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Monthly Archives: August 2012

Clomid is a go…mid.

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Popped the first pill about an hour ago. I’m aiming to do daily updates on the effects (hopefully not too noticeable!) so I will keep you all Clomididly posted.
May the odds be ever in my favor.

CD1

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Pardon my MIA-ness, I am currently in Boston visiting Hubs’ family, participating in a wedding, and spending some much needed relaxation time up in Cape Cod and (in a few days) New Hampshire. I’m at the Cape right now in an adorable Bed and Breakfast. The weather could not be more perfect.  Hubs and I shared some great laughs last night, and got to look at the stars at the beach on a perfectly balmy, sea salty air kind of night.

Here’s the update on my nether regions, done in fancy bullet point style because the Cape awaits!

 My period. In a normal world, it would have shown up tomorrow (since I finished my pill pack on Saturday).  I would have a lovely, clear cut, bloody bleed with no question on menstrual flow color or viscosity or what chart day it was. However, because my body would like to continue the tradition of fucking with me, I began spotting thick brown discharge for 5 days up until yesterday when I finally had a heavy-ish flow to the point where I needed a tampon. So I’m counting yesterday as CD1-ish. Which means I start CD3-ish of Clomid…tomorrow.

 My rash: Because it’s been 90 degrees here in Boston (plus humidity) and I’ve been forced to wear pads for the last few days because my flow was annoying enough to warrant them, but not heavy enough for a tampon, I got a really bad rash “down there” (this happens if I wear pads or any type of non-breathable material. Note to self: searing rash on vaginal area does not equal wanting to get busy with Husband. I’m doing everything I can to air out the area and keep it dry, but it’s slow healing. I was laying on our bed last night in a night gown with my legs up near the window AC.

Hubs: Are you airing out your vag?

Me: Why yes, yes I am.

Hubs scrunches nose and makes an “ew” face..

End scene.

 Other body related nonsense: As I was rushing around to pack for the Cape yesterday I ran across the guest room to get something and the cap of my knee connected in a very direct way with a sharp metal corner of the guest bed. The pain I experienced was nausea inducing. After screaming in shock/legit pain, I collapsed on the floor in a puddle of tears, sweat, vaginal rash and old brown menstrual blood. Yes, folks, I lost my shit. I’m doing a bit better now, but the knee cap is still incredibly tender to the touch and I’m walking down stairs like an 80 year old.

The pain of my knee was legitimately awful, but I think part of my mental break was just being entirely fed up with my body. Aches, pains, menstrual blood monitoring, rashes…I just want 6 months where I don’t think about any of this…and I realize that is highly unlikely to happen. Clomid is going to be a brand new ride for me and my body. We’re putting a lot of hopes into this…I just don’t want it all to feel like the hidden metal edge of a guest bed.

Although I will be vacationing, I will give a play by play of Life With Clomid this week.

See spot.

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See Spot say, WTF.

I woke up this morning to thick brown spotting discharge. The stuff dreams are made of. Ortho Tri Cyclen Lo, you have failed me. I had a feeling that the low amounts of estrogen in this pill would not be good for someone like me whose estrogen levels are already crap. (From what I understand, spotting occurs on the pill mainly due to a lack of estradiol). Of course, when I logically brought this up to my gyno as he was giving me the free sample he “poo-pooed” it, and said it would be fine and that many patients like the new “low estrogen” pills. Too much estrogen leads to cancer, yadda yadda… Yes. Yes, I’m sure it does. But it’s because most bodies ALREADY MAKE ENOUGH ESTROGEN.  Can someone tell me why it is that doctors always seem to look at patients as a collection of statistics rather than individual cases? It’s making my menstrual blood boil. Because if my gyno took one look at my labs, he’d see that after 4 months of nary a period, my estradiol levels were basically undetectable. I mean, seriously. I’m not trying to be a pain, I’m not trying to be “special”–it’s just that, well, my case IS fucking special. I’m not like the 90% of women out there who wander in and out of the gyno aimlessly with a huge shit eating grin on her face and blindly take pills prescribed to me. I need a bit more analysis than, “Well, this should work for you because so many women respond well to it.”

Guess what other drug he said this about?

Wait for it…wait for it…

If you guessed Clomid, you’d be correct! As soon as I did my homework on Clomid, I discovered that many women w/ PCOS don’t respond well to it due to the fact that it screws with estrogen levels and lowers them, thus making the uterine lining too thin for implantation. Hot flashes and dry CM are also another indicator of screwy estrogen levels. Many women are even given estrogen supplements along with Clomid to help with these issues. Of course, when I brought this up with him, he gave me the “so many women respond really well to Clomid. You should give it a try” response. Just like he did with this birth control that I had reservations about.

Yes, I know I’m over reacting a bit…spotting isn’t the end of the world, and hopefully it will lead to a full bleed as soon as I stop the pill pack on Sunday. It’s more the feeling that I am not being listened to by my doctor. That I’m being treated like every other one of his fertile patients.

Also: word to the wise. If you’re Googling: “spotting on ortho tri cyclen lo” DON’T go on a run of the mill birth control message board. You’ll get questions like this:

“I already have too kidz, and I’m having brown blood. Does this mean I won ever be able to have more kidzz??!!!?”

Or this gem:

“I’m on ortho lo and I’m 6DPO, but I’m spotting! Does this mean I’m pregnant? CAN SOMEONE PLEASE HELP???”

Really. You’re 6DPO. On birth control? It was all I could do to not hit a “reply” button with a really snarky response. I feel like if you’re taking birth control, you should be forced to know how it works. Like I said, these women just smile, nod, and take these magic birth control pills their doctors shove at them by the fist-fulls, and they don’t have a goddamn clue what is going on in their bodies.

Ugh, it’s so tiring to be up here on this soapbox!

So now, assuming I get a full bleed at some point soon, I might be starting Clomid early next week. We’ll see if my theories on my estrogen levels prove correct this time around. I anticipate lots of night sweats, and thin uterine lining in my future. I’m trying to maintain a positive attitude about it all…but this whole thing feels sucky right now.

Stuff n Stuff

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I realize I haven’t been a good blog tender the last week. This is in part due to the fact that my ovaries are currently in medically induced shut down mode right now due to the pill and partly because I have been sick as a freaking dog the last week. Not just your run of the mill sort of cough sneeze and be done with it sort of “sick”, either. We’re talking fevers, chills, hacking up of viscous fluids and evoking  the voice of Bea Arthur kind of sick. I felt like I was coming down with something right before I left for Santa Cruz, and once I came back 4 days later, it was shitsville. The antibiotics are doing virtually nothing for the cough, but at least I lost a couple of pounds (take THAT weight loss challenge!) and I’m not shivering under covers anymore. Grandma Sunny brought over home made chicken soup yesterday, and Hubs has been making Gatorade pit stops for me, along with wincing every time I have a really good hack and saying, “Hmmm….that really doesn’t sound good…”. He has also become an excellent Lysol spritzer.

In a few days, I hit it to the right coast for Hub’s sister’s wedding, and about 10 days of R&R in Boston and New Hampshire. I am praying the cough subsides soon. This is really freaking annoying.

And now, because I’m sick and lazy, here are some life bullet points to jazz you up on this fine Tuesday:

  • It’s been in the triple digits here in the San Fernando Valley and our home doesn’t have AC (we bought the home knowing that it needed to be fixed, and haven’t wanted to put the 5K into doing it) so I get to hack up my lungs in a pool of my own sweat which is amazing. Really magical.
  • I bought a professional wax warmer and honey wax and waxed my own upper lip yesterday! Not only is my upper lip as smooth as a baby’s ass, I saved $10 or so on a salon wax, which means I only have a about 4 waxes to go before the thing pays for itself. If PCOS is going to make me sprout facial hair, at least I’ll be economical about it. I’m so excited about how easy it was to use this waxing kit that I’m thinking of waxing my legs now.
  • In a “kill two birds with one waxing kit” move, I attempted to wax Hubs’ back for shits and giggles. It was less about shitting and giggling and was more like “holy fucks” and blood curdling screams. Hubs has never been waxed before, so it’s hard to tell if it was more painful than your run of the mill lip wax or if he was being overly dramatic, but let’s just say he got through two medium sized strips on his back and then said, “You’re never touching me with that fucking thing again.” Is it wrong that I was laughing silently and hysterically behind his back as he was screaming after I ripped the first strip off?
  • I’m getting “pill boobs” again. This happens every time I get on the pill, no matter what brand (I think because of the progesterone in the pill?) Basically, my boobs get GINORMOUS overnight. Back in 1863 when I used to ovulate on my own, my boobs would also get huge and tender right before my period. I must admit, I sort of like this side effect of progesterone.
  • I finish my 3 weeks of active pills on Saturday, and then once my period starts, I jump into 50mg of Clomid. My prescription for Clomid says to take the pills Days 3-7, but I have also heard of people doing Days 5-9. Has anyone heard of why this is the case? Anyone had better luck ovulating on one start day vs the other? Does it matter?
  • I bought self tanner, and damn it, I’m going to use it.

Dr. Good Eggs was all he was “Cracked up” to be

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Pardon the puns this early in the morning, but I have a chest cold/flu-like something from hell, and the last of my Nyquil hasn’t worn off yet.

Despite feeling like my chest cavity was being trampled from within by angry infertile midgets yesterday, I made it in to Dr. Good Eggs who really was a “good egg”. Probably one of the kindest, most attentive, and compassionate doctors I’ve encountered. And young and handsome to boot! He certainly lives up to his reviews. Speaking to a professional who knew his way front, back, around and upside down PCOS was very comforting.

After spending over an hour (!!) reviewing my charts with me, he let me know that based on the blood work I’ve had to date, he suspects that insulin resistance is my primary reason for anovulation. He stressed that it was imperative that I try Metformin (again) and that I stick with it for up to 6 months. I explained the intestinal issues I’ve experienced on it, and he says he wants me to try a very slow ramp up this time, taking about 1 month to get up to 1000mg, and then another month to get up to 2,000mg. He said I could try the slow release formula, but that the clinical studies he’s seen show much stronger results with the standard release formula, and I said, “bring it on”.  If I’m going to do this, I’m doing it right. In the meantime, he is having me do a 3 hour fasting glucose/insulin test that is only done between days 1-10 of my cycle (I forgot to ask why!)–I’ll have to wait a couple more weeks for that one until I get my period from the pill. He’s also giving me a very sensitive testosterone test, as he said my levels are very high right now (62 free) but he’s not sure what sensitivity the test I had was. He says at their lab, anything over 35 is considered high.

He wants me to wait until after my glucose challenge to start to Met so we know my baseline numbers. In the meantime, he says that a round of Clomid should be fine with or without the Met.

And now for question time!:

1. Looking at my ultrasounds and the fact that my ovaries are covered in cysts, how will that effect ovulation moving forward. Will my cysts block future ovulation?

It was once thought that cysts could actually block future ovulation from occurring, but it has been shown that this is not the case. In other words, just because your ovaries are cystic landmines of ASS doesn’t mean that with the right meds, you won’t be able to pop out a good egg.

2. Most of my results are in the borderline “normal” range–this means they are often one or two points off from being too high or too low (my A1c test that measures my blood glucose levels over 3 months is one point away from being too high). My question is: is a borderline “normal” number the same as a low high number? My thyroid, Vitamin D, and DHEA numbers are also borderline.

The borderline numbers are not an issue. He wasn’t too concerned with any number except my glucose levels.

3. Has he seen women with this severity of PCOS get pregnant with Clomid or other fertility injectables, or is it generally through IVF. What has been the most effective form of treatment that he has seen for infertility in people with similar cases to mine.

Metformin has been very successful when taken consistently for long periods of time. He has also seen many women respond very well to a combo of Met and Clomid. Then again, he made no promises, and said that it’s hard to tell exactly how each body will respond to all of these drugs.

4. Does his course of examination/ treatment of thin women with PCOS differ from obese women? How so?

It’s not really about being thin or obese, it’s about what your goals for the treatment are. Many obese women have a goal of losing weight. In my case, it’s pregnancy–so he’s going to work with me in the best way he knows how to make that happen.

5. Has he noticed a correlation between frequent yeast infections and PCOS? If so, why is that?

Forgot to ask that question!

6. Are FSH levels that are not taken on Day 3 still accurate? Meaning, do they accurately reflect my fertility? I have been concerned because my FSH levels have gone steadily upward over the last 2 years, but none of my FSH levels were ever drawn on Day 3.

There is a possibility of inaccuracy if not taken on Day 3. He is not concerned with any of my levels (8.2 being the highest), but said that it’s good that I’m “getting the show on the road” right now.

7. Why did I have one ovulatory cycle after birth control? What did the hormone in the pill do to trigger my natural ovulation the month after I was off the pill?

There is still no definitive medical explanation for why the pill helps some women ovulate shortly after getting off of it.

8. My estrogen levels were very low after 4 months of not ovulating, and my uterine lining was basically non existant. What does this indicate? Has my body stopped producing natural estrogen? Are signals crossed? Are the receptors on my cells blocked by pill hormones? Will estrogen pills help build my lining? Would he recommend estrogen supplements if I were to go on Clomid?

Forgot to ask him this question too. Bad me.

9. Would it be wise to do a scan of my pituitary gland to see if there is a tumor?

No, he doesn’t recommend that at this point. My levels are not off enough to warrant it.

10. What about my thyroid? My numbers there are borderline. Could there be an issue?

My thyroid numbers don’t seem bad to him at all. He likes to see anything lower than 2.3, my lowest was a .78 but he didn’t seem concerned with it being too low. My others came in the low 1’s.

11. Does he have an RE he trusts to refer me to?

Yes, he referred me to two, both PCOS experts in their field!

12. What are the blood tests he finds the most informative when dealing with PCOS. Is there any that I am missing?

The glucose tests and the testosterone tests as well as the LH/FSH ratios are all important. Thyroid is too. I’ve had every important test except the 3 hour fasting glucose/insulin test that he recommends.I’m getting that test done any time between Days 1-10 of my cycle.

A little extra tidbit of info is that interestingly, the majority of obese women with PCOS don’t have skewed LH/FSH ratios, whereas the number of thin women with PCOS do. Mine are all at least 1.5/1 or 2/1 in some cases, when they should be 1/1. Weird!

I have a 6 month follow up appointment scheduled with him to see how I’m progressing. We will do another glucose tolerance test at that time to see how I’m responding to the Met.

Endocrinologist Day Is Here!

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Yahoo!!

Today is my first consultation with Dr. Good Eggs. Although my first appointment was scheduled for October 3, he had a miracle appointment open up this week and I snagged it like a crazy woman at 3AM on a Black Friday wedding dress sale.

The doctor has all of my files to date, and I received no less than 3 calls and one letter confirming that I am keeping my appointment today. Clearly this guy is in crazy demand–liquid gold for the ovaries, me hopes!

Although he is not a reproductive endocrinologist specifically, he does specialize in PCOS related hormonal disorders. I’m hoping that he can decipher some of my blood work done to date, order some new tests, and give me some hope that pinpoints the root cause of my severe PCOS.

Questions I am going to ask him:

1. Looking at my ultrasounds and the fact that my ovaries are covered in cysts, how will that effect ovulation moving forward. Will my cysts block future ovulation?

2. Most of my results are in the borderline “normal” range–this means they are often one or two points off from being too high or too low (my A1c test that measures my blood glucose levels over 3 months is one point away from being too high). My question is: is a borderline “normal” number the same as a low high number? My thyroid, Vitamin D, and DHEA numbers are also borderline.

3. Has he seen women with this severity of PCOS get pregnant with Clomid or other fertility injectables, or is it generally through IVF. What has been the most effective form of treatment that he has seen for infertility in people with similar cases to mine.

4. Does his course of examination/ treatment of thin women with PCOS differ from obese women? How so?

5. Has he noticed a correlation between frequent yeast infections and PCOS? If so, why is that?

6. Are FSH levels that are not taken on Day 3 still accurate? Meaning, do they accurately reflect my fertility? I have been concerned because my FSH levels have gone steadily upward over the last 2 years, but none of my FSH levels were ever drawn on Day 3.

7. Why did I have one ovulatory cycle after birth control? What did the hormone in the pill do to trigger my natural ovulation the month after I was off the pill?

8. My estrogen levels were very low after 4 months of not ovulating, and my uterine lining was basically non existant. What does this indicate? Has my body stopped producing natural estrogen? Are signals crossed? Are the receptors on my cells blocked by pill hormones? Will estrogen pills help build my lining? Would he recommend estrogen supplements if I were to go on Clomid?

9. Would it be wise to do a scan of my pituitary gland to see if there is a tumor?

10. What about my thyroid? My numbers there are borderline. Could there be an issue?

11. Does he have an RE he trusts to refer me to?

12. What are the blood tests he finds the most imformative when dealing with PCOS. Is there any that I am missing?

I feel like I’m forgetting about 10 billion questions, but I think this is a good start for Good Eggs. Any other glaring questions I’m missing?