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.

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!

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.

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.

On Wanting a Second Baby (with infertility and after loss)

I had trouble even coming up with a title for this post.  I want to say "after infertility and loss" in the parenthetical, but we all know that once you are infertile, you are always infertile... even if you have a child and even if said pregnancy came about without any medical intervention.

See... I'm rambling already!

I ran my first marathon in 3 years yesterday and it was fine.  I had a decent race (for me) considering that I did one long run and very little running-specific training.  After my clot, I was told I might never run again (residual clot can mean lifelong problems with numbness, tingling, swelling, etc.).  I feel fortunate that isn't the case for me, and yesterday reminded me that I am strong and I spent a lot of time thinking about how grateful I am to be healthy right now.  I also spent miles 16 through 26 feeling so very sad that I was running through the streets of Austin, Texas while my husband and daughter were at home. There were waves of overwhelming guilt and longing to be home and with them that I just could not keep at bay.  It made me question whether training for a race is something I want to prioritize right now -- I was basically hyperventilating and trying not to start sobbing.  I think a lot of the feelings were real -- I was traveling for work 2 weeks ago and then away this weekend and I miss B (and my husband) like crazy -- and some of it was hormonal and some was exhaustion.  But man... it caught me off-guard and has left me feeling very conflicted about what it is that I want going forward (from the perspective of my personal goals and athletic endeavors, which were previously very important to me).  Walking through our door last night to this face was the best feeling...

That is all along introduction into what I really wanted to write about, which is that I am constantly thinking about another baby these days.  Getting a marathon under my belt this year was a goal and now that that is done, I know getting pregnant will increasingly be on my mind.  R and I talked this week and decided that, for now, we aren't going to pursue IVF.  I would go back to my RE in a heartbeat, but R was seriously traumatized by everything that happened when we lost L. For me, all I could think about was that my baby died.  My little L was gone.  But for R, he almost lost me and for now he is so happy that I'm healthy and happy and that we have B and that things are calm for us medically right now.  The idea of all the drugs and hormones and increased clotting risk, etc. is more than he wants at this time.  I also hesitate with being busy at work to add RE appointments into my schedule, knowing they would detract from quality time with B that is already so limited for me.And I am okay with that... for now.  We agreed to revisit in a few months or if either of us changed our mind in the interim.  To be clear, we would both love to have a second child, but R isn't convinced we should go through multiple rounds of IVF to have a second child.

Going forward, I'll resume taking my supplements and vitamins, track ovulation and we'll make an effort to give ourselves a shot at getting pregnant on our own each month.  With what we know about my fertility struggles, the odds are SO low of that happening.  On one hand, I've been pregnant twice after being told by CCRM (and others) that I would *never* have a baby that was genetically mine.  But on the other hand, I've been pregnant twice... and the odds of it happening again are SO low.  And then this line of thinking queues feelings of guilt... because we have amazing, joyful baby B and how can I be so greedy as to want another baby?

Do any of you have any super-secret getting pregnant tricks for me?  :)  Anyone else in a similar position and have thoughts?  I don't want to have any regrets, which is why we'll revisit the RE conversation in a few months.

A dear friend who had her first baby just a week before B was born just told me she is 7 weeks pregnant again and the jealousy that I'm feeling caught me totally by surprise and, frankly, makes me disappointed in myself.  Obviously her pregnancy has nothing to do with me, but it is JUST SO EASY FOR HER AND THAT IS INFURIATING.  I'm so jealous.  I find myself staring at pregnant women and wishing for their bump... and these reactions have confirmed what I already know, which is that I do want another baby...

[This is an incredibly disjointed post.  Apologies.]

Supplements & Such

Since my DOR diagnosis in March 2013, I've spent a lot of time reading books, studies, and blogs and listening to advice from doctors and acupuncturists about which supplements and vitamins I should be taking, what lifestyle changes can be helpful, and what I can do to get ready for the best possible IVF round.  I know it is impossible to know what "works," but to the extent something isn't harmful, I'll try it.  I'd love to know what others take, what advice you've received, etc.

These are the supplements and vitamins I currently take:

• Vitamin D 2,000 IU D2 (2/day)
• Prenatal Vitamin (1/day) (Prena1 Plus)
• 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)

This book offers some guidance on supplements.  What else do you take?  Any recommendations? I know some folks take melatonin with the Inositol, but I can't take it because of my clotting issues.

I've also been going to acupuncture once each week, eating gluten-free and with limited sugar and no caffeine or alcohol, and exercising moderately but not aggressively training for things like I normally do (I'm a big runner and triathlete).