make sure everything was out and to check for any scar tissue. He said it was all clear and never said anything about a septum.

When he called me back yesterday to discuss the ultrasound report from the ER tech, my RE said that if there is a septum, it is a "mild" one, but that we should do the MRI if I want to know for sure. And I do. Because the fact that the tech noted no Doppler blood flow/irregularity at the fundus makes me think that I need to get this checked out because this is an area of my uterus that may not get nourished properly in a future pregnancy.

edit- typo

Unknown · November 2014

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Drgn30 · November 2014

BookishMomma said:

KMW08 said:
I'm glad your RE called back. My RE also said MRI was the best diagnostic test to confirm a septum. If yours doesn't show up on MRI (mine didn't & had us baffled) or if nothing else is found, please continue to be an advocate for yourself and get other testing done like a hysteroscopy and/or a sonohysterogram(shg/sis).

@KMW08 @alleycat39 The crazy thing is that I've had 3 hysteroscopies with my RE in the last 4 months. The first one was in July as part of my initial fertility work-up to check for structural issues. That was when the RE saw retained tissue from my May D&C. He scheduled an operative hysteroscopy in August to get the tissue out, so got a look inside my ute again. Then in September, I went in for another hysteroscopy to make sure everything was out and to check for any scar tissue. He said it was all clear and never said anything about a septum.

When he called me back yesterday to discuss the ultrasound report from the ER tech, my RE said that if there is a septum, it is a "mild" one, but that we should do the MRI if I want to know for sure. And I do. Because the fact that the tech noted no Doppler blood flow/irregularity at the fundus makes me think that I need to get this checked out because this is an area of my uterus that may not get nourished properly in a future pregnancy.

edit- typo

mine was mild too - 2 cm by 2 cm. but my RE didn't want to risk implantation on the septum so she recommended a resection.

for what it's worth, i'm not sure how much your physician is able to see during a hysteroscope - especially if its a small septum. either way, i hope you get more answers soon.

BookishMomma · November 2014

@meladoriestar I see from your older post that you didn't end up needing treatment for your arcuate uterus. What do you take the Lovenox for? Do you have a recognized clotting disorder?

Unknown · November 2014

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