SART 生育专家 - 子宫内膜异位症

本播客中表达的信息和观点不一定反映ASRM和SART的立场。

The information and opinions expressed in this podcast do not necessarily reflect those of ASRM and SART.

这些播客提供的是通用信息，不能替代与医生的咨询。

These podcasts are provided as a source of general information and are not a substitute for consultation with a physician.

欢迎收听SART生育专家播客，我们在这里讨论对想要组建家庭的人们重要的话题。

Welcome to SART Fertility Experts, a podcast that brings you discussions on important topics for people trying to build a family.

我们的专家是SART的成员，SART即美国辅助生殖技术协会，致力于确保您获得高质量的生育护理。

Our experts are members of SART, the Society for Assisted Reproductive Technology, an organization dedicated to ensuring you receive quality fertility care.

大家好，欢迎收听本期SART生育专家播客。

Hello, and welcome to this edition of the SART Fertility Experts podcast.

我是约瑟夫·芬德利，一名生殖内分泌与不孕症医生，就职于俄亥俄州克利夫兰的大学医院克利夫兰医学中心。

My name is Joseph Findley, and I'm a physician in reproductive endocrinology and infertility at University Hospitals Cleveland Medical Center in Cleveland, Ohio.

今天，我们将与一位患者讨论她关于 endometriosis 的经历和治疗方法，以及这种情况如何影响了她成为母亲的旅程。

Today, we are going to be talking with a patient about her experience with and treatment for endometriosis and how this condition affected her journey to motherhood.

Endometriosis 大致定义为子宫内膜组织，即构成子宫内壁的 tissue，出现在子宫之外。

Endometriosis is roughly defined as endometrial tissue or the tissue that makes up the lining of the uterus, being present outside of the uterus.

当这种情况存在时，可能会伴随各种不同的症状，从盆腔疼痛到不孕不育。

When this condition is present, it can be associated with a variety of different symptoms, ranging from pelvic pain to infertility.

今天，克里斯蒂娜和我在一起，她很慷慨地愿意与我们分享她的故事。

Today, I am joined by Christina, who is generous enough to share her story with us.

欢迎。

Welcome.

谢谢。

Thank you.

那么，你能告诉我一些关于你何时以及如何被诊断出患有 endometriosis 的情况吗？

So would you be able to tell me a little bit about when and how you were diagnosed with endometriosis?

所以，我实际上并没有经历任何疼痛，也没有任何……

So I, didn't actually experience any pain or have an...

任何可能出问题的迹象，直到我三十岁出头，而我现在三十多岁。

Any idea that anything could be wrong until, my early thirties, and I'm in my mid thirties now.

所以，我在2018年结婚，然后我……

And so I was getting married in 2018, and I...

所以我在结婚前大概六个月，也许更早一点，就停止服用避孕药了，然后我的月经开始变得非常痛苦。

So I stopped taking birth control maybe, like, six months before, maybe a little bit earlier than that, and I started having really painful periods.

我当时没太在意，因为从小到大，我一直听说有人月经期间会很痛苦。

I did not think too much of it because I feel like just growing up, I've always heard about people having periods that were painful.

所以我就觉得那只是变老的一部分。

So I just thought that was, like, part of getting older.

没……

Didn't...

就是没太放在心上，但有时候我确实不得不请假。

Just didn't give it that much thought, but I did occasionally have to take off work.

比如，我太痛苦了。

Like, I'd be in so much pain.

我记得有一次，我早上七点到的，到了七点半，当别人跟我说话或靠近我时，我心里就想，请离开房间吧。

I remember one time, I got in at, like, 7AM, and by 07:30AM, like, when people were talking to me or coming up, I was just thinking, like, please leave the room.

我太痛苦了，甚至都听不进你说的话。

I'm in too much pain to, like, even listen to you.

就是，请离开房间。

Like, just leave the room.

就是，我，我，就是，我需要一个人待着。

Like, I I, like, I just need to be by myself.

然后，最终，我不得不回家，因为显然，你没法，没法在这种状态下工作，而且会服用布洛芬，然后蜷缩在床上。

And, eventually, like, I had to go home because, obviously, you can't you can't work with that mindset and would take ibuprofen and just kinda be curled up in bed.

我还是没太在意。

Still didn't think much of it.

就是，我想我甚至可能有过我的年度预约……

Like, I think I even had maybe my annual appoint...

妇科医生的预约，其实并没有，就是……

OB GYN appointment didn't really, like...

也许我说过，我的月经很痛苦。

Maybe I said, like, my periods were painful.

也许我没说。

Maybe I didn't.

我甚至都不记得当时觉得那是个症状，因为它对我的影响真的就是每个月有一天。

I don't even remember thinking that it was necessarily a symptom because the way that it impacted me, it was really just, like, one day a month.

通常是在第一天或第二天。

It was usually my first or second day.

我的月经会特别特别重。

I'd have a really, really heavy period.

时间快进到我婚礼前的那个星期四，我和我丈夫在进行最后一次舞蹈排练。

And fast forward to the Thursday before I was getting married, it was my husband and I were having our last, like, dance rehearsal.

我当时疼得不行，基本上就是坐在舞池上，说，我需要休息一下。

And I was in so much pain that I basically just sat on the dance floor and was like, I just need a break.

我丈夫就说，你要不要站起来？

And my husband's like, well, do you wanna stand up?

我就说，哦，不。

And I'm like, oh, no.

我疼得，我疼得都站不起来。

I'm in, like, I'm in too much pain to stand up.

他就说，这不对劲。

And he's like, this is not normal.

我想带你去紧急护理。

I want to take you to urgent care.

我就说，哦，不。

And I'm like, oh, no.

我每个月都这样，虽然他知道我请过假，但他不一定在我发作的那几天在场。

This happens to me monthly, which, like, he knew I had taken off work, but he hadn't necessarily been there on the days that it happened.

比如，如果是在早上发作，他不会看到我回家。

Like, if it happened in the morning, he didn't, like, see me come back home.

他带我去了紧急护理，我碰巧发烧了，而且正好是在……

And he took me to urgent care, and I happened to have a fever, and it happened to be, like, on...

我当时是侧面疼痛，所以他们觉得可能跟阑尾有关。

I was experiencing it on the side, so they thought maybe it was appendix related.

所以他们叫我去急诊室。

So they told me to go to the ER.

所以我就去了那里。

So I go there.

他们做了各种不同的测试，然后急诊医生对我说，嗯，不是阑尾炎。

They do a bunch of different tests, and the ER doctor says to me, well, it's not appendicitis.

这是好消息。

That's the good news.

但是我们希望你去找你的妇科医生跟进一下。

But we want you to follow-up with your OBGYN.

我们认为……

We think...

我们怀疑可能是子宫内膜异位症。

We suspect it might be endometriosis.

这不是我们能诊断的。

It's not something we can diagnose.

所以我以前从未听说过这个。

So I had never heard of it before.

从来没听说过……

Never...

然后我就预约了个医生。

Like, and so I scheduled an appointment.

那个周末我还结婚了。

Like, I got married that weekend.

婚礼很顺利。

Was fine.

预约安排在下周，然后我就去了。

Scheduled an appointment, for the following week, and I went in.

我的妇科医生说，对。

And my OBGYN said, yeah.

我……我……

I I...

我觉得他们说得对。

Like, I think they're right.

我们……

We...

我……

I...

除非我们真的做腹腔镜检查，否则我们没法百分百确定诊断。

We can't really diagnose it for sure unless we actually, like, do laparoscopy.

我不确定我有没有说对。

I'm not sure if I said that right.

好的。

Okay.

对。

Yes.

腹腔镜检查。

Laparoscopy.

然后他说，我们……

And so he said, let's...

为了保险起见，就……

Just to be, like, safe, give...

一个月后再回来。

Come back in a month.

我们看看它有没有长大……

We'll see if it's grown...

看看那个肿块有没有长大，或者还是保持原样，就是想看看它的进展如何。

If the mass has grown, if it stayed the same, just to kinda see how this is progressing.

所以我还是天真地觉得，哦，也许不是那样，也许没事的。

And so I still, like, naively thought, like, oh, maybe it's not that or maybe it'll be fine.

所以一个月后我回来了，他说，它……

And so I come back after a month, and he said, it...

它又长大了。

It's grown more.

我们得……

We're gonna have...

你周二要手术。

You're gonna have surgery on Tuesday.

我当时就想，好吧。

And I'm thinking, okay.

哪个周二？

Which Tuesday?

不是吧。

No.

就是，这个即将到来的周二，我要你来手术。

Like, this upcoming Tuesday, I want you to come in and have surgery.

所以我就去了。

And so I did.

就这样，我就知道了。

And so that's how I found out.

说到生育和我们的家庭计划，我和我丈夫在结婚前已经交往了八年。

And in terms of, like, fertility and our, like, our family planning goals, my husband and I had been dating for eight years before we got married.

所以，我们结婚的时候基本上就是想要开始组建家庭的时候。

So, like, when we got married was basically the time we wanted to start a family.

而且这和我被诊断出来的时间也几乎完全吻合。

And so it's also aligned pretty much exactly with when I got diagnosed.

所以这两件事是同时发生的。

So those two journeys happened at the same time.

所以它们一下子都凑到一起了？

So they converged all at once?

是的。

Yes.

那么，当你听到可能是 endometriosis 的诊断时，你感觉如何？当时关于这个情况，他们向你解释了什么？

So how did you, feel when you heard, about the possible diagnosis of endometriosis, and, you know, what was explained to you about this condition at that time?

我当时很困惑。

So I was confused.

就是，只是……

Like, just...

我当时觉得，我没什么大问题。

I, like, I didn't think that I had anything serious.

我不知道……

I didn't know...

我从来没听说过这个。

I had never heard about it.

所以我就开始做一些研究，试着去了解一下。

And so I started doing some research and just trying to, like, look into it.

我理解的是，它就像……我……

The way that I understand it is that it's, like, I...

我……

That I...

然后我向别人解释的时候也是这么说的。

And I explain it to other people.

所以，希望这是对的，或者大致正确。

So, hopefully, this is correct or generally correct.

它的成因还没有完全被理解或达成共识，但有点像一种逆向的月经期，不是所有的……

It's not completely understood or agreed upon why it occurs, but it's kind of like a retrograde period where not everything...

当你月经时，不是所有的东西都会排出体外，有些会留在体内，然后就像把不该粘在一起的东西粘在一起。

When you menstruate, not everything exits your body, and some of your flow stays inside, and that kind of, like, glues together things that shouldn't be.

就像，它会愈合、闭合，然后那就是……

Like, it, like, heals and closes, and that's...

就像，你很难怀孕，而且会疼，因为有些东西连在一起了，本来不该连的。

Like, you have a difficult time getting pregnant and you have pain because things are connected that shouldn't be.

对。

Correct.

我就是这么理解的。

That's the way I've understood it.

然后那……

And that...

那确实是主要的诊断之一……

And that's certainly one of the major working diagnose...

或者说，是这种情况的主要病因之一。

Or, like, working, etiologies for this condition.

我们认为，月经期间确实存在通过输卵管回流的情况，子宫内膜组织会在盆腔和腹腔内扎根生长。

We think that the administration does have retrograde flow back through the fallopian tubes, where those, implants of endometrial lining can sort of set up shop within the pelvis and in the abdomen.

由于这些组织对激素有反应，它们会在月经周期中生长并尝试脱落。

Because they're hormonally responsive, you know, they grow and attempt to shed when someone goes to their regular menstrual cycle.

不幸的是，你说得完全正确。

And unfortunately, you're absolutely correct.

这些炎症和刺激会导致疤痕组织的形成。

A lot of that inflammation and irritation that occurs can result in scar tissue formation.

听起来你当时的情况是，医生一开始就通过影像学检查有了较强的怀疑。

Now it sounds like you were, in a situation where they had a stronger suspicion for what was going on right off the bat because they saw things on imaging.

但不幸的是，并非所有患者都能一开始就得到这么明确的诊断。

You know, not all patients, unfortunately, have that much of a a clear cut diagnosis right off the bat.

那你最初开始接受了哪些类型的治疗？

So what types of treatments did you begin initially?

你是直接去手术了，还是先尝试了其他方法？

Did you go straight to surgery, or did you try anything else first?

我们确实是直接去手术了。

So we actually did go straight to surgery.

我有……

I have...

我……

I...

那个……

The I...

我觉得我很幸运，因为我的妇科医生好像已经做过那种手术。

You know, I guess I'm lucky that my OBGYN has, like, says done that.

他是一位老医生……

He was an elderly doc...

或者说年纪较大的医生，他就是……

Or older doctor, and he just was...

他一看就认出来了，然后决定按那个方式处理。

Like, saw it, recognized it, and that's how he wanted to proceed.

而且我当时也挺信任他的，也同意他的诊断。

And I, like, was comfortable with him and agreed with the diagnosis.

我带我丈夫去了。

I took my husband.

我丈夫喜欢问很多问题。

My husband likes to ask a lot of questions.

我带他去了术前咨询，我们讨论了所有风险，然后决定继续。

I took him, you know, to the presurgery consultation, and we talked about all the risks and move forward with it.

那是我第一次手术，除了之前拔过智齿，所以那真是……

It was my first surgery other than having my wisdom teeth removed, so that was...

那确实很紧张，但看起来那是最好的选择。

It was definitely nerve racking, but, it seems like that was our best shot.

而且对于想要孩子来说，最好的办法也是先清理干净。

And the best shot too for, like, moving forward with wanting to have kids was clearing it out.

那肯定是一次非常紧张的经历。

And that certainly had to be a a nerve wracking experience.

现在，最初很多患者都是用激素疗法来治疗的，比如避孕药，听起来你在症状出现之前已经服用了一段时间。

Now initially, many patients were treated, with hormonal therapy such as birth control pills, which it sounds like you had been on for a significant amount of time prior to having the initiation of symptoms.

而且听起来这些药效果还不错，因为症状是在你停药之后才出现的。

And it sounds like they supposedly worked relatively well as the symptoms did not, onset until after you had discontinued that medicine.

从停止服用避孕药到开始出现痛苦的月经，中间隔了多长时间？

What kind of time frame was there between stopping the, birth control pills and starting to have painful menses?

我想想……

I think it...

我不记得确切的时间了，但我觉得大概是六到八个月吧。

I don't remember the exact timing, but I think it was probably, like, six to eight months.

好的。

Okay.

所以停药和开始感觉到症状之间确实有一段时间的延迟。

So there was a little bit of a lag time between discontinuation of the pills and starting to feel things.

你有没有注意到，症状一开始出现的时候，是达到一个高峰然后稳定下来，还是说……

Did you notice that once symptoms started, they, kind of hit a peak and then plateaued, or did they...

它们是随着时间推移持续加重吗？

Were they continually increasing as time went on?

它们是……

They were...

疼痛越来越严重。

The pain was getting worse.

我觉得我很幸运，因为真的只有每个月有一天会特别痛苦，那种感觉就是，我几乎没法正常生活。

I I feel like I'm lucky in the sense that I really only experienced severe pain one day a month where it was, like, I couldn't really function.

比如，我没法去上班。

Like, I couldn't go to work.

我也没法走动。

I couldn't walk around.

但大多数时候，除了那一天，我的月经期，我只是……

But for the most part, other than that, like, my period, I just...

我觉得我的疼痛程度，就像我当初在服用避孕药时的那种感觉。

I feel like I have, like, the level of cramping that I would have had when I was medicated on birth control.

所以，我……

So I...

它从来没有持续很久。

It never extended.

就像，它从来没有导致，比如，更长的疼痛期或者整个周期都疼痛。

Like, it never led to, like, a longer period of pain or pain throughout my cycle.

就是那一天，但那天变得越来越严重。

Was It just the one day, but that one day became more intense over time.

而且我其实……

And I actually...

现在我也想起来了。

Now I'm remembering too.

我觉得它可能，嗯，有点交替变化，而且我觉得那就像是……

I think it might have, like, alternated a little bit, and I think that was, like...

我……

I...

就是一边……

It was one...

那个月是哪边的卵巢在排卵，可能某一边会疼得更厉害。

Whatever ovary was menstruating that that month, like, it might have been worse on one side than the other.

但总的来说，趋势还是随着时间推移越来越严重。

But overall, still the trend was that it was more intense as time went on.

明白了。

Gotcha.

明白了。

Gotcha.

所以你在诊断后不久就做了手术。

And so you had the surgery shortly after diagnosis.

那次手术之后你感觉怎么样？

And how did you feel after that procedure?

我……

I...

其实……

It act...

手术很顺利。

It went smoothly.

我基本上就是重看了《办公室》这部剧，然后在沙发上躺了整整一周，尽量限制自己走动的量。

I basically just rewatched the office and was on the couch for a week straight and tried to, like, limit how much I could walk.

我家里有一只大狗，所以没办法遛她。

I have a large dog at home, so I wasn't really able to walk her.

所以她就去了 daycare，我就专心休息，直到恢复。

So she went to day care, and I just buckled down and rested until I recovered.

大约一周后，我就能回去工作了。

And about after a week, I was able to go back to work.

所以……

So

那是什么

And what was

哦，抱歉。

the Oh, sorry.

我本来想……

I was gonna...

我记得我当时很惊讶。

I remember that I was surprised.

我觉得手术之后好像有个什么，就是跟疼痛有关，比如气体积聚什么的，我当时躺着，其实应该多走动走动。

I think there's something, like, with surgery that was related to, like, pain when you have, like, a buildup of gas or something, and I was laying down when I should have been actually walking more.

所以我记得后来打电话问了一下，发现我不应该休息那么多，不然气体积聚，会引起一些尖锐的疼痛。

So I do remember calling early on and finding out that I, like, I shouldn't be resting so much that I have that buildup because I was causing some sharp pain.

不过除此之外，恢复得还挺好的。

But other than that, it it was a good recovery.

哦，那太好了。

Oh, excellent.

那接下来有什么计划？

What was the plan moving on from that procedure?

你是打算再接受一段时间的治疗，还是打算等一段时间再尝试怀孕？

Were you going to undergo treatment for an additional period of time, or were you going to wait x amount of time before, attempting pregnancy?

我的医生建议我先尝试自然怀孕六个月。

So my doctor advised to try to get pregnant naturally for six months.

如果六个月后没成功，就回去找他，然后再看下一步怎么办。

And after that, come come back...

如果没成功，就回去找他，然后我们再从那里继续。

If it didn't work, come back to him and, you know, we move on from there.

所以基本上我们就是这么做的。

And so that's basically what we did.

而且我记得大概在……

And I think right around...

差不多六个月的时候，我又开始感到疼痛了。

So it was around the six month mark, I also started feeling pain again.

而且我们当时没有立刻采取任何行动。

And and we didn't do anything right away.

所以他给我安排了……

So he put...

抱歉。

I'm sorry.

我们当时没有立刻针对子宫内膜异位症采取任何措施。

We didn't do anything in terms of the endometriosis right away.

但是我们……

But we...

六个月后，他给我用了克罗米芬，我记得我用了三个月。

He did put me on Clomid after that six month mark, and I think I did three months of it.

我觉得那段时间我的月经又变得特别强烈，而且非常痛苦。

And I I I I feel like my periods were getting really intense around that time again and very painful.

所以他再次做了超声波检查，发现子宫内膜异位症似乎又回来了。

And so he did do another ultrasound and found that it appeared that the endo was back.

那时候，我决定开始做更多的研究，我在Facebook上找到了Nancy's nook，她讲了很多。

And at that time, I decided to start doing, like, a bunch more research, and I found Nancy's nook on Facebook, and she talks a lot.

这是一个……

It's a...

她是个护士，讲了很多关于子宫内膜异位的不同资源，还有一份推荐的手术医生名单。

She's a nurse that talks a lot about different resources for endometriosis and has, like, a recommended list of surgeons.

从那个名单里，我找到了一个在克利夫兰算是顶尖的手术医生。

And from that list, I found somebody that was, like, a top surgeon in Cleveland.

幸运的是，在我们这里的医疗圈，你有很多选择。

Luckily, you know, with our medical community here, you've got a lot of options.

所以我就和他预约了第二次手术。

And so I scheduled my second surgery with him.

那是几个月后……

It was several...

那是，大概几个月之后，所以它……

It was, like, a few months out so that it...

但结果离我第一次手术还不到一年。

But it ended up being less than a year from my first surgery.

所以非常快。

So it was very rapid.

哦，我还想提一下，当我的医生……

Oh, I also wanna mention when my doctor...

在我……

After my...

在我术后检查时，他打印了一些影像给我看，就像他实际手术时看到的那样，比如那些肿块，然后他诊断是第四阶段。

At my post op appointment, he, you know, printed out some of the imaging and was showing me, like, what what it looked like when he was actually doing the surgery in terms of, like, the masses, and he diagnosed it as stage four.

所以他确实说过，比如，这……

And so he did say, like, it...

考虑到它有多严重，我居然没有一直感到疼痛，这很了不起。

It's remarkable that I wasn't experiencing pain all the time considering, like, how extensive it was.

但就像我说的，疼痛来的时候非常剧烈，只是不是整个月都这样。

But, like I said, the pain was very intense when it hit me, but it just wasn't, like, throughout the entire month.

而且

And

你提到关于子宫内膜异位症的一点非常有意思。

that's one of the things that's very interesting that you bring up about endometriosis.

疾病的严重程度和范围并不一定与患者经历的 symptoms 数量相关。

The severity and degree of disease does not necessarily correlate with the amount of symptoms that a patient experiences.

有时候患者疾病范围很广，但 symptoms 很少；而反过来，有些患者疾病范围很小，却有……

Sometimes patients will have very extensive disease, and have few symptoms, while on the flip side, patients may have minimal disease and have the...

有些甚至让人相当困扰的 symptoms。

Symptoms that are, somewhat debilitating.

在讨论子宫内膜异位症和进行生育治疗时，分期也很重要，因为每个阶段的子宫内膜异位症被认为对生育能力的影响程度不同。

You know, the stage is also important to consider, when talking about endometriosis and proceeding with fertility treatment because each stage of endometriosis is thought to affect, fertility to a different degree.

当存在三阶段或四阶段子宫内膜异位症时，像你那样先进行手术被认为是正确的做法。

And when there's stage three or stage four endometriosis present, proceeding to surgery, initially, as you did, is thought to be the correct move.

所以……

So...

太好了。

Excellent.

那么第二次手术之后，你是怎么继续的，感觉怎么样？

So following that second procedure, how did you proceed, and how did you feel?

我感觉和上次差不多，休息了一个星期，之后恢复得还不错。

I felt about the same where I rested for a week and was able to have, like, a a good recovery right after that.

我确实有一些，像是，一些……

I did have some, like, some...

有点过敏反应，第一次没有的，只是因为……

A bit of an allergic reaction that I didn't have the first time just to...

那是在不同的医院集团，我想他们用的某种胶带或胶水让我过敏了。

It was at a different hospital group, and I think whatever, like, tape or glue they used gave me an allergic reaction.

所以那……

So that...

但那是我的……

But that was my...

所以我当时特别痒。

So I was terribly itchy.

但就恢复而言，那是……

But in terms of recovery, it was...

如果我休息的话，就感觉还行。

You know, the if I rested, I felt alright.

如果我试图做太多事情，那时候就会疼。

And if I tried to do too much, that's when I was in pain.

所以我尽可能休息了大约一周，然后感觉好多了。

So I rest as much as I could about a week and then felt better.

第二次手术是否提供了……

And the second surgery provided the...

类似程度的缓解，针对子宫内膜异位症带来的疼痛？

A similar degree of relief from the endometriosis pain?

我没有……

I didn't...

手术后的几个月里，我月经期间没有感到疼痛。

After, like, the months following, I didn't feel pain during my period.

那时候，我被诊断为三期。

And at that point, I was diagnosed as stage three.

太好了。

Excellent.

那么，你有没有……

So, did you...

你等了多久才再次尝试怀孕，并且开始进行生育评估或治疗？

How about how long did you wait before attempting pregnancy again and proceeding with any form of fertility evaluation or treatment?

我想我们等了第一个周期，也就是手术后……

I think we waited the first cycle after...

比如，我第一次月经来的时候，我们没有尝试怀孕，之后我们就开始了。

Like, the first period I got, we didn't we didn't, try to get pregnant, and it was right after that we did.

但与此同时，我也尽早预约了生育诊所，反正也要等几个月。

But at the same time, I also scheduled an appointment as early as I could with the fertility clinic, which it's a couple months wait anyway.

所以我只是想先预约上，以防万一。

So I just wanted to get in the books just in case.

所以我想我七月份做了手术，然后九月份才在生育诊所第一次预约上。

And so I think I had surgery in July, and then I was able to get my first appointment at the fertility clinic in September.

太好了。

Great.

那你在生育诊所进行评估和接受治疗的时候，体验怎么样？都尝试了哪些方法？

And when you went through the evaluation and treatment with, the fertility clinic, what type of experience did you have, and what types of things did you try?

我见到的那位医生，安妮，她同时也是子宫内膜异位症的专家。

So, the doctor I met with, Anne, she also is an endometriosis, like, specialist.

她以前其实和……

She actually used to work with...

在另一家诊所，和我那位外科医生一起工作过，所以他们彼此很熟，能够交流记录，她能看到他处理过的所有情况，并且确信他把子宫内膜异位症都清除了。

At the other clinic with the surgeon that I had, and so they knew each other very well and were able to, like, share notes, and she was able to see everything that he treated and felt confident that he removed the endometriosis.

所以她呢，就给我们列出了不同的方案。

And so for her, she decided she kinda, like, laid out what the, you know, different plans are.

而且因为她非常信任他的手术能力，知道他采用的是切除式清除，所以我们可以先尝试IUI，如果需要再转向IVF。

And since she had a lot of faith in his surgical abilities and knows that he practices, like, excision removal, that we could try IUIs to start with and then move on to IVF if needed.

所以我对这个计划感到满意，尤其是在经济方面和……

And so I was comfortable with that plan, especially, like, in in terms of finances and in terms of...

我有点怕针，不想直接进行IVF。

I have, like, a fear of needles, I didn't wanna go straight to IVF.

所以我们做了几轮IUI，然后每次……

So we we did a few rounds of IUIs and then kind of each...

我觉得每次IUI……

I feel like each IUI...

我……

I...

到了某个时候，我就是有预感这不会成功。

At some point, I just had a gut feeling it wasn't gonna work.

然后我们做了……

And we did...

我们原本计划做三次，然后再讨论试管婴儿。

We had planned to do three and then talk about IVF.

然后……

And so...

我们就是按照这个计划走的。

And that's, like, the schedule that we went on.

我们做了三次。

We did three.

而且，每次IUI没成功，我都觉得更沮丧，更烦躁，也更担心。

And, like, every round of IUI that didn't work, I was just feeling, like, a little more depressed and just more frustrated and more concerned.

我觉得我可能会……

I think that I would...

就是永远都不会成功。

It would just never happen.

就是有可能我永远都怀不上孕。

That, like, there was a possibility that I just would never be able to get pregnant.

而且这时候，我丈夫也做了个精子分析，确保他没有问题。

And at this point too, my husband had done, like, a sperm analysis to make sure there wasn't a problem.

他那边呢，我觉得他的精子活力数字有点低，但他通过一些维生素和生活方式调整，把数字提上去了。

And on his side, I think his motility numbers were a little low, but he got those up with, like, some vitamins and lifestyle changes.

然后他……

And then he...

他的……

His were...

他那边没问题。

His side was fine.

然后……

And...

但我还是有点担心，觉得这事永远成不了，一直有那种压力。

But I was still just kinda worried that it was never gonna happen and feeling feeling that pressure.

而且，当然，这时候家人和朋友都会问，哎，你们什么时候打算要孩子啊？

And, of course, like, family and friends are asking at this point, like, oh, when are you guys gonna have kids?

你想要孩子吗？

Do you wanna have kids?

这让你感觉更糟。

Which just makes you feel worse.

而且当你正处在那个紧张的过程中时，你不想分享你所有的私事，至少我觉得不舒服。

And when you're in the heat of it, you don't want to share all of your business, or at least I didn't feel comfortable with it.

我觉得事后我才能更多地与人分享。

I think after the fact, I was able to share more with people.

但在当时，我宁愿说，我希望我们有孩子。

But in the moment, I would just sort of rather say, like, you know, I hope we have kids.

看看会发生什么。

We'll see what happens.

他们会问时间表。

They'll ask a timeline.

我说当我们准备好了。

I said, you know, when we're ready.

但反复听到这个问题确实让人很烦。

But it it does get frustrating to hear that question over and over again.

当家人告诉你他们多么想要孙子或曾孙时，你心里想，我也一样想要。

And, you know, when family is telling you how much they want grandkids or great grandkids, and you're like, I want it just as much.

但就是很难。

But it's just difficult.

所以我们去咨询的时候，我觉得只是我的周期时间问题，我们得再等一个月。

And so we got to our our consultation, and it was, I think, just the timing of my cycle, we'd have to wait, like, another month.

然后我就……

And then I was...

我们要去以色列参加我丈夫表亲的婚礼。

We were going on a trip to Israel for my husband's cousin's wedding.

所以我们决定再做一轮IUI，万一成功呢，就像……

And so we decided to do a fourth round of IUI just in case it works, just, like...

因为反正中间会有时间间隔。

Because there was gonna be a time gap anyway.

所以我们做了，但没成功。

And so we did, and it didn't work.

然后我们去了以色列。

And we went to Israel.

我们参加了婚礼，然后我们回来了……

We went to the wedding, and then we came...

我周三回来的，周五世界就因为COVID封锁了。

I came back on a Wednesday, and the world shut down for COVID on that Friday.

哦，哇。

Oh, wow.

我丈夫当时还在那边，所以他不得不重新预订航班提前回家，因为他们基本上说边境很快就要关闭了。

My husband actually was still there, and so he had to, like, rebook his flight to get home early because they basically said they're closing the border soon.

所以如果他想飞出去，那就是……

And so if he wanted to fly out, that was...

他得尽快行动，而不是拖到后面。

He was gonna have to do it, like, sooner rather than later.

哇，真的吗？

Oh, wow.

所有的生育诊所都关门了。

All the fertility clinics closed.

然后，是的，我们只能干等着。

And, yeah, then we were we were just waiting.

那段时间真的很难熬，因为我不知道什么时候才能……

And then it was really hard because I didn't know when thing...

没人知道。

No one knew.

你懂吗？

You know?

没人知道什么时候才能重新开放，也不知道什么时候才能做那些非紧急的手术……

No one knew when things were gonna open up again and when you didn't be able to have elect...

非紧急手术。

Elective surgery.

那

That

那肯定会让人非常沮丧。

would be just That would be very frustrating.

一切都暂停了，我当时就在Facebook群组和不同的生育论坛上，看别人的故事。

Everything was just on pause, and I was on, like, you know, I was on Facebook groups and different, like, fertility boards and just reading other people's stories.

抱歉。

Sorry.

看别人的故事，听播客，试着建立虚拟的社区和支持，因为我知道我不是唯一有这种感觉的人，但确实感觉很孤独。

Reading other people's stories and listening to podcasts and just trying to, like, build out, like, a virtual community and support because I knew I wasn't alone in how I was feeling, but it does feel very lonely.

我只是想试着感受...

I'm just trying to feel pay...

比如，得到...

Like, get...

在这个过程中保持耐心，当你...

Be patient during the process when you...