pcos complication: polyp, endometrial hyperplasia,& surgery
I have openly shared my experiences with PCOS (polycystic ovary syndrome). For more details, you can check out this previous blog post here. However, there were many times when I wished having an irregular period was the biggest obstacle standing in the way of my dreams to be a mother. It's been a long, lonely, and confusing road filled with endless tears and wondering why I was chosen to carry this burden. I now see that I was meant to go through all of this so that I could share the truth with you all that God still performs everyday miracles. I guess I should start at the beginning.
In February 2019, I diagnosed myself with PCOS through bloodwork and an ultrasound. My labs showed that I had elevated levels of testosterone and the ultrasound revealed that I had polycystic ovaries. What prompted these tests was that I would go months at a time without a period, followed by a continuous month of bleeding and spotting. I was prepared for a PCOS diagnosis because I always suspected it. However, I wasn't prepared for the ultrasound tech to tell me that my endometrium (lining of my uterus) looked thick. Maybe it was just a polyp (overgrowth of tissue) which are usually benign. Worst case scenario, it could be cancer. I was only 29 at the time so the chances of cancer were slim.
Still, I went through one of the most torturous experiences of my life, which was to have an endometrial biopsy. I wish I was exaggerating, but it literally feels like someone is sucking out your insides. An endometrial biopsy gathers cells from the lining of your uterus. It confirmed that I indeed had a polyp, but it also said that I had endometrial hyperplasia. If you check out this blog post on PCOS complications, you'll see that endometrial hyperplasia (overgrowth of cells) is a risk factor for endometrial cancer and often caused by a build up of the endometrium due to not shedding regularly. Like I said, I had missed my period for a few months so my lining continued to build during that time. Although these conditions were benign, I didn't want my endometrium to stay thick because of the risk of it developing into cancer later and the fact that an embryo couldn't implant in an unhealthy environment.
So in April, I had a D&C and polypectomy to remove the polyp and clean out my uterus. I never expected that I would have to have surgery on my journey towards motherhood, but I was optimistic that once I finished this procedure, then I could start fertility drugs to help with ovulation. Unfortunately, it was advised that I do not start fertility drugs right away and instead take a medication called megace, which is essentially progesterone, to keep my lining thin and then repeat the biopsy in 4 months. I don't know why, but I broke down and cried when my doctor told me this. It had already been a year and a half of trying to conceive naturally with no success, so this just sounded like additional time that I wasn't prepared for. However, I knew it made sense to make sure the hyperplasia cleared before conceiving. I repeated the biopsy in August (again torture!) and was relieved when it came back completely negative.
At this point, I was pretty tired and work was crazy, so I put off seeing a reproductive endocrinologist or starting any fertility drugs. I guess I was trying to come to terms with the fact that I dealt with a pretty serious health issue and surgery, which was unexpected. I just needed time to breathe.
Femara: fertility drug
January of 2020, I began working part time because I was burnt out and could no longer meet the ridiculous demands that my toxic work environment was placing on me. This gave me time to start taking better care of myself and to finally see a reproductive endocrinologist. He was very optimistic that I would get pregnant easily due to my age (now 30) and started me on Femara, which stimulates ovulation. If you have PCOS, advocate for this drug over Clomid as research has shown that Femara works better for women with PCOS. He said to use the drug for 3 months, and if I didn't fall pregnant to consider moving on to more advanced reproductive methods, such as IUI or IVF, which I detail in this blog post. He did recommend, though, jumping straight to IVF instead of bothering with IUI since the success rate for someone my age with IVF was really good. I pushed this to the back of my mind because of how confident he was that I would fall pregnant within 3 months using Femara.
So the way Femara works is that you take it for 5 days every month, starting on day 3 of your period to day 7. Since I wasn't having regular periods, I took a course of progesterone to stimulate my first period so that I could start. My first Femara dose was 5 mg, but when I didn't become pregnant after the first month, he boosted my dose to 7.5 mg. I also did labs at this time to measure my ovarian reserve. Everything looked good on the labs, but then he recommended I do a HSG (hysteriasalpingogram) to check my Fallopian tubes. This is a special x-ray where dye is inserted to determine if there is a blockage in one or both of your tubes. If the dye flows perfectly, there is no blockage. However, if it doesn't (and you experience pain), there is probably blockage.
Unexpected diagnosis: unicornuate uterus
I went for the HSG procedure just to check things off. I really didn't expect anything to be wrong. Usually blockage occurs if you had an untreated STD for a long period of time, pelvic inflammatory disease, endometriosis, or a past ectopic pregnancy. These were things that I never had, so I figured everything would come back fine. The procedure was very uncomfortable, but not unbearable, yet it was the news that broke me. I thought I was having a nightmare when the radiologist showed me the results of my x-ray. It wasn't that I had tube blockage, it was that I didn't have my right tube at all, or the right side of my uterus. The entire right side of my reproductive system never developed, which is a congenital defect known as a unicornuate uterus. I'm sure I learned about this in school, but I definitely forgot about it as I never saw a patient with this. I have seen people with a bicornuate uterus, which is another Mullerian anomaly, but I honestly didn't even know a unicornuate uterus was possible, much less that I could have it.
When the reality of what he was saying set in, I broke down right on that exam table and starting crying. It was just too much: the years of trying to conceive, the repetitive negative pregnancy tests, my PCOS struggles, the never-ending uncomfortable procedures done to my body, and now this. It was like a truck hit me out of nowhere because I didn't even realize I was standing in the middle of the road. How could this have happened? Why didn't I know until now? What does this mean? It was just more bad news, and I couldn't handle it. I felt like my body betrayed me and that I wasn't a full woman, but instead half of a woman. My body was laughing at me, and I felt foolish for thinking I could conquer this. My doctor reassured me that I could still become pregnant with one tube, but I was anxious about the possibility of an ectopic pregnancy and the chance of losing my one and only tube. To make matters worse, the limited research on a unicornuate uterus (its VERY rare) talked about the increased risks for miscarriage, preterm labor, fetal growth restriction, and a host of other problems. All of a sudden, the though of conceiving sounded like the first obstacle in a long and complicated journey to birth a full term and healthy baby.
I became hopeless.
Faith Without Works is Dead
Everyone told me to have faith. I prayed with my mom and even saw a therapist who helped me with manifestation. My doctor told me to give the Femara an additional 3 months (a total of 6 months) before moving on to IVF due to my uterus. I started to become serious about tracking my ovulation and having timed intercourse. I also changed my diet and started walking/running a few times a week. I figured lifestyle changes would only help the medicine, and it was time for me to try other things. For a breakdown of what I started eating, view this blog post. However, the main difference is that I cut out white carbs, such as white bread, pasta, and rice and switched to whole grains. Many of my meals would consist of lean meat, such as fish or chicken breast, and veggies, but if I had to have carbs, I chose the brown version instead. I also cut out juice and challenged myself to drink 100 ounces of water a day. I stopped putting sugar in my coffee and used only creamer. If you follow me on Instagram, I'm sure you remember me talking about this. PCOS thrives off of sugar and carbs, so if you limit those two items, your body can start to work better. To ensure my body had all the nutrients it needed to support a pregnancy, I started taking a prenatal vitamin (this is an affiliate link) regularly. I was determined to help God as best as I could.
The truth is when that 6th month rolled around, I was back to feeling hopeless. I just didn't understand why nothing was working. I mentally gave up and decided that I would talk to my doctor about starting the process for IVF. I even sat down and talked to my husband about the reality of this. My mind was made up: I wasn't going to conceive unless I did an actual procedure to help me. My husband, on the other hand, had unwavering faith and began to declare that I was pregnant. He kept saying it, which made me mad, but he said we needed to have faith like that until it happened. He said I needed to believe that it could happen and will happen, and that there was no room for doubt. I tried to act like I believed, but really I had moved on to the next step in my head, unsure if that would even work. That last month, I didn't even bother to track my ovulation or to engage in timed intercourse. I took the Femara out of habit, but I didn't follow through with the process as we had done the previous months. There definitely was no way we could fall pregnant since I wasn't tracking my most fertile days. I transitioned to a new job and was waiting for my new insurance to kick in so I could talk to my doctor about IVF.
When my period was late, I was frustrated because I didn't understand why the Femara didn't work. Why didn't it give me a period this month? It didn't even occur to me that I could be pregnant because I had already determined that I couldn't conceive without extra help. Well, I did have extra help: God decided to bless me! It literally happened when I least expected it, which is why I keep saying that our son is a real life miracle. There is no drug, no diet, no procedure that is more effective than when God decides to work in your life. I know that now and this process has renewed my faith and taught me who really is in control. I needed to go through this because I needed to share with you all that God is the answer. I am a very scientific person working in the medical field, but I cannot deny what has occurred in my own life, my own body. And God continues to keep me and my son, as my pregnancy is going very well and I have not encountered any of those issues that used to trouble me.
So how did I conceive? I did the work of having tests done to fully understand my body, underwent surgery to ensure my uterus was healthy enough to support a growing baby, used Femara to stimulate regular ovulation, and practiced lifestyle changes. Then, when God decided the time was right, I was blessed with my sweet baby boy. I believe that everything over the past few years worked together to create this moment, but God's intervention was necessary to bring forth life.
xoxo, Global Midwife