The surprises never end (possible septum?)

BookishMomma · November 2014

YOU GUYS. Please bear with me and all my AW-ing. I feel like the information just keeps rolling in.

I just 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 TTCALers who have knowledge or experience with any of this stuff. I'm also am going to XP this on PGAL to get some insight from ute crew ladies.

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.

edit- typo

FutureMrsWright2012 · November 2014

I don't have any advice or experience to share, but I hope you're able to get some answers soon. Hugs to you!

rmpar29 · November 2014

Oh honey, I'm sorry that your head is spinning here. I have no advice, but many, many (((((HUGS))))) I hope that you hear back from your RE very soon and can get some answers. This certainly could explain a lot though.

Km380 · November 2014

Whoa that's a lot of new info. I hope your RE gets back to you quickly! I don't have any advice, just (((Hugs))) sweetie. Let us know what the RE says

BookishMomma · November 2014

furrypaws said:

Whoa...That is a lot of info. I think @pinkcamino had septum surgery if I'm thinking correctly. I would be up my Dr.s ass about the fibroid. Why did you not know of this before?!
Hope they get you called back ASAP!
(((hugs))) sweetie!

edit:tag fail

@furrypaws No shit, especially since I've had 3 hysteroscopies in the last 4 months!

edit- quote fix

Nikolie93 · November 2014

I also have no experience or advice just wanted to give a *hug*

Your head must completely be spinning right now! I hope you find the answers soon.

ellebelle2384 · November 2014

Oh my goodness, that is so much at once! WTF? I hope your RE calls you ASAP. (hugs)

megrae12 · November 2014

Holy crap, batman! That is A LOT to take in. I am sorry for all that craziness. I hope that you can get some answers very soon!! All my love and ((Hugs))

eliida · November 2014

W.T.F. No advice, just hugs. I hope you get some real answers soon.

MrsG80inTN · November 2014

No experience here, but there are definitely TTCALers with cute new utes that will help I'm sure. As for the last part... I need to know, what's a Fundus? I'm hopeful you get answers soon!

BookishMomma · November 2014

@mrsg80inTN the fundus is the top of the uterus.

MrsG80inTN · November 2014

@bookishmomma - thanks. I didn't think I should google it at work just in case :-) As my husband always says, you learn something new every day and usually it's don't do that again...

uromys · November 2014

Oh wow Bookish. Holy crap! I'm sorry you are having such a difficult time. Huge (((HUGS))) At least the radiology tech was being thorough and found some things that may help get the ball moving again. Keep us posted when your RE gets back to you.

tlc35 · November 2014

I don't have good advice but sending all the hugs.

PinkCamino · November 2014

This explains A LOT. I'm at school right now but will be in touch with you to discuss.

BookishMomma · November 2014

Thanks @PinkCamino. I just talked to my RE. He said that if I have a septum, it is probably only a slight indentation because he did not note it during any of my hysteroscopies. However, he did say that the note about the Doppler flow at the fundus could be related because the area of a septum or scar tissue often doesn't have adequate blood flow. He recommended I get an MRI to get a definitive diagnosis.

MrsOscarFelix · November 2014

No advice or input but ((hugs)) to you ! Hope you get some answers soon!

BookishMomma · November 2014

PowerOfBacon said:

Good that the RE recommended an MRI, that would show it definitively.

He wants me to wait, though, until my HCG is at 0 and I don't have any more spotting. He don't want any residual effects from the pregnancy to make the MRI results unclear.

yellowcat10 · November 2014

Wow that is a lot! I would get the RE to check out the images ASAP! Did they do a saline sono in the past, the septum would have shown up then?

reginaphilangee · November 2014

I wish I had ute advice, but I don't. Here are some (((hugs))) and understanding on receiving a lot of doctor "mumbo jumbo" and having to wait for the doc to come actually explain it. I really, really hope they give you some good (i.e helpful) answers!!

>:D<

MrsPhD83 · November 2014

Wow Bookish, this is a LOT of info!! I'm sorry you had to find out all this ute info this way, but I'm glad you are on the path to answers and that your RE is sending you for an MRI. Big ((hugs))!! I'll be thinking of you!

stephy1221 · November 2014

Good luck with the MRI and I hope you get clarification soon.

rslh10 · November 2014

((Hugs)) bookish! I'm glad you have all this new information, but I'm sorry you're dealing with all the crap!!!

EIsieMae · November 2014

Big hugs! I'm glad that you got all the information, but I'm sorry that you are feeling so overwhelmed. I hope you get answers soon.

PinkCamino · November 2014

Hi Bookish,

First, I want to tell you how sorry I am that you were totally sidelined with this information. I know how scary this is (((hugs)))

Second, I want to urge you to get that MRI pronto because the MRI is what ultimately led to my diagnosis.

So my septum like Petra's was shallow and wide which means it was not very large but extended across the top of my uterus. My septum was missed on my A/S with my girls and was only first suspected at my viability u/s with my second pregnancy. Having said that the irregularity that the radiologist noted at that 6 week u/s was coined as bicornuate and not septate. (I'll explain in a minute).

Ultimately, my plan of action was SIS and MRI to get a final diagnosis.

The SIS found nothing but scar tissue which I was expecting because my periods never returned after my two D&Cs. She did however tell me that my uterus looked normal otherwise. I left there thinking I was likely dealing with an acruate and some heavy uterine scarring.

I then had an MRI. That was the game changer. The MRI found that my uterus was a normal shape and that there was a broad shallow septum extending from one side of the fundus to the other. I then had an operative hysteroscopy scheduled to resect the septum and remove the scars.

Here's an image that I think you should look at:

So I was a combination of the left and center photo. The center photo was the result of 2 D&Cs. We still don't know which D&C caused the scarring but I do feel like the first one was so aggressive that it was likely the start of all these issues.

As for having a Septum, I really think it would explain your situation. My first pregnancy was coined a "miracle" in that I was able to get out of the first trimester. The things with septums is that they don't have blood flow - or, they have really minimal bloodflow which then results in an otherwise healthy embryo failing to thrive and ultimately arresting. In my case, a heartbeat was visualized on Friday and by Monday there was none so now I realize that the lack of bloodflow essentially prevented the embryo from continuing to grow.

I would seriously pursue this before you do anything else. My surgeon told me that the odds of successful pregnancy with a septum are less than 10% while with a resection the odds are just about as normal as normal gets.

I'm so sorry you're facing this added burden but I'm somewhat relieved you're headed down the right path for testing because regardless of what your plan to conceive was (IUI or IVF) a septum causes miscarriages and I would have for you to go through this again and again without a known cause.

Now a few questions:

1) Have you had any D&Cs?
2) Have you had a SIS?
3) Did you go full-term with your son?

Frenchteachermama · November 2014

OMG (((((((((((((HUGS)))))))))))))) I am so sorry you are going through this but if you do indeed have a septum I am glad that someone finally picked it up. xxoo

alm288 · November 2014

I'm so sorry that this is never ending! I don't have any advice, but keeping you in my thoughts. ((((((Hugs))))))

meredithcarole · November 2014

I'm sorry, Bookish. I am sure you are totally overwhelmed. I will say, for whatever it is worth, that an MRI will give a very good idea of what is going on. I would recommend open MRI if you can. PC warned me that hers was 80 or 85 minutes and mine turned out to be 90. I was able to watch HGTV which was nice.

PinkCamino · November 2014

meredithcarole said:

I'm sorry, Bookish. I am sure you are totally overwhelmed. I will say, for whatever it is worth, that an MRI will give a very good idea of what is going on. I would recommend open MRI if you can. PC warned me that hers was 80 or 85 minutes and mine turned out to be 90. I was able to watch HGTV which was nice.

Ack 90 minutes. The thing with MRIs is that they are totally painless but such an enormous mindfuck. Within the first 5 minutes I honestly felt like I couldn't go through with it but eventually started to try and control my breathing so I wouldn't freak the fuck out. I ended up falling asleep. Had I been awake I doubt I would have been able to make it through.

How was it?

BookishMomma · November 2014

PinkCamino said:

Now a few questions:

1) Have you had any D&Cs?
2) Have you had a SIS?
3) Did you go full-term with your son?

Thank you so much for the info, @pinkcamino. To answer your questions,

1) Yes- I had a D&C on May 1 of this year for my 3rd loss. I ended up having retained tissue and had to have an operative hysteroscopy in August to get the remaining tissue out. Since then, my RE has looked in my ute again both via hysteroscopy and ultrasound and never mentioned any septum or scar tissue (he was specifically looking for scar tissue, since I'd had so much "going on" in there recently).

2) I have never had an SIS

3) Yes, I carried my son full term and I never had any losses before him. My water broke on my EDD with him and I had a smooth delivery with only one complication--the docs had a hard time getting the placenta out of my ute after I delivered my son. I remember a lot of pushing on my abdomen and a lot of bleeding. Of course, now knowing that I've had retained POC since then, I have to think that the 2 things are related and that something is "not right."

I think my normal pregnancy with my son is part of the reason this potential problem has not been noticed before. Medical professionals tend to think, "Well, she had one full term pregnancy, so everything must be fine in there." Of course, we all know that things can change considerably from one pregnancy to the next. And from what I've read, I know it's possible for women with a septum to have children and never know they have a septum. But now that I know there's a possibility I could have one, I feel like I have to know definitively one way or another, rather than just keep going through losses without having that information.

So, yeah. MRI in my future. I'm not too worried about the MRI. I've had a CAT scan before where you lay still in the white tube... I'm guessing it might be similar?

purplehaze11 · November 2014

Hugs, With my experience these past few months, an u/s didn't find anything, but a saline sonohysterogram brought to light my fibroid (they were looking for a septum actually, since fibroids are not as common after successful pregnancies apparently and usually visible by u/s. The one thing I wish I had picked up on earlier, is that my uterus was actually changing position due to the fibroid (each ultrasound listed it at a different angle). Since then, I've looked at my numerous reports and been able to piece it together.

buggirl72 · November 2014

Lots of (((hugs))) bookish and I'm glad your RE is being proactive about this.

schuebja · November 2014

I have no advice, but wanted to send hugs. I'm glad your RE is on the ball and having you get the MRI. I hope you get answers soon.

sunflwra · November 2014

***Child mentioned***

I'm so sorry that you're dealing with all of this Bookish. I will say that I find this really interesting since I definitely see some similarities to my situation. My OB found that I had a vaginal septum before I got pregnant with my daughter. It split my vaginal canal and made it difficult to find my cervix depending on which side the speculum went in on. I'd been to 5 different OBs previously and no one noticed it until her. She sent me for an HSG to make sure that the septum wasn't extensive or somehow split my uterus. The results seemed to show that it only split the canal and didn't affect my tubes, etc but there was no MRI. Once I delivered my daughter, the septum was removed.

I've had 2 losses since and I also agree that things took longer to be looked in to because I'd had a successful pregnancy. My MFM kept asking me if I could think of anything that changed between my 1st pregnancy and my 2 losses- and we can think of nothing by the septum being removed. With my last pregnancy I had a partial uterine prolapse starting at 11-12 weeks, so it makes me wonder if having the septum there previously helped keep things in place (the MFM did recommend using a pessary from the beginning with my next pregnancy). I wonder if the HSG that was done previously would have given at least a glimpse if there was any sort of internal uterine septum that would have needed to be looked at more closely? Ugh- it's so frustrating. I hope you get some good answers from the MRI!

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