Cycle 2 of shut-down, also a fail!

Well, not going to try the "third times a charm" theory.  I used the progesterone cream days 7-26 and still ovulated on day 37 and had a 15 day luteal phase (longer than usual - unless TCOYF and I are both off on O date?).  I don't think that I will go for another shut-down cycle, seems to not be doing what it's supposed to do and just delaying ovulation rather than suppressing it which is making for longer cycles than before even!  So.... not really sure what's next.  Menses started today, will think more about it tomorrow.

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!

Finally... ovulation, whew!

Crazy cycle finally balanced out and I ovulated last week. I am glad that's finally done with and I can relax and look forward to the next cycle. I feel good and temps seem to be nice and high, so hopefully progesterone and my body's response to it is improving. Time will tell. Here's to 12 days of rest...

Plans (occupying my mind)

Hanging in here!  I am trying very hard not to look for signs, but it's hard!  8dpo and nothing exciting to report, my lp is 12-13 days normally.  We'll see.  I try to use this time to consider the cycle and what worked and what changes, if any, to make for next cycle should it come (that way I have something to look fwd to if af shows).  I am thinking that I will take the soy isoflavones again at 150mg days 5-9 and I also will commit to getting maca in me.  I really, really dislike the taste of maca and just cannot get it down in smoothies or by just guzzling it in a bit of water (that was about disastrous).  I am planning to capsule it and commit to taking 4 capsules a day which should equal 2 tsp.  Starting Monday, I also plan to exercise for 30 min daily whether af comes or not, and work more on eating well - low carb whole foods.  I did get a menu made for this week and did grocery shopping based on it yesterday so that shouldn't be too hard!

Oh, one thing to make note of is that I have had the sciatica pain on my right side and that strange itchy nerve pain in my right hip for the past 4 days.  It seems to be subsiding today.  Very annoying, painful and frustrating!

Some improvements this cycle

Well, my chart looks even better and ovulation came a few days sooner and definitely stronger than last month... now we are in the two week wait which can be so hard, but I try to look at it as a break from all the tests and observations that I have to be so careful about in the follicular phase, I still temp and track cm but no OPKs, no microscopes, and it's just waiting.  :-)  I am encouraged by this cycle so far.

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!

Not this month...

Still a very encouraging cycle.  Temp finally dipped below coverline this morning and I can feel af on her way.  I tested with a First Response on Sat morning (12dpo) and it was negative.  I had been hopeful as I could see a true ovulation.  I do still think that ovulation was "weak" and the corpus luteum was definitely not producing sufficient progesterone as the temps were barely above coverline.  I hope to see more improvements on the next cycle.

We are thinking and praying about the next steps and will update here as we decide.  Thanks for your prayers and support!

Ovulation!

I am so excited!  By all signs, it appears that I have actually ovulated and my charts looks so beautiful to me. :-)  Check out the TCOYF chart in the sidebar link --->.  I am in the lovely 2ww, actually half way through it now, so we shall see... I may start testing the middle of next week because if I get a + I want to get a progesterone test ASAP.  Pray for us!