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.