This blog is going to be a little different. As I'm going in for surgery to remove the septum from my uterus I thought I would provide some information for my friends and family about the phenomenon. Hopefully, women who have the same problem will find some comfort and direction in what I'm going to provide. Maybe if more people hear my story the rare people that have these conditions will hear about this and will have a resource to go to for advice. Bicornuate and Septate uterus are rare enough that there are only personal testimonials of it on YouTube. There are few websites explaining the difference between the two conditions or the complications they might cause. Most information that can be found online are in pregnancy forums. A Bicornuate and a Septate uterus are rare. They are called paramesonephric duct abnormalities. They occur at a rate of .1-.5% of the population. .1-5%. So that equates to anywhere from seven million throughout the world (of of 7 billion people) to two hundred and eighty million world wide. (https://en.wikipedia.org/wiki/Bicornuate_uterus) First Diagnosis At first, I was diagnosed with a Bicornuate Uterus. This was back in 2005 when my doctor Ellen Fraiser did a D & C because of excessive bleeding. The lining of my uterus had become really thick and was not sloughing away as it should. At the time she said that it might lead to pregnancy complications. The Bicornuate Uterus is sometimes referred to as a Birth Defect or a mutation. The cause is unknown. A Bicornunate has two horns at the top and it has a separation or a septum in the middle so that the uterus is effectively split in half. One side of the uterus might purge it's lining per month and the other half might not. Women with a bicornuate uterus might have experienced their period while pregnant because half of their womb is, technically, not pregnant. A bicornuate uterus can not be operated on because there is muscle between the two chambers. Muscle cannot be removed from the uterus. Here is a picture of a drawing of a normal uterus and a bicornuate. The difference is obvious. Septated Uterus A septated Uterus is similar to a bicornuate uterus. The key difference is that a septated uterus doesn't consist of muscle. Instead, the septated uterus simply has a wall that passes through the uterus. This Septum, much like your nose has a septum dividing it into two nostrils, can be removed in a surgical procedure. The tissue is similar to the part on the bottom of your ear where it is easily pierced. I went through multiple tests to determine if my uterus was septated. The first was a test where they injected ink into my uterus called a Hysterosalpingogram. The procedure was not fun and I think it was an unnecessary risk. I would urge anyone going for diagnosis to go straight to an MRI and skip this procedure. There is a slight risk that they could, accidentally, perforate the uterus in the procedure leading to a hysterectomy (removal of the uterus). Plus, the procedure is extremely unpleasant. I was sent for a full pelvis MRI. The technician also identified a septate uterus. The procedure was far less invasive and more conclusive than the Hysterosalpingogram. Dr. Richard J. Paulson at the Feritlity Department of USC confirmed conclusively after viewing the MRI and the Hysterosalpingogram with ultra sound images that it was a septate uterus. Dr. Paulson explained to me that the procedure to remove the septum should be simple. He also stated that there was only a slight risk of perforating the uterus. He explained that I might have something between the two (a hybrid) because they are rare and very slightly different. I've included a picture of a the ultrasound of my uterus here and I've highlighted the different areas in another picture. As you can see my Uterus does dip down a bit and appears to have two "horns" similar to the bicornuate which has been a cause of concern with the some doctors. This is why the first doctor I went to, an inexperienced private fertility specialist that has only had a practice for a few years, suggested that the surgery was not advisable.
Reason For Miscarriages I have had 7 miscarriages during my life time. Most of these (aside from a Blighted Ovum which was another case where I had a woefully inexperienced OBGYN) occurred within the first trimester. The fetus simply never formed. The problem is with a biconruate or a septate uterus is that if the embryo implants on the septum it cannot receive sustenance. The Septum does not have a lining like the rest of the uterus. So the pregnancy fails despite the fact that an egg was fertilized. Unfortunately, because the diagnosis is rare and inexperienced doctors are not familiar with the situation they don't want to commit to the idea that it is a bicornuate or septate uterus. Finding A Doctor The hardest part for me was finding doctors who were familiar enough with the subject that they understood the issue. I had to fight for two years and collect a folder of documentation to prove that I had a septate uterus to every doctor that I saw. The diagnosis is so rare that most inexperienced doctors won't even consider it to be a possibility and that is why I learned that documentation is so important. The first OBGYN's that I went to when I decided to have children on purpose (the others were mistakes) insisted that a normal pregnancy without surgery should be fine. When my daughter, Lilith-Ann as born prematurely, it took my young OBGYN by surprise. Lilith-Ann was partially implanted on the septum of my uterus which was a miracle and it was a high risk pregnancy. While I will never know the exact reason why I went into premature labor the septum did make the pregnancy High Risk. The OBGYN that I went to for Lilith-Ann subsequently assured me after her premature birth and subsequent horrifying death that it would be fine to try again without any procedures. When I had another first trimester miscarriage he brusquely informed me that I should seek surrogacy. He never mentioned the surgery option and he discharged me as a paitient. Beware of young OBGYN's if you have a bicornuate/septate uterus. Seek out doctors with decades of experience. I was lucky to find Dr. Kassar in Southern California who has many years of experience. He immediately referred me to Paulson at USC. Unfortunately, the information Dr. Kassar was operating on was slightly outdated. I then learned that a few years ago there were surgeons who broke away from the "fertility specialty" for the Septum Removal procedure. They are called "minimally invasive gynecological surgeons." Luckily, Dr. Paulson referred me to a the minimally invasive gynecological surgery center at Cedar Sinai hospital in Southern California. My experience with Cedar Sinai has been a very pleasant experience. Mathew Siedhoff will be the surgeon who will remove my septum. First they will go in with a camera to confirm that the septum can be safely removed. Then they will remove it and I will hopefully be discharged the same day. Luckily, the procedure is done in a hospital so if there are any complications I may be admitted. My Advice To Others If you've had more than two miscarriages and been diagnosed with a bicornuate uterus make sure that it is the case. The difference between a bicornuate and septate is very fine and there are hybrids of the two such as in my case. Find a doctor who has enough experience to understand what it means and have an MRI of your pelvis done to diagnosis it properly. Two miscarriages, according to some fertility specialists, is too many and you should be referred to a specialist then. If you do confirm that you have a Septate Uterus I think that the best idea is to have surgery. I've listed two doctors in Southern California that you can consult. Dr. Robert Paulson at USC and Dr. Matthew Siedhoff at Cedar Sinai. Although, I would go straight to Matthew Siedhoff at Cedar Sinai. Be prepared to bring documentation to speed up the process. Most Fertility Specialists really focus on the IVF treatments and not corrective surgeries. So, while they are some are knowledgeable about Septate Uterus's they probably won't do the procedure unless you are willing to pay out of pocket. Conclusion While the last two years has been a long hard learning curve I've learned a lot about my rare condition. I am hoping the surgery to remove the septum goes well, as I'm undergoing the procedure on Thursday. The goal of the surgery is to ensure that the embryo implants successfully increasing the odds of a successful pregnancy. While I may wish that I had stumbled over a blog such as this one to explain the situation earlier on and what to do I cannot change what I experienced. Hopefully, the valuable experience I have will lessen the burden and trials of another individual. I will update this blog later this year regarding the surgery experience and any developments that we might have as we try. According to Dr. Siedhoff my husband and I should be able to start trying to have kids three months after the surgery. If you so wish I would appreciate it if you keep me in your thoughts and prayers this week or offer a toast in hopes of a successful surgery.
3 Comments
Roma
11/1/2018 03:18:56 am
Hi Bridget,
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Bridget Korns
11/3/2018 11:03:56 am
Roma,
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Ana
11/12/2018 08:21:07 pm
Hey! Thanks for sharing your experience. People don't usually talk about it. I am happy to hear that you had a baby!
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Brave Soul! May Your Journey On The Path Of The Seeker Bring You Joy and Peace! I'm currently posting every Saturday. With a new addition the family I have pre-scheduled most posts through December 2022. Full Moon Posts will contain up-to-date content when I can get to them. Thank you so much for your support and understanding! This is a place where you can encounter new spiritual ideas that have helped me develop as an Individual On The Path of the Seeker. Take or Leave this information as you see fit. Archives
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