Monday, September 16, 2013

hCG is Outta Here; Onto Hysteroscopy & FET #3

Lots of good news today. First and foremost, my hCG is already back down to zero.  I was obviously just paranoid about this being anything other than a very early miscarriage. Notice, I don't use the term "chemical pregnancy" which is actually the medical term for a miscarriage less than 6 weeks along. I can't stand that term or "spontaneous abortion" for that matter. I know that's what appears in my medical chart, but it's just a personal pet peeve I guess. I feel those terms take away from the significance of even the earliest loss of life or make it sound as though it was the patient's choice. Is it just me?

Very happy indeed that this short lived pregnancy is already over and a new cycle has begun, because we are ready to move on from it. I think my past experience going through methotrexate shots and zigzagging levels of hCG for 10.5 weeks during our last loss scarred me mentally big time, so I panicked a little fearing this could result similarly. However, there is nothing funky here to worry about, no ectopic or anything remotely abnormal...other than extremely painful cramping and lots of bleeding.

The cramping was so intense yesterday that nothing could touch the pain...not even a double dose of 500 mg hydrocodone. I'm actually not even going to complain about the pain and bleeding too loudly though. I was SO freaking happy to see progress arrive quickly and in full force yesterday.  With every painful gush, I've been so thankful and am rejoicing that things are happening so swiftly!

Today we had our "WTF appointment".  Gotta love my RE. He deserves the "Patience with Patients" award. I walked in with a laundry list of questions and a stack of SART rates for the last five years; My questions did not poo poo around any uncomfortable topics, and I did directly ask him to defend different aspects of things I am questioning....such as inconsistent SART rates in certain categories, what I consider "less testing" requirements as compared with other clinics, and various protocol choices and differences. I am not rude by any means,  just well prepared and documented....total nightmare of a patient I'm sure. ;)

I guess for us, we are beginning to feel like we're throwing embryos into the vast unknown. 5 down and only 2 left...yikes! For me, part of this feeling is because we've never had a laparoscopy or hysteroscopy to evaluate my insides more invasively with a camera. I've always wondered if there's something being missed. I've had two HSG's which have both been crystal clear and a mock transfer prior to IVF, but that's about it. Ultimately, we all agreed that although there has been no real push for me to get a hysteroscopy previously (my clinic does not require it pre-IVF), it is certainly an option still on the table.

We did ask about hysteroscopy a couple times before IVF but were told that we didn't really need it and that it might end up being $3000 spent for nothing. Well, once you've spent $30,000 on treatments and still haven't had success that sticks, that $3000 doesn't seem so "unnecessary" anymore if there is even a teeny tiny chance of finding something that could prevent implantation. We wanted to do this surgery no matter what, but low and behold after hours on the phone to my insurance company and the surgery center, the surgery coordinator at my clinic thinks that outside of a small co-pay to the surgery center this will end up being covered 100%! They will use my uterine septum as evidenced on my HSG's to warrant an actual medical coding and turn what is normally a "diagnostic procedure" into a "medical procedure" so it's covered. WhAt the WhAt?!?!

Um, kind of wish we had the hysteroscopy done a long time ago. DUH PEOPLE! What happened was...My doctor saw in my file that I have no fertility coverage and not even any diagnostic coverage, so he is the one who told me it wouldn't be covered when we asked him about the procedure before. He obviously hadn't considered a different way of coding, which is what the surgery/insurance gal specializes in...creativity if you will. She is the one who said she could get it covered on my behalf all of a sudden. Gah! This is why "checks and balances" are so important when you're getting fertility treatments and have no insurance coverage for them. Oh well, no sense being too pissed about this "slip through the cracks" at this point...We're just grateful we found a way and it IS getting done now and should be covered. I will only believe it when I see that bill for $0 of course.

So, we've scheduled the hysteroscopy for this Friday 9/20. Dr. V will look for any polyps, and will remove anything which could be hindering implantation. We have no reason to believe I have any polyps, because I have never had anything show on ultrasound or HSG. However, there is still a chance, albeit small, he could find something in there. Here is a basic rundown of what the procedure entails...




Additionally, I have always had a slight uterine septum. This is a uterine abnormality (a slight dip in the top of the uterus) that I was born with. It's so slight and shallow that it would probably never cause issues with infertility, but it's POSSIBLE it could cause issue further into a pregnancy....if an embryo implants on the actual septum. Again, it's probably not a huge issue, but I'm not really willing to take my chances with "probably not" anymore at this point. During the hysteroscopy, the uterine septum can also be repaired, so we're kind of killing two birds with this one procedure. This is kind of gross, but this is what it looks like when they fix a septum with hysteroscopy...


It feels like we're basically flying into this procedure in only 4 days, but I am content with the decision. We both feel like it's the right thing to do before transferring our last two embryos, whether they find anything or not....at least we'll know for sure the coast is clear up in there. Should be interesting to see if they find anything!

I know many of you have had hysteroscopies. Would love to hear your experiences, tips, anything you'd like to share!

55 comments:

  1. I had a hysteroscopy, D&C, laparoscopy, and tube blow out at the same time. I had endo so my RE burned my endo with a laser. My biggest complaint was cramping/burning for about 3 weeks after. When I had my HSG I felt fine within a day or two. Expect them to straight cath you, but ask if you can go potty before they take you back because the straight cath burns the first few times you go potty after.

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    1. Good advice from the OR nurse. Thanks E!

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  2. Hey Emily! I called my HCG of 22 a chemical...but I think it really is a personal thing.
    Hysteroscopy: Mine was done under propafol (same as during egg retrieval). Not sure if that's standard. It took me the rest of the day at home lounging around to feel back to normal. I don't remember a thing about the procedure. Very minimal cramping the day of but back to normal by the next day.
    I also had an endometrial biopsy performed because there is a body or research that shows the regrown/repaired endometrium comes back thicker than before. The cycle after the biopsy I did have my thickest lining. You might already be doing this as part of the septum repair.
    Fingers crossed for you.
    You and I continue to be floating along in the same boat. We're both 5 embryos down now with one more FET to go. Ours is scheduled for November. We BOTH need out of this boat! :o)

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    1. That is promising news on your lining. Thanks for sharing that!

      Wishing you all the best with your final two as well. Gets kinda scary the less we have to work with, but I'm just thankful we had any frozen embryos at all. Some women would have to have 3 retrievals to amount to this many embryos to use, so I never lose my gratitude for even having the chances.

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  3. Emily, I love you! I imagine you in the doctor's office and I can't help but smile! You my dear, are awesome!

    I hate that this pregnancy ended for you, but I'm so glad to hear that everything is clearing out naturally! I too HATED to hear the terms chemical pregnancy and spontaneous abortion applied to my baby. Chemical makes is sound mystical, like it only occurred in numbers not reality and abortion makes it sound like I chose it… both suck!

    I'm proud of you for sticking to your guns and getting the tests run that you want. Wishing you the very, very best on Friday! Hugs!

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    1. Thanks Amanda. Yes! My point exactly....like it was just a number. I was attached to those little embryos and they were life, and they mattered far beyond just a "chemical reaction."

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  4. First off, I loathe the terms "chemical pregnancy and spontaneous abortion", it's called a miscarriage and I don't care how far along you were, and my heart is so sad you had to go through another one at all. I am glad you are going with the hysteroscopy. I had one too, although I think it was a hysteroscopy +. I was knocked out for it, about 45 minutes for the whole thing, it included the HSG dye to check the tubes, a camera to look at the uterus, tubes, everything, and also they scratched the endometrial lining for a lab analysis. Those results took a couple of weeks for me. I really hope it gives you some good answers and helps give you comfort as you head to FET #3. After your hysterocopy I take it Dr. Vaughn will meet with you and tell you where we proceed from here? I know it's been such a hard road for you. You are one amazing, strong woman, I am praying for you daily. *hugs*

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    1. Was it the beta 3 integrin that they did with the endometrial scratch while they were in there with you? That is yet another thing my RE doesn't really do or believe is necessary.

      We already talked A LOT about where to proceed after the hysteroscopy, but I didn't want my blog post to be ridiculously long. I'm actually starting Femara today just to give this cycle some sort of a chance....to give us options post procedure.We also want to use this cycle as "test run" with Femara...to see if I'm still producing 9mm+ linings on Femara like I did before. I noticed that my linings were the BEST on Femara of all things. If that is the case, we may actually simulate a Femara cycle and do our FET 5 days past ovulation with our blasts. It would mean my body is producing it's own estrogen for a more natural FET (with a better lining)...minus dumping loads of estrogen every day into my body. I haven't been super thrilled with my lining past two FET's, so we're exploring other options next time when simulating the cycle. Will post more on that as we get to it.

      Since we have no idea "how much" will need to be done while he's in surgery, we don't know yet how fast we'll be able to move into an FET...could be right away, one month, or two months.

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    2. I responded to your last post before seeing this comment, but now that we know the results of the hysteroscopy, I'm even more excited you are taking Femeara this cycle. I am really hoping that now that both tubes are free and clear that you get a BFP, how awesome would that be to not even need the FET next month. Honestly, I don't remember what I was scratched for, but whatever it was, it was normal. They said it was a biopsy for some sort, I don't think it was beta 3 integrin though.

      I am praying for you girl!!! You deserve this so much. *hugs*

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    3. Oh no my friend, that plan is out the window for now. I stopped the Femara the moment I found out we were adding the laparoscopy. My body will need time to recover before TTC'ing now since we added the lap. Hubby said the RE told him it won't be until November until we can TTC again.

      If you didn't have the beta 3 integrin, it was probably just an endo biopsy or something. I know sometimes, if they don't find any noticeable endo, they will still take a tissue sample and test for it, because endo can be microscopic. I'm guessing that is what you had. Other RE's believe that just "scratching" a little space in there can create a place for an embryo to be drawn to during implantation, so it could have been that also. Thanks for the info. Amber!

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  5. So good to hear from you - I've been thinking about you and praying for you tons! I am praying for great results on Friday as well! Glad that your appt went well today and that you can move forward. Hugs!! xoxo

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    1. I am going to keep you busy with prayer girl! The saga continues. haha! ;)

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  6. I hate the term "chemical pregnancy" too. I'm glad your HcG came back down quickly. Saying some prayers for you guys!!

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    1. Me too! Thanks Kasey! We can use the prayers!

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  7. I will be thinking of you on Friday!! XO

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    1. Thank you darling! I've been thinking of you non-stop too. Praying for good results on the CCS testing of your embryos!

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  8. Hey Emily - I am new to your blog. Wowza it seems like you have been through a lot. You have such a positive attitude!

    I am glad they are looking into everything.

    Good luck with all the tests.

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  9. Sigh. Well, I'm still so sad that you lost another pregnancy, but I'm also so relieved that you don't have to go through the HCG hellride you were on last time.

    I couldn't agree with you more about being thorough. Part of the reason we left our clinic is because I didn't feel like they were taking some of my concerns seriously. I want a hysteroscopy because ever since my miscarriage I haven't felt like everything is as it should be in there. But they kept avoiding it. If you don't know for sure that you've investigated everything you can think of, it's hard to want to chance putting your precious embryos back in a less than ideal situation. I totally get it. As for hysteroscopies, my last one was very straightforward. I took some ibuprofen beforehand as instructed, and required no meds during the procedure. I felt a slight discomfort mostly from the dilation of my cervix and the insertion of the fluid, but otherwise it was easy. I don't think I needed the ibuprofen. I did almost pass out after it was over, but that's more due to a weird history I have of getting woozy over seeing weird medical stuff. If that bothers you too, don't watch the screen! :)

    Also, the month of my hysteroscopy, I miraculously conceived the old fashioned way despite our RE telling us we had a less than 1% chance of that ever happening. My husband and I both think somehow the procedure aided that in some way, even though our primary diagnosis is male factor. Sadly, I lost that baby (my beta was an 8, and I agree, that counts as a miscarriage), but I'll always wonder if somehow the fluid they inserted somehow cleared the way for sperm and egg. You never know.

    Thinking of you and hoping your procedures go smoothly and painlessly this week. My next hysteroscopy is just 5 days after yours. We know how to have fun!

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    1. Thank you Lisa. It sounds like maybe you had a diagnostic hysteroscopy. I'm doing the operative kind.....in a surgery center where you are under general anesthesia completely knocked out. I'm glad yours was fairly easy breezy though...still reassuring to hear.

      Yeah, isn't it weird how sometimes just the clearing out of things with that fluid seems to help somehow? We got pregnant naturally the firs time around on a "break" cycle a couple weeks after getting the HSG test too....but we also miscarried that time. It really does make you scratch your head and make you wonder if even the smallest little blockage being moved out of the way can help.

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  10. I had one, it was super similar to the HSG (the dye one?). Nothing to crazy minus mild cramping and then when I stood up a lot of fluid gushed out. I too didn't expect any issues but couldn't go through IVF #3 without knowing I wasn't missing something. You will feel more peaceful knowing that you checked out all the "just in cases." Best of luck and I'm praying for your 2 little frosties!

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    1. Yes, no matter what, we'll feel better knowing just in case. Plus, one thing I didn't mention....If our last FET doesn't work, we may decide to look at other clinics. All of the other clinics I've looked at so far DO require a hysteroscopy to be done before beginning treatment with them. So really, this is a win win for us, even if they don't find anything major as a cause for previous implantation failure. The procedure will need to be done eventually no matter what if we do switch clinics...hoping we have success and that isn't the case of course.

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  11. Emily- I love your plan. I think it's smart to ask those questions. I finally just got a bill for the $700 worth of testing that was not covered by insurance when I asked for a RPL panel (yes like 5 months later...) and even though they found nothing and it did us no good it was worth the money for piece of mind. I'm glad you are doing this and I hope this is the last step before a successful FET! And whew on the hcg, I can't imagine the worry there after last time. Hugs and I'm rooting and praying for you!

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    1. oops, PEACE of mind, LOL. That's what I get for replying during insomnia in the middle of the night. :)

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    2. Thanks Sarah. I think your RPL was definitely worth it too, especially now that you're pregnant....a lot of those clotting factors they test for actually can cause 2nd and 3rd term losses, so knowing you don't have them is definitely worth it!

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  12. I have never had either but I feel that if this doesn't stick a lap or hyst is our next step. So I don't have any advice for you. You are so through, you should be a infertility advocate. You are very well educated and versed in treatments. Your are amazing with all the knowledge and advice you hold. I wish you the best on Friday. I will pray that the doctor finds and fixes what he needs to. Xoxo big hugs

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    1. You are too kind. I definitely never wished to become so well informed on this crap! haha!

      I hope your cycle works, but if not...a little procedure to take a look can't hurt. I would have gotten a lap a long time ago too, except that procedure is quite expensive @ $12,000 and there definitely isn't any way I could get that one covered. My RE says that if you do IVF, the lap is completely pointless, because you are going around the fallopian tubes anyways...as long as you have no tubal issues, evidence of hydrosalpinx on HSG, etc.

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  13. I'm glad things are moving forward and you can look to the future, but I'm so sorry you lost this pregnancy, Emily. :( There's nothing worse than losing a pregnancy and THEN wondering if something is wrong, so I think it's great you are going to move forward with the procedure. You're right; there's sooo much money already spent ... a few more "bucks" to double check everything can put the mind at ease for the next cycle. Obviously, I'm wishing you didn't have to go through allll of this in the first place ...

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    1. Thank you so much. I know you have been through the ringer with failed FET's lately too, and I wish none of us had to go through this. I'm definitely not giving up yet though, and neither are you! Thinking of you this week. :)

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  14. Great news! I am so hopeful that this will be THE cycle! Prayers as always!

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    1. Thanks Catherine. Not sure if this can possibly be THE cycle to actually conceive post-surgery (you never know!), but if nothing else we'll get some answers and that is good enough for us!

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  15. Great news all around Emily. I love your plan. I've had 2 hysteroscopies this year. The first was done at the same time as my laporoscopy. The lap was the roughest part of that procedure and usually what sucks is the gas accumulated in the abdomen afterwards. The second hysteroscopy was during my ODWU at CCRM. I was awake and it took less than 3 minutes. I was expecting painful, and it wasn't in the least!!

    Will be thinking of you Friday for sure. Good luck with the surgery!! xoxo

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    1. See, my point exactly...most of these other clinics, including what we all consider "the best" require this procedure. Glad yours was so easy breezy. I'll be knocked out with general anesthesia since this is actually an operative hysteroscopy, but I think you are right....since I'm not doing the lap as part of it, recovery should be quite minimal. Thanks for thinking of me Friday. I'm thinking of you and praying for you always girlfriend!

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  16. I'm sorry this wasn't it but can definitely see your point with being able to quickly move on. Looking forward to hearing Friday's results! Praying for quick and painless recovery.

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    1. Thanks woman! Indeed, I am thrilled I'm barely even bleeding anymore now. Thanks for the continued prayers. Quick and painless sounds great!

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  17. We did our first IVF and since it failed, they scheduled us for a hysteroscopy. It went fine, they gave me the same stuff i had for retrieval, i had mild cramps and some spotting. Nothing major - was back to work the next day.

    I am quickly learning you really have to be your own advocate when it comes to this stuff. We also had our dr add on chromosomal testing to the list. Even though we've never had miscarriages and i want to cover all bases before we do a FET and "waste" embryos. I also asked about a lap but was told I really don't need one. That one is much more invasive, painful, etc, so for now I'll take my dr's word for it. Ugh. so much to think about/consider and research!

    Good luck!

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    1. Thanks Shay! Yes, I was told I'll be under the same sedation as during our retrieval. I think I agree that if you're doing IVF, the lap is kind of pointless if you've already had the hysteroscopy. Sounds like you are being extra aware you are covering all your bases too!

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  18. After 2.5 years and 4 early miscarriages (all before 6 weeks, and I refuse to call them chemical pregnancies), we finally scheduled a hysteroscopy. I was asleep during the procedure. They found a uterine septum that did not show up on my sonohist months before, and repaired it. Turns out our babies were implanting on the septum, and once the blood supply ran out they couldn't survive. We got pregnant via IUI our very next cycle. I'm so glad you were able to work out the insurance coverage... stay positive! You have a ton of people rooting for you!

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    1. THANK YOU for reaffirming what I feel in my heart needs to be done. I needed to hear that! This is exactly why we're doing it!

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  19. Keeping you in my prayers and hoping that everything goes well on Friday Emily :)

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  20. It's good to see u post giving all an update. I just had a hysteroscopy about a week and a half ago. I was completely knocked out for this procedure & they told me they would empty out my bladder during surgery even though I had to the restroom when I got there. When I awoke I really didn't have pain just discomfort. The bleeding lasted about 2-3 days and then poof! My dr restricted anything going up the vaginal hole for two weeks. Hahaha! This girl did not listen to his instructions very well. After a week I said to hell with this and did the deed. I did get pain medication but was not needed. Everything that was scraped off was sent for testing as well. Hope everything goes smoothly at ur appt and praying ur insurance covers it 100%.

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  21. I think you're making a great decision! I had a hysteroscopy done prior to my first sFET in June because I had small polyps on my uterine wall. It is a very simple procedure- they typically give you a Local-A and you're out for about 25 minutes. I had some pain when I woke up but nothing a little intravenous drug couldn't fix. I was walking around Manhatten within 45 minutes and flew home after 2 hrs of the procedure. I'm sure you will be fine.
    My RE said that you are more likely to have implantation occur after it too because they can do a light D&C while in there. Cleaning out your uterus and making a cozy environment for your baby! I had slight bleeding (so wear a pad when you get up!) but other than that it was hands down the least painful procedure to date for me. I hope this is all it takes for you to get your baby. I will be praying for your success.

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    1. Good to know Kelly. Yeah, I know each RE is different, but I guess the reason they haven't recommended one as of yet is because the don't see any polyps on either ultrasound or HSG....but as we all know it is possible to have really tiny ones that just don't show up UNTIL you do the hysteroscopy. It's good to hear you actually had stuff removed and were still so mobile so quickly after!

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  22. Also, my RE REQUIRED a Hysteroscopy after a failed transfer. It's strange the DR. didn't recommend one to you. They are critical in diagnosing implantation issues.

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  23. So, so sorry about this loss. I remember being so confused about my chemical pregnancy. I just wanted to ask "so am I pregnant or not?" and "is it a baby or not?" I think a lot of it has to do with your own beliefs about this stuff. And I think it can be important to know what you believe so that you know how to grieve. Again, so sorry you have to go through all of this. Hoping that these next steps have you in a place of hope.

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    1. Thanks Em. I will say it's amazing how much different a loss does feel with only a couple weeks difference in progression. My first loss was @ 6 weeks and it was a whole different ballgame. This loss is already over as of today. It happened right away and now it's over, and I am just SO grateful. The loss at 6 weeks, and suspected ectopic which took 10.5 definitely were a lot harder for me...not only because of my beliefs but also just the physicality of them.

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  24. I'm glad you have a plan to get more information. I'm always a fan of making sure you have all the testing done even it costs more...no regrets later. Good luck, Em. I had a bad reaction to the anesthesia last time and it was rough. Hope yours goes smoothly. Hugs!

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    1. I'm sayin! It's like I just want to shake my doctor and say, "Stop trying to save me $ and just get me pregnant!" He tends to be a little conservative, and I'm like, "What about that box? You didn't check that box!!!" haha ;)

      Sorry to hear you had a bad reaction to the anesthesia. You poor thing! Fingers crossed I won't have issue since I never have before. xx

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  25. Well, my friend, YOU deserve the award for perseverance, dedication, commitment, and positivity. I am always blown away by you and your ability to bounce back after being let down, and move on and stronger than ever. Since I have followed your blog, I've laughed, cried, and related to so many things you've said. But, each and every time I finish reading a post...I think to myself "damn, that is one strong woman!"

    Yay for your HCG being down to 0 (I guess, it doesn't really seem right to say "yay" to this, does it?). I'm just glad that it wasn't another ectopic for your sake.

    I'm hoping that the next tests and procedures bring you some answers and some peace. And, I'm obviously hopeful that FET #3 (I'm assuming your last FET with this set of embies) is the rainbow that you so deserve.

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    1. I am definitely saying YAY for that zero! Thank you for saying I'm strong. Anytime someone says that I'm like, "I am? Really?" It's so strange when others can see in us things we don't really see in ourselves. Some days I do feel strong, but other days I feel anything but! Anyhoo, thanks Darcie. :)

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  26. Way to go for getting right back in the game! I've had 2 hysteroscopies. The first was a little rough because I had a lap at the same time. Got a UTI about a week after so I was NOT a happy camper. Second hysteroscopy wasn't bad- just sore for a few days.

    Thinking of you and sending lots of prayers and hugs your way!

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    1. Good to know. I will have to drink oodles of water and drink some cran after. Anytime they are sticking something up there like that I do get overly aware of trying to flush out the system. Thanks for the head's up!

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  27. I think it's great you are being so thorough. I have not had a hysteroscopy, but have learned a lot from reading through the other comments. It might be something I will press for if this cycle doesn't take. I am also constantly amazed and inspired by your attitude and strength in all this. Will be thinking of your tomorrow!

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  28. So glad you're able to get the hysteroscopy at no cost! I hope it helps provide some answers for you!! :)

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