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!

On RPL

First and Foremost: I apologize for all the blank posts. If anybody is having issues with posting, try changing your browser. I kept posting with Firefox, only the title of my post could be published (Lots of hair got yanked out!!). Changing to Internet Explorer fixed it. Blogger deserves to be abandoned for Wordpress or something else that does not mess up like this.

After my second loss, my Indian RE strongly suggested I read the book 'Coming to Term'.  The author and his wife had 4 pregnancy losses (2 chemical, 2 more advanced), and he decided to do a careful study on the subject of recurrent pregnancy loss. His book covers the scientific spectrum of causes of pregnancy loss, and he has the most heartrending case studies. Its horrifying and uplifting all together to read those stories. The average women in there had about 4 losses, but many of them has as many as 6 or more. Almost ALL of them went on to have healthy children. Almost all.  Tears and joy aside, reading that book gave me a good idea of the scope of the monster that is RPL, an invaluable thing in itself.

The book also highlights that science does not have all the answers and that miscarriage is the murkiest of pools. One story in particular stood out. This woman had 4 first trimester losses. She was finally diagnosed with Factor V Leiden, which predisposes to blood clots that end the pregnancy.  At that time, heparin had not been established as the treatment for this issue. Her fifth pregnancy, with no medical intervention whatsoever, went completely smoothly. She had a healthy baby. She got pregnant again, and this time, took heparin, and that pregnancy also went just fine. What amazes me was her 5th pregnancy. If clotting was what had ended 4 of the pregnancies, what saved the 5th?  Science definately does not have the answers.

Still- there are times when it can help. I stumbled across the most amazing website. It is an archive of all the research done on the myriad causes of pregnancy loss.

https://sites.google.com/site/miscarriageresearch/

I did a lot of reading up on the the two that have been implicated for me, Vitamin D and Thyroid autoimmunity.  There is PLENTY of evidence linking the two to pregnancy loss, and even more gratifyingly, vitamin D to glucose metabolism. The parts about Selenium and anti-thyroid antibodies I also found useful. This website is a treasure trove, I'm not done going through it yet.

However linked something is to either infertility or pregnancy loss, the converse also applies, there have to have been women who have many of these issues, and have gone on to have perfect pregnancies.Nothing is absolute and almost all the iceberg is still below water. 

The statistic is that one in 5 pregnancies end in loss. I have 4 friends currently pregnant. I'm the only person they know who has had pregnancy losses.  When I listened to my friend, who had just started trying and who is now 15 weeks along, a sense of failure came upon me. How could I have been the one to fail not just once, but twice? A stupid, immature feeling, but its not one that is going to go away anytime soon.

What I've learned along this painful road: tell nobody. I've made a few new friends in NYC who I'm getting closer and closer to as time goes by. One year ago, I would have happily told them what I intend to do. Now, I'm going to keep my mouth firmly shut. Nobody is going to get to know the next time around, whenever that blessed event occurs. 

Giving thanks

Somedays, I just have to thank god that I got to live in this age.  It is a kind and politically correct time and importantly, an age where there is such a variety of things you have access to.

I'm currently working my way through the most enormous book I've ever read.  I usually tear through a book in a single setting, finishing a 400 page book in approximately 4 hours. This one I've been reading for 10 hours over 3 days and I've just over halfway through. Its the latest book in the series the completely awesome HBO show "Game of Thrones" is based on.  One of the characters just stands out for me.  He has the horrible fortune of being born a dwarf into one of the most powerful, ambitious and callous families in the land, in an immensely cruel and tough time.  His father, a complete monster, despises and manipulates him. The world he lives in constantly mocks him. His life is made so much worse because of the kind of person he is. Had he been a person of average intellect and depth, he would have blended into the background and might have lived an uneventful, mostly ignored life. But his immensely intelligent, shrewd and larger-than-life personality results in him being thrust into the complex political scene. He survives a number of horrific events, is betrayed at many turns and through all of it, is constantly mocked for being a dwarf.  He is understandably bitter about the horrific hand life has dealt him. Yet, in situations where most would have despaired, he still keeps going. He fights hard to survive and at the end of the day, remains interested in humanity and retains his innate kindness, empathy and sense of humor (though its about as black as black can get). This character, wonderfully portrayed by Peter Dinklage on the show, fascinates me. Though this is all make-believe, there have to have been people of comparable depth, born or thrust into such difficult situations. Sometimes, it seems like the more extraordinary souls are the ones more likely to be  dealt crapfests. Or is it the other way around, does the crapfest bring out the extraordinary in people? This definitely seems true of many people who have gone through hell in life- some of the most amazing people I have seen out here are the people who have been dealt the harshest blows by IF.

I have to be thankful for the fact that I live in an age where people are so much kinder (the world in this book series is unimaginably barbaric), an age where we can be exposed to the imaginations of some wonderful minds, who can create such marvelous entertainment for us in so many ways. Its something that may have been unavailable to say, our grandparents. I'm grateful for the choices we have- its not something we should take for granted.

In infertility-related news, I'm determined that I will schedule the Glucose Tolerance Test this week. I've never been so conflicted as to what I want the result to be. Why would anybody want to fail it? It might mean a future where I more likely to be insulin-dependent, with the variety of problems that come with diabetes waiting for me.  On the other hand, if I pass it, we will not know if metformin will help me. Most doctors just shrug when asked whether I should be on it, they say, why bother? You seem to have little need of it, you have no PCOS-related problems. Well, I don't.  Its just that my babies keep dying at about 8 weeks of gestation, and gee, it would be nice to have a culprit and something I can attempt to fix before rushing in headlong again. I'll still take metformin, but if I pass the GTT, it just means more uncertainty on whether I need it, and its not an easy drug to take.  Well, I can't decide what I want the result be, but will be glad to finally have an answer.

To beleive or not to beleive....

My life, as usual, has been on fast forward. Partly contributing to that was the fact that I had my mom come visit me for the past 3 weeks. Among trips to Canada and seeing New York, a great deal of philosophical conversation ensued. Sometime in the last month would have been Turbulence's due date. Amazing as it may seem, all that causes me is one small pang every time I dwell on it, but the sorrow is not there anymore.

The philosophical conversations I have with my mom all center about one theme - predestiny. In a sense, this is like having faith in god, which I don't, being firmly agnostic. But,  for the sake of convenience or because some little intuitive voice inside me urges me to believe, I cannot rule out the idea that maybe all of this IS predestined. That there are children destined to make it out into this world.  To paraphrase my mom, nothing can stop these births. Improbable conceptions will occur, previous problems will disappear, all things will fall into place and these lives WILL come into being.  By this token, all the things that fail, for the myriad reasons, do so because they were not meant to be. However awful and tragic the circumstances of failure, no matter how close one comes to success,  if one believes in predestiny, one just says, it did not happen because it was not meant to be. This is a harsh, ruthless philosophy with absolutely no room for emotion. I accept it because it represents the ultimate escape hatch, the ultimate way to justify all the things that do not work, the lives lost. I have to explain to myself why my babies did not make it.  My mom and I have also started to talk about adoption. I'm far away from that option, but as my mom keeps saying, if that is what is in your destiny, that is what will be.

In the last post, Emily asked whether I met somebody in June as the astrologers had predicted. Sheepishly interjecting here that I had got the month they mentioned wrong, it was July. But so far, have met nobody, and would be extremely surprised if I did.  I cannot really take this stuff seriously. But upon more detailed explanations from my mom on what they had predicted, what one of the astrologers said shook me greatly.  My father had asked him to look at my chart and tell him about the possibility of marriage by looking at it.  He told my father that a strong possibility for marriage existed in this year, but I should wait till November (the 23rd actually), because according to him, if I got pregnant before this date, either I would die (this part I knew from previous conversation with my mom), or the child would die (?!?!). This part was spooky because it came out of nowhere-- nobody had asked him about pregnancy. Apparently there is a strong indication on my chart for pregnancy issues.  Some other astrologer years ago had predicted that I would have an issue in a pregnancy, that I would come out of it fine but my child would not. Anyway, after November 23rd, apparently, its smooth sailing. If there is any fervent desire to believe in astrology, I would hope that this guy is right, that I finally hit some luck in this department.

Procrastination

As the months go by, the desire to get back in the saddle is steadily getting stronger.  But its going to be oh so tricky, with timing. I need to figure out when I can wrap up my work here and return to India (for about 2 years or a bit longer). Though I know this will be somewhere between Feb 2012 and August 2012, the month is impossible to predict. As time passes and I become more and more eager to proceed, delaying TTC past December (the first month I could try) would require herculean restraint.

So I have two uncomfortable scenarios to contemplate- having to go through the first few months of pregnancy by myself (the anxiety with nobody to lean on/help distract me is not something I am looking forward to) , or  far, far worse, the prospect of going through a third loss by myself. My mom would fly out in that event, but still, the prospect of walking into another ultrasound, that awful uncertainty, with nobody to hold my hand is daunting.

I keep saying this, I have to learn equanimity.  No matter how long or how painful the road gets (especially then, actually), I have to believe that one day, I will have a child, and that is the child I was meant to have, and that everything that happened along the way before was because it was not yet time. For me, this is the only conceivable way to look into the abyss of failure and loss  and find some measure of peace.

In the meantime, I am procrastinating on a number of things
-scheduling a glucose tolerance test
-scheduling a HSG/sonogram
-Getting the swimmers shipped
-Scheduling a psychologist appointment, since I'm a single woman TTCing. This one I managed to argue my way out of in San Diego.  My new NY RE wants it done. If insurance will cover, I'll do it, but if not, I will work on persuading him to waive it- there is no bloody way I'm shelling out hundreds of dollars for a conversation where they just tell me things I already know.

This to-do list continues to taunt me on a subconscious level all the time, but with work being as busy as it is, every week goes by with me pushing it forward. And the taunting increases in crescendo in my head...

In which I share far too much information

I've told about 3 IRL friends (and my mom and my brother) about this blog. If you are not my friend M or my mom- stop reading or you will regret it.

So anyway, this post is about the symptom you mention in hushed tones while being forced to converse with your RE's office in a public place- breast tenderness.

In the past year, the only times I noticed I had breast tenderness was occasionally in my luteal phase, and of course, both the times I got pregnant, from about day 3 DPO. At this point, I have to remind my readers, my vitamin D levels, unbeknownst to me, were in the deficiency range- below 20 ng/ml.

In December, I found out I was deficient and started supplementation. I noticed this first in January, where my blood Vitamin D levels had just entered the normal range (around 35 ng/ml)- I had  breast tenderness well before ovulation.This thew me for a loop, who had ever heard of this?!?!

Anyway, it continued that entire cycle. Then, I increased my vitamin D dosage, from 4000 IU/day to 6000 IU/day.  My blood level increased to 60 ng/ml. A great many things changed (including the tenderness disappearing. All of these changes (which included decreased cervical mucous and delayed ovulation ) were collectively indicative of lower estrogen levels. Not liking the changes, I cut back my Vitamin D dosage, and within a month, everything went back to the way it was before I upped the dosage.

This is the second cycle with a lower blood level  (probably back to 30). And, predictably, when my blood levels of vitamin D are around this mark, the tenderness is back. It is pronounced. I have a cat who likes to walk all over me first thing in the morning- she steps on my chest, and oh my bloody god, my neighbors get to hear me screech.  The rest of the time, it feels like I have a couple of lead weights strapped to my chest. Not fun. I'm kind of nervous thinking about how bad it would get if I got knocked up again, if it is this bad now.

I cannot believe that I have this symptom, this strongly, well before ovulation. It has to be a refection of increased estrogen sensitivity- either my estrogen levels are up, or levels of estrogen receptors are up. Vitamin D can affect both these parameters, so its not entirely illogical that this is happening.

My question to anybody reading is- did you feel this as a symptom in the pre-ovulatory phase, with injectibles or while doing IVF, ie conditions designed to increase your estrogen levels? Just curious.

yearnings and musings

My visit to Philly brought the one thing I had successfully avoided thinking about for the past few months back to glaring center stage. Babies. The friends I stayed have a two year old, and she is a lovely child (also a genius-- she is spelling at 2!). More than anything,  I could not stop marveling at the utter trust and love that exists between parents and their children. It is the best of relationships. When you spend two days observing it, you get a wee bit wistful that despite having been pregnant twice, you don't have it yet, and far worse, there is the gnawing fear that something so wonderful might be forever denied to you.

As my mom tells me, I need patience. And, more importantly, I need to stop catastrophizing (if that is even a word). I cannot honestly imagine that after getting pregnant, that my baby will actually keep growing and that at some point, I won't have to stumble out of an ultrasound crying my eyes out. When that is all you know, its hard to imagine that an alternative exists, although, rationally, you know very well that it does.

I've completely lost the faith that I will actually have a baby someday, and its not going to come back until well,  maybe I cross the 5 month mark and the anatomical scan shows that all is well. God, the fear.  FDR did have it right when he said that the only thing we have to fear is fear itself, this terror and anxiety is bloody stupid.

I chart my cycles, and I now kind of beleive that when you are using natural cycles for conception, observing your fertility signs, which are very rough indicators of estrogen and progesterone (and by extension, egg quality) might be telling. For example, I hated the cycle I used for my second conception, I thought it was my worst ever. But I went ahead with it, though at that point, I compared it to a poker player going all in with a substandard hand.  And I ended up with a baby with an entire chromosome missing.  IF that error was in my egg, did it have anything to do with the possibly lower-than-my-average and definitely less-long peak estrogen levels in that cycle? No RE will even attempt to address this question, it is speculation beyond speculation. There is so little you know of this process, nobody knows what are the driving factors behind meiotic non-disjunction (where the chromosomes do not segregate correctly, causing numerical errors like trisomies or monosomies). Studies make it clear that estrogen has a role to play in this process, but correlating the estrogen levels, and moreover, the importance of time period of the estrogen peak, to the probability of meiotic non-disjunction is far beyond our ability to speculate, we simply have no clue.

Every now and then, you have a cycle where everything looks so good  you wish you could have used it to attempt conception.  The one that just ended was one such one. There were virtually rivers of the egg-white you-know-what (sorry for the icky detail). Then, my luteal phase, instead of being the usual 14 days, was a whopping 16.

If I had not been sure that there was no way conception could have occurred, I would have been fairly nervous when it took over 16 days after day of ovulation for AF to show!  Whenever I conceive next, I hope it is in a cycle I feel this good about.

A rambly post

I go away to Philly this weekend, where my old group of friends is experiencing a baby boom. 2 people got pregnant around the same time and are now close to the end of the first trimester. It still amazes me that when most people dodge this bullet pretty easily, I was slammed by it twice.

I still can't comprehend it and the why of it all would make for one rambling post or three. 

Why did my first, apparently chromosomally normal baby die? Was it my anti-thyroid antibodies? My mom was probably positive for these when she had my youngest brother, and that was an easy, perfectly normal pregnancy. She developed over Hashimotos about 6-7 years later--- people are antibody positive for many years before thyroid function is deteriorates to the level that it starts producing clinical hypothyroidism.  Correction: we recently found out that while my mom has hypothyroidism, she does not have anti-thyroid antibodies. So the cause of her hypothyroidism is not autoimmune, it is not Hashimotos. So I in fact have a pregnancy-loss associated factor she did not have.

Who made the abnormal egg or sperm that made my second baby die? That is really a million dollar question that haunts me to this day---I know there will never be an answer, but that really stops nothing.

There are some things in life you thought you would have no problems with. I always thought baby making would one of these, just because I come from a family with amazingly good fertility, so much so that sometimes it can turn into a horror story. Despite every attempt available at that time for birth control, my grandma had 9 children and it exacerbated her diabetes and caused an untimely death at 55.   My aunt had 3 kids then decided to have her tubes tied. It worked as birth control for a few years, then , in a one in million case, something grew back, causing a tiny opening in the fallopian tubes, enough for a sperm to get in. She of course, got pregnant even with such odds, had an ectopic pregnancy that nobody diagnosed and nearly died, and it started a lifetime of medical problems resulting in a chronic pain syndrome. Sometimes, what is a boon for one person can turn into a curse for another.

So why me?I've got the same freaky good genes in this department (that I thank my stars for, and now, no longer take for granted), as far as getting pregnant goes.  Most REs categorically refuse to think there is anything wrong with me, that I need to get treated for. I get pregnant, all my tests check out, right now they are going with the 'shrug-your-shoulder' diagnosis to explain my losses. I've tried to hit them over the head with the PCOS, and they are like--- yeah, looks like you might have some presentation of it, but we would refuse to think that really of any detriment to you, because you ovulate and get pregnant easily.  Except my Indian RE, who immediately jumped on the PCOS diagnosis for me after just listening to my history of conception and loss. Interestingly, I did turn out to have that, and I hope he is right and metformin is all I need.

Anyway, there has been something I wanted to share for a while: Last year, after I started charting, I found my cycles fell into 2 clearly different patterns---

Pattern 1: High temps on day 3 (around 97.2-97.3), more egg-white cervical mucus (usually), surge starting on the morning on CD19, ovulation on CD20, and a 14 day luteal phase.

Pattern 2: Low temperatures (96.9 approx) on CD3,less evident egg white cervical mucus,  Surge starting afternoon of day 15, ovulation on day 16 and a shorter, 12 day luteal phase , though you can't see that in the picture below:)

 You could say that if progesterone (which determines length of luteal phase) and estrogen (which determines quality of quantity of cervical mucous) were indicators of egg quality,  this was my less stellar pattern.  Both my conceptions were in this cycle pattern. I had expressed concern to my doctors about this, and they pooh-poohed it.

Since my second loss (and subsequent increase in Vitamin D levels), my second short pattern with the day 16 ovulation has disappeared.  Last year, it was there for 3 out of the 6 cycles I had, and this year, in the 5 cycles I've had so far, it has not made its appearance even once.Undoubtedly, something has changed in my physiology to cause this effect-- I doubt it was the loss itself, simply because this pattern repeated after my first loss. The only other discernible change is vitamin D, a hormone that regulates a large number of processes in your body. Nonetheless, no matter what the cause, I find this change remarkable, we shall see if the trend continues.

My new, utterly unanswerable million dollar question (I have a lot of them): Was vitamin D deficiency contributing to my shorter, less pretty cycles, and possibly my losses?

I was talking to a friend the other day and I told her that one day in the future, I would look back at all of this and it might make sense, but it sure as hell does not now, from any standpoint.

Catching up

I cannot believe almost half of this year is over, it has flown by.  Life is even more frantic, there are days I'm at work well past midnight, and the weekends, they are pretty exhausting as well. This past Sunday I literally walked atleast quarter(?) the length of Manhattan, starting from union square and walking through Central Park, with a few meanderings along the way. Plus, I've been playing tourist with the multiple friends and family visiting me...uuhhh. Its been loads of fun though.

Not much is happening on the fertility monitoring front- My FMR1 genotyping came back as normal, I have some significant anti-thyroid (still low though) autoimmunity and I'm still waffling taking that all important glucose tolerance test.

From all the crap that happens in life, one good thing or two does have to emerge. This year, this time out of time, is a good thing. You have to look at the silver linings and smile. I've also been meeting up with SMC tryers. Looking at them- they are all going through the roller coasters of the buildup to ovulation and the 2wws, I feel both deeply envious that they get do that and passionate relief that I don't have to right now. Just remembering how stressful it all is makes me turn green. The worry that you might not get pregnant, the joy and the fear once you do, can I just say I hate the rollercoaster? Mostly because every time I've ridden it, its only taken me crashing to the ground. After my first loss, I was determined to get back on it immediately and the next 4 months rank among the most stressful of my life. After my second loss, I realized, for the sake of self preservation among other things, that I had to take a break. I shut it all out almost immediately, and I am so very proud of myself for being able to do that. I'll be even prouder when I actually willingly get back on the rollercoaster again.I was in Times Square the other day, and I saw this----The Wishing Wall  at Times Square.

I read through many of the post-its, and they ranged from desires for boyfriends to wanting to make it on broadway before they turned 17, and then I saw this little one (sorry for the horrible photo quality). It made me both want to smile and cry at the same time- I thought, given that it had to be posted on Dec 31st 2010, it might be that it was a woman facing fertility problems.  I can empathize, and its exactly my wish----hope it comes true!


Hope everybody is doing well. I try to keep up with the blog reading, and I'm keeping all of you in my thoughts.

An under-the-influence post

I should start this one by saying I weigh in under a 100 pounds. Which means I’m the world’s cheapest drunk. So even with a single cocktail in my system, I can be buzzed.  Tonight, when I got to that state of mind, I started remembering my babies. They were so perfect, especially Turbulence, that candle in the wind--- she looked beautiful and healthy and just right on ultrasound one week and was dead within the next 5 days.

Then I looked up my bloglist on my iphone for the first time in 3 days in a bar (bad idea) and saw this post, and my heart broke all over again, all the more so because it was like what I went through. Go to offer support.