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.

I'm sure many of you read the Little House on the Prairie books by Laura Ingalls Wilder. I bet you missed this part, or that it didn't make sense to you then. I reread the series last Summer while waiting for my miscarriage and this small section was so much more vivid based on what I know now:

...and then one day that was really warm they drove the four miles to see their good friends, the Boasts.

Mr. and Mrs. Boast lived by themselves on their farm They had no children and could hardly make fuss enough over Rose.

When at last the visit was over and Mr. Boast was standing by the buggy to see them start, he started to speak, but then hesitated and finally said in a queer voice, "If you folks will let me take the baby in to Ellie for her to keep, you may take the best horse out of my stable there and lead it home."

Manly and Laura were still in astonishment, and Mr. Boast went on. "You folks can have another baby and we can't. We never can."

Manly gathered up the reins, and Laura said with a little gasp, "Oh no! No! Drive on, Manly!" As they drove away, she hugged Rose tightly; but she was sorry for Mr. Boast as he stood still where they had left him, and for Mrs. Boast waiting in the house, knowing, she was sure, what Mr. Boast was going to propose to them.

From The First Four Years, by Laura Ingalls Wilder.

As it happened the Wilders had their little girl Rose and then a son who passed away in his first year. They had no other children of their own after that. Still, I wonder what the true backstory was of the Boasts and what conditions and circumstance had left them childless and so convinced that they would have none.

Today's my birthday. I'm 35 now. That means that in Western medicine I'm now considered advanced maternal age. Whatever! I can't believe I'm 35 and I don't have any children. Life just pulls you along sometimes and there you are, not where you expected to be.

My partner got in the "mood" this morning so I thought why not. I don't really have any sex drive right now but that shouldn't stop everyone from having a good time. In the middle of it though I started crying, tears kept running down my cheeks. It wasn't anything in particular, just happened. I think it is everything starting with having to use a condom during BD to prevent pregnancy, yeah that's what I want to do right now. I have to manage my fertility. Why, because the rational part of me knows that my body needs a break and I need to make sure that I'm not hurting myself by throwing a possible pregnancy at my tired body right now. I need to wait. But waiting just makes things feel even less normal right now. Then there's so much else hovering. Like all the people who don't know. I feel like I'm putting up a brave face and all but I want everyone to know what hell I've been through. Hardly anyone IRL knows the challenges we've been through in our pursuit of a child. And now, losing my second pregnancy, I just want a little more love and kindness. But I don't want to have to tell them. Can't they just know?

I've continued feeling weepy all day and my right ovary is aching; I fairly feel like I'm going to explode somewhere inside. I think the crying is the hormones, probably the biggest drop in my estrogen level that I've had in a couple months as my body prepares to ovulate. I've got to just ride out the hormones, wave by wave, somehow. But mostly I just feel like I wish I didn't have to feel it at all.

Hey, how about that?

My ovaries started hurting last night. First the left one which I thought was curious as that is my stronger ovulating side and it was the side that had the corpus luteum that sustained (or didn't) my last pregnancy. Then a little while later my right ovary started aching. Just aching and aching off and on for the rest of the evening.

A couple weeks ago, when I went for my scan after that big weekend of labor and hemorrhaging, my ovaries were hurting badly as well. The nurse practitioner took a look at them and there wasn't anything that showed up physically in the scan, no cysts or anything, just plain ovaries. It was interesting to me that I could feel so much and an ultrasound didn't show anything. I wonder if one of those color scans would show up differently though, they show blood flow and heat.

But I digress... Late last night when I got home from dinner with my friend I had my first encounter with EWCM since the end of April/beginning of May. Hey I thought, my body is trying to ovulate. I don't think it has happened yet but we're on our way. And that means that I'll get my period in a couple of weeks. Hmmmmm... a couple of weeks from now...when I'll be in New York visiting family. Argh! AF and family visits don't mix very well, especially with my family being as dysfunctional as it is, my having not been there for a year and a half (the longest ever), my friend with her twins that I need to meet (now just over a year old), my mother with her cancer and treatment and me, anemic and still recovering in some ways from my miscarriage. Sounds like a party right?

I had acupuncture this morning and she did an Internal Dragon treatment after I told her that my body is still a bit confused about what just happened to it and that I'm feeling like my whole being is a little confused about pregnancy now as it's such a start and stop experience that never reaches fulfillment. She said it was a good time to try to clear that out. I shed a single tear during the treatment which was done lying on my back and without an open window this time. The needles were in one just below my sternum, one on either side of my navel but out about 1 1/2", on in the outside of each upper thigh and one in each ankle. Again I was to think about letting the grief and confusion go, ask my mind to not block it and ask for help from a higher power. Definately qi was moving around my body, I really could feel it, how resolved I will be from the treatment I don't know. I did go in with bad allergies this morning and after treatment I was cleared up, pretty amazing. My primary thing to work on is my blood deficiency still, everything else in my system is present right now.

spot.spot.spot.
when's it gonna
stop.stop.stop?

My temp went down to a new low of 97.3 F this morning, a nice pre-ovulatory temp if I ever did see one. I don't get lower temps than that, if I did it would mean there was something wrong with me.

I can't wait until AF shows so that my system will be fully cleaned out. Hopefully then I'll slide back into a normal temp.

I did qigong while I was camping and it was so weird, I could feel my deficiencies. Earlier this year I could feel my liver qi excess and stagnation, this time it felt kind of empty. My heart qi was weak and on Monday morning my Spleen qi was deficient. I'm not feeling any excess, just deficiency. I've got to keep my practice up.

I've got acupuncture tomorrow AM (not today like I thought) and hopefully things will be ticking along better than normal soon enough.

Blood Draw Results

I'm going to celebrate today because my beta level came back at 12. Last summer it took until the end of October to get that low, and I miscarried/had my d&c in July (I had retained tissue remember).

My hematocrit is low but I can treat it with continued iron supplementation and eating iron rich foods. My acupuncturist also has me on a blood building herb formula.

We're still going to take a break until August so I can build up my reserves.

It's still hard though, I thouhgt I was doing well and then I went into Borders at lunch and passed by the wall of pregnancy books and it just made it a little harder to breathe. I remembered standing there a few weeks ago and hoping in my heart that I would have reason to need some of them. Maybe next time.

A summer of last hurrahs

So last night I went out drinking and dancing with friends. I let my hair down, got all girlied up and boogied. It was a lot of fun. If I was pregnant or had a kid already then hanging out until 2 am would not really be an option. But since I'm not, I can have one last hurrah, actually a summer of last hurrahs. No babysitters for me, I can just throw on a cute, sexy outfit and hit the town.

It's really rather amazing. It's like getting that card in monopoly where you get to go ahead and get $200. I'm going to take it for the gift it is.

We're also thinking of going to Barcelona in September for 10 days. That would be so awesome. I'm going to help make it happen.

I'm still spotting a little but physically I'm feeling pretty okay. No big emotional stuff lurking or anything, I think it all went out the window during my dragon treatment on Thursday.

I'm off camping for the weekend. I hope you have a nice one too. Don't forget to celebrate what you do have.

Whoa.

I had acupuncture this morning and after reviewing more about my history (emotional as well as physical) she said she would like to try an acupuncture treatment called a Dragon treatment. It comes from Japan she told me and the points don't make sense in a traditional channel sense but they seem to unlock where we hold onto grief in the body. She wanted to clear out the grief from my body. I told her aside from the early weeks after this BFP where my mood lifted, that I had sadness for the better part of the past year.

She told me to ask my body to let it go, ask my mind to not fight it and if I could, to ask a higher power for help.The needle points were at the crown of my head, two just below my neck on either side of my spine, two in my lower back and two in my ankles. Then she opened the window and told me that was a part of the treatment.

She left the room and I started weeping. I lay face down on the treatment table and the room was silent. Everything was running, tears and my nose. I cried for having this happen to me. For my dead babies. For not being pregnant now. For having two, my twin angels, due within three weeks of one another. For both times being able to start planning for what was to come in my life and then to have it dashed away. I asked God to help me. Not in any particular way. Just to help me. I thought of the footprints in the sand. I thought about how my partner doesn't want to think of them as dead babies. I thought of how I had all the gushing surprise and expectancy last time though the baby seemed less real to me. This time I felt less gushing but since my fibroid was gone I felt more like there woudl be a baby at the end. I cried for having to manage my pregnancies and fertility to this degree. I didn't blame anyone though.

Next she will have me take an herbal formula but the one she wanted originally wasn't in the office so she wanted some more time to review my case and then try to come up with something that's a good fit. We're going to try to clear out any remaining stagnation from my abdomen, any blood stasis, etc. My tongue shows signs of digestive issues, I feel that as well. I'll be eating more blood building foods going forward, redoubling my efforts.

I can breathe a little better now.

doing better.

My hives went away after I left the office early yesterday afternoon. I guess all that repressed emotion had to come out somewhere. I picked up some Rescue Remedy at the natural health store and had some when I got home.

I didn't feel like cooking at all. I put some potatoes on the stove to boil and finally my partner agreed that he would cook if I would please doing some painting, we're finishing some renovations at home. So I painted and thought about Scarlett and Lisa and wondered how she was doing. (I know her in passing). We ate dinner and my appetite had come back finally so that was a good sign. I had a little bit of a hard time going to sleep again last night but nothing the lavendar eye mask and some ear plugs couldn't fix. My nervous system has been a little overstimulated lately plus all these hormonal changes ya know?)

I'm still spotting lightly and having light cramps but mostly things are settling down a bit. I took one of my fertility monitor tests this morning and both lines came up so I've still got some good beta going in my system (LH predictors will show up positive as well for beta HCG in case you didn't know).

I'm glad I don't feel like hell and hopefully I can just start looking forward to our next try. The best try ever.

Last night I was so tired and not hungry. I ate a small dinner my partner cooked for me (he's trying so hard) and then after a while I was exhausted and went to bed at 9:00pm. I was emotionally exhausted and completed uncomfortable. I was having cramps and feeling awful in no particular way. I used a hot water bottle because I was so freezing and couldn't get warm. I used my lavendar eye mask for a while but then I started crying. Eventually I passed out asleep and had weird dreams. I dreamt about my sister and a doberman and Christmas at my parents and the Girl Scout house where I grew up with my two employees who just quit doing a religious ceremony. I woke up this morning covered in sweat and it's cold here (60 degrees).

I have a cough and post nasal drip today. I've got hives on my face, neck and shoulders that are itching me. My eyes feel a bit puffy and coming in to work I kept getting misty.

I am grief.

Just to give you a little "aww..." moment I came across this article and thought you might like it

http://news.bbc.co.uk/2/hi/health/3105580.stm

(ignore the part about the pro-life people, it ruins the moment)

Here's a link to a site showing ultrasound images of retained POC (products of conception)

Spontaneous abortion - Retained products of conception

Here's a link which explains how to read ultrasound images of the uterus.

My scan today showed something in the upper part of the uterus but my RE said it wasn't there last time so it is likely just some clots. I sure hope so. I'm ready to be done now.

I had my scan this morning. I did indeed pass the gestational sac and whatever. There is still something higher up in my uterus and I'm feeling some cramping still today; my RE thought it might be some clots that I needed to pass. I'm not convinced but whatever it is I want it out of me.

I am tired and grouchy today, even before I went in for my scan. There was a slow driver in front of me as I went to park to go to the clinic and I yelled at her out of my open window to "Drive!" and she said "I'm driving". I thought to myself, "get out of my way so I can go and get a scan showing that my uterus is empty of my dead baby now," oh if that woman only knew.

They were behind schedule at the clinic and I did see the RE and not a nurse but it took a while. I read some magazines while in the operatory waiting with that paper thing across my lap. I read about how to redecorate your summer porch with wicker furniture and day beds. I also read about how some director of an upcoming Nicole Kidman movie (something called The Translator?) hates to direct. Or how this guy changes out his plants in his window boxes four times a year and they were showing how lovely the coleus was looking.

The RE asked me after my scan how I was doing and reminded me to come back in for a consult in a few weeks. She was trying to be nice but I wanted to not be having this experience, not to have people wondering how I'm holding up or feeling bad for me.

How do I feel? I feel like crap still and I wish someone would come cook for me. The house is a mess and I need cleaning help. My ovaries ache, I have those cramps, I feel like crying and I hate all the women who are pregnant now and didn't have to experience yet another scan showing that their pregnancy didn't develop right. I want to pretend that none of this happened. I don't want to have doctors and acupuncturists hoving over me this next time but I believe that I'll need it in order to actually do this pregnancy thing. My partner says that he's glad that I'm not all big and pregnant and that he gets to hang out with me for a while longer. We're going camping next weekend and I can't wait. I need to get the f*ck out of here.

Acupuncture & Traditional
Chinese Medicine Links (TCM) Related to Fertility

These are a selection of links a TCM buddy group I'm on helped compile over the past two years. I want to thank everyone who contributed to this list. I'm only posting them here in the hopes that they might offer assistance to others dealing with infertility.

GENERAL RESOURCES
Acuxo
Chinese Medicine Sampler
The Institute of Classical Five-Element Acupuncture
Internal Healers - TCM Diagnosis and Treatment
Traditional Chinese Medicine (TCM) Foundations and Philosophy
The Three Treasures and Women's Treasure
Yin Yang House
The Five Stagnations: The Mother of all Diseases
NCCAOM Practioner Directory

TONGUE AND PULSE DIAGNOSIS
Tongue Diagnosis
TCM Acupuncture Theory - Tongue Diagnosis
The Significance of Traditional Pulse Diagnosis
TCM Acupuncture Theory - Pulse Diagnosis

DIET
Fertility Retreats Diet Info
Traditional Chinese Medicine Nutrition Theory and Applications in Dietary Therapy
Chinese dietetic therapy
Food Therapy
Chinese Dietary Therapy
Food Energetics
TCM Lifestyle/Nutrition and diet
Chinese dietary therapy
Diet suggestions for Blood Stasis
Diet suggestions for Excess Heat

GYNECOLOGY AND FERTILITY
Eastern Harmony Clinic - Medical Articles
Overview of Gynecology - Menstrual cycle in TCM
Acupuncture in Acupuncture in Gynecology and Obstetrics (PDF)
Pregnancy in Premature Ovarian Failure after Therapy Using Chinese Herbal Medicine (PDF)
Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy (PDF)
Acupuncture in Fertility Medicine (PDF)
Treatment of Female Infertility - A New Approach in Chinese Medicine (PDF)
Gauging a Woman's Health by Her Fertility Signals (PDF)
Various Menstrual Diseases
Li Dong-yuan's Gynecology

OTHER
Crane Herb Symptom Search
IVF & Acupuncture
Honso Herbs
Forms of Qigong

I passed a hunk of something this morning. I took a three mile slow walk (I'm am fairly blood deficient right due to the bleeding of the past week now so a fast walk was out of the questions) around the neighborhood last night and that must have done it. It wasn't anything exciting, it mostly looked like a large blood clot but it was denser and more formed than a blood clot. Maybe it was the placental tissue.

I'm going to go for another long walk today with the dog and hopefully whatever else is in there will clear out so my scan will show that I'm done. That would be great as my uterus can then heal and I can get my blood levels back to normal and soon enough we can get a little intimate (it's been a few weeks since we BD).

Waiting. Waiting. Waiting.

The RE wants me to wait out the weekend then go in for an ultrasound on Monday morning before deciding to do drugs or a d&c. Okay, I'm all right with waiting a little longer. I don't want a freaking d&c.

I thought I might be lucky enough to move it out last night but nope. That feeling of nausea and pressure must have been something else, or else the upper part of my cervix was trying to grab at the tissue and wasn't having any luck. I have the occasional cramp now and again but mostly my uterus is quiet.

We had a work party last night out and were out on the town. The streets of Capitol Hill were teaming with people, probably due to it being the end of the school year/start of summer and gay pride weekend. Whatever the reason I liked it as I got to just be another person having a good time.

While at this one bar one of my coworker's wives asked me if my partner and I planned on having kids. I told her that we'd see how things went, my typical vague answer which leaves people thinking that yes we are interested in having kids and might actually be trying now or in the near future. Then she told me that they had started trying and that she had a miscarriage a couple of months ago. So I decided to tell her about mine, the last one some people at the office knew about (due to one blabbermouth who no longer works with us) but this time no one knew. I figured that it was okay to tell her though and even if she tells her husband as I suspect she wll it's okay, sometimes it is good for people to know this stuff about you. Especially since I didn't much miss a beat at work (as far as anyone knew).

This morning I have a little hangover and maybe that wasn't the best idea considering my weakened condition right now but I kind of needed the time out and it was fun.

For Someone Going in for Her First Infertility Appointment

If you are going in to see an RE (reproductive endocrinologist) it is good to have an idea about what will happen, know more about things that will be tested and also understand the range of things that could contribute to your fertility non-performance.

Usually the plan is to start with the least invasive testing and analysis and then progress into more invasive as required. Here are the usual steps:

1. Blood work
2. Semen analysis
3. HSG (before trying IUI or Clomid)

Here are some links to sites and article that I've found over the past couple of years that have been the most helpful about the general infertility workup (I've got loads of links on specific conditions and hormones as well, but I'll have to publish those in other posts.)

I like this section quite a bit for getting a handle on what you want to get out of your fertility treatment. It's very thorough.

Making Your Fertility Treatment Plan:
How to Avoid Hit-or-Miss Fertility Treatment

Here's a good link about testing:
A Comprehensive Infertility Work-Up

Here are hormones levels to reference:
Hormone Levels & Fertility Bloodwork



Another page about infertility tests

This article (Infertility Care and the Role of the Compounding Pharmacist - PDF format) has some info about how your chart can indicate different issues with follicular development and hormones

This page is for a group in Britain that does pre-conception consultations. They are after healthy mothers and babies, it might give more insight into nutritional issues for you:
FORESIGHT PREPARATION FOR PREGNANCY PROGRAMME


Remember at your appointment that your treatment plan needs to match up to your social, financial, spiritual and ideological beliefs. Be sure to communicate if you are not comfortable with anything they recommend. I've known couples that wouldn't have a semen analysis due to religious beliefs so don't be shy about standing up for yourself.