i should probably be expecting the unexpected by this point

I had my follow-up appointment to have another ultrasound of the cyst from hell yesterday. This was supposed to be the appointment where they said "it's all cleared up, you're good to go, see ya lata alligata!" and I'd be out the door in five minutes.

It didn't really go that way.

I thank my awesome sense of intuition and reading people for tipping me off early. The ultrasound tech (whom I love) was all friendly and chatty at first, joking and talking. She confirmed my expectations: "we're just going to take a look and make sure it's all cleared up and then you'll go talk to Dr. L before you go, okay? I'm sure it will be great!" And then a minute later, she gets all quiet and nervous and keeps changing the subject...and asks if I remember when my last ultrasounds (not the ones from April, but from back when I was having treatments/monitoring) were so that she can make some comparisons. That was my first clue. And then they decided to put Matt and I in an empty exam room for 30 minutes before Dr. L would see me in his office...while he and Ultrasound Girl looked over some things.

Dr. L calls us in and shoots straight with us. Like I'm about to do with you. I will put my own thoughts/comments/editorializing in red so that you know what's really up.

There are a lot of kinds of cysts. Apparently I have all of them. They should put me in a museum. The cyst on your left ovary is still there and it's growing (shows me a really sad, empty-womb ultrasound picture with a big blob on it that is supposed to mean something to me). It's about 5.5 centimeters long. (Holds out his fingers 18 inches apart from each other or so, to demonstrate) It's actually an endometrioma. There are a lot of similarities in the symptoms of endometrioma complications and hemorrhagic cysts, and they are often confused. On your ultrasounds in April, there was so much fluid/swelling/etc it was difficult to tell what the issue really was, which is why we needed to follow up. Unfortunately, now we can see that it's an endometrioma. It will not resolve and will continue to grow. I asked if it was present on my ultrasounds from late 2010. He said yes, it was present then but only 4.2 cm. Those ultrasounds were done as part of a follicle study (I was on Clomid, doing an IUI cycle) and so I had LOTS of follicles/cysts at the time...this one was one of many, but was to be expected due to the Clomid. And after that cycle, I basically stopped doing IF treatment and never had another follow-up baseline ultrasound. So this guy's been hanging out for a long time (probably since long before I did Clomid), just...growing. And now, apparently, starting to cause me some problems. I asked him point-blank: "You're telling me this is an endometrioma... does that mean I have endometriosis?"

Yes.

I have endometriosis.

We talked for awhile longer. Of course, this could be yet another reason why we can't get pregnant...but probably (in my opinion) not the major reason. Remember, having sperm is considered really helpful when one is trying to become pregnant. We don't really have a lot of sperm to speak of. So I'm not pegging 3.5 years of infertility on this. But I can certainly see it as a major contributing factor. I guess it's only fair that we should have EVERYTHING IMAGINABLE WRONG WITH US. But I've digressed.

I will need surgery to remove the endometrioma AND to give them an opportunity to see whether there are other ones lurking in places the ultrasound can't see (behind organs, etc). Because I have very few of the other typical symptoms of endo, I am hopeful that this is the only one and that I'm a very early Stage 1-er. My doctor sort of poked holes in my optimism, though, when he told me 8 different times that although he could do the surgery himself, he really would feel much better about me going to the specialists in Atlanta. Something about the size, the placement, and the 'intricacy' of this particular growth that he just didn't feel qualified to deal with. I appreciate his honesty, but also thanks for making me feel like a medical freak. He repeated multiple times that this should definitely give us a better chance of getting pregnant. I kindly reminded him multiple times that this doesn't fix our sperm issues, but thanks. I also asked whether my insurance would even cover the surgery, since infertility stuff is all excluded. He stated that he considered the surgery to be "medically necessary" completely regardless of infertility. I'm not sure if that made me feel better or worse.

So he's going to have a consultation with the surgeons in Atlanta and make a game plan for us. He will get back to me later this week and let us know what's up. Surgery will be in my near future. Yippee. Awesome.

Of course, hindsight being 20/20 and all, I now do recognize some of the symptoms of endo developing over the last year or so. And although nothing has been unbearable up to now (April's experience excluded, of course)...I can extrapolate what the future might be like if the endometrioma(s?) keep growing, and that's not a future I would want to experience if I can prevent it. So I guess I'm glad they figured it out. But honestly, since pregnancy is really not something I even have any expectation of anymore...this really just feels like a giant waste of emotional time and energy. Like, it's needlessly emotional because of the geography of the area involved and the ties to infertility and fertility treatment. I don't know how to explain it. I'm tired. Maybe I'll have better words later.

I just wanted to update. Sorry if I'm fresh out of optimism, but...yeah. It is what it is. My life certainly hasn't gone according to (my) plan up to now, so I should probably have expected that it would continue to veer off course, just in new and exciting ways, right? Or something. I'm trying desperately to hold onto some hope that SOMEONE (hint, hint, GOD) has things under control, but...some days that's harder to cling to than others.

At least I'm going on vacation soon, right? There's always that. 

Thanks for listening. And clinging to Hope on our behalf. I really appreciate it.