We did the sonohysterogram a few days ago and found no polyps! That was great news but it did show something else known as a Uterine Septum. In my case, the septum is not severe and that area of the uterine wall is just slightly thicker than it should be. For reference, anything over 1.5cm thick is considered a septum, I’m at 1.7cm and a typical uterus is about 7.6cm in total length. So, this means the outside of my uterus is a typical shape, but the inner layer is too thick at the top/center. This septum is shaped like an upside-down triangle at the top of the uterus and it can make conception and pregnancy difficult for a few reasons: In severe cases the septum can extend the full length of the uterus creating two separate cavities. The septum itself does not have the same blood vessels and is made up if different tissues than that of the uterine wall so an embryo trying to implant near the septum will likely be unable to implant at all. Likewise, when the placenta forms it needs to connect to the inner wall of the uterus and get a blood supply, but if the inner wall is too thick where the placenta attaches the villi will not be able to reach the blood vessels. This is why even a minor, partial septum like I have can cause recurrent miscarriage.
So how does a septum even happen? You’re born with it. Here’s (basically) what my doctor told me which is actually really interesting (as told by Wikipedia):
The uterus is formed during embryogenesis by the fusion of the two Müllerian ducts. During this fusion a resorption process eliminates the partition between the two ducts to create a single cavity. This process begins caudally and advances cranially, thus a complete septum formation represents an earlier disturbance of this absorption than the incomplete form. Causes for incomplete absorption are not known.
Here’s what it can look like:
Yesterday I had the odd realization that I had this before I was born. All of this fertility stuff that has become my focus in life was part of me when I was still in utero myself. Regardless of how I exercised or ate right or anything for the past 27 years, this was already part of me from day one. In that way I was “meant” to deal with miscarriages and fertility doctors and all that goes with it. A tiny piece of tissue that didn’t develop completely before I was born may have caused all of this. I feel kind of amazed by that. It makes me questions how many little dents and divots do we all have that affect us in ways we may not even know?
Anyways, I feel really happy because this is the first thing that makes sense as a possible reason for our previous losses. Of course, they could have been random genetic abnormalities, but this is a real solid piece of information that makes a lot of sense to me and I count it as a huge blessing in this realm of mostly unanswered questions.
And next up will be surgery. We have a pre-op appointment scheduled at the beginning of November to get the details and until then we will not be TTC. What we know is that there is a risk of getting scar tissue where they cut away the septum. If this was to happen, I’d have to have another surgery to remove the scar tissue since it too would block blood supply. But that’s the only major risk we know of at this point. If everything else sounds good at the pre-op appointment we will move forward with surgery in mid-November or in January. We’d like to do it sooner than later, but we already have a lot to pack in before the end of the year (sell our house, celebrate Thanksgiving, move to Utah, trip to Europe, settle in to our new house, get ready for Christmas, fit in real life between all that, etc.) Plus, we won’t know which dates the surgeon is available until the pre-op so it’s possible we’ll squeeze surgery in before we move, but not super likely. And although it’s not an overly risky recovery since there isn’t an incision or stitches involved, I’ll still probably be feeling less than my best for a full week after and I don’t want to be stuck in bed with the stress of an out of state move looming over my drugged up head. So yeah, not super likely, but still possible I’ll have the surgery before the end of the year. Otherwise, I’ll do it in January and I’ll travel back here to Arizona to have it done.
In the meantime, I’m keeping up my supplements (CoQ10, Iron, Vit C, Vit D, cranberry, prenatal multi), thyroid medication, and daily baby aspirin until the next appointment and I’m holding on to my clomid and progesterone supply until after the surgery. We’ve been at this for several months now and as much as I wish we could start trying, I’m really happy with the progress we are making. It feels great to be setting up a solid foundation and getting a clear understanding