Avoiding a Second Surgery: How a Change in Medication Could Lead to Pregnancy
Our last blog post detailed a successful isthmocele repair surgery that will hopefully lead to a healthy pregnancy. Today’s post is a little different.
Here is a case where surgery, performed by another surgeon, had failed. The patient, Lindsey*, was still symptomatic with fluid in the cavity. Dr. Miller provided the patient with a new medical protocol, avoiding a second surgery.
Read Lindsey’s story to find out the result.
After almost four years of struggling with secondary infertility, I was fortunate enough to discover Dr. Charles Miller and the Advanced IVF Institute. I had been diagnosed with an isthmocele, which was a defect in my cesarean scar that was leading to fluid accumulation in my endometrial cavity. Just reaching the diagnosis of an isthmocele and the potential impact it could have on my fertility had taken many years. I was exhausted, frustrated, and unsure if I would ever have another child. My local physicians seemed to be at an impasse. Despite having my isthmocele surgically repaired, I was continuing to develop fluid which was impairing the ability of my physicians to transfer any embryos.
After contacting Dr. Miller, I knew it was the right decision. He was very resolute in the forward management of my situation. He did not recommend a repeat surgery to repair the defect that had not been successfully repaired. This was initially surprising to me! Repeat surgery seemed to be the obvious decision, but his thoughts were that possibly changing the protocol for my Frozen Embryo Transfer (FET) would decrease the amount of fluid I was producing.
When transferring frozen embryos, the usual protocol is to use estrogen and the route can vary (i.e. oral, patch, intramuscular). The patient then adds progesterone prior to the transfer. Unfortunately, in my case, the estrogen caused a build-up of fluid, particularly with the isthmocele.
Due to his extensive experience in this matter, I trusted Dr. Miller’s judgment and I am so thankful that I did. After two previously canceled FET cycles with other protocols, I followed the protocol set forth by Dr. Miller on my third attempt.
The protocol that he recommended, and he said was successful on many occasions, is that rather than utilizing estrogen initially, the meds are used to stimulate the ovaries so that my own estrogen levels rise. Thus, taking away the need to utilize estrogen.
I am ecstatic to say that it worked and I am eternally grateful to Dr. Miller and his staff. We are set to welcome our miracle in May 2018!!
-Lindsey
*Name changed to protect patient privacy
Hope for Pregnancy After C-Section: New Procedure May Help Secondary Infertility
Today's blog post is written by Michelle, a patient who was unable to get pregnant after having two c-sections and was diagnosed with an isthmocele. She traveled all the way from Houston to undergo an isthmocele repair procedure.
I was married in March of 2012 when I was 36 and my husband was 35. It was the first marriage for both of us and we did not want to waste any time starting a family. We were so excited to start our journey together and were blessed to be pregnant four months after our wedding. I took my first pregnancy test August 10, 2012, my 37th birthday, and it was positive! We both were elated. My dream to be a mom was actually happening. At first, all was going very well but by month 4 I was having extreme swelling. My doctor kept a close watch on me, but it seemed if there was anything gestational I got it! The worst was the gestational diabetes.
At my 32-week checkup my blood pressure was through the roof and at one point reached 190/115. I was immediately put in the hospital and diagnosed with preeclampsia. On my fourth day in the hospital, it appeared things were under control, until I took an extreme turn for the worse. I developed HELLP syndrome, a life-threatening liver disorder and a type of severe preeclampsia. It is characterized by Hemolysis (destruction of red blood cells), Elevated Liver enzymes (which indicate liver damage), and Low Platelet count. My liver and kidneys immediately started to shut down, so I was prepped for an emergency c- section. At the time of delivery, it was discovered I had a mild case of placenta accreta. Thankfully, my son was born very healthy considering coming so early. He was perfect, and I finally felt complete. I had dreamed of being a mommy all of my life.
Despite my complications, I knew without a doubt that I wanted more children. So, when my son was 8 months old we tried again. I got pregnant the first time we tried! I delivered my second son at 39 years old and had a great pregnancy with no complications. However, I had another C-section at 37 weeks and the doctor noted that my uterus was paper thin. He mentioned for baby #3 he would most likely deliver me at 36 weeks due to a thin uterus. Needless to say, we had our hands full with two beautiful boys that were just 18 months apart, so we knew we needed to wait a bit before trying.
After my second son was born, I noticed a difference in my cycles. They were very light and some months I didn't even have a period. I know that may not be uncommon for some women, but for me it was. Previously, I started my cycle like clockwork and was very specific in pattern every month. In addition to my irregularity, I was having extreme bloating, pain, pressure, and very light spotting that was dark in color and would last 7 to 10 days. The doctor told me that it was not unusual for your cycle to be different after having children. I went back two or three times with the same complaint and symptoms and was told I was fine. However, at Well Women checkups I was told that I had an unusual amount of cervical mucus. Well, that meant nothing to me at the time, but was key in diagnosing me later.
Fast forward to March 2016. We decided we were quite ready to try for baby #3 and naively thought it would be easy like the times before, but it was not. After 6 months of trying I went back to my OB because I was now 40 and concerned. After running some blood work, he referred me to an infertility specialist. The infertility specialist immediately told me that I was more than likely in menopause and then he proceeded to tell me that he thought I had cancer because of the amount of mucus in my cervix and uterus. I was devastated. It was 4:30 in the afternoon in the Houston Medical Center and I was all alone thinking I had cancer. A million things were running through my mind. I was thinking this just can't be happening. I immediately ran back to my OB that delivered my babies. After all, he saved my life on my first delivery and I absolutely adored him. He quickly did a biopsy and concluded I did not have cancer. Thank you, Jesus! But then we were left to figure out what was going on with the fluid in my uterus and my other symptoms. I continued to see the infertility specialist. We tried test after test and biopsy after biopsy. I even had surgery to remove "scar tissue" from my uterus. I had my tubes flushed, but nothing was helping. In April 2017 the infertility specialist had an MRI done and consulted with some other doctors. That was the first time I had ever heard the word An isthmocele is a C-section defect that occurs when the uterus does not heal correctly from the C-section incision; a portion of the two edges do not adhere. These surfaces often times become inflamed, develop scar tissue and can lead to problems with abnormal uterine bleeding, pain and infertility. I went to six doctors here in Houston, after all, this is Houston with one the best medical centers in the world. Only one of the doctors had performed the surgery one time. I was not comfortable with being patient number 2 so I set out to do my own research and that is how I found Dr. Charles Miller. I called his office and spoke with his nurse, Kate. She immediately knew what an Ismothcele was and set up a phone consultation with Dr. Miller for May 22nd. Dr. Miller was very knowledge and immediately put my mind at ease. He set my surgery for the following week for June 1st. He performed a surgery to correct my Isthmocele and also a uterine uplift procedure to keep pressure off of the newly created incision on my uterus. He was also very encouraging that I could try for baby #3 after three months post-surgery.
He concluded that the lining of my uterus measured normal and that the fluid was not present! Dr. Miller was very caring and had an excellent bedside manner. He is an extremely busy doctor, but he makes time for his patients and never makes you feel rushed. He was so positive and encouraging for me to try for baby #3. At my age, most doctors make you feel like you need to be making arrangements for a nursing home, not a baby. Now, I understand at 42 it may be more challenging, but it means a lot that he is so positive. Also, he has an amazing staff of people in his office from Theresa who performs the ultrasounds, to Kate who initially set up my consultation, to Jennifer who scheduled my surgery. I hope to follow up soon that I am pregnant!
-Michelle
Her Own View: A Patient’s Journey Through IVF- And The Results Are In...
Well... Dan and I are happy to announce, we are PREGNANT!! Dr. Miller has done it again! I took the beta test 10 days post 5 day transfer (10dp5dt), and my level was 428. To ensure you have a viable pregnancy, beta levels must double every 48 hours. I had to do a repeat blood test 13dp5dt to make sure my levels were doubling, and they were over 2600. This was exactly what we wanted to see and meant I had a viable pregnancy!
A week later, I went in for repeat blood test/ultrasound, and we saw a yolk sack and heard a heartbeat of 120 beats per minute. When the ultrasound tech was looking for the heartbeat, she had a blank face, and I was just trying to stay calm. Then I heard the heartbeat and felt such relief. I know you are thinking, “why isn’t she more excited?” I feel that after you have had losses you can never truly enjoy the moment. It’s always like “well, I hope I see a heartbeat the next time.” You only know there is a baby in there while you’re seeing it on the screen. As soon as you leave the doctor’s office, you’re anxiously awaiting the next ultrasound. But, you have to celebrate the little things so Dan and I remained cautiously optimistic…a term that perfectly describes this process.
My beta levels were also checked again and they had increased appropriately! I am experiencing pretty bad nausea (yay!), but I am trying to eat light and healthy. Thankfully, I have not experienced any bleeding, which is markedly different that my other pregnancies and makes this pregnancy feel a little different.
I am still on daily Progesterone in Oil shots (100mg), Estradiol (8mg), Lovenox 40mg, Baby Aspirin, synthetic Folic Acid and a prenatal vitamin.
I’m almost 7 weeks pregnant now, so everything is moving in the right direction. To be completely honest with you all, I am still hesitant to let myself feel completely happy due to my history of miscarriage, so I’m going to weekly therapy to help process my feelings. Every time before I go to the bathroom, I wonder if I’ll see spotting or bleeding. Fortunately, each week passes and so far we are where we need to be. My next appointment is in about a week and I will see Dr. Miller every week until I am 8 weeks at which time I will graduate to seeing my regular OB.
Dan and I hope and pray for a successful and healthy pregnancy! Wish us luck!
-Katie
My Journey to Motherhood: Turning a Dream into a Reality
We are honored to have Allison, a former patient of Dr. Miller's, share her story on today's blog post. 1 in 8 couples have difficulty conceiving, and as Allison writes, while there are so many people struggling, there is hope. Allison's story is an inspiration to us all.
Our journey with Dr. Miller began in June of 2015. Mike and I, high school sweethearts, had waited until later in life to get married. We were focused on our careers and, like so many others, we just assumed that once we decided to start our family, it would just happen. The first couple months of trying were no big deal. We got our hopes up a few times, but we knew that it can take healthy couples a year to conceive naturally. Well, when one year turned into two, despite trying every trick in the book and being told by our primary care doctors that there was no obvious reason why we couldn’t get pregnant, we were heartbroken. We wanted nothing more than to be parents, something that comes so easy to so many, but we just couldn’t make it happen. It was hard to admit that we needed help, but I’m so glad we did.
During our first consult with Dr. Miller he made us feel so…normal. Infertility can be such an alienating feeling, but, for once, I felt like we were going to be OK. After so much pain and hopelessness, I finally had hope. Due to irregular periods and severe cramps, Dr. Miller recommended a laparoscopic hysteroscopy to rule out endometriosis. This procedure was done in early July, and he found evidence of pelvic congestion syndrome, but no issues that should be causing infertility. We were back to square one. Still no answers, but I still had hope. We were in good hands and getting the help we needed. The plan was to proceed with 3 rounds of IUI.
After Mike and I underwent all the necessary blood tests, sperm counts, etc., it was time to start our first round of IUI in October of 2015. I was so excited to get started and optimistic that our outcome would be positive. After all, there was no obvious reason why we still hadn’t conceived! Everything went according to plan. Once I was ovulating, we went in for the insemination – everything went great. When the pregnancy test was approaching I was so excited – I just had a good feeling. I was starting to experience (what I thought) were pregnancy symptoms – tiredness, sore breasts, nausea. I thought this for sure had to be it! When my blood test revealed an HCG of 25, I was so excited! This was enough to be considered a positive pregnancy test, and we were overjoyed! However, a few days later, when we went in for repeat levels, my HCG had fallen to 4.3 – not pregnant. I was absolutely devastated. I had the next 9 months all planned out and then, just like that, it was over. I needed some time, but I was scared to throw our plan off course. When we discussed our next round of IUI with the nurses, I was scared to say that I didn’t want to try again right away. I was nervous that I would be pressured to keep going. Well, I was completely wrong. Not only were the nurses so sweet and caring, they told me to take as much time as I needed and to let them know when and if I wanted to get started again.
December 2015 and January 2016 were our second and third rounds of IUI – both unsuccessful. It was time to meet with Dr. Miller and re-evaluate. At this point in our journey, I was starting to feel discouraged. I was starting to feel like a family might not be in the cards for Mike and me. When we met with Dr. Miller, we again discussed our options. We could keep going with IUI or move on to IVF. Based on our previous experience and the much higher success rate with IVF, we decided to go forward with IVF, implanting 2 embryos.
In March, I started the IVF protocol. Birth control pills, injections (lots of injections) and ultrasounds to identify follicles. During this process, my estrogen became very high, so we were told that we could not do the transfer in the same cycle as our retrieval – another bump in the road. I was so upset having to wait another cycle, but I knew it was for the best. I had complete trust in Dr. Miller and this whole process. When we went in for the retrieval, Dr. Miller was able to obtain 18 follicles (I think…my memory is a little foggy due to the sedation). We were told this was a good number - things were starting to look up! Out of these follicles, we were able to get 10 frozen embryos. I started the IVF transfer protocol (a little different and slightly less intense with no stimulation!) and on June 6, 2016, Dr. Miller transferred two 5-day blastocyst embryos into my uterus.
On June 16, our pregnancy test was positive! And not just a little positive like last time! The subsequent days revealed climbing HCG levels and on June 28th, we had our first ultrasound of our little peanut. I had never heard a more beautiful sound in my whole life than that tiny little heartbeat of 104 beats per minute. Our second ultrasound at 7 weeks revealed a growing bean and we were discharged to OB from Dr. Miller’s office shortly thereafter.
Infertility is awful. It’s unfair and cruel. When you are struggling, just remember there are so many people out there just like you and there IS hope. Even though we’re on the other side of it now, I will never forget our journey. The ups and the downs, the good and the bad. I truly feel like Dr. Miller and his staff were there to help us every step of the way. Even during the dark times, I had complete confidence in the care and attention that was being given to us. We are forever grateful to Dr. Miller for giving us our miracle baby, Amelia Rose. Dr. Miller made our dream become a reality. I hope anyone that has stuck through this long story finds comfort in knowing that although your journey will not be easy, you are in the best possible hands with Dr. Miller.
-Allison M.