Today is actually CD 14 and still no AF. I was thinking about Toni's TCOYF book and how it says that your LP should be constant. I know when I've been ovulating due to using the fertility monitor and check out my past 6 cycle LP lengths:

10
7
13
8
13
8

Hehe -- I guess I've proved that wrong -- at least while nursing a 2yo.

I just ate an entire bag of Hershey's kisses that I meant to bring to the office. Naughty me as the dairy and chocolate will make J's eczema flare up. But I needed it (and his eczema is down right now anyway).

I believe less than 10 days is considered a short LP. Your body needs at least that amount of time for the lining to be in the correct alignment for implantation.

I'm breastfeeding and TTC#2. Breastfeeding is all about the hormone prolactin, which suppresses estrogen and progesterone production, and increases FSH. It is common while breastfeeding to have delayed ovulation and a short LP.

One herbal treatment option is to use Vitex, which adjusts the amount of prolactin in your system.

I've read that too much stress can also elevate the prolactin level, as can too much sex (go figure). Trying to reduce the amount of stress on one's body is a multi-faceted endeavor - including significant diet and lifestyle changes.

Another approach is to try acupuncture/TCM, which can adjust your hormone levels, but TCM will also require diet and lifestyle changes.

Someone I know had short cycles and she opted to try Clomid and that worked for her. She made no lifestyle changes, but the she had a rough time while she was pg with hyperemesis gravidarum and the baby had intrauterine growth restriction and had to be born early by c/s. I wonder if she tried a different, more healing approach for her body if she wouldn't have had a better, healthier time during pg.

Bloated as anything

Have you ever had a cycle where you went from feeling normal, almost skinny before ovulation and then felt like you gained 10 pounds after ovulation? It's been driving me nuts and I thought to myself, surely I've not been eating that much. Even my underwear hasn't been fitting right for the past 10 days.

This morning I have my consult with my ob/gyn to discuss my care plan for my next pregnancy. I figured that to rule it out, I would test this morning before my appointment to see if anything was there. I wasn't that optimistic. I took the test and it was blank, and waited and it was blank. So I stuck it in my drawer and then after a couple of minutes I checked again. And sure enough there was the faintest line coming up. I sort of felt like something must be going on for all that bloating.

So here you go, my third BFP, without any enhancement:

So, that's three for three of getting pg around this time of year.

I'm just hanging out, bloated as anything. What a fun LP this one is. And all my pants are tight and I'm fighting with my underwear all the time due to my backside being a little too fluffy for its own sake. I swear I gain inches during my LP. My partner is out with his friends, he should as he's been working, working, working non-stop as he's overloaded with projects right now. The poor guy needs a break. Since I have to fend for myself I'm thinking couscous, salad and grilled asparagus -- I've got a load of veggies to use up.

PMS Induced Mastalgia

Oh yeah, it's that time of the month -- time for sore breasts. My breasts have been killing me and I've been so freaking bloated during my LP that it is not even funny. I haven't been able to get to acu due to travelling out of town but I do have a massage scheduled for this Thursday afternoon. Yesterday morning I took a look back at my blog posts about PMS, estrogen and the like and came across my info about elevated estrogen, prolactin and then vitex to treat the same. I decided that I had to try something as I was just about to DIE or burst or something like that. I took 10 drops in a glass of water and by the time I got to work I was like crazy get-out-of-town peeing. It was like my body randomly decided to drop all that water -- well actually it felt more like the vitex coaxed it out of me. My breasts are still sore but not nearly as bad and my belly doesn't look like a balloon (though I swear my ankle are looking a little bloated still). I think I'm going to keep trying the vitex for a few days more to see if it takes my edge off.

So here's my question to you all, if I've had my prolactin checked and it has been fine then why does it seem like that might be the problem? I've also got that weird headache back, like right between my frontal lobes. I keep getting it during my LP, since January. What the heck is wrong with me and my stupid hormones! The problem is that I don't feel like any of my docs will really listen to me and if they give me a med it will likely be something really nasty. Grrrrr.

I have been feeling bit less painful today thankfully. Maybe I'm onto something.

Here are some links about breast pain, cyclic mastalgia specifically, that you might find interesting.

Cyclic Mastalgia

Painful Breasts

Severity of Mastalgia in Relation to Milk Duct Dilatation

Toremifen May Be Helpful for Mastalgia

Info about Vitex for PMS/mastalgia

Holding up

I'm in the middle of my luteal phase and my breasts aren't killing me. Hows' that for an improvement? I think the acupuncture is helping out.

We went out with friends the other night and I wasn't drinking and I mentioned it was a chinese medicine/acupuncture thing and our friend's girlfriend who is an ear-nose-throat doctor asked me about it. I was dubious of how interested she was but I mentioned that I was having bad PMS, nausea for the better part of five weeks, really bad congestion and post-nasal drip, etc. Her response? That it was probably gastro-esophogeal reflux and that there's medication for that. I said I don't think acid reflux gives you bad PMS, and then she said, well no... I said that the dietary changes and the acupuncture and herbs seemed to be helping and the nausea was now gone. She said it was probably coincidence to which I replied I was sure that it wasn't. Oh sigh.

I went for a massage today, the first time that I've seen this practioner since September 2004. She practices Lomi Lomi massage, a technique that comes from Hawaii. Sometimes she chants during the massage, and she usually starts out with a type of prayer, but she always checks in with you on an emotional level before she starts so she can help use the time for more healing. When she asked how I was doing I said pretty good. But then I told her about the recent EDD and anniversary and I started getting teary. I filled her in a little about the second loss, about my frustrations with Western medicine having nothing really to offer since they don't really listen, and about how depleted I've felt since last June.

We started into the massage and I started crying a bit, it was hard just being touched. Before I got there I thought I might fall asleep during the massage but there was no chance of that happening. She worked a lot on opening up my hips and that didn't hurt but it felt like there was a little grief hidden there. Then I asked her to do some abdominal work and when she started doing that it felt like there was a big tight knot in the middle there. So she pulled back some and started asking me to do some visualizations and breathing and after a while my hands started buzzing, sort of like an electric shock but ongoing. She had placed one hand on my heart and the other on my belly and they were just buzzing and buzzing with energy. Then suddenly I started sobbing and crying and it was really intense, I told her I supposed I had been holding a lot of grief in there. She told me to just cry if I needed to and the tears rolled down the sides of my face into my ears and down my neck. Big fat tears.

She told me to breathe in and on the exhale to direct hope, or light or healing to the part of me where I'm holding my grief. I kept thinking of it like my shadow, a full body of myself but only a few inches thick that was dark and I held in my back. She asked me to acknowledge the place in my center, to ask it if it had a name or perhaps a shape -- what came to mind was the color green and the shape of a kidney bean. It was so odd and emotionally intense.

I'm going to go back for another massage in a few weeks to keep trying to resolve this, to help my body move on more. It's amazing what you can find hidden inside the folds and curves of your body.

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.

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.

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.

Ovulation, eventually.

I took vitex for about 5-6 days and it really did help stop my breasts from hurting. But then when it gave me a headache I stopped taking it. It took me an additional 5-6 days until my body ovulated this cycle which was on May 1 or 2, so no ovulation in April.

After I ovulated I was exhausted for a few days. Really, really exhausted. Like after a full nights sleep wanting to lay down in my office at work and nap. I wasn't on herbs or meds or anything. The second day of that I did go home in the afternoon and fell right asleep. I woke and went to a community meeting and then went back to bed for another 10 hours.

When I saw my acu for my weekly visit I asked him what was up. He said that my kidney yang was depleted, that is the warming energy that heats things up during the luteal phase. He did some moxa and other heated needle work on me and told me to have more cinnamon. That seemed funny to me too but it worked. I had a lot more energy on Thursday. Friday, well that was another story.

Friday I was dealing with a deadline and some really nasty horrible moody feelings. Kind of miserable really -- I can't be the only one who feels this way during their luteal phase. Saturday I was still a bit on a downer note but then in the afternoon I decided to kick my own a$$ and make myself do things that would make me feel better. I decided to cook dinner for our extended family and give some gifts. You know, it worked. Then I spent a good amount of time on Sunday exercising, washing the car, working on home improvement projects, and baking. I've been much better this whole week thank goodness.

My basel temps were awful though, not only that but they were tanking when they should have been at their peak for a non-pregnant cycle. I started using my natural progesterone cream Sunday night (it was part of my original plan for this cycle but I somehow didn't get around to it), and my temps have been up all week into a reasonable range. I think that this cycle is a total nogo but what the heck do I know. I'm on 10 dpo so technically I'm still in the reasonable range for implantation.

I'm tired of all the energy that I've put into TTC right now though. And with all the grief and healing that I had to do (physical and emotional) my work really bore the brunt and now we are all feeling it. I had to change my priorities, so for now I'm feeling a lot quieter.

Progesterone Affects During Luteal Phase and Into Pregnancy

I've been researching the affects of progesterone in our bodies, particularly focusing on the affects during the luteal phase. Here is a compilation of the things I've read it does (note that some of the pages I’ve linked to are long, to find the references on the individual pages use your browser’s search function (CONTROL+F in Windows/IE), to locate key words. I suggest starting first with “progesterone” and then going for specifics such as “endometrium”)

Affects of Progesterone During Luteal Phase

• Maintains endometrial lining during luteal phase, and into pregnancy in the presence of a fertilized egg (blocks collagenase from breaking down endometrium(PDF))


• Changes endometrial lining surface to be more receptive of the fertilized egg; causes the surface to have a more mucus like coating; causes glycogen bubbles to occur in endometrium which provide energy for the fertilized egg


• Promotes the endometrial glands to become enlarged, undergo maximum secretory activity and its blood vessels become coiled and enlarged.


• Prevents the woman’s body from rejecting the fertilized egg, stops rejection of fetal (foreign) DNA


• Reduces certain types of prostaglandin production to reduce uterine contractions making the uterus more hospitable to the fertilized egg/embryo (“progesterone block”)


• Affects blood sugar levels


• Affects zinc and copper levels (1),(2)


• Stimulates growth of breast tissue


• Facilitates thyroid function


• Raises body temperature about .5 degrees Centigrade (0.9 degrees F.)


• Causes relaxation of smooth muscle cells throughout the body (1), (2)


• Facilitates egg transport through the fallopian tube

Another list of functions of progesterone