Can I obsess a little?

Here are my symptoms:

Sore bbs
Runny nose
Spotting
Pain on the left side of my uterus yesterday afternoon prior to spotting
Uterus feeling full and a little crampy
and here's a nice one, a sore, itchy vagina

These symptoms are all within the realm of possiblity for early pg.

I looked at the cycle gallery on Ovusoft and some FAQs about HPTs and implantation and you need to wait 2 days from the time of implantation spotting to test. Soonest might be tomorrow. But what if it is just due to my being sick last weekend? And what if I am pg and it fails again?

TCM Tongue Diagnosis Tool

In Traditional Chinese Medicine the practitioner is trained to read signs of your health from your tongue. It's a little odd at first but it isn't without any parallel in Western medicine -- when I contracted Salmonella poisoning in France back in 2000 the French doctor asked me to stick out my tongue and he knew right away what my illness was. My tongue then was coated with a thick grey coating, it looked so awful.

One of my online buddies found this great tongue diagnosis tool which helps you figure out what's going on with your body based on signs on your tongue.

You will want a mirror in a well lit area when you do it, plus write down notes as you go as it tells you things on each screen but it doesn't give you a summary of what it all means.

Tongue Diagnosis Tool

My diagnosis right now using this tool is blood deficiency and dampness with substantial phlegm, deficient Qi and Yin, Heat or blood Stagnation in the lower Jiao (lower belly). I've got to stay the course on my TCM diet right now and nourish myself to help get rid of some of this stuff.

Ick

I totally had to push myself for work and of course I got sick. Sick, starting with a cough a week ago. A dry cough that progressed into bronchitis and all that fun on friday. I've missed two days of work and I still feel like crap. Mostly I'm just achy and tired right now.

You should see my tongue, it's awful pale and white coated -- in TCM this means I'm a mess. My acu said last week that it was related to my sickness.

I'm 5 dpo, actually based on my ovulation pains last week I would say I'm already at 6dpo tonight. At any rate, do you think Robitussin DM affects implantation?

Is it possible to get a BFP in the middle of this misery? Actually my partner got sick as well and he never gets sick so I think it was just a really nasty virus going around the office.

Here's to feeling better quickly.

Busy, busy.

Work is ceaselessly busy right now. It makes it hard to stay relaxed, rested and the like. Still, it's a lot better than when I was younger, or when I was dealing with my fibroid. I can deal so much better now.

I'm drinking my pre-ovulatory tea twice daily, taking my prenatal vitamins and iron supplements, temping each morning, charting CF, using the fertility monitor (starting in a couple days) and then I've got my acupuncture treatments. Qigong has been off the radar for a while, other than doing breathing exercises when I remember, lately almost every day, and then some movement sequences occasionally. Classes started up again last week but work has prevented me from being able to go. Maybe in a few weeks. I did make an effort to go for a jog with my dog tonight. She loved it so much, I love to watch her run -- she's 15 years old already.

I can't believe that I ovulate again next week. When will this endless dog track end. When will the rabbit die?

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

A Wacky Start to My Next Cycle, But Improvement

AF this time is just odd odd odd. Usually I won't have more than half a day of spotting prior to her arrival, this time I've had two. I feel totally hung up, sort of like when I was waiting for my m/c to start in June and it took a whole week before my body was ready. Today I marked as the start of AF but it's just barely stronger than spotting and dark red/brownish. It's so weird. I had a really great chart, I wonder if things have started to move in a new direction for me hormonally. Sounds scary a bit, but it could be a good thing as I had that fibroid, anemia and excess estrogen working against me before, which were all bad things.

At acupucture this morning she noted that my tongue coating looked better (it was awful and white coated last week out of the blue), confirmed that my liver qi stagnation was not an issue any more (I had noted this myself), and said that we're just dealing with minor stuff right now. She said that the spotting and symptoms of the cycle transition from LP to the Blood Phase were related to my qi deficiency and spleen qi deficiency.

My treatment helped dissipate a lot of the pain I was having (thank goodness) and she gave me a handout with some qi building foods on it. I've also got a pre-O herbal powder to take starting CD4.

It's so weird though, but perhaps my body pushed through to the other side of its deficiencies. I don't know if you had noted this but I've heard/read that sometimes the deficiency of something will trigger its excess. So heavy menstrual bleeding can be a sign of deficiency, excess estrogen can be a sign of yin deficiency and so on.

As I've mentioned I was anemic for years, even as a child I had lots of nosebleeds ages 5-12, the last big on was when I was 14 that I recall -- I got my period later that year. In TCM not being able to contain your blood is a sign of deficiency though it's harder to pick which one it might have been as it was years ago. I do think it is possible that my body got used to operating in a state of deficiency so the journey has been to reset the expectations so that it can adjust to a healthy pattern. In some ways no different than for people who have blood sugar issues, etc.

Some more miscarriage links

Check it out, lots of interesting information about early scans, percentage rates of various situations, etc.

Management of Early Pregnancy and Loss

Page of stats about miscarriage

First Trimester Miscarriage from Dr. Spoock

Dr Alan Beer is mentioned in the book Coming to Term as a repeat loss specialist. I took a quiz on the site and it said that it wasn't likely that I had an immunological reason for my losses. Probably pretty accurate for me, though the mention of retained tissue leading to an immune reaction (at link below) kinda freaked me out since I had retained tissue for so long with my first loss.

I found this page about RPL testing with posts from patients which is interesting

I'm CD 15 today and feeling heavy with achey ovaries. I started spotting yesterday and I can't wait until AF shows up as at least that will indicate that things will soon be better. I've got acu in the morning, hopefully that will help. I hope I feel better by the weekend when my MIL is in town.

Thyroid Information

Some of the links I've found helpful in understanding thyroid health, and its relationship to fertilty and reproduction.

American Thyroid Association

Thyroid Tests -- Normal Ranges and Interpretation

EndocrineWeb: Thyroid Gland Diseases

Thyroid Problems in Women

Physician Interview: Richard Shames, M.D., on Treating Thyroid Dysfunction, Chronic Fatigue Syndrome & Fibromyalgia

Maternal Thyroid Function During Pregnancy

Postpartum Thyroiditis

Thyroid Power
I've got the book and I found it interesting.

Also I know that some women have noted better results than Synthroid when they have taken Armour Thyroid as it contains T4 and T3 and not just TSH.

My Medical Care Providers Over the Past Three Years

Before having to deal with infertility I had the unfortunate luck to have been injured in a car accident back in 2000. Through that experience I realized that my healthcare providers didn't have my best interests at heart, they wouldn't let me know to come in for a follow-up appointment, sometimes I was referred to lame care providers. I came to understand that the only one fully vested in my recovery and well being was me. That helped set the stage for the adventure that started when we got into TTC.

September 2002 -- Internist diagnoses fibroid (dump internist due to issues with getting appointments and information from her in the couple of years in her care -- I had to wait a week for an appointment when my neck went out and I was in constant pain and couldn't turn my head).

October 2002-March 2003 -- worked with a naturopathic doc who helped me gain better balance in my diet and lifestyle but also wanted me on a ton of supplements. She asked me if I had considered adoption and how long I intended to cut back on alcohol and taking prenatal vits in a way that wasn't entirely supportive so I stopped going there.

February 2003-May 2003 -- Met with RE#1 who I liked and she did an okay job but she left the State and clinic after a few months. She told me I should have my fibroid out after my HSG but to find a new surgeon. Even though my basel temps charts showed that I had regular cycles and temp rises consistent with ovulation she dismissed them after saying "yes you ovulate" and then told us we should do the HSG and then move onto IUI with Clomid and that she could "make me ovulate" which I didn't like the sound of at all.

June 2003-Nov 2003 -- Met with RE#2 to try to figure out if I needed to have fibroid surgery or not. He decided to give me a fertility work-up (just blood work) and wasn't a good listener. He told us that my partner had anti-sperm antibodies almost certainly and we would need ICSI to conceive (you won't be able to conceive on your own he said). While he knew his stuff I really didn't like him and his arrogance so I left him after one last consult in Nov to review my pooled progesterone results and to see if he would provide care if I had a fibroid embolization instead of abdominal surgery for my fibroid. It ended with a strong conversation about fibroid embolization.

July 2003-Sept 2003 -- Gyn #1 who I was scheduled to have my fibroid surgery with but I got such a bad feeling from her that I cancelled the surgery 10 days before and decided to pursue other options.

November 2003 -- consulted with an interventional radiologist about having my fibroid embolized (they block the blood flow using small particles through the uterine arteries). He was nice but I wasn't sure and couldn't find a gyn to provide support to this procedure.

Dec 2003 -- met with Gyn #2 who was all right but a little young and I cried in her office and she just looked at me, offered no consolation or anything. Her office was hard to book appts with so I decided to bag them.

Jan 2004-May 2005 -- started working with acupuncturist #1 after prompting by a couple of friend in alternative medicine. He was very nice

April 2004-current -- fell down the stairs and reactivated my back injury from a car accident in 2000 prompted a visit to chiropractor #2 (chiro #1 took bad care of me after my car accident)

Jan 2004-July 2004 -- met with RE#3 who was very nice and a good listener. We were going to try clomid/IUI under his care in July but we got pg on our own in May. He did my first d&c but left the clinic the following week; he told the nurse that I didn't need to have my beta checked post procedure which was wrong. I had continued bleeding for weeks afterwards due to retained tissue and had to see RE #4.

August 2004-current -- RE#4 took care of me after my m/c showed to be incomplete. We decided to wait it out rather than try methotrexate to avoid doing a repeat d&c so soon after the first one. With my enlarged fibroid not decreasing and the retained tissue not resolving on its own she was the one who did my surgery on both in November.

June 2005-current -- acupuncturists #2/3 work together in a practice that specializes in fertility. I went to see them first the week of my miscarriage as I was in so much pain.

Sept 2005 -- gyn #3 was very sympathetic, but gave signs of being a little conservative such as 37 week c-section due to my myo though he did say that they would take good care of me on a subsequent pg.

I'm not really a problem person but I wasn't really to take standard b$ care from my docs, especially after seeing how lame they were 5 years ago after the car accident --- you have to look out for yourself.

Report from the ob/gyn visit today

My appointment went well but I was really upset by the end of it, having to explain about all I've been through. The doctor was very nice though and when he saw that I was getting upset he switched over and started saying lots of consoling, positive things which was what I needed. We talked about a c-section delivery and how he would do that and I learned some about their practice. He was a little confused as to why I was seeing an RE without having fertility treatment but finally I think he got it, just circumstantial that we hadn't yet gotten to any fertility treatments. I feel like Annie in the musical, "I think I'm gonna like it here."

I dropped by my RE's office which is now on the next floor down to say hi the office staff who know me pretty well now. Still feeling upset, I decided that I wasn't ready to go in to the office so I went home and took a nap for an hour and a half (I did get up at 5:30 this morning) and then felt tired and icky after I woke up. I cooked lunch and made some passionflower tea to calm my nerves (good stuff) and realized that I was holding my muscles related to my uterus. I've been feeling crampiness like after my HSG. I think it was the PAP that set it off, probably brought back pain memories as well.

I finally got into work after 2pm. C'est la vie right?

Stuff about Crohn's Disease and Ulcerative Colitis

[I'm always searching out weird topics so I thought I would share this recent post]

I met the author of the book Eating for IBS once a few years ago and thought she had an interesting perspective on how to manage IBS and other diseases of the bowels using diet. You can visit her site here:

HelpforIBS.com

I don't have this condition but it's totally plausible to me that diet/lifestyle/medications were contributory causes. It isn't a normal, healthy, homeostasis condition. Here are some other links that you might find interesting:

small-bowel bacterial overgrowth(SBBO)

Bacterial Overgrowth Syndrome

Breaking the Vicious Cycle - The Specific Carbohydrate Diet

Cultured Cabbage Juice - Make the Best Lactobacteria

I've also found reference to birth control pills sometimes being a factor -- making the condition worse or better, which seems to indicate a hormonal contribution as well. Knowing that progesterone relaxes smooth muscle tissue and changes the way our bodies deal with blood sugar levels, it isn't so far fetched that hormones coud affect all aspect of our system.

Crohn's Disease and UC came up while I was searching for information on Chronic Fatigue Syndrome as well. Do a search for more information though, the terms "crohn's disease chronic fatigue" turned up a bunch of interesting results.

Gyn Appt

I posted a couple places today about looking for a good Seattle ob/gyn and someone on Babycenter's fibroid board gave me her docs name. I called over there to speak with them and let them know my story: 35, TTC, 2 m/cs, fibroid surgery, RE, etc. and also about how lame my other ob/gyn's office was and asked if they could do better. They had an opening tomorrow so I set up an appointment for a pelvic exam -- with a doc whose name had been given to me by a friend a while back -- she switched her ob in the 8th month of her pg to this guy. I'm a bit nervous as I hate having to deal with allopathic doctors and their myopic view of medicine, but I still keep hope that he's going to be nice to work with.

I'll have to go through the medical records I have at home tonight and bring along copies with me to the appointment. Oh and they told me not to insert anything vaginally for 48 hours prior to the appointment. I mentioned the prog supps and the person on the phone said not to use them. I'm mid LP though. What should I do? Use one tonight and not in the AM? It would be dissolved by then. It probably has to do with the PAP though I doubt it will interfere in a measurable way -- who knows.

I have checked my temp during the night as my partner keeps coming to bed after 1am (grumble) and waking me up. I haven't yet had a sustained high temp overnight. When I was pg the first time my temp was 98.6 in the middle of the night as well as when I woke up. I also don't have an itchy forearm which happened both times I was pg. I tested yesterday with my last FM stick and it just showed a little LH as it did last cycle around this time. The curiosity got the best of me this AM and I used one FRE (I so want to be one of those gals who goes in for a beta on CD9 and has a raging great result) and it came back negative as anything. It's still early though and the cycle I got pg last I tested negative on CD9 and ended up getting a BFP on CD13 so perhaps there's hope yet.

It could have been me

Last night I went to a community BBQ and brought along my SIL and my baby niece and nephew. I watched the baby while my SIL followed round her son as he played on the playground equipment at the park we were at. There were lots of people there I know from around the neighborhood, due to my community activism. Almost all of them came over to ask me if my niece was mine.

Yes, I don't see these people all of the time, mostly only in email and at occasional meetings. Yes, I was holding a baby with dark hair like mine. But really folks, an 8 month old infant doesn't come out of thin air and most of them have seen me within the past year when I would have looked pregnant. Many of them knew I had abdominal surgery last year as well, though not what kind of surgery and I suppose that still didn't exclude me from having a kid now.

So, it was a mixed thing. A little fantasy about what it would be like if I had a baby, this baby that I held that was born the same week as my first [a] was due. There was also the stupidity of it all, the frustration as well. Of course I want a baby, no this isn't my baby but it could have been -- at least in an alternate reality. I guess I should be thankful that no one asks why I don't have children yet. As if there is any easy answer to that question, because even I don't know why we don't have children now.

(P.S. I'm at 10dpo and no sign of anything vaguely pregant with me yet. Two things I'm looking for are an elevated basel temp in the middle of the night and an itchy right forearm -- my symptoms that are particular to when I've been pg)

Types of Iron

There are two kinds of iron, heme (heem) and non-heme. Heme is found in animal sources of food (red meat, liver, clams, salmon, eggs, etc.) and non-heme is found in vegetables (spinach, raisins, kidney beans, lentils etc.) Heme iron is easier for your body to absorb, though in what I've read your body can absorb more non-heme iron in the presence of heme iron.

So you want to have some spinach with your lamb curry and then you'll have your bases covered. As an anemic gal trying to build her iron stores I've been eating like that (by the way indian and ethiopian are great ways to get good iron in your diet from plant and animal sources) and taking my prenatals plus my chewable iron as well.

Bowling and Babies

We had a company bowling event last night and in addition to my niece being there one of our employees bought along his wife and baby. The baby was 5-6 months and babies that age just remind me of my first m/c and make me really uncomfortable (that could have been me, ya know?) I didn't even say hi to the woman, I'm sure she thought I was cold. Other people from our company were carrying the babies around and the like but I just feel like babies are a loaded subject for me. I could see the wife of another employee staring at the babies as I know they are interested in starting TTC. It just made me think of how much heartache TTC has brought me and as I fell asleep last night I kept thinking to myself that maybe I would be better off just not having babies.

An update on the dysmenorrhea

I had a stomach virus or something. It was connected to a different virus I caught weeks ago with a temperature and everything -- the connection was the stomachache that lasted for weeks. It's possible it was some sort of micro-organism as in the end several of the symptoms were similar to when I had salmonella, though the timing was spread out and the symptoms didn't happen all at once. I felt like I needed to throw up two weeks ago, and also like I was going to have diarrhea. I made mention of it to my acupuncturist. The following Sunday I woke up and felt really ill and proceeded to empty my digestive tract over and over for several hours. That seems to be the end of it though my acupuncturist today noted still some disturbance in my stomach channel.

Pretending

Lately I've been feeling like it's all just pretend. I'm pretending that eventually I am going to have a baby. I'm pretending that this is something that will happen to me. Like looking at some Hollywood actress or rock star and thinking that I could do that (don't we all have those moments?) Since its been so darn long I just feel like I've been pretending for a long time, that small piece of hope left seems almost a little silly.

The other side of it is that I worry that I'm just getting too comfortable in my own life (not such a bad thing) and that I'll not be able to adjust to sharing my world with a wee one. That I should even be so lucky. It's been an ongoing worry of mine, though feeling comfortable is a newer addition.

But then here I am in the 2ww again (2dpo) and that little piece of hope (and distraction) lifts its head and says "what if..." If it wasn't so sad it would be aggravating.

We went camping over the weekend and I brought along my digital basal thermometer to temp with. Of course it was freezing at night (38 degrees) and so I slept with a hat on and a wool blanket over my head but who knows if my temps are what they would have been otherwise. It was challenging getting one BD session in with our friends there with us. We had one session Saturday morning before we left and then one on Sunday afternoon and then I ovulated on Monday. Not as much as we usually try to get in but maybe the timing was good enough.

I had acupuncture today and it was very relaxing. I'm on a luteal phase herbal formula that tastes okay though a little smokey. Fingers crossed pleased that we catch another eggie.

Unbelievable indeed.

Last week I got an email from an old boyfriend announcing his engagement. We've stayed friendly all these years, it was only a little thing we ever had, so I was happy for him. This morning however he follows up with an email blast to all his friends announcing that he's expecting a kid next March. WTF? It sounds like they weren't even trying though if she's due in March then they have known for a while now.

It's nice how he phrases it:

Unbelievable really as we were always told it would take ages once you were in your thirties etc, etc and hey presto wham bam, first time trying ! Always knew I'd be super fertile ;-)

This guy has said for years that he would never get married and never wanted kids. Uh, yeah right.

Feeling poorly

I'm on cycle day three of my 38th cycle charting. I've been feeling so poorly these past couple of days that I finally looked up dysmenorrhea (painful periods) and I fit the definition to a T this cycle. What's up with that? I've got stomach pain, lower GI discomfort, headaches, I'm not sleeping well. Its actually not a normal pattern for me. I've also still got symptoms from that virus that's been going around the office, others have the same symptoms -- sore back, sinus congestion, faint numbness in hands and feet. One of my employees saw her doc about it today and was told it was indeed a virus and that it might take another 2 weeks for the symptoms to clear out.

I had an acupuncture treatment this afternoon and she treated me for blood stasis in my abdomen that was causing me a lot of menstrual pain, as well as my immune system and also to help stimulate follicle development. They told me to take a break from the herbs for a wee while and see how my body does. I told her about how when I was younger and stressed out my stomach would hurt me (I spent many hours in the nurse's office in 6th grade with stomach aches when my parents were fighting constantly and close to divorce and I wasn't doing my homework), and sometimes if the emotional stress was intense I would get diarrhea (first bad breakup I couldn't eat for a month and when I did I had diarrhea -- I lost 10 lbs). Certain types of really bad stress would even cause me to have mid-cycle bleeds, but never annovulation, I never missed a cycle. She said that it fit in with what she knew already that I have an overactive liver but that normal Western testing wouldn't show any dysfunction and it ties in with my other complaints as well. In TCM the liver is associated with emotions and I'm such a freaking sensitive person and a bit neurotic as well (but I'm sure you noticed that by now). Its just who I am and while I've made lots of changes I don't know how much more I can do. To think that sometimes just being can be the thing that throws you off. I don't even want to know about it. I fell asleep during the treatment at any rate, for a good 40 minutes, which felt good.

While sweeping our back porch the other day I was thinking to myself about what someone on the boards wrote to me after my first loss; she said "God must really love you to put you through so much." I too know that I'm stronger in some ways, maybe more wise to the ways of the Universe and my connection to the world around me. My losses are a part of who I am now.

Sometimes lately I've been thinking of just getting used to the idea that we won't have kids. It's been such a very long road so far. At least I'm needed at work and I'm getting to do more consulting work. I don't know what the future holds and I talked to my great-aunt about it when I was in New York. There are places for all kinds of mothers in the world, and not all of them are biological. You don't even have to be an "adoptive" mother to make a difference. You know I've heard that for troubled children even a 15 minute positive encounter can build esteem enough to help that child find hope and change direction. Maybe there's a place for me there in the world. I just don't know yet.

Tonight I did a brief liver qi cleanse as I missed my qigong class for the second week in a row. This time because I wasn't feeling well, last week was due to traffic and class just not being at the park where they were supposed to be.

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.

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
quote:

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)
quote:

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

(carbuncles?)

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
(http://www.gianna.org/). Where you can learn more about her condition during her last pregnancy.

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.

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.

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.

L-arginine and implantation

L-arginine, an amino acid supplement might help aid implantation as well as development of the egg and follicle.

"It was concluded that oral L-arginine supplementation in poor responder patients may improve ovarian response, endometrial receptivity and pregnancy rate."
From: Adjuvant L-arginine treatment for in-vitro fertilization in poor responder patients

"Little or none of the cationic amino acids in eggs (i.e., lysine, arginine, and histidine) are lost in exchange for methionine, whereas these amino acids are greatly depleted by methionine in blastocysts...Whereas these data relating transport activity with the essential amino acid content of early embryos are not extensive, they seem adequate to support the conclusion that essential amino acids improve development largely because they are transported into preimplantation embryos"
from: L-tryptophan and Pregnancy, under the subheading "Essential Amino Acids Beneficial to Development"

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.

Athletically Induced Amenorrhea/ Female Athlete Triad

A woman posted to an online group about her high school aged daughter having amenorrhea and low estrogen. The gynecologist wanted to put the girl on birth control pills to boost her estrogen. Since I had already come across references to this condition during my searches I went out looking for more links so that she and her daughter could see there were other ways to treat this condition that did not include hormones.

The female athlete triad is three conditions that show up together in women athletes who overexert themselves: osteoporosis, amenorrhea and disordered eating.

Here are some links to learn more about what they know about this condition:

ATHLETIC AMENORRHEA

Amenorrhea in Adolescent Athletes

Female Athlete Triad

Female athletes face risks in overtraining

Menstrual Disturbances in Female Athletes


Poor diet, excess exercise can mean weak bones, heart trouble for young women

The Opponent: the Female Athlete Triad


From a quick scan it sounds like the issue is dietary and that increasing calcium and D intake (don't forget about magnesium, and likely zinc as well) might help improve hormone production/balance.

Do a google search on the terms "athletically induced amenorrhea" or "ballet amenorrhea" (lots of ballet dancers have this problem), also "female athlete triad" and you will find more info.

You also might be interested in this article from a traditional chinese medicine standpoint:

Restoring the Flow -- TCM and Amenorrhea

Back in the saddle again.

I thought about waiting until September to try again but then work demands that we can't travel to Europe so my fears about conceiving in August and being away in early pregnancy in September (just in case we got lucky) is a non-reality. So with ovulation upon us this weekend it just seemed like the natural thing to do a little BDing.

I'm feeling okay about it right now. As the days go by I'm sure I will start obsessing over my temps and chart and then whether or not we caught a shooting star but for right now, I'm okay with trying.

Wish us luck.

About Anti-sperm Antibodies

I've looked up links on this topic for online friends who have had to contend with this male-factor fertility problem.

There are a few different types of anti-sperm antibodies, they can attach at the head, mid-section or tail. Identifying what type you have is key as it helps the doc to know what kind of wash to do prior to an insemination.

General information about this condition:

Treatment of Infertility Associated with the Presence of Sperm Antibodies in the Man

Anti-Sperm Antibodies

Antisperm Antibodies

Immunological Factors & Infertility

Immunological Testing and Treatment for Infertility

When Sperm Meets Egg: Sperm-Mucus Interaction

Medical articles and abstracts about anti-sperm antibodies

Semen sample collection in medium enhances the implantation rate following ICSI in patients with severe oligoasthenoteratozoospermia

Sperm antibodies

Intra-uterine insemination versus cyclic, low-dose prednisolone in couples with male antisperm antibodies.

A comparison of intrauterine insemination in superovulated cycles to intercourse in couples where the male is receiving steroids for the treatment of autoimmune infertility.

Characterization of spermatozoa surface antigens by antisperm antibodies and its influence on acrosomal exocytosis.

[Chinese traditional medicine yi kang ling to treat immunity infertility caused by anti-sperm antibody: the experimental research II]

[Effect of antisperm antibodies on assisted reproduction]

[Effect of heavy metals on immune reactions in patients with infertility]

[Immunological approach to male contraception]



The Infetility Cure also mentions that ASA can be treated with chinese herbs, focusing on the pattern of deficiency or excess. At any rate, the anti-bodies indicate an immune reaction in the body and taking the efforts to try to improve the man's health overall should help provide some results, even if it is just better quality sperm for IVF. I'd do the MFI supplement cocktail, though consulting with a TCM practitioner would be an excellent place to start.

Training my fertility monitor

My last cycle using my fertility monitor, the third cycle using it, was unusual and it threw the monitor off a bit. As you might recall I had high estradiol and a delayed ovulation (CD22) brought on by vitex that cycle, the same cycle I got pregnant.

I wanted to use my monitor this cycle to see how my hormones were doing and see if everything was back on track finally. Today was CD9 and finally it asked me for a test; usually I would start testing on CD6 or so. Today's test registered at a high day, pretty normal for mid-follicular phase. I'm due to ovulate next Monday/Tuesday (CD15/16) and hopefully it will be less hormonally challenging and with a lot less discomfort this time around.

Hopefully a more normal cycle will get this monitor back on track with me and then next cycle when we consider trying again it might be of some use. (It's so hard not to try this cycle speaking only from an opportunistic and competitive standpoint but really I need to have a rest for a little while longer and I would not do well with another loss right now so I'll just continue to bench myself for a while longer.)

More about the adrenals, chronic fatigue syndrome and fibromyalgia

I've studied up a bit on the affect of prolonged stress on the adrenals and cortisol in relation to my partner's panix-anxiety -- we were able to successfully treat him based on our findings and coupled with the male infertility vitamin supplements he's been off of Paxil and without any big attacks for almost 2 years now.

So, this cortisol thing for me has really piqued my interest. My partner and I have similar lifestyles obviously (we eat, live and work together) so what is bad for the gander is bad for the goose. I've been looking at medical articles this afternoon about the adrenals and progesterone and fertility and I found a few more things that might interest you.

Chronic Fatigue is associated with elevated cortisol and decreased adrenal function

(Hypothalamo-pituitary-adrenal axis dysfunction in chronic fatigue syndrome, and the effects of low-dose hydrocortisone therapy)

I don't think I've got this but decreased adrenal function is also associated in a different type of pattern as having low estrogen and progesterone with lesser amounts of LH released. I don't have amenorrhea, my LH appears to be fine I think based on my fertility monitor and trying to use its sticks prior to my period being due, a time of the cycle where the LH normal increases. Still it is interesting to read the summary.

(Isolated adrenocorticotropin deficiency presenting as primary infertility.)

Fibromalgia patients have a similar pattern of but with lowered estrogen. Still, it seems to be related to these other patterns in terms of what happens with the hormones. The elevated prolactin was interesting here. Also, before I started working with a naturopathic doc a few years ago, part of my PMS set of symptoms including burning in my extremeties, my partner couldn't touch me hardly at all because it was painful to me. Evidently "Psychological stress and hormonal changes also may be possible causes of fibromyalgia."

(Secretory pattern of GH, TSH, thyroid hormones, ACTH, cortisol, FSH, and LH in patients with fibromyalgia syndrome following systemic injection of the relevant hypothalamic-releasing hormones.)

At any rate, perhaps I've been periodically dipping into deeper levels of adrenal exhaustion, insufficiency and depletion. Qigong, the dietary changes and acupuncture will all help. What I found though was that there is an additional supplement that can help.

L-Carnetine, one of the supplements that is commonly included in the MFI vitamin regime, also helps to treat a variety of issues including chronic fatigue syndrome.

(L-Carnitine: therapeutic applications of a conditionally-essential amino acid.)

"Although L-carnitine deficiency is an infrequent problem in a healthy, well-nourished population consuming adequate protein, many individuals within the population appear to be somewhere along a continuum, characterized by mild deficiency at one extreme, and tissue pathology at the other."

We have some L-carnetine in the cabinet downstairs and I ran down and took one. I think The Infertility Cure might have mentioned this supplement as well, or else it was Arginine. Very interesting. We'll have to see what regular supplementation will do to help me out. I'm so freaking tired all the time since the miscarriage, even worse than prior when I was just waiting to miscarry.

There was an Italian study from a while back that tried treating women at risk of miscarriage with carnetine and it seems like it helped cause some improvements in the quality of their blood, specifically myoglobulin which helps carry iron:

[Serum myoglobin in pregnant women treated with tocolytics and carnitine]


Here's an article that mention chronic fatigue, miscarriage and infertility:

Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease

I bet something will show up in my bloodwork next week. When I had my pooled progesterone checked a couple years ago and I got the results back I was like "I told you so." go figure that reproductive endocrinologists aren't good at figuring out the pathology of normal endocrine issues. They like to just go for the big guns and it is so like they say, when you are a hammer everything looks like a nail.


GENERAL ADRENAL INFO

Your Adrenal Glands

Adrenal Glands - Wikipedia

Anatomy of the Adrenal Gland (PDF)

adrenal gland from Columbia Encyclopedia

Pelvic Adhesions

Adhesions are really common after pelvic surgery but they don't necessarily have to cause you problems or impact your fertility. Some doctors will perform an HSG (hysterosalpingogram) a few months after a myo for women wanting to try to conceive but mine thought we should just see what happened for a few cycle on our own. We were able to conceive and have implantation in my uterus so no problems there for me.

Adhesions & Pelvic Pain
What Women Need To Know About Prevention and Treatment

Pelvic Adhesions

Pelvic Adhesions - Their Role in Infertility and How to Prevent Them
PDF brochure from RESOLVE

Reduction of Adhesions

Asherman's Syndrome

Pelvic Abnormalities: Pelvic Adhesions (photos)

International Adhesions Society
(they are also conducting a survey of patients regarding informed
consent forms with regards to mention of adhesions)

Adhesion Related Disorders

Chronic Pelvic Pain
(includes some info about how to minimize adhesion formation)

Pelvic Adhesions
(fairly clinical and scientific information about adhesion formation and prevention in a Powerpoint presentation)

Pelvic Pain Needing Treatment

Wound Healing and Scarring - Sutures

Prospective clinical trial of SprayGel as a barrier to adhesion formation: an interim analysis.
(there are other media that can be used to prevent adhesion formation as well, if you are interested continue searching on these terms:
"pelvic adhesions barrier agents")

Fibroids and Pregnancy

Behavior of Leiomyoma during Pregnancy

Dr Walker's study of UAE and pregnancy

Fibroids During Pregnancy

Fibroids in Pregnancy

Fibroids in Pregnancy
scroll down the page to get to this section

If you join the uterinefibroids Yahoo Group there is more information available about fibroid degeneration and pain during pregnancy based on individuals experiences in the Links area.

Fibroids and Fertility

Some of the better links I've found which discuss fibroids and fibroid treatments impact on fertility.

GENERAL

Fibroids & Fertility

Fibroids and Younger Women

Management of Uterine Fibroids

Myomectomy: It's Role in Infertility

FIBROIDS AND MISCARRIAGE

Recurrent Miscarriage (Pregnancy Loss)

Small fibroids may increase miscarriage risk
Small uterine fibroids may increase the risk of miscarriage, according to early findings from a study by researchers at the University of North Carolina at Chapel Hill.


MYOMECTOMY & UFE

Gynecologic Myomectomy

Long-term results of laparoscopic myomectomy: recurrence rate in comparison with abdominal myomectomy

Myomectomy
Article about endoscopic myomectomy

Myomectomy During Cesarean Section – Time To Reconsider?
A medical article looking at removing fibroids during cesarian delivery

Myomectomy: a retrospective study to examine reproductive performance before and after surgery.
Watch a web video of a myomectomy being done

Replay of: Abdominal Myomectomy-A Treatment for the Removal of Fibroids

About Degenerated or Infected Fibroids

Here are some links I've found which deal with fibroid degeneration or the very rare condition, pyomyoma, where fibroids can become infected.

DEGENERATION
Unusual Appearances of Uterine Leiomyomas: MR Imaging Findings and Their Histopathologic Backgrounds
Lots of images of fibroids with degeneration and other changes

An Unsuspected Case of a Degenerating Leiomyoma
requires free registration

Photo of a fibroid that has undergone degenerative change

Thrombophlebitis (aka Deep Vein Thrombosis)
Can be associated with red degeneration; general risk to women with fibroids and possible post surgery complication

PYOMYOMA - INFECTED FIBROIDS

Streptococcus agalactiae Endocarditis and Giant Pyomyoma Simulating Ovarian Cancer
Medical article looking at one case in particular and reviewing other cases since 1945


Uterine Pyomyoma as a Complication of Pregnancy in an Intravenous Drug User
JOSEPH A. PRAHLOW, MD, JAMES O. CAPPELLARI, MD, and SCOTT A. WASHBURN, MD, Winston-Salem, NC (1996)

Back from the doctor's

There are two ways to interact with a doctor. One is to sit back and see what they tell you. The other is to research more about your situation, symptoms and options and then ask a lot of questions. I prefer the latter as the former doesn't get you very far with today's managed care and insurance limitations. Doctors seem to get a little less engaged (if they ever were otherwise I don't know) and just give you the standard answer. I don't want the standard answer, which I anticipate was that our second loss was just bad luck. I want real answers.

So, I'm waiting in a consult room and my RE comes in and asks me how I'm doing. I said I was there to see about what next in light of my recent loss since even she thought there was possibly something more. I then told her, "I'm going to throw a lot of information and observations at you and I want to hear what you think" to which she agreed.

I mentioned the diagnosis of adrenal exhaustion from my naturopathic doctor a couple years ago, about my consistently low progesterone levels at each testing (not rock bottom low but always kind of a non-performer) and about how my recent acupuncture pattern has evidenced a consistent kidney yang deficiency which translates into weak adrenal functioning.

I mentioned my night sweats during my luteal phase and she said some women are really sensitive to drops in their estrogen level. Then I told her about the night sweats during my pregnancy which she said was common. I said that while I know it is a symptom of pregnancy that the stories that I've read online don't have this symptom until further along and that the ones I've seen with it starting early have also been losses. Obviously just circumstantial but when I said I had the sweats really early on I think she understood the difference.

I mentioned my charting and about how a nurse and an acupuncturist worked together to look at charting symptoms and that I have a characteristic slumping mid-luteal phase consistent with a type of luteal phase defect -- in spite of my consistent and regular ovulations and periods.

I then brought up about my sensitivity to stress and about excess cortisol and how that might impact my T3 levels and that I'd never had a full thyroid panel done. She agreed and said lets take a look and put down for the anti-thyroid antibodies which was brought up in one of the loss forums I was on. I told her that thryoid problems had surfaced for other women in my family around childbirth and that while I had always tested normal for TSH and T4 that I wanted to make sure there wasn't anything we were missing.

I talked about my pregnancy symptoms which she said could have been my body reacting to a poorly performing pregnancy as much as anything else. I mentioned the cycle I got pregnant and all my hormonal ups and downs over the past 6 months. About vitex, which she knew nothing about and I really want to send her some printouts about it, and rhodiola rosea. I mentioned the book Coming to Term and about how it said that up to four losses in a row didn't increase your risk. She hadn't heard of the book and wrote it down in her notes to check it out. We agreed that we would hold off testing for anti-phospholipid antibodies and some of the other standard repeat loss tests for now.

She said that because I'm thin she didn't think diabetes was an issue but I told that I didn't think that I had a disease or anything, but I've noticed I'm more sensitive and want to know if there's possibly a little something there as I've definately been feeling weird about eating sugar and simple carbs. She said that one a few occasions she has come across thin women with blood sugar issues that she didn't expect and thought it was worth ruling out. I asked about testing for adrenal functioning with a glucose test and mentioned the 24-hour test my partner had done. She said okay but instead we would do a fasting glucose and insulin test which since I had breakfast will be tomorrow morning.

She said when she was in medical school she thought she had 3 out of 4 diseases that she read about. I told her that really I don't think I'm diseased but I want to rule out a few things that have shown up as a part of my acupuncture treatment and since these hormones are part of the supporting cast the affect my fertility I want to make sure that we don't ignore it. I'm not a hypochondriac really. I told her about how for years I had poor eating habits and high levels of stress and anemia -- that I really ran my system ragged.

I asked if we could test my ferritin to check my iron stores and she thought we should to the full blood count again as well. She also wanted one more beta HCG to make sure it had all gone down. Yeah well, for some reason that test always makes me sad since I've had like a dozen draws to watch me get unpregnant and only 4 to watch it rise.

When I told her about feeling like needing a little break due to all that my body has been through over the past year she agreed, it was a lot for one person to go through physically. She said when we were ready to start trying again give it a few months and if nothing happened then we coudl talk about ways that she might be able to help out, which I took to mean Clomid or another fertility drug, Rx progesterone perhaps in a different format, etc. Ugh. I don't want to think about it.

I won't get test result for many of the things until Tuesday next week. I wonder if anything will show up.

I went away to New York for the weekend, to visit my parents and brother and a few friends. It was an emotional time for me, the first time I've been home since my two miscarriages and my surgery. I'll have to post more about it when I have a chance, I wrote a bunch down on the way home on the plane.

My partner and I had dinner together last night and went for a walk and talked about stuff. We talked about the TTC stuff and when we should try again. I told him that we might need to wait and that listening to one album on the ipod on the way back reminded me of when we didn't have all this TTC crap in our lives. I asked him what he thought and he said that it was up to me, if I want to try he will try and if I want to stop trying then we can do that. We both laughed about the irony that after all we have been through now we have to worry about getting pregnant. I told him that maybe he should just get another vas done. He said that he didn't like how all our recent attempts and failures have been making me so miserable so if I thought that I could make it through with another loss or two we should keep trying but if not then maybe we need to just take a break.

My friend who I saw on Monday said she was sorry that TTC had been such a physically painful thing compared to all the other people she know who have had trouble conceiving. With my great-aunt we talked a bit about what the future might hold for me if it doesn't include children.

It's hard being 35 and having to deal with all this; less time to just step aside and let things happen so it feels. I suppose it just won't get any easier. I'll see how it goes at my doctor appt in the morning. I'm going to ask a lot of questions.

My partner and I have been more lovey since I've been back though and that's a blessing. Things were a little strained due to the m/c as it can happen. In spite of all the family crap, taking a break and even crying some both seemed to help.

More about cortisol (hypercortisol)

I opened up my reproductive endocrinology textbook this morning and found some info about cortisol. Evidently your body will produce excess cortisol in a variety of situations (addison's disease, cushing disease, anorexia/bulimia, tumors, etc.) but stress will increase it's production most certainly.

Low blood sugar will also cause an increase in cortisol production and it is related to blood sugar levels that you will have the night sweats, it has to do with some metabolic thing that happens overnight with the blood sugar.

Facts You Should Know About Night Sweats...

Here's another thing, excess cortisol will interfere with your thyroid hormones but your TSH and T4 will show up normal. It's the T3 and anti-T3(?) that will e low, and those aren't tested unless you have a full thyroid panel done, normally they only test for TSH and T4. Other signs of this pathology include low blood pressure -- how very interesting that I have that and it runs in my family. I'm also really sensitive to stress, one of my responses is to lose my appetite and thirst -- which only makes this cycle worse as it adds to the stress.

Thyroid and Anti-Thyroid Drugs

One test for adrenal function is a 24 hour test where you collect all your urine and they are able to see how your body is handling its sugar. My partner had this test a couple years ago and it showed he was hypoglycemic.

I did find mention of surgery increasing cortisol production in the body and it can be related to amenorrhea as well.

There was a liver component as well where one of these hormones (I also looked up prolactin but I don't think it was that one) in excess interferes with liver function. Potentially one might assume that this might result in one other possible cause for excess estrogen in the body -- oh yes, I've got that too -- and estrogen excess is linked to fibroids. (also too much cortisol will impair immune functioning, which might be why so many women seem to notice fibroids occuring after periods of extreme stress such as divorces and deaths in the family).

And I remembered one more thing, with this type of pattern of excess cortisol interfering with T3 and the blood sugar issues, they noted (in the case of anorexic/bulimic women) that fertility decreased during the Fall and Winter months. It had something to do with the affect of adding increased melatonin into the mix, melatonin production evidently increases as the amount of daylight decreases. How weird it all is.

In all that I've read though, the best ways to reduce your bodies cortisol production is by resting, taking regular exercise, cutting back on sugar and salt (craving these are one indicator of adrenal exhaustion), reducing stress, and eating small, regular meals. Parsley might be a help (of all things) as it is a adrenal tonic. Also rhodiola rosea which is an adaptogenic herb.

This page has more info about dietary things to do:

Adrenal Glands Revival

Look what I came across, this is what one medical author described pregnancy as:

"...a neoplastic, endoparasitic (i.e. neoparasitic) autoinfection of relatively high pathogenicity and low average virulence which is localized, self-limited, and nontransmissible; "

And we want to do this to ourselves why?

It's an article about whether or not pregnancy might be considered a disease. You can read the full thing here:

THE ILLNESS PARAMETERS OF PREGNANCY

Cortisol and Night Sweats

I'm onto something, a few things really but the one that has my attention right now is cortisol. I had really bad night sweats at the beginning of my pregnancy. Evidently panic attacks are associated with night sweats and I know from my partner who has panic anxiety that adrenal exhaustion triggers cortisol production. I came across a reference last week that mentioned that kidney yang deficiency was akin to adrenal exhaustion and I've been diagnosed with kidney yang deficiency -- boy doesn't it all come full circle with the night sweats.

ADRENAL FATIGUE

I found a couple of links about cortisol and pregnancy loss which I posted to the progesterone and miscarriage post, look towards the bottom of the links.

I've also been looking up about heparin and blood thinners to help stop immunological rejection of pregnancy. I posted a few weeks ago about some similar cases treated with chinese herbs that contained dongquai which is a blood thinner so I wonder if trying the blood thinner route might be worth it -- and then it is a matter of eastern or western medicine.

Just a quick one. I got my period today finally, the first time since April. Granted I had the bleeding with the miscarriage but if you've been there, you know it is different and doesn't count as a period. I had cramping and spotting last night and today and now just a somewhat normal flow. I don't think there will be anything dramatic this time, I sure as heck hope not.

It's hard not to be reminded of the last time I had cramps a few weeks ago and all that crazy hemorrhaging.

We're planning on going on a trip to Europe in a few weeks and I think we may need to hold off trying again until after that as my ovulation this cycle will land us not at home with my medical and acupuncture care in the early weeks of a possible pregnancy and I so don't want the experience of pregnancy and possibly loss while travelling, not with my brilliant history. I guess we can just do FAM for a cycle for avoidance.

I know that casually on the Internet it has been suggested here that you start trying again when you are ready, or as soon as your first post-partum AF has came and went, but lately I've been thinking differently. I'm not even going to go into emotional healing before TTC, but strictly about how strong you are post m/c.

With this second loss I found myself completely knocked to the ground with anemia. I lost a lot of blood, probably more than 2 pints over several hours, it is so hard to quantify as it spills out of you into the toilet. I was having horrible head rushes where everything would go black if I got up ever so barely quickly, I had no energy, I've been cold, out of breath, my skin looks a bit dry, my gums are pale, etc. All symptoms of anemia. My RE had my blood levels checked and I'm anemic, not dangerously low but need to get it up there you're not healthy low.

When healthy people donate blood, they usually only give one unit of blood (close to a pint I think, maybe someone can correct me). They tell people to wait 8 weeks before donating blood again and I've heard that it takes a month to rebuild a pint of lost blood.

It's common for women to get anemic in pregnancy due to the greater demands on her blood supply, which increases to help support the pregnancy. I was just talking to a friend of mine and she's 21 weeks pg and anemic. I imagine that she wasn't very anemic, if at all when she went into her pregnancy. Its probably doubly challenging to build your iron stores when you are already pregnant.

How unwise would it be then to get pregnant if you are definately anemic? I've just started AF, the first one since my loss, and I just don't feel like my body is up to it yet. I'm due to go in to see my RE this week and I'm going to get my ferritin checked, that's where they look not just at how many red blood cells you have but they are able to determine what your body's iron stores are like. From my uterine fibroid friends I've learned that even with just low ferritin and not low red blood cells you will have symptoms.

Based on all that I've been feeling and then learning more about this I think it would be most wise for me to wait until September until I TTC again. I did have the two losses and surgery this year so I might be a bit unique. I just wanted to share in case it helped you in your journey as well.

I've compiled some info about treating anemia and iron-rich foods previously.

With the way the medical establishment is managing obstetric care many women don't get in to see their docs until they are 8, 10, 14 weeks and sometimes later. But when you have a hard time getting in to see your doctor they are also giving you a signal that they aren't available to provide care to you in those early weeks, right when there might be catastrophic problems as in ectopic or molar pregnancy, not to mention missing other things like progesterone deficiency which some of the time is likely a cause and not a result of failed pregnancy (Coming to Term mentioned this).

It's so hard to know what feels right when so many of the symptoms of early pregnancy just feel like crap anyway. And we all know that when people post on teh pregnancy board that they are having spotting in early pregnancy and people reassure them that it is normal, we know that they aren't always right. I'm sure there are a bunch of women here for which that was the case. Or how about having your symptoms lessen? Lots of people say that it can happen that your body adjusts -- well this last time that didn't happen for me; that was when my pregnancy failed. Then when you add inaccess to medical care due to practice management* of course you are going to end up with a lot of anxiety.

* Practice management has to do with how medical office manage their practices. It's become a more organized routine with workshops being offered by outside agencies to doctors and their office managers. We see it as patients when you see a nurse practitioner instead of a doctor or are told you need to wait 2 1/2 months for an pelvic exam or that you can't see a doctor until you are 15 weeks pregnant and that you will see a nurse practitioner at 10 weeks. These things are not entirely based on what insurance will or won't cover, it has to do with maximinzing the number of patients the doctors can see and increasing their gross revenues some of the time.

Progesterone and Miscarriage

I've found a few links that I've bookmarked about progesterone and I'll add to this post as I'm able to comb through more. I think that progesterone is part of my problem.

"I myself give progesterone. I'd rather take a chance on delaying a miscarriage than writing off a baby that just might make it..."

"Note: The normal level of progesterone is usually "15-20." If the progesterone level is ~13 or so, this is seen as salvageable. If the progesterone is <5, I've not really seen progesterone do any good."
From: Exercise in Early Pregnancy: Risk, Low Progesterone, and Miscarriage

Hormonal causes for recurrent pregnancy loss

Progesterone Therapy (PDF)

Luteal Phase Progesterone Level(s)

Also estrogen dominance can lead to prolactin excess and low progesterone production. Here's an article about elevated prolactin and miscarriage
High Prolactin Linked To Recurrent Miscarriage

Progesterone Therapy in Pregnancy

Possible Ways to Prevent Miscarriage

"The researchers found stress hormones such as cortisol are raised in the bloodstream, suppressing the production of progesterone - a hormone which is crucial to the maintenance of a healthy pregnancy."
From: Stress 'linked to miscarriages'

"Increased levels of cortisol are associated with pregnancy. Physical and emotional stress can also elevate cortisol levels."
from: Cortisol tests

Birth control patch linked to higher fatality rate/ Estrogen thickens blood?

Birth control patch linked to higher fatality rate
Report: Device has three times greater risk of stroke, blood clot
than pill

"Blood clots are an accepted risk from hormonal birth control because estrogen promotes blood coagulation."

Had you heard this about estrogen? In Traditional Chinese Medicine
blood stasis as one of the causes of fibroids. Chinese herbs that I
took last year that did cause a reduction in my fibroid size included blood thinners (which I noted since I used them during my period accidentally and had some crazy bleeding for a few hours). Very interesting...

BTW--

Since I'm Ms. Infertility I've had lots of blood work done to check
on my hormones, I've tested borderline low for progesterone and
elevated estradiol (at least at last check)

How many of you have had your cycle day three bloodwork done by the
way? It's a common panel dones for women who are trying to conceive,
especially when you are experiencing infertility, but I'm not sure
how common it is for regular ob/gyn care. I don't expect that many
women to have had their progesterone level checked (7 days post
ovulation), another common blood test done for fertility. I just
wonder how many of us are running around with hormonal imbalances
that are going unchecked, treatable perhaps by diet and lifestyle
changes.

I'm doing okay.

I had my acu appointment yesterday and the practitioner asked how I was doing about my recent loss. I told her I was feeling a bit confused still about it, as to whether or not anything could have been done and that the idea of meeting with my RE makes me mad (if there was something she could have done last time why didn't she just do it). I'm feeling better than I have for weeks and I think the nice weather and having the workmen out of our house has helped with that. I've actually been doing housework again, I was slacking for a long while and the house was showing it.

I told her that my SP6 had been bothering me (point a couple inches above the ankle bone on the inside of your leg, a point associated with ovulation and the joining of the kidney, spleen and liver channels) and also the kidney points in the indentation on the insides of my ankles had been throbbing. She put in a bunch of needles and I felt better after that. She said my liver pulse was a little wirey but it tends to feel that way for most people, but the most problems were my spleen, blood and kidney were weak.

Today I will start going to qigong class again. I've been doing some on my own but haven't been to class since March.

My fear right now, and not at the forefront of my mind but just there, is whether or not I'm destined to keep losing my pregnancies. We're a couple weeks away from TTC again so that's what comes to mind (as if we should be so lucky to get pg again on the first try[:|]). I told my acu yesterday that I just don't see how the next time will be any different at this point.

I'm supposed to go in to talk to my RE but I don't see the point. I should do it anyway and not be so arrogant because maybe she'll have something interesting to say. I was thinking of bringing in my list of symptoms and see what she says about it -- I'm sure many of them she won't have any idea about though they are recognized as symptoms in TCM.

I'm making myself drink more water, struggling still but trying. I don't get thirsty and it really isn't healthy for me to be so dehydrated.