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.

The Second Trimester

I'm just days away... I'll be 14 weeks at the beginning of next week, which means the arrival of the second trimester.  If it means that I'll stop feeling so fatigued, I'll take it -- my new job starts on Monday and I could use some extra energy.

Our MaterniT21 test results came back this week and everything looks good.  This combined with our 12-week ultrasound makes me feel slightly reassured, although I am still weighing the pros and cons of an amnio in the back of my head (I have a few weeks to decide).  We agreed to be surprised about the gender and I'm feeling really excited about waiting.  It's fun to ponder whether B will have a sister or a brother.  Driving home from school the other day she was telling me about her classmates who have babies (younger siblings).  She mentioned a few and then said "We should get a baby at the story."  This was completely unprompted by me.  I asked whether she wanted a sister or a brother and she answered "a brother."  When I asked what his name should be, she suggested we ask Forest (our cat).  Obviously he has all of the answers.  B will have a baby brother named "Meow".

According to "The Bump", this baby is a lemon this week, which makes me nostalgic for my pregnancy with Baby L / Quinn.  We called her "Lemon" throughout my pregnancy (we called Baby B "meatball").  Somehow that fruit just stuck and since our last name begins with "L", it had nice alliteration.  I remember how joyful R and I were just to be pregnant and how much fun I had reading about the baby's development each week.  I wonder if we'll ever get to a place in this pregnancy where we feel that way -- I know I could get there, but I think I need R to lead the way and I just don't see that happening.

I was just thinking that, like Lemon and Meatball, this baby needs a nickname, but I realized B already took care of that - Meow!

**********

On a completely separate note, this article in the NY Times this week was fascinating.  For those of you with POF/POI and/or low AMH, I recommend reading it.  Essentially, the article concludes that "AMH doesn't dictate a woman's reproductive potential," although it is one marker used to assess overall fertility.  What this study concludes is that "Among women attempting to conceive naturally, diminished ovarian reserve was not associated with infertility; women should be cautioned against using AMH levels to assess their current fertility."  These findings are certainly in line with my experience, which is that while I've been pregnant five times, I do have an issue with egg quality (hence two miscarriages) and I don't always ovulate regularly.  Plus, a friend who endured numerous IVF cycles while living abroad in various places mentioned to me that doctors outside the United States place a much lower value on AMH as a predictor for getting pregnant than they do on follicle count and FSH.  

Thanksgiving & Clomid Cycle

Happy Thanksgiving, friends!  We are back from a week-long trip to Boston that was mostly really enjoyable.  We saw a ton of friends and family and even did some city exploration, including one day where I had the day to myself in Boston with nothing to do and it was glorious.  You all know I love B more than anything in the world but man was six hours alone in a city so incredibly rejuvenating and fun.  I went shopping, had a quiet lunch, sipped coffee, walked, and just thought about... who knows what?!  I'm feeling like a bullet-point list is the way to go today to share more about my Clomid cycle and about life in general:

Fertility Update

• I'm halfway into my first cycle on Clomid.  The Clomid didn't affect me at all. I was particularly worried because my father-in-law knows how to push my buttons and I didn't want to be emotionally a wreck around him but I actually felt quite good.  I'm very thankful for that knowing what some friends have experienced while taking Clomid.
• Since we were traveling, I couldn't be monitored at all so I have no idea if it did any good and we couldn't draw day 3 labs.  Next cycle we will if that happens before we leave for our trip.
• Dr. A did draw my AMH the last time I was in and it was 0.23.  I know this is still a terrible number, but mine has always been undetectable (which I am told means below 0.1) so I'm taking that as a positive sign, even if the improvement is infinitesimal.  We'll check FSH and do a follicle count with the next cycle.
• I have no expectation that I'll get pregnant this cycle, but I'm feeling good, I had EWCM, and according to the OPKs, I ovulated.  

General Update

• If I hadn't miscarried this spring, I'd be due now.  I'm having a harder time with this than I expected.
• Every one of our friends in Boston seems to have just had a 2nd or 3rd baby, is pregnant with a 2nd or 3rd, or already has 3 children. When did 3 become the new 2?  
• We had dinner with friends who we don't keep in touch with regularly who have a daughter 4 months younger than B.  They had trouble getting pregnant with #1 but she surprised us and is 6 months pregnant with #2.  I always thought of them as our friends who might, like us, just have one, and who understood what a struggle having a family could be.  I know two babies don't erase that struggle, but seeing her pregnant belly made me have a minor meltdown.  
• I may finally be accepting that pregnancy will never be an easy topic for me and will always trigger jealousy and other unpleasant emotions and I probably just need to figure out how to manage and accept those feelings.  I thought I might feel differently after having B, but it isn't entirely true.

To end on a happy note, I LOVE the holiday season and B is SO excited about Christmas, the tree, snow, candy canes, stars, etc.  Even though we are running around like crazy trying to get everything ready to leave for a year, it is going to be a great holiday season.