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