So far, the combination of mefenamic acid, paracetamol and tramadol works pretty well. I am not in much pain. There have been uncomfortable hours, here and there, but nothing nearly as fall-to-the-floor-horrible as previous cycles. I’m even prepared to go to work tomorrow morning. Is it a fluke? Is it a joke? Is it a visitation from Angelic Hosts? Only draw-back: as advertised on the box, tramadol makes me extremely sleepy. I nod off on the tube, now. I fall asleep face down into my dinner (salad, thank you for asking). I’m dozing off writing this. Every now and then my head jerks back and I go ‘wha? Wffst? Urgh?’ and start typing again.
So that’s one answer – how do we tame the Cute Ute and get her to just chillax, already? Knock her unconscious with scary addictive pain-killers. Yay!
Onwards to the follow-up visit to The Professor this afternoon.
Dragging my bleeding self across town was not too dreadful (despite nearly missing my stop and flinging myself through the closing tube doors going ‘aaaaaaaaaaaaaagh’ for the edification of my fellow passengers (see above for reasons wherefore)).
I found H near the hospital and let him steer me to the clinic. The nice receptionist warned us that there was a half-hour wait. Heigh-ho. For this we pay much much silver. I knitted, slowly and carefully, because I was dopey and there was an interesting possibility I might fall asleep into my half-a-sock and stab myself in the face. I peeped nosily at the other patients (‘but, but, she’s fatter than me!’) (nooo, I don’t have residual anger issues about the weight thing. Whatever made you think that?). I pestered H, who was being silent and anxious and had been refusing to admit he was anxious for days, until he got me water.
Meh. It’s a nicer waiting room than I’m used to. The seats are upholstered. But waiting is still very dreary.
Anyway, after exactly the promised half-hour delay, The Professor called us into her office, looking very full of good cheer, resemblance to Famous And Well-Loved Actress startling as ever. She had results to share with us, and we had questions to ask, and I was still one-third in la-la-land on tramadol, so I’m not sure I’m writing this down in the order in which it all occured. I shall have to get H to footnote it all in the comments. Anyway:
I asked about coeliac disease – Daisy the Commentator has mentioned it as worth looking in to. The Professor thinks if I’m really concerned I should get a referral to a gastroenterologist and have it checked out properly, but I have no indicative symptoms, so she doesn’t think it’s an issue. Possibly because I weigh *cough*many*cough* pounds and have beautifully behaved bowels when I’m not lavishly pouring opiates or prostaglandins into them.
Metformin. We asked about that, again, as everything I read or hear about it is wildly contradictory. She quoted some studies that metformin did increase ovulation in non-ovulatory patients with PCOS, but seemed to have no real effect either way on recurrent miscarriers. I ovulate au naturel these days and I am capable of losing weight solo as well, so she wouldn’t advise metformin for me.
As for the weight-loss, she was very pleased with me, and encouraged me to keep it up and see if I can get down to BMI 25 or under. (H has made a very pleasant low-carb stir-fry for dinner. Onwards).
We also discussed any possible further surgery for me, given that I am going to see the gynaecologists at The Hospital Out In The Country tomorrow (busy week, this) about the adenomyosis and anything else they’ve spotted in there. The Professor is of the opinion that we should leave Cute Ute strictly alone unless surgery is needed urgently. Anything exploratory or for shit and giggles (I’m pretty sure she phrased that differently) is not worth the risk, given that the plumbing seems to be in working order. She is also pretty sure that courses of lupron etc. would only be a waste of time at present. I am 35. I can get pregnant. Best leave well alone. And given that the new pain-killers make me feel almost functional, I think I shall leave well alone for a while longer. Unless the HOITC lot have spotted an Alien in there. Or the forceps they couldn’t account for after my last lap [joke!] [At least, I hope it's a joke].
Now for my blood test results.
Negative for Prothrombin Factor II mutation. Negative for Factor V Leiden mutation. Negative for MTHFR. I am immune to Rubella. Negative for APS/APLS. Oh, um, good?
And then there were my AMH results. She gave me a little print-out which included what would be very low, low, satisfactory and optimal results for comparison, and I got a result of 31.95 pmol/l. Anything above 15.7 is ‘satisfactory’, above 28.6 ‘optimal’. My God. Satsuma is a fresh-faced little superstar. Readings over 48.5 indicate PCOS or possibly even ovarian tumours, so I assume this lovely number means Satsuma isn’t in the throes of decorating herself with a double-thick layer of cysts after all. Well, we were assuming that already because she was ovulating so startlingly often. She’s a reformed ovary, indeed she is. Thank fuck. I was worried sick she was conking out and I’d have about three weeks of ovarian function left before she exploded in a puff of ashes. I shall stop freaking out about being 35 at once.
The Professor then turned to the TEG (thrombo-elastogram) and fibrinolytic tests. These are the ones the NHS does not do. And, lo and behold, I do, after all, have a clotting issue. My TEG result was elevated, ie even non-pregnant I am more likely to make a big fat blood-clot, and my fibrinolytic results indicated that my blood-clots take longer to disperse than usual. Neither is a risk factor for my everyday life (though does this explain the exceedingly icky clotty nature of my periods?), but when it comes to trying to establish a placenta… Well, damn me blue and call me Captain Obvious, but there’s a good old-fashioned point-a-finger cause of recurrent early miscarriages for you.
But, but but but, there’s a simple treatment. I go forth and buy some low-dose aspirin (apparently nice and cheap if you ask your Friendly Local Pharmacist). I start testing for pregnancy on the eleventh day post-ovulation with my super-sensitive tests. I see a second line, I start taking 150 mg a day of aspirin and I call The Professor immediately for a follow-up TEG and fibrinolysis test. If I still look clotty, I can have some low-molecular-weight heparin to stab myself with too (Lovenox, to you Statesiders). For (hopefully) nine whole months.
And yes, H and I are cleared to start banging each other sans goalie again.
I trundled slowly all the way home again, made myself a cup of tea, checked the clock to see when my next dose of tramadol was due, took my shoes off, sat down, and promptly burst into tears. Happy, relieved tears. Yes, OK, it sucks to have stupid clotty blood that clots and killed off five probably perfectly lovely embryos. But having an answer, a reason, a treatable reason why this keeps happening (also, bonus, a functional ovary in good nick), oh, God, the relief.
Not being a tomfool ‘nana-brain, I know this is all no guarantee of anything. I have PCOS, Satsuma could go on strike anyway, because she just bloody feels like it. I might not start the aspirin in time. I might not get the heparin in time. I might miscarry for a whole ‘nother reason (common-or-garden genetic mince, for example, which probably causes most ‘one-off’ miscarriages).
But suddenly, painfully, like blood running back into a foot that you’ve sat on until it went numb, I feel hopeful, for the first time in a long time.