35 week update

Can.not. believe that we are at week 35 already!  It is amazing how quickly this pregnancy has gone by.  Sad and exciting all at the same time.  :-)

I had my final progesterone blood draw at the lab yesterday.  Level was still just below level 2 (see chart at top) but NaPro doc says I can go down to 100mg for 2 more injections and then be done.  Hooray for no more needles!!!

Home visit with the midwives is this Friday so I am furiously intending to clean the house the next few days.  Ha ha!  We'll see what I actually get done.  I have had a lingering cold for almost 6 weeks now and am just starting to feel a bit better.  I tell ya - it is no fun to have sudden, intense coughing fits while having a 5# baby squishing your bladder.  I also pulled a belly muscle during one fit, thankfully that healed up quickly as it was rather painful.

Otherwise, I am feeling good.  Very little swelling, blood pressure still fine, blood  glucose readings have been good, urine stick readings are all good, baby is moving lots.  Little monkey still likes to go breech and transverse often, but seems to be starting to settle down in a good position.  I am still visiting the chiropractor weekly for adjustments and that keeps me walking at least.  I have regained all the weight I worked so hard to lose last year, but that is just how it goes.  It's been hard to exercise the latter part - especially with this cold.

All birth supplies are gathered and ready to go.  It's amazing to imagine birthing our baby.  I can't wait!  I love birth - yes, it is hard work but it is such an incredible process and the reward is like none other.  Prayers for all to go well are much appreciated.

Birth story will likely be when you hear from me again - in the next 6 weeks or so, unless something exciting happens in the meantime!

21.5 week update and progesterone chart

Quick update.  All is going well with pregnancy.  I am feeling good, blood pressure is good, blood sugar readings are good.  Weight gain - well... we are at 17# gained so far, which is hard for me after working so hard to get it off BUT at the same time, I am not swelling, I am walking 2 miles a day and watching my diet pretty closely SO I am not going to worry, it's for a good cause!  :-)  I am having some pubic symphisis pain and am seeing a chiropractor every week or two which seems to be helping.  All of these appointments and labs are pretty crazy - I am running somewhere at least 1 day a week!

My Dr in Richmond is "unexpectedly out of the office for an undetermined amount of time" and so my progesterone monitoring has been transferred to Dr Poehailos in Charlottesville.  I met with her yesterday to get established under her care.  She said all is good and wrote me a new lab order and new rx (closer compounding pharmacy and cheaper - yay!).  My results from this week were lower, just barely down into level 1 so we have bumped my doseage back up to 200mg 2x weekly.  She gave me a chart and we plotted my results for the pregnancy thus far - it also shows expected level and treatment for the various trimesters.  I love the visual and being able to see where we are and want to be!  :-)  I will post it at the top of the blog here and keep it updated so those interested can see and be praying.

That's about it for the update so far.  I have a good bit of the "nursery" (a corner in our room) done and have recieved my first order of cloth diapers.  I will post pics soon.

Progesterone Levels update

Here are the nitty gritty details of my progesterone levels through this pregnancy:

Week 5 - 10 progesterone / hcg 1374 (started 200mg injections 2x weekly)
Week 7 - 16.2 progesterone, still level 1
Week 9 - 16.5 progesterone, still level 1 / hcg > 118,000
Week 11 - 19.7 progesterone, still level 1 (added 300mg suppositories 2x daily)
Week 13 - 36.1 progesterone, level 2 (stopped suppositories, continued injections)
Week 15 - 34.9 progesterone, level 2
Week 17 - 46.3 progesterone, level 2 (lowered dose to 100mg injections 2x weekly)

All progesterone is natural, bio-identical.  I much prefer the injections (which my husband gives) to the suppositories (messy and time-consuming!).  Hoping I get to wean off more soon though.  :-)

Care is through my NaPro Doctor and the recommended levels/doses for PCOS (corpus luteum deficiency) patients.  So thankful for them!

Radiology report

NaPro Dr kindly forwarded me the radiology report so I could read for myself all the details (fitting, since they ARE my ovaries - why we don't get them automatically is beyond my understanding!).

Here we go - FINDINGS:
"Examination shows endometrium to be normal for age with the uterus measuring 8.5 x 3.1 x 4.9 cm. Calcification is suggested adjacent to the cervix which could be seen secondary to prior inflmmation or delivery. The right ovary measures to 3.7 and the left to 3.4 cm in size. Multiple cysts are seen bilaterally within the ovaries with the largest on the right measuring 2.3 cm and the largest on the left measuring 1.9 cm. No free fluid is identified. Small nabothian cyst is noted which may reflect earlier inflammatory or post surgical change."

My NaPro doc said that the larger cysts are consistent with physiologic follicles (follicles preparing to release an egg). He also said that he can't tell from this report whether my ovaries are consistent with PCOS or not. The cyst and calcification on my cervix was not mentioned to me by either doctor, but is a bit alarming to me.

So... now what? I don't know. My NaPro Dr. has moved to MO and requested that I find local care. :-( The family doc here offered me a referral to the ob/gyn in their practice and I may take them up on that for further testing and treatment. Planning to sit down with my hubby tonight for some R&R and discussion.

Appt yesterday and another Monday

My NaPro doctor moved from NC to MO and he has been helping me via e-mailed charts and prescriptions, etc... This last cycle just was not looking as good BBT wise as the previous one and I was asking him what else we could do. We discussed upping my meds dose and he recommended getting an ultrasound of my ovaries prior to that so that we could make sure there were no large cysts or a lot of unruptured large follicles. I found a family doctor locally who would see self-pay patients (harder than I imagined)! I met with him yesterday. We talked for a while about my history, current treatment, what I needed and he palpated my belly and pretty quickly found my right ovary seemed enlarged and likely cystic. I guess with PCOS, that isn't a big surprise, but I was still disappointed. We have the ultrasound scheduled for Monday afternoon to get a good look and see what is going on there, how many cysts, how large, what kind and how the follicles are looking. It's a relief to finally be getting a "look-see" but intimidating nonetheless. I am also considering and discussing with both doctors trying to get an hsg done to check on blockages and see what my tubes and uterus are looking like... costly, but seems worth it? We are also going to check into getting a semen analysis done, it hasn't been pushed by doctors since Tom is "proven" :-) but a lot can change in 10 years and he is around a lot of chemicals and nasties in his work, so probably worth another check. We figure that throwing over $200 at meds a month, we should be good and certain nothing else is blocking the way. So, that's the update here. It's funny, now that the Dr. pressed on my ovary and I felt what it felt like (tender), I can find it now and feel the cysts. Eeek! I am nervous about the news of what all we find in there.

I've been feeling a little more "off" for the last 2 1/2 weeks. Ever since 10dpo last cycle, not sleeping real well, night sweats, temps erratic. Grrrr.....

May & June cycles

We gave in and have tried some new meds the last 2 cycles. I have taken Femara (letrazole) days 3-7 and hcg injections days 3,5,7 and 9 dpo. These are to stimulate a stronger ovulation and to jump start the corpus luteum into producing progesterone. The cycles have definitely improved, but I am not yet pregnant. They have both been 35 days long and ovulation occurred around day 20 which makes my lp go from 12 days to 15 days - very nice! I am encouraged by these things and thankful that my follicular (estrogen dominant) phase and luteal (progesterone dominant) phase are waaaay more balanced - this is so much healthier for me over all. My bbt chart the 1st cycle on the meds was beautiful and I was very hopeful. The 2nd cycle (ended yesterday) was not as good, temps went up a bit, went up some more but then by 10dpo they were dropping and stayed just barely above coverline the rest of my lp. I also had a tiny bit of spotting on 10dpo and a headache the day before menses (with migraine "aura" the night before the headache), all of this indicates low progesterone to me. So... keeping on keeping on. Sent an e-mail to my Dr and FP tonight to see what's next and if any changes are in store for the next cycle.

Discouraged

Well, here I am at cd43 and no sign of ovulation or af yet. It is very discouraging to say the least. I am feeling okay, have had a few days of being moody/angry - my joints are pretty achey - I am tired. I actually am wondering about my thyroid, I had a temp of 95.8 this morning - eek! I have been having cold hands and feet again too. Bummed 'cause it was doing so much better, wonder if I am sensitive enough that the leak in Japan is bothering me? I stopped all supplements this month except the Metformin, wasn't really a conscious decision - just got so busy. Just had a phone consult with my Creighton Practitioner and sent off an e-mail to my NaPro Dr. I am hoping that my 8 months of charting and almost 6 months on Metformin will earn me something... labs at least? I am getting tired of being patient, especially when I'm not seeing improvement. So, that's where I am currently. I'll keep ya posted!

Cycle update

Okay, so haven't updated here this cycle yet - in short, it's been disastrous!

I upped my dose of soy iso like I had planned and I have been spotting continually, estrogen has been spiking and plummeting making my bbt chart look like the rocky mountains. I so rarely have mid-cycle spotting that this has been very strange for me and discouraging. I literally have spotted 20 days out of the 26 days so far in this cycle, and am annovulatory so far.

I now feel guilty for taking the soy against my better judgement, it was a "compromise" to hopefully avoid the clomid or femara. It has really messed me up this cycle and I pray it clears quickly and we can move on. This has likely set me back with the Dr. at least 2 months as far as getting labs done and moving on... :-( He knew I was taking it and even said last month that it seemed to be helping along with the metformin, but it wasn't prescribed.

Today, I am very crampy and have leg aches and twinges in my R sciatica, I am very hopeful that this is the end of the cycle coming... but hard to say. I'll let you all know how next cycle works out.

Thanks for your prayers and hanging in here with me.

Book notes

Finished reading The NaPro Technology Revolution:  Unleashing the Power in a Woman's Cycle. Yes, all 400 pages of it!  It was good, enlightening, sobering, encouraging and overwhelming all at the same time.

Here are a few notes that I took:

In PCOD women, 61% of their ovulations (often 6 or fewer per year) are defective in some way.  That alone drastically reduces chances of conception!  That means if I ovulate 6 times this year, only 2-3 of them will be viable chances... a woman of normal fertility would have 12-13 chances in a year.

Androgen levels can be treated medically, but the gonadotropin levels respond only to surgery.

Benefits after surgery (ovarian wedge resection) include:

1. decrease in testosterone, free testosterone, androstenedione, & DHEAs. 
2. LH comes down significantly while FSH remains the same - correcting the ratio
3. over 90% return to regular cycles.

Long-term medical impact from PCOD (besides the obesity, abnormal hair growth, skin problems):

1. 7x increased risk of heart attack and heart disease due to lower HDL, higher triglycerides, higher homocysteine levels.
2. by age of 40, 40% of PCOD women have Type II diabetes
3. increased risk of endometrial cancer due to elevated insulin levels and unopposed estrogen (because of long follicular phases without ovulation to produce progesterone).
4. 3x increased risk of postmenopausal breast cancer
5. increased risk of hysterectomy because of dysfunctional uterine bleeding
6. ovarian cancer risk increased
7. women with PCOD are more likely to have chronic fatigue syndrome

He states that all too often we are asking "Is ovulation occurring?" when we should be asking "Are there defects in ovulation?"
Quote:  "In actuality, when one studies ovulation closely by daily ultrasound and hormonal parameters, one realizes that there are a number of different "ovulatory events" that mimic ovulation but are either completely annovulatory or represent a significant defect in the ovulation mechanism.  An example of an ovulatory defect that is anovulatory is the luteinized unruptured follicle syndrome.  An example of an ovulatory defect in which the ovulation process is significantly defective is the immature follicle.  While ultrasound is commonly used in the ART programs to monitor ovulation inducing medications, it is rarely used for studying spontaneous ovulation patterns and their defects.  The latter is extremely important if one is to design treatment strategies that meet the specific demand of the underlying problem."

It goes into descriptions of several different types of ovulatory dysfunction and the follicular and luteal phase deficiencies associated with them, along with symptoms.  Intriguing and mind boggling!

Currently reading...

The NaPro Technology Revolution: Unleashing the Power in a Woman's Cycle

by Thomas W. Hilgers

Very impressed so far, will update once finished.  Thank you LaDean for sending it to me!

Brief update

I just had a lovely chat with my Creighton practitioner.  I just love her.  It is so encouraging to hear that you're on the right track.  She is going to look into some things for me and I am also going to contact my Dr at the end of this cycle with all the info I have gathered (my bathroom looks like a lab -seriously!) and see about some more aggressive / long-term treatment.  Waiting is so hard and it seems we've been on this track forever - even though it's really only been since August since we've been actively pursuing this!  I am still encouraged with my temps, have only had one dip in the 19 days of this cycle - much more stable so far which is encouraging.  Still waiting for my peak this cycle but feeling much more positive thus far.  Tom has been doing my CrMS charting for me each night - somehow that helps my sanity lots!  :-)  That's it for now...

A new month, a new cycle...

Feeling a bit encouraged this morning.  I had a rough week last week, feeling very moody and overwhelmed and confused.  :(  However, last night that cycle ended - AND it was right when I predicted that it would come.  My peak day and probable ovulation was on day 30 which gives me a 12 day luteal phase.  I say probable because while cm and ferning support this, it wasn't a very strong shift in temps - you can see a gradual shift but the variance wasn't great and it's not a good indication.  Dr. Yeung thinks that I am ovulating but not very strongly or adequately.  The corpus luteum is not producing enough progesterone to support a pregnancy (build a lining).  The corpus luteum could be underdeveloped due to insufficient FSH or my ovaries not responding to the FSH... need to look into that more.  We will be doing progesterone blood levels on peak day +7, +9 and +11 of this coming cycle to confirm this.  I am taking the antibiotic during menses right now in hopes that it will clear up any other reason for the continuous cm and make identifying peak more clear.  Please pray for my ability to easily identify peak day this month!

NaPro Dr appt update

Hi everyone!  We are sitting outside Duke having ice cream and I
thought I'd send an update.  The appt went fine - quick, but Dr Yeung
did a good job answering our questions and concerns.  I have a script
to get lab work done to check on my kidneys and liver and cholesterol
and if they check out fine then I have a script for Metformin which
will help with insulin resistance and weight and lowering
testosterone.  It may help me to ovulate.  He said my cervix looks
fine and I have great CM.  :-).  He did give me a script for an
antibiotic too to see if that clears up some of the continual CM.  He
said he does not suspect endo based on his exam.  He reinforced the
fact that there is no cure for PCOS and the 3 options for treatment if
one wants to conceive are Met, Clomid and Femara - the other 2
stimulate ovulation and he admitted are less of a long-term help and
more of a band-aid fix.  We were clear about wanting my long-term
health to be top priority but that we would love to be fertile also!
I am to stay in touch with LaDean and to send Dr Yeung my chart and an
e-mail every 3 months or if anything changes.  If I become pg, I need
to notify him right away so he can order a lab for a progesterone
test.  I think that's it!  Let me know if there are any ?s.

On the edge...

... of the unknown.  I am excited, nervous, a bit scared, mostly excited!

Tomorrow is my appointment with my NaPro Dr.  :-)

This will be my initial visit and some testing, possibly ordering some labs and getting some prescriptions, maybe an ultrasound to see my ovaries, possibly discussing a lap to check for endometriosis... just guesses.  I am working hard on not obsessing and trying not to get carried away with attempting to predict and prepare for every possible scenario.

Last week I was going kinda nutso, Tom and I went out for dinner and left the kids with our wonderful friends.  It was so good to talk about my feelings with him.  I was feeling a little alone on the fertility train... but he really is right there beside me, holding my hand, making sure I don't jump overboard with crazy obsession and paranoia.  He is so good for me.  I started into a long discussion about how I am doing this and this and I think this will happen and what if this happens and what do we think about this possibility, on and on.  He looked at me and said "Above all, I want you to be healthy and with me for as long as possible.  If getting you healthy means we can have more children, I would love that.  We will not take short-cuts and do things that may harm you.  Let's see what the Dr finds and recommends and we will ask questions and research as things come up.  I love you.  Calm down."  (Paraphrased but that's the gist.)

I've been much better since then.  :-)

I know that while I have all the daily charting and testing and observing and temping and things that I can do and be absorbed in, it may seem that he is hardly participating (except obvious necessities, ha!)... but that is not the case.  I know that he is thinking about it and working very hard to stash away money for treatments and probably bearing more of the burden than I realize.

So, pray for us!  We are leaving at 9am and have a 2 1/2 hour drive to Duke University.  My appt is at 1:30pm.  I will post an update here as soon as I can.  We are driving another 4 hours down to SC to see some wonderful friends and spend the weekend with them.  It will be very nice.  Thank you!