Progesterone Levels in Early Pregnancy

In the event that the serum progesterone level is 5-25 ng/mL, further testing using US, additional hormonal assays, or serial examinations is warranted to establish the viability of the pregnancy.
from: Pregnancy Diagnosis

Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages].
From: Luteinizing Hormone Deficiency

...a quantitative serum progesterone level of more than 25 ng per mL (80 nmol per L) proved 99 percent accurate in predicting a living intrauterine pregnancy. Sixty percent of the patients with progesterone values below 25 ng per mL had abnormal pregnancies.
from: Advances in the diagnosis of first-trimester pregnancy problems

Fourteen infertile women and two women with recurrent abortions were suspected of having luteal phase defect (LPD) by BBT charts. In these patients, the midluteal phase serum progesterone (P) levels were determined together with histological examination by the late luteal endometrial biopsies during the same cycle. The diagnostic criteria for LPD was BBT of luteal phase < or = eleven days, mean P level of 3 blood samples taken on three days during midluteal phase was less than 48 nmol/L (15 ng/ml) and the histological dating of endometrium was two or more days behind. The results showed that histological abnormality and low P level were 6.3% and 31.3%, respectively. When histological abnormality combined with lowered P level at the same cycle, the diagnosis of LPD increased to 87.5%. The author suggests that both midluteal phase P level and late luteal endometrial histological examination should be assessed at the same cycle in the diagnosis of LPD. BBT should also be assessed.
from: Diagnosis of basal body temperature, serum progesterone and endometrial biopsy for luteal phase defect

More about Progesterone Testing and the Value of Pooled Progesterone Testing for Luteal Phase Defect

"Single or multiple pooled serum progesterone values have been used between 21-24 days into the menstrual cycle. A progesterone level greater than 10 ng/mL may represent adequate progesterone support from the corpus luteum. Most authors now agree that a single mid luteal phase progesterone level is not sufficient to evaluate the adequacy of the luteal phase."
From: Lutenizing Hormone Deficiency

"Among women who present with a history of infertility, approximately 3-5% of those with infertility have a true luteal phase defect, with repeated cycles lacking adequate luteal support. The incidence of luteinizing hormone deficiency is higher (10-15%) in subsets of patients who are infertile and have had [repeated miscarriages]."
From: Lutenizing Hormone Deficiency

"As with many hormones, progesterone levels fluctuate hour to hour and day to day, so that a single level is not always an accurate reflection of ovarian function. Also, it is important that progesterone levels are sufficiently elevated for an adequate number of days after ovulation. For these reasons, it is ideal to check more than one blood progesterone level during the time in your cycle when progesterone levels are the highest, approximately 5 to 9 days after the LH surge. In the pooled progesterone test, blood is drawn on three days between the 5th and 9th days of the luteal phase. Blood samples will be "pooled" together, and a single progesterone level will be determined, representing an average of your progesterone levels."
From Pooled Progesterone Test (PDF)

"The results suggest that the most sensitive and specific prediction of low integrated progesterone (and therefore of LPD) was a value of <30 ng/mL for the sum of three (midluteal) serum progesterone measurements (100% sensitivity, 80% specificity).

Even a single (midluteal) progesterone result of <10 ng/mL was highly predictive of LPD (84% sensitivity, 82% specificity). However, a diagnosis based on a single progesterone determination continues to be controversial. Progesterone is secreted in a pulsatile manner, and serial samples obtained over a 24-hour period can range from 2.3 to 40 ng/mL.3 Such fluctuations raise questions about the reliability of a single progesterone determination for the differential diagnosis of LPD. The pulsatile secretion of progesterone argues for either assaying multiple specimens separately or pooling multiple specimens for processing in a single assay."
From: Progesterone: Physiology and Clinical Utility (PDF)

With a pooled progesterone test you should do it fasting, on any three days during your mid-luteal phase -- 5-9 dpo.

I've also read that luteal phase dysfunction is best tested in tandem with an endometrial biopsy and basal charting.

L-arginine and implantation

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

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

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

Low Iron Stores!

I knew there was something wrong with me. I just got my last test result, my ferritin level, which measures one's iron stores, was 10. The scale is 10-282 so I'm at the bottom of normal. Actually a gynecologist a couple years ago had me taking extra iron to get up around 30, so I've got a ways to go still.

I think the extra iron in my diet has helped to get my red blood cell count and hemeglobin back up to normal, largely drawing from my iron stores, or at the expense of them. I need to keep taking more iron to boost my stores.

Doctors don't often test for ferritin but its a good test for women, especially if you have heavy menstrual bleeding or have lost a lot of blood for other reasons.

Athletically Induced Amenorrhea/ Female Athlete Triad

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

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

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

ATHLETIC AMENORRHEA

Amenorrhea in Adolescent Athletes

Female Athlete Triad

Female athletes face risks in overtraining

Menstrual Disturbances in Female Athletes


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

The Opponent: the Female Athlete Triad


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

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

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

Restoring the Flow -- TCM and Amenorrhea

Back in the saddle again.

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

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

Wish us luck.

About Anti-sperm Antibodies

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

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

General information about this condition:

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

Anti-Sperm Antibodies

Antisperm Antibodies

Immunological Factors & Infertility

Immunological Testing and Treatment for Infertility

When Sperm Meets Egg: Sperm-Mucus Interaction

Medical articles and abstracts about anti-sperm antibodies

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

Sperm antibodies

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

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

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

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

[Effect of antisperm antibodies on assisted reproduction]

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

[Immunological approach to male contraception]



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

Training my fertility monitor

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

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

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

More about the adrenals, chronic fatigue syndrome and fibromyalgia

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

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

Chronic Fatigue is associated with elevated cortisol and decreased adrenal function

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

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

(Isolated adrenocorticotropin deficiency presenting as primary infertility.)

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

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

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

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

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

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

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

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

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


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

Chronic Fatigue Syndrome, Fibromyalgia, and Autoimmune Thyroid Disease

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


GENERAL ADRENAL INFO

Your Adrenal Glands

Adrenal Glands - Wikipedia

Anatomy of the Adrenal Gland (PDF)

adrenal gland from Columbia Encyclopedia

Pelvic Adhesions

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

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

Pelvic Adhesions

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

Reduction of Adhesions

Asherman's Syndrome

Pelvic Abnormalities: Pelvic Adhesions (photos)

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

Adhesion Related Disorders

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

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

Pelvic Pain Needing Treatment

Wound Healing and Scarring - Sutures

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

Fibroids and Pregnancy

Behavior of Leiomyoma during Pregnancy

Dr Walker's study of UAE and pregnancy

Fibroids During Pregnancy

Fibroids in Pregnancy

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

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

Fibroids and Fertility

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

GENERAL

Fibroids & Fertility

Fibroids and Younger Women

Management of Uterine Fibroids

Myomectomy: It's Role in Infertility

FIBROIDS AND MISCARRIAGE

Recurrent Miscarriage (Pregnancy Loss)

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


MYOMECTOMY & UFE

Gynecologic Myomectomy

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

Myomectomy
Article about endoscopic myomectomy

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

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

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

About Degenerated or Infected Fibroids

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

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

An Unsuspected Case of a Degenerating Leiomyoma
requires free registration

Photo of a fibroid that has undergone degenerative change

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

PYOMYOMA - INFECTED FIBROIDS

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


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

Back from the doctor's

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

More about cortisol (hypercortisol)

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

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

Facts You Should Know About Night Sweats...

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

Thyroid and Anti-Thyroid Drugs

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

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

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

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

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

This page has more info about dietary things to do:

Adrenal Glands Revival

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

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

And we want to do this to ourselves why?

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

THE ILLNESS PARAMETERS OF PREGNANCY

Cortisol and Night Sweats

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

ADRENAL FATIGUE

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Progesterone and Miscarriage

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

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

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

Hormonal causes for recurrent pregnancy loss

Progesterone Therapy (PDF)

Luteal Phase Progesterone Level(s)

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

Progesterone Therapy in Pregnancy

Possible Ways to Prevent Miscarriage

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

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

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

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

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

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

BTW--

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

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

I'm doing okay.

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

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

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

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

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

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

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

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

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

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

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

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

From The First Four Years, by Laura Ingalls Wilder.

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

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

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

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

Hey, how about that?

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

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

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

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

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

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

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

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

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

Blood Draw Results

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

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

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

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

A summer of last hurrahs

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

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

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

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

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

Whoa.

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

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

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

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

I can breathe a little better now.

doing better.

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

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

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

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

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

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

I am grief.

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

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

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

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

Spontaneous abortion - Retained products of conception

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Waiting. Waiting. Waiting.

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

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

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

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

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

For Someone Going in for Her First Infertility Appointment

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

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

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

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

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

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

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

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



Another page about infertility tests

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

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


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

About Qi and Spleen Qi Specifically

Someone posted on the uterinefibroids message board about having a watery light colored period.

I looked it up in The Infertility Cure by Randine Lewis and it says that this is a sign of a Spleen Qi deficiency. You are meant to "avoid sugar, refined carbohydrates, starches, dairy products, cold drinks and raw foods" to help restore the spleen (those things listed damage the spleen). There are herbs mentioned (ginseng is one) but those are best taken under guidance of a qualified herbalist.

Someone else was interested in what spleen qi was so I wrote this up and I thought you might be interested as well. I have spleen qi issues as well as I've mentioned.

Qi (pronounced chee and sometimes spelled chi) is most easily described
as energy. See this page for more about qi

Traditional Chinese Medicine recognizes channels or meridians in the body which are associated with different organs. One book I read described how this is so by explaining that from our early embryological development certain tissues developed in relationship to one another and from certain groups of cells. The body retains this memory and energetic map of the body throughout our lives.

This page describes more about the functions of each organ channel

Spleen qi refers to how well that channel is performing its functions of aiding in digestion (transformation of food to energy and blood specifically) and control of the blood.

Here's more about the Spleen

Here's a map of the spleen channel on one side of the body, it is on
both sides in the same places.

I've been amazed at what they have been able to treat in me over the past year, things which Western medicine don't even recognize as problems, such as: feeling full of cold water; slightly swollen glands gone in seconds; inflamed back gone in minutes; a subtle ache across my stomach yesterday which turned out to be very blocked channel that was painful to open up but I feel much better now (I'm going through a miscarriage right now so my body was quite out of sorts and Tylenol wasn't helping at all in the end).

Herbs, acupuncture, movement such as qi gong which is like tai chi or any exercise really, plus the foods we eat, how we think/feel all affect the qi.

More about intercourse timing

Timing Intercourse to Achieve Pregnancy: Current Evidence

"Timing and Frequency of Intercourse During the Fertile Window
Intercourse on multiple days throughout the 6 days of the "fertile window" raises the overall probability of conception further, though not additively. In couples of apparently normal fertility, daily intercourse during the fertile window is preferable to less frequent intercourse because each day of intercourse raises the probability of pregnancy. Although sperm concentrations drop with increasing frequency of intercourse, in most men performing daily intercourse the drop does not reach a threshold that would reduce the added conception benefit of each act of daily intercourse. Whether intercourse less often than daily would be of benefit in men with baseline low sperm concentrations has not been studied."

This totally fits in with my theory and practice outlined in a post last week. See, my math, research and observations are not too bad.

Back from acupuncture

I went over and met with two women acupuncturists today who both took case notes and my pulse. Obviously we had a LOT of information to go over since I've been there and back over the past three years.

They were a bit amazed that we hadn't tried any fertility meds, not because they thought we ought to have but just because I had been seeing REs (4 total) and all I've had them do is provide consult, an HSG, some bloodwork, 2 d&cs and a myo.

After going over the here and now miscarriage stuff, then into my pregnancy a bit and then over my cycle history and the fibroid stuff finally we got to do some needlework. I was like a porcupine today with them all up and down my legs, on my hands and feet and across my belly. Two particularly painful areas were the palace of the uterus (down low near my bikini line) and my girdle (aka belt) meridian. The needles were fine but some of the movement they were trying to get to happen was fairly painful, not acute but really sore. Evidently my kidney channel was depleted, my lung qi was being drawn on heavily and it was depleted (channel associated with grief go figure) and my heart channel had some stuff as well. My spleen/stomach channel was doing its almost usual weirdness as well and of course, liver qi stagnation.

I feel much better now, not so entrapped by the changes my body has been going through. I'm going to sort out next steps with my REs office in the morning if the sac doesn't move out by tonight and then we'll see about medical management or herbs to try to move things. I'll have another acupuncture appointment next Thursday with them to follow up on getting my body out of this miscarriage phase and then we can start focusing on building me up again.

It sounds like a good plan to me.

In response to Anna's post about the neighbors...

Doesn't all this infertility secrecy, hurt and frustration (sometimes pain and grief too) make you realize how many people are going through bad things. Since my loss last year I now try to remember that around me are people who are hurting because they lost their father, or someone in their family is sick or things aren't going well in their life right now. There are some things that you can't say though you wish you could wear a badge sometimes and have people be nicer, more understanding.

Thanks for checking in on me.

Headache is just about gone today.

I went grocery shopping after work yesterday and did a little instinctive shopping, I see what I start craving as I start walking by the food. I offer my body things like apples, strawberries, kale, potatoes, fish, meat, broth and last night it told me to buy a pineapple, more grapes, beef broth some red meat and red cabbage (not spinach for certain). I bought other things for my partner off of our regular shopping list. When I got home I washed and ate a bunch of grapes and then cut up the pinapple which was very ripe. My headache started to dissipate after the pineapple, the bromelain it contains is a natural anti-inflammatory. Then I made beef noodle soup for myself and had it along with a cup of my dong quai/peony tea. My head felt a bit better after that as well.

When I woke up this morning I could still feel something, congestion or heat, but the killer frontal headache is gone for the most part.

I got a call back from the acupuncturist this morning. She had a cancellation so I'm going in to see her at 1pm and see if we might be able to work together. Wish me luck.

This evening I'm feeling frustrated, just a little bit but it's there. How did this happen to me again? How is it that I was so close and then the whole project got called off. Why wasn't I consulted? I don't feel like I lost a baby, I feel like I lost a pregnancy. Next time, if I can sort it out so that we don't lose it I imagine people coming up and asking me "oh, is it your first?" and I will answer "No, it is my third pregnancy and no I don't have any children."

When I'm coming to and from the house I think of my neighbors and how they must perceive our life as this childless couple. Little do they know what has happened in their midst. Yet again.

I wish I could be even trying again but I'm still in the midst of getting rid of the remainder of this loss (still haven't passed the tissue -- I think I'm going to have to try drugs this weekend).

What I felt during my brief pregnancy

It was probably more than liver qi stagnation but here were things that I noticed:

SP6 kept throbbing -- it didn't bother me last year

Breast pain that felt like I was having knives stabbed into me for days. This pain surfaced at a new greater level over Memorial Day weekend after which, a couple days later, my symptoms backed off and I had the faintest amount of spotting one day. I think that weekend was when things tipped and my body fought back against the disruption the pregnancy was causing.

Cold feet -- they were as cold in the evenings as they ever were. It didn't feel right to me.

Sweating at night

I had and still have this odd sensation of pressure above my navel.

I emailed Eastern Harmony yesterday and got a referral to someone who has studied with Randine in Seattle. I'm trying to get an appointment to see if we can't do more to rectify my imbalances. I like my acupuncturist but he doesn't specialize in infertility and I've had to suggest that we try herbs or different approaches a bunch of times. He's a little too needle work focused.

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Here are my general symptoms we've been treating:

Uterine fibroid -- associated with blood stagnation and liver qi stagnation

I was anemic for years (just enough to have it not be a problem for my docs evidently) and this gave me other symptoms such as phlegm issues (coughing a lot, especially after meals), getting sick a lot (so much so that my friends were worried for me)

PMS symptoms starting right after I ovulated including irritibility, depression and breast pain including fibrocystic breasts (this was somewhat improved based on naturopathic and TCM diet changes and tx)

Night sweats during LP

Heavy periods that last 6-7 days

Cold feet at night, cold hands

Constipation

Stress makes me lose my appetite and thirst

Fatigue generally, depressed somewhat

Basel temps tend to lull a bit mid LP (horse pattern as per that article you/I recently posted); jaggy temps during the cycle fairly frequently

Tend to shed hair during LP and also since my surgery also during follicular phase

It's hard to be totally objective since I feel like crap (physically) right now but that's most of it.

I've had headaches since last Saturday, I think it is due to the blood loss, low blood pressure and also some qi disturbances. I'm still bleeding but my body was craving the dong quai herb mix my acupuncturist gave me and so I had some this morning. I drank the entire cup which is unusual for me, I usually only have half a cup of anything. I'm still craving more, though it is a bit of a blood thinner so I'm trying to be conservative. I'm also coughing, I think it is related to being a bit blood deficient as this was a chronic sypmtom I had while I had anemia for years (it's been better since I supplement regularly but I lost a lot of blood last weekend). My hands and feet hurt at night and when I wake up in the morning.

I emailed to the Eastern Harmony clinic and asked for a referral to someone who had trained with Randine Lewis, author of The Infertility Cure, and they sent me to this clinic here in Seattle.

They are pretty close to my office and in the same building as the dentist I go to so that would be convenient. I like my acpuncturist but I don't feel like we have made enough ground in the almost 18 months that I've seen him. Granted that was peppered with my getting pregnant and have a miscarriage and then the surgery and all but I think that I've still got too many old patterns sitting tight. I've beenthe one to suggest different approaches to my issues and I think we've learned more from those times than from anything else (that's just my opinion though).

I still haven't passed the sac. I'm going to do some yoga and qigong later this afternoon to try to help my body move things along.

Still thinking about that qi and what it might have had to do with this all

"Although invigorating the uterine blood can be risky during pregnancy, when blood stasis is present, if it isn't addressed and resolved, the fetus will abort."

"The herbal formula I prescribed for Christine is often used to treat endometriosis and uterine fibroids, and other manifestations of uterine blood stasis."

"[She] suffered from very severe PMS. About a week before her period was expected she became extremely depressed and irritable....Her menses were regular, coming every 30 - 32 days. She bled rather heavily, and the menstrual blood was dark red and clotty. She was always cold, especially her feet."

"During one visit, Claudia off-handedly told me that every month she experienced vision changes premenstrually. She had told her gynecologist and reproductive endocrinologist that her vision would dim and she saw floaters just before her period arrived, and they both told her it was insignificant. According to Chinese medicine, the liver, which governs the eyes and vision, also supplies blood to the uterus. This clue allowed me to hone in on another aspect of Claudia's menstrual disharmony. Although the liver qi had been rectified, the liver blood remained relatively vacuous and couldn't supply both the eyes and the uterus."

From: Immunologic, Autoimmune Factors, and Recurrent Miscarriage

Those things are my symptoms, my normal symptoms I have lived with for years.

I feel like there was something to how painful my breasts were that last weekend I felt pregnant. I think it was related to stagnation. My body didn't feel happy at all and while I know things like morning sickness also show that the body isn't happy there is something that tells me that my body was trying to protect itself instead of giving in to the pregnancy.

I like my acupuncturist but I think he's a little less practiced in fertility. I think a deeper understanding would be a help for me. I sent an email to Eastern Harmony Clinic to see if they know anyone to refer me to in Seattle. I don't see how any other treatment is going to work as just using progesterone last year made me feel so sick and I don't want to go through this again.

Still working on it

My ultrasound this morning showed that the gestational sac has moved down towards the area of the cervix but it has not passed yet. It still showed up as a dark blog on the screen so it still is fluid filled, though that doesn't have anything to do with it being still in there.

The nurse checked my cervix and boy did having that speculum opened feel like a treat. Everything is a little more sensitive down there right now, even the cotton swab she used to move blood away from the cervix opening was intense and ouchy.

My doctor, the nurse and I agreed that avoiding a d&c was worthwhile (see there is a reason I named my blog that) so I will just have to let my body do the remaining work to move the remaining tissue out of me which should happen within a few days but maybe a little longer. We'll reevaluate later on this week if nothing has happened by the end of day Thursday.

My head is foggy and my body still feels weird, unresolved as it was. Not as hormonally hung up as last time though but somewhere in between. I've realized that the hormonal changes your body goes through for a miscarriage somewhat impair the analytical part of the brain. Oh well, if I can just push through and focus on design work and not on any more proposals or client meetings I should be able to make it through the week.

It's 1:15 am and I can't sleep. I had a nap earlier this evening because I felt sleepy and heavy and then I woke up. I've been surfing around and not working on this proposal that is still hanging over my head.

I wish I felt tired. I feel like an insomniac.

I also wanted to thank you all for coming and lurking and posting and sending me prayers and good thoughts. It helps to make this seem less of a lonely time. I wish it was because we were all celebrating instead of worrying over this non-event.

Today I kept thinking of this song by Sarah McLachlan,"Out of the Shadows". It's from her first album. It's a pretty song but a bit moody. Reading the lyrics they hover around what I'm feeling, but I'm not going to let myself be depressed. Well okay a little. But not in a big self-indulgent way. Just a measured amount.

I'm going in for an ultrasound in the morning. I don't believe I passed any tissue, the so-called Products of Conception, over the weekend. When I called the nurse she wanted me to come in sooner rather than later. From last time I know that you can have retained tissue for a while without any problem. From other women who have gone through miscarriage I know that there is a real risk of infection. They said they might want to do a procedure tomorrow. I so don't want that. There is always the possibility of using medications to try to bring on contractions again, but who knows how long that will take. It's hard to be discreet about these things when you are dealing with nature and nature takes its own good time.

I spoke to my mother today and told her about it. First I sent her an email after she sent me a nagging one about not calling for Father's Day. I just was blunt about it, no details or anything. We talked and she was okay about it. I don't know why she was this time and not last time. Maybe it is because I've already been there and she knows it. Maybe because she has already seen me wounded. I told her maybe third time's a charm. She said that is what happened for her. I wish we didn't have so much in common.

If I can get my miscarriage to be resolved I could try to go visit her this weekend. The next two weekends after that we are busy and then it is the middle of July. She's going to start her radiation therapy and she would like to see me while she still has energy. Though isn't it ironic that I won't have any. I can't win at this game.

I'm so beat. It's like the life has been drained out of me. I woke up today at 5am to a flooding sensation and then went through hours of passing large clots and having awful pains. I still haven't passed any tissue though (argh!)

I was bleeding so much that in spite of using a cold pack and taking 1000mg of vitamin C there was no stemming the flow. I talked to my partner about how we would know if I needed to go to the hospital, it was pretty scary for a while. I took a shower around 8am (?) and it looks like that shower scene from the movie Psycho for a while. After a while longer sitting up with intense pains I started getting sleepy and so I went upstairs and fell asleep for several hours. When I awoke the bleeding was less. I sat on the couch all day and knitted.

This evening we went over to see my niece and nephew as they are going out of town for a couple of weeks. It was a good break from all the torment of the weekend but I'm absolutely wiped now.

I've got some proposals due for work that I can't get around so I'll just have to push on through and then make up with more rest and shorter days during the week.

It's been such a different experience this time around, I think last time was punctuated by needing an abortion (d&c) to get rid of the failed pregnancy while my hormones were still high and that was immensely difficult for my body to deal with. This time things waned and while I'm sad a bit it's much more okay, I can manage.

I didn't call my father for Father's Day though. Last year I called him on Father's Day to tell him that he was going to be a grandpa and then that was dashed a few weeks later. I was feeling so drained that I knew that I would have to say something of why (or at least I would want to) and I just couldn't bear to pass on that sadness today. Not on this same freaking holiday.

We've talked some about when we will try again. I'm feeling like August might be a good time, give my body a chance to recover hormonally. We'll see how it goes in the coming weeks.