Fatigued

I know I'm out of shape, since with the miscarriages and surgery and anemia my body was feeling like hell; and then my back was terribly out of alignment as well so that caused further reasons to not want to move. I've been taking my iron for months to try to build up my iron stores but now I need to start dragging my butt out to get it moving to start gaining some more strength and endurance. Also, aerobic activity helps to promote the production of more red blood cells so provided my iron stores are closer to a normal range it should help build my blood oxygen in many ways.

I went skiing yesterday for the first time since 1989. Yes that's right, I haven't been downhill skiing since the 80's. In addition to my known fatigue I also knew that my muscles are a little weaker so I had to pay attention to how tired I was to make sure that I wouldn't injure myself by overdoing it. I only did four runs down the mountain before I finally fell (only once all day!) and decided that it was time to rest. My partner and friend went back out in the afternoon but I just rested in the lodge. On the way back home I was falling asleep in the car (unusual for me) and I went to bed at eight-o'clock and slept for eleven hours. How's that for fatigue?

Here are some links about fatigue that I found:

Fatigue: When to rest, when to worry

Anemia and Fatigue

Anemia Symptoms

Puzzled by fatigue: what can I do when my doctor says my lethargy is caused by stress and that there's nothing wrong with me? … and more of your questions answered here

Precaution Can Be the Best Remedy for Skiing Injuries

The short list of things to rule out

Still working on taking my break. Aside from marking down my period on my charting program and taking my first temp of the cycle (just to make sure it dropped appropriately) I haven't been charting or temping this cycle. Feels a little liberating.

I was talking to my partner the other day, and I told him that I feel as though there is something fundamentally wrong with our fertility -- though I don't know what it is. I see gals with fibroids getting pregnant on enough boards to know that fibroids alone aren't necessarily the only thing that causes infertility, though I know enough post myo gals to know that lots of them are having similar experiences to mine as well.

I've probably done this before but here's my list of things that might be possibly impacting our fertility without going out on too much of a tangent.

FEMALE	MALE
Anemia - low ferritin Low Progesterone	SCSA - sperm DNA fragmentation Repeat semen analysis (#8?)

I don't want to go in for a consult right now as that would make me cry and I'm trying to not put myself in situations like that right now. I called over to my favorite assistant at the RE's office and asked her to see about my getting my ferritin rechecked (since all evidence I've found online indicates that a level less than 40 can impair fertility) and a pooled progesterone test.

I can get the ferritin done at a lab, totally innocuous and generic place that I've been to before -- I think that will be less emotionally loaded for me. As it turns out the lab is way faster than the hospital lab was the last time I had it checked. I've heard that you can get your blood work done whereever -- and particularly for standard tests, as many hospitals and clinics are sending their lab work out of state because it's better for them, you as the patient might want to intervene and make sure that those cost-savings are yours or at least you are getting the benefit of the quick local turn-around. My ferritin test in July took about 3 weeks to get back. This lab can get it within a day or so -- they run the ferritin tests daily.

Then the pooled progesterone test, the assistant told me that my RE said that she didn't think that a pooled progesterone test was indicated by our infertility but that if I wanted to do it she would order it. I explained to the assistant that I had seen other REs, specifically as my first RE left the state, and that one RE in particular thought that I would need progesterone support on any cycle I was to conceive and that all of my progesterone tests had been on the low side. She said that was why working with more than one RE was difficult as they would of course have differing opinions. Still, I was welcome to do it if I felt like it would be helpful to me -- and evidently the other RE working in the same practice as my RE does do them frequently. I told the assistant that I would probably wait until the new year but at least I've gotten that sorted out.

So, I've got an RE not on the up and up with progesterone -- or rather definately not in the progesterone camp. Is that enough to consider working with someone else? Or should I just stick with her and just demand the care that would make me feel more secure -- particularly if I get pregnant again -- such as weekly progesterone draws until I'm out of the danger zone? Why does it have to be this difficult?

Then for all my spinning of wheels, it might not be me, it could still be the poor sperm morphology that's challenging things. Ugh, but with all that blood loss last June from the last miscarriage and how awful I felt subsequently, plus a couple of cycles that don't make sense (did something happen but not take hold?) I should at least rule out the impact my anemia might be having.

Interesting info about Anemia and Infertility

"Be sure your iron levels are adequate. A blood test (a ferritin level combined with an iron level and iron binding capacity) will tell you this. Unfortunately, doctors are trained to say the iron is normal if your ferritin level is at least 9 ng/ml. Although a ferritin level of 9 shows you have enough iron to prevent anemia, one can have infertility from ferritin levels less than 40. Because of this, I would look at your ferritin test results yourself and make sure the level is at least 40 ng per ml. In a study of women with infertility with ferritin levels less than 40, half of the women quickly became pregnant when put on iron. If for some reason you are unable to get your ferritin level checked, it is not unreasonable to take iron (e.g. Ferrous Sequels 1 tablet 1-2 times a day for four months). I also would take iron if the percent saturation of iron (calculated from the iron & percent saturation tests noted above) is under 22%."

From: Effective Holistic Treatment for Infertility
By Jacob E. Teitelbaum, M.D.

In a letter to the Editor of The Lancet, a group of British physicians has presented evidence suggesting that depleted iron stores, as indicated by low serum ferritin levels, may prevent conception.

A total of 113 women with increased scalp hair shedding associated with reduced serum ferritin values (40 ng/ml or less), were treated with daily supplements of 35 mg iron and 200 mg vitamin C to achieve optimal hair growth. Seven patients became pregnant during treatment. Three of the seven had histories of infertility and the other four had not become pregnant before iron/vitamin C treatment, despite regular menses and unprotected sexual intercourse. All seven conceived within 28 weeks of starting iron and vitamin C, and all had shown substantial increases in serum ferritin before conceiving.
From: Serum ferritin and fertility

In slim women with PCOS, a SHBG is particularly helpful. This will usually be below a level of 80 IU/l. The serum prolactin level will be modestly raised (>350 IU/l) in about 15% of women with PCOS. A high proportion of women with this condition will also have a low serum ferritin. This is probably caused by raised levels of insulin-like growth factor III in response to hyperinsulinaemia. The raised IGF-3 levels inhibit the production of transferrin, which will then reduce iron absorption. Correction of any iron deficiency is particularly helpful for women with scalp hair thinning and for women with PCOS-associated sub-fertility. A ferritin level of >50 ng/ml is generally needed to meet the iron demands of any pregnancy.
From: POLYCYSTIC OVARY SYNDROME AND THE USE OF METFORMIN

Women's Health: Iron May Be the Answer for Some Infertile Women, U.S.News.com 10/31/06

My ferritin two years ago was at 22, I took lots of iron and got it up. After my June miscarriage my ferritin was down to 9 and I still feel it being low. My new ob/gyn said to just keep taking iron and that I'll have to take it through my entire pregnancy (we are still optimistic that this can be done).

I think I explained about Ferritin elsewhere, but it is a protein that your body uses to store iron in the body, this site is interesting and confirms what my naturopathic doctor and acupunturist have told me about anemia/blood deficiency-- plus what I myself have experienced:

"Chronically low iron causes numerous adverse changes in your immune system, resulting in recurrent colds, flus, & other infections."
(from: FERRITIN)

Anemia and Copious Cervical Mucus

I came across this today and thought how interesting that my copious fertile quality cervical mucus was actually associated with my anemia.

"Anaemias are usually accompanied by an increased amount of L and S mucus. After treatment, these symptoms cease."
From Diseases and the Billings Ovulation Method

S- refers to "sperm-transmission" mucus (the kind that lets the sperm through easily) L - stands for "locking-in" mucus "because of the capacity of that mucus to attract and enclose malformed sperm"

One more sign of anemia to watch for.

I was at two parties yesterday with lots of kids. I kept getting asked which one was mine (*sigh*) and then someone pointed out that we were one of two couples there without children. Nice. Yeah, we actually do have babies. Dead babies. The first one's due date was in February and the second one was due in January next year. There's no winning the infertility game.

See also: Treating Anemia/Iron Rich Foods and Advice to Someone Trying to Build their Iron Stores

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.

Low Iron Stores!

I knew there was something wrong with me. I just got my last test result, my ferritin level, which measures one's iron stores, was 10. The scale is 10-282 so I'm at the bottom of normal. Actually a gynecologist a couple years ago had me taking extra iron to get up around 30, so I've got a ways to go still.

I think the extra iron in my diet has helped to get my red blood cell count and hemeglobin back up to normal, largely drawing from my iron stores, or at the expense of them. I need to keep taking more iron to boost my stores.

Doctors don't often test for ferritin but its a good test for women, especially if you have heavy menstrual bleeding or have lost a lot of blood for other reasons.