You know that thing you can do when you subtly (or not) induce someone to independently endorse your opinions by spinning them the data in such a format that they think the inevitable conclusion was all their own work? (If you overwhelmingly do not, then you have probably never worked in sales; further, I have just singled myself out as someone whose moral ground just became a leetle stickier underfoot.)
I’m a little anxious that I may have pulled this trick, albeit unwittingly, on my Consultant. I shall s’plain.
The twists and turns to my reproductive history are so myriad that they bore even me: let us simply term my uterine activity a fair personification of Murphy’s law. In précis: I have been pregnant four times in my left uterus and twice in my right – redeemingly, one of which went on to be awarded Star of the Week at school on Friday. (Reason? He finally worked out how to read. Also? It was kinda his turn. The kids haven’t realised there is, loosely, a rota.)
After Harry’s IUGR, I moaned loudly about my perceived poor vascularity of the right uterus, especially after finding that my heart’s aortic/venous plumbing is laid back-to-front through my abdomen, and might not necessarily be on the best of geographical terms with my right uterine artery. I postulated the theory to one and all, but seemed to be rather lone-voiced among my doctors in blaming Suspect Vascular Supply, although they all dutifully wrote it down in my notes.
But here’s the thing: by your 5th failed pregnancy, doctors start noticeably pandering to any harmless bees you might diffidently produce from your bonnet. Thus pregnancy six, Turbo, was duly replaced into my nice, inaccessible, arterial-haemorrhage-menses-producing left uterus purely in order to make me happy. The subsequent violent miscarriage – my body badly wanted those heparin-assisted burrowed-in placental shreds gone – sent everyone’s diagnostic weathercocks swinging round to Immunological. And I’ve been feeling cosmically picked-on about it ever since: Uterus Didelphys coupled to infrequent ovulation is a sufficiently complicating handicap – must I also suffer the indignity of an immune system that can’t read the simple sign on my ute?
Warning: Live Pregnancy. Do Not Extinguish. This Means You.
Anyhoo, when I cited ‘immunological’ in passing discussion with Head Chap earlier this week, I goggled when he said he would be inclined to look no further than poor vascularity associated with my didelphys as the culprit. I did the whole distended-eye-goldfish-mouth impression slightly, so he had time to enlarge upon the fact that the uterine arteries, intended to feed half a uterus each, are obliged to feed a whole uterus each with didelphys (I had known this, John had not) and that this factor could well be expected to have a marked effect on even an early pregnancy.
Say what now? I’ve been banging on and on and bloody on for months about the fact that I thought my right ute was at the absolute end of the radiator system for the hot water, so to speak, and was even humoured to the extent of Choosing My Own Uterus For IVF. It made no difference, as it happens, but no-one has ever so much as hinted before that I might just have had a real point in blaming the physical logistics of blood supply. I remember specifically asking him to keep an eye out for dodgy arterial uterine wiring during my hystero-& laparoscopy, but he said it’d not be visually detectable, and gave no hint that it might be anything other than Ann’s Crackpot Theory.
So, it essentially felt like he was reading my half of the script, and I’m not quite sure how we got around to switching lines.
Having said that, I didn’t anticipate him taking quite that tack, as the accepted medical wisdom is that Uterus Didelphys, in the lump, is not strongly associated with early miscarriage. Late miscarriage, premature birth, IUGR, lousy presentations: yes, yes, yes, yes; didelphic uteri tend to be small and the cervixes sometimes incompetent. (Mine are both normal-sized, as it happens, and my formerly neat, competent cervixes were only buggeroonied into a pretzel by Harry’s emerging through one of them like Rocket Man, followed by a comprehensive pelvic-floor exhale.)
But I know, because I read the Mullerian Anomaly message board, that early miscarriage does, in fact, anecdotally seem to crop up fairly often. So do irregular periods, thrombophilias and every other sort of reproductive havoc; it’s the nature of the comorbidity beast. If you have a Mullerian duct anomaly – any of ’em – you have problems. Except for the women that don’t. There are women, particularly with UD, who sail through conception and pregnancy without a tremor. Others – the majority? – have a mixed bouquet of early and late miscarriages, interspersed with premature births, interspersed with full-term uneventful pregnancies.
And no-one knows why the hell.
My Magic 8 ball says ‘Cannot Predict Now’. His said ‘Outlook Not So Good’. He said he thought the odds were against me, but not stacked against me so badly as to render it all pointless.
Anyway. I could well have immunological issues, too. I asked him about the shiny-new-uterine-biopsy they are offering for Natural Killer Cells, but he gave us the strong impression that he, personally, thought that NKCs were the stuff snake oil is made from. So, given that I was supposed to be taking prophylactic steroids next time anyway, I’ll probably pass.
I explained my quantity over quality preoccupation. He agreed that replacing cleavage-stage embryos would probably give us more bites of the pregnancy cherry.
Him: ‘Should we replace one or two?’
Me: ‘Oh, God. Definitely one.’
(My last frozen 2-embryo cycle resulted in a twin pregnancy of sorts. Do Not Want. However, I have since noticed the £750 price tag attached to frozen transfer cycles, and I’m thinking I might need to reconsider.)
I asked about my weight (‘you don’t look to have a significant problem’) and age (‘I wouldn’t say you’re at an age-critical stage yet’). Which is odd, because I sat cringingly in front of this chap 7 years ago, a stone and a half lighter than I am now, and he told me my weight wasn’t helping, and that I was too obese for NHS IVF. Of course, I’ve been pregnant 6 times since then, so he’s possibly not sweating the small stuff anymore.
After recently learning that elevated levels are associated with recurrent miscarriage, I told him I would like my prolactin level looking at; apparently it’s never been checked. I don’t know if I ever posted about it, but I was still fairly full of milk a year after I’d finished breastfeeding. I had eventually dried off (John suggested a diet of sawdust and straw) by my last pregnancy – but by the time I miscarried at, what – 9 weeks? my milk had come in. Properly come in. Which was nice. He said it wasn’t desperately unusual, but he agreed it was worth checking, and sent me off for a blood test immediately afterwards.
I suppose I should have walked out of clinic depressed. I think John did. But I actually felt as if a small weight had been lifted from my shoulders. If it isn’t immunological after all, if it’s just (just!) the didelphys, then at least I have one less thing wrong with me than I thought.
Now: to lose some weight. I have abducted my in-law’s Wii, bought the Zumba fitness game+belt, and tomorrow the floors will begin to shake with my frantic gyrations. I will be whippet-thin by June.
Here. The sun’s been beaming, and it’s been lovely. Have some pretty flowers.