Saturday, January 26, 2013

The bugs in your stomach

As the title suggests, this will be one of my technical posts. Just FYI, you have a trillion bacteria (I'm not making that number up), in your stomach. They have a tremendous effect on your health, both good and bad.

Staring with my story--the first time I got pregnant, maybe a month and a half into the whole thing, I noticed I was getting a baby bump of sorts- there was this very distinctive mild distention between the navel and diaphragm. I figured, wrongly, naively,  maybe it was because my uterus pushing up, the rest of my internal structure was getting 'rearranged'.

The next time I got pregnant, I saw that distention become even more pronounced, and I knew it portended I was pregnant, and this was by like 8 DPO, which is kind of crazy.

The 3rd time I was pregnant, I knew it because of the much worse heartburn and that immediate distention, again, manifesting around day 8 post ovulation. 

Many months/years later, I've finally connected  the dots..that 'bump' is because of heartburn.

Turns out, like a good proprtion of the world's population, I have GERD or Gastroesophageal reflux disease, or in simple terms, acid reflux.The list of risk factors for GERD, not surprisingly, include pregnancy- I'm convinced progesterone plays a role, because every time my luteal phase rolls around, the problem gets a bit more pronounced.

 This month, my heartburn got bad, finally, making me look into it. The first thing I did was get a H. Pylori test done, because this bug is strongly linked to GERD or heartburn- I have the antibodies for it, which means I'm infected. An astonishing 80 % of Indians are H. Pylori positive, so its not surprising that I am.

Here is another interesting thing- H. pylori is also linked to PCOS, because a higher % of women with PCOS are positive (40 % of PCOS  vs 22 % of normal countrols).

Importantly, not all H Pylori are the same- there are some 'super' H pylori, these are positive for the Cag A mutation.  Turns out, infection with the Cag A+ H. pylori (but not normal H pylori) is linked to a higher risk for early pregnancy loss.   Its can also, possibly contribute to both male and female infertility by other means as well. Lots of literature on this.

Moral of the story- If you are infertile, may be worth it to order a H. pylori test (especially if you have GERD), and if it comes out positive, try an H. pylori eradication. This bug also increases risk for duodenal ulcers and stomach cancer , so yeah, If you have it, trying to get rid of it is definitely recommended, just in case you have the Cag A strain.

I'm saying try, because getting rid of this bug is difficult as hell.  If you take the triple therapy recommended in combination with N-acetyl cysteine, you chances get as high as 50 %.  That is really shitty, but what can you do? Also, during the eradication and after, and just, as a general rule of thumb, I'd advice going crazy with the probiotics. The bacteria in your stomach can have a tremendous influence on health, research now shows. This is one of the hottest topics in science right now. Maybe more on that someday, but all of you can just google and get educated on this.

In non sciency news- The surrogate's cycle is underway. Transfer in maybe 13 days! Scary! But hey, she is proven- 2 kids, full term, no issues. I wonder what the hell is right with her, and wrong with me. But then as my blog, and this very post highlights, there are many, many roads to infertility.

Saturday, January 19, 2013

Meeting my surrogate

Sadly, I've missed International Delurking Week by a mile. Its nice to have a legitimate excuse to ask people to delurk and its even nicer when some of you do so. I've got one of those blogs where the proportion of commentors to readers is microscopic- I'm clearly not one of the writers whose writings make people inclined to emerge from the shadows and say something, and I have to say, I'm madly jealous of those who are! But still, I'm so glad there are people who come here to read, you make me feel good. And even if it is a week or two late, I hope some of you delurk in the spirit of International Delurking Week.

Things have been happening to relieve the limbo. My green card petition was approved! This one is through the horribly long process, which means I may end up getting it in 2016, still that fits in nicely with my plans, assuming I get to make a baby. The petition that gives it to you immediately is still under scrutiny, I kind of want it to pass too, because it gives me the freedom of choice.

In my last post, I had mentioned I was afraid to find out about the surrogate, mainly because I thought I would find major fault with whoever got picked- mostly because how the heck can you trust somebody to do something so freaking important? Because of that, I delayed finding anything about her and meeting her for as long as possible, but finally, it was time to sign the contracts, because the process is almost ready to begin.

My parents and I met her, and her 'handler' yesterday. Just FYI, here is how things work in India- the surrogate is from a lower economic strata, and the handler is a woman who has previously been a surrogate, who lives in her neighborhood, checks up on her, takes her to her doctors visists, and who guides her through the whole process, based on the familiarity with the system and the process.

The handler also is instrumental in recruiting the surrogate. Apparently, my handler is an old hat at this process, after her surrogacy, she has handled over a 100 pregnancies. 

Anyway, my fears turned out to be baseless. These are women who can't speak English, they had no idea that fish during pregnancy can be bad but they are simple, nice women I instinctively had a good vibe for, as did my parents. I gave her my fancy prenatals and vitamin D, thanked her repeatedly, cried a little when I told her about the fact that she might go through a loss because I had already lost 3 babies.  She, on the other hand reassured me and told me that she would take the best possible care of the gift she would carry for me, and that god willing, things would go well this time. It was really sweet, and reassuring. I'm so very thankful I feel so positive about this going forward.

She gets her period in a few days. Then-- we start.

More in a little while on other topics, including H pylori, PCOS and GERD. 

Wednesday, January 2, 2013

Craziness all around

I get a call back about my AMH, with the lab informing me that they have to retest it. I used my 'Dr.' title to make them give me the preliminary result- its apparently OVER 6.9, and out of range probably.

An explanation of the reference ranges used by a testing lab in India

2 years ago, I was looking definately PCOS-ish, with an AMH of 5.6 and an AFC of 30.

3 months ago, it was 1.9 one month, rose to 2.6 the next month, at which point my AFC was 13.

Fastforward 2 more months, now my AMH may be over 6.9, with an AFC of 25- back to looking PCOS-ish.

Like I've said, all I can monitor that has truly changed in my body are my vitamin D levels. My doctor, playing devil's advocate pointed out there could be a lot more changing that you could be aware of. Theoretically, that is a perfectly valid point. What confounds me is the timing- when my vitamin D levels stay within a range, say, deficiency, nothing changed over many months monitored. When my levels were really high, things changed and then stayed constant for a while. Now that they are lower again (but, above my original levels), things have changed again- we will need to monitor for many more months before drawing conclusions of any sort. 

What is my diagnosis? I have fertility issues sure, but the underlying causes are damned near indecipherable. Most people can get a clear label- of 'PCOS' or 'Diminished ovarian reserve'. With all my knowledge and recall of all the minutiae of my case, I have no idea how to label myself. I lean towards PCOS, but I'm not quite there.

So what I'm wishing for in 2013, aside from a baby-- enlightenment. Also, for concrete and viable solutions to counter gun violence and  violence against women, but sadly, there is a much higher chance of me actually having a baby than meaningful progress being made in those directions. 

Happy new year everybody. I hope this one is a kind one, on the whole.

Also, please go offer a shoulder to MN, as she faces the unthinkable, yet again.