For David and me, our fertility journey has never been quick, easy or straightforward, and it continues to be that way. But we have met every challenge, and learned what we could and made the best decisions we could with the information we had.
I wanted to write about our latest experience while it was fresh in my head, so here it is.
David and I met with the TAC Surgeon yesterday and the surgeon, Doctor A, was good at explaining things. She explained the risks, her opinion, and answered all of our questions.
Doctor A said that my situation is what they call a “mixed picture” because infection likely caused the loss, but the torn TVC with Anika potentially compromised the cervix. Doctor A then told us that she agrees with Doctor C that I am a candidate for the TAC procedure. Doctor A said that in her experience, pre-pregnancy TACs have an 85 – 90% success rate in “mixed picture” pregnancies, with the average gaining about 12 weeks gestation. When cervical damage is the only cause of concern (such as in situations like cervical cancer) the stitch is nearer 100% successful.
The biggest risk is that an uncontrolled infection could cause preterm labor and that the pregnancy would need to be terminated in order to prevent uterine rupture. Our understanding before yesterday was that such circumstances would require a vertical cesarean and I would then have a large permanent scar, for a baby I don’t have. But Doctor A said that common practice now with a second trimester loss is to make an incision at the back of the vagina and sever the TAC allowing the cervix to dilate enough to deliver vaginally. I assume recovery from that would be similar to how I recovered from Anika’s delivery (where my transvaginal cerclage tore). But such a scenario would definitely END mine and David’s journey to parenthood. We both know that if we lost another baby we would be done looking for other intervention.
Another risk is that during surgery a mistake could be made that would cause damage to the bladder, intestines or an artery, but Doctor A says that she has done hundreds of these surgeries with only one instance of injury: a case where they had originally said they wouldn’t do the surgery because the risk of injuring the woman’s bowels was too great, but then she got pregnant again so they did the surgery and injured her bowels. The baby was still born healthy at term and there were no lasting effects.
Doctor A was confident that the surgical risks for me are low and that with proper monitoring and intervention the chances of the worst case scenario are quite low. She can’t say TAC complications would be a 0% chance, but she can say it’s far below a 1% chance.
The surgery is done laparoscopically, under general anaesthetic, with four incisions: one through the belly button and three others in the abdomen and only one of the incisions will need stitches. It’s an outpatient procedure and patients are given a prescription for narcotics or pain killers for the first few days and then use over the counter pain killers as needed. Recovery should be two weeks at the long end.
A mother can have multiple pregnancies on the same stitch, it’s a permanent stitch which stays in unless medically needed to be removed due to erosion into the vagina (Doctor A has only seen that happen once) or a second trimester loss. TAC pregnancies have a scheduled c-section and the TAC stays in place. If contractions start before the scheduled c-section, they are given drugs to stop it, and if contractions don’t stop, then they do an emergency C-section section after 24 weeks or sever the stitch if it’s before 24 weeks. The average delivery with the TAC is between 30 and 34 weeks.
Doctor A offered to put me on birth control until I have the procedure done because while they can put the TAC in during pregnancy, it is a more complicated procedure, it has a lower success rate and it can only be done within a certain window of time. I had thought that if I had to get an in-pregnancy TAC they would do it as an open incision, but Doctor A said that she would do it through a vaginal incision and place the suture similar to how they would remove it if delivery needed to happen in the second trimester.
Both David and I left feeling hopeful! We have a tentative surgery date of January 10, but that is dependent on another appointment with doctor C, and a pre-op with Doctor A, school stuff, and of course, our willingness to do it.
For David and me, the next steps are to meet again with Doctor C and discuss our plan for how to deal with the infection and what pregnancy care would look like, especially given how far we live from the hospital. Before doing surgery we would also need to have another appointment with Doctor A, to sign consent forms and to do the necessary pre-op stuff. I also need to discuss accommodations with the school to make sure that if I have surgery and need to be off school for a couple of weeks that I will be able to keep up academically. Our tentative surgery date is right in the middle of the final exam week for the courses I’m currently taking, and the new semester starts on January 15 (because of the massive Ontario colleges strike).