The House passed that bill for National Food Labelling Uniformity. I looked it up on Thomas (I hope that link works) and it evidently doesn't affect organic food labeling:

(g) No Effect on Certain State Law - Nothing in this section or section 403A relating to a food shall be construed to prevent a State or political subdivision of a State from establishing, enforcing, or continuing in effect a requirement relating to--

`(1) freshness dating, open date labeling, grade labeling, a State inspection stamp, religious dietary labeling, organic or natural designation, returnable bottle labeling, unit pricing, or a statement of geographic origin;

You Are What You Eat

After coming across a few interesting news items this week I though I'd just include a general email about nutrition and food quality in the United States.

Some months ago I met a new doctor, an internist, just out of her residency and starting to work with patients. Since I had read that medical school curricula only included about 30 hours total information about nutrition, and that was spread out over all of their studies and not in nutrition courses. I asked this young doctor if that was still accurate and she confirmed it was about right. She said that she didn't buy into all this stuff about food, that people had been eating for thousands of years and people should just eat what they want. She also had an attitude that indicated that nutrition was akin to dietician or nutritionist, the lowest of the low -- she was a doctor. Wow I thought to myself, not only ignorance but arrogance about it even. I was not impressed.

Did you know that the food we eat today is not the same as what people ate 100 years ago? I don't just mean food preparations, but the nutritional value of the food has actually changed. Beef came from cows that ate grass and the omega-3 to omega-6 fat ratio was actually a lot more inline with what our bodies can handle. With the feedlot handling of today's cows/steer they eat a lot more of corn and other grains which drive up the omega-6 content. Too much omega-6 in the diet is linked to some types of arthritis and other health conditions. That's just one example that I heard about from an arthritis expert on NPR some years ago.

Then there are trace nutrients in the soil such as selenium. Wheat is usually a good source of selenium but with depleted soils in farmlands and crops grown predominently on fertilizer you likely aren't getting as much selenium in your diet as people were even 50 years ago. Selenium is one of those nutrients on the fertility supplement list -- if people dealing with infertility are having to supplement for this then you know on average there is a deficiency in the food supply on the whole.

So I wasn't that surprised when this article popped up on the ABCNews site this week, perhaps you saw coverage about it on the news this week:

Fruits, Veggies, Not As Vitamin-rich as in Past, Says New Data
Larger Fruits and Vegetables Mean More Plentiful but Less Potent Bounty

So the food you eat has 30% less vitamins than before, and it sounds like they weren't speaking even about trace nutrients, probably just the basics like Vitamin C, Iron, Calcium, etc. Does that mean that the average American is also 30% less healthy? I don't even need to say much about the recent figures about obesity in this country, I'm sure you haven't missed that.

Here's another good one:

What we don't eat can actually hurt us, Seattle Times 3/8/06

So the real deal is that if you want the best nutritional value you should buy organic. And eating local is also another way to help make sure you are getting food that hasn't been in storage for months, or ripened in warehouses with methane gas (that's what they do to those nasty pink tomatoes they sell in the supermarket).

A great couple of books you might be interested in to learn more include:

This Organic Life by Joan Dye Gussow

Coming Home to Eat: The Pleasures and Politics of Local Foods by Gary Paul Nabhan

So had to be mad about something

When I was brushing my teeth this morning I remembered that my acupuncturist last week had asked me to do castor oil packs on my belly. Oh well, forgot about that for a good number of days. But then I was thinking about it and got all annoyed. I don't like doing castor oil packs. Castor oil packs don't do anything. When has a study ever shown that castor oil packs help shrink fibroids? Wouldn't a hot water bottle do the same thing? And so on.

I did do castor oil pack a few years ago when I first started working with a naturopathic doctor, the routine left a lot to be desired -- heat up a cloth soaked in castor oil in the oven for 15 minutes and carry it upstairs. Place it carefully on my belly and then lay a sheet of plastic over it and a towel over that and then top the whole affair with a hot water bottle. Sit like that for 25-30 minutes every day. Then after that you had to wash your belly off with a baking soda solution though I usually just used a washcloth with soap and water. Hoo boo was that a lot of work. I did it too for about a month but after that I just shrugged it off. It's too much work. Taking a bath every single night would be less work.

But really, I don't mind sitting with a hot water bottle on my belly but what's up with the castor oil really. Where did this tradition start and why do they keep pushing it? Grumble, grumble.

My breasts did start getting sore right after I last posted about how they weren't. Nice isn't it? So that's about mid-LP, just as my hormones peak, I start getting sore this month and it will stay that way until AF (due on Monday). Well, that's better than last month. I'm going to go back through my Ovusoft notes in the new 2.0 version of the software and see about any patterns for breast pain that I can pick out.

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.

Alert: Protect Your Right to Food Safety

In case you are interested in the politics of what you eat, I received an email alert from the Organic Consumers Association that Congress was poised to pass legislation that would disallow States from having separate standards for food safety and the like. They called it the National Uniformity for Food Act. This wouldn't allow States to continue having things labelled as certified organic for California, or Oregon, or Washington. I count on those labels when I shop at the store to help me make my buying decisions. This affects me and everyone else who eats organic food most directly.

The legislation was put on hold for a few more days so there's time for you to step in a help combat this attempt to eliminate some of the few trust-worthy controls that are available in this country.

Learn more about it and take action by emailing your congressional representatives and sending info about it to your friends.


Congress Poised to Pass Bill Taking Away Your Right to Know What's in Your Food

Here's the link to the Washington State Department of Agriculture Certified Organic Program if you want to know what these types of programs entail.

How My Mom's Doing

I realized that I haven't posted much about my mother and thought I would give you an update on how she is doing post breast cancer.

As you might recall she was diagnosed finally with breast cancer in May of last year, a couple days after I found out I was pregnant. She had a lumpectomy at the beginning of June, where they also removed a lymph node in her breast/armpit area. The cancer hadn't spread at all and it was small so her prognosis was and continues to be very good. As with my abdominal surgery, small nerves were cut in the skin, though for her it made her armpit numb.

Over the summer she underwent daily radiation treatment in White Plains. They had given her two little freckle sized tattoos that the radiation technicians (is that the right term?) used to line up the equipment to focus the treatment on the area. She had some skin changes as a result, mostly a kind of sunburn. She found the treatment made her very tired. Radiation treatment stopped in September/October or so.

She was put on an aromatase inhibitor, Relafin (I think) which has the nice side effect of cognitive impairment. This she was not warned about and had to learn about it online after the symptoms were preventing her from doing almost anything. She asked her doctor about it and he said "oh yeah, that can happen." She talked about it with a family friend who is a cancer specialist (but not a breast cancer specialist) who felt that an aromatase inhibitor was not the correct way to treat a totally focalized instance of cancer and that the side effects would outweigh the benefits.

After much deliberation my mother determined that if she couldn't think then she didn't want to live, as thinking is what makes her tick. It's true, she's a very analytical person who is constantly using her critical thinking skills -- not having access to them would just be wrong, it wouldn't be her. So currently she's not taking anything, just watching her diet, increasing her consumption of fiber and eating more organic food.

I think she's still physically dealing with the stress and I know that she's wanting to lose some weight. Her endocrinologist has cut back her thyroid medication level, thinking that as humans mature they can't handle such a large dose of TSH all at once. Having been on thyroid medication since the late 1960's though, this means that her body is running a lot more slowly than it was used to -- and her early doses of medication were much higher than they would start someone on today. It's just another drag for her though, and too bad as well. She mentioned to me during my visit last weekend that she hopes that someday someone would come up with a better delivery system for thyroid medication that would better mirror the body's typical pulsing doses.

So, she's doing well and taking care of herself and she's got a good outlook. I guess, if that was the bargain (her health for my second baby) then I can live with it, even if it pains me. She's my mom after all, as imperfect as she is.

More Spleen Qi Deficiency Info

I've been reading through my copy of The Web That Has No Weaver, it's one of the first books that brought TCM to the West. My previous acupuncturist said that there were better texts than this one so I take it with a grain of salt but so far it makes reasonable sense based on what else I have read.

I've been looking through the sections about the Spleen, dampness and mucus and it's been interesting what I've seen. Here are a few items:

"copious, clear, or white, and thin discharges (leukorrhea) usually signify Deficiency and Dampness" (p.192)

"The Spleeen like Dryness...Dampness can distress the Spleen...[and] can be seen in signs such as loss of appetite, indigestion, nausea, diarrhea and abdominal edema" (p.148)

"When a person experiences Dampness, the head may feel dull...limbs may feel heavy and sore, and the person will express a dislike for damp environments" (that would be Seattle this time of year with all the rain and dampness)

"Dampness can easily obstruct the movement of Qi producing ...incomplete urination..."

"Mucus in the stool, relatively soft, mobile swellings, lumps or tumors...and a phlegm cough can all be signs of Mucus" (p.252)

It also mentioned that not being able to discern any taste in the mouth (when there is no food, just as it is when it is empty) is also a sign of a Deficient Spleen.

When I read it and I see the various descriptions of things pointing towards heat, wind and other variations on Spleen Deficiency they don't match but the symptoms of dampness and mucus, cold, etc. they all point right at my symptoms. It's pretty weird. I do also have continued signs of Blood Deficiency, particularly Liver Blood Deficiency as I keep seeing dark spots before my eyes and it's been quite constant and distracting to me lately.

I hope that the acu treatment works, the diet changes aren't much fun but I'm already feeling a lot better and the nausea has gone away. I guess we'll see when I hit my LP whether or not the bloating and breast pain has dissipated yet.

Yeah. Sure. Right.

Why is it that doctors don't want to hear about it if they hurt you. I'm still spotting today from that HSG the other day so I called and left a message at the nurse's station. I mentioned that it was more painful than last time. The nurse called back and said it was all normal and to be expected and that the bleeding might continue for a week, it's all individual she told me. And that the doctor said that it was totally normal and nothing out of the ordinary. I don't know, if I was going around hurting people with my technique I think I would want some feedback.

Nope, it's all just to be expected. I didn't expect any of it. Nothing except the infertility part.

Give me land lots of land under starry skies above (Don't fence me in)

My partner and I talked last night and we're going to take another break to focus on other parts of our lives. This is a continuation of the same feelings that caused me to take a break in November. When I took the time to reapply myself to work and my other interests I feel stronger and more accomplished. My entire being is screaming at me right now that I'm more than an infertile person.

Yes maybe we will conceive on our own again. Who the heck knows. I just can't do this anymore -- you know what I'm talking about. The little compromises, the hopeful thinking, the little things that you do and don't do when you think that somewhere in your near future there might be a pregnancy.

I think just quitting this game is the best answer for me right now. No one has any answers or reason and throwing medication at that won't fix the fact that we mostly don't get pregnant but when we do we lose them and each time it happens it sucks the life out of me.

I'd rather just be an artist and travel the world and not be directing so much energy to this really painful, damaging and unsatisfying process. I have more to give the world than to be a mother.

I'm going to work on my kitchen remodel and probably my artwork as well, it's been a long while since I had a show.

I'll continue to post here about how I'm feeling and what's going on with me.

Thank you for your continued support.

I'm feeling depressed tonight, I don't feel like I can keep doing this. I feel like I don't really want to try anymore, that I don't want to get pregnant, that I don't want to have a baby, that I don't want to deal with any of it.

How do you handle that?

I feel like crying but I can't get it out.

Dang that hurts like a b*tch! (HSG Report)

I'm just back home from my HSG and what is there to report... I found it really painful again but thankfully I'm not having deep seated cramps right now (they made my knees weak last time three years ago). I had some bleeding/spotting right away afterwards which hopefully will stop before the end of the day.

The test showed that both tubes were open. Imagine the likelihood of that with all the mucking about in my woomba that's gone on in the past couple of years. The uterine shape looked pretty normal otherwise, no funny distortions from adhesions or fibroids this time.

I think they would have let my partner in to watch but since recents reports have said that it is best to limit your lifetime exposure to radiation, including x-rays, it's all for the best. And, as I said to my RE, I have found the HSG to be way more physically painful than a d&c since they sedate you for the d&c. It's over quick but DANG! OUCH! OW! OH! EEEEE! and THAT HURTS! I don't know who the people are who say it is no big deal, I hate it.

Also, a word to the wise, even if you can drive afterwards and go back to work doesn't mean that you should a) go by yourself or b) plan on going back to work. If your scan shows something is wrong, or if you have a strange reaction to the dye (such as weak knees or low blood pressure) then you will most certainly want someone there to take care of you. I'm staying at home the rest of the day and soon I will be taking a nap.

About Femara/Letrozole Safety for Ovulation Induction

I'm just starting to research the safety of Femara/Letrozole but I'll continue to update this post as I find out more. This summary from the ASRM 2005 Conference was interesting:


Biljan (Montreal, Canada) and colleagues[7] reported the results of a study of the births of 150 babies following treatment with the aromatase inhibitor letrozole. In this study, 5 mg of letrozole was given in all cycles analyzed. Perinatal outcome information over 36,000 deliveries from the same hospital was used to provide the control population. Maternal age and the proportion of multifetal deliveries (110 singleton and 20 twins) were higher in the letrozole group. Malformations were detected in 4.7% of the newborns in the letrozole group and in only 1.8% of the newborns in the control population. When the type of malformation was considered, locomotor, bone and cardiac malformations were more common following letrozole treatment.

The findings of this study are surprising, as until now no adverse perinatal effects had been reported with aromatase inhibitors. They were considered to be safe because they are used in only the early follicular phase and their half-life is short. Some points about this report need to be raised, however. The rate of malformations in the control group is lower than that usually observed. Several factors influence the rate of malformations, such as maternal age, the order of the pregnancy, gestational age at delivery, medication use during pregnancy, and maternal medical complications. One must make an effort to control for these factors during the analysis. Maternal age was higher in the study group and there were more multiple gestations. It is also known that the incidence of congenital malformations is higher following infertility treatment, so it would be better to compare the letrozole group to groups undergoing other types of infertility treatment. Still, the findings of this study should lead to more careful use of aromatase inhibitors for infertility management. Further studies need to evaluate the association between aromatase inhibitors (various doses) and congenital malformations.

More about the Highlights of the ASRM 2005 Conference

The half-life of Letrozole is about 2 days. This means that it takes about 2 days for the concentration of the drug to drop in one-half in the serum. In general, a drug will be completely eliminated in 5 half-lives. In the case of Letrozole, this is about 10 days. The pharmacokinetic studies which determined the half-life of the drug may not have been done in women of reproductive age as the drug was to be used in post-menopausal women. Thus it may be metabolized differently in younger women. In fact, two unknown metabolites are mentioned in the PDR which may have untoward biological activity. Most studies used Letrozole until about day 7 of the cycle. Thus, it is possible that the drug could still be in the system at the time of conception around day 14 or so if we assume it takes 5 half-lives to be completely excreted and potential metabolites exist that could have biological activity. Also, the half-life of a drug may be increased by increasing the dose of the drug. Some use Letrozole at 5.0 mg or 7.5 mg doses, potentially increasing the half-life of the drug. The dose in breast cancer patients is 2.5 mg per day. There is more to drug disposition than simply the half-life. The clearance of the drug is slow and the volume of distribution is approximately 2 L/kg, indicating that it is widely distributed in the body (2). This raises the possibility that the drug or its metabolites could be distributed to the ovary or uterus, organs vital for reproduction. Letrozole is mainly bound to albumin as a carrier protein in the blood. The PDR warns of fetal toxicity in rodent studies at doses of 0.003 mg/kg (about 1/100th the human dose) where increased intrauterine mortality, increased fetal resorption, increased post-implantation loss, decreased numbers of live fetuses, fetal anomalies fetal anomalies including shortening of the renal papilla and ureter dilation and incomplete ossification of the frontal skull and metatarsal. In rabbits, Letrozole was embryotoxic at doses of 1/100,000th and fetotoxic at doses 1/10,000th of the maximal recommended human dose. Thus, standard experimental models showed that Letrozole is toxic to the fetus. The PDR considers Letrozole to be a Category D drug in pregnancy (Positive evidence of fetal risk). Anytime a drug is Category D, the benefits must clearly outweigh the risks. Data on the health on the babies would certainly help to determine this. While the patients are not technically pregnant at the time they are taking the drug, can we be absolutely certain that it or one of its metabolites is no longer in the body especially given the low doses that are toxic in experimental animals?
From: Femara (Letrozole) as a Fertility Treatment: Potential Risks

AIs may be a viable option to replace CC in the
future as the new primary treatment for ovulation induction and in combination with FSH for assisted reproduction procedures. However, larger randomized controlled studies are required to determine the best treatment regimen. If such large studies confirm effectiveness and safety, the use of AIs for ovulation induction would be the first improvement in oral ovulation induction in decades.
Aromatase Inhibitors for ovulation induction
Casper and Mitwally, Sunday, August 21, 2005

Acupunture Update

Just a quick post to let you know that acupunture treatment went well and I had lots of points of pain in my abdomen that she treated. Overall the diagnosis is: spleen qi deficiency, damp accumulations, phlegm obstruction and blood deficiency. Nice eh?

She worked a lot on points to help dry things up, and being that she asked how I was doing, of course I cried. It was weird to have my sinuses drying even as I had just been crying.

I'm going to take this month off to work on the fibroid with herbs. I'll feel much better about things if I do (and chances are that if I don't I won't conceive anyway since my body is disrupted enough to start growing another fibroid). Keep your fingers crossed for me that it helps.

Empty Arms

An online acquaintance (Zuzu) created this beautiful and sad movie about infertility that you should experience. It is deeply moving and perhaps it helps to express how you are feeling, or if you are someone who hasn't experienced infertility, maybe it can help you understand a little more.

Empty Arms

Spleen Qi Deficiency and Liver Qi Stagnation

I came across this the other day and it sounded like me:

Stagnation of Qi and Blood

Poor Liver function can lead to stagnation of Qi and eventually Blood. Stagnation of Qi is experienced in the body as a feeling of fullness, discomfort, or pain in the chest, belly, or head, and in the mind as agitation, nervous tension, suppressed emotion, and frustration. Stagnation of Blood is experienced as a localized stabbing or cutting pain. If this stasis of Blood persists for too long, it gives rise to hard lumps, masses, tumors, or chronic inflammation in the chest, abdominal and pelvic region. A mass or lump may come and go unpredictably, like an intestinal spasm when Qi is obstructed, or may become a benign or malignant tumor in the final stages when Blood becomes "congealed". This situation is often the case in women who develop uterine fibroids, uterine hemorrhage with large clots, irregular, scanty, or suppressed menstruation, cervical dysplasia, ovarian cysts, or tumors.

Stagnant Qi can also obstruct the Spleen, affecting its ability to generate and distribute moisture and nutritive essence in the body. This impairment of Spleen function results in the accumulation of Dampness and an attrition of vitality. The fluid excess itself then may become a secondary source of stagnation since it impedes the flow of Qi. The body often generates Heat to counteract this fluid excess by drying it. This Heat then accumulates and intermingles with the Dampness. Damp Heat can settle in the pelvis, where it damages and obstructs the Blood. Over time this will lead to coagulation and deficiency of Blood. Damp Heat in the Liver also sets the stage for problems such as genital and perianal herpes, jaundice, and hepatitis.

and this:

Although a blood stasis condition is slow to develop initially, once it is entrenched it can recur easily when it is triggered and aggravated by factors leading to Liver Chi Stagnation.
From: Ovarian Cysts and Chinese Medicine

As for my new fibroid, I'm thinking of talking to my acu about it, perhaps it is related to an ongoing issue of spleen qi deficiency that I have symptoms of -- anemia, excess phlegm, get sick all the time, poor digestion, fatigue, allergies, copious EWCM, fibroids and even my bad PMS/breast pain. These symptoms are all related in chinese medicine to the same pattern, blood deficiency, dampness, blood stasis, spleen qi deficiency and liver qi stagnation. Since the symptoms have continued and I've got a new fibroid I think that its even more likely that I have an underlying issue that continues, yes that and a genetic predisposition to fibroids.

The other day I coincidently decided to search out more about digestive disturbances related to Spleen Qi deficiency and suddenly a lot more became clear (and I'm so not surprised to hear that there is a new fibroid in there). Here are some links with info about herbs and dietary changes to help deal with Spleen Qi deficiency:

UNDERSTANDING CFIDS FROM A CHINESE PERSPECTIVE

Digestive Issues

Applying Dietary Therapy

Help for Holiday Digestive Woes

How Do You Treat Intestinal Gas?

Common things I'm seeing on these pages are:

ginger, oatmeal, cooked foods
stay away from sugar, salt, fried foods, stress, fermented foods, citrus (but I like oranges!)

Kinda like my acus told me. I started my search with this string if you are interested to see more: "spleen qi deficiency acidophilus"

Here's a link to a q&a about miscarriage with Randine Lewis where she mentions spleen qi deficiency.

Introducing my new fibroid

I just had my RE appointment this afternoon and it was an interesting experience. My partner basically laid it out there for her, that we were feeling that it was worse to get pregnant than to not get pregnant -- since losing the pregnancies was far worse than not having them. She suggested that we try using Femara to induce ovulation for a few cycles, in the hopes of promoting a stronger ovulation. After a few cycles we could then move on to trying IUI. She said that really, in spite of my partner's poor morphology, that getting pregnant on our own really was the ultimate test of his fertility.

We also discussed and scheduled a HSG for next week, to check for adhesions, any damage to the lining from the two d&cs and make sure the tubes are open. Sounds reasonable, and its what I wanted.

I brought up again that I had read that low ferritin had been linked by some doctors in Britain to lower fertility and increased miscarriage rates and she dismissed me and said that she had never heard that and it wasn't something that she would check for on her own. If I pressed she would do the bloodwork but whatever.

Then she suggested that we do an ultrasound right then and there to see about any new fibroids. Sure I thought, but there weren't any when I had my ultrasounds around the last miscarriage. Low and behold, there was a brand new 2.5 x 3.5 cm intramural fibroid, but away from the uterine lining and towards the outer wall of my uterus. I was in total disbelief. I just went through major abdominal surgery just 14 months before, and there wasn't anything on the scan last June. How could this happen so fast, and in the same are of my uterus?

She said it seemed to be pushing the right ovary out of the way a bit, distorting it on the scan. How nice eh? She said she doesn't think it is causing me any problems right now. She also checked my lining via ultrasound and said that it didn't appear inconsistent which can sometimes be an indicator of adhesions. I'm going to have an HSG on Tuesday next week to check my tubes. If that all looks okay then we'll try for a few cycles using Femara/Letrozole to see if maybe there is an ovulation dysfunction that we can override.

As my doctor was leaving the operatory I said dryly, "well at least I've been growing something in there," and she totally didn't know what to say but then she laughed (my twisted sense of humor overwhelms them you see).

So what should we name this new little interloper?


Some of the lovely things you find in the RE's office.

A few raindrops turn into a downpour

I went to my niece's first birthday party last night. I've written about how uncomfortable I've been around her, starting during her mother's pregnancy as I lost mine.

The baby was being a pill last night, she was really clingy with her parents and didn't want to hang out really with anyone else. It didn't help that my period showed up yesterday (and wasn't it a full moon or just about as well?) After dinner we gave our presents, a dress I bought at the Lavender Festival last summer, plus a box to store baby keepsakes in and then a photo album in which I placed a bunch of our photos that they didn't have. Then my partner and his brother started playing the piano and guitar together doing old covers and my mother-in-law and I law on the couch. I was soooo tired with the cramps and drop in hormones and all, plus too much socializing all week long.

Then it started, just a couple tears at first which I subtly wiped away pretending my eyes were tired or itching. It's okay, I thought to myself, maybe just letting a little bit out will help me feel better. But as I continued to sit there, the feeling of not being acknowledged for my losses began to swell and gradually I couldn't contain it any more.

I walked over behind my partner who was facing the wall near the piano and whispered in his ear that we needed to go because I was crying. He nodded and then turned his face as he played and kissed my cheek through my hair that I was using to cover my face. At the end of the song he got up and said that it was time for us to go, I was already by the door with my things, and he quickly said goodbye. His brother came over to open the door and saw I was crying and asked if I was okay to which all I could say was its the anniversary of my dead babies not being born, how could I be okay? Which he didn't understand at all as he called after me as I walked into the darkness outside, "what? what?"

I totally lost it then as we drove back home, coughing and crying. My partner understood though, I was grateful for that. I told him that I couldn't keep holding it back, especially around his family since I don't really get any acknowledgement from them because I don't know how to talk to them about it. I told him that I thought that in some ways it was healthier for me to not be around babies and small children because then I could just focus on the me I am and not the me that I'm not, the losses that I've had in that area.

When we came home I continued to cry and it came to me that this time of year, with my two due dates going by without my even being pregnant, it's like having to keep driving past the finish line that you never get to cross.

Now that the family has seen me cry though, the first time I think, I don't know what to do. My instincts are to avoid them now because they couldn't possibly understand having never experienced this type of loss themselves. My other thought is to send them an email, my family and friends as well, and point out to them that January 23rd and February 13th are a time of mourning for me and that I just need a little acknowledgement of that. But I just don't know how that would go over.

Sperm Chromatin Damage from SSRIs

There's a study underway right now, I just read about it but it totally underscores what I suspected based on our experience with my partner's sperm count and subsequent improvement when we got him off of Paxil and onto vitamins to deal with some nutritional deficiences -- from 2% morphology to 5% morphology in just four months. We've not ever had his sperm chromatin checked but take heed -- those SSRIs aren't necessarily helpful for all of what ails you.

Federal Grant Awarded to Study Effects of Antidepressants on Male Reproductive Health

Study on Antidepressants and Male Fertility Generates International Interest

WSU Spokane Scientists Launch Clinical Research

Soy Might Impair Your Fertility and Hormone Balance

A lot of hype has gotten Americans consuming soy products in large quantities, in addition to the hidden additives of soy to many processed foods. But soy has hormonal affects and can be disruptive to your endocrine system, primarily interfering with thyroid function but it also may impair your ferility. Check out these links to learn more.

"Processed soy (actually, ANYTHING processed) is indeed bad. But, why soy? Three reasons: (a) contains chemicals that 'pull down' the thyroid (leads to hypothyroidism); (b) contains phyto-estrogens that block important minerals like Zinc and Magnesium from being absorbed into the body (2 VERY important minerals especially for women since having a deficiency in either one can cause numerous problems due to an estrogen/progesterone imbalance); and (c) does not contain essential amino acids. Soy products are commonly linked to weight gain and other hormone imbalances for these very reasons. It's also among the top allergens in this country, (the other top allergens include wheat, corn, dairy, chocolate, eggs, shellfish, and citrus). Many people have food allergies to soy and don't even know it. "
From: http://www.allergydir.com/Article692.php

"Soy foods couldn't possibly have a downside because Asians eat large quantities of soy every day and consequently remain free of most western diseases. In fact, the people of China, Japan, and other countries in Asia eat very little soy. The soy industry's own figures show that soy consumption in China, Indonesia, Korea, Japan, and Taiwan ranges from 9.3 to 36 grams per day.1 That's grams of soy food, not grams of soy protein alone. Compare this with a cup of tofu (252 grams) or soy milk (240 grams).2 Many Americans today think nothing of consuming a cup of tofu, a couple glasses of soy milk, handfuls of soy nuts, soy "energy bars," and veggie burgers. Infants on soy formula receive the most of all, both in quantity and in proportion to body weight."
Whole Soy Story: The Dark Side of America's Favorite Health Food

Chemical Found in Soy Products, Legumes Could Damage Sperm, Impair Fertility, Study Says

"The estrogen receptor beta is also known to respond to environmental and dietary chemicals that can mimic the effects of estrogen and stimulate the body's natural hormones. One example is genistein, a common component of soy products. These new studies by Korach and colleagues suggest that such environmental exposures could interact with estrogen receptor beta and possibly alter ovarian function in women."
from: New Discovery May Help Doctors Treat Infertility

Uterine adenocarcinoma in mice treated neonatally with genistein

It's not just that but most soy beans are genetically modified nowadays:

"Genetically modified soy has been on the market just five years. Yet it already accounts for two-thirds of the U.S. soybean harvest. Soy products are used in hundreds of processed foods, often to add texture and protein. So the biotech beans end up in pancake mix and baby formula, chicken soup and margarine, crackers and salad dressing, ice cream and granola bars."
From: Long Article on Roundup Ready Soybean Controversy

Some people say what choice do we have, but really there is a choice but we've not been given the chance to give our opinion. I remember listening to some FDA guy on the radio a few years ago as they debated GMO/GE crops and he said that the American public didn't care about the controversy and that they were fine with it. But, they didn't tell us that they were putting these products into the market, they just snuck them in. But other countries around the world weren't asleep and their press and public took action and blocked the use of these crops/products pending further scientific evaluation.

Corn is another crop that's largly GE these days in the States. It's hard to find any manufactured food items that don't contain corn or some corn-derivative. You have to look for products made overseas.

If you are interested in more info sign up for the Organic Consumers Association email newsletter -- http://www.organicconsumers.org

Too much information

I saw this site linked from another blog so I decided to try it out. You can get t-shirts printed up with a "word cloud", a dynamically generated image based on content from your blog.



I have to say that seeing it all laid out like that, and even thinking about the possibility of seeing it on a t-shirt, it makes me feel a bit glum. Not really fun stuff at all, and is it really worthwhile?

And It All Comes Rushing Back

Sick and twisted girl that I am, dropped by the records department for the hospital/clinic to see what I was missing so I wouldn't have to pay $20 for getting a whole lot of chicken scratch. I've got most of the information already and just wanted the bits that I was missing. Instead what happened was that I got to sit around with my file and relive the first miscarriage and my surgery. How I was able to stand w/o dizziness after the first d&c (they check this stuff for patient release post procedure); how I was "pleasant", walking around, or having "tea colored" urine after my surgery. All these details came into sharp focus in my mind again: the color of the tile floor, calling for help with the PCA pump, sitting on the toilet trying to pee and having nothing come out after they first took out the catheter and the anxious voices behind the door. All the little notes they made, the nurses and doctors and patholgist too, and I felt like I was swimming in memories that my mind had put away for safe keeping, or rather to protect me from them. While I walked quickly and confidently to the office building after work, after picking through the file I left in a daze. And even more frustrating is that there isn't really any good information to be had from my second m/c. There was no pathology done, just blood work and some scans. I felt partly like there might be answers in that thick file and partly that it was sad that there weren't.

On the way home I dropped by to visit my friend, the one who was close to divorce a few months ago (and had a miscarriage a year ago). She's been diagnosed as bi-polar and is on lithium now. She's having a bit of a hard time adjusting to the meds and finally some of the mania she was experiencing is starting to dissolve and so she can remember things a little clearer. We talked a bit about how crazy it was that it was four years later and I was still talking about TTC. For now babymaking plans are totally on hold until they figure out which end is up.

Baby Steps

I bit the bullet today and scheduled an initial consult with my RE (the RE who did my surgery and helped me through 1-1/2 miscarriages). We're going to see if we can stick with her, recognizing her limitations but also the leverage we have with her and her staff.

I set up an initial consult with her since we never had one with her. I just ended up in her care after my previous RE left the clinic and trusted her with my surgery and that's where it was left off. I sort of feel like let's start over with all this and see where that gets us. Yes, I have lots of information and opinions but we also want to know her take.

I think I mentioned before, but the plan that was laid out for us by more then one RE was:

1. Have surgery to remove fibroid
2. After healing (3 months), try on our own for three cycles or so
3. If not pg then move onto Clomid/IUI for three cycles
4. If not pg then consider moving onto IVF (possibly with ICSI -- though with the SPA test his sperm performed really well so this shouldn't be an issue)

We were going to do a trial of Clomid/IUI in July '04 but then got pg and had the firsst m/c. Then we started TTC again after my surgery and retained tissue experience in Feb '05 only to get pg the third cycle and then lose that one as well. It's like we never get to go to the next step. Sharing it with you guys just reminds me of the feeling I had with each loss that maybe God was trying to tell me something -- it's so hard to know that though.

My appointment is scheduled for February 14th - Valentine's Day. I know that's a bit of a downer but at the same time it fits in really perfectly with my cycle -- so if we don't get pg this cycle (and chances are we won't based on our past lack of success) then AF is due right about then and there will be time to either get right into a Clomid cycle or do the HCG or both. There's a chance we might change the appt so to not ruin v-day but for now that's where it stands.

I also just set up a time to review my medical records so I can pick out the sections that I need for my files, which can supplements the ones I already have so I can transfer the files to my RE's new clinic.

One step at a time, right?

Sometimes a pregnancy goes by like a vapor

Today was my EDD for my second pregnancy. I know two other online gals who had that due date -- one is in labor today (how perfectly on time!) and I've not caught up on the details of the other gal.

What helped me last year with the EDD of my first loss was to consider the week before to be a time to help come to closure about it. I was sort of forced to do it by the birth of my niece that same week -- based on advice from women online I bit the bullet and went to see her on the day she was born at the hospital. Yeah I cried a little too but I feel like I was able to change my perspective a little.

Since my surgery would have required me to deliver by c-section early, the second baby would have already arrived so in that sense there is no date for it really, it just would be here already. I don't have time to take off from work right now so I'm just trying to find some resolution about it.

Now, my niece's first birthday in a couple weeks might be more difficult (I still have some tension when I'm around her) but whatcha gonna do.

For all my stocism thought I'm still feeling a bit mucky about it. But it's been a long time since I was pregnant though so how could I really feel it, it's not like I was physically about to have a baby today. And from visiting with my niece yesterday, it's not like I know anything about the minutes/hours/days/weeks/months of attention that it has taken to get her to this point where she is taking her first steps. My past year (and then some) have been about a different journey.

Behold the Wonders of the Cervix

The Behaviour of the Cervix over the Phases of the Ovulatory Cycle

The Discovery of Different Types of Cervical Mucus and the Billings Ovulation Method

There are several methods of tracking your fertility that exist, the newer methods are actually more sophisticated than just counting days as in the Rhythm Method. Now we have charts, and even software to help us track our cycles and fertility patterns.

The ones I know of include:

Billings Method -- pioneered by Dr Evelyn Billings and promoted in the US by Billings Ovulation Method Association - USA

Fertility Awareness Method -- as described in Taking Charge of Your Fertility by Toni Weschler and incorporated into the Ovusoft/TCOYF ovulation calendar software

Creighton Model Fertility Care System -- promoted by Fertility Care Centers and the Pope Paul VI Institute and referenced in this article "Infertility Care and the Role of the Compounding Pharmacist" (PDF)

Easing Into It

I've been trying to ease my brain into the idea that it might be time to go that route, the possible IUI/Clomid route (and who knows what else). Even though we did it on our own twice there are reasons for us to see about other options as the clock keeps ticking.

I've been trying to slowly give my partner more info about it, he sometimes acts like he knows everything so I try not to jump on him with too much info. The other night he told me to hand him something to read so I reached in my nighstand and a copy of Conceive magazine was there and I gave them to him while I brushed my teeth. He read the ad for Preseed and saw how bad Astroglide is for sperm and he was like "I didn't know that!" To which I replied that I had told him over and over and even suggested that we try Preseed a year ago and he said no. He then said "Yeah but I didn't know you meant that bad"

Yesterday I sent him links to the three main fertility clinics in our area -- I've seen docs at all three. My partner and I talked about it briefly last night and he said that our greatest issue was with the profession and not the doctor per se, so he thought we should stick with Dr. Marshall who did my surgery and just coax her into trying things our way for the progesterone. I'm friends with one of the nurses in the office so that's a help too. Still, I loathe having to go back in. I had that consult last April where they told me to hang tight for a while and then got pg right after that and then lost it. My last appointment with the RE was in July, and then the ob/gyn appt but that was just for a pap.

I'll just have to ease myself back in slowly.

TTC After 35

Here are links to some articles I found when looking for info about my advanced maternal age.

Female Fertility After 35

36 and Over

How Aging Affects Fertility

Pregnancy After 35 - March of Dimes

Age Related Miscarriage


You might also appreciate:

How to increase your chances of conceiving and preventing miscarriages

Vitamin C: Too Much of a Good Thing

Commonly in fertility diets vitamin C is mentioned, it's really good for you and aids in iron absorption and tissue repair. There is a point when too much vitamin C might actually interfere in female fertility. Men can take twice as much and it will help with semen factors but here are a few points about what too much does to impact female fertility.

Other things which can cause infertility include taking more than 1,000 mg of vitamin C a day. If a woman is doing this and trying to get pregnant, she should decrease it to 500 mg a day. Infertility caused by a higher dose should resolve within a few weeks.
From: Effective Holistic Treatment for Infertility

Vitamin C and bioflavinoids help strengthen the blood vessels lining the uterine wall. When C is too high, however, it can decrease the absorption of copper, a mineral necessary for ovulation, and increase the risk of both infertility and miscarriage.
From: Alternative Health Care Methods of Improving Fertility

Women should avoid megadoses of vitamin C because it can dry up cervical fluid, preventing sperm from reaching the egg. Limit the amount you take to the dose included in your prenatal vitamin.
From: Natural Ways to Boost Your Fertility

What do you think we should do?

It just struck me that I've never asked your opinion of what you think we should do for 2006 in our pursuit of having a child. I don't have a plan right now at all and I'm really wondering what other people think when they read about our situation.

Do you think we will get pregnant again on our own? (it's been 5 cycles since we started trying again -- though the past two cycles I haven't been trying trying just not preventing. It's also been over a year since my myo)

Should we try an IUI? With Clomid or not? (what about the excess estrogen and The Infertility Cure mentioning that it tends not to mix well with liver qi stagnation -- I wonder if I still have that...)

Should we go straight to IVF? (even though this offends our sensibilities and makes it all seem so desperate and only heightens the stress of the situation)

Should I consult a new RE or stick with the one I've ended up with who isn't up on progesterone supplementation? Should we consult with someone outside of our area in another state -- preferably a larger metropolitan area?

What do you think? Please share. Thanks.

Cute Diapering Accessories

I did say that I was going to share some of my pregnancy and beyond links so here are some really cute bags and things.

Diapees & Wipees -- cute little holders for a few diapers and some wipes.

Darling Diaper Bag from Lexie Barnes


I'll add more to this post as I come across more things worth noting.

More Thoughts About Fibrocystic Breasts

So the common things they say to do if you are having PMS and fibrocystic breasts are:

Increase calcium consumption

Decrease caffeine consumption

Make sure there isn't a thyroid problem

Cut back on refined sugars

Increase dietary fiber

Increase B-vitamin consumption

Increase magnesium consumption

Drink more water

Use natural progesterone cream

Increase vitamin E consumption



-----

So I used to eat a fair amount of dairy and I had bad PMS but cutting back to almost none hasn't made any difference so dairy doesn't seem to do anything for me favorable. Less dairy does seem to help with my allergies and digestion so I'm going to stick with that plan.

I've always been a very moderate consumer of caffeine, I didn't drink coffee or cola. I do eat chocolate and have some black or green tea but in moderation. So, that didn't seem to make any difference at all -- in fact I recently started drinking a little more coffee than usual (a few time a week instead of once a month) and it's made no difference.

I've had my thyroid checked several times including a full thyroid panel last summer as it comes up as related to many of my conditions (fibroids, elevated estrogen, PMS) -- each time the test results were so normal it was boring. My mother has thyroid trouble so I thought for sure this might be related for me but evidently not.

Due to my naturopathic and TCM treatment I was told to cut back on refined sugars. It's helped me to feel better but I was never a total nut about eating candy or anything. I've made a concious effort to be careful about my intake of simple carbs. Still I've got sore breast in my luteal phase.

Increase of dietary fiber does seem to help me feel better generally but it hasn't seemed to help with the breast issue at all. Since this helps your body to eliminate excess estrogen I'm sticking with this for general health.

I eat a largely vegetarian diet (though I am an omnivore) and the foods I eat contain a lot of vitamin B and magnesium. Stress depletes b-levels and my work can be stressful and sometimes I don't get enough foods rich in vitamins B or magnesium but I really do try. I was never on birth control pills which can rob the body of B vitamins and magnesium so that's not an issue with me. I have been trying to be better about taking my vitamins but the best I usually do is 4 times a week -- better than nothing in my book.

I am bad about drinking enough water every day -- mostly when I'm at work. I'm much better than I used to be I think.

Natural progesterone cream didn't really seem to do much to help, maybe a little, but it mostly makes my breasts seem to swell more, not necessarily become more lumpy or sore.

And then there's the Vitamin E thing. It's in my prenatal and that on it's own doesn't seem to do anything.

But then there's that DIM/Vitamin E thing. It really did seem to help over the past three days. Today I'm spotting so AF is just around the corner but previously I used to not have my breast stop hurting until I had full-blown AF. It seems so curious to me. And some of the links I've found mention that vitamin E can increase estrogen levels, and also that DIM might do the same -- it just doesn't seem to be doing that to me -- it seems to be helping something hormonally.

(Vasectomy and) Vasectomy Reversal Information

I'm surprised that I haven't really posted about it before but I guess since my partner's reversal was so long ago (1998) that I haven't really gone into it in much detail over the past three years. I'll try to remedy that so that others can learn from what I've learned.

My partner thought that he was going to help out the overpopulation problem and in a fit of idealism and with encouragement from his wife at the time, underwent a vasectomy. That was several years before we met, and as it would happen, on the cusp of the end of his marriage. I can't really speak too much as to how his post-op recovery was though I know that he went in for the procedure alone and was hurt that she didn't even come to see him home afterwards. (Lesson #1 -- it is an emotional thing and the female partner should be there to provide support).

I've had a few sexual partners in my past and so I was a little familiar with what ejaculate looks like. What was weird about my partner's prior to his reversal was that it was thicker than the intact guys I engaged with. I guess this is due to the ejaculate just containing the portions from the prostate and seminal vesicals. After his reversal it returned to a normal looking consistency.

The final product of semen that you see when you come contains only 5% sperm; the other 95% is made-up of secretions from the seminal vesicles (considered an extension of the prostate) and prostate fluid (about 80% of the final mix), which gives ejaculate its whitish color.
From Premature Ejaculation


From when we first started dating he told me he intended to have a reversal, he had already worked through his regrets about having the procedure and so we knew it was on the horizon. From what we learned online at the time, having a reversal within 4-5 years of the initial vasectomy supposedly would help to ensure a greater likelihood of success.

The first step was to locate a doctor who specialized in vas reversals as we wanted this done right the first time. I searched online and at the time, Columbia University had and still has some great vasectomy reversal info and doctors who looked pretty good but through a friend's father who is a urologist in Washington, we learned about Dr. Dale McClure , a urologist specializing in fertility at Virginia Mason Hospital. My partner, since we were still just dating at the time, went for his appointments without me. I remember feeling embarrassed when he came back and told me that Dr. McClure asked about the fertility of his partner (me) and he provided some answer about my having regular cycles -- ack! things were going really fast for me and we'd only been together for a couple years.

The surgery was scheduled to be done through a facility at Group Health Hospital on Capitol Hill; there was some reason it was done there which if I recall correctly might have had to do with both insurance and the technology available. I insisted on being at the hospital the day of the operation, knowing how hurt he had been by the lack of support when he had his vas.

On the Internet prior, we had learned that the medical term for a vasectomy reversal is vasovasostomy and that there was a microsurgical technique used to sew the tiny vas deferens back together again using a fancy sewing technique under intense magnification -- this techique was supposed to have a higher success rates than older techniques.

Prior to the procedure my partner was sedated in a pre-op are and I was able to spend time with him and massaged his feet and kept him relaxed and calm (it was from this experience that he learned how to take care of me surrounding my first d&c and then my fibroid surgery which was really nice for me). The nurses told him that he better be really nice to me and that I was a "keeper". When he was good and loopy on the meds I stepped out into the waiting room and he went into the operatory. I told him that I would be there the entire time he was being operated on so he should know that he wasn't alone ever.

[Graphic detail]
From what he's told me, in the operatory he was awake but sedated during the operation. There was a camera pointed at his testes throughout the procedure, with a screen within his view which was fairly intense for him to watch. The doctor made two incisions into the front of he scrotum and lifted out his testicles to have access to the surgical site (in contrast, vasectomies are done through very small incisions through the back of the scrotum). When it would get too intense for my partner he would tell the nurse to dose him more. It took about two hours to do the operation and then he was moved out into post-op where I was able to come in and see him and rub his feet some more.
[end graphic detail]

We left the hospital that afternoon and went home to rest. He was instructed to not ejaculate/have sexual intercourse for four weeks after the operation to help with healing. Since then I've heard of other doctors wanting to have men begin ejaculating sooner (10 days post-op) to help keep the vas open. I don't know if there is a standard, I assume it is still going to be based on your doctor's own experience and preference. While he was healing the most noticible thing was that his scrotum was HUGE. His balls were swollen to the size of large oranges at least and it took weeks for the swelling to go down.

I believe he was meant to have a semen analysis within a few months of the procedure but we weren't ready to start a family yet and the doctor said that he had found sperm during the procedure from the testical side of the vas. I think it was fear of it not working more than anything that made my partner delay his semen analysis. Finally over a year later he went in and had it done and the results were pretty poor by WHO standards. He was instructed to come back for another test in a few months if I recall correctly. He asked the doctor at the time about some ongoing pain that he had in his scrotum/testes and the doctor thought it might just be part of the healing process. We felt a bit discouraged but only time would tell.

Specific things we learned along the way from our experience:

There might be pain for a while

Sperm counts might be low for a while and continue to improve over time without intervention (we saw significant improvement after 2 years)

Ejaculate consistency will change after the reversal, to a more normal consistency

You should be sure to have a semen analysis based on Kruger morphology standards and not just WHO standards, and also make sure you are tested for anti-sperm antibodies as well

MFI supplement cocktails can actually improve morphology

The our doctor felt that our chances of conception would be better with a repeat reversal (though it wasn't required ultimately because things improved on their own) than with trying TESE/IVF

General post vas reversal fertility info:

There is a greater chance of having ROS damage to the sperm

That the success rates post procedure have more to do with the health and age of the female partner than just on the time between vasectomy and reversal

That there is about a 50% chance of conceiving on your own post reversal

Vasectomy and Vasectomy Reversal Links:

FIND A SURGEON

Society for Male Reproduction and Urology (SMRU) - Member Search

INFORMATION ABOUT THE PROCEDURE

The Patient's Guide to Vasectomy Reversal

Microscopic Vasovasostomy

Vasectomy Reversal - Introduction

Microsurgical Vasectomy Reversal

What's New in Male Infertility Treatment at Cornell
Vasectomy Reversal: The Microdot Method for Precision Suture Placement

Google Groups: alt.support.vasectomy

International Center for Vasectomy Reversal

Vasectomy Reversal - Johns Hopkins

Building Bridges to Conception - Vasectomy Reversal

Vasectomy Reversal Questions &s; Answers

Microscopic Vasectomy Reversal

Vasovasostomy

The Infertility Center - FAQs - vas reveral Qs and As link

Cary Urology Vasectomy Reversal

Vasectomy.com

ARTICLES ON VARIOUS RELATED TOPICS

Warning over vasectomy reversals

Vasectomy - Can it be reversed?

Morphological changes of spermatozoa in proximal vas deferens after vasectomy

Microsurgical Vasovasostomy versus Microsurgical Epididymal Sperm Aspiration/Testicular Extraction of Sperm Combined with Intracytoplasmic Sperm Injection

Some vasovasostomized men are characterized by low levels of P34H, an epididymal sperm protein.

Vasectomy Myth Debunked: NewYork-Presbyterian/Weill Cornell Study Finds Vasectomy Reversal Highly Effective, Even After 15 Years

Vasectomy Reversal & Sperm Antibodies

VASECTOMY

Vasectomy Blog

Vasectomy Information

Requesting Patient Medical Records

It's a good thing to keep a copy of all your records, particularly when you are dealing with an ongoing condition (but generally as well). Request the records be sent to you if you are switching practices as well and then you can bring copies of the records to each new doctor you see --- you will be better informed and it will cost less too.

Some doctors are very strange about not giving you access to your records, they are actually required to do it under the Federal HIPAA law. You have to make a formal written request, and you need to specify both the time period and sometimes even the specific test results/appointments/etc. you are looking for. They have the right to charge you a reasonable fee. (See HIPAA and Medical Record Copy Charges

Here's a great site from the Health Information Management Association about Creating a Personal Health Record with some excerpt below.

Your Rights Under HIPAA:

Right to access, inspect, and copy health information
Right to request correction or amend health information
Right to request accounting of disclosures of health information—who has received it

Accessing Your Health Records
You have the right to access your health records. You may view or receive copies of your records, or instead request a summary of the information. If you receive copies of your records, the office holding the records has the right to charge you the cost of making the copies. You may have to submit a written request to view or receive copies, so the office has a record of your request.

You also have the right to request that changes be made to your health record. If you believe that information in your record is incomplete or incorrect, you can request an amendment.

Amendments can be requested by either contacting the person who made the entry (such as your doctor) or by contacting your healthcare organization's health information management professional. If your request for an amendment is denied you may still request that your request for a change be kept with the record and given to anyone who requests a copy of your health information.


Here's another link that you also might read to help bolster your confidence as a health care consumer if you are having surgery:

Quick Tips -- When Getting Medical Tests

Bad Estrogen

Sounds dramatic doesn't it but there really is estrogen known to be the bad kind, the kind that can lead to cancer. Since I'm not doing acu treatment or chinese herbs right now and its just up to me to try to fix me I decided to do some more research into PMS and estrogen. It's that time of the month (mid-luteal phase) and my breasts are so uncomfortable. The only time I've had real relief for a while was after both pregnancies, I guess due to the pregnancy types of estrogen being dominant then.

So here are some of the links I came across that interested me:

Predictors of the plasma ratio of 2-hydroxyestrone to 16-hydroxyestrone among pre-menopausal, nulliparous women from four ethnic groups

The relationship between physical activity and 2-hydroxyestrone, 16alpha-hydroxyestrone, and the 2/16 ratio in premenopausal women

DIM (Di-Indoly Methane)For Natural Protection from Estrogen's Effects

What I picked out that might relate to me are:

...that since dietary therapy alone hasn't helped, and my mother had PMS as well that there might be a heriditary factor.

...that exercise really might help my body to metabolize the bad estrogen more

...that taking DIM for a while might not be such a bad idea, at least to see if I can detect any changes.

Back from Paradise

So I can now say that if you feel like infertility is getting you down that you haven't been pampering yourself enough and you should make plans to go to Fiji. The people are lovely, the sun and sea and coral are beyond compare, and it's far enough away that you don't find lots of families on vacation -- provided you pick the right island resorts.

I've been happier than I've been in years -- no sign of depression for me (though I've got a touch of PMS right now). All that wonderful sunshine and the warm sea -- we went swimming every day and there was no need for a towel it was so hot every day. My biggest decisions each day would be which bikini to wear and whether or not I wanted a cocktail at happy hour. Sooooo incredibly relaxing.

Oh and here was a thing, my myomectomy incision, the bikini-cut, it fell just below the top edge of my string bikini. How about that? I've never worn a string bikini before but I thought why not start now.

I got lots of exercise as well while on holiday -- running, playing volleyball, swimming, snorkeling, and hiking -- which helped work off some of my fluff. (Some I said, not all)

Seattle is so cold, dark and damp in comparison -- I think I'll just have to move to Fiji and learn how to weave mats.

The Boo-hoos Caught Up With Me

Yeah so I'm not invincible. Finally Friday night, when my partner came home from visiting with friends I erupted. Two of his friends are currently TTC with their girlfriends and finally he has guys to talk about it with. But for all his enthusiasm it's been an anguishing time for me personally, what with the miscarriages and anemia and all. I hate feeling like he's just lumping us in with these other women who have just started trying, even though I know enough about them to know that they both have infertility issues (a 21-day cycle for one and fibroids and a miscarriage for the other). He comes back from hanging and talks about how he told them about how I chart and all that and how so-and-so's girlfriend wouldn't do that because it would make her obsess too much. It just makes me want to scream. I'm not like them, it's been too many years, we both had surgery, I've been through two losses and seen all those doctors and charted and temped and used a fertility monitor and got bloodwork and still no baby after more than three years.

So I started crying and I cried and told him that he better leave me and I just kept crying in the dark on the pillow and so I got up and I cried more, for another hour at least. Crying and blowing my nose and all that for a good long while.

When I woke up on Saturday I pulled out a journal and made a list of all the things about our fertility that are bothering me -- and cried some more. I read it to him and the rest of the day Saturday I just felt emotionally drained. Sunday I felt a bit better though.

I'm still congested from the flu and a little queasy as well. Everyone in our office has been sick. Half of them have had the stomach flu but no one has had both. I hope that I'm just feeling the remains of the same flu and its just lingering and not because I'm going to get the stomach flu as well. Oh please no.

Looking forward to sunshine

We're going away to the tropics for a couple weeks in the sun. I'm so looking forward to it and the break from work and everything, though I will miss my pets while I'm away.

My period showed up today, right when Ovusoft said it would; a little crampy in the morning but not too bad so far. A nice, average 29-day cycle.

It's hard for me to lurk on my TTC buddies, so many of them have gotten pregnant this year, even ones that had infertility problems. A fair number are still waiting in the wings as well so I don't feel a total freak but it's still pretty ouchy knowing that for some of us this is not something that happens anything close to easy.

Still, this year had things arranged in a way so that it was for the best. We had some staff turnover and our business really needed our attention. It wouldn't be an easy thing to be expecting a baby right now. And you know I wouldn't be going to the tropics right now if I was pregnant. Even AF is cooperating with the plans and should be cleared out before we leave town.

Hysterosalpingogram (HSG)

An HSG is a hysterosalpingogram, an x-ray of the interior space of the uterus and fallopian tubes using a contrast dye. It can be used to look for uterine abnormalities and adhesions, determine how much infringement fibroids are making into the interior of the uterus (to some degree), and identify if your tubes are open (referred to by docs as "patent"). Some docs do it standard a few months after a myomectomy, mine did not. The dye does have what my RE referred to as a "voodoo effect", where there is some slight increase in pregnancies after the procedure, speculated to be caused by the dye perhaps causing the little hairs (cilia) in the tubes to function better.

It can be done by your doctor in a radiology facility or by a radiologist -- mine was done by my RE and she was a lot more comfortable with the procedure than the radiologist I could tell.

They insert a catheter to insert the contrast dye through your cervix; a good cough evidently will open up the cervix so it is less painful. The dye feels like pressure going in, and it can cause a drop in blood pressure. It's generally uncomfortable and causes some cramping. My RE tried to manipulate my uterus for the xray shots using the special speculum and I found that to be very uncomfortable with my 6-7cm (at the time) fibroid.

Here is an link detailing Guidelines for the Performance of HSG - it advises taking 1000 mg of NSAIDs prior to the procedure.

Rarely it can cause infection, and some people are allergic to the contrast medium. Some docs give antibiotics preventatively ahead of time, they also might have you take a heavy dose of Tylenol an hour beforehand.

Here are some links to sites showing images from HSGs:

HSG Link 1

HSG Link 2
HSG Link 3

I should go pick up my x-ray film from the University of Washington Radiology Department, where I brought it when I consulted about UAE a couple years ago. I'd like to scan it and and post it here so you can see what my distorted uterus looked like.

DIM Plus for PMS? (and more about estrogen excretion)

On one of the discussion groups about healing fibroids naturally I learned about this dietary supplement called DIM Plus which was supposed to help your body rid itself of excess estrogen. Evidently some of the cancer circles were talking about it. I bought some a while back and tried it for a week or so, no side effects that I could see but since I was doing chinese herbs and trying to get pregnant and you aren't meant to take it if you are pregnant I didn't continue using it.

Well, with my breasts sore as ever for the second luteal phase in a row, I decided finally yesterday to take one capsule to see if it would help. Forget just about the fertility stuff for a minute and know that for me, feeling bad PMS symptoms mean that my body is still lined up for more fibroids -- something I really don't want. The recommended dose is 2 capsules but I took just the one, and then coincidence or not my breast pain receded. They are still sensitive and full and fibrocystic but not just aching me outright now. Was it possibly the DIM Plus?

Here's the link to the product page on the manufacturer's site:

DIM Plus by Nature's Way

Estrogen Metabolism and the Diet-Cancer Connection: Rationale for Assessing the Ratio of Urinary Hydroxylated Estrogen Metabolites (PDF)

Hormone Balance - Hormonal Health (about DIM)

Physiological Functions of Phytonutrients (PDF - info about DIM starts on p.9)

Foods for Cancer Prevention

Estrogen Dominance Syndrome

Nutritional Factors in Menstrual Pain and Premenstrual Syndrome

Liver Detoxification Pathways

Estrogen's Two-Way Street

Premenstrual Syndrome Types -- I mighta have posted this link elsewhere in this blog, but it might be helpful to you in this context so here it is.


It makes me think, why is it that many doctors don't consider things a problem until they might kill you? Why do I have to live with hormonal imbalance and cyclic breast pain for years. Pooh on them. And honestly I've tried the no caffeine, no dairy, no meat, no alcohol approaches and they didn't help me. No chocolate, well that's not really an option and my acu told me that with Spleen Qi deficiency it was a common craving. Like pica (craving and eating clay and ice and stuff) I guess but better.

About Prolactin and Abnormal Breast Discharge

A hodge-podge of links related to prolactin for your light reading.

AMSR Patient's Fact Sheet: PROLACTIN EXCESS (PDF)

Elevated Prolactin (PDF)

High Prolactin Levels

Hyperprolactinemia (High Prolactin)


Prolactin-Lowering Medicines: Your Questions Answered

WHAT YOU SHOULD KNOW ABOUT PARLODEL® (bromocriptine) from Novartis

Bromocriptine Addendum


Nipple discharge - abnormal

Nipple Discharge


Lack of expression of endometrial prolactin in early implantation failure: a pilot study

The Environmental Estrogen Bisphenol A Stimulates Prolactin Release in Vitro and in Vivo*

A murine model of adenomyosis: the effects of hyperprolactinemia induced by fluoxetine hydrochloride, a selective serotonin reuptake inhibitor, on adenomyosis induction in Wistar albino rats.

Revelations

I've been sick all weekend with an awful cold virus. Using up boxes of tissues and my joints are aching so much. Not much fun. I didn't go out shopping so instead I've been doing what I call "cooking something from nothing"; we're having long grain and brown rice with roasted brussel sprouts, carrots and turnips. It tastes okay but this is not one for the recipe book.

I've been thinking about the holidays this year. I'm making some effort but it feels hollow and I wasn't sure why until I started thinking about it. I used to go back East to see my family; they would drive me crazy but they were my family. Now my mother isn't talking to her family, my grandmother and I aren't speaking since she was so awful in relation to my first pregnancy (a disgrace to the family she said), my sister is in Seattle but I hardly ever see her (though we were best friends when we were growing up) and I find it hard to talk to my brother, he's not grounded in reality unfortunately. Add to that how little support my family gave to me during my miscarriages and after my surgery last year and it feels like my family has fully disintegrated -- and much of it feels to me to be related to my fertility issues.

So my family isn't really there anymore, and the family we were going to have hasn't materialized. Add to that the feeling of general alienation the past few years have engendered in me and socially I've been feeling isolated as well -- probably more through my own doing than not. It's no wonder really that I hit the wall with the TTC business.

Years ago, a friend of mine told me when life felt out of control to me that I needed to create touch stones for myself in my life. I did take that to heart and it was within months of hearing that message that I met my partner and met a few of my good friends. Over the past years though people have changed jobs, pursued different interests, moved away and so there are fewer touchstones that there once were. There haven't been many people IRL to talk to about what we have been going through, it's hard to talk to friends who know they don't want to have kids about infertility and pregnancy loss. Then the ones that have had kids, well their kids are getting older and so they have parties with a bunch of four year olds, etc. and since we don't have kids we don't get invited (though really I wouldn't want to go anyway).

So I feel like I'm standing at the edge of a bridge, trying to leave one side, two failed attempts to cross that bridge that hurt me, and a bunch of nasty momminess, child care, teething, diapers, terrible twos etc on the other side (is that supposed to seem appealing?) And more and more I feel like I won't be able to cross the bridge without medical intervention, which I don't want to do. It just feels wrong to me.

I think that my current RE is part of the problem. Over and over in my head do I hear those words from a couple weeks ago "that's (low progesterone) not what's wrong with you" which makes me want to scream back THEN WHAT THE HELL IS WRONG WITH ME?!

If I feel the time comes for another consult I might just consider going with a different RE. Maybe we should even consider going for a consult outside of Seattle, there's too much crap going on with the fertility clinics here. It makes me the patient feel like a pawn or an asset instead of like a person.

By the way, Virginia Mason Hospital decided to close the fertility center outright. Dr McClure, the urologist who did my partner's vasosostomy (vasectomy reversal) was the only one left after Dr Marshall, my RE left to open Pacific NW Fertility. My partner had some crappy frozen sperm there, from before we knew what we weren't going to do and since it was only about 1% kruger we're going to dump it.

That's enough of a book for one night. Thanks for your replies and talk to you soon.

Little hope links

For you Crystal, for when you need them.

The Flood (even more poignant in light of the recent flooding of New Orleans)

Footprints in the Sand

Why Good Things 'Don't' Come to Those Who Wait

Should I be happy or sad?

Ah sh*t I'll just be cranky, the PMS is really doing me in this month. All the acu and herbs and diet changes and here I find myself back at square one. At least I know how to manage my stress better and I can fight my anemia a little better without the heavy periods. My breasts are killing me, I'm feeling uncharitable to say the least and I would love to just go home and sulk by myself for the rest of the day.

I also think I'm coming down with a cold -- I'm sneezing and mid-LP my immunity always plummets. My theory is that it has something to do either with the hormones or the anemia or perhaps both. Progesterone compromises your immunity slightly and then with my body devoting more blood resources to building up my endometrium this time of month maybe it just tweaks my anemia and my resistance slumps. Who knows.

I've found out in the past day that two of my fibroid sisters are pregnant now, both moving along okay so it seems. I coached both of them through the pre-myo stress and now they are going to have babies. Considering how many more women with fibroids I know online who aren't getting pregnant I should be celebrating the miracle. Me, I just feel a bit dejected. I think I would rather know that someone in a similar situation to mine was having success but still it bites a bit.

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Is anyone actually reading this blog? I get so few comments that it makes me feel like I'm a bad blogger or something. I appreciate the few of you who drop notes now and again. Thanks so much for your continued support.

Talking about it

Lately I've taken to selectively letting people know, when they ask about whether or not I've had kids that I've had two losses in the past 18 months. Rather than say "maybe" or "perhaps" I figure its better to speak the truth. It's something I've wanted to do anyway, let it out there and let others recognize it. I've also added when appropriate that we've been trying since 2002, just to let them know how long the road has been (too long).

I was on the phone with my mother last night and mentioned that we were going on vacation to some place tropical and that we might as well since we don't have kids. She responded in a way that sounded negatively to me, like I was lame or not trying hard enough to have kids. I think it is just her own disappointment at not having grandkids to spoil but it felt a bit selfish and mean to me. It was probably due to what I said, though you know that hidden behind that cavelier phrase is a lot of pain and agony over the same subject.

If my mother only knew that basically my heart is broken and that Christmas feels oddly hollow to me this year. That psychologically I'm bracing myself for the fun weeks ahead in January and February when I get to live through my EDDs of my two dead babies. That I'm in the middle of my luteal phase and trying not to think about it, about how my sore breasts mean nothing, how my period will show up again -- that my body feels like a punishment to me right now. Maybe if she knew she would be a little nicer. But who wants to go into that level of depressing details with me, no probably not even my mother.

Fatigued

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

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

Here are some links about fatigue that I found:

Fatigue: When to rest, when to worry

Anemia and Fatigue

Anemia Symptoms

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

Precaution Can Be the Best Remedy for Skiing Injuries