I'm so glad it is the weekend, finally some time to rest! I was soooo hungry today that I keep on eating every 2 hours or so. I made homemade fettucini with tomato sauce a while ago and that was filling. I've been craving a lot of south-east asian cuisine this past week though, like Thai and Vietnamese food -- thing with a little fish sauce in them. I've also been craving/eating a lot of fruit. They say the trick is to only eat things that appeal to you to help with the nausea. I was at a creperie yesterday (a restaurant that serves crepes) and nothing looked good to me, the thought of cheese sounded so unappealing. I ended up eating half of mine and my partner ate the other half plus his dinner -- he was stuffed. I'm bummed about not being able to eat sushi although our favorite sushi waitress said that she ate sushi through her entire pg as she was working and it was free food. Different cultures have different takes on what is safe and not in pg. There's this book I read a couple years ago called From Paris to the Moon and the author describes the contrast between the pregnancy and birth of his first child in the U.S. with the pg and birth of the second in Paris. Doctors in France tell women to drink wine (in moderation of course) to sooth the nerves and such during pg.

This may sound crazy but caffeine can help sperm swim faster. Truly. Read about it:

Coffee makes sperm speed up
18:24 14 October 03
NewScientist.com news service
http://www.newscientist.com/news/news.jsp?id=ns99994267

You might have your partner stop and get a double espresso before the next IUI or you get up early and make/get coffee for him and switch your BD schedule to the AM (as the coffee certainly would disrupt sleep if taken at night).

Just for everyone's information I thought I would share with you a reason why I thought we could influence our fertility in spite of doctors telling us that morphology is just something that you are born with and you can't change. We were working with a biotech company a couple years ago and they had developed a compound that would enhance a plants ability to both combat pests and disease and at the same time had the added benefit of increased fruit production of increased proportions. That was why I went looking for all those links in my sig for sperm maturation and morphology. I thought surely there has got to be a way to influence this process. Finally I got my partner to agree to try the extended supplement regime, thinking that at the very least we would be improving the opportunity to grow better sperm. Take a look at the PDF article at the link below when you have a chance and you can see what I'm talking about.

Messenger for Citrus
http://www.edenbio.com/documents/Eden+Citrus.pdf

Today I've been feeling mostly good but then burpy- yucky, then STARVING (at 11am after I already at leftover Thai food for breakfast and a banana and a glass of almond milk at work), so I had to go buy something pronto. I don't know what would have happened if I didn't but it sure felt desperate.

My partner and a good friend at work are both noticing the physical changes in my already (I noticed them two weeks ago). I've got a little extra fat around my belly button, I'm starting to be a little more rounded in the front as well, and still with the big boobs. I'm thinking about getting some new bras because the ones I have aren't really enough support but that was just based on what I own on not because I look like Busty Dusty (ever hear of her, famous porn star).

I thought I had regular PMS this cycle but there were a couple clues that it was different that I didn't pick up on at the time (these symptoms were around 10-15 day dpo):

Breasts didn't start to get less sore as AF approached

I was more bold in expressing myself, to the point that I was off-putting to others

My uterus was swollen which I only noticed because I've got a large fibroid and I can normally feel my uterus because of it. I was feeling a bit down because it felt larger and I thought that perhaps my fibroid was growing but it felt too squishy and I was confused.

When I was a day late I started having some odd itching on my right forearm and I started getting these tiny pin prick like itchy blisters on my hands and forearms. I'm still getting those and it seems like it is connected.

I felt good for a few days and then I had a lot of cramps that first week when my period was late so I kept thinking it was coming, even after the + HPT and blood test. Progesterone supplementation helped keep the cramps in check.

I've been feeling hungry and blech all week. Eating doesn't help the blech feeling much but not eating makes it worse so I'm going to keep nibbling. My breasts are less sore than over the weekend thank goodness. I'm such a total space cadet though. I forgot about two appointments this week (although you can be sure that I wouldn't miss a doctor’s appointment).

I wondered as well about what late implantation might mean. I guess the embryo had less fuel to burn. Progesterone increases the amount of glycogen, a type of sugar and fuel for growth, in the endometrium so that's why it might help the heartbeat.

Don't you all think it is weird how obsessed they are with how far along we are. What's a few days? Aside from clear health problems (which I don't have so far) I guess I feel like my body is going to do the best it can. Blood tests and the like aren't going to make this go more smoothly. Do you think you will have amniocentesis?

I've still got the m/s, I guess usually it starts around the 6th week which is this week which means it can only get worse. This article link someone sent me says that if you get motion sickness then you are more prone to m/s. It is a beautiful day here and I don't feel like doing anything except laying down. I might take the bus to another neighborhood to go look a baby knitting patterns and yarn to start working on presents for my friends twins. She told me I could wait until the Fall since the summer is too hot for knits in New York.

Other than getting up 3 times to pee last night I slept like a log which is good. I've been trying to do some cooking this weekend as well I made homemade pasta and sauce yesterday and today I baked blueberry muffins.

Someone asked about the supplements my partner was taking. Here's a list:

Daily Multivitamin that included selenium
Chewable Zinc tablets with Vit C
Grape seed extract 2 caps a day (cheaper than pynogenol and also a potent anti-oxidant)
Carnitine capsule

Selenium and zince are both found in highest concentrations in a man's body in the ejaculate so we tried to make sure that he had a good amount of both in his diet. Selenium is found in whole wheat flour usually and zinc is found in pumpkin and sunflower seeds. Walnuts were also recommended by my acupuncturist as something to boost male fertility.

My partner is a vegetarian who eats fish and very rarely freerange chicken and pork wontons. He eats a lot of beans and rice. We were also eating more leafy greens to help with hormonal balance for us both.

I'm feeling queasy today, sort of like the edge of car sickness. Blech! I would love to work from home for the rest of the week but my team needs me.

To an online friend...

It isn't up to doctors if we get pregnant or not. The human species has survived millennia without help from doctors. As I said before they told us that based on the statistics we had a 2% chance of the 25% chance that most couples have on average. That's so small that I need my calculator to figure it out (sorry I'm not good with math!).

I think that God has a lot to do with it too. I feel blessed that I didn't have to have the IUI and that we were able to conceive. I also always think of this story someone posted to a buddy group I was on months ago and it ended like this "what is impossible for man is possible for God" (evidently from the Bible, Luke 18:27 "And he said, the things which are impossible with men are possible with God")

You keep your hope, even if it is in a very small place. Take your vitamins, meditate, eat well and exercise. Also, find another doctor who is more supportive.

(and to another person)

What you need to remember is that it takes more than one sperm to fertilize an egg - each sperm had enzymes in its head that they use to weaken the shell and collectively a large group of them help dissolve it, it really is a team effort. You will want to maximize your opportunities by loading up when you have EWCM, prior to since sperm can survive in EW for days. Once ovulation occurs the biological valve into your uterus is already closed and it is too late. Eggs mature ongoing inside the ovaries so nutrition and hormonal balance have a big affect on how they mature (I looked into this in my big medical text called Gynecologic Endocrinology and Infertility a couple months ago to help out some women I know with ovulatory problems). Have you had hormonal work done to check your prolactin and progesterone? Do you ovulate regularly?

---

I've been feeling just icky, like barely getting car sick and I'm hungry a lot but eating doesn't help stop that feeling very much. Thank god I'm not puking like some of the girls I've met with Feb due dates.

Two years ago when we were starting to TTC I was having some odd spotting around ovulation or so. It wasn't normal for me and yet it kind of fit the description of ovulatory spotting from TCOYF. A couple months later I was having pelvic pain and my doctor found a fibroid. I then switched to a naturopathic doctor for treatment and the spotting stopped. She had the full basic hormone work done, but not the CD 21 progesterone test. I had to change my diet, my stress level, my lifestyle to help my body to be healthy. I was on herbal supplements for several months as well and on iron to help combat anemia that was hanging around for years.

At the beginning of this year I started seeing an acupuncturist and he helped balance my hormones further. It was a little ouchy at times but amazing. I think he helped even my cycles more than anyone I have cycles that are so regular.

I also saw 3 REs and had more hormonals tests, an HSG, and several u/s (for my fibroid). I have to say that the combination of alternative therapies combined with traditional western medicine helped me to feel like I had all bases covered. I talked to a lot of docs because they wanted me to have surgery and I didn't want it (for the fibroid). Talking to lots of different practitioners was really valuable, though time-consuming. My insurance covered all but the co-pay but that fibroid was helpful in validating the consultations.

Doctors gave us miniscule odd of conceiving on our own but we did it. I think acupuncture had a lot to do with it.

Here is a link to a page that references many studies about acupuncture for use in fertility issues:
http://www.easternharmonyclinic.com/medart/medart.html

I was feeling awful today so I worked from home. I had a major crying fit last night due to work stress and the upset feelings lasted all night and into the morning. My stomach was upset as well, I'm really not certain if it was something I ate or what, sometimes emotional upset can do that to me. I'm feeling more reasonable now though. It was interesting trying to explain to my partner this morning that he needs to leave me alone when I tell him too, that was what triggered the problem last night but I was already feeling weepy before that so maybe my hormones hit some new threshold that was a bit overwhelming. I don't like feeling like that and I hope I can avoid going there again.

At least it is a beautiful summer day today.

Since it is on my mind I thought I would point out that the every other day plan didn't seem to work for us. I have lots of EW normally so we decided to take advantage and load up ahead of time by BD'ing (baby dancing) every day and sometimes twice a day. Hard to keep that pace up and yes, it can be sore but no it didn't dry me out as that web link indicated. Instead what it did was get us pg.

Doctors told us that we had a really small chance of conceiving on our own and that we would need some major interventions (abdominal surgery to remove my fibroid and then IVF with ICSI -- where they inject the sperm). We instead worked with natural healthcare providers -- naturopaths, acupuncturists, chiropractors to improve our health and balance. We also consulted with 3 REs and 2 Ob/Gyns and my partner has a UR as well since he had a reversal.

I'm amazed that we were able to conceive but based on our experience I would say throw in a few tries with as much BD as you can bear plus vitamins.

Wow, I'm feeling fortunate compared to some of the other pregnant women I know who are experiencing bad nausea and vomiting. I did remember reading about someone who was so sick through her pg that all she could eat were frozen blueberries.

I just have to eat when I get hungry or else this car sick feeling starts creeping up. If I eat there isn't any problem. I also wake up in the morning and my breasts kill, I have to hold them on the way to the bathroom to stop them from moving and I'm only normally between a B and a C cup. I think I'm pushing the C-cup now.

Today work was stressful with a couple of clients and I was having a hard time holding it together. I either wanted to cry or I was having to hold back grouchiness -- not good for consulting. I felt depressed and anxious. When I came home I took the dog for a walk to wind down.

So it seems like many women are confused by the difference in counting -- either from ovulation or from LMP. I don't care what any doctor says, I know when I ovulated and they aren't going to shift any dates for me. 26 cycles of charting tells me more than they can by my LMP.

I still wonder too about being able to keep the baby. My mother had 3 miscarriages before she had my older brother. She is allergic to iodine and has thyroid trouble so that's the likely cause and I don't have any thyroid trouble. I don't think God (sorry to anyone who isn't religious) would let anything happen to this baby though, I really feel as though God finally decided that it was time for us as strange as that might seem.

My MIL was in town this weekend and I wasn't online that much. We've also been having amazingly nice summer weather here and I've been trying to take advantage of it -- in between taking naps. I love weekends because I can rest in the afternoon. I'm thinking of working afternoons at home when I can to help manage the fatigue. I think it is the thyroid going overtime and keeping my temps high that is taking a lot of extra energy.

I don't temp religiously so I'm not doing so now either. I figure that I'll keep eating whole foods, taking my vitamins, drink lots of water, and supplement progesterone. Aside from keeping down my stress level I figure that the baby will either stay or go based on genetics and I've done all I and anyone else can do.

I'm surprised at how much "fluff" I've got around my middle already. Another woman I know who is about 30+ weeks along right now told me that she put on most of her weight in the first 10 weeks and is now at the lower end of her weight gain category. I shouldn't worry and I know I shouldn't cut back or diet. I've always been thin and this is a bit of a difficult adjustment.

I've got to go eat something before I feel yucky.

Okay, but here is the totally wild news. My sister-in-law who lives in town just told us last night that she's due also in February, about a week after us. Two weeks ago we were walking around the neighborhood with her toddler and complaining how everyone seemed to be pregnant except for us (all the stars and then tons of women about town for some reason -- I think Seattle is having a baby boom). Low and behold that even as we were feeling sorry for ourselves we were both already pregnant!

No m/s here I'm just hungry in the morning and tired in the afternoon. I wake up hungry and absolutely have to eat before I leave the house. I've also been craving more iron rich foods, I'm taking iron supplements as well since my iron stores are lower from my heavy periods.

I find that when I'm feeling crummy that exercise helps but I have to push through feelings of quitting until the relief happens. A long walk, dance class, etc. are all helpful. My breasts were killing me yesterday and this morning. I put on a sturdy athletic top for modern dance this morning and that completely helped.

I'm struggling with my wardrobe since I was already needing to invest in some new pieces and weed out some of the older ones. The big boobs and full abdomen are a little interesting to decorate. I don't want to be a frump the whole time though so I think I'm just going to buy a few fun things and I can always wear them next summer (note to self: plan ahead for breast feeding).

I've been considering making some maternity clothes myself, and starting to prepare the nursery. I'm working so I can use the lead time to help make sure things are ready when they are needed.

With my almost 4 weeks pregnancy my uterus has enlarged so that my
fibroid feels just about a centimeter below the surface on the right
side of my abdomen when I'm lying down in the morning with a full
bladder. I read in the Merck Manual this morning you aren't meant to
feel the uterus above the pubic bone until 12+ weeks but as I have
mentioned previously, one gyn in December said that I was the
equivalent of a 14 week pregnancy.

I'm feeling good aside from the general feeling of malaise and sore
breasts. The progesterone (suppositories!) are helping to keep the
contractions in check which is great. I'm starting to believe that my period isn't coming ;) No morning sickness but I absolutely HAVE TO eat something in the morning, I can't get on without it. I'm also
thirsty and am drinking a lot.

Evidently we've been growing the vascular system this week and start
working on organs next week.

In two weeks I'll have a follow on appointment and ultrasound and I
will be sure to let you know what comes of that.

My partner is so sweet, he's already giving me kisses on the belly at night. I've been going to bed before he has by at least 2 hours now (he's been working late and I've been more tired and with that wacky sleep schedule - 5am today! I feel like I should be a farmer's wife!!!)

We did tell our families over the weekend. They were all in disbelief since they thought that we couldn't do it. When my mother visited early in May she started talking about how she knew people who had adopted children from China, as if we should keep our options open. I think ultimately they are all thrilled.

REs are so curious that I couldn't tell you if they always do u/s but mine is going to.

Today I've been feeling weepy and less tired, my nipples are aching right now. Can someone please explain why the boobs get so big right away when they won't be put into service for 8.5 months?

My biggest conundrum right now is the care provider question and I bet a lot of you are thinking about that as well. I've thought for years that I would use a nurse-midwife, or a ob with a midwife, in a hospital/birthing center setting and have a doula. My sister is in training to become a doula so that would be neat to have her there to support me. But after all I've been through I finally found an RE who respects me as a patient and isn't patronizing or threatened when I ask questions. A good care provider counts for a lot in my book. So I guess I'll have to prepare my list of questions for him to ask at our next appointment like:

C-section delivery rate
Willingness to work with a midwife and/or doula
When he/she does interventions and when not
etc.

How are you all today? I've been supplementing my progesterone with natural progesterone cream since the Rx for the suppositories was messed up on Friday. I started the suppositories last night. Today I'm feeling a little tired and achy, my breasts are sore and there are fewer contractions (which could be because of the progesterone).

I woke up before 5am this morning for no reason in particular. My partner stroked my back for a while until I fell asleep again but then I still woke up at 7am -- still early compared to me before last week. It's like the pg hormones have triggered my circadian rhythms to go to a different pattern or something.

I also have to get up in the middle of the night to pee whereas before I was sleeping like a rock all the night through.

I get a little faint queasiness in the morning so I have to eat but that doesn't count as morning sickness in my book.

When can they see the heartbeat do you know? I'm wondering if anything will show up on my 7/1 appointment u/s. [I found this link which describes the various things they are looking for in the ultrasounds of early pregnancy: http://radiology.creighton.edu/ultraofearlypreg.html]

My partner's mother left a message on his phone yesterday saying that she had a dream that he told her I was pregnant; I think she's pretty excited for more grandkids than just my dear nephew.

We had doctors tell us along the way that SSRI meds for panic-anxiety that my partner took didn't affect fertility but when I read the fine print their tests on rats left a question mark. He got off of Paxil and his count increased.

Then they told us that morphology was something that you are born with and there is nothing to be done about it but he had a vasectomy and reversal and I found it hard to believe that might not contribute.

They also said there was nothing you could take, or do to improve MFI but we didn't give up. My partner saw a naturopath and was Dx as being hypoglycemic so he changed his diet and eating habits and he's felt a lot better since.

They told us IVF/ICSI was the only way but they would take us through a progression -- abdominal surgery for me with 3 months recovery (and 3-4 weeks missed work) before we could try again, then try naturally for 3 months, then try IUI/Clomid for 3 months and then move on to ICSI. We were devastated.

We watched and read the stories of the other couples online who succeeded in spite of similar low morphology and had hope. I noted every instance of slight improvement and finally looked up all of the anti-oxidents and nutritional supplements that people were trying. He's been taking those for 6 months and coincidently hasn't had any problems with panic-anxiety. He started walking to work each day as he was able and he's feeling great.

Then we just tried to maximize the odds (plus I did a bunch myself to improve my fertility since my fibroid was an issue as well) and kept our fingers crossed but I thought for sure it wouldn't work, we were hopeless and intervention might be the only way. But then my period was late and my breasts were large, my body was hot and I took the test and we got our first positive pg test.

I waver between not wanting an ultrasound (fewer are better, less possible interferance) and wanting to know how close it has implanted to the fibroid.

I think when you have had infertility troubles it is just standard for REs to do -- especially if one had undergone fertility treatments (which we did not other than naturopathic and acupuncture care).
quote:

From the FDA site:
Certain tests are routinely done to check the well-being of the fetus during pregnancy and labor. The most common of these, ultrasound, uses sound waves that bounce off internal organs to project images of the organs and the fetus on scanners. There have been no reports of harmful effects associated with ultrasound, which has been used for more than 20 years. Ultrasound does not use radiation, drugs, dyes or chemicals and is beneficial in providing valuable information. For example, it can reveal the number of fetuses and age, size, fetal position, some birth defects, and other information vital to the health care of the pregnant woman and her baby.

There are three types of ultrasound, each used during pregnancy for different purposes. The most common is real-time ultrasound, which takes still pictures in rapid succession and detects the heart-beat, placenta, movement of the arms and legs, and the number and position of the fetus(es).

The second is the Doppler ultrasound, used before and during labor to provide electrical signals that are converted to audible signals of the fetal heartbeat.

The third, vaginal ultrasound, can help diagnose the cause of bleeding and pain or an ectopic pregnancy, in which the fertilized egg grows outside the uterus. It can also detect some birth defects early in the pregnancy.

Also, FYI the FDA advises against keepsake 3-D ultrasound images

I've also heard less is better but it is hard since we have technology available now that can help us understand more what is happening to us when we are pregnant.

Even with being pg my temps aren't that high. I've taken it twice since Wednesday and I've only been at 98.6 and 98.4, although normally when I'm in the first half of my cycle the temps are like 97.7 usually and during my LP my temps are usually 98.4. That's a big enough jump for now though.

I already had 2 blood tests (#1 435 @ 17dpo, #2 985 @ 19dpo) as I was already scheduled to see my RE last Wednesday to check up on my fibroid.

My symptoms so far:
* thirsty
* sore bbs that are large (but still less sore than during PMS)
* waking up early at 6am or earlier and wanting to go to bed at 8:30pm
* tired (can't I take a nap at work?)
* smelly - my sweat was pretty strong last week
* sensitive to smell of car exhaust and cigarette smoke (and cooked brown rice -- I had all the windows open on Saturday to get rid of the smell
* little queasiness
* little headaches
* argumentative (I thought it was the PMS being weird this cycle but I guess not)
heavy feeling in lower abdomen
* mood swings that pass quickly (feel like crying and then it passes)

I'm feeling really tired right now like I need a nap. I'm also feeling a little warm right now as well as a kind of a general malaise. If I wasn't pg I would think I was getting sick. Here's another weird one, I keep feeling like going BLECH and sticking my tongue out -- how's that for weird (and no I'm not actually doing that).

I'm feeling pretty good this morning. I wasn't on the computer over the weekend much, we were trying to have a life (we work on computers all week long and then some).

My blood tests came back in the normal range. I got the second HCG test result on Friday afternoon and the level had doubled appropriately.

This weekend I decided to not go to New York at the end of the month since traveling that far would be stressful and I'm really sensitive to stress. Besides, I don't know how I'll be feeling then. I called and told my parents, brother, grandmother, great-aunt (she'll be 96 in Sept) and the mother of the bride -- my mom's cousin (I was going east for this wedding). I thought my mother was funny, she asked me when I told her "Are you sure?" My goodness, what does she think? I told my dad first and he replied excitedly "tell your mother". My brother was blown away. They knew we were trying for a long time but maybe they thought we couldn't do it.

We also told my partner's mother, brother and sister-in-law, aunt, uncle and cousin. The clan has been notified and activated on both sides.

When my bladder is full in the morning and I'm lying on my back I can see my fibroid faintly on the right side because of my uterus being swollen. The fibroid isn't feeling active so I hope there isn't any competition for blood supply going on so our baby can get all it needs. My breasts are really full and dense, that's the biggest symptom by far. I have noticed that I tend to feel more cramps, queasiness, and waves of emotions in the afternoon so that will be the biggest challenge at work until we are ready to tell everyone.

I'm feeling pretty good so far. My PMS is enough to contend with and this seems a lot easier to deal with -- just feeling a little queasy (almost barely) and then there are I guess some light cramps. My breasts are a little fuller but you would have to be intimate with them to notice, they actually hurt less than they did last week when I was PMS-ing.

Honestly for those of you who haven't been pg before it isn't earth shattering necessarily (which in my head it always seemed like it was). It is like a natural progression of the menstrual cycle which I usually describe as being a test cycle each month to help things tuned up and ready to go.

I often felt desperate as medical practitioners offered up:

"Have you considered adoption?"
"I'm sure he has antibodies; it is very common post-vasectomy reversal. You won't be able to conceive without IVF/ICSI"
"We won't treat you unless you have your fibroid removed"

I was a wreck from the time I found out about my fibroid until 18 months later when I changed gears completely by:

Trying another RE who it turns out I love
Started going to acupuncture weekly
Started going to counseling several times a month
Got us on more vitamins and supplements
Reduced my stress level
Went for chiropractic (which helped with an old back injury)
and then we tried, and tried, and tried, and tried, and tried, and tried every cycle as much as we were able to fit in prior to ovulation

I'm amazed that we did it but here I am 6 days late and the tests say it is a done deal. Don't give up hope and if you want to stay natural just know that it is a game of odds and that it just might take time.

I'm off to get my next blood sample. The nurses were total flakes yesterday. My doc said on Wed to call on Thursday to find out if I should do supplemental progesterone. I had to call twice and I didn't hear back until 5pm yesterday that I should but by then they couldn't call the order in until today. I've been using my natural progesterone cream in the meantime. My mother had low progesterone when she was pregnant with her first baby so I think it might be a genetic thing that we aren't such great producers of progesterone.

We'll tell one grandma over Father's Day weekend since she'll be in town (she will be so excited since my partner is her favorite and she's been wanting lots of grandkids to spoil). My parents I think I'll wait until the end of the month when I'm in New York for a family wedding.

I got my blood work back and my HCG (beta?) is 435 and my progesterone was 18.4. I'm waiting to hear if they want me to supplement progesterone but I can feel the extra hormones -- especially in my bbs which are feeling a little fuller and less sore than what I experience normally with PMS. I told you all back
when my CD21 test came back low in November that my suspicion was
that low progesterone was part of my issue. The elevated progesterone so far actually makes this pregnant part easier than my PMS -- my breasts are full but less sore and my mood is better. Normally I go from grouchy and sore to feeling hot in my lower abdomen and weak when I get my period. Are you sure my period isn't going to show up on my unexpectedly? Should I keep running around with sanitary products in my handbag?

I saw my acupuncturist this morning as well and told him that my
fibroid was smaller. I didn't tell him about the pg and asked him to
check my pulses (this is something that you have to find a good
acupuncturist to do but it is amazing what he can sense from both
wrists). He checked first on the left, then on the right and then he
looked at me and asked "are you pregnant?" I've been going for
treatment since January and it has really helped calm my system down. I tend to be a bit frenetic and very sensitive -- work and emotional stress knock me down quickly and I get sick a lot because of it. With acupuncture I feel a lot more even. We're going to give treatment a break for a few weeks while my body adjusts to the pregnancy.

Because of my fibroid and TTC I've gotten quite attuned to the
different pains and sensations in my lower pelvis. I would have
fibroid related pain on the right side, a couple inches to the right
of my belly button in a vertical channel. Last night and today I feel a sensation more in the center but just to the left of my belly
button. Not pain but something is going on in there and it feels like the front, side and back of my uterus that are involved. In
acupuncture they say that things are being reorganized.

I'm just back from the RE. He said it was too early to see a gestational sac and it is really early still. I told him that we were pleased just to see that our equipment works!!!

My fibroid was a bit smaller too no 9cm measurements this time. It was only 6x7cm.

They did a blood draw to check my progesterone and HCG. I'll have the latter in an hour or so. Progesterone will have to wait until tomorrow.

I told them that I wasn't sure if they would show me the door since we got a positive pg on our own and they said no, that's not how they work. The doc was pleased about the positive pregnancy test just by itself. I thanked him for making me feel like my fibroid wasn't a life sentence and that in that he helped alleviate my stress and that surely that influence helped out as well. He said he would happily take credit. I also asked him to please tell the UR in the same clinic (the one who did the reversal) that he had another success story.

My partner is so excited he's already telling me what to eat and not eat. Let's hope it is a keeper because we are so ready for this change in our life.

I just wanted to add that I too used every last positive posting about MFI successes to have hope even though doctors sometimes made it feel like there wasn't any reason for any. If there is anything I can do for any of you to help make you feel better supported please let me know.

I tell you I don't really feel that different. My breasts are a touch fuller and less sore than normal, I'm late, I had a touch more of acne on my chin (but I get a little of that during PMS usually), slight crampy feelings and feeling full like just before my period. I kept asking my partner "what if we are?" and he would say "do you think you are" and I would say "I don't feel like it but I've never been before".

The expected due date falls right around my sister's birthday in February and she's in training to become a doula. When I told her she said that she'd have to come back from France (she's going to be teaching there next year) to help attend the birth.

Things that may have helped (other than luck, God and timing):

Iron supplements
Acupuncture
Happier about work, more fulfilled
Meditation
Giving up hope
Chiropractic adjustments (to help heal my back from falling down the stairs 2 months ago and also problems from a car accident 4 years ago)
Lots of prayers from family, and friends

With my fibroid my uterus was already estimated to be comparable to a 4 month pregnancy (crazy I know) but I'm thin and it is amazing how much extra stuff you can fit in the abdomen without it showing. If this holds then I imagine I'll start showing sooner rather than later. Risks with the fibroid are:

Blood supply to the embryo/fetus/placenta can be compromised since fibroids are so demanding. This can happen even if the placenta isn't placed over the fibroid and can result in miscarriage.

The fibroid can go through rapid growth because of the pregnancy hormones. This can cause the fibroid to outgrow its blood supply and some of the fibroid tissue starts to die and this is supposed to be quite painful. I've heard of women having to be on bed rest and narcotics for 1-3 weeks because of this. Still, some fibroids don't grow during pregnancy, and some even shrink.

The fibroid can cause premature labor which can result in a preemie or in a pregnancy loss. There are no guarantees.

I'm feeling lucky though somehow. Let's just keep praying that it’s all good.

So today is full of all kinds of good news for me and my partner. We
just got our first pregnancy test positive, confirmed by the doctor's office just a little while ago (my pregnancy hormone level is very good). We've been trying, actively trying, for over 2 years. My partner had a vasectomy reversal in 1998 and we had a sperm morphology issue as well. This happened though completely naturally, the old fashioned way.

I already had an appointment scheduled with the RE (reproductive
endocrinologist) today to check on the size of my fibroid since I've
been going for acupuncture treatment since January. I was worried
because the ultrasound wouldn't be accurate since my period hadn't
arrived yet (with its corresponding drop in the estrogen level). The
fibroid in February measured 6 x 6.5 x 9 cm, today it measured about
6x7. Who knows what's up with it but at least it didn't get larger!!

We are really excited that the "equipment" works and have our fingers crossed.

I don't feel pregnant at all and honestly, I even told the doctor,
when you have a heavy period and it doesn't arrive when you expect it you feel like you are walking on eggshells until it does. I guess the biggest thing is that my PMS symptoms are backing off and I don't feel hormonal or yucky. So far my impression is that this is all a good thing hormonally.

It is 6:00AM and my partner pushes me to move over and mumbles that I'm too hot. Too hot I think, that's kinda odd if I'm just about to get my period. So I take my temp and it is 98.6 - really high for being woken up an hour and a half early. So, I figure 34 day cycle, temp a little warm, still no sign of my period, I guess that warrants a pregnancy test. So I go down the hall to the bathroom and do. And I watch the paper fibers being saturated and it looks oddly bluish and it settles into two very clear blue lines. That's right, my first positive.

I have no idea what we are up against at this point because of my fibroid but I wanted to share. We have been trying for over 2 years, unprotected sex since February 2000 as well. This seems amazing and I don't really feel different. Not really. I guess that visit to the doctor will be for something else this afternoon.

Our UR didn't check for antibodies until we asked. That was frustrating to say the least since one RE (the male head of a university fertility center in our area -- who fired me as a patient b/c I didn't want to have abdominal surgery) I was talking with assumed we had an anti-body issue without any tests being done.

My partner likes to think that the doctor's know it all and I was raised to question doctor diagnoses (my dad went to medical school and was in practice as a dentist so we had a different perspective on the medical system). He's open to my research but one RE (a woman) told him a year ago in Feb that he probably always had a morphology issue and that it was genetic and there was nothing to be done about it -- yet the UR works in the same clinic and he is optimistic for us in spite of the bad morph numbers. (We don't have antibodies thank goodness -- we've got enough working against us).

Here's the fact sheet from the ASRM site about Diagnostic Testing for Male Factor Infertility

Still waiting. I did ovulate a little late this month on CD 17 instead of 15 like usual. Work stress or the stress of my mother visiting I'll never know. I don't think I'm pg though but I'll keep a candle lit just in case I'm one of those people who can't tell their pg. I'm so sensitive to my hormones that seems unlikely. I do feel wacky moody today, holding it together as a professional at the office but feeling weepy and the like -- signs that aunt flo approaches.

I do have this ultrasound scheduled tomorrow and it won't be accurate at all unless I get my period. When the hormones drop at the beginning of the cycle my fibroid shrinks and that's what we use as baseline. It takes a couple days for the effect though. I think it is still growing although I don't want it to. I'm fighting messed-up DNA at this point in time though; that just keeps replicating itself. Blah! I'm still shooting for trying the IUI with the fibroid in place. Don't want to go through major abdominal surgery if I can help it.

My cycle average length is 30 days but the longest one since I've been charting was 33 days. I could be hours or minutes away from it starting though. Here's to cycles longer than 30 days though.

The psychological burden of fertility

Infertility I think, from a psychological burden standpoint is so hard to take. Will we or won't we? Can we or can't we? Actually I know people who don't even plan on having children who still struggle with their fertility.

One friend of mine thinks this is due to the fact that out of any of our instincts the desire to reproduce would be one of the strongest since that is what perpetuates the species. Watching the birds nesting in our yard and how they do it year after year in spite of the grueling feeding schedules I think that is probably true.

I called the fertility clinic on Thursday and got the SPA test results which are completely normal (a good ratio of sperm penetrated the ova showing good functioning). I've got an ultrasound scheduled for Wednesday to check up on my fibroid. I had continued growth from September 2002 through February 2004; I would love to see that there was no growth but that might be too much to ask for.

My partner is feeling really good about the IUI prospects and he's getting psyched up for me getting pregnant soon. It is kind of cute but it feels so far from reality to me. It feels like winning the lottery, you can't even imagine what it is like until you do it. There are sooooooo many pregnant women and new babies in town right now that I'm constantly gazing after. I try not to make it too much of a head trip but it is hard to not think Why not me?

SPA Test Results (poor hamster)

I just got off the phone with our fertility clinic and they gave me the results from the SPA test (the hamster egg test). The results were 5.8 and less than 2.x is failing. She told me that we were normal.

They didn't check morphology this time (I tell him he's got to ask for these things or else they forget) and his count is 36 million and he had 57% motility. Not too bad.

I would love to know if there was any change in the morphology due to his supplements but no such luck this time.

Then, I heard the oddest story today. This woman couldn't get pregnant and was going to have a hysterectomy (maybe for pain). Since she wanted to have a baby they did some procedure on her to remove endometriosis. She had odd adhesions maybe covering her ovaries. They cleared out the film that was blocking the passage of the egg and low and behold she got pregnant with quadruplets -- and this was totally natural, no medications. How crazy is that?

The only other boy tests I can think of us having done is the SCSA test (thanks for reminding me) which I'm waiting to hear back from the UR about, and then maybe more blood work since his FSH was a little high at last check a while back.

Here's for small blessings!

Nothing much happening here. I've gotten so used to the not being pregnant signs that I know nothing is going on with me this month. I only wish we had a hint of something EVER. Sometimes it is hard not to feel sterile through all of this. (I'm just tired and cranky from PMS right now). My partner still hasn't called the doc to set up the appointment to review the SPA test results. Maybe next week while AF is visiting, that would be a great time don't you think

I did speak with my friend of 20+ years this morning and she had just finished nursing her week-old twins. It was nice talking to her and seeing how she was doing with this new life phase and responsibility. I could hear one of the babies over the phone making little squimy whimpers. I'll see them later this month.

Please God let something work for us.

All About Sperm

These are some of the better links I've found about sperm generation and basic men's infertility.

MALE INFERTILITY

Male Infertility Overview ~ Assessment, Diagnosis, and Treatment

Male Reproductive Problems

Advanced Urology - FAQ's on Information pertaining to Male Infertility

Infertility in Men


SPERMATOGENESIS

Maturation of a sperm cell - diagram

Spermatogenesis Slides -- with details of various constituents involved in process

Spermatogenesis

MORPHOLOGY

Semen Characteristics: Advancement in Andrological Assessment - PDF
Indian Journal of Clinical Biochemistry, 2005, 20 (1)
173-183
R.S. Sharma** K.K.Gaur#, P.C.Pal*, Monika Manocha*, Deepak Tomar*, Arif Azam Khan*, Vinita Tripathi*, Vineeta
chattree* and A. Kriplani+

The Importance of Sperm Morphology in the Evaluation of Male Infertility

Poor Sperm Morphology

Sperm Abnormalities: Testicular Causes

Illustration showing nomal to abnomal sperm

More images showing sperm morphology (Google Image Search)

Differential production of reactive oxygen species by subsets of human spermatozoa at different stages of maturation

FOR MORE INFORMATION VISIT:

Vasectomy Reversal Information

Semen Analysis

Improving Your Semen Analysis

Interesting facts about estrogens

Estrogen, that is too much estrogen without enough progesterone to counterbalance it, is theorized to cause disease such as fibroids and endometriosis. Here's a complilation of information about estrogens.

"over 30 different forms of estrogen have been described; the most common forms tested are estrone [E1], estradiol [estradiol-17 beta,E2], and estriol [E3]"
http://www.labtestsonline.org/understanding/analytes/estrogen/glance.html

"The majority (over 90 percent) of the estrogen present in a pre-menopausal woman's body is made in the ovaries. A smaller additional quantity of estrogen is produced by the adrenal glands and peripheral tissues such as fat, liver, and kidneys by converting androgens to estrogens. Estrogen hormones are also formed in the placenta during pregnancy."
http://www.dhyansanjivani.org/Estrogen.asp

"Increasing FSH levels during the late luteal phase leads to an increase in the number of FSH receptors and ultimately to an increase in estradiol secretion by granulosa cells."
http://www.endotext.org/female/female3/female3.htm

"Estradiol-17b (E2), a steroid hormone, is the most active estrogen in the body. In circulation, E2 is primarily bound to sex hormone-binding globulin (SHBG)."
http://www.dpcweb.com/medical/reproductive_endocrinology/estradiol.html

"Estriol is produced predominantly in the liver as a metabolite of estrone and estradiol."
Is Estriol Safer Than Estradiol?

"For the first 4-6 weeks of pregnancy, estrone originates primarily from maternal sources such as the ovaries, adrenals, or peripheral conversion (57). Later, the placenta secretes increasing quantities of estrone from the conversion of circulating maternal and fetal DHEAS. The placenta continues to be the major source of circulating estrone for the remainder of the pregnancy (53). Estrone concentrations are less than 0.1 ng/mL during the follicular phase and may reach a maximum of 0.3 ng/mL during the luteal phase of a normal menstrual cycle. Following conception, estrone concentrations remain within the luteal phase range through weeks 6-10 of gestation(54). Subsequently there is a gradual increase to a wide range of 2-30 ng/ml at term (53,54,57) (Figures 6 and 8)."
http://www.endotext.org/female/female13/female13.htm

Estrogen Dominance Syndrome
by Ronald Hoffman, M.D.
Conscious Choice, September 1999

About Keloid Prevention Post Surgery

When I was facing surgery I was freaked by the prospect of having a
scar; I did cancel my surgery so I've not had to deal with that yet. My father who went to medical school told me that they use steroid shots in the scar, even a year or two later and it can help soften the scar and make it less noticible. It is mentioned in the first article link below as the oldest treatment but it does have some drawbacks.

You probably are looking for anectodotal things that others have experienced but at the very least here are a few links for you to look at. You should talk to your doctor, and if your surgeon isn't interested in treating you then you might consider seeing a dermatologist or plastic surgeon instead. I don't know how that kind of post-op care works with the myo surgeon, plastic surgeons specialize in minimizing scarring though. Maybe others could offer more informed advice.

Keloid and Hypertrophic Scar

Keloids And Hypertrophic Scars - AOCD

Keloid

Treatment of Hypertrophic Scars and Keloids: A Multi-faceted Approach

Prevention of Hypertrophic Scars and Keloids by the Prophylactic Use of Topical Silicone Gel Sheets Following a Surgical Procedure in an Office Setting

A message to another woman with fibroids

I have low progesterone as well, I haven't had my DHEA tested though.

Low progesterone is linked to several things which can happen in any combination (and I'm sure there are more than I'm listing here):

* poor ovulation -- the follicle doesn't develop as well as it should and the remaining corpus luteum doesn't produce enough progesterone. also, progesterone is produced by the ovary prior to ovulation which helps to mature the follicle granulosa cells and helps set the stage for ovulation to occur. If you are low progesterone I suppose that this process can be somewhat compromised.

* annovulation -- your aren't ovulating and therefore aren't having the corpus luteum available to produce progesterone. The more cycles without ovulating the higher your estrogen to progesterone ratio rises furthering the imbalance. Polycystic ovaries can also cause annovulation I think.

* stress -- when you are under prolonged stress your adrenal glands go from producing adrenaline to producing cortisol. Cortisol is made in the body from progesterone and I've heard mention that this reduces the availabilty of progesterone in the body. Also, cortisol will bind to progesterone receptors in the body so that they aren't able to do their progesterone related actions.

Working too much, not eating regular meals, consuming too many simple carbohydrates and sugars -- basic the equivalent of running your body on empty (and we all know that feeling) -- creates additional stress in your body and stresses the adrenals and further promotes adrenal exhaustion and cortisol production. If you get tired easily then this might be a contributing factor.

This page/site is rather interesting in how it talks about symptoms of low progesterone/estrogen dominance, and other endocrinological imbalances:

http://www.digitalnaturopath.com/cond/C8769.html

Things to do:

* Eat regular meals
* Make sure you are getting enough nutrients from your diet and supplement when needed
* Cut back on caffeine (bad for adrenals) and simple sugars (don't give in to the sweets in the late afternoon -- eat something healthy like nuts if your energy starts to lag)
* get enough rest -- sleep deprivation is stressful on your body
* drink 6 glasses of water a day
* consider consulting with an herbalist, naturopath or chinese medicine practitioner for assistance with a customize herbal regime

Also, I used natural progesterone cream for a few cycles with some good results (even mood, less sore breasts among other things). This may be beneficial although treatment with progesterone has had mixed results in randomized medical trials and might for some women be linked to increased fibroid growth.

This actually goes back to my cake metaphor for hormones (I think I posted a couple months ago about it on the uterinefibroids list), a cake takes all of its ingredients in their proper measure, adding more salt won't make up for too little sugar -- it only makes it worse. Our hormones are a complicated, individual "symphony" (I think that is what Dr John Lee referred to it as). The more stories we hear from the list members and from the studies we read, etc. that while pregnancy can make fibroids grow, that for some other pregnant women they shrink. Fibroids are thought to be a condition of peri-menopausal women and yet we've seen young women of 19 and 20 show up with fibroids in our groups. Obviously there is a lot at play and the more we each learn the more we start to realize that our behavior and lifestyles have contributed to our hormonal imbalances which in turn has helped activate our genes to start developing fibroids.

Uterine Cramps and Pelvic Pain

Fibroids cause pelvic pain, here's what I know about uterine cramps and their physiology from a variety of sources...

From an RE...
Prostaglandins cause uterine contractions. Ibuprofen can be taken regularly to reduce prostaglandin formation but won't help if contractions and pain are present since the prostaglandins are already causing problems. If you are trying to conceive though you shouldn't be taking ibuprofen or other NSAIDs as they can impair ovulation and possibly implantation (there's no winning is there?).

From naturopathy...
Arachidonic acid is involved in the production of prostaglandins and is found in animal products. Reduce animal products consumption such as meat and dairy products, increase essential fatty acid consumption (such as flax seed oil). As ibuprofen interferes with the liver it is not advised.

From acupuncture...
My acupuncturist says that the weird crampy fullness in my belly is related to blood flow not going the right direction. Acupuncture can stimulate blood flow to go in the correct direction.

From my personal experience...
Ibuprofen won't stop cramps from fibroids. Hot water bottles do help with the pain and discomfort. Food and gas passing through your colon that is having to negotiate around the fibroid can also feel like cramps or cause uterine area discomfort -- as can a full bladder. Acupuncture can help with pain. I just had an amazing treatment this morning BTW, and I can't feel my fibroid at all right now and I feel really energized, almost lightheaded and lighthearted. My practitioner said that my blood was swirling around the fibroid and that instead of flowing in the right direction it was coming back around where it wasn't supposed to.

From the web...

There are links between progesterone and ararchidonic acid but I haven't totally made sense of them yet (I'll continue to research and see if I can make more sense of it for us).

I do know that progesterone stops contractions of smooth muscle (see: http://www.rnceus.com/hormone/progest.html and http://arbl.cvmbs.colostate.edu/hbooks/pathphys/reprod/placenta/endocr
ine.html)

Arachidonic acid is also linked to tumor formation as well (scary but here we all are with our tumors):

The Role of Essential Fatty Acids in Cancer
http://www.positivehealth.com/permit/Articles/Cancer/good6.htm

Skin carcinogenesis, inflammation, arachidonic acid metabolism, cancer prevention
Susan M. Fischer, Ph.D.
http://sciencepark.mdanderson.org/documents/sfischer/fischer.html
(note that they are interested in applying this research on skin tumors to prostate cancer)

This page has links to a bunch of studies that are available through Amazon.com about arachidonic acid:
http://www.health.xq23.com/arthritis/Arachidonic_acid.html

Abdominals not cut, Myo not panacea for fertility problems

ARE THE ABDOMINAL MUSCLES CUT DURING MYO?

I was worried about my abdominal muscles being damaged during myo (which have yet to undergo) and I asked the surgeon about it. She told me that they do not cut the abdominal muscles, instead they just push them to the sides, and I imagine they brace them there.

They do cut through some connective tissue and the abdominal fascia, a membrane that holds your internal organs together, but they stitch the fascia closed at the end of the procedure (I'm not sure if they reconnect the connective tissue -- I haven't seen mention of that anywhere) What Your Doctor May Not Tell You About Fibroids includes a detailed description of the procedure that you may with to refer to.

MYO TO IMPROVE FERTILITY

The ability of myomectomy to improve fertility is not definative at this point in time (this is confirmed in What Your Doctor May Not Tell You About Fibroids by Dr Michael Brody, an ob/gyn and former RAND medical researcher). There have been annectodal stories of success by patients and doctors but current research has had flaws that limit its usefulness in determining the appropriateness of this procedure to treat infertility, especially if other factors exist that may be contributing to the infertility (male factor, blocked tubes, endocrine issues, etc.) This is partly why I have been reluctant to undergo this procedure for my largely asymptomatic fibroid, we have a known male factor.

Gynecologic Myomectomy
"Myomectomy is also performed frequently in patients with infertility with the presence of fibroids (Vercillini, 1998). Studies supporting myomectomy as a fertility-enhancing procedure are uncontrolled and do not use life-table analysis; nonetheless, a number of authors recommend offering myomectomy to women who are infertile after other causes of infertility have been eliminated (Hutchins, 1995;
Nachtigal, 1989; Verkauf, 1996).

Several papers suggest that patients with fibroids who are undergoing assisted reproductive technology procedures may have lower success rates compared to patients without fibroids. Stovall et al (1998) noted decreased fertility rates in patients with any myomas undergoing in vitro fertilization or zygote intrafallopian transfer. Eldar-Geva and coworkers (1998) noted decreased success in patients with intramural and submucosal myomas but not in those with subserosal myomas. Ramzy et al (1998) noted no change in fertility, but this study specifically excluded anyone with large, submucous, or intramural myomas that distorted the endometrial cavity. Importantly, note that no randomized studies document that removal of these myomas
improves success rates."


TABLE 1 - ACOG CRITERIA FOR MYOMECTOMY IN INFERTILITY PATIENTS
Procedure:
Myomectomy* (68.29) (CPT Codes 56309 [laparoscopy with removal of leiomyomata], 58140 [abdominal approach], or 58145 [vaginal approach]

Indication:
Leiomyomata (218.0-218.9) in infertility patients (628.3), asa probable factor in failure to conceive or in recurrent pregnancy loss
(646.3)

Confirmation of Indication:
In the presence of failure to conceive or recurrent pregnancy loss:
1. Presence of leiomyomata of sufficient size or specific location to be a probable factor
2. No more likely explanation exists for failure to conceive or recurrent pregnancy loss

Actions Prior to Procedure:
1. Evaluate other causes of male and female infertility or recurrent pregnancy loss
2. Evaluate the endometrial cavity and fallopian tubes, e.g. hysterosalpingogram
3. Document discussion that complexity of disease process may require hysterectomy

Almost two years and facing Clomid/IUI

We've been trying for two years but we haven't used protection since 2000. We had the reversal before we were ready to try. It has all been an exercise in patience and faith.

I'm a bit scared of doing Clomid, we really don't want multiples. Couldn't they just do a trigger shot and IUI?

How does one find a fibroid specialist?

I agree, it is a difficult process. Most of the hospitals and clinics around here in the Seattle don't include very substantial information on their doctor profile pages about their expertise. Since OB/Gyn training and practice revolves around surgeries for multiple conditions I think they don't differentiate between procudures. But we as patients desiring uterus saving procedures know that there is a complexity here with the issues of blood loss, adhesions, retaining fertility, etc. that make us want someone who is passionate and fully vested in the outcome of our procedures.

I recently reread Sex, Lies and the Truth About Uterine Fibroids
and in it Carla mentions that some states have databases tracking medical procedures. Here is one of the examples mentioned in the book:

Center for Medical Consumers (NY)

Not all states track this information that it could even be published, that's another place where we need to weigh in and try to get our state legislators to help get us better information.

That said, it still seems like it is hard to find a doctor. There used to be a site that would allow patients to rate their doctors on a variety of criteria but I believe that was bought out by WebMD and it doesn't include that information anymore. Here are links to some directories that might be useful:

uterinefibroids Board Physician Database
Contains names of doctors that have been mentioned in the messages posted to this list with the number of the message to refer to -- inclusion in the database does not qualify as an endorsements of any of the practitioners however.

American College of Obstetrics and Gynecologists Physician Directory

WebMD Physician Directory

AMA Physician Select

You can also find out about licensed doctors in your state by visiting the state medical board web site; do a search to find the link.

The American Society of Reproductive Medicine has a page with links to a few other directories on it....

AMSR: Find a Doctor

MEDICAL RECORDS
Oh, and while we are on the subject, make sure that you request and keep copies of all of your records from the various doctors you see. You can then make copies to take with you if you confer with multiple care providers and it is helpful to be able to refer to them as well. Each State determines how much the clinic is allowed to charge for copies of the records but it seems to average around 75 cent to a dollar per page in my experience. To keep costs down just request the most relevant test results but you may want to have copies of all the chart notes as well. Each clinic will have a slightly different process for requesting records, sometimes a form or sometimes just a letter will do, and most of the ones I've been in contact with accept faxes.

The CDC -- hysterectomy info but no fibroid info

You all will like this one, the other day I was looking through the Center for Disease Control and Prevention (aka the CDC) website and I was surprised to find no mention of uterine fibroids. One would think that at the very least they would provide links to some of the other government heath websites (such as the ones listed in their response to me). There are other topics missing as well but my correspondence with them focused on fibroids. Read on...

My question submitted through their web form:

How is it possible that you have hysterectomy listed on the CDC website as a condition yet you don't have any listing for uterine fibroids? Since uterine fibroids are far more common than hysterectomy, and fibroids are also a disease while hysterectomy is a procedure, I would expect that the Center for Disease Control and Prevention to provide information for the former. Women need more
information about this condition -- prior to developing uterine fibroids.

Response from the CDC:

Thank you for your inquiry regarding uterine fibroids.

The Division does not have information for consumers on this topic. However, the National Women's Health Information Center (NWHIC) may be able to provide this information to you.

There are two ways to obtain information from NWHIC. You may call their toll-free number to speak with an Information Specialist (800-994-9662 or 888-220-5446 for TDD services) from 9 am to 6 pm (Eastern Standard Time), Monday through Friday. At any time, you may view and search their website (http://www.4woman.gov ) at any time.

Two other Federal information services may be helpful if you have access to Internet services. The National Library of Medicine offers MedlinePlus (http://medlineplus.gov), which provides extensive health information for consumers, including dictionaries, health information in Spanish, extensive information on prescription and nonprescription drugs, health information from the media, and links to thousands of clinical trials. Another general information service is the Department of Health and Human Service's HealthFinder (http://www.healthfinder.gov), a searchable guide to general health information. Many public library systems provide Internet access to local residents needing assistance or access.

Please accept our apologies for not being able to fulfill your request.

Public Inquiries Group (knb)
Division of Reproductive Health
NCCDPHP/CDC

Information about the endometrial lining and menstruation.

There is a substance produced in the uterus which is supposed to help prevent clots from forming, it is called fibrinolysin. When the blood flows too quickly (profusely) the anti-clotting fibrinolysins can't keep up and clots form. Heavy bleeding is called menorrhagia.

"Blood clots or flooding are indications of heavy loss. Normally the blood lost from the vessels in the lining of the womb forms small clots and this tends to reduce the flow. The small blood clots within the uterus are broken down by chemicals called fibrinolysins and the normal menstrual loss should be a fluid. When the bleeding is heavy, the blood is extruded too quickly for it to clot within the uterus. In this situation, the blood clots in the vagina and the menstrual flow includes blood clots. Whilst menstruation is inevitably an inconvenience, it should not result in limitation of social activity."
http://askwaltstollmd.com/archives/menstruati/95779.html#95952
(This doctor had his licensed revoked but the information seems valid so I included it, you will see mention of it if you scroll down through the previous link so I thought I would link to this page FYI: (http://askwaltstollmd.com/faq.html)

Check out these two interesting pages with detailed descriptions and diagrams of how the endometrium forms each month, for your reference:

NORMAL MENSTRUATION

THE ENDOMETRIUM

For more information search with these key words in different
combinations (such as "endometrium anti-clotting"):

menorrhagia, endometrium, fibrinolysin, anti-clotting

Is it possible to not have problems when pregnant with fibroid/s?

From all the stories I've seen shared fibroids seem to be problematic during pregnancy, in example:

* they may grow
* they may outgrow their blood supply and cause pain
* they could restrict the baby's growth
* they (in rare cases) could cause deformity in the baby (pressure on developing bones)
* they could increase problems with bladder, kidneys
* they could outcompete the baby for the blood supply and cause miscarriage (or otherwise cause a miscarriage)

Surely there are people who have had other experiences such as fibroid reduction, no growth, no complications...and lived happily ever after. Anyone got a story to share?

Patient sharing info online and my mother's thyroid treatment when I was conceived

I know that doctors and the medical community are afraid of the information sharing that patients do online but I think it actually is to the benefit of the patient. Being able to meet other women in similar situations, and some not so similar, helps me keep things in perspective and not feel so alone. I like being able to ask tough questions of the doctors, I want the best medicine possible for myself.

I did meet a couple of women at a party recently who had fibroids during pregancy. One had no symptoms, the other one said that taking birth control pills afterwards (which she had never been on before) "melted" the fibroids away.

Here's a question my mother threw out to me last night. She was diagnosed as hypothyroid when she was trying to conceive back in the late 60s. They put her on thyroid medication, she said it was bovine source, and it was at really high doses. What might the affects of very high doses of thyroid hormone/s be on a developing fetus? I have only had the TSH test done with normal range results. Anyone care to speculate on whether this might have influenced some hormonal wackiness in me?

Mifepristone (RU-486)

In my research into progesterone over the past few weeks I did come across a couple interesting links which talked about how RU486 worked from a hormonal standpoint. These articles talk about it in relationship to endometriosis and depression, not really in the context of it an an emergency contraceptive. It's pretty interesting.


RU-486 may dramatically relieve psychotic depression


RU-486 Explained

Help Support Fibroid Research & Education

[please feel free to forward this to your friends and family, with whatever modifications you would like to make.]

I wanted to ask you to please contact your representatives to the House and Senate and ask them to support the Uterine Fibroid Research and Education Act of 2003 (House Bill H.R.2157, Senate Bill S.1087). These are both still in the Health subcommittees but it would be
great if more women would write in.

Uterine fibroids, non-cancerous tumors of the uterus, affect between 25% and 80% of women and can cause symptoms that may include: excessive bleeding leading to anemia, infertility, and put pressure on the bladder, urethra, intestines.

From the Senate testimony given last Spring by Maryland Senator Barbara Mikulski (with Senator Hillary Clinton of New York):

"Despite their prevalence, little is known about uterine fibroids, and few good treatment options are available to women who suffer from them. Right now, hysterectomy--the surgical removal of the uterus--is the most common treatment for uterine fibroids. More than 200,000 women undergo a hysterectomy each year to treat their uterine fibroids, which requires a six week recovery, has a 20 to 40 percent
risk of complications, and means a women can no longer bear children. Less invasive treatment options, like drug regimes or fibroid embolyzation, are promising, but many have not undergone the rigorous testing that women expect. In fact, the Agency for Healthcare Research and Quality at the Department of Health and Human Services
found 'a remarkable lack of high quality evidence supporting the effectiveness of most interventions for symptomatic fibroids.'

Women deserve better. That's why I am introducing the uterine Fibroid Research and Education Act--to find new and better ways to treat or even cure uterine fibroids.

This bill does three things. First, it expands research at the National Institutes of Health, NIH, by doubling funding for uterine fibroids every year for the next five years. Despite a budget of over $27 billion, NIH spent just $5 million on uterine fibroids research in 2002. This legislation authorizes $50 million over five years to provide the investment needed to jumpstart basic research and lay the
groundwork to find a cure.

This additional funding will help researchers find out why so many women get uterine fibroids, why African American women are disproportionately affected, what tests women can take to prevent uterine fibroids, and what are the best ways to treat them."

The research they might be able to do if this is approved could help other reproductive and gynecological conditions as well. At the very least it would help make sure women are given other options before hysterectomy.

Find your representatives here:

http://www.senate.gov/
http://www.house.gov/

To learn more about uterine fibroids, visit the National Uterine Fibroid Foundation website: http://www.nuff.org/health_statistics.htm

My Reasons for Not Wanting a Myo

Here are my reasons for not wanting a myomectomy:

1. major abdominal surgery
2. risk of adhesions
3. length of recovery period
4. fact that with multiple factors there isn't a documented increase
in fertility
5. they would require me to deliver by c-section if I did get pregnant post myo
6. that I'm largely asymptomatic except for slightly heavier periods and some pelvic pain for a few days prior to ovulation and at the start of my period

We don't even know if we want to do any assisted reproductive therapy anyway, we went to the reproductive endocrinologists (RE) to get their opinion on our situation (my partner had a vasectomy reversal and has an issue with sperm morphology -- morphology refers to shape of the sperm). It was just kind of intense having the head of reproductive endocrinology at a leading university tell you that he consulted with all of the other REs and they've decided they don't want to be my friend.

I've always wanted to go the natural way -- I was never on birth control pills, don't eat junk food really, stay fit. I don't like it when the medical establishment says (in its Terminator voice) "you are infertile. we will cut you open and remove that fibroid. take these drugs and we will harvest your eggs and MAKE you pregnant."

Now I don't know how the rest of you feel but I'm not feeling like I want to go out on a limb with any procedure since I would feel worse if I didn't feel like my care providers were on my side. I guess I will continue doing my watch and wait routine and in the meantime at least take advantage of the MRI order from the RE so I can learn more about what's inside of me. Maybe God or the Universe will intervene in the meantime.

Sheesh!

So, I've been keeping you apprised of my situation. I just got off the phone with the RE (RE#2) and here's what he told me...

...that they won't do fertility treatments on me unless I have my fibroid treated

...that if I have the embolization they won't accept me as a fertility patient

...that they recommend myomectomy

...that he no longer authorized the MRI

They won't do fertility treatments if I have the embo because they are worried about the uterine wall being weak (weaker than a uterus that has had multiple fibroids removed -- aka. myomectomy!?) and the possibility of multiple births being so much higher with fertility treatments. They are also a little concerned about not the liability but their stats, that somehow I might compromise their success rates.

Heck, no one knows why I haven't been able to get pregnant, it could be any of the following that I've been able to deduce...

* sperm morphology
* low progesterone (I started using natural progesterone cream)
* anemia/low ferritin (being treated)
* fibroid (though I've never even been kinda sorta pregnant)

I don't even know what to think know. It seems like my options are a) leave it up to God, or b) do the embo and then leave it up to God, or c) do the embo and do fertility treatments if needed, elsewhere.

We're not interested in adoption.

Maybe I should just go save the dying children in 3rd world nations and give up on this mother thing.

Luteal Phase Dysfunction - Low Progesterone Info

I found this article which talks about low progesterone in the post-ovulatory (luteal phase) and saw that it does mention fibroids in the clinical section.

Luteal Phase Dysfunction

I know that not everyone has the same hormonal cause for their fibroids, and that they don't really know very precisely which they are and in which combination but for some of us progesterone supplementation might be helpful.

Anyone know the status of the fibroid research and education bills?

I wrote to my representatives last winter about the 2002 attempt to get this passed and wasn't paying attention when they were introduced again this past Spring.

Anyone know the status of Senate Bill 1087 and House Bill 2157 regarding funding for education and research of uterine fibroids? They were referred to commitee but I don't see anything on the committee web pages.

I thought this was a great line from the start of HB2157:

"The Agency for Healthcare Research and Quality found a 'remarkable lack of high quality evidence supporting the effectiveness of most interventions for symptomatic fibroids'."

Might we want to do a push where we write and call into our representatives? If I have time I might call the offices of some of the committee members to see what's up next week.

Here are some links:

House Bill 2157

Senate Bill 1087

About Menstrual Suppression

While researching the effects of progesterone on the endometrial lining today I came across some interesting site debating the efficacy of menstrual suppresssion (aka: extended contraception). I
can't say that I noted whether or not these sites mentioned it for use with uterine fibroids but take a look...

ASSOCIATION OF REPRODUCTIVE HEALTH PROFESSIONALS:
Choosing When to Menstruate: The Role of Extended Contraception


The Society for Menstrual Research
(click the link down the page for the statement on menstrual suppression)

CeMCOR - The Centre for Menstrual Cycle and Ovulation Research

Would you stop menstruating if you could?


More about menstruation:

Menstrual Cycles: What Really Happens in those 28 Days?!
(scroll down for more links)

The Menstrual Cycle: What your body is telling you

The Science of Menstruation

The Museum of Menstruation

Natural Progesterone Info

This site has a lot of information about progesterone but the navigation is a little weird -- you have to use the left navigation bar, roll-over HORMONES, the over SEX HORMONES, then over PROGESTERONE and you can click on the links that show up there. The directions they give are in contradiction with other information I've seen where you should only use it post ovulation (whenever ovulation occurs).

http://thecompounder.com/hormonesprogesteronefaq.html

I have this article bookmarked from this site linked which you might find helpful, it is by Dr John Lee and it talks about why transdermal dosing of progesterone is preferable. Note that it says too much progesterone can "[result] in rather high levels of allopregnanolone and the woman becomes rather anesthetized by it, a state that is sometimes confused with depression" -- so that would be a side effect if too much is taken.

LETTER TO A COMPOUNDING PHARMACIST
Delivery of steroid hormones.

You can learn more about progesterone by reading What Your Doctor May Not Tell You About Pre-Menopause(also by Dr Lee)

Back from RE#2

I've just gotten back from a visit with the RE and guess what my pooled progesterone test showed....I have low progesterone. (I feel like I have a twisted mind because I'm glad they actually found something off in my endocrine system). The doctor said that they would have to supplement me during the second half of my cycle when I was trying to conceive (um, wasn't that what I was already doing?). My progesterone is 9.4 and I found mention of it on a site that said "A level above 15 ng/dl is desirable".

I brought up the desire to have UAE with him and he said he could tell I was extremely knowledgeble on the subject -- thanks of course to the ladies on the NUFF group and on the embo list. He wasn't aware that there was anyone doing the procedure at that medical center (and the RE is the head of the fertility clinic) so my research and consultations with the IR may help other women as well. He did mention that he was understanding my willingness to be a guinea pig (which I am), since there isn't that much information (no randomized studies) on the affects of embolization on fertility.

He told me that I should continue taking iron supplementation ongoing due to my heavier periods. I know this to be true even though my menorrhagia (heavy periods) are nothing compared to the flooding some other women have reported in the NUFF group. FYI my period lasts a full 7 days, it is a little heavier now than when I was younger (I'm now 33) but not dramatically so. I do have some clotting and I do also double up on protection since a bad episode with flooding when I was in high school.

He said that there wasn't a link between hypothyroidism and low progesterone (although Dr Lee mentioned that low progesterone may mimic mild hypothyroidism).

I have a referral/Rx for the MRI now so I can schedule that and get more info.

So, it wasn't that bad and we didn't get into any arguments. He's going to consult with the IR next week.

Stay tuned for more info soon.

Response to someone concerned about myo and bleeding

You can ask your doctor to have an Interventional Radiologist (IR) on call in case there is excessive bleeding. That way they can stop the bad bleeding.

Remember as well that the UAE procedure was discovered as an effective treatment for fibroids because a surgeon in France sent in some of his patient to get embolized prior to their myomectomies --so he could reduce the amount of bleeding during the surgery. Rather than being polar opposites or just alternate procedures, myomectomy and UAE are also complementary procedures.

The IR I've been talking to about UAE here in Seattle told me that he recently was called in, after there was excessive bleeding and some other complications arose from a myomectomy. He asked the surgeon why he didn't just call him in when things first started going wrong. The surgeon just hadn't thought of it.

If our doctors are going to rely solely on their training, which most of the time didn't include interventional radiology as an approach to stopping hemorrhaging, to do these procedures and aren't going to be a little more creative about taking advantage of alternate approaches than it is even more important that we educate them. The risks of hemorrhaging are there with all of the gynocologic surgeries including hysterectomy, myomectomy, c-section, and even with childbirth (and probably miscarriage too).

Going in for a Consult with the RE about UAE

I'm going in to see the RE (reproductive endocrinologist) next Friday. He's one of the doctors I interviewed for my myomectomy (the one I cancelled last month). I needed to continue working getting more information, particularly about my hormones, and he was the only one that suggested that I have my progesterone level checked prior to surgery. I just did the pooled progesterone test this past cycle, 3 blood draws on days 5-9 post ovulation. I'll get the results at this appointment. (I'm kind of hoping they say that my levels are low, just so that there would really be something wrong with me -- do you ever feel that way too?)

I'm feeling a little nervous about going in and telling him that I want to have the embolization procedure instead. I'm afraid of having to get into a disagreement with him, where he doesn't believe in UAE for women trying to conceive. Well, if I don't like his reaction then I just will have to work with a different doctor.

One thing I've been thinking about is that for years I had low level anemia and none of my doctors made a big deal about it. I didn't like to take pills/vitamins and besides my doctors said that some women just tend to run anemic. My naturopath that I started seeing right after I was diagnosed with my fibroid last year thought that this anemia needed correction and I think she was right. I was so used to having low energy that I didn't even realize the affects, or even that I could feel differently. I think probably a lot of us had heavier periods our whole lives and didn't understand the affects of that on our health.

I still have low ferritin, at least as of September. I basically have to just take iron supplements ongoing. Luckily I've found a chewable type that is agreeable with my system. Related to the fertilty issue that many of us are dealing with, I found this mention yesterday and thought it interesting (link to full article is below), especially in light of the fact that many of us our anemic here.

"Be sure your iron levels are adequate. A blood test (a ferritin level combined with an iron level and iron binding capacity) will tell you this. Unfortunately, doctors are trained to say the iron is normal if your ferritin level is at least 9 ng/ml. Although a ferritin level of 9 shows you have enough iron to prevent anemia, one can have infertility from ferritin levels less than 40. Because of this, I would look at your ferritin test results yourself and make sure the level is at least 40 ng per ml. In a study of women with infertility with ferritin levels less than 40, half of the women quickly became pregnant when put on iron. If for some reason you are unable to get your ferritin level checked, it is not unreasonable to take iron (e.g. Ferrous Sequels 1 tablet 1-2 times a day for four months). I also would take iron if the percent saturation of iron (calculated from the iron & percent saturation tests noted above) is
under 22%."
From: Effective Holistic Treatment for Infertility

Dermoid Cyst for my Sister

My sister's MRI last week indicated that her right ovary is twice the normal size and that she has a dermoid cyst. This was the first MRI she has had done. Her doctor didn't do an MRI prior to her abdominal myomectomy last Spring where they removed 6 fibroids totally the volume of a grapefruit.

She continued to have pelvic pain after the surgery and didn't know what was up. The doctor told her she would feel better after the myomectomy and that wasn't the case. She started having ovarian pain when she was in high school. The dermoid cyst was probably the thing causing her pain and not her fibroids.

She will have to get more information before deciding on when to schedule the surgery.

Dermoid Cyst Facts:
* Dermoid cysts contain cells that are fetal in origin. They can contain hair, teeth, skin, sebaceous oil, and even eye tissue (I don't know what that means). One website said that it was from a self-activated egg that was trying to start growing in the absence of fertilization but I'm not sure if that is true or not. Otherwise it might just be left over from when you were a developing embryo.
* Ovaries are fairly adaptive and even a portion of tissue remaining will continue to function
* Sometimes the dermoid cyst will take over the ovarian tissue, this sounds rare
* There have been cases where dermoid cysts have turned cancerous, but it is a small percentage of the time.
* The medical term for a dermoid cyst of the ovary is a ovarian teratoma.
* The name of the procedure that doctors do to try to save the ovary is called ovarian cystectomy.

Related Links:

Will dermoid removal affect getting pregnant?

Dermoid Cyst

What are ovarian cysts?

Ovarian cysts ~ treatment
"If you are under forty, s/he is likely to recommend leaving the ovary intact, particularly if you want children. Even if the ovary is badly damaged by the cyst and only a small part remains, that part can still go on working normally."

Ovarian Cysts

Laparoscopic surgery of dermoid cysts--intraoperative spillage and complications.

LAPAROSCOPIC OVARIAN CYSTECTOMY: SELECTION OF PATIENTS AND CONSEQUENCES OF RUPTURE OF OVARIAN MALIGNANCY

Ovarian Teratomas: Tumor Types and Imaging Characteristics

Teratoma, Cystic

I cancelled the myo

I posted yesterday about being depressed about my upcoming abdominal myomectomy. Thank you to all who replied. I went back and looked at Carla's book, and reflected on the other information I have obtained over the past year. I also thought about how the surgery was making me feel, right now at this point in my life.

I wasn't going shopping for new fall clothes because I knew I wouldn't be able to wear them for some time. I couldn't sign up for a printmaking class I wanted to take because I was going to be recouperating. I couldn't audition for a modern dance company this month, even though I'm dancing the best I have in my life. There were so many other things too that the surgery was going to prevent my participating in.

Then I thought about the fact that a myomectomy won't definately improve my fertility and that with male factor infertility (MFI) we hadn't even tried any less invasive procedures first.

I talked with my partner last night and we agreed that I'm not ready for the surgery right now. The prospect of surgery, when I'm not feeling ill and don't expect to for some time, was akin to torturing myself. I would have cried for days prior to surgery, up until the time they put me under and then when I awoke I would cry again, for the discomfort, the impacts (albeit hopefully short-term) and for not knowing that the surgery fixed anything. I know myself and how I react to things, I'm not making this up.

I have decided to shift my plan back into the wait and see strategy that has worked fine for me to date. We'll continue to look into treatment options that will deal with the MFI; I'm figuring that if surgeons are so quick to operate on me for a fibroid that I should at least have the option of trying ART (assisted reproductive technologies) first.

Here is an interesting article that I found (after I decided):
http://www.obgyn.net/displayarticle.asp?page=/infertility/articles/myomectomy_infert

There is also this study, but it is $19 for 1 days access:
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Retrieve&list_uids=10402378&dopt=Abstract

Wish me luck. I may decide to go ahead with the myomectomy but for right now I'm not in the right place to move forward with that option.

Myo next week, feeling depressed

My surgery is scheduled for next Thursday October 9th and I'm feeling depressed about it. I need to have the surgery due to fertility issues -- we're likely going to have to do IVF (although I pray that we don't). I'm 33 and my 6cm fibroid is just going to continue to grow, even if my naturopathic treatment helped slow it down.

I don't have the bleeding that many of you are experiencing; my heart goes out to all of you with debilitating symptoms. I feel periodic discomfort and then there is the infertility. Otherwise I'm completely healthy and I think that's why the prospect of having the surgery is so sad for me. I just don't want to feel bad, and right now it is the surgery that is going to cause me more short-term pain.

When I compare that to the prospect of not having children I think it is a reasonable trade off to have the surgery. But still, how did the rest of you get through the last few days of anticipation prior to your surgeries?