Some birthday gift

So I got the date for the vial used in IUI # 2, where my second pregnancy ended because of a chromosomal number defect, *maybe* because of crappy swimmers, and not any issue with me.

That vial, which may have been so very ill fated, was collected on my birthday. Of all the 365 days in the year, my birthday. I do have vials from other dates, but ironically, the one collected on that day has the highest counts.

So the date weirdness continues---the first bit was where the astrologer predicted that it was safe for me to get pregnant only after a particular date. That date was the day my baby's heart stopped beating, one year before.

My brother argues that its just random probability, you can ALWAYS find make some connection between 2 random things. One part of me knows exactly what he is talking about and tends to agree with him, that I should make absolutely nothing of it, but the more fanciful part of me just can't let it go. Which feeling would you predominantly go with, were you in my shoes?

Need advice (post on male aneuploidy)

I'm about 2 months (maybe) from my next IUI and soon, I'll have to make arrangements to ship my donors swimmers over to my new clinic. That brings me to an question that has been brewing in my head for almost a year now.

My second pregnancy loss was because my child had Turners Syndrome, she had only one X chromosome but lacked the other (either X or Y) which determined gender. Whether it was the egg that came without an X chromosome, or a sperm without an X (or Y) chromosome haunts me.

The genetics counselor I met with told me that in Turner's syndrome, 70 % of the time,  its the sperm that turns out to be the culprit. Still you can't say. There are times I kick myself that I did not pursue this question further, I had the means, I could have probably sequenced my DNA and the baby's DNA, that might have provided the answer.

Give that in a healthy, fertile male, only 2 % of sperm have numerical chromosomal errors, if it had been a defective sperm, you can say it was either random, colossally bad luck, or the universe really, really did not want me to have a baby at that point.

What worries me is: what if it was from a bad day, where the frequency of chromosomal errors was higher that average? This fear is kind of baseless-- studies have compared aneuploidy rates in men with male infertility (which my donor has absolutely no risk of suffering from, he seems to be really good in this department)--- aneuploidy rates are about 18-24 % in men with different kinds of male infertility and 2 % in normal controls.

So though there is not much basis for it, I'm wondering whether I should check that all my donors vials are from the same day, and if possible, use a different day's lot, though a) this might require a lot of digging and b) might even mean added expense. Rationally, I know there is no real need for this, but the niggling fear remains. What would you do?

We know nothing and can control nothing-- the question is- to what degree do you make peace with that...or...how far do you go to try to control the uncontrollable?

Vitamin D and melanoma

In response to my last post, both Jem and Oak asked the very relevant question about how one treads the fine line between getting Vitamin D from the natural source (the sun) when you are at risk for melanoma.

I think the first question one should ask is, do I have an elevated melanoma risk?  I should add, from those discussed in the link, the strongest is a family history of melanoma.. If you do have elevated risk, then yes, you should be very careful and avoid the sun. I would look into what is IN the sunscreen you use though-quite a few products are filled with carcinogenic crap. I highly recommend using the cosmetic database to see which brands are safest.

Also, another interesting thing - a lot of studies show that a Vitamin D deficiency seems to provide higher risk for multiple cancers, including melanoma.So its kind of a vicious cycle if you think about it. IMO, it provides a great explanation for why the melanoma risk is surprisingly high in the black population.

People with melanoma risk factors should be definitely advised to minimize their UV exposure and get their vitamin D through supplements.

However, I don't think advocating it for the entire population, on a constant basis, is that great an idea. If you are going to spend 5 hours on the beach, yeah, sunscreen is a good idea, but all the time you step out? Let me put it this way, everybody needs vitamin D, but only a subset of the population is at increased risk for melanoma.

But I digress--my post was not an advocation of going sunscreen-free as it was an essay on how such a large proportion of the population has come to be Vitamin D-deficient and the many, many dangers of it.  A Vitamin D-deficient mother is herself at risk for pregnancy complications, postpartum depression etc, and her child is at an increased risk for autism,schizophrenia, depression, cognitive disadvantages, diabetes, autoimmune disease, fibromyalgia, various cancers---its freaking scary!!!!

The moral of the story really was, it is very hard to get enough vitamin D from sun exposure in our modern day lifestyle---so check your D levels and supplement if you have to. Although I advocate trying to spend more time in the sun if you do not have melanoma risk (mostly because its what mother nature wanted us to do and our constant deviation from her set plan sometimes ends up being really bad), its amazing how many people who actually get a decent amount of time in the sun ARE deficient and end up supplementing. For many of us, there is no way out, and so far, nobody has been able to come up with any data showing taking  around  2000-4000 IU Vit D daily may be bad for you.

Vitamin D- Its not just about fertility : Part I

Nothing fascinates me more than the workings of the human body. How it evolved to be what it is today is mindboggling. Nature is pretty darned amazing in utilization of resources- while designing an intricate system, you need multitasking. Vitamin D (which is a hormone, not a vitamin) is the ultimate multitasker. Its receptor is almost universally expressed on every tissue in the body. It is strongly involved in regulation of the immune system, the brain, the kidneys, your thyroid gland, bone development, your metabolic pathways, the list is endless.

When you look at evolution, you realize nothing ever happens without a purpose. Nature plugged vitamin D as an important regulator/processor into so many pathways, she also realized you need a good system to make it, wherein you would not be dependent on external sources for it.  So it came about that every time you go into the sun, you made vitamin D.

Vitamin D is also one of the two things (the other is folate) that has probably governed the evolution of skin color. Life probably originated in Africa, and the intense levels of sunlight there destroyed folate (so tanning beds are a bad idea during pregnancy:)). So dark skin evolved, to protect folate. Although this acted as a barrier in the production of Vitamin D, the ample sunlight there created a harmonious balance. When people migrated to colder climates, with weak sunlight and long months of winter, they were making far too little of an important metabolite. This was probably the driving force behind evolution of light skin.

But we started to change. Not only we migrate far away from the places that we were designed for, but we started wearing clothes. That did not cause that much damage IMO, still because 200 year ago, people were still spending plenty of time outside, they walked places or they rode on horseback in good weather, they got out a lot because they did not have so much to do indoors.

In the past 30-40 years, our bad habits have really piled up. We've also let go of some of the old ways of life. In India, a common practice would be to give babies an oil massage and then let them sleep in the sun, fully naked,  for a little while. I asked my mom about this the other day, probably nobody in the cities, with our new lifestyles, does it anymore. We built big buildings with far too few windows where we spend the day, we invented cars so you spend very little time outdoors getting from point A to point B, we invented video games that kids stay indoors playing all day, and probably the worst offence, we started using sunblock by the bucketload, which almost totally blocks vitamin D production. We are literally, in the worst cases, almost completely shutting down our Vitamin D3 supply route. We did start supplying it in our diet, but the amounts were not high enough.

We messed with what nature intended. And what the research shows is, some of us have been paying for it in ways we are just starting to understand. Vitamin D deficiency is linked to Type I diabetes, Type II diabetes, rheumatoid arthritis, other autoimmune disorders, thyroid disorders, bone deformities, fibromyalgia, depression, chronic pain syndromes, autism (!!!), PCOS, obesity--the list goes on and on and on.

Importantly, other than a lack of time spent in the sun, the two other big risk factors for vitamin D3 deficiency is dark skin and obesity- this website talks about the latter.

I'm going to post a comprehensive list of what diseases its involved in a while- but in the meantime, it is bloody important to be vitamin D3 replete during pregnancy. This website does a good job talking about it.


http://www.vitamindcouncil.org/news-archive/2009/pregnancy-and-gestational-vitamin-d-deficiency/

I totally believe the theory proposed herein of a maternal vitamin D3 deficiency 'imprinting' the baby so he/she has a much higher risk for other diseases later in life. Please spread the word- post it to Stirrup Queens, talk about it on facebook, tweet it, whatever. We don't know what the end result will be of any woman being Vitamin D3 deficient during pregnancy (a lot of times, the effect is probably minor), but if you can prevent even one child from developing asthma, schizophrenia, diabetes or autism later in life, its worth it.

The day before Thanksgiving

I've told the story of an astrologer's spooky prediction before, but have to recount it again here.My parents, being pretty darned eager to get me hitched, and being Indian, have consulted with multiple astrologers about my matrimonial prospects. I usually wave whatever they say away, but one person did get my attention. He said its a good thing I have not been married yet, because until November 23rd of this year, I should not get pregnant, because if I do, there is a strong chance either I will die, or my baby will die. Afterwards apparently, is smooth sailing.

Although I've known about this prediction for months, but the significance of the date hit me today. On November 24th 2010, the day before thanksgiving last year,  I discovered my baby no longer had a heartbeat.  And now, on the day before thanksgiving, one year later, I get the celestial green light to attempt conception again? Of all the bloody days in the calendar, the astrologer names this one momentous date. This makes me clutch my head...what DOES it mean?!?!!?

Cosmic weirdness aside, I should also be thankful. I went though a lot of crap last year. My first pregnancy loss had me lost and groping. I was fixated on making this process work and I'd forgotten how to live life, long before that loss. I'd have thought a second blow would have toppled me completely. Instead, that second loss reset me, it made me stronger.  I've written a post before about how the only way I could cope was the hope that something good would come out of the bad that had happened with me. In a way that still amazes me, positive things have happened, only because my second child did not make it.  I discovered my Vitamin D deficiency only after that miscarriage. If I had stayed pregnant, I don't think it would have come to light, and it strikes me that I was at risk for a number of  pregnancy complications in that state.  Lets just say that far worse scenarios could have unfolded.

A lot of women have come by my blog and have discovered that they too had the same issue. Some of them have had (or are going towards) their happy endings. I don't think anybody can say whether their correcting their deficiency was the cause, but it remains a probability. If that is so, then its kind of amazing and emphasizes the point that even an event that appears wholly negative, may indeed not be so. There is a lot to be said for that butterfly effect.

I also got a cat this year. She is over 5 years old and I rescued her from the ASPCA. I do not know whether she would have found a good home, but she looked pretty wretched when I got her. Now, she is happy and fat and whole, and I'm just so glad I did it. If I had had a baby, there is no way I'd have got her.

We cannot control what happens. All we can do its try to find some comfort in our new reality, and I'm happy to say I'm finding plenty in mine today.  One year ago today, I was a horrified, confused mess. Today, I'm happy, healed and ready for whatever life brings.  I'm very thankful.

Investigating miscarriage

This is a response to another comment left on my 'Science of Infertility' page

Hi, my husband and I have been ttc for almost 2 years. I've had 2 m/c in the past year and am desperate to figure out why...my bloodwork came back normal and now i'm scheduled to have an hsg test in the next week or 2. I had to beg my gynecologist to put an order through for my Vitamin D levels. Finally she did and they are low (18L). Do you think this could be why I've been miscarrying? Should I still do the HSG testing?? Thanks for any help/advice! 

This is an impossible question to concretely answer. Most doctors would shrug and say, who knows? Me, I try to wildly speculate. But you need an incredibly detailed medical history to speculate and I do not have it for the commenter.

I can only offer my first miscarriage (the one that is still a complete mystery) try to speculate if vitamin D had a contributing roles.

This is a basic checklist one goes through, of examining risk factors for pregnancy loss. All issues were not tested, the full RPL panel covers more ground.

1) Was the embryo chromosomally normal? --Yes (no issue of mixup as was male)
2) Was there a structural uterine abnormality (determined by Ultrasound/hysteroscopy. I'm not sure if an HSG can contribute) -- No
3) Was diminished ovarian reserve a contributing factor miscarriage risk -- No, lots of eggs left
4) MTHFR mutations? -- unlikely, My homocysteine level was super low.
5)Autoimmune issues
Lupus anti-coagulant-No
Anti-phopsholipid antibodies- borderline positive then repeat negative so unlikely

Thyroid autoimmunity-yes

6)Progesterone Issues:  No, levels were excellent
7)Luteal phase defect:  borderline...11 day luteal phase in similar cycles.

8) PCOS:  Yes.

I do not know why my baby died, but I do know that a vitamin D deficiency is a risk factor for PCOS, all autoimmunity(including thyroid) as well as luteal phase defect. After becoming vitamin D replete, my ovaries are no longer poly/multicystic (My antral follicle count came down from 30-34 to around 16-18). More importantly, I consistently have a 14-16 day luteal phase.

Based on what was 'wrong' with me, do I think my D3 deficiency possibly contributed to my miscarriage? Yes. Can I be certain? Hell no. There is no way to know anything for certain.

About whether a HSG is useful: It can only be useful if it helps reveal anything about your uterus (not so sure about this) and tubes. So if you have not had this investigated, do so, because it is something off the checklist that must be crossed off.  

Also, this is by no means infallible or a comprehensive list,  but this is what I would suspect was a more likely cause depending on WHEN pregnancy loss happens.

Very early pregnancy loss risk factors: Bad egg quality (hindering growth of the embryo),  and immune factors that hinder implantation such as activated NK cells and T cells.

Mid-late first Trimester loss risk factors: Chromosomal/genetic abnormalities, anti-thyroid antibodies, and god knows what else.

Second trimester loss: autoimmune issues, anti-phospholipid antibodies, clotting issues.

Low AMH: Diminished ovarian reserve or a Vit D deficiency?

I received this email a few days ago. This post is to address this question and as well as the many people  who have come across my blog doing Google searches for "low AMH" or "AMH and Vitamin D."

"I came upon your blog while googling for information about low AMH levels, which I'm sure you know, is very difficult to find.  I'm curious whether you've found any other information about increasing AMH levels other than Vitamin D.  I was diagnosed with low AMH (all else normal) and my RE told me there is no way for it to increase and that it would only decrease.  He was pretty doom and gloom about everything.  I'm currently using royal jelly, acupuncture, Chinese herbs, sprirullina, and a general prenatal multi-vitamin.  I haven't had my Vitamin D level checked yet but am considering doing that and asking about DHEA next time I go to the doctor as I'm hesitant to add anything else to the mix right now.  Thanks for sharing your story online."

In addressing the question asked of me, I have to point out one important fact that I think falls between the cracks with most people.

AMH is a surrogate marker. Why it is considered a good indicator of your ovarian reserve is because it tells you how many antral follicles are present in your ovaries each cycle. The antral follicles actually make your AMH. So more the antral follicles you have, the more your AMH, or at least, that is the logical stream of thought. Women with a failing or low ovarian reserve have very few follicles left, so their AMH is low. In other words, the problem is not that their AMH is low, but it is that they have few follicles left.

The question is, can your AMH be falsely low? To find this out, you must have an antral follicle count done. AMH alone, or AMH + FSH/E2 cannot give you the full picture.

If you have a low AMH and very few follicles left, then the probability, sadly, is indeed that you do have a case of diminished ovarian reserve.However, if your antral follicle count is normal/good/high and your AMH is too low, then something may be wrong.

One of two possibilities may account for this:

1) The lab messed the test up
2) The tantalizing Vitamin D theory: Now----I came up with the theory only based on the finding that the AMH gene is turned on by Vitamin D. This is solid, irrefutable science here.  What is still unclear is whether a vitamin D deficiency leads to suboptimal AMH production in the antral follicles. My findings imply that it did, but we cannot rule out that the first lab really messed up my AMH test. It needs to be studied clinically.
Updated 2 years later: Yes, this has been studied, and it is now fairly certain that your vitamin D level affects your AMH level. If your AMH level is too low when compared with your AFC, Vitamin D may be the culprit.

Overall, if you have a low AMH, then your plan of action must be to test for both vitamin D and your antral follicle count.

If your vitamin D is normal and your antral follicle count is low, then that just means you do have few eggs left.  DHEA seems to have some little success at improving the success rate in cases of diminished ovarian reserve, but its horribly unclear as to what is happening. Is it increasing recruitment of antral follicles from the diminished supply left? Is it improving egg quality as well? There was a study which actually showed that DHEA decreases the rate of aneuploidy. I don't know how solid the data is, but that is tantalizing if it is indeed so.

When you truly have DOR, then it is what it is. There is no way to fix it. You can, however, improve your chances with supplements (look for the CCRM cocktail).

I'll end on this note, and this is purely an informed opinion on my part: If  you want to have a baby, it is folly not to investigate your vitamin D3 levels. Its not just to treat infertility, but it is also proving to be very relevant in preventing pregnancy-related complications stemming from infection, autoimmunity, or pre-eclampsia. Just taking supplements is not the best way to go, because you don't know how much to take: you could end up taking too little, or in rare cases, too much.  

In which I meet my future baby's half-sibling......

This, as the title suggests, is a tale of staggering cosmic coincidence. Around November 2009, I found my donor. On seeing his profile, I knew within an hour that this was just perfect for me. That moment of perfect clarity came after months of indecision and trolling entire databases of multiple banks and wringing my hands trying to make a decision. The relief was indescribable. I bought a few vials, opened a yahoo donor sibling group, and hoped that women using my donor would run google searches and show up.  Not much happened for a while.

I was also a member of Wendy Kramer's Yahoo DSR group. I never ever visited it though. One day, late at night, I was aimlessly browsing. Something made me open up that Yahoo DSR. One of the first few posts had a link to an article in Marie Claire, where this woman talks about her donor. No bank name or donor ID was mentioned, but this was what was said.

His voice sounded warm and kind. I listened to stories about his family, friends, wife, and life experiences. He said he became a donor not for the financial incentive, but to give an amazing gift to an individual or a couple, which was great news after hearing so many guys say flat-out they were doing it for the money. [A donor can make up to $100 per sample.] It was really moving. During the last minute, I had tears rolling down my face, and I knew this was right for me.  

I read this, and I was like, huh, she has my donor. I just knew.  Thankfully, the article gave her full name. I found her on facebook and contacted her. She was extremely enthusiastic and YES, we had the same donor!

She had had multiple failed IUIs at that point. She went for her first IVF a little after I went for my first IUI. We both got pregnant, she had her baby, I lost mine. But we kept in touch, though our contact has been almost nil this year.

She joined our little donor group. Quite a few other women found us as well. Some of them went on to have kids and now, all of these women are in touch with each other. Their kids will meet each other, and hopefully forge relationships.  I am so glad so many good things came out of that entirely random stream of events.

Last weekend, I went to the New York SMC conference. It was totally a last minute decision. It was a roomful of about 200 women maybe. I step out for lunch, people milling around everywhere, this woman comes up out of nowhere and introduces herself. Even though she is a facebook friend, I did not recognize her-- but it was M, with her baby! My jaw literally hit the floor and stayed there. I hung out with her, I got to play with her son who is just the most delightful baby.. it was surreal. I don't know if I can ever have a baby with my donor--- but if I indeed do get to do that, I just met my baby's half-sibling before meeting my baby!!!

I've just been floored by the incredible coincidences that keep connecting me, time and again, to M. I keep thinking, the universe must have a grand plan in engineering all of this, and I drive myself nuts trying to figure out what it is.....

Turning into a hermit again...

The last time I initiated serious planning for TTC was Jan 2010. At that point, even though I was about months away from the actual process, my routines started changing. I no longer felt like going out.  I became more of a stay-home-in-my-jammies kind of person. Now, to my dismay,  the very same process is restarting. I should be getting ready to go out and help somebody celebrate graduating. I don't WANT to.  I have done nothing the entire day other than catch up on chores, watch TV and work.  I should be getting ready to go out and mingle with other human beings. But I can't bring myself to and I'm feeling bad because there is another person inside of me who actually does want to go out, but TTC me won't let her.

I don't like this version of myself, because I'm much more of a hermit than I normally am.  And NYC is going to be even more isolating than San Diego- people go out late and they stay out till the wee hours of the morning.Nobody stays in and plays boardgames and watches movies. I'm going to be spending SO much time by myself once the TTC process actually begins- I don't want this exile to begin even earlier, but that is what it looks like its going to be.

And sometimes, I wonder for what it all is. The last time I jumped into this process, I was so very certain I'd get to take a baby home. Now, no such confidence exits, only a hope.  Its going to be a bloody scary, and quiet few months (hopefully, an entire year). Thank god for this virtual universe and you guys!

Please go give support..

Anna was pregnant with a boy when preeclampsia struck in full horrifying force at 20 weeks. She lost her baby. Her story is heartrending- please go offer support here

Thanks to the 'miracles' of science, we can now tell what genes predispose to preeclampsia. Both maternal AND paternal genes contribute. Sometimes the greater, higher risk gene actually comes from the father. Someday, I hope medical science evolves enough to the point where they include these genes in routine pre-pregnancy screens- they might help avoid such horror stories.

I'm so sad-life can be so bloody unexpectedly horrible.

Catching up

I'm amazed and gratified that this blog still gets people coming by even when there is absolutely nothing happening I am so, so very glad I connected with all of you, it may just rank among the most positive things that have happened to me in the past two years---thank you so much for being there!!

Now for a pent-up rant--- the  NYU Fertility Center has not been making me too happy. I called the last time my period rolled around to schedule a HSG, only to find out that my doctor (Dr L,the purported genius at the HSG) would be on vacation for the next 10 days. Its not the first time I've heard that either. So, I'm sitting this cycle out. I'm still not over the fact that he does not think anti-thyroid antibodies even might be a contributing factor to miscarriage and does not even want to treat with synthyroid (!!!!!!!). If I get started on my opinion of this, I may go on for a while. I pray I have the sense not to tell him how I really feel, that would be a very bad move.

The general lack of attention of detail in this practice pisses me off. Lots of little things, but one thing stands out- at my original consult, when they were counting my antral follicles, I committed to memory what numbers he came up with, but since I could not remember which ovary had how many, I asked for my medical records from that visit.   My numbers were 14 and 4. Instead of writing down the numbers the doctor had called out, the nurse decided to use adjectives (very good and normal, respectively). When I read this, my jaw fell open.Good and normal?!!!? That could mean just about anything. I'm a scientist, I know how important it is to note the details, and I know that it is something important in the medical community as well. Dr. Garzo's practice would have done no such thing. They have done multiple antral follicle counts for me and at each count, the numbers are recorded into a form meant for this purpose.Their record keeping overall was far superior, this is a far more meticulous practice. When you think about why, say, an IVF cycle succeeds or fails, its mostly biology of the patient and the suitability of that particular cycle design for that patient, but a small but significant portion is about how the staff and doctor handle the little details. I cannot say how many times I've seen an experiment fail or work based on one tiny detail - the devil IS very much in the bloody details!

Somebody asked me what I miss most about San Diego- the diplomatic answer was - the beaches, but the real answer is, I miss my RE. I miss my lovely, compassionate, infinitely smarter nurse.


As to where things stand: I'm revving up for an IUI (no meds), for the first good (based on fertility signs) cycle I see in 2012.About Plan A, the quest to do this with a real live man and not a catheter inserted by a gloved hand- its not going too well. I dated quite a bit, thanks to Eharmony, but nothing came out of it. I've had an on again-off again flirtation at work, with somebody who is a lot of fun but with absolutely no relationship potential. I spoke to (and am still speaking with) a couple of eligible Indian boys, who I'm supposed to meet in October. One of them irritates me when we talk on the phone, but he is a nice guy and my parents love him. Sigh.  The other I like and have fun talking to, but I have a feeling I'd want him as a friend but would not have chemistry when we met up. Even if we do 'like' each other, this process is very difficult. Unless I fall head over heels, committing is going to be very hard. It takes time to build a relationship, and its much harder if you are in different geographical locations.

So yeah, astrologer's predictions of marriage notwithstanding, I have a feeling I will be going to be trying to make babies with my dreamboat of a donor, who has helped  4 women produce 5 beautiful, healthy babies. I hope I'm similarly blessed someday.

Indecision 2011

Boy, you do not fully appreciate how relatively stress-free your existence is until you decide to jump back in the gladiator ring of TTCing again. I'm sitting here with this gigantic decision to make- to start metformin or not???

I talked to my Indian RE about it.  What he told me took me back to my first thought about this: he deals with a different ethnic group than REs in America and PCOS figures very heavily there.  Its not terribly surprising, you cannot throw a stone in India without hitting somebody with Type 2 diabetes- its really, really common. PCOS is related to Type II diabetes. Its all logical.

He reiterated he does not really know if metformin works. His reasoning is its cheap and safe- so why not? I'm not so sure its safe though. My body functions perfectly, medication-free right now. I'm really nervous about upsetting that cart.

The other reason I'm hesitating is that if you lined up all the possible causes of my 2 miscarriages, examining each and every detail , I'd say the highest probability is that it was the vitamin D deficiency, which *probably* made for crappier eggs more likely to have genetic defects. Its also possible that my second loss was not even my fault- It could have been the universe really not wanted me to have a kid at that point and letting the one sperm with a missing chromosome impregnate my poor egg.

For the millionth time, I'm going to discuss all the changes that have come about, when my vitamin D3 blood levels are in the 30-40 ng/ml range, as opposed to the deficiency range I was in (17 ng/ml) just post miscarriage # 2.


My bbt patterns have changed.  My temperature used to vary from maybe 97.4-96.7 in the preovulatory phase- now it flatlines at 97.3. And when I say flatline, I mean it. Maybe for one day, every 3rd cycle, a really strong estrogen surge will push my temperature down to 97.1, but that is it. Nothing can be made of it, but I think its very interesting.


Breast tenderness- nearly constant - ie- more progesterone and estrogen, overall. That is good :-)


My luteal phase has gotten longer. MUCH longer. This has to be the most startling, and clear indicator that things have changed. The two cycles I conceived in had an early day 16 ovulation, with a luteal phase of 11-12 days. If I ovulated at day 20, my luteal phase would be 13-14 days. Now, almost all my ovulations have been at day 20 or later.  The luteal phase in such cycles is now increased to 14-16 days, with average being 15. 

Luteal phase defect (9-10 days or less) has been implicated as a miscarriage risk factor, which again, is logical. Shorter luteal phases are indicative of less effective progesterone mechanisms, which is in turn indicative of poorer quality eggs, which of course means you have a lower chance of seeing that pregnancy succeed. Though to qualify for LPD, you have to have a really short luteal phase, maybe for somebody like me, a 11 day LP was probably indicative of an issue- who knows?

So basically, I really think that it was highly likely that my problems were tied, principally, to a vitamin D deficiency, that has now been fixed. What makes it even more interesting is that a lot of women with PCOS are vitamin D deficient, and I think its likely that some part of the PCOS presentation can stem from vitamin D deficiency. So- I do not know if I need metformin, and I'm really don't want to take it, but I don't want to end up regretting that I did not do it.

In less scientific matters- I'm going on a cruise in December! I am so excited and I really, really wanted to go snorkel in some really blue waters- but I calculated ahead because some dreaded instinct told me this may be an issue.... Going with my current cycle patterns, bloody AF is going to show up on the day we dock at the Bahamas! My frustration knows no bounds...Eff You Universe!

Do we listen to the experts?

About Irene, I think a facebook friend said it best- her status update was' Irene, you bore me'. Thank god for boredom. I was in the mandatory evacuation zone, I packed up, stayed with a friend, had a tranquil weekend and came home to a perfectly untouched apartment. I did get to talk to many branches of my far flung family who called up panic stricken, because of CNN,  who were making it sound like the apocalypse was coming.  The majority of the reporters, were of course in Manhattan, trying to make as big a deal as they could of 1 foot of water. It would have been funny if it had not been annoying. From what I could see, Irene did very little to Manhattan, but did stir up trouble (though hardly as much as had been anticipated) to places like Long Island. Hope everybody is ok.

Even though many of the precautions seemed over the top in retrospect, I'm glad everybody played it safe.  But that is my nature. I got to witness an interesting example of the choice between playing it safe versus the alternative this weekend.  A friend cooked dinner, and one of the things she made was fish. Since I never eat fish without first finding out what kind it is, I asked, and was told, swordfish.  I definitely would not eat that. The reason I declined was because swordfish (along with shark) is one the the fish varieties that is very high in methyl mercury. My friend had no idea about that fact, and was completely taken aback that I would not even have a tiny bite of the fish.  She was like, well, what harm can eating it once do? The answer is, probably not that much, if you are not pregnant. Mercury is deadly during a pregnancy- tiny quantities can disrupt neuronal migration and hence can cause major defects in brain development. There is that ill-understood, poorly defined possible link between mercury and autism. The deal is, once you take mercury into your body, it is very hard to expel completely.  A good portion will go sit in your cells, in some corner of your body. If that cell is every broken down and recycled during pregnancy (low probability), mercury can renter your blood stream, and travel past the placenta, where it can wreck havoc.  So there is no way I will ever eat shark or swordfish or even tuna (certain varieties are kind of high) not until I close the door on having any children in the future.  I explained all of this to my friend, who ate all the swordfish anyway, and will probably continue to do so.  She served it to everybody else there- all women. One of them asked why I was not eating fish and I told them what I had told my friend. All the  women there were of child bearing age, 4 of us were single (it IS new york) and one woman was married, and I think, from her alarmed reaction, plans to TTC soon. Nonetheless, after initially bypassing the fish, she went and ate a few slices.  Honestly, the odds of any harm coming of eating it, this once, is pretty low. But because of my training and my knowledge and my own personal history of pregnancy loss, I could not help but be alarmist. Everybody ate the fish, and I'm glad, for my friends sake, that they did.  But it struck me, that, despite knowing how bad it is (the FDA counsels against any woman of childbearing age consuming any seafood species high in mercury, and I told them this), everybody went ahead with it anyway.  Maybe they will not repeat the process, now that they know, but who can say? Overall, the thing I was surprised by that none of them knew about the dangers of mercury and certain seafoods. Making a choice is fine- its your body, your life but I just want people to be educated before making that choice.

In other news- I got browbeaten by my doctor into agreeing to get the HSG done. I've protested to him time and time again, that an HSG is not supposed to be the best test to reveal scarring in the tubes/uterus. His rejoinder each time has been, the people who are doing it have not been using the test correctly, they do not know how to read it, an HSG, in the right hands, done by me, will tell us what we need to know.  What can I say? He IS the RE, I hope he knows what he is talking about. So, while I'm with him, the HSG is what I will have. 

Gray

Big chunks of the east coast seem to be cold and gray and rainy, and in a way, it echoes my mood. Nature can be an evil, capricious bitch sometimes, I think there are no words to express the rage and helplessness we feel when babies are targeted by that capriciousness- Shannon's news has left us all reeling. But still, there is definitely room for optimism, and while the coming period might be a harrowing one, there is a high likelihood that things will end WELL. I'm praying.

I want to apologize to whoever shared reviews of their doctors with me- I've procrastinated putting it up for so long it has been inexcusable. Still, better late than never, its up now, in its own page, with plenty of room for more if others wish to contribute.

The Glucose Tolerence Test...

They ordered the 2 hour GTT for me, instead of the 3 hour.  One part of me was fairly unhappy about this because I wanted more data points and the other part was resoundingly relieved that I'd have to just give blood twice, instead of being jabbed 3 times. After the first blood draw, I realized I had never confirmed that they were going to also check for insulin, I just assumed this would be so. Nope. They just had been ordered to do the bare needful, just glucose. And they collected blood in the wrong kind of tube, so they could not even add it on. This is when I wanted to just SCREAM.  The people ordering the tests knew I was worried about insulin resistance, but no, they did not bother adding insulin to the panel. ARGH!!!!

First, before moving on to the results- When I got the glucose drink, instead of being disgusted and sickened by it like most normal people, I tolerated it just fine, because its about a slight shade sweeter than my morning cup of coffee. That was when I realized I about give my body about half (in terms of volume) a GTT every bloody day! Scary stuff.

Anyway- I passed. With flying colors. My fasting glucose was 80, and the 2 hour was  lower, at 78. These are very good numbers, my body apparently is a champ at putting away sugars.

Should I take metformin? The majority of doctors would say no. Not with such clearcut evidence that I do not have any issues metabolizing glucose.. I'm stumped, I don't know what to do.

I had a quick phone conversation with Dr. L, where he said he does not want me on metformin. He also said he does not believe anti-thyroid antibodies are linked to miscarriage, and does not beleive in treating for them. I'm glad I get to call the shots there, thats all I can say.  I then asked him, if nothing is wrong with me, if I have a fantastically good ovarian reserve, make lots of estrogen and progesterone, and PCOS does not appear to be having a negative effect on my fertility, why did I lose 2 babies?? No answers were forthcoming, obviously. I should not blame him for that, this is a situation where nobody has answers, but his confident waving away of thyroid autoantibodies irked me a bit- atleast show some degree of uncerainity, because these is evidence both pro and con for that one.  

Sometimes this certain aspects of this debate on infertility and pregnancy loss seems like an atheist, an agnostic and a believer sitting there arguing about god. Nobody has any concrete answers, but everybody sure as hell has opinions. My Indian RE would want me on metformin. About 4 other doctors have said no. I'm conflicted. 

In the meantime- I have to call and order an HSG, to make sure my 2 D&Cs left no scarring in the uterus and fallopian tubes- last thing I need, is an ectopic. This is probably the one thing I can get an answer for, though I'm dreading the test. If anybody has an HSG done, or has heard an opinion about the usefulness of this test to evaluate scarring and is inclined to share, please do so!

On RPL

First and Foremost: I apologize for all the blank posts. If anybody is having issues with posting, try changing your browser. I kept posting with Firefox, only the title of my post could be published (Lots of hair got yanked out!!). Changing to Internet Explorer fixed it. Blogger deserves to be abandoned for Wordpress or something else that does not mess up like this.

After my second loss, my Indian RE strongly suggested I read the book 'Coming to Term'.  The author and his wife had 4 pregnancy losses (2 chemical, 2 more advanced), and he decided to do a careful study on the subject of recurrent pregnancy loss. His book covers the scientific spectrum of causes of pregnancy loss, and he has the most heartrending case studies. Its horrifying and uplifting all together to read those stories. The average women in there had about 4 losses, but many of them has as many as 6 or more. Almost ALL of them went on to have healthy children. Almost all.  Tears and joy aside, reading that book gave me a good idea of the scope of the monster that is RPL, an invaluable thing in itself.

The book also highlights that science does not have all the answers and that miscarriage is the murkiest of pools. One story in particular stood out. This woman had 4 first trimester losses. She was finally diagnosed with Factor V Leiden, which predisposes to blood clots that end the pregnancy.  At that time, heparin had not been established as the treatment for this issue. Her fifth pregnancy, with no medical intervention whatsoever, went completely smoothly. She had a healthy baby. She got pregnant again, and this time, took heparin, and that pregnancy also went just fine. What amazes me was her 5th pregnancy. If clotting was what had ended 4 of the pregnancies, what saved the 5th?  Science definately does not have the answers.

Still- there are times when it can help. I stumbled across the most amazing website. It is an archive of all the research done on the myriad causes of pregnancy loss.

https://sites.google.com/site/miscarriageresearch/

I did a lot of reading up on the the two that have been implicated for me, Vitamin D and Thyroid autoimmunity.  There is PLENTY of evidence linking the two to pregnancy loss, and even more gratifyingly, vitamin D to glucose metabolism. The parts about Selenium and anti-thyroid antibodies I also found useful. This website is a treasure trove, I'm not done going through it yet.

However linked something is to either infertility or pregnancy loss, the converse also applies, there have to have been women who have many of these issues, and have gone on to have perfect pregnancies.Nothing is absolute and almost all the iceberg is still below water. 

The statistic is that one in 5 pregnancies end in loss. I have 4 friends currently pregnant. I'm the only person they know who has had pregnancy losses.  When I listened to my friend, who had just started trying and who is now 15 weeks along, a sense of failure came upon me. How could I have been the one to fail not just once, but twice? A stupid, immature feeling, but its not one that is going to go away anytime soon.

What I've learned along this painful road: tell nobody. I've made a few new friends in NYC who I'm getting closer and closer to as time goes by. One year ago, I would have happily told them what I intend to do. Now, I'm going to keep my mouth firmly shut. Nobody is going to get to know the next time around, whenever that blessed event occurs. 

Giving thanks

Somedays, I just have to thank god that I got to live in this age.  It is a kind and politically correct time and importantly, an age where there is such a variety of things you have access to.

I'm currently working my way through the most enormous book I've ever read.  I usually tear through a book in a single setting, finishing a 400 page book in approximately 4 hours. This one I've been reading for 10 hours over 3 days and I've just over halfway through. Its the latest book in the series the completely awesome HBO show "Game of Thrones" is based on.  One of the characters just stands out for me.  He has the horrible fortune of being born a dwarf into one of the most powerful, ambitious and callous families in the land, in an immensely cruel and tough time.  His father, a complete monster, despises and manipulates him. The world he lives in constantly mocks him. His life is made so much worse because of the kind of person he is. Had he been a person of average intellect and depth, he would have blended into the background and might have lived an uneventful, mostly ignored life. But his immensely intelligent, shrewd and larger-than-life personality results in him being thrust into the complex political scene. He survives a number of horrific events, is betrayed at many turns and through all of it, is constantly mocked for being a dwarf.  He is understandably bitter about the horrific hand life has dealt him. Yet, in situations where most would have despaired, he still keeps going. He fights hard to survive and at the end of the day, remains interested in humanity and retains his innate kindness, empathy and sense of humor (though its about as black as black can get). This character, wonderfully portrayed by Peter Dinklage on the show, fascinates me. Though this is all make-believe, there have to have been people of comparable depth, born or thrust into such difficult situations. Sometimes, it seems like the more extraordinary souls are the ones more likely to be  dealt crapfests. Or is it the other way around, does the crapfest bring out the extraordinary in people? This definitely seems true of many people who have gone through hell in life- some of the most amazing people I have seen out here are the people who have been dealt the harshest blows by IF.

I have to be thankful for the fact that I live in an age where people are so much kinder (the world in this book series is unimaginably barbaric), an age where we can be exposed to the imaginations of some wonderful minds, who can create such marvelous entertainment for us in so many ways. Its something that may have been unavailable to say, our grandparents. I'm grateful for the choices we have- its not something we should take for granted.

In infertility-related news, I'm determined that I will schedule the Glucose Tolerance Test this week. I've never been so conflicted as to what I want the result to be. Why would anybody want to fail it? It might mean a future where I more likely to be insulin-dependent, with the variety of problems that come with diabetes waiting for me.  On the other hand, if I pass it, we will not know if metformin will help me. Most doctors just shrug when asked whether I should be on it, they say, why bother? You seem to have little need of it, you have no PCOS-related problems. Well, I don't.  Its just that my babies keep dying at about 8 weeks of gestation, and gee, it would be nice to have a culprit and something I can attempt to fix before rushing in headlong again. I'll still take metformin, but if I pass the GTT, it just means more uncertainty on whether I need it, and its not an easy drug to take.  Well, I can't decide what I want the result be, but will be glad to finally have an answer.

To beleive or not to beleive....

My life, as usual, has been on fast forward. Partly contributing to that was the fact that I had my mom come visit me for the past 3 weeks. Among trips to Canada and seeing New York, a great deal of philosophical conversation ensued. Sometime in the last month would have been Turbulence's due date. Amazing as it may seem, all that causes me is one small pang every time I dwell on it, but the sorrow is not there anymore.

The philosophical conversations I have with my mom all center about one theme - predestiny. In a sense, this is like having faith in god, which I don't, being firmly agnostic. But,  for the sake of convenience or because some little intuitive voice inside me urges me to believe, I cannot rule out the idea that maybe all of this IS predestined. That there are children destined to make it out into this world.  To paraphrase my mom, nothing can stop these births. Improbable conceptions will occur, previous problems will disappear, all things will fall into place and these lives WILL come into being.  By this token, all the things that fail, for the myriad reasons, do so because they were not meant to be. However awful and tragic the circumstances of failure, no matter how close one comes to success,  if one believes in predestiny, one just says, it did not happen because it was not meant to be. This is a harsh, ruthless philosophy with absolutely no room for emotion. I accept it because it represents the ultimate escape hatch, the ultimate way to justify all the things that do not work, the lives lost. I have to explain to myself why my babies did not make it.  My mom and I have also started to talk about adoption. I'm far away from that option, but as my mom keeps saying, if that is what is in your destiny, that is what will be.

In the last post, Emily asked whether I met somebody in June as the astrologers had predicted. Sheepishly interjecting here that I had got the month they mentioned wrong, it was July. But so far, have met nobody, and would be extremely surprised if I did.  I cannot really take this stuff seriously. But upon more detailed explanations from my mom on what they had predicted, what one of the astrologers said shook me greatly.  My father had asked him to look at my chart and tell him about the possibility of marriage by looking at it.  He told my father that a strong possibility for marriage existed in this year, but I should wait till November (the 23rd actually), because according to him, if I got pregnant before this date, either I would die (this part I knew from previous conversation with my mom), or the child would die (?!?!). This part was spooky because it came out of nowhere-- nobody had asked him about pregnancy. Apparently there is a strong indication on my chart for pregnancy issues.  Some other astrologer years ago had predicted that I would have an issue in a pregnancy, that I would come out of it fine but my child would not. Anyway, after November 23rd, apparently, its smooth sailing. If there is any fervent desire to believe in astrology, I would hope that this guy is right, that I finally hit some luck in this department.

Procrastination

As the months go by, the desire to get back in the saddle is steadily getting stronger.  But its going to be oh so tricky, with timing. I need to figure out when I can wrap up my work here and return to India (for about 2 years or a bit longer). Though I know this will be somewhere between Feb 2012 and August 2012, the month is impossible to predict. As time passes and I become more and more eager to proceed, delaying TTC past December (the first month I could try) would require herculean restraint.

So I have two uncomfortable scenarios to contemplate- having to go through the first few months of pregnancy by myself (the anxiety with nobody to lean on/help distract me is not something I am looking forward to) , or  far, far worse, the prospect of going through a third loss by myself. My mom would fly out in that event, but still, the prospect of walking into another ultrasound, that awful uncertainty, with nobody to hold my hand is daunting.

I keep saying this, I have to learn equanimity.  No matter how long or how painful the road gets (especially then, actually), I have to believe that one day, I will have a child, and that is the child I was meant to have, and that everything that happened along the way before was because it was not yet time. For me, this is the only conceivable way to look into the abyss of failure and loss  and find some measure of peace.

In the meantime, I am procrastinating on a number of things
-scheduling a glucose tolerance test
-scheduling a HSG/sonogram
-Getting the swimmers shipped
-Scheduling a psychologist appointment, since I'm a single woman TTCing. This one I managed to argue my way out of in San Diego.  My new NY RE wants it done. If insurance will cover, I'll do it, but if not, I will work on persuading him to waive it- there is no bloody way I'm shelling out hundreds of dollars for a conversation where they just tell me things I already know.

This to-do list continues to taunt me on a subconscious level all the time, but with work being as busy as it is, every week goes by with me pushing it forward. And the taunting increases in crescendo in my head...

In which I share far too much information

I've told about 3 IRL friends (and my mom and my brother) about this blog. If you are not my friend M or my mom- stop reading or you will regret it.

So anyway, this post is about the symptom you mention in hushed tones while being forced to converse with your RE's office in a public place- breast tenderness.

In the past year, the only times I noticed I had breast tenderness was occasionally in my luteal phase, and of course, both the times I got pregnant, from about day 3 DPO. At this point, I have to remind my readers, my vitamin D levels, unbeknownst to me, were in the deficiency range- below 20 ng/ml.

In December, I found out I was deficient and started supplementation. I noticed this first in January, where my blood Vitamin D levels had just entered the normal range (around 35 ng/ml)- I had  breast tenderness well before ovulation.This thew me for a loop, who had ever heard of this?!?!

Anyway, it continued that entire cycle. Then, I increased my vitamin D dosage, from 4000 IU/day to 6000 IU/day.  My blood level increased to 60 ng/ml. A great many things changed (including the tenderness disappearing. All of these changes (which included decreased cervical mucous and delayed ovulation ) were collectively indicative of lower estrogen levels. Not liking the changes, I cut back my Vitamin D dosage, and within a month, everything went back to the way it was before I upped the dosage.

This is the second cycle with a lower blood level  (probably back to 30). And, predictably, when my blood levels of vitamin D are around this mark, the tenderness is back. It is pronounced. I have a cat who likes to walk all over me first thing in the morning- she steps on my chest, and oh my bloody god, my neighbors get to hear me screech.  The rest of the time, it feels like I have a couple of lead weights strapped to my chest. Not fun. I'm kind of nervous thinking about how bad it would get if I got knocked up again, if it is this bad now.

I cannot believe that I have this symptom, this strongly, well before ovulation. It has to be a refection of increased estrogen sensitivity- either my estrogen levels are up, or levels of estrogen receptors are up. Vitamin D can affect both these parameters, so its not entirely illogical that this is happening.

My question to anybody reading is- did you feel this as a symptom in the pre-ovulatory phase, with injectibles or while doing IVF, ie conditions designed to increase your estrogen levels? Just curious.

yearnings and musings

My visit to Philly brought the one thing I had successfully avoided thinking about for the past few months back to glaring center stage. Babies. The friends I stayed have a two year old, and she is a lovely child (also a genius-- she is spelling at 2!). More than anything,  I could not stop marveling at the utter trust and love that exists between parents and their children. It is the best of relationships. When you spend two days observing it, you get a wee bit wistful that despite having been pregnant twice, you don't have it yet, and far worse, there is the gnawing fear that something so wonderful might be forever denied to you.

As my mom tells me, I need patience. And, more importantly, I need to stop catastrophizing (if that is even a word). I cannot honestly imagine that after getting pregnant, that my baby will actually keep growing and that at some point, I won't have to stumble out of an ultrasound crying my eyes out. When that is all you know, its hard to imagine that an alternative exists, although, rationally, you know very well that it does.

I've completely lost the faith that I will actually have a baby someday, and its not going to come back until well,  maybe I cross the 5 month mark and the anatomical scan shows that all is well. God, the fear.  FDR did have it right when he said that the only thing we have to fear is fear itself, this terror and anxiety is bloody stupid.

I chart my cycles, and I now kind of beleive that when you are using natural cycles for conception, observing your fertility signs, which are very rough indicators of estrogen and progesterone (and by extension, egg quality) might be telling. For example, I hated the cycle I used for my second conception, I thought it was my worst ever. But I went ahead with it, though at that point, I compared it to a poker player going all in with a substandard hand.  And I ended up with a baby with an entire chromosome missing.  IF that error was in my egg, did it have anything to do with the possibly lower-than-my-average and definitely less-long peak estrogen levels in that cycle? No RE will even attempt to address this question, it is speculation beyond speculation. There is so little you know of this process, nobody knows what are the driving factors behind meiotic non-disjunction (where the chromosomes do not segregate correctly, causing numerical errors like trisomies or monosomies). Studies make it clear that estrogen has a role to play in this process, but correlating the estrogen levels, and moreover, the importance of time period of the estrogen peak, to the probability of meiotic non-disjunction is far beyond our ability to speculate, we simply have no clue.

Every now and then, you have a cycle where everything looks so good  you wish you could have used it to attempt conception.  The one that just ended was one such one. There were virtually rivers of the egg-white you-know-what (sorry for the icky detail). Then, my luteal phase, instead of being the usual 14 days, was a whopping 16.

If I had not been sure that there was no way conception could have occurred, I would have been fairly nervous when it took over 16 days after day of ovulation for AF to show!  Whenever I conceive next, I hope it is in a cycle I feel this good about.

A rambly post

I go away to Philly this weekend, where my old group of friends is experiencing a baby boom. 2 people got pregnant around the same time and are now close to the end of the first trimester. It still amazes me that when most people dodge this bullet pretty easily, I was slammed by it twice.

I still can't comprehend it and the why of it all would make for one rambling post or three. 

Why did my first, apparently chromosomally normal baby die? Was it my anti-thyroid antibodies? My mom was probably positive for these when she had my youngest brother, and that was an easy, perfectly normal pregnancy. She developed over Hashimotos about 6-7 years later--- people are antibody positive for many years before thyroid function is deteriorates to the level that it starts producing clinical hypothyroidism.  Correction: we recently found out that while my mom has hypothyroidism, she does not have anti-thyroid antibodies. So the cause of her hypothyroidism is not autoimmune, it is not Hashimotos. So I in fact have a pregnancy-loss associated factor she did not have.

Who made the abnormal egg or sperm that made my second baby die? That is really a million dollar question that haunts me to this day---I know there will never be an answer, but that really stops nothing.

There are some things in life you thought you would have no problems with. I always thought baby making would one of these, just because I come from a family with amazingly good fertility, so much so that sometimes it can turn into a horror story. Despite every attempt available at that time for birth control, my grandma had 9 children and it exacerbated her diabetes and caused an untimely death at 55.   My aunt had 3 kids then decided to have her tubes tied. It worked as birth control for a few years, then , in a one in million case, something grew back, causing a tiny opening in the fallopian tubes, enough for a sperm to get in. She of course, got pregnant even with such odds, had an ectopic pregnancy that nobody diagnosed and nearly died, and it started a lifetime of medical problems resulting in a chronic pain syndrome. Sometimes, what is a boon for one person can turn into a curse for another.

So why me?I've got the same freaky good genes in this department (that I thank my stars for, and now, no longer take for granted), as far as getting pregnant goes.  Most REs categorically refuse to think there is anything wrong with me, that I need to get treated for. I get pregnant, all my tests check out, right now they are going with the 'shrug-your-shoulder' diagnosis to explain my losses. I've tried to hit them over the head with the PCOS, and they are like--- yeah, looks like you might have some presentation of it, but we would refuse to think that really of any detriment to you, because you ovulate and get pregnant easily.  Except my Indian RE, who immediately jumped on the PCOS diagnosis for me after just listening to my history of conception and loss. Interestingly, I did turn out to have that, and I hope he is right and metformin is all I need.

Anyway, there has been something I wanted to share for a while: Last year, after I started charting, I found my cycles fell into 2 clearly different patterns---

Pattern 1: High temps on day 3 (around 97.2-97.3), more egg-white cervical mucus (usually), surge starting on the morning on CD19, ovulation on CD20, and a 14 day luteal phase.

Pattern 2: Low temperatures (96.9 approx) on CD3,less evident egg white cervical mucus,  Surge starting afternoon of day 15, ovulation on day 16 and a shorter, 12 day luteal phase , though you can't see that in the picture below:)

 You could say that if progesterone (which determines length of luteal phase) and estrogen (which determines quality of quantity of cervical mucous) were indicators of egg quality,  this was my less stellar pattern.  Both my conceptions were in this cycle pattern. I had expressed concern to my doctors about this, and they pooh-poohed it.

Since my second loss (and subsequent increase in Vitamin D levels), my second short pattern with the day 16 ovulation has disappeared.  Last year, it was there for 3 out of the 6 cycles I had, and this year, in the 5 cycles I've had so far, it has not made its appearance even once.Undoubtedly, something has changed in my physiology to cause this effect-- I doubt it was the loss itself, simply because this pattern repeated after my first loss. The only other discernible change is vitamin D, a hormone that regulates a large number of processes in your body. Nonetheless, no matter what the cause, I find this change remarkable, we shall see if the trend continues.

My new, utterly unanswerable million dollar question (I have a lot of them): Was vitamin D deficiency contributing to my shorter, less pretty cycles, and possibly my losses?

I was talking to a friend the other day and I told her that one day in the future, I would look back at all of this and it might make sense, but it sure as hell does not now, from any standpoint.

Catching up

I cannot believe almost half of this year is over, it has flown by.  Life is even more frantic, there are days I'm at work well past midnight, and the weekends, they are pretty exhausting as well. This past Sunday I literally walked atleast quarter(?) the length of Manhattan, starting from union square and walking through Central Park, with a few meanderings along the way. Plus, I've been playing tourist with the multiple friends and family visiting me...uuhhh. Its been loads of fun though.

Not much is happening on the fertility monitoring front- My FMR1 genotyping came back as normal, I have some significant anti-thyroid (still low though) autoimmunity and I'm still waffling taking that all important glucose tolerance test.

From all the crap that happens in life, one good thing or two does have to emerge. This year, this time out of time, is a good thing. You have to look at the silver linings and smile. I've also been meeting up with SMC tryers. Looking at them- they are all going through the roller coasters of the buildup to ovulation and the 2wws, I feel both deeply envious that they get do that and passionate relief that I don't have to right now. Just remembering how stressful it all is makes me turn green. The worry that you might not get pregnant, the joy and the fear once you do, can I just say I hate the rollercoaster? Mostly because every time I've ridden it, its only taken me crashing to the ground. After my first loss, I was determined to get back on it immediately and the next 4 months rank among the most stressful of my life. After my second loss, I realized, for the sake of self preservation among other things, that I had to take a break. I shut it all out almost immediately, and I am so very proud of myself for being able to do that. I'll be even prouder when I actually willingly get back on the rollercoaster again.I was in Times Square the other day, and I saw this----The Wishing Wall  at Times Square.

I read through many of the post-its, and they ranged from desires for boyfriends to wanting to make it on broadway before they turned 17, and then I saw this little one (sorry for the horrible photo quality). It made me both want to smile and cry at the same time- I thought, given that it had to be posted on Dec 31st 2010, it might be that it was a woman facing fertility problems.  I can empathize, and its exactly my wish----hope it comes true!


Hope everybody is doing well. I try to keep up with the blog reading, and I'm keeping all of you in my thoughts.

An under-the-influence post

I should start this one by saying I weigh in under a 100 pounds. Which means I’m the world’s cheapest drunk. So even with a single cocktail in my system, I can be buzzed.  Tonight, when I got to that state of mind, I started remembering my babies. They were so perfect, especially Turbulence, that candle in the wind--- she looked beautiful and healthy and just right on ultrasound one week and was dead within the next 5 days.

Then I looked up my bloglist on my iphone for the first time in 3 days in a bar (bad idea) and saw this post, and my heart broke all over again, all the more so because it was like what I went through. Go to offer support.

Sorry for being MIA..

I rarely blog nowadays and the reason for that is twofold- first, there is nothing concrete to say and secondly, life is, in a word, frantic, with work during the week and a fairly hectic social life on the weekend.  The second part is surreal.  A year ago, I gave up my carefree existence to start TTC. I gave up drinking completely, I became a homebody, I completely lost interest in the opposite sex.  After my 2 losses and the move and having to shelve my TTC plans temporarily, I'm suddenly thrust into this 'Sex and the City' lifestyle which is all about having a good time and meeting new people.   Its just a completely different set of priorities. This change actually feels good. It feels weird thinking about giving all up to go to last years way of life,  but there would be no regrets. All of this is fun, but if I had to abandon this to stay home in sweats and watch TV while being pregnant, I would do it without a second thought, and with complete happiness. 

Things are changing so rapidly, I feel like Alice in Wonderland, not knowing what will happen next. I think its highly unlikely that I will meet somebody and abandon plan B, but at the same time, I have no idea how the future is going to unfold. I have just a feeling that this year has some tricks up its sleeve- I just hope they are ones that lift me up, not knock me down. But even if they are ones that knock me down, I have to say, what does not kill you only makes you stronger. Despite all my misgivings of whether I will be able to handle another catastrophe in the baby-making department, I know this- I have a far greater reserve of equanimity than when I first started out. I've started realize, and more importantly, accept that I have no power, so when life does not go my way, I  have a better chance at not fighting it and just accept and adjust to whatever comes along. There is nothing else to do.

Science stuff

My antral follicle counts- done twice last year, have been very high, in the 30s. At my appointment with Dr L, I was shocked to see that one ovary had 11 follicles (small decrease), while the other had only 4-5 (huge drop down), giving a total of about 15. My antral follicle count has decreased by half. I was flabbergasted. I don't know what it means.  As you all know, I tend to attribute everything to the change in my vitamin D levels (because that has been the only big change in my physiology). Metformin has been shown to decrease antral counts in women with PCOS,  but that data, as my SD RE put it, is not too good. It would be interesting if vitamin D could do this as well, because both things actually influence sugar metabolism, which is has mysterious, ill understood links to fertility and egg production.

I don't know if my decreased AFC is good for overall egg quality, we shall see. As my next TTC cycle will be completely unmedicated as well, the only thing I have to go on is quality of my natural cycle. This takes into account BBTs, length of luteal phase, number of days with egg white cervical mucus, number of days of high fertility, etc.  Following your fertility signs can tell you a lot about your own cycle- this doctor describes it well here. The problem is though, you are shooting in the dark. The last cycle I conceived in, was, in my own opinion, an absolutely crummy one. I was very concerned about egg quality. Nonetheless, the RE, looking at my uterus and ovaries the day of ovulation, thought things looked good and we proceeded. And it was all good enough to produce an embryo that implanted beautifully and thrived in the first 6 weeks even thought it had a gross chromosomal abnormality. What I would love to know is whether my egg was missing an X chromosome because it was produced in a cycle with less than one day of high fertility before the LH surge began, but I will never know, will I? And even though I understand my cycle far better than the average person, I haven't a hope of figuring out what works and what does not.

Miscellany

Life is progressing well in NYC. I think at this rate, my liver is going to be pickled (quite a change from the I-don't-touch-alcohol slogan which as the backbone of last year) but I'm slowly settling in and meeting new people.  Loads of fun!

I *finally* had my new RE appointment today (Dr. Licciardi, NYU). I walked out of it fairly pleased, on the whole.

The highlights
Finding out IUIs will be covered (or so I believe at this point)
No forking out 300 odd dollars for a new consult- only a flat small copay!
He agreed right off the bat to genotype me at the FMR1 locus (this is also the fragile X test)

The Plan Forward- do I really have a problem and can it be fixed??
We have no idea why the crapfest that was the last year really occurred.  I think the question to ask is- do lean/ovulatory PCO woman really have problems either conceiving or maintaining a pregnancy? There is a trend to suggest this, but really large, well designed studies have not been done. What I want is the opposite of the studies that are done- I want them to take women who conceive easily and have had multiple healthy pregnancies, and ask if THEY have lean PCO and thyroid autoimmunity and heightened NK cell activation and anti-phospholipid antibodies and all the million other vague problems that plague infertiles.   Sigh. 

Dr. L was willing to go with the theory that I might have lean/ovulatory PCO, but was completely noncommittal (as any sensible person would be) on whether this was the real cause of my losses and whether metformin would help me.  The way he put it- there are two types of PCO patients...The first category, that I fall into, which he referred to as 'New York PCO' (ha) wherein women are thin, are not visibly too hirsute and might even ovulate regularly. Then there is the second class of overweight women with overt glucose metabolism issues and ovulatory problems. In his opinion, metformin really helps the second category, but seems to not do so much for the first. I've read the studies, I've read the reviews discussing the studies, I can't really be sure metformin helps either, but nor can I discount it. There are studies which show it does seem to reduce the antral follicle counts and AMH levels, however bigger and better designed studies are needed IMO. So as it stands- we agreed I would start metformin about 3-4 months prior to my TTC cycle.  I think there would be significant debate about when to end it- I would probably atleast go to the end of the first trimester.

We are also getting my glucose metabolism investigated. I've had fasting glucose tests done and they are excellent- normal sugar levels and actually LOW insulin, indicating insulin sensitivity, not resistance. What we have not done though, is a glucose tolerance test. Given that I love to shock my system with an insanely sharp sugar spike atleast once a day (such a good idea for a girl coming from a family of type 2 diabetics...NOT), it will be interesting to see how my body responds.

More on vitamin D and BBTs and charting and follicle counts to come soon----and I've also got the doctor reviews to put up. Not that I have that many- but- my page is now the FIRST that comes up when you do a google search! Its even pulling up doctors mentioned in the comments- super cool!

Why does miscarriage hurt so much?

I was honestly, given everything, taken aback at how much my two losses have hurt me. I can understand why a woman who has gone through IVF or years of infertility is that shattered by a pregnancy loss: it is not just the the fact that she has lost an incredibly precious promise of the future, its also about the years of emotional investment, of taking nasty drugs that disrupt your body's natural processes. It is almost like the Sisyphus and boulder situation, where you have spent eons pushing that boulder up the hill, only for it to flatten you on its way down.  I can understand their pain and frustration.

In my case, so far, I have paid relatively little money and even that I could comfortably afford. I have had no drugs injected into me (or taken orally for that matter), my conceptions were entirely without any medical intervention other than getting the swimmers into me. I got pregnant both times I tried. My 2 first trimesters were pretty easy.So basically, I went through the entire get-pregnant-and-lose-babies with a minimum of financial and physical liability.

With early pregnancy loss, its not the same as have lost a child you know, it is more like the loss of an infinitely precious promise that had yet to be realized.  From a philosophical standpoint,  I'm pretty darned aware that miscarriage has happened billions of times.  All this has made me wonder, has my soul ever occupied the body of any child that died, at any point, during those 9 months? If the theory of the soul + body is really true, then its highly likely. Maybe after that death, my soul entered the body I occupy now. If I had gone somewhere else, I would'nt be where I am now. I would maybe have different parents (NOT ok with that!), a different identity.  When you think about it in this way, then the grief associated with early pregnancy loss diminishes a little.

Also, one really does not think about this, but sometimes, your situation could be far worse than what it is. If we think early pregnancy loss is hard, then imagine a parent watching their child die of Tay Sachs, or or childhood cancer, or some of those completely horrible premature aging syndromes.  Or imagine a child being born with a disability that would make his or her life difficult forever. If, as Hinduism puts it, that the body is only a garment for the soul, then I wish, above all else, that my child gets a good dress, with no rips or tears or sleeves missing. So if a first trimester miscarriage is really saving me from something worse, then I am okay with that, honestly. I've been in a unique situation, of actually knowing that to be true in the case of my second pregnancy, with the Turner's Syndrome diagnosis.

So- little physical or financial investment and being at ease, mentally, with the theory of the journey of souls---and still this hurts like crazy. I feel like I've been scarred for life, with each loss gouging the cut a bit deeper.  I want to make that hurt go away, because, I might have to go through the process of pregnancy loss yet again. And if it keeps hurting so much each time, I fear I would not have the emotional resources to keep at it multiple times, to find my golden egg.

I've always been an eminently practical person. That practical nature, now, is demanding that I diminish in some way the specter of miscarriage, so even if I have to go through it again, it is a little stumble rather than a giant fall.

Despite all this tough love and merciless laying out of facts, I fear I've made little progress.

Astrology and me

For anybody reading my blog who does not know this already, I’m Indian.  If you have ever heard the stereotype about Indians fervently believing in astrology, it is true.  There are armies of astrologers telling a gullible nation of a billion people when to plan their weddings, when they should start a business, when they should buy a new house, the list is endless.  And they buy it.  They bend over backwards, arrange everything around the prediction. It is bloody incredible. 

Astrology is an ancient practice, with a mathematical system behind it.  Interpretation is drawn from the positioning of the planets and the stars.  Most modern day ‘astrologers’ are charlatans, not knowing anything about this ancient system. There are a few people who actually have made a study of it and apply it properly, though the real question is, is there is any validity to the system?

Courtesy of Google Images

I don’t believe in astrology. However, I cannot sit here and confidently say that it is absolute rubbish either. Its kind of like my position on god, where I’m neither a believer nor an atheist.  My parents, however, believe in it. They have taken my charts, my brother’s charts, various family members’ charts to the astrologers, and occasionally I am surprised that they get interpretations that accurately sum up the situation, since the astrologers have never met the parties in question and do not have the data to make up something that will fit the case.

But still, I am disposed to definitely *NOT* believe in it.  But every now and then, I hear something that just makes me want to tear my hair out in confusion. In the past 2 months, my parents have taken my charts to two separate astrologers. Both have assured my parents that I *will* get married (My response to that…..HAH + rude finger sign). The part that raises my eyebrows is the following

Both parties independently predicted that there is a strong likelihood for me to meet somebody this year . Spooky bit is that both parties independently predicted that the likelihood arises in the same month- July

One of them said there is a huge protective influence, which will make sure nothing really bad happens to me (enough things that have happened in my life so far make me want to agree with this one)

The other (who has no idea of my pregnancies) told my parents that it was really good that I had not been married till now, because my charts indicate that if I did get pregnant before November 2011, there is a strong indication my life would have been in danger.

This last part is truly the one that makes me want to screech in frustration. Why would they make up something like that? Why bring up pregnancy out of nowhere? Why go and name that one month?!?! Because, adding to the weird factor, my tentative date for trying again is December 2011.

I’ve been wondering why my babies died. My brain just keeps buzzing back to this unanswerable question, picking away at it. I’ve always had this sixth sense about things that proves itself right maybe 50 % of the time.  That little annoying voice has been piping up saying that that there was a reason all of this happened, that I just did not know it yet.

Everyday, my brain is so tired from buzzing around endless explanations, the scientific and the philosophical. Then when my parents relate all of this to me, and the buzzing just rises to a bloody crescendo. Ugh.

Do you believe in destiny? Do you think there is a grand plan to things? Would you buy all of this as whacky coincidence? Feel free to not hold back when you answer.  

Reviewing Doctors

Thank you all who have come by from LFCA to the Good/Bad/Ugly post and shared stories of your doctors. Somebody asked whether I was doing a national listing. Another person asked whether I would be willing to put my review up somewhere else.

The main reason why I wrote those reviews, was to harness the power of search engines. The most direct way to find information about anybody, is to google them.  It is the universal  and easiest way of locating anybody. I hence want to create a page that will contain honest, detailed reviews about doctors from everywhere, that has enough tags, and sufficient hits to pop up on the first search page. This last part is really important. You can write a review about somebody, that might be so far behind on the google searches that anybody who looks for the person will never find them, because your review is sitting on page 6 of the search, in a rarely visited website.

It does not matter if the doctor is American or international.  It does not matter even if they are in a small town on the other side of the world. The point is to put their names, with their hospital affiliations and regions on one giant page, which has all these different tags it can be pulled up by.

I would have to consider how to organize the page if I got a lot of material. I think I will stick with having 3 categories (Good/Bad/Ugly), and then further group by region. International is fine.

So this is the format I would prefer

Refer to yourself by any nickname you choose.  Link to your page if you want.
Choose review category (good, bad or ugly)

List full name of doctor with clinic name, region
Specialty: Example OB/ RE/ Perinatologist 
Description of your interaction

It would be easier if you emailed me the information- my address is Justlookingsd30@gmail.com

Once I have enough, I'll enter all reviews in this new format.

Three short months

I checked the date yesterday and I was shocked that it was exactly 3 months after discovering my second pregnancy had ended.  It blows me away that it has only been such a short time, I’ve changed so much, my situation has changed so much that it feels almost like years have passed.

I’ve traveled 1000s of miles in this time, and I’ve spent one month each in drastically different places, India, California and now New York.

My first month was in India. It was the happiest of these past 3 months, which is mindboggling given that it was immediately after my loss. But---being with family was going into this incredibly comfortable cocoon. It’s the same one I will return to, to fight out this battle of trying to create another human being.

The next month was spent in California, with the stress of moving cross-country while dealing with my new reality. 

The third has been spent in NYC, and here it is the stress of settling into a new place.

I’m just amazed at the speed at which my life has been moving, and the utter lack of control I have over anything.  Its also just bewildering how much I’ve learned in this short time. The most shocking revelation was that my baby had Turners syndrome. Then came the vitamin D story. Then finally came the PCOS story.

Ever so often, you learn something new, often entirely by accident. You start to tug on one chain, and it takes you someplace you had never intended to go. Sprogblogger had recommended Dr. Barad at the Center for Human Reproduction (thank you, sprogblogger!).  Absolutely by accident, I ended up looking for papers Dr. Barad had authored, and found a pretty darned interesting one.

I’ve remarked on this on ‘The science of infertility’ page : I found it very interesting that a lot of woman who had PCOS also had anti-thyroid peroxidase antibodies. I could never think of or find a link.

This paper I just found says, YES, there IS a link between the two, and it comes down to this gene on the X chromosome, called FMR1.

Women who have low copies of this gene product have both manifestations of PCOS and autoimmunity (often anti- thyroid peroxidase antibodies) and have, according to the good doctor, a much lower chance of pregnancy in IVF cycles.

Just another thing for woman having these 2 issues together to check out, if you feel up to it. However, I should add, if you do discover you have this, I think it would end up being a face-palm moment because I don’t see what you can do to fix this. But still, having this information has to give you better clarity in figuring out what your path forward is.

Despite the fact that I have both PCOS AND thyroid issues, my microarray results (gotten a while back) suggest I’m normal for this gene- still, I have to confirm that with an expert. Also, I have no issues in getting pregnant whatsoever, and this paper is all about low pregnancy rates in women mutant for this gene.

But yet, I do have a little piece of my X chromosome missing. Interestingly it is the cytoband adjoining the one that has FMR1. And I’m starting to read more and more that some of the X-linked abnormalities contributing to fertility issues- I think I’m going to have to see a top notch geneticist, just for my own peace of mind.

It never ends.

And a lot can happen in one day, let alone 3 months. I should not be so surprised  (nor unhappy) on account of  the volume of change in this short time.

Stasis sucks.  Rapid change, although disconcerting, is better.