TTC Update 8/28/08

I had an appointment with Dr. M this morning. He is my OB/Gyn. He is a mild mannered, soft spoken, practical and easy to talk to Dr. Despite the fact that he is male (which normally means I won't even see a male Dr.) he is very compassionate and understanding. I really like him and I really like his approach to prenatal care as well as other gyno issues.

When I received my diagnosis of PCOS with Insulin resistance (IR) I was actually diagnosed by my Endocrinologist, Dr.L. Now Dr. L does not normally deal with women of child bearing age. He primarily deals with thyroid issues and diabetes in older adults. So I am not his normal clientele nor am I his area of expertise. But he was covered on our Ins and he is a good thyroid Dr which is my main reason for seeing him. But when I was diagnosed with PCOS, I was somewhat hesitant to believe whole heartily in that diagnosis. I honestly thought the reason I was not accepting of the diagnosis was because I was in DENIAL! LOL! But now that I have seen Dr. M I am thinking that maybe I wasn't so far off the mark.

Dr. M reviewed the lab results that Dr. L had made his PCOS diagnosis from and came to a different conclusion. Dr. M's basic feeling on "pcos" (every time he said PCOS he held his hands up and made quotation marks. LOL!) was that Drs use that as a label for women with unexplained infertility. Basically he thinks of PCOS as a dumping ground diagnosis. He thinks that IR can cause infertility. He thinks that cyst on your Ovaries can cause infertility but you can have one or both of those conditions and not have the "typical PCOS". About 1/2 way through the conversation he just stopped calling my infertility PCOS and just said to deal with the symptoms and see where we are at.

He explained it to me like this: Due to diet or actual IR the cells in your body can become resistance to insulin. Your body needs insulin to convert glucose into energy. So if your cells are resisting the insulin then your pancreas has to produce extra insulin to force the cells to covert glucose into energy. With the excess glucose not converted to energy it gets stored as fat in your body. Which is why IR folks are typically overweight. IR effects fertility because with the extra Insulin coming from your pancreas, your pituitary it tells your ovaries to produce more androgens and then your body turns androgens into testosterone which suppresses the estrogen and without estrogen your ovaries do not produce follicle to ovulate. Without Ovulation, no pregnancy.

So even without the whole cysts on your ovaries thing which is the primary symptom of PCOS you can still be infertile due to the IR and that can be called PCOS. What I DON'T have that is typical with PCOS is annovulatory cycles, male pattern hair growth, or excess androgens. I do have mild case of IR which the Metformin is treating.

I also asked Dr. M about my cycles and if he thought I was actually Ovulating. He asked me some questions about my cycle. I told him I have the normal thermal shifts, normal cervical mucous patterns, typical cervical positions, normal luteal phase length, normal cycle length, Periods that arrive on time, the bloating, breast tenderness etc of typical PMS symptoms. He said that given the obvious hormonal changes (evident by my symptoms per cycle) that there is a 95-98% chance that I AM ovulating. He felt that giving us some more time to try to conceive will most likely result in a pregnancy.

I asked about Clomid. He said that he feels strongly that I AM ovulating. He felt that using Clomid would NOT improve my chance of actually conceiving but WOULD improve my chances of conceiving a LITTER of children. He said in women that are ovulating, (which is where he feels I fall) that using clomid increases your chances of twins or triplets to 30%. That is NOT a risk Tim and I are willing to take.

Now if I fall into the 3-5% that have hormonal changes but still don't ovulate then there are 2 tests that he would like to do. The first being an Ultrasound study that looks at my ovaries before Ovulation to measure the follicles and determine which is the dominate follicle and then again an ultrasound after ovulation to see if the dominate follicle was actually released. If my ovaries are releasing the egg and I am STILL not pregnant then they would have to look at a few things. They might do a semen analysis on Tim's swimmers and also check my fallopian tubes. They would like to do a procedure (i can't think of the name right now) that involves them injecting dye into my uterus and tubes and then taking pictures to make sure the tubes are clear and no blockages are present. If that test comes back clear then they would probably want to take the next step in fertility drugs, which we would decline. In actuality we would probably not do the semen analysis or the dye test either. The Dye test is WAY to invasive for my taste. And if there is a problem with sperm mobility or my tubes the only answer/treatment is high tech (read $$$$) Intrauterine insemination or straight IVF. We would not spend the money on either of these procedures, so we would most likely decline the test as well.

Now the U/S might be something we would consider. The treatment for ovulation failure would be a low tech medication like progesterone trigger or clomid. In the case that I am NOT ovulating then the risk of twins or more when taking Clomid is only 10-12%. So we would consider that as a possibility.

I also got my questions answered about taking Prozac and Metformin when you are pregnant. He refilled my script for Prozac and we talked about the risks and benefits for Metformin during pregnancy. He also gave me a script for progesterone suppositories that are less expensive (albeit more messy) than the progesterone pill I was on. The suppositories are less expensive and covered by most Insurance. We will see how that goes. I have to use them twice a day. So that means MESSY all day. I could handle it if it was just at night cause I could shower in the morning. But twice a day means Messy all day! So we shall see.

Anyway, Bless you if you actually read this whole thing. I wrote all the details out for you to read but also for me to have a record of my appointment. I sometimes forget things and so I wanted to write this out while it was fresh in my mind so that I could re-read it when I forget what Dr. M said in a week!

So for now Tim & I will just be trying and trying.... and lets face it, that is the funnest part of the whole journey!

Lots of random things to say.....

Hi to all my readers out in Blogger land. I haven't updated in a few days because I have been very busy working on the final preparations for throw some friends a birthday party. It was a 1950's sock hop theme party. It was VERY fun. It was alot of work. I am glad after putting all the extra work in that the party was a success! I will post more about this event a bit later. I have some fun pictures to share.

As some of you may have been wondering, I did finally hear back from my Endocrinologist on Thursday of last week. I have officially been diagnosed with PCOS and Insulin Resistance (IR). My blood work confirms an elevated ratio of LH to FSH and also an elevated fasting glucose level. I guess the LH to FSH indicates the PCOS and the Elevated glucose level indicated IR, which is a precursor to diabetes. When I received the official diagnosis I felt like someone punched me in the stomach. My diagnosis was sent in a letter and reading the phrase "these findings indicate that you are at increased risk for the onset of type 2 diabetes" was very scary and upsetting. Yuck. The treatment is of course diet changes and exercise plus the drug Metformin. Here is a blurb from Wikipedia on Metformin:

Metformin (trade names Glucophage, Riomet, Fortamet,
Glumetza, Obimet, Diabex, Diaformin, and others) is an oral anti-diabetic drug
from the biguanide class. It is the drug of choice for the treatment of
type 2 diabetes, particularly in overweight and obese people and those with
normal kidney function, and evidence suggests it may be the best choice for
people with heart failure.

Metformin is the most popular anti-diabetic drug in the United States and one of the most prescribed drugs in the country overall, with nearly 35 million prescriptions filled in 2006 for generic metformin alone. It is also used in the treatment of polycystic ovary syndrome. (PCOS)

I have not started the Metformin yet, the nurse did not get it called into the pharmacy in time for us to pick up it before we left for the weekend. I have also done some reading on Metformin and it does cause some stomach upset with diarrhea. Basically the people I have connected with online have said not to be too far away from a bathroom until you know how your body will react to the meds. So this week should be interesting, I am starting the Metformin tomorrow and I just got done with the Provera to bring on my period. My period should start this week, along with the potentially for sickness with the Metformin. Hopefully I am just expecting the worst and will be pleasantly surprised with no side effects from the Met and a lighter than light period! LOL! I am supposed to go to Seattle next weekend for a Birthday party, I hope I can still make it.

Kaleb lately has been missing Future alot. He keeps asking me when we can go pick Future up. It makes me very sad that I can't just drive up and get Future. Kaleb just really does not understand why I can't. And honestly I am not sure I understand either. That makes it hard to explain to a 5 year old. I emailed the social worker and asked for some visitations. We will see what they say. I emailed on Friday, hopefully she will get back to me on Monday. Hopefully we will be able to see him soon. I know he probably misses us as much as we miss him.

Since we were out of town for Father's day and Tim had to work today, we are celebrating on Wednesday. But for all you Dads out there:

Happy Father's Day

Busting out the BIG Guns!

Yup. I had to break down and do it.... I had to go to my OB/Gyn and ask for Provera. Ugh. Let me explain....

About 3 weeks ago I went to my OB/Gyn to ask for help with my cycle from hell. At that time she said that I needed to repeat the pregnancy test in 2 weeks and once it was negative she would give me "something" to trigger my period to start. Well I thought that perhaps the "something" they would give me was just progesterone. And since I already had some prescription progesterone I just started taking it since I knew I wasn't pregnant. The Dr needed to chart that I was not pregnant to CYA, before giving me anything. Anyway, I started to take the progesterone last week and still no period. I am on day 92 of my cycle. Yes you read that right. Ninety-two day cycle. nine two. 9 - 2. So today out of desperation I called the OB/Gyn and went in for a pregnancy test (which by the way costs $25, highway robbery if you ask me). Pregnancy test was negative just like I thought. But for my $25 I did get the prescription for the Super Progesterone, aka: Provera.

The Pharmacist told me that it will make me sick to my stomach, possibly lightheaded and dizzy. Oh Lucky me.... I get to go through all the crappy side effects and THEN get my period! Woot.... I can't wait. LOL! The only glimmer of sunshine in this whole mess is that the Provera is on Walmart's $4 prescription list. So at least I only had to pay $29 for my period. hahahaha

I start taking the Provera tomorrow and will take it for 5 days. It might take up to another week or 10 days for my period to actually. I will be waiting with baited breath.

The Insulin-Resistance Diet

After my blood draws and talking with a fellow PCOS-er I figured I should do some research on Insulin-Resistance (IR). I looked online for some books I could read and perhaps a diet I could follow. I came across "The Insulin-Resistance Diet" By Hart & Grossman. My Aunt Kathy had actually recommended this book, but I didn't make the connection until I read the back of the book and in the bio of the Dr. it said that they run a Wellness Clinic in the same town I live in. Over the weekend I have been reading and absorbing the book. I have been trying to fully understand the Link And Balance recommendations of this book so that I can lower/eliminate my insulin spikes. I learned so much from this book. It is amazing what I didn't know about food and how it relates to other foods and how our bodies process that food. It was an amazing read. I would strongly recommend ANYONE that has struggled with weight loss to read the book and adopt the wellness lifestyle described in the book.

I am going to make some changes in my lifestyle. There I said it. It is written down so I must actually follow through! LOL! I have learned a few things in the past few weeks.... When I went to the Endo Dr to find out why I am not having a period or ovulating I had to step on the scale for first time in about 8 months. Now I didn't own a scale at home. Probably because I didn't want to admit the number that I would see. I didn't want to know on a weekly, monthly or even every 6 month basis what I weighed. I figured as long as my clothes still fit that I did not need to know the ACTUAL number. So when I stepped on the scale at the Drs office I was SHOCKED. So shocked I made her weigh me again, in hopes that the scale was wrong. But alas it was the same number. I read those 3 numbers and almost cried. I have achieved my TOP WEIGHT. I have never before weighed as much as I do now. Not even when I was 9 months pregnant, any of the 3 times, did I weigh this much. I am normally a very open person about everything and anything, this blog accounts for that. But I am too embarrassed about the actual number that I will not be sharing it with my blog lovers.

I am not sure if my lack of period comes from the weight gain or if it comes from the PCOS. For that matter I am not sure if the PCOS caused the weight gain and the lack of period. Either way something needs to change.... and soon. PCOS causes IR or maybe the other way around. But changes to your diet and activity level can have positive impacts on both the PCOS and the IR. What I am hoping is that by changing my lifestyle which includes my diet and my activity level that I will be able to lose some weight and get my period and ovulation back. I may also be taking some medications to help me as well, although I don't know what if anything yet, as my Endo Dr. still needs to call me back.

I am making changes to my lifestyle that can last a lifetime. I will always have IR and PCOS, but I can probably reduce or eliminate the symptoms of both with lifestyle changes. IR can turn into full blown diabetes, not to mention increase your chances or heart disease, HBP, certain forms of cancer, and stroke. I really want to grow old with my husband and see my grandkids one day. So my lifestyle must change........

I am going to go on the Insulin Resistance diet with the linking and balancing of Carbs and protein. I am going to increase my activity level. I am giving up sugary soda (yes Megan I am coming over to the dark side of "diet" soda LOL). And I am going to eat smaller meals more frequently. I am going to switch to whole grains and low fat/ leaner meats. I am going to increase my water intake.

Oh and I even bought a scale.

PCOS Continued

So I went in this morning for my blood draw. I had to fast from last night at 8:30pm until this morning. It was OK. I just woke up and went to the lab for the draw. It was not a huge deal. The only thing that was kinda sucky was that they had to stick me twice. The nurse got the blood draw orders wrong, so they just drew the Thyroid panel not the rest of the blood work. It was a good thing I asked about all the extra tests because they did not catch the mistake, until I said something. I have now learned to double check the order BEFORE they stick you!

I am hoping that the results will be back by Monday so I have an answer one way or the other. I still haven't done much research yet on Metformin or a better diet. I think I may just have to buy a book or something on that. I am hoping that I already eat healthy enough that I may just have to chance a few things like cutting out soda/sugar, switching to whole grains exclusively and probably changing the combinations of foods I eat (ie. always eating a protein with a carb, etc). Oh and eating smaller meals more frequently. If anyone has a book they could recommend.... I would love that!

As always I will keep you posted!!!!!!

PCOS?

Well I went to the Dr. He said that most likely my symptoms are from PCOS (Poly Cystic Ovarian Syndrome). He is doing a bunch of blood tests to figure it out for sure. Test include levels for: Prolactin, Testosterone, LH, FSH, DHEAS, Basic Metobolic panel(includes insulin), and a Thyroid Panel. Most of those tests have to be done fasting, so I plan to go get them done in the morning. He was fairly certain of his diagnosis even without the blood tests. So much so he talked about treatment of PCOS. His treatment plan is 3 fold. 1) diabetic diet with emphasis on portion control. 2) regular exercise 3) Medication ~ metformin.

Dr. is not so concerned about weight loss as he is on the benefits to your body's metabolism that exercise offers. I guess it helps your body process sugar and insulin more effectively. And of course eating right would have the same effect in terms of blood sugar and insulin. And then the meds would keep everything even, I guess.

I am still doing research on Metformin. I have heard you can't take it while pregnant. So I am not sure what his plan would be for that. I am a bit leery of taking medications in general. That part of the treatment plan is the most difficult for me to get on board with. I mean I already take a Thyroid pill and Prozac on a daily basis. Good grief, I really don't want to take another pill.

Overall the news is disturbing. I am not handling it very well emotionally. I am hoping that I just need to process it and then I will feel better. But another part of me is in denial and wants to wait for confirmation from the blood test before believing it is true. I am guessing that after the blood test results come back I will be more inclined to do more research.

But for tonight I would like to stick my head in the sand.

Calling my Girls!

Hi ladies. I am having a WACKY cycle. I know that some of you have personal experience with weird cycles and I just thought that perhaps someone could give me some insight. I thought that if I gave you some information on what was happening with me, that you could play "Mystery Diagnosis" and help me out! LOL!

Here is my story: After I had Mason I had the normal amount of post partum bleeding. I nursed him for 18 months with an abundant milk supply. These two things seem to indicate that all was well with me hormonally. At least at that point. At the end of January to the beginning of February I weaned Mason. As I started the weaning process I started to pay more attention to my cervical mucous (CM) as my nursing were fewer and fewer. CM is the first indication of returning fertility. As my CM became more and more fertile, I started to take my temperature in the morning. I still had not had a Post Partum Period yet, so I just started my chart from when I started to see returning fertility in my CM. Tim & I were still undecided on whether to try to conceive (TTC) at that point or wait a few more months. Well during that week of returning fertility Tim had a momentary lapse of reason and "failed" at our method of Birth control. LOL! I was not really worried since I thought it was too soon for me to Ovulate since I had just begun spacing Mason's nursing out. But Low and behold my temp shifted a day or so after our birth control mishap. ECK! We figured that I should start taking the prometrium (progesterone supplements I usually take when TTC to help maintain a pregnancy and avoid a miscarriage). I called my DR and got a prescription filled and started taking it. Here is my chart from that cycle:

So Tim & I had our "mishap" on Cycle day (CD) 14 and I ovulated on CD16. I started taking the prometrium on CD 18. Not surprisingly, I started to spot on CD24 and my period started full force on CD 27. That gave me a 11 day Luteal Phase (LP = the time from Ovulation to period starting). Considering this was my first cycle since weaning it was not alarming that it happened this way. But once the baby bug hit me I could not get it out of my head. So we decided to actively TTC the next cycle. My pre-ovulatory temps were kinda all over the place and the day that I actually ovulated is still kinda debatable. Because I did not have a clear thermal shift and Tim was working out of town we again were unsure if we catch the egg or not. And I had a delay in Ovulation which I am not sure of the cause. I probably started taking the prometrium too soon and it delayed or even prevented a viable egg from being released. So again our timing was off. This time thanks to the prometrium and a decrease in my Breastfeeding hormones my LP was 12 days long. During my LP I thought for sure that I was pregnant so I had a blood test drawn when I went in for my routine thyroid blood draw. The pregnancy test came back negative, but my thyroid test was within normal range. So again at this point my hormones seemed to be in somewhat of a balance. Once I received the 2nd negative blood pregnancy test I stopped taking the prometrium and my period started within a few days. See chart below:

When we did not conceive on the last cycle we decided to sit the next cycle out and let my body kinda reset and also avoid conceiving a baby that would be due in December. We thought that the next cycle would be easy peasy, just wait it out and then get back to TTC in April. Well I am still currently ON that cycle! Today is CD50. Yes you read that correctly... 5-0, 50, fifty. Yup. Long cycle. It seems that my body has "geared - up" to ovulate a few times without actually releasing the egg. We thought I Ovulated on CD27, but 12 days later and no period. All the pregnancy tests are negative. Then I thought perhaps I ovulated on CD 40. But my temps took a nose dive to a pre-ovulation range of temps. So then today I thought perhaps I have ovulated since my temp is higher today (97.6*) than it has been the previous 31 days. But I won't know for sure for another 2-3 days. I need a few more temps to confirm ovulation. The sad thing is that since I have "thought" I ovulated like 3 times now, and I "thought" Tim and I were safe to go without birth control, we have done so on a few occasions. While the potential for pregnancy is a LOOONNNGGG shot, there is still some potential. This is only a problem because pregnancy is one of those things I really LIKE TO PLAN! Ugh. Here is my current (and somewhat never-ending) cycle:

You can go to: http://www.fertilityfriend.com/home/35660 there you can see my charting homepage for a clearer and more detailed view of my chart.

The other portion of this is some new symptoms that have cropped up in conjunction with old symptoms. I am mostly concerned that all of these are indicative of a hormone imbalance, be it PCOS, Thyroid, or some other hormonal dysfunction. My "old" symptoms are:

• Low Thyroid function - but has been well controlled on meds
• skin tags
• thin/thinning hair
• dark pigmentation of skin folds and groin area
• low waking temps
• Long patches of fertile quality CM (more than 4-5 days)
• Ovarian cyst on right ovary that causes constant dull pain for most of cycle.

New symptoms are:

• dark hair growth on upper lip
• long cycles
• delayed ovulation/possible annovulatory cycles
• No clear thermal shifts confirming ovulation

I know that a few of my close friends have had PCOS or still have PCOS. Other close friends have had other non diagnosed hormonal imbalances. So I am hoping to hone in on the minds of my girls and the collective research we have all done to find some answers. I am really wanting to avoid things like Birth control pills, clomid or other fertility drugs if possible. Tim & I have been doing some soul searching on what these developments mean in terms of our family planning, but feel we don't have enough information yet. Please if you have information to share, do so!

Thanks so much!!!