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Since your first abnormal Pap "went away" fairly quickly, your doctor is on the right track to just wait for the next Pap. Wanting to get pregnant soon complicates things and I agree that you might want to get this resolved.
The history of DES both lessens and worsens concerns. On the one hand we worry about cancerous changes because of the DES and on the other hand, the glandular changes of DES will lead to more "atypical glandular cells of unknown significance". Since you want to get pregnant soon and have this resolved, I would favor an office endocervical currettage at the time of a colposcopy. That way if there is any cancerous or dysplasia changes up in the endocervical canal you can get that diagnosed and treated.
You should get this resolved before conceiving. The options would be:
- Wait 3 months and talk to Gyn MD and have a endocervical currettage to "resolve" at time of a colposcopy.
- Talk Gyn into doing that now.
- Get Pap in 3 months and see what it shows.
No menses coming off BC pills
Ovulation can be delayed after coming off pills even though that's not what happened to you before. There's no way of telling if you
are pregnant or have had delayed ovulation except by pregnancy symptoms or periodic pregnancy tests. Usually if women have not had a
period (or become pregnant) for 3 months, it's time to induce a period with progestins. Sometimes that's enough to get you ovulating. If it
doesn't, then you may need a work-up for anovulation at that time.
You will ovulate 2 weeks before your period but in general, no period means no ovulation except possibly within the last two weeks.
I don't know.
That's consistent with no ovulation.
Go ahead and make an appointment for about 3 or 4 weeks from now. If no menses by then, the doctor will probably start you with a
progestin withdrawal.
What to look for checking BBT
For us, a serum progesterone about day 24 of your cycle that is over 2.5. For you, an ovulation predictor kit in which you check your
urine daily around time of expected ovulation for LH.
An elevation in the temperature of about 0.4-0.6 degrees F in the second half of the menstrual cycle over the baseline temp of the first half of
the cycle. Usually the rise is preceded by a slight dip in temperature which is actually when you ovulate.
14 days prior to your expected menstrual period.
They can live up to 7 days in the crypts of the cervix glands and periodically shower the uterus and tubes. I think inside the uterus they
only last about 2 days, but 3 days wouldn't surprise me.
How long before conceiving after laparoscopic ovarian surgery?
Should be ok. Main reason to wait is that ovary is in state of shock due to surgery and won't ovulate so chances are less of getting
pregnant. Also, recommendation for no sex is so that there is no chance of infection introduced to the healing ovary. Assuming you didn't get
infection ( would be evident by 3-7 days after surgery with fever and increased pain) then there shouldn't be a problem.
You can resume sexual relations within 2 weeks but it's best to use additional protection to just let the tissues heal.
Average time to menses after stopping pill
In your case, there was more endometrium present either because your own estrogens were higher on the 3 days of the pill and they built up some
endometrium. If the large clots don't slow down to spotting only by seven days, you should call your doctor to see if you shouldn't go ahead and restart
the pills over one more cycle. Next time it would be better to stop the pills at the end of a cycle.
The one pill shouldn't delay menses. Average time to menses after pills is about 6 weeks.
Does cervical mucous color indicate ovulation?
Color is not that reliable. Most cervical mucous is often clear color. By egg-white, you mean clear like white (albumin) part of
egg BEFORE it's cooked. The stretchability of the mucus is a pretty good sign though. At ovulation you can usually stretch the
mucus about 6 inches or more. These signs are good but not perfect.
Prolapsed uterus but want to become pregnant
Here are a couple of articles that refer to uterine prolapse and
subsequent pregnancy. Both cases resulted in successful outcomes.
*****
Successful pregnancies and vaginal deliveries after sacrospinous
uterosacral fixation in five of nineteen patients.
Kovac SR, Cruikshank SH
Department of Obstetrics and Gynecology, St. John's Mercy
Hospital, St. Louis, Missouri.
OBJECTIVE: We sought to determine whether sacrospinous
uterosacral ligament fixation restores the uterus to its normal
anatomic position, preserving uterine function and allowing
future childbearing.
STUDY DESIGN: This study was undertaken at
two separate medical centers. Women with symptomatic uterovaginal
prolapse who desired either uterine preservation or future
childbearing were included.
RESULTS: We successfully performed
sacrospinous fixation of the uterosacral ligaments in 19
patients. Five patients have since been delivered vaginally (for
a total of six deliveries). Normal anatomic restoration was
accomplished in all but one patient.
CONCLUSIONS: Sacrospinous
uterosacral ligament fixation is an acceptable surgical means to
care for symptomatic uterovaginal prolapse in women desiring
uterine preservation or future childbearing. To our knowledge,
this is the first report of successful pregnancies and vaginal
deliveries after sacrospinous uterosacral fixation.
*****
J Reprod Med 1984 Aug;29(8):631-633
Uterine prolapse complicating pregnancy. A case report.
Hill PS
A patient developed uterine prolapse during pregnancy.
Conservative management consisted of bed rest and use of a
pessary. A viable infant was delivered at 30 weeks' gestation
following premature rupture of the membranes. A review of the
literature suggests that maintaining conservative treatment of
these patients throughout pregnancy can result in uneventful,
normal, spontaneous delivery.
Ruptured uterus in last pregnancy
You are correct that uterine rupture is rare and that pregnancy
after repair of a uterine rupture is even rarer. I couldn't find
anything written about that and have never had a patient in that
situation.
While you certainly would be high risk for repeat uterine rupture,
the thinness of the scar can be followed with ultrasound
throughout pregnancy. We don't so that routinely because it isn't
common but in your case it could be done. I've enclosed an
abstract about following uterine scars with ultrasound.
*****
Tohoku J Exp Med 1997 Sep;183(1):55-65
Ultrasonographic evaluation of lower uterine segment to predict
the integrity and quality of cesarean scar during pregnancy: a
prospective study.
Qureshi B, Inafuku K, Oshima K, Masamoto H, Kanazawa K
Department of Obstetrics and Gynecology, School of Medicine,
University of the Ryukyus, Okinawa, Japan.
A prospective randomized study was conducted to measure the
serial thickness of the lower uterine segment (LUS) by
transvaginal ultrasonography in a control group of 80 women
having no history of uterine surgery and in a study group of 43
women having a history of previous cesarean section (C/S). In the
study group, more than 2 mm of thickness of the LUS was
considered as good healing and less than 2 mm of thickness as
poor healing. After serial sonographic examination, the women
with good healing were given trial for labor unless an
obstetrical indication for C/S existed. The appearance of the LUS
during surgery was compared with antenatal ultrasonographic
assessment by direct inspection. Twenty two (79%) of 28 women
with a well healed scar had trial labor with the result that 46%
had a successful vaginal birth without any uterine rupture of
dehiscence. Eight women with poor healing all had elective C/S.
Seven women with a 2 mm LUS thickness were individually
categorized for delivery mode. Two of those women delivered
vaginally. The LUS was found to be thin to translucent in these
later two groups. Two mm or less as a criterion for poor healing
had the sensitivity and specificity of 86.7% and 100%
respectively. The positive predictive value was 100% and the
negative predictive value was 86.7%. Ultrasonographic evaluation
is effective in predicting the quality of a uterine scar and in
differentiating the risk group of probable uterine rupture from
the non risk group.
*****
Here is another abstract that notes 8 cases of uterine rupture
that were repaired and subsequently had pregnancies and were
delivered by Cesarean section.
Int J Gynaecol Obstet 1996 Jan;52(1):37-42
Pregnancy following rupture of the pregnant uterus.
Soltan MH, Khashoggi T, Adelusi B
Department of Obstetrics and Gynaecology, King Khalid University
Hospital, Riyadh, Daudi Arabia.
OBJECTIVE: To review the cases of ruptured uterus at King Khalid
University Hospital (KKUH) over the 11 years of the hospital's
existence(1984-1994), to analyze the causative factors of uterine
rupture with a view to its prevention, and to highlight the
management approach in relation to maintaining the patients'
future fertility.
METHODS: Case notes were reviewed for all
patients with ruptured uterus at KKUH over a period of 11 years
from January 1984 to December 1994. Relevant data relating to the
clinical features, characteristics of labor, operative
procedures, and maternal and perinatal outcome were assessed.
RESULTS: There were 11 cases of ruptured uterus, six of which
occurred in patients with previous cesarean scars. Two patients
were primigravidas, one of whom ruptured her uterus following a
road traffic accident. In one patient with six previous preterm
labors, rupture resulted from non-removal of cervical cerclage
during labor. The rupture occurred in the fundus in one case, and
in the lower segment in the remaining 10. Fetal heart
abnormalities were observed in all cases in which the uterus
ruptured during labor. Abdominal hysterectomy was performed in
three cases, two of which were total and the third subtotal. The
remaining eight patients had suture repair, all of whom became
pregnant later and were delivered by cesarean section.
CONCLUSION: Even though rupture of the uterus was a rare
complication of pregnancy at KKUH, it occurrence should be
suspected when there are sudden fetal heart abnormalities during
labor, or unexplained postpartum shock. Suture repair should be
considered whenever possible in order to preserve the patients'
reproductive potential.
Possible Asherman's Syndrome - uterine scarring after D&C
Based on the fact that it took you 4 months after your first
pregnancy to ovulate and have a period, I don't think its unusual
for you to have gone 2 months after this pregnancy without a
period. In fact, anovulation rather than Asherman's Syndrome
would be the most likely diagnosis.
Asherman's syndrome is the formation of intrauterine adhesions.
These adhesions can obliterate the endometrial cavity. The most
frequent cause of Asherman's is curettage associated with
pregnancy - either after a term delivery or a miscarriage. For
certain types of miscarriages, the incidence of Asherman's
syndrome is as high as 30%.
There is some controversy in the literature about the use of
hormone therapy to diagnose suspected Asherman's. Most women with
the syndrome will have a withdrawal bleed following the regimen
your doctor gave you so it's relevance as a test in this
situation is not certain but it should give you a withdrawal
bleed and won't hurt you. Hysteroscopy is the surgery needed to
diagnose Asherman's Syndrome. I don't think you would need that
yet.
After you take this sequential estrogen/progestin regimen, if you
have a period, I would probably wait and do nothing for the next
two months to see if you start menses on your own. Your doctor
could check serum progesterone levels every couple of weeks to
see if you ovulate. If you ovulate (serum progesterone above 2.5
ng/ml) and still don't have a period, then Asherman's is a real
consideration and you may need to have the hysteroscopy. If your
serum progesterone never rises, then you are not ovulating and
the doctor may want to investigate that and treat rather than
going first to hysteroscopy.
Remember that the odds are that you will start your menses on you
own and that you don't have an "Asherman's" problem. Your doctor
may suggest avoiding pregnancy (use other contraception) until
this is straightened out just so you and he won't get doubly
confused when you don't have a period.
Is IVF with lesbian partner possible?
You need to make an appointment to see a reproductive
endocrinologist who performs advanced reproductive technology
techniques such as invitro fertilization.
Basically they induce you to ovulate with medications (usually
so there is more than one egg). At the time just before
ovulation, they use a needle through the vagina to aspirate the
eggs from the ovary and then mix them with the sperm sample in
the laboratory. Then after about 48 hours, one or more fertilized
eggs are placed back into your partner's uterus which has to be
exactly in phase with yours (controlled my medications they will
give you. This success rate is about 30% to get pregnant each
cycle they do. Cost per cycle ranges from $5000-$10000 plus the
cost of the semen samples which are about $600 if obtained from
commercial labs.
You may run into some RE's who won't take you in a program
because of objections to your life style, but I would imagine
about 90% would be pleased to have you in the program because,
presuming you don't have infertility, your odds of conceiving are
quite high (maybe more than 30% per cycle) and there is
substantial competition to have high pregnancy rates to quote
others.
There are report cards on most of the IVF programs at the CDC
site at:
IVF Report Cards
For more information on complications during pregnancy check out our pregnancy videos.
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