Getting Pregnant with POF / DOR / Low FSH

Supplements anyone? I recently got rid of these and gave away my remaining OPKs, which felt really, really good.

I'll never forget the moment when I found out I have premature ovarian failure / diminished ovarian reserve. My OB ran a few "routine" blood tests after I told her I was having short cycles after coming off of birth control (24-25 days).  I didn't even know for what she was checking, but I was sitting at my desk at work when she said "Your AMH level was undetectable and your FSH very high.  You may have a very narrow window in which you can have your own children.  But don't worry, you can always use donor eggs."  Those three sentences completely upturned my world and everything I thought about building a family (not to mention that I had no idea what AMH was and what, exactly, she meant by donor eggs.

After the initial shock wore off and I scheduled an appointment with CCRM, I fell down the rabbit hole that is Google and started to learn everything I could about high FSH, low AMH, DOR, POF, etc.  In a situation where I felt like I had no control, I wanted to arm myself with any information I could and to do whatever was in my control to become pregnant.  I scoured the internet for success stories, read every book available on the subject, and had consults with three Denver fertility clinics, including CCRM (where I was handed a packet of information on donor eggs and told I wasn't really a candidate for IVF).  

I found great hope in posts I read online from women who beat the odds and got pregnant despite depressing statistics and seemingly insurmountable odds (see My Bum Ovaries and Torthúil as examples) and I promised myself that if I had success, I would share my story and what I learned with others.  I've been wanting to write this post for ages, but I knew I couldn't do it until Baby C was safely in my arms.   

I live in Colorado, so I've included local resources that I utilized and liked.

Background

• Diagnosed at age 32 with DOR/POF. AMH less than 0.15 (undetectable) and day 3 FSH of 17.3
• My FSH has since been as low as 7 and as high as 59 (immediately following my first miscarriage).  My AMH has been as high as 0.23.
• I have mild hypothyroidism and low Vitamin D
• Day 3 ultrasound shows only two follicles on one ovary and one follicle on the other
• I have been pregnant 5 times:
• Spontaneous (unassisted) pregnancy 8/2013, which ended in the stillbirth of our daughter at 26 weeks (unrelated to fertility)
• Spontaneous (unassisted) pregnancy 5/2014, which ended in the birth of Baby B
• Spontaneous (unassisted) pregnancy 3/2016, which ended in miscarriage at 6 weeks
• Pregnancy while taking Clomid 12/2016, which ended in miscarriage at 6 weeks
• Spontaneous (unassisted) pregnancy 8/2017, which ended in the birth of Baby C
• I have tried IUI once and have tried 2 cycles on Clomid.  I have planned to do IVF cycles 3 times but had a spontaneous pregnancy before each planned IVF cycle.
• My husband has no issues with sperm count or quality.
• I am otherwise quite healthy, eat well, exercise regularly (marathon runner and triathlete), drink only in moderation, don't do drugs, and have never smoked.  

Books I Read

• It Starts with the Egg by Rebecca Fett (I can't recommend this one enough)
• Taking Charge of Your Fertility
• Real Food for Mother and Baby: The Fertility Diet, Eatingfor Two, and Baby's First Foods by Nina Planck
• The Hormone Cure by Sara Gottfried
• The Fertile Female

What I tried

• Acupuncture (Jane at Acupuncture Denver and Gina at Insight Acupuncture)
• Hypnotherapy (Eastburn Hypnotherapy Center)
• Mayan Uterine Massage (Artemisia & Rue - Shelley is incredible)
• OPKs
• Less exercise
• Eliminating BPA and phthalates
• Changes in diet, restricting caffeine, and eliminating alcohol 
• Charting / AVA Fertility Monitor
• Supplements & Vitamins
• Vitamin D 2,000 IU D2 (2/day)
• Prenatal Vitamin (1/day)
• Fish Oil EPA/DHA - 2,000 mg/day with food
• COQ10 (300 mg, 2x day) - taken in the a.m. with protein (purchased from a compound pharmacy with a prescription)
• Inositol (2 scoops, 2x day) - 4g day total
• OPCs (1 capsule daily) (http://umm.edu/health/medical/altmed/herb/grape-seed) 
• DHEA - 75 mg (taken in 2 half doses and purchased from a compound pharmacy with a prescription)
• Amazing Grass Green Super Food (650 mg x 5)
• Amazing Grass Organic Wheat Grass (1000 mg x 5) 
• Life Extension PQQ (Pyrroloquinoline Quinone) (10 mg)
• Therapy
• Regulating Thyroid 
• Regulating Vitamin D
• Baby Aspirin
• Tracking cervical mucus
• Tracking fertility (I like the Ovia app)

What I think worked

• OPKs - While I found that tracking my cervical mucus was the best indicator of ovulation, I heavily relied on OPKs to confirm ovulation and to identify potentially fertile days in otherwise wacky cycles (for example, when I'd have egg white cervical mucus (EWCM) but not other signs of ovulation, or EWCM was oddly early or late in a cycle).  I purchased the Clearblue Fertility Monitor at some point, but far preferred the basic Clearblue Digital Ovulation Tests and the Clearblue Advanced Ovulation Tests.  In some cycles, I used both (can you sense my desperation?).  For me, it was critical to have confirmation of peak fertility or to identify that my cervical mucus might otherwise be off. 
• Tracking cervical mucus - This was the easiest way for me to tell when I was ovulating.  There are many primers online and I found this to be an extremely accurate way of knowing when I was ovulating.
• Acupuncture - Acupuncture helped me to regulate my cycles and generally to improve my mental health throughout the challenges of the last 5 years.  I can't say whether it directly impacted fertility because I did acupuncture in conjunction with taking supplements, etc., but it made me feel better emotionally and my cycles did regulate.  When I was having perimenopausal symptoms, it helped to diminish those as well. 
• Trying to stay positive / mental health / exercise / therapy - This isn't specific, but for me trying to stay positive, even in the depths of overwhelming sadness after losing Baby L, was really what kept me going.  Hand in hand with keeping a positive attitude for me exercising, not eating a super restrictive diet, having a drink here and there, and finding things to do that I still enjoyed that were unrelated to baby-making.  Vague, I know, but it is all too easy to become completely engulfed in the world of infertility and to lose sight of everything else going on around you.  I saw a therapist after Baby L died and throughout my pregnancy with Baby B, which helped immensely.  
• Supplements & Vitamins - Generally speaking, I felt that taking supplements absolutely helped me feel better.  The two that the research shows help the most are DHEA and COQ10.  At various times, I took all of the supplements listed above, but sometimes the sheer number was overwhelming so I dropped to just taking the DHEA and COQ10. 
• Regulating Thyroid and Vitamin D - Research shows that having a TSH level (thyroid function) in a normal range, as well as normal Vitamin D levels both have an impact on fertility.  Both can be checked with a simple blood test and easily regulated if they are out of whack.  These are simple and inexpensive areas to "fix" if there is an issue.
• Tracking Fertility - I used the Ovia app to track my cycles, cervical mucus, intercourse, OPKs, etc.  You could certainly do this on a calendar, but the app makes it easy and offers insights regarding your cycle. I have found it helpful to be able to scroll back through the past few years to see what my cycles looked like when I did get pregnant, etc.

What may have helped and that I didn't mind doing

• Eliminating BPA and phthalates from our home - I got rid of plastic, checked all of my toiletries, changed up household cleaners to a certain extent, etc. I go into more specifics here if you want to know more.  I have no idea whether this impacted my fertility, but it seemed like something I ought to be doing regardless.
• Mayan Uterine Massage - I had only had one session when I found out I was pregnant with Baby C, so I have no idea whether this helped, but I continued working with the same masseuse through my pregnancy and found it helped with stress, anxiety, mental health, and preventing back pain and soreness in pregnancy.  
• Eliminating Caffeine - I periodically have eliminated caffeine entirely and generally drink decaffeinated coffee or a half caf (which is what we make at home).  I like the taste of coffee and I don't mind drinking decaf, so this wasn't a big deal for me to do.
• Baby Aspirin - Because I have a history of clotting in pregnancy, I take a baby aspirin when pregnant.  There is some evidence that taking a baby aspirin can assist with getting pregnant, so I have taken one when we were trying.  

What didn't work for me

• Restricting food, exercise, and alcohol  - I tried removing gluten from my diet, giving up running, only drinking decaffeinated beverages, and entirely giving up alcohol, but it turns out I am someone who prefers to moderate than to abstain.  I am a very healthy eater, and do not drink excessively.  My evidence is anecdotal, but I was not eating or drinking in any sort of limited way when I became pregnant and I find it is a huge drain on me emotionally.  Exercise was the hardest of these for me because I find running to be therapeutic and essential for my mental health.  Again, for each of my pregnancies that didn't end in early miscarriage, I was running quite a bit and feeling strong and fit.  One caveat to this is that I would have strictly adhered to it leading up to and during an IVF cycle, which is recommended.
• Hypnotherapy - I was glad I tried this once, but I didn't feel compelled to go back. Interestingly, the woman who ran the session told me I'd have two living children, a girl and a boy.
• Charting / Basal Body Temperature - Call me lazy, but I could never get the hang of taking my BBT each morning.  The thermometers always beep (which my husband hated), I often forgot to take my temperature before I got out of bed, etc.  I even bought the Ava bracelet, which is supposed to do this for you, but it always fell off and didn't seem to be all that accurate.  I found that monitoring cervical mucus and using OPKs were more effective for me.

Sugar & Spice

I am thrilled to share that we welcomed a healthy, screaming, beautiful baby girl on Monday, April 16th at 8:41 AM.  She weighed 7 pounds, 11 ounces and is perfect.  She has a head full of dark hair like her sister and as I type this, she is resting on my chest and I am pausing to kiss her head every 30 seconds or so.

Is it just me or do newborns smell divine?  There may not be a better scent than that of a newborn baby.

Despite big sister B's requests to call her Latte Shop, Coffee, Stop Sign, and Canopy, we have named her Claire.

My c-section was mercifully uneventful. Unlike when B was born, I walked myself into the OR, got a spinal/epidural combo, had some moments of feeling absolutely terrible and like I was about to pass out, which were fixed by some sort of concoction the anesthesiologist gave me by IV, and then we started.  I was prepared with a Spotify mix called C-Section Tunes that will most certainly go viral (ha), and Claire was born to the song "Show me love" by Robyn, which seems fitting.

Our journey to have babies started almost exactly five years ago.   Since then, I've had five pregnancies, two miscarriages, one stillborn daughter, and two incredible blessings in Baby B and Baby C.  I've been staring out the window at the spring blossoms on the trees remembering spring of 2013 when I thought I'd never have a child... and remembering spring of 2014 when Q had just died and I couldn't fathom feeling happy again... and spring of 2015 when I had B in my arms and was so filled with joy... and spring of 2016 after my first miscarriage when I realized how much I wanted to have another child... and spring of 2017 when we were in Japan and I'd had yet another miscarriage and was doing my best to stay positive, get healthy, and enjoy our travels amidst sadness, disappointment, and even some anger.

And here we are.  Thanks for following along on our journey.

(By the way, it was so fun to be surprised by the gender.  I was convinced we were having a boy and I'll never forget Rob's voice saying "It's a girl!"  More on the actual birth in my next post.)

Déjà vu

I had my NST this morning and the baby looked great - movements were as expected and no signs of contractions.  When I met with my OB following the NST, I mentioned that I have been having a lot of shortness of breath in the last week (more than previously), and not when I was doing anything.  At night when I try to read in bed, I cannot find a position (other than sitting up, criss-cross-applesauce) where I can get a "full" breath.

(I won't bury the lead - everything is fine)

Because of my history of blood clots in pregnancy, her concern was that, despite being on therapeutic anticoagulation (blood thinners - Lovenoax), I might have a pulmonary embolism (PE - a blood clot in my lungs).  Shortness of breath is completely normal in pregnancy, but you can't really be sure without getting a more thorough evaluation.  So, off to the ER I went.

I was initially pretty calm and felt certain that I didn't have a PE, but my EKG came back abnormal (which may be my normal, apparently EKGs are somewhat like fingerprints and each are different) and so the ER doctor felt that the abnormal EKG coupled with the shortness of breath meant I ought to have a CT scan.  I haven't had one before and when they ran through the litany of risks, I started to panic a bit (radiation exposure being the key risk for both Mom and baby).  

Mostly, the entire situation felt so similar to when I went to the ER with Q when I did have a clot and it went from being a normal day when I was pregnant to everything crashing down in a matter of moments.  I tried to stay calm, but I was alone and everything started to feel totally overwhelming.

In any event, my CT scan came back normal (no clots), the doctor recommended I have a follow-up EKG 2 months post-pregnancy to see if my EKG is still abnormal, and I went about my day, but the whole thing really shook me.  I am 12 days from meeting this baby and even being so very close, I know how many things can go wrong and yesterday just reminded me of that.

Needless to say, I'm looking forward to wrapping up work this week (Friday is my last day), and spending a week getting some rest -- and hopefully the week will be uneventful.

************************

One upside to spending 5 hours in the ER is that I finished the book I was reading, Everything Happens for a Reason by Kate Bowler.  I can't recall where I first heard about it, but Kate is in her 30s, a professor at the Duke Divinity School, a mother and wife, and battling Stage IV colon cancer.  The book interweaves her experience with cancer and motherhood with her religious background and I really enjoyed it (in the way one "enjoys" sad books).  There were a few passages that resonated with me that I wanted to share:

• The book is dedicated to her son, Zach: "Zach, my darling.  I can see now how my beautiful life was always for you."  I sometimes feel so completely overwhelmed by how much I love B (and Q of course) and that love has just shifted my perspective about so many aspects of my life.  I thought she expressed that sentiment so succinctly and perfectly.
• Kate describes the moment she learned she had cancer: "There was a before, and now there was an after.  Time slowed to a pulse.  Am I breathing? I wondered.  Do I want to?"  This reminded me of how I felt when I found out Q's heart was no longer beating.  My world stopped.  And for a long time, I wasn't sure I cared.
• Finally, these words: "I have had two perfect moments in my life.  The first was running down the aisle with Toban [her husband] on our wedding day, and we burst through the church doors and stood, breathless, alone as husband and wife, gazing at each other like complete idiots.  And the other was when they put Zach in my arms for the first time and we looked at each other like it was a conspiracy of mutual adoration.  These are my Impossible Thoughts.  These are my Can't-Live-Withouts.  I cannot picture a world where I am not theirs.  Where I am simply gone."  These words prompted me to think of the "perfect moments" in my life.

I highly recommend Everything Happens for a Reason and if you'd like to read something similar that may be the best book I've read in the past two years, I recommend The Bright Hour, another memoir written by a mother dying of cancer.  Both books really shook me to my core.

The Final Countdown

I'm 36 weeks pregnant today and have 2 weeks until my scheduled c-section.  After much deliberation, we pushed the date back to exactly 38 weeks so this baby will have a bit more time to grow.  There is the added benefit that, if all goes as planned, I will have all of next week off of work to relax, set up the room, and prepare for baby's arrival, plus spend some quality time with B.  This past weekend we picked up a crib from a friend who kindly offered hers to us (I sold B's crib and dresser last summer), borrowed a Halo bassinet and Dock-a-Tot friend a different friend, and moved everything out of the office so that it could officially become baby's room.  I have yet to go through any of B's clothes, but I have ordered diapers and wipes and will take the time next week to sort through B's newborn gear for gender-neutral clothes.

All things considered, I feel relatively calm about delivery and the next two weeks. I had a non-stress test last week and have another tomorrow morning.  As always, they begin with more stress since inevitably it takes a while to find the baby's heartbeat (every single time).  Even when I felt a kick moments prior, panic begins to set in.  

I can't tell if I have completely forgotten how I felt with B, but I FEEL very pregnant these days. I'm having shortness of breath, lightheadedness, and generally am completely exhausted.  I'm still getting to pilates a few times each week, but my energy levels are really low and I feel like I am letting B down in my lack of enthusiasm for running playing, climbing, etc. I truly don't recall feeling this way with B, but then I wasn't chasing a toddler, making meals, doing bedtime, etc.  I suspect I just came home from work and laid down? 

My OB again raised the possibility of tying my tubes and while R seemed ready to sign on the dotted line, I am not.  Do I think we will have a fourth child?  No.  Do I like even considering this before giving birth to a third baby? Absolutely not.  But do I like the finality of making this decision now?  No, thank you.  

B has suggested some classic names for this baby: Hot Sauce, Latte Shop, Stop Sign, Coffee, and Blythe.  We joked that if we had the baby on April Fool's Day, we'd send out an announcement saying we named it Latte Shop Levy because it has a nice ring. 

I am having trouble wrapping my head around the fact that it is April and that on the morning of 4/16, I will have a c-section and hopefully deliver a healthy baby into this world.  My due date with Q was 4/9 and it is ironic to me that this baby will be due so close to that date and that B was born 2 days shy of the anniversary of Q's death.  It is wonderful to have important dates to celebrate during times that would otherwise be marked solely by sadness.

So, that's the report from here.  T-minus 2 weeks. Two doctor's appointments remaining (and two more NSTs).  No more ultrasounds unless something unexpected happens.   We are crossing fingers and toes around here that nothing happens in the interim and that this baby arrives safe and sound.

I have been trying to take time to do little random acts of kindness for R and B and to pamper myself a bit.  Last week a friend and I went to see Hamilton, which was fantastic, and exceeded my expectations in so many ways.  I've been getting regular massages and have 2 more scheduled before baby arrives.  I'm letting myself enjoy my pilates class or a night out with friends rather than feeling guilty about it as I often do (this was a resolution for 2018).   I'm both so very excited to meet this baby and aware that our world is going to change and want to be sure B (and R) know how much I love them.  I hear over and over that loves multiples rather than divides, but I am nervous about making sure everyone knows and feels loved, especially B.

Oh, one final observation from this pregnancy.  Two things have happened that didn't happen with B that have totally weirded me out:

• I have been leaking milk for the last few weeks.  Not much at all, but it is there.  I hope this bodes well for breastfeeding again.
• My belly button has been "out" for weeks (months, really).  This didn't happen with B and I find it so creepy.  

I'll leave you on that happy note...