Wednesday, February 23, 2011

my ttc story

flanked by dr. 19-weeks and dr. 28-weeks in grand rounds yesterday [i love them both, but yeesh], i thought about how much it has helped me in recent weeks to share my story with others. when i have a problem or receive bad news, my go-to coping mechanism is almost always to talk about it with someone -- or many someones -- rehashing things and telling my story again and again until it starts to sound normal and okay.

i guess that's one of the reasons that this whole blogging thing has worked out.

but it actually took me well over a year before i felt comfortable opening up about my (unmet) desire for a baby. here, i declared that i wanted to be pregnant by the end of 2010 (umm, great achievable goal, SHU); here i start to discuss the possible contribution of running to my infertility and in this post i am a bit clearer in relating things from the beginning.

however, i do not have a post where everything is clearly laid out. instead, it's all in bits and pieces, with mysterious acronyms and vague allusions. this is because in the earlier stages, i still had some denial/doubt/shame/guilt surrounding the issue, and i just didn't feel ready to share. but now i'm over that; i'd probably tell the UPS guy if he asked nicely!

since i know there are some of you who may be going through similar experiences, i thought it would be useful to write a post where i just lay it all out there. (and let's face it -- it's also therapeutic for me. win/win!)

first: a glossary
have you ever read a blog about someone trying to have a baby only to have your eyes gloss over from all of the weird terminology and acronyms? (i did! and i thought after med school i knew every acronym that had ever existed!)

TTC: trying to conceive

BBT: basal body temperature (referring to charting that is done to help predict ovulation)

BFP/BFN: i hate these acronyms, but they stand for 'big fat positive' and 'big fat negative' respectively. or, you can insert your favorite colorful "F" word, which seems reasonable in either case to me.

a BFP! but definitely not my BFP

O: ovulate. get your minds out of the gutter.

DPO: days post ovulation.

OPK: ovulation predictor kit = urine test strips that sense LH, which surges 36 hours prior to ovulation. this can be used in conjunction with BBT to predict the most fertile days of the cycle.

HSG: test in which they put a scope into your uterus, squirt dye in there, and watch to see a) filling of the uterus (to check for any defects in the wall, like polyps) and b) spilling of dye through the tubes into the peritoneum (to make sure they are patent and go where they are supposed to). i got to experience this yesterday, and for me, this test was extremely painful. put it off if you can!!

EWCM: yep, there is an acronym for this sign of a fertile cervix!

RE: reproductive endocrinologist (ie, OB/GYN who does an additional fellowship specializing in infertility)

my story
no, i will not be discussing anything related to my own CM ("EWCM" or otherwise) -- that's just crossing the line. but most of the rest is fair game. i think that a chronological organization makes the most sense here, so here goes:

january 2009: josh and i feel ready (we think) for a baby, and i had wanted to take advantage of a special 'newborn month' built into the pediatrics fellowship -- a whole extra 4 weeks at home, mostly with the baby, added onto maternity leave! sounded like a great plan to me! so i stopped my seasonale. i had been on OCPs of some kind at that point for ~7 years.

march 2009: huh, no period. interestingly, i noted that i lost a few pounds unintentionally when i stopped taking the hormones. i have to admit i considered this a bonus [for reference, my BMI went from around 20 --> around 19; i was never underweight]. i was running 30ish miles/week, training (casually) for the upcoming charlottesville half. my 2nd niece ellie was born, and i remember thinking about how excited i was for the day we would have our own baby to hold.

may 2009: huh, still no period. well, maybe it's not SUCH a bad thing -- after all, i get to drink as much champagne as i please on our napa/sonoma vacation!

june 2009: hmm, it's 6th months post pill, and still no period. i decide to see an OB/GYN to see what might be causing my post-pill amenorrhea. i get my first ultrasound, and my ovaries look like this. i remember crying on the table.

july 2009: referred by the OB, i report to the duke fertility center for an evaluation. i have a number of labs drawn, ruling out 'easy' fixes: thyroid, prolactin, even nonclassical CAH -- all normal. my LH and FSH are normal (6.9 and 7.1, respectively), my estradiol on the low side, and my fasting glucose and insulin 70 and 1.7 (superlow!) respectively. my testosterone level was normal for a female. i remember having these labs drawn at the end of a 30-hour shift, stumbling to the clinic having fasted for 14+ hours.

discussing the results with the RE, she is reluctant to put me in any sort of neat category, but states that with my ultrasound findings and amenorrhea, she would treat me like a patient with lean PCOS. she gave me a course of provera to induce a cycle, and . . . it worked! the plan was to begin clomid soon.

december 2009: PR marathon! but because both josh and i were starting to get nervous about what would happen with his career (there was a period when we didn't know if he would be able to find a local fellowship), i decided not to start right away on the clomid. (after the withdrawal to provera, i was still cycle-less.) by this point, i did start to wonder whether my mileage/lifestyle was contributing to the problem. i hoped that everything would sort itself out after the marathon, though i planned to continue running ~30 miles/week. (after all, the RE would have told me to stop if she thought it was a problem, right?)

january 2010: niece maelie (#3) is born. i am excited but i have to admit there were pangs of envy, too. i had started TTC before she was conceived, and now she was here.

april 2010: we find out that josh will be going to duke for his vascular fellowship! still no period. i am (almost) ready to start the clomid, although i am nervous about the possibility of twins.

june 2010: we get genetic counseling. because we both have ashkenazi judaism in our genetic pedigrees, combining of our DNA means there is risk for a number of recessive conditions, none of them good. luckily, i tested 100% clean (so josh didn't even need to have his blood drawn).

september 2010: i begin adjusting to life in fellowship and i finally get my act together, starting my first cycle of clomid at the lowest dose. according to the mid-cycle ultrasound, i respond to this beautifully. i am not sure whether to be thrilled or crushed when my cycle arrives right on schedule 30 days later.

oct - december 2010: the RE increases my dose, hoping to stimulate even more follicles to reach the finish line. however, each cycle is a failure. i never got the follicular growth that would have been expected, and a blood test confirmed LACK of ovulation in cycle #3. at this point, josh laid down the gauntlet and after reading papers like this one he basically decided that i needed to essentially stop running. he also felt i should gain some weight. i did not like either of these ideas one bit.

december 2010: i finally agree to cut my mileage -- drastically -- while working on my nutrition. i wrote about it a bit in this post -- talk about an unusual resolution! i also saw an RD for the first time, and she really encouraged me to work on bringing my body fat up a little.

january 2010 - february 2010: i have two 'successful' cycles on the highest dose of clomid. 'successful' here means that my ovaries responded well. each time, i was prescribed injectible HCG to help precisely time ovulation. however, neither cycle ended in a BFP. i am sure the effects of the medication on my mood probably are not helping, but each time i was hit pretty hard.

meanwhile: i am still running only 11ish miles/week, supplementing with (a fair amount of) yoga and weight training. admittedly, i've even added in a bit of elliptical on the days that i do lift weights. with these changes, i have gained probably around 5 lbs in just 2 months, bringing me up to a BMI near 21. this does not sound huge, but it was FAST, and this is bigger than i have ever been in my life. as i mentioned before, my clothes are not working so well for me right now and i have to admit i am pretty uncomfortable with the changes. even the RD agrees that it would be fine for me to shift my focus to stabilizing at this size. [translation: no more coconut milk ice cream 'just because i can'! and i have to say i'm oddly relieved by this.]

to be continued: i am on an unmedicated cycle right now, which will be an interesting physiology experiment for me, as it will be the first time i get to see what my (less athletic) body does WITHOUT an extra push from hormones. i am not sure what the next step is going to be after this, but will find out at my next RE appointment in march. i am still working on taking this whole thing more in stride, capitalizing on the time and freedom we have right now. but in truth, i'm still really, really hoping for a BFP.

and i'll keep you all posted! although i will say that when it does finally happen for us, i am not sure when i will reveal it in this forum. part of my feels like, "well, if i can share all of THESE details, what's the difference?"; however, others have urged me to keep things quiet for the first 10-12 weeks. i think i will leave it up to josh -- after all, at that point, the story will be ours, not just mine.

if you're still reading,
thank you! and another special thank you to those of you who have written in to share your own TTC stories -- it always feels good to know that i am not alone in a lot of this. as always, please feel free to comment, or to email me if you have any questions or suggestions!



workout: 30 minutes elliptical, levels 9 - 11 + weights (NROL4W phase 1, workout A, week 3):
-- 2 x 12 squats (bar + 20 lbs, up from 15)
-- 2 x 12 pushups (regular pushups)
-- 2 x 12 seated rows (50 lbs, up from 45)
-- 2 x 12 each leg - step-ups (high bench, holding 10 lbs total)
-- 2 x 10 jack-knife crunches on ball

tv dinner: for the first time in years, josh and i enjoyed dinner while watching TV (come on, glee was on!!)

this real simple recipe was a step up from your standard tv dinner.

roasted tomatoes, swiss chard, raisins, and chickpeas with brown rice

(i added that little bit of goat cheese for good measure and it worked!) i won't say this was the most exciting dish i've ever had but it was easy and healthy.