More and more cycles.

I decided back after my last cycles post that it really didn't make sense for us to be ttc just then; we're building a new house, and being pregnant while doing that didn't make a whole lot of sense (which turned out to be a good thing because had it happened relatively quickly, the house has NOT, and would have made things, um, interesting).

In the meantime, I've been tracking my cycles. It's interesting to me, while they generally tend to be around the normal 27-28 days, I O a few days late and then have a short LP. Here's the list so far:

Cycle # CD of O LP length
1 37 6
2 22 6
3 23 7
4 21 9
5 21 9
6 15 9
7 20 10
8 17 10
9 18 10?

(The last is a ? because it hasn't happened yet. And maybe it won't...)

It's nice that my LP has been getting marginally longer each month, usually about 6-12 hours per month. And yes, I have been somewhat obsessive about all this tracking!

Exercise and Fertility

Very interesting article from the Norwegian University of Science and Technology: Original article is at http://www.ntnu.no/news/hard-workouts-reduced-fertility, I copied the text below as I don't know how long the article will be up for.

Hard workouts -- reduced fertility
New research from the Norwegian University of Science and Technology (NTNU) shows that the body may not have enough energy to support both hard workouts and getting pregnant.

NTNU Info/Rune Petter Ness

Are you a female athlete – or just someone who likes challenging workouts -- who also wants to get pregnant? It may make sense to ease off a bit as you try, according to new research from NTNU.

Roughly seven per cent of all Norwegian women are believed to have infertility problems, which means that they are unable to become pregnant during the first year of trying - even if they might later become pregnant.

Infertility can have many causes, both medical and lifestyle-related. Known risk factors include smoking, stress, and alcohol. Being extremely under- or overweight can also play a role.

It is known, however, that elite sports women have more fertility problems than other women. But does extreme physical activity play a role in fertility among other women as well? NTNU researchers examined precisely this question in a study involving nearly 3,000 women. They found that overly frequent and hard physical exercise appears to reduce a young woman's fertility. But the decrease in fertility probably lasts only as long as the hard training.

Two vulnerable groups
The study was based on material from the Health Survey of Nord-Trøndelag from 1984-1986 and from a follow-up survey in 1995-1997. All of the women who participated were healthy and of childbearing age, and none had a history of fertility problems.

In the first survey, women responded to questions about the frequency, duration and intensity of their physical activity - and ten years later were asked questions about pregnancy and childbirth. The NTNU researchers also recorded other information that could have significance for the study.

“Among all these women, we found two groups who experienced an increased risk of infertility,” says Sigridur Lara Gudmundsdottir, a PhD candidate in NTNU's Human Movement Science Programme. “There were those who trained almost every day. And there were those who trained until they were completely exhausted. Those who did both had the highest risk of infertility.”

Age an important factor
If the women also were under 30 years old in the first study, the relationship became even more evident in both groups. Among those who reported training to exhaustion (regardless of frequency and duration), 24 per cent had fertility problems. In the group that had trained almost every day (regardless of the intensity and duration), 11 per cent reported the same.

Even when the data were adjusted for other possible contributing factors (such as body mass index, smoking, age, marital status and previous pregnancies), the researchers found that women who trained every day had a 3.5 times greater risk of impaired fertility as women who did not train at all.

“And when we compared those who trained to exhaustion to those who trained more moderately, we found that the first group had a three-fold greater risk of impaired fertility,” says Gudmundsdottir.

In women who reported moderate or low activity levels, researchers found no evidence of impaired fertility.

A transient effect
But the negative effects of hard training do not appear to be permanent, the researcher says.

“The vast majority of women in the study had children in the end. And those who trained the hardest in the middle of the 1980s were actually among those who had the most children in the 1990s,” she adds.

There may be various explanations for why the women who first were least fertile ended up with the most children. “We do not know if they changed their activity level during the period between the two surveys. Or if they just had trouble getting pregnant the first time, but afterwards had a hormonal profile that made it easier to get pregnant again,” Gudmundsdottir said.

Too demanding?
Scientists have a theory that high levels of physical activity are so energy intensive that the body actually experiences short periods of energy deficiency, where there simply is not enough energy to maintain all the necessary hormonal mechanisms that enable fertilization.

On the other hand, previous research shows that moderate physical activity gives women better insulin function and an improved hormonal profile - and thus better conditions for fertility - than total inactivity, particularly in overweight people.

Forget the easy chair
But Gudmundsdottir says that women who want to become pregnant shouldn’t give up all physical activity.

“We believe it is likely that physical activity at a very high or very low level has a negative effect on fertility, while moderate activity is beneficial,” she says.

But as far as identifying how much is “just right”, the researcher is careful. “An individual’s energy metabolism is a very important factor in this context. The threshold can be very individual,” Gudmundsdottir says.

She also recommends that physically active women be particularly aware of their menstrual cycles. “A long cycle or no menstruation at all is danger signals,” she says.

Cycles

I've been cycling reasonably regularly since that first post-Timmy O, if it's possible to say that after three cycles. The next cycle I O'ed on CD44, after *nine* days in a row of EWCM. I did start temping because I had a couple of days of EW at CD17-18, then at about CD23 I wanted to know if I had O'ed yet... and down the slippery slope I went. My temps then were higher than my pre-O temps had been before Timmy, although not quite as high as my post-O, so I had to keep doing it to make sure, right? So I O'ed CD44, and my EWCM dried up that day. Which made me re-evalute my O date from the cycle I mentioned below, I think it was a couple of days later resulting in a four day LP. My CD44 cycle my LP was six days - heading in the right direction!

We've been debating on whether to try and have a third baby for a long time, and after much angst (mostly on my part - I really really would like another baby, but practically it doesn't make a whole lot of sense. I decided that I've been practical all my life and this is one choice I really don't want to regret), have decided to go for it. So... the next cycle was the first that we actually 'tried'. I O'ed CD22 (yay!), but still only had a six day LP (boo!). I have to wonder if my body will ever have a normal LP. We're probably not going to find out for a while though, as I'm going to call my RE and get back on progesterone again after I O the next time.

Commencement

I don't post here much anymore, but I figure I'll keep updating with HA related stuff, as well as things related to my cycle so I remember them. I do come back to this blog quite frequently when I'm wondering about what happened when, or details about things that are no longer easily accessible to my poor addled brain, it's great to have as a reference.

So... I think I'm about to O again! I'm super excited about it, as I'm still BFing Timmy 2x/day (at 10.5 months old). I also weigh about six pounds less than I did when Timmy was conceived, so I was a little worried that my HA would be back again. (Although I'm not exercising nearly as much now, I'm lucky if it's 3x/week, so I've been hoping that would mitigate the weight loss).

Anyway, I've had a day of EWCM every two weeks since April, which suggested to me that things were slowly revving up. The first time freaked me out a bit as DH and I had been less than careful just a few days before, but it was just a random day (with a BFN a couple of weeks later). So I had it 7/2, 7/16, then every day since 7/24. And in copious amounts, more than I've ever had before! I'm not doing OPKs or temping or anything like that, I figure I'll have a good sense of when I might have O'ed based on drying up, and then I'll find out in somewhere from 5-15 days for sure if the good old CB (crimson bitch aka AF for any new readers) arrives. Fingers crossed!

Update: CB arrived on 8/3. So, I definitely O'ed! I would guess it was Monday night, 7/27, as I had some cramping that night, EWCM the following morning but nothing after that. So that's probably a 6-ish day LP. Not too bad... although I would have thought it would be longer than that based on all the egg-white. eh. now hopefully on to the next cycle!

Hypothalamic Amenorrhea Recovery / Treatment Summary

I have been posting on the hypothalamic amenorrhea (HA) bulletin board over at fertilethoughts forums for almost three years now - I wished when I was diagnosed and starting treatment that there was someone who had already been there that I could talk to about what I was going through. It makes me warm and fuzzy inside to be able to provide that input and insight to others who are going through the same things now.

Over those three years, I've learned a lot, and also collected some pretty interesting stats that I thought I would share here for anyone who finds this blog searching for info on HA.

There seem to be two different flavors of HA, both with the same manifestations. The first variety comes in women who are normal to low weight, and undereat / overexercise to a BMI anywhere from 21 on down. The second happens in women who were overweight to begin with, then lost a significant amount of weight; in some cases going to low BMIs as well, but occasionally just to a 'normal' BMI of 23-25.

In the first case, gaining weight and cutting exercise seem, without fail, to restore natural cycles. This is despite what many doctors have told women on the board, "You could gain 50lbs and still not start cycling again." This is NOT TRUE. I'm finally starting to see posts from some women who say that their doctors won't treat them until they've gained some weight. The thing is, not only does gaining weight and cutting exercise help with complete recovery from HA, it also helps with treatment cycles if the natural approach isn't fitting in with timelines. There have been a number of women on the board who have either tried Clomid with no success, or injectibles with cancelled cycles for overstimulation, and even multiple failed IVFs. After weight gain, Clomid works in *many* cases despite the traditional wisdom in the literature that it won't work for HA because of the low estrogen. Injectible cycles go significantly better after weight gain. And IVF cycles seem to be much more successful as well. Also, the weight gain that comes with pregnancy is mentally much easier when some of the disordered eating / exercise / body image issues have been conquered prior to pregnancy.

In this first type of HA, what happens is that as the body goes into a semi starvation mode with a constant energy deficit due to the undereating/overexercising, leptin levels decrease (see Welt CK et al. for the full article). This then leads to decreases in the levels and pulsatile frequency of LH, and estradiol, and the natural hormonal cycle stops. Increases in eating, particularly in carbohydrates and fats (good and bad) restore the natural leptin levels within a reasonable amount of time - usually 6 months to a year after making wholehearted changes (in many cases cycles are restored even more quickly than that; the quicker the weight is gained, the more quickly the cycles return).

In the second type of HA, in women who were overweight and then lost a significant amount, it seems take much longer for cycles to return. I believe this is because in people who are overweight, leptin receptors become desensitized, and not as responsive to the leptin signals. When the weight loss occurs, leptin levels decrease, just as in the first variety. But when eating is resumed / overexercising moderated, the increase in leptin levels is not registered as quickly by the body because the leptin receptors are not as responsive. This is my own theory, but it's the only thing I've been able to come up with to explain why women who were overweight seem to have a less tractable form of HA.

So the upshot is, if you have HA having been normal weight / thin most of your life, you can restore your cycles reasonably easily by gaining weight to a BMI of around 23. For most women that has done the trick; many have resumed cycling at a lower BMI than that. It takes committment, it takes handling feeling "fat" (although as a whole we tend to have quite skewed body images - many of our significant others and friends comment on how much better we look after gaining weight - and they do mean it!), buying new clothes in larger sizes really helps. If you have HA and were overweight before losing / exercising, weight gain will still help with treatment, but it will likely take longer before your cycles will return naturally.

If you want to be pregnant NOW (and who doesn't after deciding it's time?), weight gain can still really help. As you can see by checking the stats below, Clomid DOES work in many women with HA after weight gain. Sometimes even without a positive response to Provera. If you have HA, and don't have insurance that covers injectibles, I think you should absolutely 100% give Clomid a try before putting down the cash for an injectibles cycle. If your OB or RE will go for it, the extended Clomid protocol seems to have great results; if not, even a standard Clomid protocol will often work.

Starting in October 2007 I kept track of (just about) all the women who posted on the HA board, how they got their BFP's (which almost everyone has, still working on some of the recent joiners) and other random information.

So far, there have been 82 BFP's in total. Unfortunately, 14 (17%) of those have resulted in miscarriage, which is fairly close to the rate that is normally quoted for miscarriage. Of those 82 pregnancies, the breakdown by method of conception is as follows:

Natural: 31 (38%)
Clomid (including extended protocol): 22 (27%)
Injectibles: 20 (24%)
IVF: 5 (6%)

Also, these stats do include some women second pregnancies after recover from HA. By and large, if weight loss post partum is moderated and the patterns of undereating/overexercising are not resumed, natural cycles are restored after weaning (it is extremely rare for a former sufferer of HA to resume cycles while nursing). Most of the subsequent pregnancies are falling into the natural category.

As you can see, this totally belies both the assertion of medical professionals that you can gain an infinite amount of weight and still not cycle again, as well as the idea that Clomid will not work. In fact, 70% of the pregnancies achieved (after 10/2007) on the HA board have been through one of those two methods. And I am firmly convinced that many of the women who did use injectibles or IVF could have gotten pregnant either naturally or with Clomid had timetables been different.

As this is my summary of all I've learned about HA over the past three plus years, a few other things that seem to come up frequently:

* As our cycles return, they tend to be quite a bit longer than normal cycles, with ovulation in the CD40's (or higher) for the first cycle not uncommon. As weight gain is maintained, cycles get shorter. This isn't a surprise, as it takes a while for the body to respond to the restored hormonal levels.
* A BFP on a late ovulation is not a problem at all, despite what you may read online. The thing is, that the follicle is not sitting around with a mature egg in it; once the follicular recruitment really takes off, ovulation is actually occurring in a normal timeframe; it just takes longer to get to the follicular recruitment phase.
* Speaking of which, it's not uncommon to go through 2-3 follicular recruitment waves accompanied by changes in cervical fluid / temp prior to actual ovulation occurring, especially as cycles are returning.
* Estradiol is NOT the be-all-end-all as far as HA diagnosis goes. In fact, estradiol levels don't really seem to correlate much with whether natural cycles will return or Clomid will work. For me personally, my e2 when I was not cycling was 32; the two cycles where I got pregnant it was 27 and 34 respectively. It seems that the LH number is much more indicative of HA status - LH below 2 is likely to indicate HA; as recovery continues, that number rises much more reliably than e2 does.
* If Clomid is used, we *still* tend to have longer than normal cycles, often not ovulating until somewhere between CD20-30, so that should be your expectation. Monitoring is a great idea if you can afford it / your doc will do it - there are cases where women have grown good sized follicles but just not been able to muster the LH support to surge properly to ovulate. If you're being monitored and this seems to be the case, a shot of Ovidrel can be given at relatively low expense, to induce ovulation.
* If you want to move on to treatment and have the option of using the GnRH pump or patch, jump on it! They seem to be far the best ways to induce follicle growth without overstimming.
* In injectible cycles, it is extremely easy to overstimulate as our bodies are not used to the hormones that are being injected. First, your injectible should absolutely include LH (so Menopur or Repronex) - the cycles that have been completed on the board with FSH alone (e.g. follistim, bravelle etc.) are generally much less successful. Second, your protocol on your first cycle should be to start with a single vial (75U, or even less) for at least 4-5 days. Increase the dosage after that, preferably by just a half vial at a time. I have seen too many cases where either a higher dosage (common in injectible cycles for non-HA women) or too quick/big jumps in dosage lead to multiple follicles and either cycle cancellation or multiple pregnancy. In most cases we tend to be quite fertile once ovulation is induced, so the goal on the first cycle should be one mature follicle, or at most two. Of those 82 pregnancies, 3 were triplet pregnancies (two from Clomid) and one was a quadruplet; prior to 10/2007 there were two other triplet pregnancies and another quadruplet on the board. *Many* of the women on the board who moved to injectible treatment were successful on the first cycle.
* Injectible cycles following the recommended low/slow protocol DO tend to be quite long, with stimming for two-three weeks not out of the ordinary. There's nothing wrong with this, and no reason for the cycle to be cancelled - you will find a dosage at which you respond, and your follicle(s) will take off from there. Generally once a follicle gets to be 12mm+ / e2 goes over 100, the stimming will just take a few more days until trigger.
* For subsequent cycles, if needed, you should NOT start with the dosage that you finally responded at; that will almost certainly lead to recruitment of too many follicles. Start at least half a vial lower than that for the first 4-5 days, then bump up to the dose you respond to.

If anyone comes across this post and has questions or comments, I'd be happy to respond, feel free to use the comments section.

SO NOT THE POINT!!!

I posted over on my other blog about how I am having a hard time figuring out how to teach my kids to appreciate the things they have as I did, where things come to them so much more easily than they did to me. One of the things I mention is that I really wanted a Cabbage Patch doll growing up, but never did get one.

My MIL reads the post. And what does she take from it? NOT the point I was TRYING to make about the extravagance of their gifts to the kids:

"...how will they learn about delayed gratification? That they aren't always going to get everything they want (like my cabbage patch)? How will they learn to appreciate what they do have? If Christmas and their birthdays are always extravaganzas of presents (not necessarily from us), how do we teach them to be thankful?""

She shows up on Tuesday with an early birthday present for me. Of said Cabbage Patch kid.

I'm going to be fricking 35, what on earth am I supposed to do with a doll at this stage in my life????? SOOOOOOOOO not the point of my post. Which was apparently completely and totally lost on her. So much for a subtle hint.

The birth of TER.

Timothy Edward (formerly known as Fwed) was born on 09/18/2008 at 1:48pm, weighing in at 7lb 5oz, and 20 inches long. My BIL was joking about how we talk about babies as if they're fish!

Here's how it all went down:

I first noticed contractions that felt different from the BH I’d had all along in the pg when Ant woke me up at 4am. They were about 3-5 minutes apart, lasting 15-20 sec. After a while when I couldn’t go back to sleep, I got up to finish up some last minute work stuff, and have something to eat. The contractions spaced out quite a bit, to about 10-15 minutes apart, so I figured we were either in for the long haul, or it was false labor. Until I went to the bathroom and there was some bloody mucus on the TP… I got a big smile on my face and thought that we probably would be having the baby that day. More than a week sooner than I had been anticipating (I was 39w6d).

By the time I finished up the work stuff at around 10am, I was having contractions that were 4-5 min apart, but only about 30 sec long. I hopped in the bath for an hour and only had 3-4 more, so in my mind more evidence that we were in for a long day. When I got out, they were 2-3 min apart but only 30 sec or so, so I thought they would space out... they also weren't that uncomfortable, I was just stopping and leaning on something through them, then getting on with what I was doing (which did include a little bit of packing, turned out to be a good thing). I started having to lie down for them at around 12:15 - and then my water broke at 12:20. Called the doctor, and they said, "come in RIGHT now". I still wasn't convinced because although the contractions were coming pretty quickly they were still fairly short, and I wasn't finding the pain unmanageable in the least. But I decided they were probably right.

We ended up leaving the house at 12:48. Got stuck in traffic on Storrow Drive (figures!), at which point Mark asked if he needed to flash his lights etc and try and get through. I said no, but did have him call smartraveller to find out how long we were likely to be stuck for. Fortunately it was just a short jam due to some road work, so we were on our way in about 5 or 6 minutes. We also discussed how we should handle the car – should we both go and park it, should Mark drop me off, or should we leave it out front? I said I didn’t think I could make it from the garage, so either he should drop me off or we should bring the car right out front. By the time we got there Mark decided on the latter based on his assessment of how I was doing. (I had started pushing out more gushes of amniotic fluid just as we were getting through the traffic jam).

We were actually treated as a medical emergency when we did get to the hospital; there were a couple of guys out front who helped me into a wheelchair, and got us an express elevator up to the L&D floor. The receptionist there didn’t seem to have quite the urgency that Mark and I were feeling, she was asking for our insurance info! I told her my contractions were 1-2 min apart, and finally she seemed to get it and got someone to take me into triage. Once I was up on the bed in triage after discarding my amniotic fluid (and meconium – the fluid was definitely greenish) soaked towel, I climbed onto the bed. Almost immediately, I felt my uterus starting to contract from the top and push down – without my doing a thing! I told the nurse that I had to push. A midwife came in, checked me, “yup, fully dilated +2 station” and rushed me to a delivery room. The pushing phase was nothing like what I had imagined, where I would get a break in between pushes to recoup, and wonder at what was happening. Even the pushing contractions were right on top of each other. At one point they had me try and push more slowly, until the baby’s heartrate started dropping, which for me was the best motivation EVER to push as hard as I could and get him out. He did come out, just one or two pushes later, and only 13 minutes after we’d entered the room. Mark said, “It’s a BOY!”. So Timothy Edward had made his appearance.

Because he came out so quickly I had a lot of tearing, so they spent about 3 hours stiching me up and trying to stop the bleeding (all of which was honestly way more painful and uncomfortable than the delivery itself), which was unsuccessful and I ended up in the OR for about 45 minutes at 7pm to finally get everything back together. Turned out I had a second degree perineal tear, labial tears, and a vaginal tear which was what had been oozing and they couldn't find until in the OR.

It’s funny how so few birth experiences seem to go as expected. I got to experience the natural delivery I was hoping / planning for – yet at the same time because it all happened so fast, in some ways I didn’t get to experience it. I had a Nora Jones CD I was planning on listening to while laboring in the hospital, to help me relax through the contractions. That never even made it out of the bag! As I mentioned, there was no time for me to think about, marvel or wonder at what my body was doing during the delivery because the contractions were so incredibly intense. Don’t get me wrong, I’m not complaining – in fact I’m rather in awe of how it all happened. It just happened so differently from what I had imagined, since I started contemplating a natural birth when pregnant with Ant.

Gotta love that uterine irritability!

I'm going to put up a few posts over here rather than at Phred/Fwed because my in-laws read that blog as it's mostly about the kids - but there are some things they just don't need to know!

*******************

I have been lucky so far this pregnancy not to have experienced the series of contractions that I did starting at 25 weeks in my first pg. I've had plenty of sporadic contractions, to be sure - I noticed them starting at about 12 weeks. But nothing serial, that lying down or drinking wouldn't fix. Until yesterday that is. They started at about 12:45, I actually noticed them while I was standing in line to get lunch. And they continued. And continued. About every five minutes apart. I hadn't had much to drink since the morning, so I swigged about 20oz of water, and lay down on the floor of my office for a bit. Nice to have an office, I must say! They did stop while I was lying down, but started back up again as soon as I got up. I tried lying down again for a longer time, and they disappeared again - as long as I was on the floor. I decided to call my doctor's office after about three hours of this - they had been telling me to call if I had more than four in an hour, and at this point I was running at 10-12/hour. I wasn't overly concerned, as these felt just the same as all the other contractions, and I wasn't feeling any other labor-ish symptoms. I was a little annoyed, though, when it took the nurse an hour to call me back! We discussed a little, she eventually said that I should go home and call again later if they were still continuing. I almost agreed to that, but then figured I that at work I was only 5 minutes away, and I'd rather just go in at that point and get checked out than have to deal with going in later in the evening when it would be much more of a trek. She agreed that it would be reasonable for me to come in, so off I trotted.

When I got to the office, I was again kept waiting quite a bit longer than I would have expected. When they finally took me back they followed standard procedure - pee in a cup, weight, BP, and listen to the baby. I was still having contractions, but they were a little further apart at this point. Funnily enough, I often have one just as I'm lying back on the table and the nurse always comments about how "that's the baby". I don't have the heart to tell her that no, it's actually my uterus (it's doing the same thing this time as last, when I get a contraction it's all bunched up on my right side). Anyway the doc showed up a few minutes later, took a swab and checked my cervix. Long and closed, as I had suspected, but it was nice to have the confirmation. So off home I went.

I have noticed a lot more contractions today, including an almost constant one the whole time I was walking back from lunch. I think I must have just hit the point where my uterus is saying okay it's time to get ready now. Hopefully I'll be able to continue to manage the contractions just by drinking and lying down when needed (I did spend another few minutes on my floor today when I was tired of the effort).

Interestingly, when I was at the gym this morning doing my little weight lifting routine, I didn't notice any contractions at all. Perhaps I need to stop working! ;-)

The end.

It's time for me to stop posting here. I have officially kicked hypothalamic amenorrhea's butt. Whupped her to the curb. So I feel like without that, there's really not much to post here anymore. I will continue to post over at my other blog, http://phred-fwed-schweffel.blogspot.com, so if you're interested in following our story, come visit over there.

I will still post HA related things here from time to time, as I come across them in my reading/research. But that will be it. I'm also going to migrate some of the older non-HA related posts over to the other blog as well.

Thank you very very much for all the support, advice, and free shoulders you've provided me over the years! You guys are the best!

Hypothalamic Amenorrhea Cure???

I started this blog over two years ago, hoping to connect with other women with hypothalamic amenorrhea, hoping to get advice when I was going through treatment, and subsequently, to help those who are struggling today.

I have not been keeping up on the research of late. But, when I was looking for information for a woman I met through the hypothalamic amenorrhea bulletin board at fertilethoughts about whether there was any advantage to using Femara (letrozole) over Clomid, I came across an abstract that I think is quite groundbreaking.

The article, “New protocol of clomiphene citrate treatment in women with hypothalamic amenorrhea”, offers the hope of using Clomid not just for ovulation induction, but to actually restore normal menstrual cycles! I actually purchased the article so I could read the details of the study they performed, to see if I agreed with the conclusions they drew in their abstract, and also whether Clomid was the only treatment used, or if there was concomitant decrease in exercise or increase in weight.

The only drawback of the study was its size – only eight women were treated. However, all eight resumed cycling, and were still cycling six months later! I think that this treatment regimen is incredibly promising for those still struggling.

The study consisted of eight women, five of whom had hypothalamic amenorrhea from excessive exercise, the other three from restrictive eating patterns. (Aside – HA does seem to be due to an energy imbalance – either overexercising, undereating, or a combination of the two. I have been in contact with 25+ other women with HA, almost all of whom (including me) fit this profile). The BMIs of the women in the study were 17.6 to 19.5 – underweight or very low normal weight. Hormone levels were meauserd at the beginning of the study, and were classic HA – low side of normal for e2 (18-25), FSH (2.9+/-0.4), LH(2.3+/-0.3) and progesterone (0.18+/-.2). The age profile is younger than most of us who are TTC – 17-22.

The treatment regimen was 50mg of clomid for five days, followed by five days at 100mg. Ovulation was then assessed by u/s and progesterone mid-luteal phase (with a fairly stringent requirement of >25nmol). Of the eight patients, six of them ovulated and got their period after just one cycle! They subsequently took 100 mg Clomid CD3-7 on the next two cycles. The two women who did not ovulate after the first cycle repeated the initial regiment, and both did ovulate after that.

After the three months on Clomid, all eight women resumed cycling on their own, with no additional medication!!! In addition, there was no change in eating or exercising habits – the deficit in energy caused by overexercising and / or undereating seems to be very strongly correlated with hypothalamic amenorrhea.

For anyone trying to conceive, I would NOT recommend not changing the eating/exercise habits that led to HA – I think it is extremely important that during pregnancy one is not operating at an energy deficit. You would never starve your child after he was born; it is no different to starve them inside the womb. However, I think that particularly for people whose insurance does not cover injectibles, this new regimen is well worth trying.

Three of the women on the fertilethoughts HA board have now tried this regimen, with similar success (although one ovulated on the first cycle and repeated the 10 day regimen with no ovulation the second cycle). Two others have tried a longer clomid protocol than the standard five days, although not quite this regimen, one successful and one not. It seems that it is well worth giving this new regimen a shot before pursuing more aggressive treatment like injectibles. And so far one BFP!

In short, the protocol was as follows:
Bleed induced through bcp (not necessary; two of the women on the FT board did not get a bleed first)
50 mg Clomid CD 3 - 7
100 mg Clomid CD 8 - 12
u/s to check for follicles

I hope that other people in the HA boat find this protocol, and start pushing it with their RE's. The traditional thought is that Clomid does *not* work for women with HA because of the low baseline estrogen levels. But this seems to be different!

non-pregnant? not exactly!

I was feeling very non-pregnant this 2ww. No cramping 6-8dpo, no sore legs during hockey, no strange temperature feelings showering... basically none of the things that clued me in that something might be going on when I was pg with Ant, or last cycle with my chem pg. I was holding out until 14dpo to test after the debacle that was my last cycle as well. I was 95% convinced until yesterday (13dpo) that it would be negative.

Yesterday my temp was up 0.2 in the am, after what I thought at the time could have been an implantation dip on Monday although hard to tell. That was my first inkling. Then, I started having minor cramping throughout the day. I almost wished I had tested so that I wouldn't have my hopes raised only to be dashed today when I did test.

But they weren't. Dashed that is. I got a lovely perfect positive, with the test line in fact darker than the control line. Holy shit, sherlock!

I thought the best way to let M know would be to leave the test out on the counter in the bathroom (on top of the box, so it was obvious what it was). He is such a man - he was in there alone for five minutes before I joined him, when he asked, "So, did you test"

Splitting

I've been thinking about moving my posts about Ant to another blog for a while, and have finally put that plan into action. I'll keep talking about HA / TTC stuff here, and post about Ant at my new blog, http://phred-fwed-schweffel.blogspot.com. You can read all about the origins of the name over there, if you care to. I still just don't feel 100% comfortable posting about him and his antics here - I feel much better about it in a totally new place.

Knock me over with a feather.

Based on my previous few cycles, I was anticipating ovulating this cycle somewhere around 1/9, which would be CD28. And I had ultrasounds scheduled for CD15, 20 and 25 to take a look and see how my follicle(s) were developing, my lining, that kind of stuff. I haven't been temping or OPKing or anything, I figured that the u/s would tell me what I needed to know and I didn't need to bother being anal. Starting monday, though, I was getting a fair bit of EW so I thought I'd do some OPKs, just in case. Tuesday's was negative as expected. I was absolutely convinced I still had two weeks to go. But, when I tested on Wednesday, I got a postive. And not just any old positive, the most positive positive I've ever seen. The test line was markedly darker than the control line which has never happened before. ON CD14!!!! Which means if I follow my usual pattern, I will actually O tomorrow. CD16. NORMAL!

One can never know why these things happen, of course, but I'm wondering if it has anything to do with the fact that my ass has not gotten to the gym at all in the past three weeks. I usually lift weights 2x/week, but haven't managed what with the snow and babysitter illness and all. Perhaps my system really is that sensitive???

Whew!

I had my hysteroscopy on Thursday. I was imagining three possible outcomes: no polyp at all, a small one that could be removed then and there, or a larger one that we'd need to schedule another surgery for. I was fully prepared for option 3 given the general cussedness of the universe. Because I was expecting that, when they got the scope in there and there was nothing except a perfect uterus and tubes, I was totally astonished! The doctor said that what was on the HSG was just an artifact - which is why they do the HSC to confirm. What a nice surprise!

The bitch is in the house.

The crimson bitch showed up on Thursday, 17dpo. It really is amazing what progesterone does to my LP - to go from 7/8 days to 17 with one little yellow thing pushed up my clacker each night is really pretty impressive.

I have my HSC scheduled for Thursday, where we'll get a better idea of whether I really do have a polyp and what we might do about it (I am so hoping that it can just be removed then and there and I don't have to schedule a separate surgery for it).

Then the following Thursday I have my first u/s to see how my follicle is growing, and whether the fact that I don't ovulate until ~CD28 is okay because my system is just getting a late start, or if it's not okay because really my follicle is growing perfectly well but just marinating in its own juices for two extra weeks. It seems like the former is perfectly fine in terms of egg quality, whereas the latter - not so much.

In the meantime, it turns out that the new insurance I have through M (his company got bought out in July of this year) covers infertility treatments at 70%, but only if you go to one of their "centers of excellence". Which my current clinic is not. So I have to figure out A) if it really is worth it for me to try clomid, B) if clomid and the associated monitoring are considered "infertility treatment", and C) if the new clinic will even see me given that I am actually cycling and haven't been trying for the requisite amount of time. A very wise woman I was talking to about this suggested that cycles > 35 days are NOT normal and should definitely qualify for treatment before the one year period is up - I think it's a good argument, but that doesn't always mean that the bureaucrats will agree!

I finally spoke to my sister this past Friday, and I called her, not the other way 'round. She didn't ask about me at all (I was calling to say that I didn't think it was going to work for us to look after my niece this weekend). She did call me back and leave a message a few minutes later admitting that she was a bad sister because she hadn't mentioned anything. I didn't catch her when I called the next time, but left a message saying that it wasn't good news, and that she should call me. I ended up calling her later in the evening when I hadn't heard anything, and we talked for all of five minutes, because she had to go and put her new baby down. I was practically in tears while talking to her - mostly because I'm sad that despite my hopes to the contrary, we are going through (as Emma aptly termed it), infertility 2.0. I get that it wasn't a good time for her to talk. What I don't get is why she couldn't fucking call me back. It is making me really sad, because I can guarantee you that if our roles were reversed, I would have made a lot more time for her than that.

Apricot white chip cookies (updated)!

I'm a little late for Jenn's second annual cookie exchange - but I figured better late than never. I actually made these for the first time tonight, absolutely delish. Tonight was my second attempt, so I thought I would update the recipe with the changes (and added picture so I'd get Jenn's extra special bonus points!).

Ingredients:
2 1/2c all purpose flour (9oz, 360g) (or use half whole wheat white flour)
3/4 tsp baking soda
1/4 tsp salt
3/4c butter, softened (6oz, 240g)
1c packed light brown sugar (5oz, 200g)
1 tsp vanilla extract
1 egg
2c white chocolate chips (12oz, 500g)
1c chopped almonds (4oz, 150g)
1c apricot preserves (8oz, 300g)

Preheat oven to 350F (175C)
Toast the almonds until browned, once the oven is heated.
While the oven heats / almonds toast:
Cream the butter and sugar until smooth.
Mix flour, baking soda and salt in a separate bowl.
Beat the egg and vanilla into the creamed sugar.
Mix in the apricot preserves until incorporated
Stir in the flour mix until incorporated.
Add in white chips, almonds.
Drop dough by rounded teaspoons onto a cookie sheet (silicone etc. recommended!).
Bake for 10-15 minutes, until golden brown.

I also made a few without the white chocolate chips - a bit less sweet, but also a very nice combination. I love these cookies! Pretty quick to make, and absolutely divine!

Definitely NOT something.

I went and bought a real test today, and it was the usual snowy white I am used to seeing. So perhaps there was an attempt at something, but it just didn't get very far.

I'm mostly okay. Hell, I get to get sloshed on NYE, that's a positive, right? I can drink a bottle of wine at Xmas, and at the parties we're going to next week. All good.

What I can't stop thinking about though is a comment my mom made to me when I told her a few months ago that we were trying again. The background for this is that she firmly believes that three years is the ideal separation for kids, and it took her a good long while to show any enthusisasm for my sister's latest pregnancy (a fucking "OOPS" pregnancy no less) where her kids are just over two years apart. I figured I would tell her that we were trying so hopefully she wouldn't be as shocked if we made an announcement. What she said to me was "I hope it doesn't happen too quickly".

She has gotten her wish. Not too quickly. *I* just wish she could be a little more supportive. First of all, I am three years older now than she was when she had my younger sister. And, given that we did not concieve quickly the first time, I would think she could say something like "I hope you don't have as much trouble as you did before!". But no.

And then there's my sister. I know that she doesn't get it because she had no trouble falling pregnant with her daughter, and clearly no trouble this time around. But still, I would like it if occasionally, just occasionally she would actually just call and ask how I'm doing. I called her yesterday to tell her about my faintest of faint lines - if the situation were reversed I can guarantee that I would have called her today to see if there was more news, either positive or negative. But have I heard from her? Not a peep. I don't really think that is a lot to ask.

I know that I am preaching to the choir here. Not that I would wish infertility on anyone, but in some ways I think that if everyone had to experience at least having to actually try for a few months before getting pregnant, that there would be a bit more sympathy and understanding out there. Especially from your own fucking family.

Something? Not something?

I finally O'ed this cycle on CD27 again. Gotta love a four week wait. And since I seem to acquire pimples that correspond with my follicle recruitment of which I appear to have three waves, I spend the majority of that four weeks slathering my face with all the zit creams I can lay my hands on. Lovely.

At 8 dpo I went for my followup appt with my RE. She did an u/s, which showed a nice triple stripe, 8mm thick lining, which she said was showing no signs of going anywhere anytime soon. Yay for progesterone! She agreed that we could give clomid a try (the hospital does not do aromatase inhibitors as the indication is not approved by the FDA), but the final diagnosis from my HSG was that I seem to have a polyp, so before any treatment they want to do an HSC and possibly surgery to remove it. Any thoughts on this? I'm not really a big fan of surgery if I don't need it. I did ask about whether she would want to do anything if I am in fact lucky enough to be pg, and she said no. So I'm not really sure why we'd need to do something if I'm not. Have to think on that.

I have a bunch of pg tests that I got with the OPKs I ordered online. I started testing at 9dpo, because I was feeling so many of the symptoms I had when pg with Ant. Cramping from 6-8 dpo, more tired while playing hockey, a bizarre dream, waking up totally sweaty (lovely, I know!). 9, 10 and 11 dpo tests were all negative. 12 dpo was too. But when I went back and looked at it a while later, there was the faintest of faint second lines! Something? Not something? Not really sure. I know the instructions say not to read it after ten minutes, but really, who listens to that? None of the tests from previous days had any inkling of a second line.

So I was somewhat hopeful. Today's test, though, was even lighter than yesterday's, if that is even possible. So I'm thinking this is a 'chemical' pg. Although on the other hand, my temp has been bouncing around 98 the past week and today went up to 98.6. I guess time will tell...

Uterine update #1

I had my HSG today - okay news, but not great. One of my tubes appears to be blocked - the dye wouldn't go into that part of my uterus at all. The radiologist said that it could be that my uterus was spasming during the test and that's why - or it could be blocked. As one tends to ovulate from alternating sides, it likely means we'll only have a shot of getting pg every other month. And I'm pretty sure I O'ed from my right side (good tube) last month. So I think this month is likely going to be fruitless. Not that we won't try anyway, but not terribly hopeful. :-(

Should hear back from my doc tomorrow on scheduling u/s throughout my cycle (currently CD14 with snowy white OPKs), so hopefully we'll get some good news from those!

And the reproductive endocringologist says...

We can go to injections probably starting next cycle.

I was totally taken aback. I was expecting at least a few months of lower intervention treatments before pulling out those guns again.

Needless to say, I am SO not going there, for a good long while. I had four failed injectibles cycles, thank you very much, so why exactly do we think all of a sudden this will work?

I am cycling on my own, despite their not being textbook cycles (okay, fairly far from textbook with the late ovulation AND short LPs), but I feel like we should be able to work with that.

What surprised me was that Dr. C. didn't seem to think that anything had changed with my HA status despite the fact that I AM cycling now. She still said that she didn't think that Clomid would do anything, based on my low e2 and LH levels from before. (b/w this time: e2=32, FSH 6.4, LH 3.2 - e2 is about what it was BA, LH is almost double, which I think is a good sign?)

She's doing a full IF workup on me, bloodwork, HSG scheduled for next week mostly because I had a C-section with Ant to check for adhesions, and bloodwork and SA for M as well. Also u/s throughout my cycle to see what's going on. Then we'll meet again on 12/4 to discuss.

She doesn't believe in LPD, which I've heard from a number of other sources, rather that it's a follicular phase defect - which makes a lot of sense to me. And is indicated by my rather long follicular phase (21 and 28 days so far, 8 and counting this cycle). So the u/s will hopefully help figure out whether my follicles are just not maturing properly, or if they are mature but there are problems with the corpus luteum.

I did manage to score some progesterone to use in my LP. I'm hoping that does the trick, and I won't need anything else.

I really thought that I had this fricking thing kicked.