Sunday, September 11, 2011

Indecision 2011

Boy, you do not fully appreciate how relatively stress-free your existence is until you decide to jump back in the gladiator ring of TTCing again. I'm sitting here with this gigantic decision to make- to start metformin or not???

I talked to my Indian RE about it.  What he told me took me back to my first thought about this: he deals with a different ethnic group than REs in America and PCOS figures very heavily there.  Its not terribly surprising, you cannot throw a stone in India without hitting somebody with Type 2 diabetes- its really, really common. PCOS is related to Type II diabetes. Its all logical.

He reiterated he does not really know if metformin works. His reasoning is its cheap and safe- so why not? I'm not so sure its safe though. My body functions perfectly, medication-free right now. I'm really nervous about upsetting that cart.

The other reason I'm hesitating is that if you lined up all the possible causes of my 2 miscarriages, examining each and every detail , I'd say the highest probability is that it was the vitamin D deficiency, which *probably* made for crappier eggs more likely to have genetic defects. Its also possible that my second loss was not even my fault- It could have been the universe really not wanted me to have a kid at that point and letting the one sperm with a missing chromosome impregnate my poor egg.

For the millionth time, I'm going to discuss all the changes that have come about, when my vitamin D3 blood levels are in the 30-40 ng/ml range, as opposed to the deficiency range I was in (17 ng/ml) just post miscarriage # 2.

My bbt patterns have changed.  My temperature used to vary from maybe 97.4-96.7 in the preovulatory phase- now it flatlines at 97.3. And when I say flatline, I mean it. Maybe for one day, every 3rd cycle, a really strong estrogen surge will push my temperature down to 97.1, but that is it. Nothing can be made of it, but I think its very interesting.

Breast tenderness- nearly constant - ie- more progesterone and estrogen, overall. That is good :-)

My luteal phase has gotten longer. MUCH longer. This has to be the most startling, and clear indicator that things have changed. The two cycles I conceived in had an early day 16 ovulation, with a luteal phase of 11-12 days. If I ovulated at day 20, my luteal phase would be 13-14 days. Now, almost all my ovulations have been at day 20 or later.  The luteal phase in such cycles is now increased to 14-16 days, with average being 15. 

Luteal phase defect (9-10 days or less) has been implicated as a miscarriage risk factor, which again, is logical. Shorter luteal phases are indicative of less effective progesterone mechanisms, which is in turn indicative of poorer quality eggs, which of course means you have a lower chance of seeing that pregnancy succeed. Though to qualify for LPD, you have to have a really short luteal phase, maybe for somebody like me, a 11 day LP was probably indicative of an issue- who knows?

So basically, I really think that it was highly likely that my problems were tied, principally, to a vitamin D deficiency, that has now been fixed. What makes it even more interesting is that a lot of women with PCOS are vitamin D deficient, and I think its likely that some part of the PCOS presentation can stem from vitamin D deficiency. So- I do not know if I need metformin, and I'm really don't want to take it, but I don't want to end up regretting that I did not do it.

In less scientific matters- I'm going on a cruise in December! I am so excited and I really, really wanted to go snorkel in some really blue waters- but I calculated ahead because some dreaded instinct told me this may be an issue.... Going with my current cycle patterns, bloody AF is going to show up on the day we dock at the Bahamas! My frustration knows no bounds...Eff You Universe!