What's this? I started my period! :)

Most women, especially those trying to conceive, wouldn't be excited about this, but I definitely am. I started my cycle today - ON MY OWN!! This is huge for me. I think this is only my second cycle on my own since stopping birth control in April of 2008. During that particular cycle, it took me 67 days to start on my own, and I'm not even sure if I ovulated. It's hard to say though. I was still new to the whole charting thing (it was my first cycle ever charted when we started TTC), however, I certainly didn't write down any "symptoms" around the time that I would have ovulated, so that's why I'm so doubtful.

In my little corner of the world, this is very exciting! It's nice to see that my body WILL work, if nothing else just some of the time. Can you believe this makes for only my 2nd cycle where we've actually had the *chance* to have a baby (ie. I ovulated) in what will be almost a year of trying to conceive?!! Since I didn't know for sure I had at the time, it was the easiest 2ww ever! :-)

I'm excited, but I definitely realize that even when I DO ovulate, the likelihood of my remaining tube being able to function properly and pick up an eggie is pretty slim with all of the existing scar tissue that has formed due to my surgery years ago. Even still, I have HOPE!! For the next week, I will be reminded that I am indeed a woman - roooarrrr! :P And I will love every minute of it!!



For your viewing pleasure, here is my complete 93 day long cycle. Above is a snapshot of the very end, around ovulation . Our first cycle where we weren't actively trying, I guess you could say. That basically means, we weren't BDing every few days, I wasn't taking my basal body temps, doing any of those lousy OPKs or drugs or anything. In fact, you can see that in late December (when this cycle started), I stopped taking my metformin and, and yes I probably shouldn't have cut this one, but I also stopped taking my prenatal pills. Those things totally suck and I just needed a break.

The above chart snapshot indicates the days when I was having certain ovulation-like symptoms - starting with headaches off and on, very sensitive nipples and my ovary was sore, as in I when I barely pushed on my stomach it hurt, and then on Day 81 I just happened to check my cervix and it was open. Based on all of this, I *believe* I probably ovulated on either CD 81 or 82, but it could have been anywhere in the green outlined area I suppose. As you can see we did BD a several days prior to that, and one day right in that key time frame. Even though BD timing wasn't "perfect", it wasn't awful either. I'd give it a 3.5 out of 5 maybe. Just good to note. It's always nice to test my body out and give it a chance to shape up on it's own, but I'm not holding my breath. I know God can work miracles, so I just continue to pray!!

Free Infertility Radio Show - PCOS and Infertility Treatments

Frustrated with my current cycle (I think it's a total bust, but I'll post more about that later), I have been surfing the net to try and find some answers. Answers for what to do next, what various tests and procedures cost, etc. I came across Haveababy.com's live one-hour online radio show, which I hadn't heard about before. It seems like they do a lot of interviews with reproductive endocrinologists, so it seems like a good opportunity to get some reputable info.

Their shows broadcast every Thursday at 10:00am PT/1:00pm ET. They also keep a database of past shows, so you can listen to the topics that are of real interest to you. I came across the following topic, which really hit home for me, and took a few notes while I was listening... sorry for the incomplete sentences and/or misspellings. :)

Goodbye PCOS, Hello Fertility Treatment, hosted Kim Hahn and Dr. Drew Tortoriello, Medical Director of SIRM-NY. Dated 10/30/08 (archived in the scrollable column on the left).

In PCOS patients, excess androgen test worthwile. Remember, just because you have a period, doesn't mean you ovulated. Even if women do ovulate, they might be at an increase for abnormal oocytes. Excess androgen causes problems with eggs. So, even with women who get pregnant with IVF, their risk for miscarriage is 2x more, due to the androgen excess their eggs are under.

Are OPK tests or OV Watch good for PCOS patients? Yes still good to use. LH elevation in pcos patients cause false positive in opks though, so it just depends on that particular person.

Mid-cycle Follicule Check via Ultrasound while on Clomid
Recommend starting with monitoring with ultrasound to find out when a follicule is developing to give better guidance. Rather than only do ultrasounds, start on clomid. Are people monitored a lot on clomid? Always recommend both scanning and clomid because you don't want to waste time if you don't have response to the clomid and you won't know unless you get your period or if it doesn't come, you then have to figure out what to do next. If clomid is working within 10 days of last pill you should see evidence of this by an enlarged follicule through an ultrasound. If it's not enlarged, then start new dose (higher) the next cycle.

If your partner has normal sperm, it's ok to not to IUI as the first option because the problem is due to anovulation in the woman. But, IUI's are good if you have unexplained infertility because clomid by itself and insemination by itself really didn't do much, but the two together have shown better results. IUI's are fairly inexpensive, easy to do, and invasive, so these combined treatments can be very benefitial.

Things that Mimic PCOS
1st thing - rule out other things that might mimic PCOS, like congenitial adrenial hypoplasia (when adrenial gland pump out excess androgens), cushings syndrome (too much cortosol), insulin resistance b/c 40-50% can be insulin resistance (not necessairly diabetic, but their body pumps out too much insulin to fight off the diabetis; an insulin problem might cause an ovulation problem.

PCOS and Metformin
With PCOS, should metformin be used together? Open for debate. Connection between the two was discovered by a guy named Nesslin. High androgen levels can be due to not ovulating. Metformin can bring androgen levels down. However, it shouldn't be exepected to work alone (without an ovulation inducing drug).

Clomid vs. Injectables
Why is clomid the best? Why aren't injectables even better than clomid? Related to heirarchy of treatments. Injectables are an option, but most people would start with clomid first because it's easier, shorter duration, cheaper and it works for about 70% of women. Clomid is also pretty gentle - as in you don't have to cancel a cycle most of the time because they don't produce too many follicules. 25-30% of each follicule turning into a baby.

Injectables cost more, and could cause a much more troublesome response, even with low dose because the produce too many follicules. It's an option for sure if clomid has failed. Also, sometimes if you do injectables you should strongly consider IVF because you control how many embroys go into the uterus. If you can just get a PCOS patient to ovulate you don't have too many other issues getting pregnant.

Increase in Miscarriage due to Excess Androgens Present
However, there may be an increased risk in miscarriage regardless of IVF, clomid, IUI.. because oocyctes have grown up with excess androgen, which does bad things to egg quality. If you're going to to injectables you should consider doing birth control or lupron injectables to bring down androgen levels for a month or so, so that you can have eggs that grow up in an environment without all the excess androgen. Lupron PCOS users have shown a reduced rate in miscarriage (though, I've read there can be bad side effects with Lupron).

Next Steps after Ovulating on Clomid, but no BFP
If you do about 4 cycles with clomid and are ovulating but don't get pregnant, then you should consider injectables with IUI, or move straight to injectables and IVF. Most people feel comfortable with that because there's not much difference between clomid and injectables (just ovulate in a different way).

Hyperstimulation Risks
Are these people at risk of hyperstimulating? It's rare with clomid only patients, but people using injectables DO have a higher risk. In IVF you usually are at a bit higher risk because you are trying to encourage as many eggs as possible because you can control how many go back in.

Excess Testosterone?
Having more testosterone - Does your body just create this or do you get it more for hormones or steroids (possibly in food). Likely no, it's just your body. Some studies do show DHEA supplements (a weak androgen which has quality of life benefits) encourage androgens, so you should avoid this if you have PCOS. Mostly genetic that we don't completely understand. Not many meds to bring those levels down except for things like Lupron and Birth Control, which only brings it down for a short time (while on the meds and shortly after).

I started my second cycle of clomid this week!!

Well, I saw my OB on Wednesday. We did actually - that's right, me and my husband! I was so happy about that... it made me feel so much more collected mentally when I was there and it was just nice to have him move involved.

She agreed that I did ovulate last month and I had a perfect temperature rise, which is great news. The not so great part is that I ovulated late on clomid (50mg), which isn't ideal, however I have read mixed reviews on this...

This RE thinks that only short cycles are a cause for concern, and that long cycles usually indicate excess ovarian reserve, which is a good thing.

Whereas, this ART company's site states that "too late" could be anything after CD20 which simply means that there are fewer cycles in a given time period to try for a baby, and that you may be releasing eggs that haven't properly matured, or that the other parts of the reproductive system aren't in sync with the egg. You can conceive late, but your chances are just reduced.

With that in mind, she wasn't sure what to do next really. We asked her if I ovulated late because of PCOS and excess cysts, and she said it's really hard to say why. She said we DO know that the Clomid did "something" because I ovulated and my temps looked good. That's when she started debating on whether or not to do another round of clomid or do supression with birth control. She ended up doing another transvaginal ultrasound to see what my ovaries looked like, and I still had cysts - no more or less than last cycle really, which she said was fine - and the good thing is there were no big cysts. She ended up polling the other OBs in her office to see if I should stay at 50mg or up the dosage to 100mg (the vote was split), and she ended up deciding to up it and move my start date to CD3 - both in hopes that I will ovulate sooner. From what I've read it's hit and miss. I am concerned that the larger dosage might do two things - cause large cysts to develop (which I want to look into more, and to see if metformin actually descreases this chance) and that it might dry up my cervical mucus, which you need so that the sperm can travel through your vagina and into your cervix to wait until the egg pops.


Taking Robitussin to Increase Cervical Mucus
To address the last problem, I am going to give Robitussin a shot. I didn't have but one day with egg white cm last month on the lower dosage of clomid and don't want to chance it being worse.

I did a little research and BabyHopes.com states that you should take two teaspoons (200mg), three times per day. When taking it during a clomid cycle, you should begin the day after your last clomid pill is taken. The site also suggests to take each dosage with a full glass of water. An alternative to liquid that I might explore (if I can't stand to swallow that stuff) is Mucinex, as it comes in a pill form. IMPORTANT: No matter which one you choose to take, the key is that the one and only ingredient it can have in it is Guaifenesin. If it has anything else in addition to this, it could have an adverse affect on your cm. And, yes, you can get the generic form of these drugs - you just have make sure it only has the one key ingredient.

Free Online Yoga Videos for Destressing

Tonight I was having serious acid indigestion and sour stomach due to the metformin. I've read this is fairly typical, so there's no reason to be alarmed, but it's really very annoying. I remembered that the last time my stomach felt like this, I had a yoga session that really seemed to help, so I figured why not give that a shot again. I googled "free yoga online" and came up with a couple good videos worth checking out. I just finished up the first one and really ended up liking it a good deal. While my stomach is still a bit upset, it does feel slightly better. I'll take what I can get :)

http://video.google.com/videoplay?docid=-4628036076291757842

http://video.google.com/videoplay?docid=3225997721700737829&hl=en

Yoga and Fertility

After doing some research on doing yoga for infertility, I came across Yoga 4 Fertility with Brenda Strong. These DVDs seem to mimic pretty closely the style of class and types of poses I've been doing lately and most enjoy. I haven't tried this out myself just yet, but wanted to post my findings. I'll probably be ordering a copy soon and will let you know how it goes. Hope it's helpful!

I've read several things that say yoga is great for fertility because it allows your body to release stress and tension. For some women, stress alone seems to prevent them from conceiving sooner than later.

Even though my issues are deeper than that, I am sure that stress has an affect on my physical and mental health more than I'd like to think.So, even though I am not the least bit flexible (no, I can't touch my toes or the floor... it's more like the middle of my chins!), I decided to give it a shot and signed up for a once a week beginner class at the local community college. If there's one thing I have a hard time doing in life it's taking time out to exercise and just veg out.

Up until this week my experience was so so. On a good week, I would feel somewhat challenged and rejuvinated. On a not so good day, I had a hard time connecting to the poses and would find myself wandering off in thought, thinking of all of the other things I could be doing with my hour and 15 minutes.

And then yesterday's class happened! You should know that earlier in the week I upped my metformin back to 1000mg and was fine, until about 2.5 days after that and then the stomach pains came back. By Thursday, I was feeling like poo again and really wasn't up for going to yoga. But - I made myself and am very thankful I did. I went in feeling like crap, and came out feeling like I had just been at the spa! Seriously - my body was so relaxed and the tension was gone. On top of that, I was craving a McDonald's cheeseburger and fries! I know it sounds weird to be happy about that and to want to do that right after a great yoga session, but when you keep in mind that I haven't really had an appetite on metformin, this was fabulous news! So, Jay and I headed straight to the new MickyD's around the corner and I ate some trans fats and it was great! :)

In all, I think I'm learning what I like and dislike about yoga. I LOVE it's ability to take stress out of your body and let you start fresh and new. I also love that, as a result, I seem to have more energy. The night of the great session I stayed up until midnight and was mentally and physically energized. I hadn't had a night like that in quite a long time.

More specifically related to yoga itself, I like when the poses and movements are in sequence with one another so that there is a constant flow, rather than yoga that is too slow. I feel like I tend to loose focus then. Also, I don't really enjoy yoga that is too challenging... while that sounds like a cop out, it's more that because I am not as flexible as most people, it's difficult for me to get in some of the funky poses, so I tend to not be able to get as much out of them.

I'm really pretty happy with the instructor I have and the way she structures the class. From talking with a friend of mine who also does yoga, it seems that not all instructors verbalize the poses and how to get into the pose while you're doing it. As a result, you're opt to be more frustrated because you have to constantly keep moving out of the pose to look around and see how your body should be moving. Since I would rather do yoga more for the stress relief, distraction like that is a huge factor in remaining focused. I find that I have a more successful session if I am able to really clear my mind, take in the music and concentrate on my breathing.

All in all, I think I'll continue yoga and hopefully it will make a positive impact on my body and allow me to become pregnant more successfully. If nothing else, I will be a more relaxed individual and that's never a bad thing! Oh, and did I mention I got my husband to take the class with me too? Apparently yoga is supposed to be good if you play sports that put an imbalance or strain on your body. He is an avid tennis player so he was interested to see how it could help out his game.

I am going to try and get a copy of Yoga 4 Fertility with Brenda Strong soon and will let you know how it goes!

Bad case of the metformin blues...

So, I was on metformin for about 2 days or so and, on Sunday I started getting very sick to my stomach. It didn't let up and on Tuesday I figured I'd call the doctor to see if she could put me on metformin ER (the extended release version). I'd heard it was much easier to take and I figured why keep feeling that way if I could prevent it. Well, I didn't get a call back until Thursday. She did appoligize for someone not returning my call earlier, which I suppose was nice to hear. She recommended I cut the pill in half and take smaller doses throughout the day, rather than 500mg each time. So, today is my first day taking 750mg. After I called on Tuesday I went ahead and took myself back down to 500mg because it really was having a huge affect on my body. I imagine I'll be at 750 for about a week and just see how that goes. Afterall, I'm in it for the long haul I figure.

I LOVE IT when doctors listen!

I haven't written lately, but a lot has happened. The last week was primarily filled with a lot of late nights and uneasy, unproductive research for my first appointment with my OBGYN. Well, not "first" appointment ever with her... I have had the same doctor for about 3 1/2 years now, but have never been TTC and have never really went into an appointment with a true agenda.

I was so nervous because I feared that I wouldn't know what to say or what to try and demand. It's tough getting appointments with her sometimes and I just didn't want to waste any more time. After a long night of reading and studying (it felt like preparing for a college final all over again), I headed into the doctor's office that day with a binder full of key information and an outline of what I wanted to ask and insist on.

In the end, it didn't really come down to insisting. My doctor was actually very in tune and seemed aggressive about wanting to get me on track. The conversation went a bit like this: So, you've been trying to get pregnant since April. Yes. And when was your last period? 2 weeks ago - I have been charting, if that's helpful to see. Oh, you're on the ball. Yes, let's have a look at that. Ah, so you're last cycle was 67 days long - that's too long. And... let's see... you've definitely not been ovulating. If you were, you'd see an obvious shift... your temps aren't showing any sign of matching this shift. Let's get you started on metformin. This will help to regulate your cycles and encourage ovulation. If we need to go with clomid at some point, we might do so, but let's see how this does. Sound good? Sure does. Do you think we should do bloodwork again? Well, it has been almost two years since we did it last... let's go ahead and have it done. You can schedule it today in our office, if you'd like.

Long story short, they took my blood and checked for FSH, LSH, and something else... can't remember right now. The two tell-tell levels were very out of balance. I think my LSH was 3 x the FSH level, but I'll have to double check that.

I started metformin and so far so good I guess. I'm hoping my temps level out and I start seeing something normal. Wish me luck!