Mullerian Anomalies

I’ve been dealing with something for the past few months and haven’t mentioned it once on this blog.  Had I not had breast cancer, this little problem may have gone unnoticed until we tried to have kids.  Amidst all of this breast cancer crap, one of my doctors has told me that I have a “mullerian anomaly” (fancy medical term).  For me, this means that I have a malformation of my uterus.  It is congenital, meaning it happened during my development and was present at birth.

It’s crazy that I went 30 years without ever knowing I had this problem, but here’s a short version of the long story about how we found out.  Through my whole experience with IVF, I had to have multiple ultrasounds and each one showed this malformation.  The malformation did not cause me any problems with IVF, but it has now become an issue with my doctor trying to place an IUD in me.  We don’t know if chemo has left me infertile and we won’t know until I’m done with tamoxifen (4.5 years from now).  However, tamoxifen can cause birth defects if I were to get pregnant.  My body is still out of whack and we have no clue whether or not I’m ovulating.  I can’t take anything with hormones, and my doctor is not comfortable with the effectiveness of other types of birth control, so she doctor suggested a non-hormonal IUD.

In late August, I had attempt number 1 for the IUD insertion.  Since we knew about my abnormally shaped uterus, the procedure was guided with an ultrasound, but didn’t work.  Why didn’t it work?  Because I have this abnormally shaped uterus that was not cooperating.  Usually the IUD forms a “T” in the uterus, but with me they thought it formed a “Y” (which would have been okay in my circumstance).  Multiple return doctors’ visits with all types of ultrasounds (more poking and prodding) and my doctor took it out.  The IUD was not working with the shape of my uterus and was most definitely not in a “Y” or “T” position.  Initially, my doctor thought I had/have a bicornuate shaped uterus.  Basically, instead of a pear-shaped uterus, mine is shaped like a heart, with a deep indentation at the top.  This can cause minor problems down the road (slight possibility for miscarriages, breached baby leading to a C-section instead of natural birth).  But my doctor never seemed overly concerned about this.

Last week, I found myself back in the doctor’s office because she wanted to try one more time with the IUD.  Before she got started, she talked to me about some more aggressive routes if this did not work out.  The problem could be that I have a septate uterus.  This means that the inside of the uterus is divided by a wall or the septum.  Right now, we don’t know how far down this septum extends.  The septum may extend only part way into the uterus or it may reach as far as the cervix.  A true septate uterus has the worst pregnancy outcomes, and can have a miscarriage rate as high as 90%.  The good news is that a septate uterus can be fixed with surgery.

So, my doctor was basically recommending that if the IUD didn’t work out the second time around, that we do some more poking and prodding to determine if my uterus was truly septate.  If so, then the aggressive route would be surgery to fix the septate so that the IUD could be inserted properly.  But with all that I’ve been through, she didn’t want to jump to the surgery right away.  I asked my doctor if this surgery is something I would/should be considering down the road regardless of whether or not the IUD worked out.  She could not answer yes or no, but just said potentially and they’d have to see.  I think that I was a little overwhelmed at that point to actually process her response and the vagueness of it.  Usually, I prefer more definite answers, but I think I was too worked up with anxiety about the actual IUD procedure.  The even more aggressive route that she threw out there was to have my tubes tied.  Even though we have our embryos waiting for us, I’d still like to eventually see if we can conceive naturally.  The embryos are our insurance policy.  Therefore, I am not having my tubes tied.

Thankfully, the IUD procedure was a success – a painful success, but a success.  I have a mini pharmacy of pain killers in my house.  With all that I’ve gone through in the past year, I have never had to resort to the hard stuff.  Well, the other day I was in so much pain that I turned to Tylenol 3 with codeine.  It helped and amazingly and I was basically back to normal the next day.  There was a little scare on Christmas Eve and then again the day after Christmas – pain so bad it brought me to tears.  The Milams have a history of appendix problems around the holidays, so for a few minutes I had visions of me being in the hospital for Christmas with an emergency appendectomy.  Then I had fears that the IUD ripped through my uterus wall (yup, it can happen) and I’d have to be rushed in for surgery.  At this point, I’m pretty sure I’m okay.

So what now?  Aside from some lingering mild pain and feeling bloated (this might actually be a result of too many Christmas goodies), I think I’m alright.  My next doctor’s appointment is not until mid January.  And I’m looking forward to starting off 2012 happy and healthy!  Unfortunately, I did get myself really worked up about this for a few days.  I was once again feverishly Googling my “condition” and trying to educate myself.  I think part of the problem is that I’m a planner and I like to plan and prepare for worst case scenarios.  Yes, even plan for potential situations that wouldn’t present themselves for 4 or 5 more years!  After venting my concerns and fears to Bri and my mom, I am trying to make a conscious effort not to worry or think about this.  My mom feels strongly that there is a reason for everything and in time, the reason will be revealed.  After all, it may not even be an issue.  And if it is, I have years to figure it all out.  I’m really thankful that I have honest doctors who don’t try to hide or sugar coat anything.  If there’s an issue that could potentially be a problem later on down the road I want to know about it – ya know so I can start freaking out and working on my plan of attack!

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