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!

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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.  

12 Weeks

Today was the 12-week ultrasound where nuchal translucency, etc. is checked and I had blood drawn for the MaterniT21 test.  The ultrasound looked great - baby was moving around, putting its hands/fingers in its mouth, etc.  R came with me and this was the first thorough u/s he has attended, which was fun.  My OB sends patients to the high-risk OB at 12 weeks and 20 weeks (and I go to have clotting monitored) so today we met with the high-risk OB who talked us through options for prenatal genetic testing.  We'll start with the MaterniT21 and go from there, but of course my history of POF, infertility, and miscarriage, I want to know everything that we can, but I do not want to take any unnecessary risks (e.g., amnio).  When they say that, statistically, it is very safe, I know that is true rationally.  But I've been at the wrong end of very good odds several times, so I no longer am comforted by slim chances.

Here's a little shot of our little one.  R and I are considering being surprised this time.  Thoughts? Have any of you waited?

Anyone up for a little bathroom talk?  B used the toilet (unprompted) numerous times over the weekend and woke up Monday morning and told me she wasn't wearing a pull up to school.  We went with it and she was accident free all day and pooped on the toilet three times (good lord).  I guess if you wait long enough, your child will potty train herself?  I know there will still be accidents, but she does seem to be doing really well, particularly at school.  I'm sure it helps that her classroom is children ages 2.5 through 3.5 so she is at the younger end and most are toilet trained and thus set a good example for her.

I'm still in a state of disbelief about things. I haven't told my parents and I've told only a few close friends.  My slightly protruding belly is going to start giving things away in a few weeks, though, and I have no idea how I will broach this topic at work.

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.

36

 Today I turn 36.  After Chelsey's death, I promised myself I would celebrate birthdays every year from here on out, so I'm doing it.  R brought my breakfast and coffee in bed, I read to B all morning and came to work late, and tonight we are celebrating with friends.  I'm trying not to let myself dwell on the fact that even if I didn't have POF/POI as a diagnosis, I am now firmly in the "advanced maternal age camp."

Things have slowly been improving in terms of emotions and hormones.  I appear to be having another normal cycle (are you sick of hearing about my cycles yet?) and I'm feeling good.  I found a nurse practitioner who specializes in menopause in Denver (Cece Huffnagle) who is fantastic and has been incredibly helpful.  We talked through making sure I'm comfortable (e.g., stopping hot flashes, helping with dryness, regulating the emotional swings) without preventing the possibility of pregnancy.  She prescribed a cream for me to use that is super low dose and has helped and also is having me take progesterone every day from ovulation until cycle.  If, miraculously, I fertilized an egg, I likely wouldn't be producing enough progesterone to support the pregnancy so this would help.  There isn't any harm in taking it, so I'm doing it.  And I'm still continuing with all of the herbs and supplements.

"Kiss. Pumpkins."

We are slowly planning our trip!  We leave for Kauai on January 2nd.  It's amazing how much more tolerable coming to work is each day now that I have an end date.  I'm also taking my time in the mornings, reading longer with B, hanging out for a bit with her and our nanny (who I love), and having coffee with R.  Anyway, that is the not-so-exciting update from here.  I'm so glad it is fall.  B will be a flamingo for Halloween (she is obsessed) and loves kissing pumpkins (on anyone's porch or in anyone's garden).  She has so many words and she constantly amazes me with the new phrases she says.  She's obsessed with reading (particularly Toot & Puddle, Olivia, and "Higher Higher").  I couldn't love this girl more!

September, Sadness, and A Year of Travel

It's been six weeks since my last post and there has been a lot going on.  Frankly, there has been so much going on in our lives that I haven't had much time to dwell on my wacky cycles and getting pregnant and it has been a welcome break from the subject.  To briefly mention it, I've had two more cycles, one that was 35 days and one that was 19.  I don't think I ovulated either cycle.  C'est la vie.  I feel fine and haven't been having any menopausal symptoms, so I'l take it.

Two things have dominated my life in the last few weeks:

First, my best friend died.  I don't know how to share this news without being blunt.  In a period of my life that seems to be marked by grief (as well as by extreme joy), this is yet another example of how life can be so incredibly cruel.  At the same time, her death is a reminder to live each day to the fullest.  Each night when I read to B and rock her to sleep, I smell her head, kiss her cheeks, and tell her how much I love her and relish those moments because Chelsey doesn't get to do that to her little ones anymore. It breaks my heart.  She was the first person with whom I shared my infertility news, the first person at my side after Quinn died, the only person other than Rob who attended ultrasounds during my pregnancy with Blythe, and the friend I visited for coffee immediately after my miscarriage this spring.  We've been through so much together and I don't quite know how I'll get through more without her.  But I know I will because she was the toughest lady that I know and I'll use that as my inspiration.

I'm not particularly religious.  At times like this, I really wish that I were.  Chelsey's father passed away a year to the day before Quinn.  She always talked to me about how Quinn was in heaven with her Dad and he was talking the best care of her for me.  When I got pregnant this spring again, she said "thanks, Dad and Quinn, for sending Darcy another baby."  And now the only comforting thought I have about Chelsey is that she is with her Dad (who she missed dearly) and with Quinn.  I know she believed that she would be, so I'm going to believe it, too.

This photo is of me and Chelsey after our marathon in June (I'm on the right).  She was the kind of friend who would agree to run a marathon in 6 weeks because you had a miscarriage and need something to work toward.  This won't be the last time I mention her on this blog, but that's all I can say for now.  I miss her dearly and keep waiting for her to text me about our next long run or dinner with the kiddos.

Second, we have made a momentous decision: we are taking 2017 as a year to travel.  We have booked tickets, departing January 2nd, for Kauai.  From there, we'll head to New Zealand and Japan and then to Europe.  It's a crazy decision, but it felt like the right time for both me and R in terms of work.  I'm desperate to spend more time with B and with R.  It's been a tough couple of years and it will do us some good to relax, travel, spend time together, and just enjoy life.  We aren't putting ourselves in any financial hardship by doing this trip and we are so excited.

Given that we are all acquaintances via the Internet, this probably sounds insane and like something I'm making up.  I'm really not.  I will be blogging about the trip on my regular blog, which you are all welcome to follow (although we aren't leaving until January): www.darcyeden.com.  I just ask that you please respect the fact that I talk about Q and infertility in a very different way in that space (which is not very much - I'm not ready) and REALLY do not want this space revealed on that site.

It's hard to be joyous about this adventure giving Chelsey's death.  It's actually astonishing to me how differently I'm experiencing grief about Chelsey as compared to Q, but I think that is a topic for another post.  I haven't wrapped my head around it yet.

Hug your husband, wife, partner, parents, family, littles, etc. extra tight.

August Update & Pregnancy on HRT

Summer is moving along here.  We've taken a few weekend trips in Colorado and have another one coming up next weekend.  It's been so fun to enjoy the beautiful weather, the mountains, swimming, gardening with B, and generally just watching her become a little person.  She has started using two word phrases and is VERY opinionated.  I hear "no" a lot these days, but she is also extra into her Mama, which I secretly love (whenever I find it overwhelming, I remind myself that soon she will be too big to hold and then likely a teenager who hates me).

Miraculously, I just had a normal, 28-day cycle during which I had EWCM and according to the OPKs ovulated.  I didn't get pregnant, but I did feel pretty normal the entire cycle.  I could tell my period was about to arrive because I became insanely irritable... like I knew what was coming out of my mouth was an over-reaction, but there was nothing I could do to stop it.

I'm seriously considering starting a very low dose of estrogen (0.1 mg/day) even though my menopausal symptoms have all but ceased.  I still feel emotionally a bit on edge and I think the estrogen will help.  The dose is so low that it wouldn't prevent me from getting pregnant.  I've read this post over and over and my doctor said the same thing - you can absolutely still get pregnant on HRT.  I've read this study and this one, too.  Does anyone have experience with HRT, whether just in general or getting pregnant while doing HRT?  Any thoughts, advice from a doctor, etc.?  I'm desperate for more information on this topic and it doesn't seem to exist. What I'm really wondering is whether your odds are better trying to get pregnant while on HRT if you still have some ovarian function or whether it is better to not be on the estrogen if you are still ovulating?  I suppose it is time to make an appointment with my OB again...

Happy end of summer to everyone!

What the what?

First of all, Happy 4th of July!  We spent a long weekend (5 days) in Seattle visiting a bunch of friends and had a blast.  The weather was cooler, there is tons of water (obviously), and we enjoyed delicious oysters and great craft beer.  Oh, and Blythe rocked some seriously cute red, white, and blue!

So much attitude these days. I love it (I know I won't when she is 16).

Second, my body is doing some crazy things lately.  I have been feeling better (as I said in my last post). I saw my OB to talk HRT on 6/28.  We developed a plan, talked next steps, and I promptly came back to work and got my period.  She also re-ran my FSH since I was feeling better and it was 7.7.

7.7!  From 59.

This swing fits with what every doctor has said to me - DOR/POF is unpredictable.  I could have these swings regularly, it could have been the miscarriage, they just don't know.  So, we'll see. In the meantime, I feel better.  I'm less irritable, I feel positive again, I'm less snappy (poor R), and I just feel like me.  I can't ask for much more than that.  For now, we will hold off on HRT and see what happens.

Chin Up!

I'm not sure what has changed since my last two posts, but I'm happy to report that I'm feeling much better. The malaise that has been hanging over me since my miscarriage has, for the most part, lifted.  I've decided that despite the horrible test results I got, I'm not giving up on my body.  I refuse to believe that I can go from regular cycles to menopause with one miscarriage, even if that makes me a fool.

So, I'm back on all of my supplements, the herbs recommended by my acupuncturist, and I'm going to see my OB next week about hormone replacement therapy (HRT).  I'm also going to see a local NP who specializes in natural HRT.  If I'm going to start pumping my body full of hormones, I'm going to do some research first.

Whether it is the shift in my attitude or an actual change in my body or the herbs/supplements, I haven't had a hot flash in two weeks and my other symptoms have gone away.  Like writing in the early days of pregnancy, I feel like a fool for publishing this post in some ways.  I know what my numbers are.  I know what the odds are of ever getting pregnant.  And I know that I'm in perimenopause.  But I'm not giving up.

In the meantime, how could I stay sad too long with this sassy, adorable one in my life? 

I also ran another marathon last weekend.  While I have always enjoyed running and have never had an issue with mental toughness, in the two races I've done this year, I've had absolute mental collapses around mile 18.  I become really negative, I've shed tears (crying and running do not go well together), and I've questioned whether I can finish (even though there is no doubt than I can physically).  I've concluded that marathoning is something I am really not enjoying right now, so I'm taking a break.  I'm still going to run, but I'm going to do more pilates and swimming and mountain biking and things that I'm actually enjoying.

So, that's the update.  Call me crazy for not just throwing in the towel, but I'm just trying to keep things real and honest on this blog.  So there it is.

The "M" Word

I've known this day was coming since my dreaded diagnosis in early 2013 of premature ovarian failure / diminished ovarian reserve.  I'm 10 weeks out from my miscarriage and still no sign of my period.  I gave in and had a blood test run last week to check Estradiol levels and FSH.  Given the recent hot flashes I've been experiencing, the results are not surprising:

Estradiol: undetectable
FSH: 59

I'm officially in perimenopause.

How I can go from being pregnant to menopause in one cycle is completely baffling (especially since I'd had 3 normal cycles prior to the pregnancy).  But I have.  As explained by my OB, this doesn't mean I won't have cycles again as hormone levels tend to fluctuate, but I should assume that my baby-making days are over.  I'm going to start hormone replacement therapy.

Menopause.  This is something that my Mom talks about.  That women in their 50s deal with. How am I here?

Nevertheless, I am.  Please don't think for one second that I don't count myself lucky every time I look at Blythe, think about Blythe, kiss her cheeks, hug my husband, etc.  Over the past three years we have faced infertility, failed infertility treatments, a stillborn daughter, me almost dying from a blood clot in pregnancy, a miscarriage, a myriad of health concerns, and, most importantly, the birth of our living daughter.  She is a miracle and I count my lucky stars every day for her life.

But does that change the fact that I dream of having another living child?  Not at all.

I'm an only child and I loved my childhood. I think we can give B a wonderful upbringing on her own. But I really would have liked her status as our solo living little one to have been our choice.  I'm resenting the fact that this decision has been made for me, and frankly in such a cruel way.

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I have the impression that most of my readers are here because we share the common experience of losing a baby, but if any of you out there have experience with POF/DOR. I'd love to hear your thoughts/experiences.  Have you had wild fluctuations in hormone levels?  Any advice/guidance?

Crickets

I've been quiet over here for the last six weeks.  April was a very hard month for me.  I foolishly thought I would just bounce back from the miscarriage and feel like myself again right away, which proved to be the exact opposite of what happened.  Despite doing everything I could think of for self care (running, pilates, sleep, acupuncture, a weekend away), for the first time I felt like I was truly depressed.  After we lost Q, I wasn't depressed - I was devastated and grieving and angry.  I'm sure under all of those emotions, I was depressed, but this felt different.  It was just like there was a dark cloud hanging over my head that I couldn't push away no matter what.

To make matters worse, I've been having hot flashes.

A likely outcome of having premature ovarian failure and diminished ovarian reserve is that I will go through menopause much earlier than most women.  Thus, the hot flashes have been absolutely freaking me out.  I have been scared to tell anyone because I sometimes feel (even though it is nonsensical and absurd) that if I say out loud "I am having hot flashes" it somehow will make it more true than the physical discomfort of heat creeping up my body.  Ha. 

I finally went to my OB last week.  I told her about the hot flashes and about how I've been feeling. She prescribed Zoloft (more on that later) and we discussed the hot flashes.  They could mean I am in perimenopause or they could be related to my hormones being out of whack post-miscarriage.  I still haven't had a period following the miscarriage (8 weeks), so I'm taking Provera to force my body to have one.  

Needless to say, I'm feeling totally unlike myself and like things are totally out of control as it relates to my body and fertility.  That said, just having the Zoloft at home has made me feel better - like knowing I could take it has made me feel better.  I've felt more like myself this week than I have in ages.

As part of trying to feel better, I dialed it back on blogging and reading blogs.  I have relied on this community so much in the past few years, but sometimes I go down the rabbit hole of re-reading people's stories of loss and infertility and it just sucks me in.  And when I'm already feeling so overwhelmingly sad and gloomy, I've been trying to avoid making it worse.  

Thanks to those of you who are still reading and many of you who I know understand.

Spring

I had an ultrasound on Tuesday that confirmed the Cytotec worked and I don't need a D&C.  Now that  I've officially miscarried, I feel some closure and am trying to put this behind me and get back to feeling happy and positive.  Suffice it to say that this hasn't been as easy as I hoped it would be.  I've found myself a bit of an emotional disaster the past week.  I'm happy one minute and sad the next and my anxiety is through the roof.  My OB prescribed some Xanax (unsolicited - she just thought I might want it), which I've never taken before but am very tempted to try.

I keep reminding myself that my HCG is probably only just back to 0 and so I'm sure my hormones are all out of whack.  Plus, last week was Baby L's due date.  That date doesn't weigh on me as much as the anniversary of her birth, but I do find myself thinking "L would be 2 this week" and other related thoughts.    

Anyway... most of you know how the emotions go after a miscarriage (unfortunately), so I won't drone on, but I don't yet feel like myself.  I can be happy all day and the come crashing into a terrible mood and a total funk where I am upset with R and just want to cry and/or be grouchy for no obvious reason.  Please let this pass quickly.

I did sign up for a marathon in June (my version of therapy), I've started going to acupuncture again because I find it incredibly relaxing, and I've been having so much fun with B when I'm not at work, especially since we've been having amazing spring weather and she loves to roam the neighborhood with me looking at flowers and leaves.  Photo below of her scoping out our neighbor's bush that has beautiful yellow flowers (at least until this weekend when we are supposed to be hit with a massive snowstorm).  B has finally learned how to smell something rather than always trying to put everything in her mouth.  

This miscarriage has made me think a lot about how much we are willing to go through to have a second child.  Of course it is what we both WANT, but given my AMH level, FSH, follicle count, etc., everything suggests that my egg quality is low, which means a higher risk of miscarriage and chromosomal abnormalities.  IF I even get pregnant again, the odds are higher than normal that this could happen again.  As of right now, I still want to continue trying to get pregnant, but I don't know how many miscarriages I can handle.  I know many of you out there have been through this many times, but after losing L and given what we know about my fertility situation, I think there may be a point when we decide that B is a healthy, happy, fun, joyful little girl, we are thrilled to have her, and having one living little one is enough. 

We also booked a trip to Cabo for the first weekend in May.  A little vacation with beach time should help.

Beta #2 & Luck?

Phew.  Another deep breath over here.  My second beta came back at 151.  I'll wait now until what should be the 6 week mark and have an ultrasound to see if there is a heartbeat and things are developing appropriately.

I have a dear friend who went through years of struggling to get pregnant and is about to have her second baby thanks to IVF.  We have been a constant source of support for one another over the last 3 years with our various struggles.  She said to me the other day that she thinks I might be one of the most fertile of her friends.  She and I are very close and I know she didn't mean anything negative about what she said, but the comment has been repeating in my head since she made it.  And it makes me feel guilty.

R and I tried for almost a year to get pregnant the first time, and in the middle of that year I found out that I have Premature Ovarian Failure (POF) (now they call it Primary Ovarian Insufficiency, but once someone tells you that you have a condition with the word "failure" in it, it tends to stick with you).  I was told verbatim that we were "never going to have a child using my eggs."  My own OB (who I consider a dear friend at this point) told me that I should use donor eggs. Everything was so incredibly grim, as many of you can relate.  And then it got worse after I had my surprise pregnancy with Q and we lost her.  I thought I had already hit rock bottom when we got the infertility news, but little did I know...

And then we got lucky again.

But here's the thing... I don't know how much this helps/matters, but the first two times I got pregnant, I had an ultrasound (coincidentally) the day I was about to ovulate. I happen to have gone in for ultrasounds for another reason (in both cases b/c I was having an extremely long cycle and we were seeing if I had a cyst or some other issue), only to see an ovary entirely covered by an egg.  Both times the sonographer and doctor said it could be an egg or it could be a cyst, but if an egg I was about to ovulate, so it was time to "get busy."  So, yes, I've been pregnant twice without intervention, but I did have really good intel as to timing intercourse, not to mention doing acupuncture, taking supplements, having changed my diet, etc.

I didn't have an ultrasound recently, but I have been tracking my cycles, taking DHEA and various other supplements, and generally being healthy with exercise, eating right, and not drinking.  And I have been getting my period since November so it has been almost six months.

I'm being incredibly inarticulate, but somehow I'm feeling guilty about her comment and generally about writing a blog about infertility and loss when I've now had 3 BFPs. Sure, I have only one living child right now (and now the hope for one more) and certainly we've been through the ringer, but I can think back to how I felt 3 years ago when I got the POF diagnosis and how hopeless I felt and I think I might have been totally irked if I read my own blog at that time.  Either that, or it might inspire hope, which I hope is the case.

Regardless, I just want to say that despite losing Q and struggling through the devastation that is having a stillborn child, I do feel lucky that we got pregnant again, against all odds.  Please don't think that for one second I forget how fortunate I am and how grateful I am for our little B.

My ultrasound is scheduled for March 28th.  Fingers (and legs) are crossed.

Book Review - It Starts with the Egg

I don't know about you all, but I obsessed with reading the latest books and research about infertility.  I particularly enjoy those that offer some practical tips for things that we can do without drugs to improve our chances of conception.  It helps me to think I am doing everything I can to facilitate getting pregnant - it is nice to have control over something through this process.

Image via Amazon

Author Rebecca Fett just published It Starts with the Egg.  After being diagnosed with DOR prior to turning 30, the author, who has a degree in molecular biotechnology and biochemistry and is a practicing lawyer, wanted to do everything she could to improve her egg quality.  I thought I had read everything on this subject, but Ms. Fett opened my eyes to additional (easy) lifestyle changes to improve egg quality.  The following are the key takeaways:

• BPA - Recycle your plastic Tupperware and buy glass.  This article from The Kitchn offers reviews of various options. Drink from glass containers (Life Factory makes my favorites) instead of plastic water bottles.  Eliminate other plastic items from your kitchen.  Think mixing bowls, measuring cups, coffeemakers (switch to a French press).  This is particularly important if these items are ever heated as the heat releases more BPA.  Only purchase canned food if the can is specifically labeled BPA-free.  The only current product line that is completely BPA free is Eden Organics.
• Phthalates - Phthalates are known endocrine disruptors and you should do your best to eliminate these from your life.  You'll find most of them in your bathroom in nail polish, cosmetics, lotion, hair products, etc.  The Honest Company makes a number of products that are phthalate-free and this article offers helpful tips on how to eliminate them from your life.  Start with scrutinizing the labels on your perfume, deodorant, shampoo, conditioner, lotion, laundry detergent, etc.  You are looking for the terms phthalate (can be buried in a longer word), DEP, DBP or fragrance.
• Food - Generally eat organic fruits, vegetables, and meat and avoid processed food.  Depending on your specific issue, going gluten-free may be helpful.  Regardless, you want to stick to low glycemic index foods (particularly grains), which predominantly means whole grains such as quinoa, couscous, kidney beans, lentils, and chick peas. Avoid white flour, pasta, bread - anything that is a "simple carb" containing white flour.  Sugar should also be avoided.  Basically you should be eating the things you know you should eat and that are good for you.
• Caffeine & Alcohol - Studies vary and everyone has an opinion on this one, but best to avoid both, particularly if you are preparing for an IVF cycle.   
• DHEA -75 mg day from a reputable source (like a compounding pharmacy).  Mine is prescribed by my RE.
• COQ10 - 300 mg/day taken in the morning with protein.  
• Thyroid & Vitamin D - Get both of these checked and get them into normal ranges.

Even if you have read all sorts of books and blogs on this subject, I think there is new information to be gained by reading this book.  Do any of you have recommended reading?