I once had a doctor tell me to get pregnant right away or I would never have kids.

I was twenty.

He was old-school and this was way back when they knew NOTHING about endometriosis. Except that it existed.

My endometriosis has never been that bad, fortunately. And I decided not to marry the guy I was with at the time after envisioning our life together. The one where I had kids but was completely miserable because he and I were totally wrong for each other.

I always knew I would have issues getting pregnant. I never understood what, exactly those issues would be, but I knew they’d be there. But I guess I also thought they would be more… defined. More clear cut. As in, you CAN’T have kids so don’t bother trying. Or you CAN but you’ll just have to work at it a bit. Not this seemingly never-ending spiral of you can’t, oh wait you can but you can’t carry, or maybe you can but you have to go about it just so, or maybe you can’t, or maybe we just don’t effing know.

Fast forward. Wrong Guy and I decide to TTC. Within a few months of ditching the birth control pills I’m in horrible pain and end up on Lupron while he’s in Afghanistan. When he comes home we pretend to start TTC again. I say “pretend” because, although I was no longer on Lupron I also wasn’t ovulating. Lupron is the devil. Fertility work-up shows he’s shooting at about 10%. Doc says there’s no chance we’ll get pregnant with a sperm count like that. Then he tells me he’s in love with someone else and asks for a divorce.

Ah, the ups and downs of life. And my prospects for kids. It all really is a roller coaster.

Behemoth roller coaster in Canada

Fast forward again.

Still devastated from the divorce, I work my ass off to get my life back on track. I go to grad school, graduate, get a good job and buy a house. All in preparation for one day adopting on my own. At that point I’d given up on romance/partnership/marriage.

So, of course, that’s exactly when I meet Right Guy. And start to think maybe, just maybe, there’s still time and a chance to do the natural family thing.

Cue hot flashes. I ignored them for far too long. I was too embarrassed to admit them to Right Guy. I remember him commenting how sweaty I was one night. I said it was just the crowded bar we were in. I finally confessed to him after waking up soaking wet in his bed in the middle of the night – I had soaked his sheets. Caused by my night sweats. All I could do was cry and apologize profusely for “wetting” his bed and dirtying his sheets. He just held me.

Later we discussed it. Being a doctor he offered the “I’m sure it’s not menopause” speech. Him being a doctor was partly why it took me so long to tell him. It’s weird (well it WAS weird) to be diagnosed by your partner. Anyway, I made an appointment with my GYN. Who also gave me the “I’m sure it’s not menopause” speech. But ordered bloodwork just to check. And came back with the “It IS menopause and you’ll never have kids” speech.

Then I go see an RE who says that it’s a long shot, but it could happen. I start HRT (hormone replacement therapy) and the hot flashes subside. I start to feel somewhat sane again. But I don’t ovulate on my own. The eggs, they are gone.

We try some Clomid. It makes me ovulate. Sort of. As long as I use an estrogen primer (you can’t be on estrogen while taking Clomid but you can use it just before you take the Clomid). Gradually my eggs begin to reappear. I go from two antral follicles to about eight. Go me!

But I’m still not pregnant so we move on to injectibles. That cycle I think I started with THIRTEEN antral follicles. Which is how I ended up with SIX eggs in play and did a last minute conversion to IVF. And then got a BFP!

Woo hoo! This worked! I am going to have a BABY!!!!

Um no. I’m not. Instead of a baby, I’m going to spend ten days in the hospital and get chemo (methotrexate) and spend a total of five months psuedo-pregnant as we watch my beta HCG fall back to zero and get more chemo whenever it decides to stop falling. And, oh yeah, now I have another fertility hurdle called adenomyosis and this crazy ectopic might happen again. Oy.

Irony of all ironies? I start to ovulate on my own. No more hot flashes. But my uterus is damaged so I’m not allowed to TTC.

Pops dies of his 3rd cancer.

One full year after our surprise IVF I am cleared to TTC and do a FET. I get pregnant AGAIN!!!

Wow. Apparently I get pregnant pretty easily. Well, as long as I do IVF.

Um, no. Not so much. It’s ectopic. AGAIN. But this time it’s a run of the mill ectopic. More or less. The chemo doesn’t work fast enough and I end up in surgery having my tube removed. But I was allowed to go home afterward so no hospital stay at least.

My body returns to regular ovulatory cycles with no hot flashes. But I’m benched for three months.

The very first month we are cleared to TTC what happens? The hot flashes return and ovulation, while still happening, is not occurring regularly.

Sometimes I really want to graph the major events in my life. In 3D. So I can capture not just the highs and lows but all the twists and turns. I bet it would look like the craziest roller coaster EVAR.

roller coaster toy

Well maybe not EVAR. My life has really not been that horrible in the grand scheme of things (I’ve always had a roof over my head, a loving family, etc). There have just been a lot of ups and downs and twists and turns. I love roller coasters. But I always wanted a normal, run of the mill life.

I think what bugs me most is the suddenness and/or the unexpectedness of the ups and downs and twists and turns.

I didn’t see the divorce coming. People usually see it in hind sight. Although I can see a few things now that I didn’t see then, none of them spelled D-I-V-O-R-C-E. I was totally blind sided on that one.

Pops’ cancer? I can’t say that was a total surprise in and of itself. It was more of a surprise that he survived it. Twice. We kept expecting him to die. And he kept not dying. That was… mostly… a good thing. But then you get to a point where you start to think, “Maybe he’s not going to die of cancer.” And that’s when he did.

Same thing with my infertility. My body keeps doing strange things. I don’t know what’s real anymore. Am I really entering menopause in my 30s? I thought so before and my body somehow ‘bounced back.’ So now that it’s tanking again, I have to wonder, “Is this really it? Or will I make another comeback?” There’s really no predicting it. It defies modern medicine.

There is a part of me that just wants it to be done. Get me off this ride. Make it stop.

But I’ve posted that before: Get Me Off This Crazy Ride
Jane, get me off this crazy thing

But that’s silly. This is life. Life is not going to stop being crazy. Something new, and potentially crazy, is just around the corner. It might take you up, it might take you down. Or sideways. Or upside down. Life is like Space Mountain – a roller coaster in the dark. You can’t see where you’re going, you’re just along for the ride.

So… I haven’t posted in awhile. I think I start every post these days with an apology for being a bad blogger/tweep. Such is life. I’m busy. As in BUSY. Working full time, packing, planning a move that I won’t be able to make with Right Guy, taking care of Pops… I hate not being able to plan anything. Right Guy will be moving (as will our stuff) next month. I will likely move in with Pops. At present it seems like he may hang on for awhile. Which is good and bad. It’s great to still have him around but I can’t start my new life in Seattle until he’s gone. Bittersweet whirlwind of emotions. But that’s not what I want to write about today. Today I’m back to all things infertile and medical.

As I mentioned in my last post my last MRI showed that my uterus appears to be healing itself. Slowly. So I probably won’t need surgery. But I’m still benched from TTC/FET. However, that MRI also revealed lots of antral follicles. More than I’ve ever had according to my RE. I didn’t ask for an exact count. So she retested my AMH. My AMH was 0.1. Now it is 0.9. That is not supposed to be possible. Under other circumstances perhaps you would assume that one of the results was incorrect. Except that all other indications agreed with the results at the time. When my AMH was 0.1 I had 2 antral follicles, an FSH of 16 and severe hot flashes/night sweats. Now that’s 0.9 I have (presumably) >13 antral follicles and I’ve now been off my estrogen patches for 10 days. That’s the grand experiment. Will the hot flashes return without the estrogen? I’ve been more or less OK until today. There have been a few moments that may have been hot flashes or may just have been the 90 degree weather or the fact that Pops keeps his house at 80+ degrees. But this morning… no denying it: hot flash. But no night sweats. So that’s good. Those are the worst. I think I will try to stay off the estrogen for this cycle (assuming I HAVE a cycle) and then have my FSH tested on CD3 next month.

In conclusion [I feel like I’m writing a 3rd grade essay but I’m really only now getting to my point], in the grand scheme of things I’ve been getting lots of GOOD news lately. And I recognize that. So please don’t think I’m too whiny. All this good news is somewhat disconcerting because it defies logic. AMH is not supposed to go up. Pops is supposed to be getting worse, not better. Even when it’s good news it can throw you for a loop. It changes your reality. It was easier to plan next steps with the bad news. Now it’s impossible to plan anything. It’s like an interminable two week wait. You have no idea whether you’ll be able to attend that “kegger” because you might be preggo. 😉 Well, I have no idea where I’m going to be living or working in 2 months. Or whether I’ll have health insurance. I have no idea whether Pops will still be alive next week let alone 2 months from now. So I can’t plan a trip or even commit to an event more than a week in advance.

Oy. I just want to plan SOMETHING. So I plan to POAS for the first time in a long time. I guess I’ll start today. If I am going to have a normal cycle my LH should surge soon. Not that I can do anything about it.

Ring Of Fire

July 8, 2010

♪ ♫ I fell into a burning ring of fire. ♪ ♫
fireOr rather, I woke up in one. I woke up with one of the worst hot flashes I’ve ever had this morning. Not THE worst but pretty bad. And it surprised me.

I realize that hot flashes are a very common side effect of Clomid. This is the third time I’ve taken Clomid. The last two times I never had any cramping or hot flashes while taking the pills. The cramping started after I finished taking the pills. That was true for Cycle 1 & Cycle 2. In Cycle 2 I had hot flashes after finishing the pills but not during. So that’s why I’m surprised by my current symptoms.

I think I know why. And it gives me hope. Likely I’m grasping at straws and reading too much in to this. And I’ll probably regret posting this optimism for all the world to see. But maybe, just maybe, my theory is correct and I will not only respond this cycle but respond better than I did the first time (hopefully with more than one mature follie).

Let’s see if this makes sense to anyone else…

Cycle 1 with Clomid was preceded by 3 months of HRT (estrogen replacement for all 3 months and 2 months of progesterone). My estrogen had actually gotten quite high. In fact, my RE thought maybe I had a cyst because it was so high. But I didn’t. So she decided that I must just absorb the estrogen from the patch better than most people. In any case, I went in to Cycle 1 with fairly high estrogen levels. Hence the lack of hot flashes. And since I had estrogen, that cycle worked.

Cycle 2 with Clomid was preceded by Cycle 1 + 1 month of BCPs. At the end of the month of BCPs I was already fairly miserable with my normal hot flashes. I get them if I’m not on real estrogen. BCPs do not do the trick. So anyway, I somehow managed to avoid the hot flashes while taking the pills. My guess is that my estrogen was already so low the Clomid didn’t make it go any lower and part of what makes a hot flash is a lack of estrogen but the other part is a drop in estrogen. There was a lack, but not a drop. Cycle 2 produced no mature follicles on CD12. Although my body managed to finish the job and ovulate on its own a week or so later, I really didn’t respond well, if at all, to the Clomid. My RE and I decided that I need that estrogen primer before any treatment.

So now I’m on Clomid Cycle 3 (I was going to move on to injectibles but due to other stressors in my life decided to wait another month on that). This time I’m taking the Clomid after 12 days of estrogen. It was supposed to be at least 14 days but my cycle was all kinds of screwed up last month so it’s only 12. GoldilocksBut I’m wondering if this might do the trick. Silly? Probably. But what if my ovaries are like Goldilocks? They require just the right amount of estrogen – not too much and not too little but just the right amount.

So anyway, for now, I guess I’ll try and make friends with the cramps and the hot flashes in the hopes that they indicate hard working ovaries. Right Guy will just have to put on another sweater while I turn the AC down a little more…

This Week’s ReCap

June 18, 2010

It’s been an eventful week and I’ve been posting a lot. So I decided to post a much shorter version of it all with links back to the long versions in case you want more info.

In the past week:

Note: this text came from http://www.pyramidpreventativemedicine.com/education.html . It is not my own. But I found it so informative I wanted to make sure I posted it here as well.

The controversies surrounding hormone replacement therapy (HRT) is confusing for menopausal women and to the medical community. In 2001, the Women’s Health Initiative (WHI) suggested that the risks associated with HRT use outweighed any benefits. The new evidence showed an increased risk for heart disease, breast cancer and strokes. When the trial was ended early many physicians were taking their patients off of HRT and giving them an antidepressant and or were told to use the herbal remedies for menopause.

As a health care provider the duty is to understand what each study is telling the medical community. The guidelines regarding hormone replacement therapy were driven by findings from a number of research studies such as the Nurses Health Study, a 20-year prospective cohort study of 120,000 women. It found that HRT use was associated with significant reductions in cardiac events as well as cardiovascular and total mortality. The more recent Women’s Health Initiative, a 5-year randomized trial with 16,000 women, found an increased incidence in cardiac events associated with HRT, although with no increase in either cardiovascular or total mortality. Why are the conclusions at variance? The truth is that the outcomes from both studies were largely correct. They were both right but differed principally in the timing when hormone replacement therapy was initiated. Women in the Nurses’ Health Study generally started HRT within 2 years of menopause, while those in the WHI did not start HRT until 10 years after menopause.

Estrogen has protective properties against cardiovascular disease in premenopausal women, and that the risk for atherosclerosis begins to rise as estrogen levels decline after menopause. Substantial evidence supports the use of hormone replacement therapy for primary prevention of atherosclerosis in women, but only if started during the early postmenopausal period and before the onset of atherosclerosis. Once atherosclerosis has already developed, however, HRT has no effect at reversing the process and may actually promote plaque destabilization and thrombosis. This largely explains the different outcomes from the Women’s Health Initiative compared to earlier studies.

What about an increase in cancer risk with hormone replacement therapy? The WHI consisted of two clinical arms. The first arm was the Hormone Replacement Therapy (HRT) trial, using premarin (an oral form of estrogen) and progestin (an oral form of synthetic progestin, known as medroxyprogesterone acetate). The Estrogen Replacement Therapy (ERT) trial made up the second arm, using only premarin. The HRT trial found 8 more cases of breast cancer but 6 fewer cases of colon cancer for every 10,000 women, compared to the control group. The women receiving only premarin in the ERT trial actually demonstrated a small, though not statistically significant, reduction in breast cancer cases, in addition to fewer cases of colon cancer. Several observational studies also found HRT to be associated with reduced mortality for colon cancer. The conclusion from this and previous studies is that the synthetic progestin used in the HRT trial of the WHI increases a woman’s risk for breast cancer. Synthetic progestin appears to be the culprit regarding breast cancer risk, not estrogen. It should be noted that the WHI found no increase in breast cancer deaths or total cancer deaths in either trial. Other recent trials, the NHANES and USC study, did not find any evidence of an increased risk for breast cancer.

Osteoporosis a progressive bone disease is a greater risk for menopausal women than breast cancer. One in six Caucasian women in the U.S. will fracture her hip, and this is greater than the risk of developing breast cancer or gynecological cancer. In Caucasian women 50 years and older, the lifetime risk of osteoporotic fractures approaches 40 percent and 33% of hip fracture patients die within one year of injury. Osteoporosis is responsible for almost 1 million vertebral and hip fractures annually. The Women’s Health Initiative demonstrated that hormone replacement therapy is associated with a 35% reduction of hip fractures.

Hormone replacement therapy has beneficial effects in conditions other than cardiovascular disease, cancer, and osteoporosis. Some studies have shown that HRT is associated with a reduction of cases of new-onset diabetes mellitus by as much as 35%, and a 60% reduction in recurrent urinary tract infections. Moreover, it reduces the risk for Alzheimer’s disease. In cell cultures, gender-specific bioidentical estrogen or testosterone supplementation appears to slow the accumulation of tau protein, neurofibrillary tangle, and amyloid in human neurons, reducing the potential for Alzheimer’s disease.

The Journal of Internal Medicine, 2004 published findings from a meta-analysis of 30 randomized controlled trials involving hormone replacement therapy. The report analyzed several notable trials, including the Women’s Health Initiative. The authors concluded that while the risks of initiating HRT in older women or in the presence of coronary heart disease may outweigh the benefits, HRT use was not associated with any change in mortality. Furthermore, the authors concluded that the benefits of HRT outweigh the risks if treatment is begun in younger women who do not have coronary heart disease or breast cancer. The report found that initiating HRT in younger postmenopausal women actually resulted in a 39% reduction in mortality.

American College of Gynecology guidelines for hormone replacement therapy have unfortunately confined its use to short-term symptom treatment only, using the lowest dose possible. A better understanding of the conflicting evidence suggests that hormone replacement therapy provides significant health benefits and disease protection for many women if begun early. The PEPI trial in 1990 with 875 postmenopausal women proved the safety and efficacy of natural micronized progesterone combined with estrogen for the best cardiovascular protection. Other health benefits from this trial were less weight gain with women taking hormones after menopause, an increase in the HDL (good cholesterol) and protection against endometrial cancer. Later studies with natural estradiol and natural micronized progresterone have shown protection against cardiovascular disease, osteoporosis, alzheimers disease, urogenital atrophy, colon cancer, endometrial cancer and hypercholoesterolemia. Also, it helps to prevent depression, fatigue, incontinence, weight gain and the loss of feminity.

We as health care providers are compelled to look at the evidence in the older studies with the evidence in newer studies that supports natural hormone replacement. We are the front line to educate women in hormone replacement so that they become a partner in their health decisions for long term disease prevention.
© Copyright 2010 Pyramid Preventative Medicine. All Rights Reserved

Most people have heard something about the controversy of menopausal women on hormone replacement therapy (HRT). You might have heard that it causes breast cancer. There is research that supports that. There is also research that refutes it. And there is also research which suggests that hormone replacement therapy has NO bad effects if you use the bio-identical hormones instead of synthetic hormones or “natural” hormones from animals. I really don’t know the ins and outs of the research and the science on all that. Here’s what I DO know:

With my condition the health risks are GREATER if I DON’T do HRT. So that’s kind of an easy, no-brainer decision to make. I need the hormones – without out them I am at greater risk for some not so nice conditions – like osteoperosis for example. And heart disease. With the hormones I will almost certainly avoid those conditions and research is, at best, inconclusive about the risks for women my age (those studies were all done on older women with a natural decline in hormones).

The other thing I know is that anything natural is likely preferable to anything synthetic if it’s going in my body. And I’d rather it be a human hormone than a horse hormone even if that’s also “natural” (as opposed to synthetic). Some people say that HRT is the devil even if you use bio-identical hormones. Others, like my cousin, claim that as long as you use bio-identical hormones and keep them in balance then there’s zero risk. Because the hormones are exactly the same your body would make if it still could. There’s a logic in that that I just can’t refute (although I’m not sure about continuing it until I’m 90). Unfortunately science was never my strongest subject and even if it had been the intricacies of how hormones work are quite complex. I just know that it seems logical to me to use bio-identical hormones if they are available.

And so I choose the Vivelle patch for my estrogen instead of Premarin or Prempo. Regular birth control pills are also an option for some women but I still have hot flashes while on BCPs so I need something more. If anyone is nervous about wearing a patch instead of taking a pill I can tell you that, for the most part, it’s super easy. Here are some drawbacks:
– It is a little annoying to remember to change it out every 3-4 days (a daily pill is more easily incorporated in to a schedule).
– Sometimes my skin gets a little irritated if use the same spot too often
In the 4 months I’ve used it it has never come off in the shower. It stays in place and mostly you don’t notice it’s there. It’s clear so it’s not that noticeable to others (it is summer after all and we’re all showing a bit more skin). Although I usually place it somewhere on my back so it’s hidden.

And I choose Prometrium instead of Provera for my progesterone. I think I need to get my doctor to adjust the dosage a bit. The pros and cons of Prometrium are the same for me: It knocks me out. I actually wait until I am in bed to take it because I am completely out within 15 minutes of swallowing that pill. It’s a pro that it helps me sleep (and it’s some GOOD sleep). But it’s a con that I can barely get up the next day. I think a lower dosage will help that.

There is also another benefit to using the bio-identical hormones. If I stop doing fertility treatments and go back on the bio-identical hormones I can still try for a natural pregnancy. The bio-identical hormones will not harm a fetus while the synthetic ones might. Obviously the odds of that happening are much lower and that’s exactly why I’m trying the treatments. But it’s nice to know that it could still happen naturally and none of the drugs would harm the baby.

UPDATE: I just found this link that has an excellent explanation of all the misinformation out there about Bioidentical hormones.
http://www.pyramidpreventativemedicine.com/education.html

I’m not sure if this information will remain at this url for long however so I’m going to also post the full text of it here: Controversies of Hormone Replacement Therapy.

Age Management Anyone?

June 14, 2010

So my cousin is a doctor and every so often he sort of “reinvents” himself by completing training/certification in some new area of medicine. And then he opens a new practice. This time he is opening a practice in Age Management Medicine and I built the website for the new practice. He wants me to be a patient. I’d essentially be paid for the website in services. Part of what he does with age management medicine is hormone replacement and balancing. And we all know my hormones could use some balancing.

The difference between what he would do and what my RE does is that he looks at ALL your hormones. Not just the reproductive ones. He’s of the opinion that I probably need some testosterone. Obviously he would confirm that with bloodwork before putting me on it. He’s super excited about all this. I’m taking it with a grain of salt. I’m willing to try it to some extent but only if it doesn’t interfere with trying to get me pregnant. Even if it doesn’t “fix” things, I’ll be healthier for doing it.

The four elements of his program are nutrition/diet, natural supplements, hormone replacement and exercise. Well… we all know we should exercise more (most of us need more anyway). And most of us could eat better. I’m already doing some HRT (even though I’m off it at the moment it’s something I need long term) so even if I don’t do all the hormones he would like I’m still doing some. And when I remember to take it I try to take Fish Oil. So I don’t think it’s a huge leap for me to step up the exercise, change the diet and try to remember to take the vitamins and supplements.

So… the diet begins today. I’ll post more on that later. For now I’ll just say it’s low-glycemic. And since I am currently not taking any medication, the bloodwork is tomorrow. My cousin also wants me to get a bone scan and a body fat scan (they’re done at the same time apparently). I was already planning on asking my doc for a bone scan since I’m high risk for osteoperosis. So again, trying this out is not a big leap from what I’m already doing.

It might seem odd for a 36 year old to be doing anything called “Age Management.” But my body, at least hormonally, is acting like it’s 50 so… there you go. I’ll likely be following up this post with several more about the individual elements in this program. I’ll definitely write more about the diet and I’ve been meaning to do a post about bio-identical or “natural” hormones anyway. I’m also going to tell my RE about it. I have no idea what her reaction will be. In short, I think it’s gonna be a busy week or two here on this blog.