Friday, August 5, 2011

The Glucose Tolerence Test...

They ordered the 2 hour GTT for me, instead of the 3 hour.  One part of me was fairly unhappy about this because I wanted more data points and the other part was resoundingly relieved that I'd have to just give blood twice, instead of being jabbed 3 times. After the first blood draw, I realized I had never confirmed that they were going to also check for insulin, I just assumed this would be so. Nope. They just had been ordered to do the bare needful, just glucose. And they collected blood in the wrong kind of tube, so they could not even add it on. This is when I wanted to just SCREAM.  The people ordering the tests knew I was worried about insulin resistance, but no, they did not bother adding insulin to the panel. ARGH!!!!

First, before moving on to the results- When I got the glucose drink, instead of being disgusted and sickened by it like most normal people, I tolerated it just fine, because its about a slight shade sweeter than my morning cup of coffee. That was when I realized I about give my body about half (in terms of volume) a GTT every bloody day! Scary stuff.

Anyway- I passed. With flying colors. My fasting glucose was 80, and the 2 hour was  lower, at 78. These are very good numbers, my body apparently is a champ at putting away sugars.

Should I take metformin? The majority of doctors would say no. Not with such clearcut evidence that I do not have any issues metabolizing glucose.. I'm stumped, I don't know what to do.

I had a quick phone conversation with Dr. L, where he said he does not want me on metformin. He also said he does not believe anti-thyroid antibodies are linked to miscarriage, and does not beleive in treating for them. I'm glad I get to call the shots there, thats all I can say.  I then asked him, if nothing is wrong with me, if I have a fantastically good ovarian reserve, make lots of estrogen and progesterone, and PCOS does not appear to be having a negative effect on my fertility, why did I lose 2 babies?? No answers were forthcoming, obviously. I should not blame him for that, this is a situation where nobody has answers, but his confident waving away of thyroid autoantibodies irked me a bit- atleast show some degree of uncerainity, because these is evidence both pro and con for that one.  

Sometimes this certain aspects of this debate on infertility and pregnancy loss seems like an atheist, an agnostic and a believer sitting there arguing about god. Nobody has any concrete answers, but everybody sure as hell has opinions. My Indian RE would want me on metformin. About 4 other doctors have said no. I'm conflicted. 

In the meantime- I have to call and order an HSG, to make sure my 2 D&Cs left no scarring in the uterus and fallopian tubes- last thing I need, is an ectopic. This is probably the one thing I can get an answer for, though I'm dreading the test. If anybody has an HSG done, or has heard an opinion about the usefulness of this test to evaluate scarring and is inclined to share, please do so!

11 comments:

  1. Port of IndecisionAugust 5, 2011 at 7:55 AM

    I've found that "shit happens" seems to be the most common pregnancy loss diagnosis.

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  2. Port of IndecisionAugust 5, 2011 at 7:55 AM

    (which is really super helpful)

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  3. I never order insulin levels - they're just too variable and not really all that helpful.  It sounds like you rocked your GTT!  As for taking metformin - it may not help, but it certainly can't hurt, right?  

    There was another study recently linking thyroid antibodies to miscarriages - I meant to save it to send you, but of course I managed not to do so.  If I find it, I'll let you know (if you haven't seen it already).

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  4. Sorry to hear the latest test didn't bring you any closer to an answer.  Not sure how useful an HSG is for evaluating scarring---I always heard it was used primarily to examine the shape of the uterine cavity and to evaluate the fallopian tubes for blockage. I have a picture from my HSG and it just shows the ink as it flowed through my uterus and tubes. I think a Sonohysterogram or office hysteroscopy are better examination tools for examining the uterine cavity for irregularities.  My uterine polyps were undetected in the HSG and Sonohysterogram but were found during my hysteroscopy.

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  5. Not sure what to say about the metformin. Why would your Indian RE want you on it with results like that? Have you taken it before? I agree that it can be a helpful drug in some cases, particularly with women who have PCOS, insulin resistance, or full-blown diabetes. It does have side effects, and I'm not sure if those would be magnified if you were taking it with numbers that are as far into the normal range as yours are. They range from unpleasant but manageable (GI issues, nausea, tremors) to rare but serious if they do occur (lactic acidosis, kidney issues).

    I agree with Jendo that a hysteroscopy would probably be better to look for uterine scarring. If you do have to do the HSG, though, I heard horror stories about it before my first one (I've had two), and it turned out neither of them was bad or painful. The RE who did the first one gave me valium beforehand and I giggled all the way through it. I don't remember taking anything for the second one, and it was quick and relatively painless. Hysteroscopy is a lot like a pap, except they fill your uterus with gas beforehand. They had me stay laying down for about 10 minutes afterward to help with the gas (if you get up too soon it can migrate upward and cause shoulder pain). Laying down seemed to help - I never experienced any pain from the gas afterward.

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  6. My RE found what he suspected to be a submucosal fibroid on ultrasound.  I had the HSG to both check that tubes were open and see if more info could be found on the fibroid.  While my tubes were definitely open, the HSG was no help with the fibroid.  In fact, the dr. who evaluated it (not my RE), thought there was no fibroid, or if there was one, it was very small and would not be a problem. Three unsuccesful IUIs later, I followed my RE's advice and got a sonoHSG, where he could clearly see that there was a fibroid, and it was big enough and in a bad location to prevent implantation.  I had a hysteroscopy to remove it, during which the RE found the fibroid was a lot bigger than he thought, and was likely a problem with implantation.  I got pg on the very next IUI.

    My point being that I agree with Jendo - I'm not so sure sure than an HSG would reveal scarring in the same way that a sonoHSG or hysteroscopy would.  Hysteroscopies are often done to diagnose problems.

    As for the HSG procedure itself, I took 1000 mg of ibuprofen beforehand (I normally take 800 mg for the worst menstrual cramps), experienced some bad cramping during the procedure similar to the worst menstrual cramps I have had, which lasted all of 5-10 minutes, and then no more pain once it was over.  The sonoHSG was a lot less painful.  And I was knocked out for the hysteroscopy, then woke up to bad cramping that went away quickly with Demerol, and then the only issue I had was the slight nausea from the anesthesia, which lasted about 24 hours.

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  7. I had terrible issues trying to get fasting blood work done (not marking the tubes with times, mixing up results, etc).  After two tries, we took what we got - like you, my later glucose result was lower if they marked them correctly. 

    My current doctor thinks that those tests aren't great measures of insulin resistance anyway (you need to an inpatient intravenous procedure). 

    I had one doctor that said no to metformin and one that said "might as well".  I had slightly better results overall with, but I think it had more to do with better egg quality.  I it pretty well, but many people get really sick while adjusting.  Good luck either way!

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  8. Well, that is the question, can it hurt? One doctor (Dr Ramirez)  was of the opinion that it could 'deprive my body of adequate insulin'. I'm currently completely in the dark of how metformin works- I  just assumed it increased the efficiency of insulin (by upregulating insulin receptors or something like that), but not by decreasing insulin production itself- that does not seem too logical.  Its a topic to be read up on...any input you have would be very welcome!

    There are quite a few studies backing up the notion that thyroid antibodies CAN contribute, so yeah, I'm inclined overall to believe the trend. In the run-up to TTC, I've started once daily selenium supplmentation (100 mcg/day). There are studies showing just selinium supplementation can bring down autoantibody titers, lets see.  I'll probably have to also add  a blood test for selenium (if available) to make sure I'm not taking too much...sigh.

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  9. Thanks Tashia and Jendo. I HAD wanted a diagnostic, in-office hysteroscopy to start out with, but my doctor said hysterogram  (ie HSG) is the way to go to start with. The way he described it, it sounded more like a sonoHSG. I'll have to talk to him first and confirm it.

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  10. I hate being in limbo and not knowing what to do. I love the metaphor about people talking about God and having no concrete answers, just opinions.  I'm right there with you.  My RE told me today that he pretty much thinks me having celiac has had no impact on my IF/RPL problem and wouldn't be likely to change once I am gluten-free.  Maybe he's right...I have no idea.

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  11. Honestly, scientists and doctors alike know very little. There are somethings we are more sure about (like if you have high titers of anti-cardiolipin antibodies and lupus anti-coagulant, you are extremely likely to lose that baby to blood clots unless you take heparin). MOST other causes of pregnancy loss and infertility: we have no effin clue. There are studies both pro and con. There are strongly differing opinions. Nobody is as opinionated as a man (or woman) of science, I know from living in this field.. 

    You are in a very hard place. Unsolicited advice being offered here (I'm sorry:(- this is what I would do if I were you: go on that gluten free diet, increase your vitamin D (maybe you will do better at 45 ng/ml instead of 30, who knows-higher levels do tend to push the immune system into a more non-inflammatory state), take every single bloody supplement known to improve egg quality, try accupuncture while trying naturally. You lose very little by doing all of this, and you are only adopting a healthier life style. If you can, expect NONE of it to give you that miracle baby.  Pursue whatever alternate plan you have in the meantime, and see how the dice roll for you. Science does not have the answers, but when it does not hurt, play with its theories.

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