The 'gentlemen' in my life...

This morning I was with the two kindest men I have ever met in my life. One is my dear hubby and the other is my doctor. My doctor was very happy that I ovulated on my own last cycle on metformin+dexamethasone combination without the help of clomid. Though we did not get pregnant he was very happy to see my body returning to a normal cycle. He smiled and wished us luck as always and told us not to be discouraged by anything :)

There has been no great news so far on our 'making miracle' journey but the journey has not been as bad as I had thought it would be. In my last post I wrote about our unlucky #1 clomid cycle. We crossed our fingers tight and proceeded with a #2 clomid cycle just before we started kidney stone treatment for my hubby. #2 clomid cycle was overwhelming for all three of us. Three of us here means me, my hubby and our Dr.Wizard. Dr.Wizard put me on the highest clomid dosage (150mg) and he said 'this is going to be the cycle!' The high dose, the hyper responsive follicles, my hubby's upcoming treatment and our unknown future really started hitting us when it was the time to do the 'deed'. We just managed to BD twice that cycle and we were not sure if it was going to help. I got my period when we were too busy treating my hubby's kidney stones. We decided to skip November because we did not have a well laid out plan about my hubby's treatment and his recovery.

Later things turned out quite different. God was very kind to help my hubby recover quickly from his treatment of kidney stones. So we thought why not give it a try and we did!
I ovulated around CD19 and we gave it a shot every alternate day around that time. I had initially thought that last month was going to be a 'break month' for both of us but when things started to turn out well, my 'dreams' became 'hopes' and I really thought 'hopes' were turning into 'reality'.

Well...life is not that simple especially for us. My temperatures dropped two days back and I got a BFN. I thought I was going to be devastated as my hopes were so high and I was pretty sure that I was going to have a big heartache. It’s amazing how our mind and body feels each day. Every day is different. I thought I would wake up as the most disheartened soul on this planet but somehow my mind embraced the disappointment. The two weeks between our period and ovulation plays a big role here...that’s one good amount of time when we can recover and gear up!

My hubby dropped me off at work after my appointment for baseline testing with Dr. Wizard. I said bye to S and he smiled and said he loves me. I will never forget that priceless moment and that moment will help me get through the next 30-35 days :)

No more tears...

'Hope' was what we believed in and that helped us wade through the last two weeks. We lost 'hope' yesterday when I got my period. For some reason I did not break down or cry though I was very hopeful this cycle. I hate that moment when I had to tell my dear hubby about my period. I could make out from his eyes how much disappointed he was...I feel so bad that am not able to gift him the baby of our dreams :(

Today is CD2 and we visited our RE for the regular baseline testing. It was not just two of us who were hopeful this cycle, our Dr. Wizard was very hopeful too. I could see he was a little disappointed but he tried hard not to show it. He is one of the best doctors I have ever come across. He was a gentleman when he said not to get depressed about what happened and gave us few words of encouragement which meant a lot to us at that moment. The doctor is going to put me on Clomid from CD3 to CD7 which should help me ovulate more this cycle. The idea of giving Clomid is because he wants me to produce multiple eggs to increase chances of pregnancy as one of tubes is blocked. He told me I could use ovulation predictor kits to see when I ovulate and then have intercourse. He is trying not to stress us with more appointments this cycle. So we will not have a post coital test and ultrasound around the time I ovulate. We are left to fish in the dark.

The hardest part is that we are left with just this cycle for the next few months as S has to undergo a surgery for his kidney stone. The surgery is very essential based on his recent scans and reports so we cannot push it for another time. It would take at least 2-3 months for him to heal completely before we can start trying again....which initially sounded disappointing to us as we had just cleared up few things on my hormonal imbalances and were trying with a perfect hormone environment. But giving it a second thought we feel that postponing the kidney stone surgery will only cause more problems and we do not want to get into an emergency situation. So we decided to have the surgery in the first week of November. That gives us one last cycle (at least for the time being) to try....

I will be turning 29 this month. 30 does not sound too nice especially when it comes to fertility....I am trying not to get too stressed thinking about that.

Life goes on....another month, another cycle.....but no tears this time.

The Wait

I am now in the so-called popularly known '2ww' or 'two week wait'. Women who are actively trying to conceive refer to the '2ww' period as one of the most dragging time in their cycle and the most killing. Same goes with me too...I have been trying all possible ways to keep myself busy but my mind always goes back to the same old questions I have during my 2ww.

Will we get lucky this time?

Will I end up having another ectopic?

Will AF show up as it has always been :(

If something happens would everything go normal?

The questions never end.....

Today is 9DPO (9 days past ovulation). I have at least 5 to 6 more days to go until I know. Trying not to think about symptoms...because I don’t have any symptoms as of now except the usual side effects of progesterone. The progesterone level is 80 ng/ml which is high but it is because of the multiple follicles I had in this cycle progesterone. I was thinking not to blog during my 2ww but couldn’t help write my thoughts....

Only time can answer me...never losing hope!

A pause

Today I complete a year of charting my temperatures. I got so used to it sometimes becoming too obsessive about it. I did not chart my temperatures regularly this cycle because I just wanted a break! Moreover our doctor was going to plan out the cycle for us based on my ultrasounds.

This is my first cycle on 3 medications - Metformin 1000mg (lowers insulin levels/helping to reduce miscarriage/aids better quality eggs), Dexamethasone 0.25 mg (lowers DHEAS levels/testosterone levels), Clomid 100mg (stimulates ovulation/more quantity of eggs (CD6-10)) and my pre natal vitamins. Basically this is my #1 Clomid cycle.

Will my body just do the magic this time? 

So, we met our Dr. Wizard and he noticed that there are 3 potential candidates for ovulation. Once the follicle size is greater than 10 mm it has a potential to ovulate. On my ultrasound I had two follicles on the right (hopefully good) side - one measuring 14 mm and the other 12 mm. And I have a 16 mm follicle on my left side which has a blocked tube. This is what I understood after speaking to the doctor. Once LH surges, if the follicles have reached a size of 18 mm+, all of them will ovulate. Sometimes only one or two might end up reaching that size. I pray that in this case at least one of my right follicles ovulate. Is that too much to ask given the weird but amazing intricacies of the nature and human body?

Well...we will know what ends up happening...it’s going to be a wait of 2+ weeks....not sure if I will blog during that time but will certainly come back after the wait…

The plight

Me and my husband began seeing this super doctor…our RE (I call him Dr. Wizard) from last June and he has been trying to help us conceive soon. My two big problems are history of ectopic pregnancy and high androgens. This super doc with the help of another super doc figured out the reason for my high androgens.

A mild 21-hydroxylase deficiency which inhibits my adrenal gland from functioning normally

A normal adrenal gland would receive messages from pituitary to produce Cortisol. The production of Cortisol is a three step process in the adrenal gland and a lot enzymes help in the conversion. One such enzyme is the 21-hydroxylase enzyme which helps conversion in the third stage.

I have a mild case of Non-Classical Adrenal Hyperplasia which means, the 21-hydroxylase enzyme is a little deficient in my body. Hence the adrenal gland is not able to perform its conversion effectively. Due to this mild enzyme deficiency, my adrenal gland ends up producing high amounts of by-products which is DHEA.

DHEAS is good for our body but only if it is within the normal range.

For a women of my age the DHEAS levels should 65 - 380 µg/dL but my DHEAS level is 574 µg/dL. High levels of DHEAS could disrupt ovulation and cause miscarriages as well. So the wizards of Oz decided to put me on a low dose of steriod called dexamethasone which reduces the ACTH output of pituitary gland hence the adrenal receives less ACTH and produces less cortisol and lesser by products which is DHEAS.

After I was put on dexamethasone my DHEAS levels came down to 96 µg/dL. I was elated!!

Now my super doc Dr.Wizard is not sure as to whether he should let my body ovulate by itself this cycle or give me clomid (a magic pill that helps in inducing ovulation). He has asked me to come in for the routine tests tomorrow to help him decide that. Tomorrow will be our 9th appointment with the doctor. We are tired. Many baby making couples would think that this is nothing but personally everyone's case is unique and you do feel the pain anywhere in the process.

My strength is my wonderful husband and my family. It keeps me going and getting through the day. When I told my husband this morning about our appointment tomorrow, he just said we will go if the doctor wants to see us. That gave me immense strength today! His words does magic to me! and keeps me going for days.

My husband and our parents don’t deserve this pains tricking journey and all I wish for is lot of happiness for them. I really hope God listens.....

Self realization leading to a 'better' me

It’s been a while since I updated this blog. We (me and S) went to visit my in-laws and sister-in-law. It was a good change for me from all this medical follow-up and reading. My doctors were away as well on vacation so there was nothing much to follow-up and take action. As I mentioned in my last post, we are trying to figure out with the help of our RE (reproductive endocrinologist) what is preventing us from conceiving. We now know the reasons -

Reason 1 being my history of ectopic pregnancy which resulted in occlusion (complete closure) of my left tube after it healed from the surgery. As said by many doctors, it takes a year for a normal couple to conceive if they plan their intercourse around ovulation. For a woman with one tube it takes double the time. So if we plan to have intercourse around the time of my ovulation, we would end up taking 2 years to conceive due to the fact that ovaries take random turns to ovulate every cycle.

Reason 2 is PCOS (primarily high androgens circulating in my blood). Here is a little history on PCOS and its repercussions on me.

My menarche began around the age of 13 and I used to have regular periods for a very long time until I reached the reproductive age (23 years). Around that time I started gaining due to sedentary lifestyle - I blame my ignorance of healthy diet and exercise and I regret for not being conscious about that. So here is what happened... I started my job when I was 22-23 and from then on I had a sedentary lifestyle with a high carbohydrate diet. That was slowly feeding my body more fat over a period of time. I used to weigh around 48kgs when I was 22 and by the time I was 25-26 I weighed almost 60 kgs...which may not sound too bad but for my Lilliput height (5 feet 1 inch)…my ideal weight is 50-55 kgs. Slowly my periods started becoming irregular and whenever I missed my period I was put on a progesterone supplement (meprate) to bring on withdrawal bleeding (period without ovulation). Why should increase in weight affect ovulation for certain women. The reason is metabolism...every human being has a unique metabolism. Some people process refined carbohydrates like rice and potatoes easily and for some others it’s not an easy task. It’s just the way the body is built.

I was having an unhealthy diet of excess carbohydrates (primarily rice) and less proteins and vitamins. Whenever I eat refined carbs the body produces insulin to convert the carbs into glucose. As I was taking excess carbs, my body continued to produce excess insulin to convert the carbs into glucose. At one point my body just continued to produce excess insulin irrespective of me taking high or less carbs. So the insulin leves in my blood increased. Anything is excess will not do its function properly. The higher insulin levels does not mean that the carbs will be processed quickly, though insulin levels are higher the functionality of insulin decreases. An optimal level of insulin is necessary to convert carbs into glucose.

The net is result is that my blood has high circulating insulin and it is not doing its job. The carbs then get converted to fat instead of glucose, hence I will feel tired and lethargic and will gain weight.

A woman's ovaries do not react well to high circulating insulin. The ovaries will fail to ovulate in the presence of high insulin. The failure of ovulation causes cysts on ovaries (immature follicles with fluid). Presence of such cysts will increase the circulating androgens in the blood. High androgens aid the body to accumulate more fat. Everything is now tied in a circle as shown below.

And the only way to get out of this circle is to start following a healthy whole grain diet (with less refined carbs) and exercise every day. I did not realize this until I was 27.

Here is the story of a 'better me' - When I was diagnosed with PCOS I was put on birth control pills to suppress my ovulation and resume my cycles. However that worsened my PCOS symptoms and increased weight gain and acne. That’s when I started reading about PCOS and decided to start a healthy diet with exercise.

I followed a strict diet of very less refined carbs (rice, potato and pasta), ate more fruits, vegetables and whole grains. I also followed a strict exercise routine. In about 3-4 months I lost 8 kgs (18 lbs). The weight loss and exercise paid off very well...it brought my cycles back and I was the happiest. The diet, exercise, weight loss helped me get pregnant as well but unfortunately it ended up being an ectopic pregnancy.

So now we know that I have PCOS and history of ectopic pregnancy. I have not deviated much from my diet and exercise though I have been tardy at times (which I wish I was not). Now I do have regular cycles and I do ovulate regularly on my own. So what is stopping me other than my blocked left tube?

That’s where I understood the role of hormones and how they govern you and your life. An area left unexplored was my high levels of androgens (originating from my adrenal gland) in blood which indirectly affects ovulation and the quality of eggs.

No consensus yet...

I am still left in the dark about my current cycle. I gave my blood tests on Monday (Aug 8) and I hope to get a call from my RE tomorrow or day after. From my daily temperatures I know that I have not ovulated yet. I stopped charting as am not too enthusiastic to do it but I do take my temperatures every morning just to know what is happening.

I was writing up my history and here is a small excerpt.

2008 - Diagnosed pcos

2009 - Changed diet, lifestyle. Exercised. Reduced weight (~8-9 kgs)

2010 - got pregnant first time trying - unfortunately ectopic (left tube).

          salpingostomy, saved left tube but tube occluded due to scarring after surgery

2011 - consulted RE, did complete blood work, put on Metformin

          High DHEAS trying to conceive again. Might have NCAH (Non-classical Adrenal Hyperplasia due to mild  enzyme deficiency)

I am currently in that 'Might have NCAH' stage where I am awaiting my fasting blood results to confirm. So now, I need to keep looking at the hour glass now until I get a call from my doctors.

The days when you feel helpless

It was one of mornings I really dread waking up to. My alarm went off at 5.45 am and as it would happen every morning I switched it off and went back to my short deep sleep. Then it just crossed my mind that I need to stick that thermometer in my mouth to find out what was really happening in my body's "hormone matrix". I put the thermometer under my tongue around 6 AM and I dreaded seeing my BBT drop. Though I hate to see that, I had to face it. My temperature had dropped from 97.2 to 97.0. That was not a good sign. I lost my sleep and woke up to start another day of "facing the unknown".

Just to give you an idea of why am talking about BBT here. BBT stands for basal body temperature. It is the lowest temperature attained by the body during rest (usually during sleep). It is usually taken first thing in the morning or after an undistrubed 3 hour sleep before any physical activity using a BBT thermometer. BBT thermometers measures to the 1/100th degree. Some genius found that there is a link between hormones and BBT. Talking about hormones these are the basics any woman should know:

A woman's menstrual cycle has two phases - follicular (pre-ovulatory) phase and luteal (post-ovulatory) phase.

Follicular phase begins when your period starts and ends when you ovulate. Luteal phase begins after you ovulate and lasts until your period begins. Follicular phase could be anywhere between 14-25 days depending on your hormones.

Luteal phase is normally 14-16 days for most women unless you have a luteal phase defect (we will talk about that later).

So how does hormones affect the basal body temperature (BBT)?

This is the rule you need to remember - Follicular (pre-ovulatory) phase is governed by estrogens which keeps the basal body temperature lower. Luteal (post-ovulatory) phase is governed by progesterone which increase the basal body temperature. If you want to know whether you have ovulated or not, your best bet is to use a basal body temperature or monitor your follicles everyday through ultrasound. The latter method is expensive unless you have an ultrasound machine at home which no one does! The temperature monitoring method is simple, easier and inexpensive. It just require your diligence to monitor your BBT everyday. Do not use a fever thermometer for this purpose. All pharmacies sell basal body thermometers and that is what you need to buy.

Couple of months back, around September 2010, I had this question in my mind that how do I find whether I ovulate. When I was reading about methods to detect ovulation I came across the BBT method. I found that reliable and inexpensive compared to ovulation predictor kits (OPKs). I have been sticking the thermometer in my mouth everyday since October 2010 and its going to be a year now. I am still waiting for that break to this routine....

Now back to monitoring temperatures. All you need to do is:

1. Get a basal body thermometer

2. First thing in the morning when you wake up - put the thermometer in your mouth and when it beeps note the reading

3. Step out of your bed (clean your thermometer on a regular basis)

Here is one of my charts that shows how to monitor your temperature on a daily basis.

As you can see my temperatures remained below 97.5 F until I ovulated and when I ovulated it rose by 0.3 F. During my post ovulatory phase my temperatures remained above 97.5 F until I got my period.

97.5 F is my coverline for this cycle.

What is a coverline temperature?

Coverline is the highest of the last six temperatures before ovulation. You cannot determine your coverline temperature just by charting one cycle. From my experience you need to chart at least 2 cycles to determine your coverline temperature.

Two principles you need to remember while charting temperatures:

1. Basal body temperature increases after ovulation. You cannot determine pending ovulation based on the temperature. Your BBT will only show that you HAVE ALREADY OVULATED.

2. Do not come to conclusions based on your temperature everyday. You need to sit back and see if there is a pattern with a clear thermal (temperature) shift. That will indicate you have ovulated.

We might think whats the use knowing that you have ovulated when you want to know beforehand. But at least its a good indication of what your body is going through. A typical annovulatory cycle will not have a thermal shift and the chart will not follow a pattern.

This cycle I have not seen a pattern yet in my chart. I am still in my follicular phase trying to ovulate but something is stopping me. Here is my chart from this cycle.

I just spoke to my RE and they asked me to come in on Monday to do a blood progesterone. That will show them if I have ovulated or not. Doctors do not just go with temperature charts, they have more techniques to determine ovulation. My RE will review my blood results on Monday and we will talk about our next action plan.

If any of you want to chart your temperature or read more about charting temperatures you can log on http://www.tcoyf.com/. I have been charting my temperatures on this website and I find it very useful. You might want to read the Toni Weschler's book - 'Taking charge of your Fertility' which is amazing and has tons of information on what you need to know about your cycle.

My goal for this weekend is to put all this aside and enjoy my two days with my beloved hubby. He is going through a lot of this with me and I just want to see him happy :)

My first post

This is my first blog. I start this blog not really sure why I'm doing so. Part of me just wants a place to vent, part of me wonders if reading about my experience might be helpful to others, part of me is so thankful to have read the accounts of other bloggers going through the journey of trying to conceive, (And a part of me who really doesn't want to jinx herself is thinking that there might be a little one who might want to read about this someday.) So there you go..

I am 28 and am married to the most adorable man I could ever meet. He is the love of my life. I have been married to him since 2008 and we are going to have our 4th year wedding anniversary in few months. 28 doesn't sound too old..but the past few weeks have made me feel old. And the reason is..we are trying to have the baby of our dreams and we keep stumbling upon hurdles that does not let us have one!

This is my second cycle after we consulted an RE (reproductive endocrinologist) and I have not ovulated yet though am on CD22 (calendar day 22). Well, I am coming to this conclusion of 'not ovulating' based on my BBT (basal body temperature) and it might not be true (I wish!). One cannot determine anything based on the BBT on a particular day. You can draw conclusions only based on the bigger picture or the temperature pattern over a couple of days. I just wish that my BBT goes up tomorrow morning making today's a false one. This is the reason am writing this blog. We go through this journey of (in)fertility taking it one day at a time and I want to share this so that someone would benefit when they read what we are going through. Part of my solace is such blogs or forums about people who go through such journeys and end up with cute little babies. Reading those has given me so much reassurance and confidence to get through my day and sleepless nights.

Coming back to temperatures...I still kind of believe in taking a BBT everyday just to know where I stand in my cycle. My coverline is usually at 97.4 or 97.5. I thought I did ovulate two days back and my BBT had risen for the past two days but to my bad luck I am back again at 97.2 today which doesn't show me a good sign.Its not a long wait, I will know tomorrow morning and I can then decide if I need to talk to my RE about this "screwed" cycle. Meanwhile I have all these questions going through my mind...what did I do different this cycle except for taking "Metformin" which is supposed to help one ovulate. I wish ultrasound machines were cheap so that I could buy and keep one at home!