Friday, August 19, 2005

Call back from the nurse

The RN asked me if the RE had planned on any more bloodwork since my recent panel came back normal except for ferritin being dead low.

She said there is a lot that can cause nightsweats but w/o having blood work to show what's going on it's hard to know what the deal is. I noticed as well in doing some searches and looking at my reproductive endocrinology textbook last night that estradiol levels in the late luteal phase is not really something that is covered a lot; it isn't interesting or something.

She mentioned that Clomid might be an option, that the goal was to get me to have a healthy egg and a healthy pregnancy. I totally agree. I told her that the only reason I'm being such a spaz about trying to figure out if there's something we've missed is that I really really really don't want to have another m/c; if I can do anything at all to help prevent it then I will.

I've only been able to try 4 cycles since my fibroid surgery, one of those cycle I got pg and the last one was my first try after my m/c so my stats aren't really that bad again...yet...

Honestly I'm on a much better course of health than I was when I started TTC. I don't have a large fibroid any more, I'm working on building my iron stores, I'm much more relaxed, I eat better and more regularly, I'm not spotting when I ovulate, I don't have BV. That's how I was when I started out. What a winnner eh?

I've had the night sweats for years, I remember them as early as when I first moved to Seattle when I was 23 so it's not a peri-menopausal thing for me.

I'm waiting for the NP to call me back now as my RE is in surgery today. I'll let you know if I find anything out. I'll also bring it up with my acu next Tuesday and find out what her perspective is.

Thursday, August 18, 2005

Chinese Herbs I'm Taking

I just looked up the herbs I'm taking from my acu, the ones I haven't been great about taking lately and if I did they might help out with this. Anyway they contain:

White Peony

Traditional Chinese applications: Blood deficiency affecting the uterus, with irregular menstruation, dysmenorrhea, or excessive bleeding; spontaneous sweating and night sweating; abdominal pain or spasm; pain of the hands or feet; headache and vertigo due to preponderance of liver yang

Dong Quai (or Dang Gui)

Traditional Chinese applications: Blood deficiency syndromes; irregular menstruation, amenorrhea, and dysmenorrhea due to deficiency and stagnation of blood; abdominal pain due to deficiency and cold; pain due to stagnation of blood; traumatic injury; pain and numbness in muscles and joints; boils and carbuncles; constipation due to deficient blood and dry intestines


Some of my symptoms are cumulative over many years, some over the past few years with my stupid fibroid, and then some very recently with my 2 m/cs and fibroid surgery. Boy it seems like I'm getting worse instead of better as I go down this infertility path. It's a good thing that I'm doing what I can to reduce stress, eat better and drink more water or else I would be a complete wreck.

I'm probably going to call and mention my luteal phase night sweats and my weird results with the FM test sticks to my RE's office since when we talked a few weeks ago she said that some women's body reacted more strongly to the drop in estrogen but my pee test shows it was actually an estrogen surge and not a drop.

Stupid Hot Flash or Something

I had a night sweat two nights ago and a hot flash yesterday evening that lasted quite a while. I did a FM test which showed really strong estrogen, stronger than the previous 5 days (mid-LP) which I was testing for just to see if there was any LH or reason to use a HPT (we can all have dreams right).

I read on a menopause site that some women have hot flashes even with elevated estrogen levels. I guess that would be me. But why is my estrogen peaking this late in my cycle (cd10?)(maybe its normal -- see hormonal chart on this page -- but why does it give me hot flashes and night sweats?)

I feel like I'm such a hormonal mess and I don't know if its genetic, environmental or what but for all the acu and herbs I've done (not too many herbs) why is my body still such a freak. I feel broken.

And since my mother's hormonal pattern was really similar to mine and she's recently been dx with breast cancer its even more concerning ya know?

I just came across this page about CFS and some of my symptoms/pattern are there, particularly the kidney yang/spleen qi and kidney qi deficiency. I want to be balanced, not deficient.

The Patron Saint of Fibroids (in Pregnancy?)

I just came across this and I'm fascinated because I know so many women here and elsewhere on the Net who have been through similar trials and yet haven't been beatified. But, at any rate, I guess we have a patron saint.

Gianna Beretta Molla (1922-1962)

"In September 1961 towards the end of the second month of pregnancy, she was touched by suffering and the mystery of pain; she had developed a fibroma in her uterus. Before the required surgical operation, and conscious of the risk that her continued pregnancy brought, she pleaded with the surgeon to save the life of the child she was carrying, and entrusted herself to prayer and Providence. The life was saved, for which she thanked the Lord. She spent the seven months remaining until the birth of the child in incomparable strength of spirit and unrelenting dedication to her tasks as mother and doctor. She worried that the baby in her womb might be born in pain, and she asked God to prevent that."

There's also a web site for The Society of Blessed Gianna Beretta Molla
( Where you can learn more about her condition during her last pregnancy.

Wednesday, August 17, 2005

Crash and burn.

I think something may have been trying to gain a hold but then it didn't work for some reason as my temps the past two days have been down. Last night I had my typical luteal phase night sweat as well.

Here are my temps:

cd9 -- 97.5
cd10 -- 97.5
cd11 -- 97.5
cd12 -- 97.5
cd13 -- 97.5
cd14 -- 97.5 (Ovulation)
cd15 -- 98.1 / 1dpo
cd16 -- 98.1 / 2dpo
cd17 -- 98.0 / 3dpo (NPC)
cd18 -- 98.4 / 4dpo (NPC)
cd19 -- 98.1 / 5dpo (NPC)
cd 20 -- 98.1 / 6dpo (50 mg Rx Prog)
cd 21 -- 97.8 / 7dpo (50 mg Rx Prog) (dip to CL)
cd 22 -- 98.6 / 8dpo (50 mg Rx Prog)
cd 23 -- 98.7 / 9dpo (50 mg Rx Prog)
cd 24 -- 98.0 / 10dpo (50 mg Rx Prog)
cd 25 -- 98.1 / 11dpo

Sigh. Someday we'll figure this out. I wish I knew how to get my body and pregnancies to work together in a friendly long-term fashion.

AF is due on Sunday. It will be good to be done with this cycle so I can work more on building my blood stores.

Tuesday, August 16, 2005

Less is less.

So I don't think there's going to be any good news from me this time and here's why. I used some fertility monitor tests over the weekend (starting Friday I think) and the first one I did was darker for LH than the next two and the one I did this AM showed no LH at all. I also woke up early this morning so my temp isn't good but I still think that if there was something going on this cycle that it ended already.

I know, it sounds depressing and I'll wait it out until the end but I really now don't think anything more will happen for me this cycle.

Maybe it was an early chemical pregnancy.

Sunday, August 14, 2005

Obsessing, Of Course

Who wouldn't obsess with a dip to the coverline (97.8) on my basal chart yesterday followed by a spike (98.6) this morning at 4am (I woke up early due to an uninspired dream that annoyed me). I'm on 8DPO now and I started using my prescription progesterone on Friday evening, after using natural progesterone cream at least once a week since Monday. My experiment on myself this cycle is to see if I can help influence for the better the development of a pregnancy by supplementing sooner since last time with supplementation in my luteal phase the pregnancy developed further along.

I did go down the street this morning to pick up an early pregnancy test* and knowing full well that last cycle when I got pregnant that the day of my temp spike that I tested negative but it was worth a shot. So I tested and it came back negative. Still, that means nothing yet. I'm hoping that my cycle charting program will give me a triphasic message in a couple days and that testing again in a couple of days will give me a positive pregnancy test.

I feel determined to get pregnant this cycle. Our fertility has certainly improved and I'm relatively healthy really. Also, since this is our first cycle trying since the last pregnancy I'm hoping to draft that cycle's hormonal adjustments which should likely have improved my hormonal balance some.

If this cycle doesn't work then I'm tempted to try a few months of progesterone shut-down of my ovaries to help counterbalance my estrogen levels. But I'm hoping it won't be necessary.

Send sticky thoughts.

* When I went to buy the pregnancy test I was one of the first people in the drugstore this morning. I had thought I would pick up a few things but we don't really need anything right now. I thought I might buy a pair of rubber gloves for cleaning but they didn't have any. Instead I decided to buy an electric fan on sale. So I went up to the register with a pregnancy test box and a fan. Trying to make the pregnancy test seem like something that I'm all nonchalant about. But I'm not, so very not as it's been such a journey and these tests represent so much hope and can give so much pain and pleasure. I think that probably there is a story behind every test that is sold and each one is attached to hopes and dreams for better or worse.

Progesterone Levels in Early Pregnancy

In the event that the serum progesterone level is 5-25 ng/mL, further testing using US, additional hormonal assays, or serial examinations is warranted to establish the viability of the pregnancy.
from: Pregnancy Diagnosis

Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages].
From: Luteinizing Hormone Deficiency

...a quantitative serum progesterone level of more than 25 ng per mL (80 nmol per L) proved 99 percent accurate in predicting a living intrauterine pregnancy. Sixty percent of the patients with progesterone values below 25 ng per mL had abnormal pregnancies.
from: Advances in the diagnosis of first-trimester pregnancy problems

Fourteen infertile women and two women with recurrent abortions were suspected of having luteal phase defect (LPD) by BBT charts. In these patients, the midluteal phase serum progesterone (P) levels were determined together with histological examination by the late luteal endometrial biopsies during the same cycle. The diagnostic criteria for LPD was BBT of luteal phase < or = eleven days, mean P level of 3 blood samples taken on three days during midluteal phase was less than 48 nmol/L (15 ng/ml) and the histological dating of endometrium was two or more days behind. The results showed that histological abnormality and low P level were 6.3% and 31.3%, respectively. When histological abnormality combined with lowered P level at the same cycle, the diagnosis of LPD increased to 87.5%. The author suggests that both midluteal phase P level and late luteal endometrial histological examination should be assessed at the same cycle in the diagnosis of LPD. BBT should also be assessed.
from: Diagnosis of basal body temperature, serum progesterone and endometrial biopsy for luteal phase defect

More about Progesterone Testing and the Value of Pooled Progesterone Testing for Luteal Phase Defect

"Single or multiple pooled serum progesterone values have been used between 21-24 days into the menstrual cycle. A progesterone level greater than 10 ng/mL may represent adequate progesterone support from the corpus luteum. Most authors now agree that a single mid luteal phase progesterone level is not sufficient to evaluate the adequacy of the luteal phase."
From: Lutenizing Hormone Deficiency

"Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages]."
From: Lutenizing Hormone Deficiency

"As with many hormones, progesterone levels fluctuate hour to hour and day to day, so that a single level is not always an accurate reflection of ovarian function. Also, it is important that progesterone levels are sufficiently elevated for an adequate number of days after ovulation. For these reasons, it is ideal to check more than one blood progesterone level during the time in your cycle when progesterone levels are the highest, approximately 5 to 9 days after the LH surge. In the pooled progesterone test, blood is drawn on three days between the 5th and 9th days of the luteal phase. Blood samples will be "pooled" together, and a single progesterone level will be determined, representing an average of your progesterone levels."
From Pooled Progesterone Test (PDF)

"The results suggest that the most sensitive and specific prediction of low integrated progesterone (and therefore of LPD) was a value of <30 ng/mL for the sum of three (midluteal) serum progesterone measurements (100% sensitivity, 80% specificity).

Even a single (midluteal) progesterone result of <10 ng/mL was highly predictive of LPD (84% sensitivity, 82% specificity). However, a diagnosis based on a single progesterone determination continues to be controversial. Progesterone is secreted in a pulsatile manner, and serial samples obtained over a 24-hour period can range from 2.3 to 40 ng/mL.3 Such fluctuations raise questions about the reliability of a single progesterone determination for the differential diagnosis of LPD. The pulsatile secretion of progesterone argues for either assaying multiple specimens separately or pooling multiple specimens for processing in a single assay."
From: Progesterone: Physiology and Clinical Utility (PDF)

With a pooled progesterone test you should do it fasting, on any three days during your mid-luteal phase -- 5-9 dpo.

I've also read that luteal phase dysfunction is best tested in tandem with an endometrial biopsy and basal charting.