She-Baby Shenanigans

There is a lovely theme going around, of throwing a virtual 'blog shower' for women getting close to deliver and Josey at My Cheap Version of Therapy is organizing one for the amazing and funny Oak who blogs act AcornChronicles


Dear Oak, I'm having a very, very bad case of writers block--I have to write a horribly complicated scientific review and most days I stagger home after a solid 8 hours of writing with my brain feeling like it is leaking out of my ears. At this point, the thought of  trying to string even one more sentence together makes me turn a bilious green. Really. But--this is for you so I'm girding my loins and going for it.

You have made me laugh so many times. Nobody can describe life as, errr, *creatively* as you do. Its a gift!

I love all the Mac stories. And don't even get me started on the pictures. His little sister is going to be no less hell-raiser and I so look forward to following her progress through life. I know this pregnancy has been rough so far, But I hope its one those your-wedding-day-was-a-catastrophe-so-your-marriage-is- going-to-be-amazing deals. So....Happy 36 weeks!!

In which I pat myself (and you) on the back

Along this crazy, rollercoasterish journey, I've had theories up the wazoo. I'm constantly thinking about things, speculating away like mad and most of time I'm probably several miles off the mark.

But, just sometimes, I may be right, and it is so, so very sweet when I find out that it is so. A long time ago, when I first checked my AMH, it was low, resembling that of a woman almost a decade older.  But sometimes, I do believe the universe does look out for you, because, the day I had that blood draw, I also threw in a vitamin D test, based on an off-hand remark that the guy who was drawing that blood made. How is that for serendipity? Anyway, my vitamin D was low too, and I decided to look for a connection between the two and I found it, in a study which said the AMH gene can be 'turned on' by vitamin D, suggesting that the Vitamin D level could influence the AMH level. Based on that, I took massive doses of Vitamin D to correct my deficiency and retested both after 2-3 weeks.

I found that, coincidence or not, AMH went up 4-fold after vitamin D went up 4-fold. A few days ago, I got an email from a grad student who just had her paper accepted- its the first scientific confirmation of what I'd found, that if you are vitamin D low, your AMH is likely to be inaccurately low, and you can get a 'good' reading only after you get your vitamin D deficiency corrected.

The study is here

http://www.ncbi.nlm.nih.gov/pubmed/22508713

I remember how I felt when I was grappling with the possibility that based on my low AMH, I was a contender for diminished ovarian reserve. I think about what might have happened if that technician had not suggested the vitamin D test, or if I had not gone looking for a connection between the two things, and I have to shudder.  I don't think anybody else was going to put these 2 things together- I've been educating doctors about this, it has not been in the opposite direction, so really, I fixed the issue myself, and if I had not done it, nobody else would have.

It is National Infertility Awareness week. And I'm going to give myself a hand. I'm  also applauding the many, many, many women who have shown up on this blog doing Google searches for "AMH and Vitamin D." They fixed their own problem too. Most often, the only person we can rely on to save us is ourselves. And that is not just limited to doing a clever Google search- this is for anybody who has pulled themselves up by the bootstraps after their umpteenth BFN, or their miscarriage, or their stillbirth. We are all bloody amazing, and we need to take a moment to acknowledge that. 

The forks in the road (updated at the end)

Last night, the guy met a couple of my friends for the first time. They loved him. Lots of talk of double dates happened. He really, really likes me. I like him a lot and in certain areas (intelligence, kindness, capability), he is exactly what I'm looking for. But in other areas, he is not what I am looking for and yesterday, it became crystal clear to me that those aspects of him constituted deal breakers.

That was just an awful realization- I ended up staying wide awake most of the night and in the morning I called my mom and told her I was going to break up with this guy. That did not go that well, it was a very emotional conversation and comes down to the crux of the issue-I have a shopping list of qualities that may be very hard to find in one guy. My mom called it the "Draupadi" complex- Draupadi is principal female lead in the epic Hindu myth, the Mahabharata. In her previous life, she  prayed to a Shiva and asked for a man who was best looking, the best warrior, the kindest man with the best temperament etc.  So in the story, in the current reincarnation, by happenstance and accident, she is trapped into marriage with 5 men, each of whom  embodies one of the 5 qualities she asked for. Everybody involved is aghast and start trying to find a way out of it, but the god Krishna shows up and says, well, THIS is the boon you asked for, so now you have to accept it and live with the consequences-- the Mahabharata is all about teaching life lessons through very interesting and dramatic fiction, and this particular lesson is, you cannot have everything.

I know very well that finding a guy with my laundry list is hard, and while there are men who are good looking, nice, smart and kind, they are extremely few and far between and many people are either intelligent kind people but unexciting physically, or are good-looking but rat bastards (met too many of those recently).

But still, I find myself unable to compromise.

I'm going to break up with this guy this week. In doing so, I literally feel like I'm at a fork in the road and I'm  deliberately choosing the much more difficult path to walk down-  but I cannot help but do it anyway.

I"m bone-deep comfortable with the idea of having a baby as a single mom. The many problems/challenges associated with this path do not scare/put me off at all. But having a mostly nice life with a nice, lovely man who falls short of certain standards I have? That generates a whole lot of negative feelings and a knee-jerk need to get out it now (it hit me like a ton of bricks yesterday) and I'm kicking myself for that. I wish so hard that I could be happy with this guy. But how can you help the way you feel and react? You have to be true to your nature, even if your nature is that of a bloody idiot, apparently. Plus there is the guilt.  I'm so sorry to hurt this man, but better now than much later.

Update: I broke up with him on 2 days after writing this post. I really want to thank all of you for your insightful, kind comments. Many people bought up the point (and its a really valid one) that you can't lead with a list, you have to take what you get. I agree 100%. The caveat is, you have to be happy/content with the overall package, even if you wish some or many little things could be different. The problem was, staying in there, with the factors I did not find ideal, was actively making me unhappy and it was a situation that, had I buried that unhappiness, would have only gotten progressively worse. So here I am, 1 week later- I miss many aspects of him, I think about him often, but I'm profoundly relieved that I ended things, and know that I made the right decision for me. The only thing I wish I could change is my innate personality, but I have to accommodate who I am, no matter the price.

In which I speculate madly on 2nd and 3rd trimester pregnancy loss

2nd trimester loss can happen, from what I've seen, from one of 3 causes- placental abruption/rupture of membranes and incompetent cervix.

Because I've seen so many cases of 2nd trimester hell breaking loose, I've been trying to read up on this. The really horrible news, nobody has a clue and worse, no rigorous, meaningful research is being done here, mostly because its a very difficult situation to reproduce.

One thing jumps out at me- PROM/placental abruption  is strongly linked to local inflammation. Local inflammation can be triggered by infections. So UTIs, or bacterial or fungal  vaginosis, are bad news.  A pubmed search yielded this interesting study- a trial looking at whether treating women with an  infection with anti-fungal agent decreased the adverse outcome incidence- while they did not see statistical significance, there was trend toward reduction.

Interestingly, becoming vitamin D replete has been shown to help prevent bacterial vaginosis. It also decreases the risk of preterm labor.

Moving on to incompetent cervix: as a scientist the one question that jumps out for me is- is incompetent cervix merely a mechanical issue as the name suggests, or are there biological/physiological events leading to the cervix opening and labor starting?

While there is a clear link, IMO,  placental abruption and local inflammation, from what anybody can see, there is no established link between abruption /infection/inflammation and incompetent cervix.  But, because nobody has a darned clue as to what is happening here, I'd say its not outside the realm of possibility. The fact that cerclage I think has been scientifically shown to help, or rather, I hope it has, suggests that the problem may be indeed only mechanical. Nonetheless, I think even women who have been diagnosed with an incompetent cervix are definitely better off making sure they are doing everything possible to avoid local inflammation the next round.

The stuff that, IMO, is a very good idea for all pregnant woman

-Have regular tests and treatment if necessary to make sure you are both bacterial and fungal infection free
-Making sure you have 'good' bacteria -- ie take probiotics.
-Disturbances in glucose metabolism can be linked to infection--make sure your PCOS/diabetes is as well controlled as possible--metformin, vitamin D, and sadly, diet (Just FYI: Sunny at "Cease and Decyst" has a fascinating post on her elimination diet and Candida(yeast) infection)

None of this stuff is a surefire way to make sure late pregnancy loss never happens to you. We are all clueless and groping blindly here-- but I do believe all of these are simple things, which may just help a little. God knows, it can't hurt--well, except for the diet. That elimination diet (which is pretty darned extreme and I'm definately not advocating it for everybody) sounds like hell, but may do wonders for certain individuals.

Now- moving on to the non-science stuff-- I'm doing well, enjoying life, still dating that guy, have no clue whats going to happen in the future but I'm doing some very boring and difficult things to ensure that if I do want to stay in this country and skip the return to India bit, I retain the option. Sigh.