Back Story : Clomid Cycle #1

So, in November 2011, Dr. M gave me a prescription for Clomid to induce ovulation. The dose was 50mg on cycle days (cd) 3 through 7, and we were told to "do the deed" (DTD) on cd 13, 15, and 17.

On December 28, I began what could best be considered as a light flow. It was more than spotting but less than a full blown period. I called Dr. M's office and the nurse I spoke to said that Dr. M likes to see a "constant flow" in order to judge when cd 1 is. "Well," I thought, "it IS constant.... just low in volume," so I decided to make December 28 officially cd 1. On December 30 I took the first Clomid pill. Fortunately, I experienced no side effects from the Clomid other than a warmer than normal body temperature and a tendency to get mild hot flashes. Some women experience more side effects, including mood swings and increased emotions - like an extreme case of PMS. If you've never tried Clomid before, I would not let the possibility of side effects deter you - the drug absolutely works for many women, but you won't know how you react to it unless you try it.

While I was taking the Clomid, I was doing some research. I belong to a message board for those who have been diagnosed with PCOS, and in particular I follow a thread dedicated to those of us who are on Clomid. Some women there said that they found they were ovulating early with the Clomid, and others said they were ovulating late in their cycle. So, I got the bright idea to extend the time period when we should DTD. We were active on cd 9, 11 and 13..... but then the notion of scheduled "relations" got old. Really old. More for Mr. Lost than for me, but still - scheduled "relations" are not fun relations. We've since learned that you need to up the romance factor to make up for the schedule factor.

We refused to feel bad about the fact that we didn't DTD as much as we probably should have, because we weren't even sure if this cycle would really work or mean anything, thanks to that "is this a period or isn't it?" scenario on December 28.

Beginning around day 9 or so, I also began using an ovulation predictor kit (OPK). The version that I used required you to pee on a stick (some versions use strips of paper). I never saw any positive results from this test, so I was convinced that I didn't ovulate. On cd 21 I went for a blood test to check my progesterone levels - this is the only monitoring that Dr. M does in a Clomid cycle. Other gyn's and nearly all RE's will do ultrasounds to check follicles and whatnot, and this is something we will be pursuing in the future. For this first cycle of Clomid, my cd 21 progesterone was around 3.8.

Now, internet research will tell you that for a "normal" cycle, that number should be around 5 if not higher. The production of progesterone is triggered by ovulation - no ovulation, no progesterone gets made. The progesterone is needed in order to ensure that the lining of the uterus is thick enough to support implantation of the fertilized egg. The progesterone level will climb after ovulation, but if no fertilized egg is implanted, the body is given the signal to stop producing progesterone. That sudden decrease in progesterone is what brings about the next period.

So. My number was only 3.8, but Dr. M was confident that I had shown a response to the Clomid and had ovulated. That had me excited, and I did the normal girly things - my personal Pinterest board suddenly had a "Project Baby" category, full of cribs and nursery sets and birth announcements. I was trying very hard to not get my hopes up, but it was hard to not get excited about the possibility of being pregnant.

Dr. M instructed me to take a home pregnancy test (hpt) on cd 28 if AF had not shown up. If it was negative, I was to wait - if AF had not shown up by cd 35, I was to test again. If that test came back negative, I was to call the office for a serum pregnancy test (blood test). I think I must have tested 3, maybe 4, times between cd 28 and cd 34, which is when AF decided to rear her ugly head. This time around, though, there was no mistaking her - she was definitely a full-fledged period.

So, Clomid Cycle #1 was a bust. Our disappointment was slight and very short lived. As I indicated above, we weren't even sure if this cycle would mean anything. We had come to regard it almost as a "trial run," to see how I would react to the Clomid, to see if 50mg was a strong enough dose, etc. So, no bad feelings - we were just ready to take what we learned into the next cycle..... which is where my next post will pick up. See you then!

Back Story : 2010 to the Present

So let's catch up, shall we? In June 2009, I lost my job and my health insurance. In November 2009, we moved back to the town I grew up in and regained health insurance. Up through this point, I was not taking any meds to control my PCOS or prevent pregnancy. I was (carelessly?) cavalier about the whole thing - if it happened, it happened, but I was pretty sure it wasn't going to happen.

Moving back to this area after 7 years away meant finding all new doctors. Coincidentally, during this time period one of my Facebook friends (let's call her Ms. Hepburn), someone I've known since elementary school, "liked" a page or group relating to PCOS. I saw that and sent her a message. Despite the fact that we hadn't been all that close recently, I figured it was worth a shot. I explained that I saw her update and was wondering if she had PCOS, too. I also mentioned that I was looking for a gyno. Ms. Hepburn gave me the name of Dr. M and said that it was Dr. M who diagnosed her, that she was a great doctor, great personality, etc.

In the fall of 2010 I made an appointment to get an annual exam and get on the patient roster for Dr. M. We were finally ready to start our family, so that was a topic of conversation as well. Dr. M was familiar with Metformin as treatment for PCOS and gladly gave me a prescription for 1000mg per day. We settled on that dose because it controls my insulin and glucose without overdoing it on the side effects. Dr. M indicated that many women are able to ovulate and successfully conceive with just the Metformin alone. I wasn't as optimistic as she was, but she wanted to give it a full year to see how it would regulate my cycles.

It turned out that the Met brought about visits from AF about once every 60 days - so twice the "normal" cycle length. At my annual exam in November 2011, Dr. M indicated that she was OK with that cycle time ... but I wasn't. She had mentioned in 2010 that the next step after Met would be Clomid, a prescription drug that induces ovulation. So I brought up the Clomid at this visit in 2011. She was totally on board with prescribing it for me. I had some other medical issues (unrelated to my fertility) to clear up, so I waited before starting the Clomid.

Clomid Cycle #1 began at the very end of December 2011.... and you know what? I think this is a good place to take a break. These posts have gotten pretty darn long, so what do you say we maybe give each Clomid cycle it's own posting? Sound good to you? Great. Until next time, then.......

Tasty Tuesday : Low Carb Muenster Spinach Pie

Tasty Tuesday is a weekly feature designed to share low carb and / or healthy recipes. 

A low carb diet has been suggested as an appropriate method for weight loss for women who have been diagnosed with PCOS, but as always, please consult a medical professional (doctor, dietitian, nutritionist) before embarking on any healthy eating plan. 

Low Carb Muenster Spinach Pie

Source: www.food.com

12 ounces muenster cheese, sliced

2 (10 ounce) packages frozen chopped spinach, thawed & drained

2 eggs

1/3 C grated Parmesan cheese

1 (8 ounce) package cream cheese, softened

salt to taste

pepper to taste

garlic powder to taste

1) Preheat oven to 350F (325F if using a glass dish).

2) Line quiche dish or 9 inch pie plate with 8 ounces of muenster cheese slices.

3) Carefully pres all of the water out of the spinach and place in a large mixing bowl.

4) Add eggs, Parmesan cheese, cream cheese, salt, pepper and garlic powder and mix well. 

5) Spoon mixture into cheese-lined pan and top with remaining slices of muenster cheese.

6) Bake for 35 minutes. Allow to set up for 10 minutes before serving. Yield = 8 servings. 

I selected this recipe because it reminds me so much of the spinach dish they serve at our local Chinese buffet. 

NOTE : If you are following Weight Watchers, this works out to be 8 Points Plus per serving. 

Back Story : 2003 - 2009

When we last spoke, I had said that I faithfully took The Pill with few problems from 1999 until 2003, and that I saw Dr. R faithfully until 2002. Let's pick the story up once more...

In May of 2003, Mr.  Lost and I were engaged and planning a fall wedding. AF had been coming along more or less normally, but by May she had gone missing again. Being more than a little bit paranoid, I peed on a stick or two (home pregnancy tests, or HPTs) but got a BFN (big fat negative). Puzzled, and still paranoid, I found myself a new gyno in the town I had been living in for less than a year. The initial exam was fine, and I don't really remember much about it. She did bloodwork which showed that I wasn't pregnant, and she switched me to a different brand of The Pill. For a few months, AF came quite regularly... and then she disappeared again.

Once again paranoid about being pregnant, I scheduled an appointment. The gyno I saw in May was ironically out on maternity leave, so I saw a nice older doctor named Dr. B. Once I got over the fact that Dr. B very strongly resembled Santa Claus, we got along swimmingly. Great personality, truly caring and none of Dr. R's infamous anal probes. He switched my pill again..... and a few months later, he switched it again..... and a few months later, he switched it again..... You get the idea. AF would visit regularly and then disappear mysteriously. I think I was on 4 or 5 different versions of The Pill after my initial prescription for it. Dr. B changed the dosing so that I would only get a period 4 times a year instead of 12, even though I saw AF's monthly visit as reassurance that I wasn't pregnant. He was part of the camp that said that women don't need to menstruate every month, whereas I was of the camp that saw getting a period as being "normal" and as an indication that I wasn't pregnant. Starting a family was just about the furthest thing from our minds at that point.

Finally, Dr. B reached a point where he (very nicely) said, "I can't do anything more for you. I think you should see a Reproductive Endocrinologist (RE) who can give you more assistance and find out what is going on with your PCOS." Up until this point, no one had ever really done anything for my PCOS - we weren't interested in having kids, so there was no need to really do anything.... or so they had thought.

I believe it was in 2005 or 2006 that I had my first RE visit with Dr. H. She was a very nice woman who was the first to enlighten me about the connection between PCOS and the insulin/glucose cycle. She also ordered up my first transvaginal ultrasound. Oh the joys of being probed with a wand. I learned that my left ovary apparently likes to hide - that was an uncomfortable lesson to learn. More bloodwork ensued. She was a big fan of the glucose tolerance test (GTT). That test, in one word = YUCK. She wanted me to lose weight - at least 10% of my current weight - and she suggested the South Beach Diet (more on my diet history in another post). She put me on yet another version of The Pill. She also gave me a prescription for a diabetes drug known as Metformin (the generic form of Glucophage). It's been shown that if you regulate insulin, you will in turn regulate testosterone and ovulation. Met came with some unfortunate side effects (stomach-related, namely diarrhea). I had done some research on my own and found that if I was on the extended-release version of Met, the side effects may be diminished. Unfortunately Dr. H didn't acknowledge or accept that there were two different versions of Metformin. Instead, she switched me to Avandia.. I had been on Avandia for a month or two when I was scheduled for a re-check with Dr. H. At that visit, one year after our first, she told me that she was leaving the practice for personal reasons. At my next check-up, I began seeing Dr. H's replacement - Dr. L.

My first visit with Dr. L. was in 2007 right as the news about the risks of taking Avandia was hitting the airwaves. In a "better safe than sorry" move, Dr. L took me off of Avandia and put me back on the Metformin - the extended release this time, thank God. She may or may not have changed my prescription for The Pill - I really don't recall. I do know that she was not a fan of the GTT, and instead looked at fasting insulin and glucose, as well as A1c levels, to determine how well I was responding to the drugs. At that point, I wasn't consistently following South Beach, and she wasn't a huge fan of it, so she referred me to a dietitian (more on that in the diet history to come). I saw Dr. L until 2009. I was not incredibly faithful to the dietician, the Met or The Pill. In fact, at my last visit, I think I had been off The Pill and The Met for several months. I didn't really disclose this to her. I think I had just reached a point of giving up. AF was more miss than hit. I was pretty sure I wasn't ovulating - if I was, I would have gotten a visit from AF. The Met side effects weren't fun - she had me on 1500mg and encouraged me to try 2000mg. We still weren't ready for kids, so I kind of had an attitude of "why bother with any treatment". My main reason for that last visit with Dr. L in 2009 was because I had lost my job, which meant a loss of insurance. "Squeeze one more visit in before the benefits are gone," was my logic.

I left that appointment and continued drug-free until 2010, which is where we'll pick up again next time.

Back Story Part 1 : The 90's

In order to get my blog started and perform the "brain dump" that I am in desperate need of, I'm going to begin with a series of posts that will bring everyone up to date with my fertility journey. Here goes.

I got my first-ever visit from AF in June 1991. I remember it distinctly only because it came on the day before the last day of school. I had just turned 11. Things proceeded quite normally until ~1996, when AF just disappeared for several months. My mother knew that this wasn't normal, and despite my begging her not to, she told my pediatrician about it at my annual physical. What followed was my first "exam" of the nether-regions, if you could even call it an "exam". Being that she was a pediatrician, she wasn't set up for a full look-see of my southern hemisphere - she could only examine the openings and external anatomy (trust me, I am comfortable with the proper anatomical terminology, but I don't want people coming here because they've searched for p0rn or God knows what else). She determined that things were normal, and that she saw nothing that could explain why AF went missing. She said that sometimes these things just happen in teens because they aren't quite regulated in their cycles.

I do believe that particular visit was the last time I went to a pediatrician. I pretty much put my foot down - partly out of shear embarrassment, but also partly because I had clearly bumped up against the limits of their knowledge with my "womanly problem". I remember seeing a family doctor for my next visit later that year, probably for a sinus infection or something of that sort. Once again, Mother brought up the subject of AF as she was still among the missing. The family doctor suggested I see a gynecologist since they are properly trained in these sorts of things. He suggested a fellow by the name of Dr. S.

The visit with Dr. S. was probably the most uncomfortable gynecological exam I have ever been given. It was an awkward visit in general. It started off with some waiting room drama - Mother nearly blew a gasket when she was told that she couldn't come into the exam with me. She had been asked to step outside the room when the pediatrician examined me as well, so I thought this should have been old-hat to her but apparently not. Of course Dr. S. began by asking me several times if I was pregnant, is there any chance I could be pregnant, was I *sure* I wasn't pregnant, was I *sure* I wasn't sexually active, etc. He had all the beside manner of a cactus and was so quick to assume that I was sexually active and had gotten myself into a little "situation". This was absolutely mortifying. It was beyond mortifying. I had never had a boyfriend, never been kissed, never been on a date - and to be treated like I just *must* be sexually active was humiliating.

If I thought the questioning was rough, the exam was worse. There was no warning to anything he did. It felt like he was ramming a doorknob into my girly parts. There was no concern or compassion for my mental or emotional well-being. When the exam was over, he brought Mother and I into his office where he reviewed what he found. He spoke into a dictation machine so that the info could later be transcribed into my file. To show what little regard he had for me, he didn't even get my name right as he was starting off his whole speal. I think this doctor's visit was the first time I had ever felt like less of a person. Sure, I'd been picked on by the other kids LOTS of times - but this doctor took the cake. To say that the experience was "mortifying" and "humiliating" really is an understatement.

The end result was that he didn't find anything upon examining me that would suggest why AF had gone missing. He ordered up a few days' worth of progesterone to jumpstart a cycle, and if that didn't work, he said he'd do more tests. I honestly don't even remember if AF returned at the prodding of the progesterone or not. I do remember that Mother did agree with me that Dr. S was an ass clown, and there was no pressure to see him again.

Fast forward to October 1998. I was a freshman in college. AF had been hit or miss (mostly miss) since 1996, but that fall she came back with a VENGEANCE. I don't know that I have EVER had such a heavy period. In retrospect, I suppose I should have seen a doctor but I didn't.

The next milestone on this journey came in February 1999 when I met Mr. Lost. A few months after we began dating, we became sexually active and in August 1999 I did the responsible thing - I made an appointment with a different gynecologist, Dr. R, for an exam and to get a prescription for The Pill. Dr. R had a much better personality and bedside manner than Dr. S, but Dr. R wasn't perfect - he remains the only gynecologist who has ever felt it necessary to include an anal exam as part of a routine gyno exam. Allegedly it's so that my uterus could be examined better - being that I am overweight, apparently you can't necessarily feel it appropriately just by pressing on the lower abdomen. Thank God none of the doctors I've seen since have had the same notion as he has. It's an "exit only" hole, thankyouverymuch.

In any event, at that first visit I had just recently seen something about this disorder called "polycystic ovarian syndrome" in a magazine my mother had - Woman's Day, perhaps? It sounded like me - absent AF, hair in all the wrong places, etc. Dr. R agreed to order up some bloodwork, which resulted in my first diagnosis of PCOS. He based the diagnosis on an out-of-whack ratio of lutenizing hormone to follicle stimulating hormone, and said that since we weren't trying to start a family, the best course of action was to put me on The Pill which was something I wanted to start anyway.

(Man, can I just take a moment right here to say that we have come a long way when it comes to diagnosing and treating PCOS? It's amazing what happens in just a few years in the medical field.)  

I took The Pill faithfully and with few problems from 1999 until the early 2000s. AF was more hit than miss. I continued to see Dr. R for annual exams until I graduated from college and moved away from home in 2002. Stay tuned for my next post, where we'll resume the timeline in 2003.