PMS Induced Mastalgia

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

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

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

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

Cyclic Mastalgia

Painful Breasts

Severity of Mastalgia in Relation to Milk Duct Dilatation

Toremifen May Be Helpful for Mastalgia

Info about Vitex for PMS/mastalgia

Moving...

I went to dance class this morning, its time for me to take back my body from the past year. I haven't been very active in a year, except for intermittently. I went to a dance class last September I think it was, there was a half day of skiing in December, occasional ballet at home using tapes, the daily swimming and running while in Fiji but not really that much overall. I haven't felt up to it.

Now though, its time to get back into the swing of dance practice, my body needs it for flexibility and strength -- it counteracts the computer work and also the whiplash injuries.

I went to a beginning class this morning and I could feel the aches and pains. I wasn't feeling very strong through the warm-up, without strength you don't have control and you can hurt yourself.

The more I moved, the more the past two years...they started to come out, wrap around me, about how this experience came through me and then to me and it hurt me. I could feel it all welling up inside of me -- how did all of that happen to me?

I could tell I reached my emotional limit so I ducked out after the warm-up; my instructor knows what's happened just enough to understand. I started crying as I left the studio.

I feel like I am a tight ball, crouched down protecting myself and holding out. I need to open up slowly and let it all out. I was thinking about how I've been taking back myself through my French class and growing more in my role at work as and owner -- I guess taking back my body is going to take a little longer. I'll have to just keep going until it doesn't hurt any more.

When I came home I told my partner that I really don't want to get pregnant right now. I don't want to deal with another bout of all the badness that comes with miscarriage right now, I'm not in a place to take it on. And being pregnant would only be a huge emotionally loaded distration and I want to focus on work right now. I want to focus on being me and doing that well.

What's up with the neighbors

I came back from a trip out of town and my partner mentioned to me that the couple next door told him that they are in the process of adopting a baby from China.

How odd I thought, two infertile couples living next door to each other. I did wonder why they didn't have kids, they seem to live their home life so deliberately, almost regimented.

Still I don't find the wife friendly at all so I wouldn't commiserate with her at all, especially since we're not the adopting sort at this point in our lives. I get along well enough with the husband but pretty much the only interactions we have with them as neighbors is when they need something from us.

I don't know how I feel about it yet. I suppose it might make me feel frustrated or something later on but right now the infertility connection seems to be the most noticible thing.

I ovulated while I was out of town and so there wasn't a chance that anything could come from this cycle. I did meet up with one of my miscarriage buddies from BabyCenter though for a wee bit and that was really super nice. ;)

I also started mon cours de Francais hier soir, oh la la. It was tres tres bien.

The big business of fertility medicine

As I was driving to work yesterday I heard mention on the local NPR station of an upcoming program about fertility medicine. I didn't catch when it was and searching their site hasn't been helpful so I decided to do a general web search. I did find some other interesting artitles that I thought you might enjoy so here you go.

I think this first one is the program I heard about on the radio, about the unregulated big business of fertility medicine:

The Baby Business - Here and Now Podcast and a transcription on the Living on Earth site
Infertility is a painful prospect for hopeful parents, but Harvard Business School professor Deborah Spar also saw infertility as a big business, 3 billion dollars in the U.S. alone. And she says, should we view it more as a business.
Wed, 08 Mar 2006 16:58:02 EST

The Fertility Race -- a series of radio shows from Minnesota Public Radio about fertility


All Too Conceivable - Slate.com, an article about the short-lived NBC show Inconceivable


It's interesting listening to the program after our recent stint back in with the RE. I'm feeling pretty okay right now, and my period just show up yesterday even. I feel liberated right now, like it doesn't matter if we conceive or not. I don't think I wrote about it here but my sister called me last week and I told her about our recent struggles and how I just didn't like how it all felt and she said right away, quite earnestly and supportively -- "but you have so much else going on in your life." It was said with love and compassion and a deep understanding of my value and worth, something only a sister who loved you could say or perhaps a very dear friend.

I found out this week that one of my infertile buddies finally birthed her little girl, she got pregnant right as my last one was failing. And then another online buddy, this one dealing with Spleen Qi Deficiency and infertility and being treated by an acupuncturist, she got a BFP and I'm really pleased for her.

While in New York a few weeks ago, my friend Jen mentioned that it was odd for those of us who meet in the online space to have access to each other's lives in this deeply personal and intense times of our lives as we deal with fertility and family. I think she's right, it's downright profound that we should even think to share so much of that experience with relative strangers online, though it speaks volumes to the relative amount of stress the experience comes with that we need to talk about it so much. The only downside of it is when you find out that you are in the very small group of people who don't concieve on their own after two years. And then watch as others pursue fertility treatments, some of which are not available to you due to other health issues. And then when the situation changes and you realize that you have philosophical issues with fertiity treatment and that you don't want to do it (that's me right now), it just makes it hard to relate a bit to those who were infertile and are now mothers. Those who were infertile and are now pursuing treatment. Those who were infertile and are pursuing adoption.

I think that God has a purpose for me yet, be it as a mother or in some other role. I just need to be the very best me I can be in the meantime so I'm refocusing on life outside of baby-making. I'm able to focus around the house like I haven't been able to do in several years due to the emotional disruptions of fibroids, infertility, surgery and miscarriage. I'm able to focus on growing at work and I'm really proud of my strength and determination. I still care for my online friends so much, and I've been pleased to see that they are as awesome in person as online. There's a great gift in that and someday I hope to see more of them as I travel around.

Goodnight for now.

Fun with site visitation stats

I have StatCounter running on this blog so I can see where people are coming from, what they are interested in and then I make sure that the pages they are coming to contain decent information, adding new info to help hook them up with more useful information if I can.

So over the past couple weeks I've noticed that my belly shot showing my scar from my myomectomy kept being pulled up through Google Images. I was amazed that people would even thing to search on "myomectomy scar" for photos, I was intrigued.

Yesterday I looked at that posting though with my first post op photo and there wasn't anything really that would make it make sense for fibroid patients doing a search. I went to Google Images and did a search on myoscar, the name of the image and low and behold Google asked -- did you mean "my oscar" Oh brother, so these people are looking for oscar photos and they are instead finding my belly with its scar and this blog with all its sad stories. Oh well, maybe a few other people learned something about the world of womens's reproductive health issues. I adjusted the image title to be more precise and hopefully that will help fix the situation.

Warm

Just back from acupuncture and shopping. Both activities were productive. Acupuncture made it so I finally warmed up and I'm not feeling freezing cold and shopping, well I got lucky with a sale plus two dresses and a pair of shoes.

Along the TCM line I'm making progress. My tongue coating is thinning some, I'm feeling more emotionally even, and my digestion has been improving some. My lung qi is weak, still fighting that virus from two weeks ago. All of my spleen points in my legs are sore, I had needles up both my legs from my feet to my knees. She asked me if my feet were cold and I said yes, basically since I came back from Fiji. She told me to do nightly foot soaking, then use that time to meditate or do qi gong breathing. That I think I can manage, heck while I'm at it I might as well do the castor oil pack ;P

I'm actually not a big shopper but this time of year I tend to notice the gaps in my wardrobe and I am willing to do what it takes to help fix that problem.

Work is going well, I usually only complain about it, and not much here, but over all its doing well. I'm feeling knowledgable, experienced and useful (mostly).

Very amusing and informative.

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.