I’ve been dreading writing an update because I don’t want to be negative and discouraging for other women trying to help their PCOS naturally…but I am so discouraged that I just need to type this to clear my thoughts on the topic.  I guess I thought that if I worked hard enough, wanted it enough, swallowed enough herbs and supplements, had enough needles poked in me, was disciplined enough to adhere to every bit of PCOS health advice I’ve ever come across, that I could overcome PCOS symptoms in my life, regain my menstrual cycle, and conceive naturally.  I so badly wanted to avoid the emotional turmoil that fertility treatments always put me in – the feeling of isolation, the anger/pain/jealousy of the blessedly fertile.  Oh GOD, have I been there before and I was willing to do anything not to have to go back.  I wanted a glimpse of what I deem as a “normal” shot at conceiving.  I did everything I knew to do for the better part of six full months, so I can now say that it’s not diet and exercise that’s controlling my PCOS symptoms for the most part – and there is no magic fix for me with the supplements I’ve tried. The most tangible result seems to have been body fat reduction and the addition of muscle.  I know now that I can quickly gain a lot of muscle and I don’t think this particular fat to muscle ratio is very fertile for me.  With this past Femara cycle, I’ve experienced some suppressed/low estrogen side effects for the first time ever.    Women need a certain amount of fat to produce estrogen and I hypothesize that I may have dipped a little bit on the low side for my particular body.  I’d be willing to push hard and maintain the rigidity of this experiment for eternity if I had gotten the results I was after, but I just don’t have it in me anymore.  I mean, my regular lifestyle was already a healthy one and so I am going back to it.  I honestly think that the best thing may to just not think about PCOS for a while, stop researching about it, stop trying to constantly fix myself. It’s all a form of obsession and if I were to reduce an overlying theme to my life, I would say that this high strung, perfectionist crap that I can’t ever seem to change is the progenitor of any and all of my health struggles.   This is going to be yet another big change for me because I’ve been at this PCOS fight, in some form of another, for 8 years now.  Damn, I need a new hobby – something not focused on disease or dysfunction and how to escape it.  I feel a bit lost at the moment without a cause to struggle and wage war against.  I need to just flippin’ live my life, put one foot in front of another, get things done, raise my son, figure out what makes me feel inspired and happy again when I’m not worrying about my health.  I’m not giving up my dream of getting pregnant, but I’m going to leave this in the hands of my doctors and conventional medicine for a while.  It may sound like I’m giving up, but it really feels more like I am surrendering myself to whatever life has in store for me.  This has always been an impossibly difficult concept for me to accept, always trying to wrangle the progression of my life through sheer will and a very strong arm.  I’m sure I will try for a while to make lightening up my next big project – old habits die hard.  My sweet and loving husband took me out for a walk and shopping today, trying to help lift my funk a little.  We walked into a book store and despite pretending to be interested in the other sections, I was sucked in, as if by gravitational pull, to the health and self improvement section.  This is not going to be easy for me, but it’s what is best for me right now.  Since when was just simply living life such a difficult and elusive desire? I may feel defeated and a bit broken, but to tell you the truth, broken is exactly what I need to be right now…broken, more flexible, less rigid, inactive for a while.  I’m still not absolutely sure what the outcome will be with this fertility cycle, so I will update if anything exciting happens, but for now I’m signing off.  I wish you all every success in your journey.

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I seriously cannot believe another month has passed since the last time I wrote a monthly report!  I’m not going to write a long report in the usual format since I am in the middle of a medicated fertility cycle and I cannot differentiate between actual progress and the possible effects of the medications.  What I will say is that I have remained true to the basic tenants of this experience –  I have eaten well, continued to exercise often, taken my daily supplements, and have seen my acupuncturist weekly with no changes or deviations.  My weight is slightly lower than last month and very stable.  I am not going to do body measurements because I am having some wavering abdominal bloating as I approach ovulation, but based on my appearance and how clothing fits, I would guess there has been very little change.  My acne is quite bad, but I am actively messing with my hormones by taking fertility drugs and this is a very common side effect for me while on them.  Emotionally, I am a little short of temper, but I have yet to feel any depression or major psychological upheaval, which is sometimes the case during a medicated fertility cycle.  My energy level has been a bit low the past week or so (again, normal for this point in a medicated cycle), and so I have started doing a Fertility Yoga DVD that I’ve owned for several years, but had only done a few times before.  Even though it’s a step down from the more ambitious exercise I usually do 3-4 times a week, I still feel like I get a decent strengthening and stretching work-out, and it’s better than simply doing nothing and letting my conditioning dissolve away.  I have also added a nightly abdominal and lower back massage using a blend of essential oils (mixed in apricot seed oil) that are beneficial for PCOS and infertility. The oils are Clary Sage, Geranium, and Rose – all with specific medicinal benefits for balancing hormones, increasing circulation and general stress reduction.  All in all, this has been the easiest medicated fertility cycle I have even gone through in terms of physical and emotional side effects.  I have also been able to achieve follicle growth without the use of Metformin, and that is a first for me.  All of this speaks volumes for what I have achieved in doing this PCOS experiment.  The proof is in the pudding though, as they say, and the proof for me will be to conceive a healthy baby.  I won’t know if I ovulated for a few days still and won’t know about pregnancy or not for two weeks after that, so lots of watching, waiting, and testing with baited breath to go, but I feel very positive about it all and that’s the best I can hope for.

I broke the news of the Femara cycle to my acupuncturist last week, and, as usual, she was all for it and quickly switched gears to tailor my treatment plan accordingly.  The TCM herbs I’ve been taking for several weeks now are still the correct ones to be taking.  We also went down the list of my supplements to make sure that all of them were safe to take while trying to conceive.  We found nothing that needed to be changed for now.  So far nothing has changed in regards to this experiment either.  I am still eating and exercising as before.  I’m also trying to stay in a good place emotionally and take time out of my day to do some deep breathing or meditating.

As I mentioned before, I induced a period with Provera.  I’m currently on CD 4, and the period has been encouraging.  When I did the two Femara cycles this past summer (right before I started this experiment), the Provera induced period was so light, it was almost nonexistent.  I was only about 8 weeks past breastfeeding at that point and there were a lot of signs that my body and hormones had not recovered yet.  I was not 100% surprised when neither cycle worked.  Things are already starting off better with a normal period and a now fully recovered body from pregnancy and the hormonal suppression of lactation.  Obviously my hormones are not balanced and perfect, but at least they are present in enough quantity for the fertility meeds to actually do something with.  Today I take my second of five days of Femara.  I am taking 4 pills per day (10mg/day) this cycle.  I took 7.5 mg/day on my last 3 Femara cycles, including the one that I conceived my son on.  The goal is earlier ovulation this cycle.  I go in for my first ultrasound monitoring appointment a week from today on CD 11.

I realized that a lot of the anxiety I was having, just in general, and in regards to jumping on the TTC bandwagon again was about the great unknown.  Would my doc insist that I be on Metformin again?  Would my new insurance cover treatment again?  Can I continue my experiment while I undergo conventional fertility treatments?  Will I be able to stay sane enough to be functional and “present” for my 21 month old toddler?  I started this experiment because I was really having a hard time with the fertility medications and being a good Mom through it all.  I’m turning 34 next month and that only leaves one year between me and “AMA” or Advanced Maternal Age.  To make a long story short, the anxiety of not actively TTC is starting to override the anxiety of going through a medicated fertility cycle.

I decided to put a call in to my insurance company and it looks like they will pay for some monitored cycles.  I then called my fertility doctor’s office and told them that I wanted to do another Femara cycle, this time monitored.  I’m now taking Provera to induce a period so I can take the Femara.  There was no mention on Metformin, whether I was still taking it or if I should be, so that’s one worrisome question answered.  I see my acupuncturist tomorrow and we will form a new game plan for using acupuncture/herbs/supplements to compliment conventional fertility treatments.  This is my acupuncturist’s specialty.  What I am hoping is that all of my hard work with this experiment has created a hormonal profile that is mediated enough from PCOS that I won’t need Metformin.  I’m willing to take it again if absolutely necessary, but it will definitely be a last ditch effort.  Obviously I will continue with my eating plan and will exercise every other day, or 3-4 times a week.  I plan on taking all of my supplements and herbs until a pregnancy is confirmed (unless explicitly contraindicated while TTC or in the luteal phase of a TTC cycle)

I’m just a jumble of thoughts today, both positive and negative.  Starting with the positive, I managed to maintain my experiment during the holiday, for the most part.  I indulged in some chocolate and potatoes a few times and did not get as much exercise as I would have liked, but as of this morning, there has been no weight gain and my body still looks slim and toned.  I was able to wear special holiday clothes that I have saved and stored away from the last ten years.  This honestly feels better that buying and wearing something brand new to me.  In the very same breath, I am feeling excited to be looking towards pregnancy again.  I finally got my body back post pregnancy and I’m going to stretch it all back out again, but I know from experience that it’s worth it.

I asked for gifts this year that would help me with my health goals.  I got a very nice selection of essential oils, including expensive ones that I would not normally buy for myself.  I also got an electronic aromatherapy room diffuser and a great book about how to use essential oils for health and home.  It’s really a fascinating topic and something I’ve been wanting to know more about for many years.  I also got lots of tea making supplies and equipment.  I’ve been really getting into nice teas lately and I’m excited to take it to the next level considering I partake in a nice cup several times a day.  From the beginning, tea has been part of this experiment in regards to the medicinal benefits of green tea and spearmint for PCOS.  I also have a cup of tea with a little milk as a treat when I would normally be looking for something sweet to snack on.   The ritual of tea making and drinking is enough to satisfy these cravings most of the time.

As for the negative, considering going down the path to actually getting pregnant brings up a lot of anxiety for me considering my past traumas.  I’ve sort of lost faith that this experiment will end in a pregnancy for me.  I don’t even feel confident that I will ovulate naturally.  I’m still planning on completing the full 6 months and to continue many of the lifestyle changes, hopefully for life, but I’m having a hard time feeling the optimism that I had in the beginning.  Maybe it’s because it’s grey outside.  Maybe it’s because I have a cold.  Maybe it’s because my acne is HORRENDOUS.  Whatever it is, I’m hoping it’s just a phase and I can feel hopeful about my PCOS progress again.

Four months of this experiment have now come and gone!  This has seemed like the fastest month by far, probably because this lifestyle change has become a habit that I don’t think about it as much as I did in the beginning.  I just keep a general framework in my mind and try my best every single day to work within it.  I am spot on for a few days and then I may not get the chance to exercise for 2-3 days in a row.  Instead of trashing the whole endeavor, I just start right back up and make up for lost time.  It’s making good choices most of the time that makes the difference.

‘Tis the season for all manner of diet blunders, but I have been successful in resisting the temptation to fall off the wagon.  I enjoyed Thanksgiving without so much as an added pound, which I did, not by turning down the delicious meal, but by remaining moderate in my food choices and continuing to work-out, even when out of town.  I used to be fairly frustrated about the fact that I have not lost many actual pounds, despite lots of effort, but I now know that each pound lost is backed up by lean muscle gain and is stable, meaning the scale does not fluctuate wildly anymore.  When I lose a pound now, I’ve really lost it.  Because of this, I no longer feel like a slave to the scale or a rigid diet that cannot include an occasional treat (within reason).  I trust myself and my body.

My supplements have changed quite a bit this month with the addition of D-Chiro-Inositol, myo-inositol, and a weekly prescription of Chinese herbs.  I have not been taking any of them long enough to report much change yet, but I am very hopeful.  I sincerely wish that I could report today that I have recorded an ovulation, or even gotten a spontaneous period, but more time is needed it seems to get those kind of results.  Here’s a link that details my supplements and all of the changes that have been made along the way.

Despite feeling impatient at times in regards to my progress this month, I generally feel such gratitude for the positive changes this experiment has made in my life and for my husband and baby as well.  I look great, but better than that, I feel great too.  My interest in life is filled to the brim and I feel my creative juices flowing again.  I periodically catch myself smiling, almost giddy with happiness and excitement for the year ahead of us.  I am feeling more confident about being able to handle the responsibility of having two children.   I am actually just starting to feel ready to be pregnant again. This goal, I am confident, will be met in 2011.

So, I guess we should take a look back at the original success criteria for this 6 month experiment, noting my progress since last month:

1) Ovulation and Menstruation – It had been a while since my last period, and I began experiencing some signs of Estrogen Dominance (constant fertile cervical fluid, ferning on ovulation microscope every day).  I started an oral natural progesterone supplement called Progon B, and 8 days later I started spotting and got a very light period lasting about 4 days.  I have since started Chinese herbs and acupuncture to stimulate ovulation, but no rise in basal body temps. yet.  This goal is still a work in progress, but I have never felt closer to this goal than now since it was with Chinese herbs that I was able to regain my cycle back in 2006. Very hopeful to see what the next few weeks bring.

2) Stable weight and body measurements –  I am wearing clothing that I have not been able to in many years.  I once had a pretty remarkable wardrobe from my fashion design days in NYC, and thankfully I kept some of my more timeless pieces.  The clothes not only fit, but they look really good.  This thrills me to no end!  The big news is that I now have a waist!  I have not been able to wear anything that accentuated it in many years.  I actually pulled out a belt and wore it over a dress for the first time in as long as I can remember.  I have been fighting a puffy Insulin Resistance belly since childhood.  I still weigh myself most days and I hover around 112-113.5 lbs with very little fluctuation.  This goal has been met and exceeded!  See my body measurements below.  Despite not losing many more pounds, my measurements keep going down.  YES!

3) Little or no acne – Similarly to last month, I have had some success and failures this month in regards to my acne.  Myo-Inositol has helped me fight the urge to pick at and scrutinize my pores, but I have since screwed with the dosing too much and so the jury is still out as to if it can help my OCD-type preoccupation with my skin/acne for the long haul, enough to make a lasting difference in my face.  I was hoping that I would know something more by the time I wrote this, but I’m still not sure enough to make any grand declarations.  Hopefully the picture, and my face, will become clear enough to make an accurate report.  This goal is still a work in progress.

4) Stable and positive emotions – I’ve had some resumption of some roving anxiety that I have suffered with in the past on several occasions this month (likely low blood sugar from new supplements), but for the most part I have felt very even keeled and happy.  I feel confident and much more take-charge than maybe ever before.  I’m not shying away from things that used to intimidate or scare me.  I’m ready to take on more responsibility in my life.  This goal has been accomplished yet again!

Body Measurements:

1) Natural waist:
a- 27″ on 10/7
b- 26″ on 10/23
c- 25″ on 11/23
d- 24″ on 12/22

2) Lower abdomen (around fattest part of tummy):
a- 32″on 10/7
b- 29 1/2″ on 10/23
c – 28 1/2″ on 11/23
d- 27 1/2″ on 12/22

3) Lower hips (around largest part of butt):
a- 35 3/4″ on 10/7
b- 35″ on 10/23
c- 33 3/4″ on 11/23
d- 33 1/4″ on 12/22

4) Individual thigh circumference (around thickest part of one thigh):
a – 20 3/4″ on 10/7
b – 19 3/4″ on 10/23
c – 18 3/4″ on 11/23
d – 18 1/2″ on 12/22

A Change of Plans…

Whether it is justified or not, I’ve reached the point where I am getting a little anxious about my progress in this experiment.   I’ve given my current supplement regimen 3+ months and I just don’t feel like we’re (my acupuncturist and I) on the right track.  When I first started doing acupuncture, way back in 2006, my practitioner was fairly traditional and I boiled a weekly tea made from Chinese herbs that I would procure from China Town in NYC every 4-5 days.  It was only then that my stubborn amenorrhea and anovulation came to an end.  Heck, I even became pregnant naturally, although it was not with a healthy egg.  After we moved away from NYC, I’ve tried several other acupuncturists, but have never gotten the same benefits as I did originally.  I brought all of this up to my current acupuncturist and she agreed that it was time to shake things up, so as of yesterday, I have gone back to taking Chinese herbs.  For starters, she has put me on a Nourish Ren & Chong Formula (Jia Wei Gui Shao Di Huang Wan) plus a few other herbs for yin deficiency.  It’s been fun reading up on the different herbs and their usages.  I’m not about to begin to understand the intricacies of Traditional Chinese Medicine, but I do know that it worked for me before, so I have faith that it will work for me again.

In addition, I will continue to take Chaste Tree (Vitex), NAC, myo-inositol, D-Chiro-Inositol, Gymnema, fish oils, antioxidant blend, and lots of daily supplements for general health and illness prevention during cold and flu season.  Everything else about this experiment remains the same – diet, exercise, etc.

Ever since I can remember I’ve had blood sugar issues, namely hypoglycemia, when I was overdue for a meal, even by a little bit.  My Dad has the same problem and my mother adopted the phrase, “feed ’em or fight ’em” when dealing with the two of us.  It’s like all of a sudden our evil twins would possess us and turn us into belligerent psychos.  Despite the fact that it was a regular occurrence, we never recognized the signs, and after we had eaten, there were apologies to give for our insane behavior.  It’s like having a multiple personality at times.

The foods I was drawn to when I was in this state were very carby and very refined.  In fact, as a child/teen, I routinely chose meals that were mostly starch with very little protein.  I ate frozen waffles with fake maple syrup most mornings, that or canned biscuits with white gravy.  When I was around 17, I became a vegetarian, but what it really should have been called was a Carbotarian.  French fries and pasta were on the menu every day and in large quantities.  This was the first time I started putting on weight, although I would have still been considered a healthy weight.  When I started college, I became very preoccupied with losing the extra weight, but I got fairly obsessive about it and got WAY too thin, probably about 95 lbs (not shocking for 5 ft, 0 inches, but still noticeably skinny, especially for me).  I got a lot of attention and praise from my family and friends for losing my “baby fat” and blossoming into a young woman (with no boobs or butt).  I lost the weight by eating lots of fat free, but high glycemic carbohydrates.  For the next 10 years, I yo-yo’ed in my weight, always trying to stay slim, and usually doing a pretty good job of it, but usually only by calorie restriction and eating “diet” foods.

When I was in 7th grade, already far into puberty, I contracted the chicken pox and got very ill.  I missed a full 6 weeks of school and lost every bit of extra fat that was on my body.  My breast buds went away and my puberty was halted for about a year while I was able to gain back my weight.  I did not get my period until the following year, long after most of my friends had gotten theirs.  It never became regular, but I was still having one every 6 weeks to 2 months.  That is until the unhealthy vegetarian eating started and I started gaining weight.  I noticed that I was getting my period less often, but I was not about to mention it to my Mom because I knew she would have made me see a doctor about it.  It was after I lost too much weight in college that my period stopped pretty much all together.  Despite not having a cycle, when I was 20, I went to the health center at college and got on birth control pills.  I failed to mention that anything was wrong with my cycle because I was worried that they would not give the BCPs to me and would want to do testing.  I continued on the pills until about 6 months before I got married at around 25 years old.  I was having migraines and intermittent depression and I just felt like it was the pills.  I stopped taking them and the symptoms went away.  I grew concerned when my period did not come back, even after most of a year.  I was concerned about my future fertility by that point and so I went to a Reproductive Endocrinologist to get checked out.  She had a hard time diagnosing me because I fit some of the criteria for both Hypothalamic Amenorrhea (what anorexics and athletes get when they do not get their period anymore) and PCOS.  I had a high LH: FSH ratio, multiple cysts on my ovaries, and acne, but I also had a very thin lining despite not having menstruated for many months and low estrogen.  I did have a light withdraw bleed with Provera, so she decided on PCOS as the diagnosis.  I think very little was known back then about PCOS, and especially Thin PCOS.  As the years have passed, there in no question in my mind that I have PCOS.

In conclusion, I began with blood sugar issues and then had one assault after another on my HPO axis – starvation from illness, eating a diet comprised almost completely of carbohydrates, disordered/restrictive eating, and years of birth control pills.  I also have Celiac Disease, which supposedly has some correlations to PCOS.  It’s no wonder that I am having a hard time getting my cycles back despite working very hard for it.  It’s a complicated medical picture for conventional and holistic practitioners alike.   It definitely confounds me.

The day after acupuncture last week, I started spotting (on Wednesday 12/8/10).  I had been taking Progon B for about 8 days at that point.  I continued lightly spotting until Friday, when it became a very light flow.  I realize that it was an anovulatory, progesterone withdraw bleed, but it sure was a weird one.  There was barely any blood and what was there was mostly brown with some occasional pink and red.  I usually have much more blood with a Provera induced period and usually some cramping too, but none of that this go around.  As of today, the period is over.  It lasted about 4 days.

Not sure what else to report.  I’m still stepping up my dose on myo-inositol every few days, but so far I have not reached the amount I was taking before I quit.  I have also not achieved the same remission from the OCD type of skin/acne preoccupation that I got when taking it the first time.  I still need more time to reach my goal dose and then I need to be on it for a while to see if it will work again for me.

As usual, I’ve been internet sleuthing and have found some more useful info regarding myo-inositol and D-Chiro-Inositol.  It is apparently more effective to take both in divided doses, rather than once per day.  It’s also better to take them on an empty stomach.  Caffeine lessens the effectiveness of them too.  I have been taking them completely wrong, it turns out, since I was doing the opposite of all of these dosing tips.  From here on out, I will be taking half my dose an hour before lunch so that I have both an empty stomach and I won’t have just had my caffeinated tea that I drink first thing in the morning.  I will take the second half of my daily dose before bed so my dinner has time to clear my stomach.

I was also very happy to read some info about studies showing the benefits of regular old myo-inositol for anovulation.  I thought it was only the DCI that helped in those terms.  So I’m really getting a big, one, two punch by taking both.

As far as my general status, I’m a bit sleep deprived.  Jude’s been restless due to his top canines coming in, and for the past several nights, he’s been crying at around 5 am.  After I finally get him back to sleep, I am too awake to drift back off.  I am also having trouble settling down before bed some nights.  I don’t feel worried about anything, so it’s not anxiety or stress, but I am wondering if it could be the addition of the inositol again (both myo and/or DCI?).  I recall similar sleep issues a few weeks back and it quite possibly coincided with the addition of the myo-inositol (when I started taking it the first time).  That said, I am also on Day 5.5 of starting the Progon B, which contains natural progesterone.  It could just be the shifting of hormones.  Saliva microscope still reads highly fertile most days, even though I know by now that it’s not the case.