Showing posts with label infertility. Show all posts
Showing posts with label infertility. Show all posts

Monday, April 7, 2008

State of the uterus, cycle 2


It's time for another "Good News, Bad News:" *

Good news : I'm pretty sure I ovulated this month (although I didn't last month).
Bad news : it happened on day 24, which is way late. Normal would be more like day 14-16

Good news : My cycle this month was 31 days, which is well-nigh normal (down from 35 days last month).
Bad news : That means there were only 7 days between ovulation and my period starting, which, well, ack. Even if I had gotten pregnant, it almost certainly wouldn't have stuck. **

So. Where I seem to stand at the moment is that things are improving, but things are clearly still awry with ye olde hormones. After much wrangling, I got my doctor to increase my metformin dose,*** so hopefully that has helped with the normalization and as I spend more time on it, will help things improve further.

An supplementary theory is that this is my hormones normalizing after the iud removal and it's just taking a few cycles to crank up to normal. The problem with that is that my previous experience with hormonal birth control is that going off of it has a carryover effect for several months where my cycles are more normal, then start to get weird as my naturally screwed up hormonal state asserts itself. So coming off of it so badly this time isn't reassuring.

More wait and see, I suppose. Hopefully cycle 3 will show more improvement. And I'm starting to think about how soon I should to call the ob/gyn and ask for a referral to someone who specializes in infertility. She had said six months, which would technically be May. I think I may wait for June or July, since that would be six full cycles, not just six months since the iud was removed.


*With apologies to Animaniacs

**Quick primer for those unacquainted with ins and outs of the female cycle: it takes several days for the egg to meander its way down to the uterus through the fallopian tubes. Fertilization actually happens in the fallopian tubes, and the fertilized egg then hopefully enters the uterus and implants in the lining of the uterus, which is when pregnancy happens. But if there's not enough time between ovulation and period, the fertilized egg enters the uterus and surprise! Either doesn't have a lining to implant in or doesn't have time to implant properly before getting swept out to sea, so to speak. This is called a short luteal phase.

*** And this is the last time I go to my gp for anything for PCOS - I'll either call my ob/gyn or ask for a referral to an endocrinologist. First, she insisted on blood tests, but tested only one hormone which is typically found at normal levels in women with PCOS. But as it turned out, there wasn't much point to that, because when I pointed this out and told her the tests she should have done, she said that even if we did them, she didn't want to increase my metformin because she was afraid it would lower my (currently normal) blood sugar. And then she said that PCOS doesn't cause weight gain.

That sound you hear would be my jaw hitting the floor. Weight gain is one of the biggest features of PCOS, to the point that thin women with PCOS have trouble getting diagnosed. It's number three on the symptom list, behind not ovulating and polycystic ovaries. And the worry about lowering my blood sugar is just moronic because metformin doesn't cause low blood sugar unless you're diabetic, which I'm definitely not.

I finally pointed out that I've been on a higher dose before and didn't have a problem and she suggested we try it for six months. But yeesh. Not going back to her for anything more complicated than hay fever or an ingrown toenail.

Monday, January 28, 2008

Red tide (not) rising

I had a fairly angsty infertility post that I wrote Saturday night and decided that it was too whiny to actually post. It comes down to two points:

1. It's been 7 weeks since my iud was removed, my cycle hasn't started up yet and I'm starting to get discouraged. Secretly, I had thought that after successfully getting through pregnancy once and three years without any real PCOS symptoms, I wouldn't have as hard a time of it this time. Instead, I'm actually worse off than the first time I tried to conceive, when I was having regular cycles even if I wasn't always ovulating. This perturbs me. I don't necessarily want to be pregnant right this minute, since the timing would be better if it happened this summer. What I want is to know I can get pregnant, and that certainly can't happen without my cycle starting. However, my chest has been getting progressivly more sore over the past week, so I'm hoping my cycle might meander around these parts one of these days. Maybe.

2. I've read from people who've experienced both that secondary infertility can be harder than the first time because a, after having one child, you know much more acutely what you're missing and b, since you have a child, you can't avoid children and babies. It's that second one that's getting to me a bit. I think about 90 percent of the people I know who had babies the same year I did are either pregnant or have already had a second baby. I feel nothing but the most sincere happiness for them and don't begrudge them their fertility for a moment. I just want it for myself too.

Thursday, January 17, 2008

The inexorable passage of time

Periodwatch 2008: no signs yet, four weeks past iud-removal. I thought I had some hopeful symptoms this weekend, but they turned out to be from *ahem* adjacent areas. I had been hoping that my body would interpret the iud being removed as the beginning of a cycle, but apparently it's taking its time working the extra hormones out.

It feels a bit counterintuitive after years of infertility to actually want my period, but nothing is going to happen until my cycle comes back, hopefully before I turn 80.

***

It's occurred to me that if we want to send K to preschool next fall, we need to start thinking about it now. Eep. I'm not ready to think about sending my two-year-old to school, but given how much she loves daycare*, I think she's more than ready. Philadelphia has a free preschool available through the public schools, and while I've heard bad things about the public schools, the preschool has gotten some good reviews. Since I'm not worried about how well they prepare K for college, I think it's worth checking out (and it's hard to argue with free). My main concern is that it might be too academic - preschool should be about socialization and working on developmental skills, not getting a head start on reading. Their website is remarkably unspecific regarding curriculum, so I will have to make sure to ask for more materials on it when we call for information.

Or I could stick my fingers in my ears and refuse to think about my baby getting old enough to go to school. That could work too.

This boring post brought to you by my sieve-like memory that promptly expels every single fascinating topic I think of during the day the moment my fingers touch the keyboard.


*She does a little dance when I tell her it's a daycare day and cheerfully closes the door behind me when I leave. I don't want her to be horribly upset when I leave, but does she have to be so happy about it?

Friday, January 4, 2008

Resolved

When I look back at the resolutions I made last year, I get a bit depressed. So this year I'm going to make it more basic and vague: I'll make a sincere effort to get myself in better shape for getting pregnant. It seems very likely this will involve going low-carb for a while, but I'm still getting my ducks in a row on that front. I don't want to go through a radical diet change without having a complete plan for what to eat and then have it all on hand. Our exercise bike is set up in a convenient place again, so I'm climbing back on it, and I've been keeping track of my food on Sparkpeople, which usually helps me keep within reasonable limits. That's about as far as I'm willing to commit.

I finally managed to get my iud out right before Christmas. As it turns out, it needed to be pre-approved by the insurance company, so that explains part of the delay (although pre-approval for a two-minute appointment? Really? That seems to be over the edge of absurd even by health insurance company standards).* So I'm waiting for my period to come back and we shall see. I had a couple signs of ovulation right at Christmas, so I'm hoping that will be confirmed next week with the return of my cycle. It's all wait and see at this point.


*As a data point for anyone curious about the iud experience, removal was not completely painless as advertised, but that was because 1) the speculum was a bit wider than was really comfortable and 2) my cervix gave a bit of a spasm in response to having something pulled through it. However, it was brief and certainly nothing compared to having it put in.

Tuesday, November 20, 2007

Fertility delayed

I went to the ob/gyn today for my annual checkup. Everything seems healthy and in place, and she seemed pretty nice. Her advice on how to proceed with trying to conceive was exactly what I had been planning on doing - try on my own for six months with charting and ovulation predictor kits, and then go in for help if it's not working.

I found out that I would be sent straight to a reproductive endocrinologist (RE), which I would prefer since even if we just use Clomid, I'd like to be monitored better this time. I didn't realize at the time last time that I really shouldn't have simply been given a prescription for fertility drugs and sent on my merry way, but in fact should have been monitored to make sure I was 1) ovulating, and 2) not overovulating and in danger of conceiving sextuplets. If nothing else, I'd like to spare myself the uncertainty of last time of not being sure if/when I was going to ovulate. Obviously I got it right, but it would be nicer to have an ultrasound tell me next time.

There's just one hitch: I asked to have my iud taken out and she said we needed to check and make sure my insurance will cover it. I'm a little confused - I want the iud out either way, so what exactly will happen differently if my insurance doesn't cover it, besides my having to pay for it? My inner Pollyanna hopes there's some sort of insurance billing voodoo they can perform to get it covered. My inner cynic thinks this is a great way to get a second office visit fee. Either way, I wasn't expecting to have to wait another two weeks and I'm feeling a little impatient. I don't really want to get pregnant this month since it's going to be insane enough with Christmas and moving, but there are other ways to ensure that doesn't happen.

Saturday, November 3, 2007

Regular-size me

I'm feeling a conflict of diet theories these days.

A lot of what I've been thinking about diet lately was crystallized by a blog post I read recently, which talks about the moral value society attaches to foods and how this screws us up:

Teppy wrote a great post yesterday about “demand feeding,” which is a really terrible name for “eating what you want when you’re hungry and stopping when you’re full.”

That’s something I recommend frequently, as it’s a key component of the Health at Every Size strategy. The problem with it, as Teppy points out, is a whole lot of people don’t know when they’re hungry, what they feel like eating, or when they’re full. Ex-dieters, especially, are so used to categorizing foods as “good” and “bad,” and having specific foods and portions dictated to us, the thought of really eating whatever we want — as opposed to the diet version of “eating whatever you want,” which means allowing yourself one bite of ice cream SO YOU DON’T FEEL DEPRIVED (oy) — can be overwhelming and frankly frightening.

[...]

But regardless, “We will give you permission — in some limited way — to eat ‘bad’ foods!” is a tremendously effective marketing strategy.

And that’s because so many of us really believe somebody needs to give us permission; simply choosing to eat fatty, sugary food because you feel like it is absolutely not an option. And then somebody also needs to put a limit on that permission, so we won’t go and devour the world. In this culture, most of us never learn to trust our bodies when it comes to eating, and we certainly never learn to trust our desires. Choosing what to eat is a daily battle between good and evil.

I mean, think about it for two seconds. People are selling plans that allow you to “eat what you want,” to the tune of billions. That’s lunacy. Because I love you, I shall offer you the Kate Harding Lifetime Diet Plan — which permits you to eat whatever you want — absolutely free! It goes like this:

DAY 1:

Eat whatever you want. It’s your body. You’re allowed.

DAY 2 THROUGH DEATH:

Repeat Day 1.

The problem with the Kate Harding Lifetime Diet Plan is exactly what Teppy talks about — figuring out what you’re hungry for and how hungry you are after a lifetime of being told you are always too hungry for the wrong foods. I still struggle with staying on my own plan, for exactly the reasons Teppy and her commenters describe. I have a major fear of deprivation when it comes to food, plus a whole lot of baggage about “good” and “bad” foods, so trying to listen to my body instead of the voices in my head involves a lot of conscious effort — which is exactly what you’re trying to drop by, you know, listening to your body.



I highly recommend the rest of the post. Reading it made a frightening amount of sense to me, especially after I thought about it for a while. It's the way K eats, after all. I control her menu, of course, but within the foods I offer her, she chooses what she wants and how much she eats. And as far as I can tell, she only eats when she's hungry and stops when she's full. Even if it's treat like cake - I've seen her leave half a piece on the plate because she's not hungry any more. And her body seems to tell her what she needs to eat. I don't really worry about her getting enough nutrients any more because I've noticed that over the course of the day she eats a pretty balanced diet. She may eat a lunch of only turkey and cheese, but she ate mostly cheerios for breakfast and grapes at both meals, so it balances out. *

Demand feeding also jibes well with research that shows that deprivation leads to gorging - in a study where children were offered sweets, children who were on very restrictive diets gorged themselves on the sweets, whereas the children who were allowed to eat sweets ate moderate amounts and then stopped.

The more I thought about it, the more I realized that this is pretty much how I've been eating for the past couple years as well. I've made stabs at following diets and "eating better," but mostly I've just eaten what I felt like and stopped when I was full. And you know what? My weight is stable and while it might be a little higher than I would like, it's healthy. My cholesterol and blood pressure are fine. So it seems like the only thing I need to change is give up the guilt, the persistent voice in the back of my head that I should be consuming nothing but spinach salad and sparkling water.

But then there's the other side of the coin, the gigantic But.

I think demand feeding is a great idea. For people with normal metabolism who don't have health conditions that are affected by what they eat. Because the simple fact is that some people absolutely cannot eat whatever they want. People with high blood pressure can't have salt, people with food allergies can't eat the things they're allergic to and diabetics really shouldn't eat foods that cause their blood sugar to swing wildly.

And people with PCOS have a condition that is caused by insulin resistance, and therefore do much better on a diet low in carbs.

So you see the dilemma? I'm all hep to the idea of the Bobby McFerrin-zen approach to eating where restriction is the worst thing you can do to yourself. And I'm seriously considering going on a low carb diet.

The problem is that PCOS is directly affected by how much I weigh and what I eat. It started to get worse after college, when I started eating a mostly vegetarian diet and therefore eating a lot less protein. I started gaining weight, which made PCOS worse. And then I got mono, which stuck around for over a year, and all of that lying around on the couch made me gain more weight and get worse. At that point, the PCOS was making me feel so awful that I couldn't exercise or be active, so it continued on a spiral that just kept feeding itself until I managed to artificially convince my body it had a normal metabolism with metformin. I got back down to a healthy weight and things seemed fine.

But it clearly wasn't enough because I wasn't ovulating. Thus my dilemma: I weigh about what I did before I got pregnant. Low-carb diets are a proven way for women with PCOS to lose weight and improve their fertility. So if I'm serious about trying to conceive, should I go low-carb?

Before anyone starts yelling about how unhealthy low-carb diets are, I will say that any low-carb diet I follow won't be rib-eye steaks with a pork-rind chaser. It will be lean meats and lots of vegetables. Basically, I would replace the starches in my diet with vegetables that have less effect on the blood sugar and give up sugar entirely to start. Then I would get to slowly add carbohydrates back in until I'm on a diet of lean proteins, vegetables, fruits and complex carbohydrates. The way my diet would like in the end is meals that look more or less normal, but with smaller portions of carbohydrates, with Barilla high protein pasta or shirataki noodles instead of regular pasta, beans or pearled barley instead of rice, and no potatoes. Or sugar. Or white bread. And that's where the thought of this makes me groan, because I _like_ potatoes and sugar and white bread (not necessarily together). And the path I would have to take to get to that point would be long and hellish.

One wrinkle is that I've tried low-carb in the past and I think the longest I've made it is two weeks. I have reflux and my stomach doesn't like it when I remove those nice spongy carbohydrates that soak up stomach acid. But I've done a lot more research into alternative foods and recipes, so I think I may be able to deal with that better this time.

So I suppose the essential question is that if the potential improvement for my fertility is worth the deprivation, given that deprivation isn't a very good thing. I guess the thing to do is see what happens when/if my cycle comes back. I don't think it's a good idea to try and give up carbs right before the Thanksgiving-Christmas sugar-fest eating season, so I wouldn't try to start until January. At that point, I may have more of a clue if it wll be necessary.



*Note: I can be zen about how K eats because she eats a decent amount of food and will eat a wide variety, including vegetables. She's also a healthy weight. I understand completely how parents of very picky eaters and children who are very low in the percentile charts get neurotic about their childrens' diets - I was there myself for K's first 18 months.

Thursday, November 1, 2007

Fertility and the future

Two weeks ago, I turned 33. It didn't get a lot of fanfare; I was insanely busy with work and none of the friends we've celebrated with in the past were remotely close enough to come for a party. So I had a quiet day with K and B, got a few books and some nice cards. Nothing exceptional. Except that for the first time, I've started to hear the ticking of the biological clock.

I hadn't worried about it the first time. I was 28 when we started trying and had more than enough to worry about with PCOS. The thing about being infertile is that you're much more concerned about dealing with the reasons for that than worrying about age-related fertility issues, particularly if you're on the near side of 30. But now it's occurred to me that I'm only two years away from the point when they start recommending the thorough prenatal screenings and considering me elderly. And that chances are that as time goes by, I'm unlikely to get _more_ fertile, so if trying for another baby is going to take as much time and assistance as last time, I should get cracking.

Fortunately, I'm finally feeling like I'm ready to consider trying. I hadn't planned on thinking about it until this summer anyway because I would like at least three years between children. And after unemployment, a major move, adjusting to a higher cost of living and dealing with the death of a parent, it just wasn't practical to start trying until now.

However, I'm painfully aware that being mentally ready for another baby doesn't remotely equal actually getting one any time soon.

For those who weren't reading last time around, my reproductive history in brief: I have Polycystic Ovary Syndrome. The brief version of this is that due to a missing enzyme, I don't respond to insulin as well as I should. This results in my pancreas pumping out higher levels of insulin to compensate, which in turn results in weight gain, blood sugar issues and massive hormone problems (and in my case, debilitating fatigue, to the point that I was disabled). The hormone problems are what causes the infertility, but the best way to address this is to get to the root of the problem, the insulin resistance. So I've been on a diabetes medication for the past five years which increases my insulin sensitivity and it works pretty well - I'm able to maintain a stable healthy weight, my symptoms are pretty much in check and when I went off the pill, I had regular periods. But it wasn't quite enough, because I apparently wasn't ovulating very often. So after over a year of trying, I took clomid and got lucky the first time out.

So you can see how contemplating a second baby isn't as easy as just going off birth control for me. It doesn't help that I have absolutely no idea what my current fertility status is. My current birth control is a Mirena iud, which has the salubrious effect of eliminating periods, so I havne't had a period since January of 2006. In the past, I've said I prefer birth control methods where I still get my period because it's a useful indicator of how I'm doing health-wise, but honestly, I've been enjoying the honeymoon from the monthly bloodletting. I haven't been having any other PCOS symptoms to speak of, so I decided to have a nice vacation in the land of Not Worrying. But now I have to start worrying and while I didn't miss my period, I kind of wish I had some way of knowing what my hormones are going to do.

The current plan is that I have a doctor's appointment in two weeks for my annual lady parts inspection and I'll ask the doctor to take my iud out and wait for my period to come back. If it doesn't come back or six months goes by without anything happening, I'll get more proactive and go back to the doctor. I may throw in asking the doctor if we can start testing to see if I'm ovulating as soon as my period comes back. But I'm not waiting a year again since I don't have as much time to wait.

It's hard to know how to feel about being infertile sometimes. I didn't have nearly as hard a time getting pregnant as many do; once we sought treatment, it only took one dose of Clomid. Comparing that to stories of ivf and miscarriages, we got off pretty easily. But that doesn't mean it was easy, or that it won't be harder next time. I also get to worry about the fact that PCOS raises your miscarriage risk by quite a lot. One weird thing is that many women don't find out they have PCOS until they try to get pregnant and can't. It's only then that they go on metformin, and since it doesn't usually work immediately, they still need a lot more intervention. But I was diagnosed with PCOS because it was making me so very ill that I couldn't possibly ignore the symptoms. And if I had been trying to get pregnant then, I would have had an absolutely miserable time of it. But instead, I was on metformin for three years, got back down to a healthy weight and mostly straightened my hormones out before trying. It's a weird position to be in: infertility made me absolutely horrendously miserable for several years. I just wasn't trying to conceive during most of them.

In any case, there's no point in obsessing about any of this until I get my iud removed. Not that I'll let that stop me from running a constant low-grade worry.