Cervical Stenosis

[jjbubbles28]

Anyone have this? And more so get pregnant with it?

 

[bunyhuny]

I don't have it myself, but I know of other ladies who have it and have worked with clients who have it. (I used to be a doula and childbirth educator before infertility.) From what I understand, there are different levels of stenosis.

If the stenosis is mild, sperm can still get through decently, just not quite as easily as for a 100% healthy couple. Women with mild stenosis usually get pregnant fine, just taking a little bit longer than women without. Medium stenosis can make it more difficult to conceive, but it's often possible. However, severe stenosis fully blocks passage to the uterus, and prevents natural pregnancy. Luckily, surgery to correct severe stenosis is a minimally invasive outpatient surgery, so if you need help correcting the stenosis, it is nowhere near as major as other infertility operations.

Note: Women who need IUI or IVF for infertility can usually have the procedures done with mild to mid-level stenosis, but it often requires specialized catheters and general anesthesia. Women with severe stenosis need to have surgery to correct the stenosis before IUI of IVF is done, since the catheter won't be able to pass through. (Of course, if the stenosis is the only reason you're not conceiving, corrective surgery without IUI/IVF may be enough.)

 

[jjbubbles28]

Thank you so much for your response. I am 15 TTC, all bloods, SA, and HSG normal. Went for my first IUI last month and the doctor found adhesions, was able to perform IUI, but was extremely painful. This second month, a different doctor was there and agreed I had an issue, but classified it as cervical stenosis. She said I am still able to conceive since my cervix is not totally obstructed, but will have a harder time. Thence my 15 months??? Second IUI was performed and she said she was able to "pull" it to make the opening bigger. Was not painful at all this time. My concern was if this IUI doesnt take how long to I try and naturally conceive> Have you had anyone get pregnant with mild stenosis? Such minimal info on this subject.....

 

[bunyhuny]

Yes, mild stenosis usually sees conception within a reasonable window. Usually less than 15 months, but I wouldn't say throw in the towel or anything. If it's more of a mid-grade stenosis, I could see it taking a little longer, though I wouldn't wait much longer than 18-24 months before diving into more intense fertility treatments. I haven't know anyone that took longer than that to conceive naturally, but then again, most people move on to more intense treatment by then anyway.

If I can ask, what are you using for lead up to the IUI? how many follicles are you getting? and what has your uterine lining measured at at insemination? If you're getting a thin lining due to Clomid, of if you're only getting a single fully mature follicle, you might consider switching to injectable meds. IUI has a pretty low success rate with natural cycles, Clomid, and Femara. Roughly 10% in most cases.

If you want to keep trying naturally, my advice would be to give the sperm a little more time to get where they're going. Though it usually isn't helpful for most women to stay laying down for longer periods of time after BD, you may want to try it to give the swimmers extra time to make it through. You have to think about how slowly they'll have to progress through your cervix. Try to find a position where most of the seminal fluid stays in after sex and stay that way for at least an hour. It takes semen about 20-30 minutes to fully liquefy, and then the sperm need time to travel. You can always DTD right before bed, prop yourself into position for an hour, and then go right to sleep once you can get a little more comfortable. I don't think they've done any studies on doing this with stenosis, but when it comes to less motile swimmers, tighter cervical canals, and men with higher viscosity semen, laying down does seem to help, at least anecdotally. It would be worth a try in my opinion.

If for some reason you do end up ever going the IVF route- do remember that general anesthesia is a really good idea for embryo transfer if you have stenosis. Without it, you may feel pain, and (from what I've read) that can cause the uterus to spasm more than it normally would, which can lower success rates and increase the risk of ectopic. I would think for IUI though, that wouldn't be a problem since you want the sperm moving up towards the tubes.

 

[jjbubbles28]

Thanks Bunny. I have been using clomid 100mg 5-9. First IUI I had 2 mature and last 4 mature. Lining they didnt give me a number, but said it was good. I dont see us ever getting to IVF for financial reasons especially at this time, but am willing to continue trying IUI for 6 cycles. I definitely will try laying down for the rest of the night after bedding. Usually I wait 20 minutes. Especially since hubby semen did come back higher viscosity as well. You are an encyclopedia of knowledge for me

 

[jjbubbles28]

Thanks Bunny. I have been using clomid 100mg 5-9. First IUI I had 2 mature and last 4 mature. Lining they didnt give me a number, but said it was good. I dont see us ever getting to IVF for financial reasons especially at this time, but am willing to continue trying IUI for 6 cycles. I definitely will try laying down for the rest of the night after bedding. Usually I wait 20 minutes. Especially since hubby semen did come back higher viscosity as well. You are an encyclopedia of knowledge for me

 

[froggyfrog]

jjbubbles have you heard of the stork? It's a little pricey (around 70 dollars) but you seem like a good candidate for it. They are selling them over the counter now. Head over to YouTube and type in the stork otc. There is a video that explains how it works.

 

[jjbubbles28]

The stork is interesting. I did already try soft cups to no avail. We'll see if this cycle doesnt work. Thanks

 

[bunyhuny]

If you also have viscosity issues, I would definitely stay laying down much longer. Higher viscosity means that if some leaks out, if often all leaks out because it is so stuck together. Also, being it is all stuck together, gravity will have a much greater effect on it, and will make it even more likely you will lose most of the sperm upon standing.

Higher viscosity semen also takes longer to liquefy in general: 30-45 minutes instead of the normal 20-something. You need to make sure you're laying down until the semen has a chance to liquefy, because until then, the high viscosity will trap most of the sperm. Once the semen liquefies, it can then mix more easily with your cervical mucus, allowing the sperm to finally swim to the cervix.

High viscosity plus cervical stenosis is a surefire recipe for not conceiving if you're getting up before the sperm can even liquefy. Laying down might be all you need to conceive. I would try 6 cycles of laying down before getting too worried about your chance of conception.

 

[jjbubbles28]

Buny you are my infertility guru
All such good information. I am hoping this is my cycle. Although I have said this before...
I see your pregnant. How far along?

 

[jjbubbles28]

are my eyes playing tricks on me??? Now I see 6th IVF? I must be really tired....

 

[bunyhuny]

Yep. My 6th IVF transfer is scheduled for April, either on the 20th or 21st- we'll know for sure once AF arrives. I'm on progesterone for the current natural TWW, which I'll stop taking on the 1st as long at my hCG beta quant comes back negative.

We've had several losses over the last couple years, so I am really hoping we catch a break this time around. The docs are grasping at straws a bit at this point and searching for less and less common issues. They tracked down another possible problem last month and treated it, so DH and I are hoping it gives us an edge this cycle. They'll be adding in new meds this cycle as well. I'm trying to be very cautiously optimistic.

I have implantation at the statistically normal rate, I've just had a miscarriage (likely due to an ill-times change in meds), an ectopic (wherein I lost my left tube), and most recently a chemical. Hopefully, we've just had crap luck and our rainbow baby is right around the corner!

 

[jjbubbles28]

Oh, I wish you the best of luck. I hate that it is so hard for some people

 

[bunyhuny]

Thanks. I wish you luck, too! LTTTC is not a fun ride for anyone, that's for sure! At least we all have each other.