12 weeks

Today I am officially 12 weeks pregnant, and I could not be happier to be exactly one week away from exiting the first trimester. We are still not out of the woods yet, and I realize I won't technically be out of the woods until I have a healthy baby with ten fingers and ten toes and healthy lungs in my arms hopefully around early January. But still, approaching the end of the first trimester is an increasingly welcome relief, if nothing else than the fact that I can finish my progesterone suppositories this week (yes, you heard that right, more on that later!).

Today I marked a milestone: I made my first pregnancy purchase. At Target I bought a BeBand, which is a $17 version of a much more expensive BellyBand. If you're unfamiliar with this product, it's a tight piece of stretchy fabric you wear around your waist that's designed to extend the life of your pants (and I guess it claims to work on skirts as well, though that seems more complicated). When you're more pregnant you can wear the band unfolded, and you can also wear it postpartum when you're in that weird not-pregnant-but-still-have-a-big-uterus stage, but for now I would need it folded in half over my unbuttoned jeans. Right now I can get away with wearing my favorite pair of jeans without a BeBand, but I have to say even those low-rise jeans are more comfortable with the BeBand, so I might be sporting that pretty soon after all.

My belly is definitely starting to make an appearance. Here's a quick timeline since I had my husband start taking pictures of me at week 9 (notice that week 9 is more or less what I look like normally, minus the smallest of small extra bits of flab right at my waistline):

Week 9 -- Baby is the size of an olive!

Week 10 -- a weird little pocket of flesh emerges right below my waist. Baby is the size of a prune!

Week 11 -- My belly is more rounded. Baby is the size of a lime!

Week 12 -- My stomach is most assuredly sticking out. Baby is the size of a plumb, or about 3 inches crown to rump.

I am still hiding my pregnancy at work, so these bump-worthy looks are reserved for home, dog walks and the like right now, so I am thrilled to start having something to show for this pregnancy because the first trimester otherwise feels unreal.

We will plan to start telling people outside the immediate inner circle (my closest girlfriends and our parents and siblings already know) by early July. At that point I will be at least 14 weeks pregnant, and we will hopefully by that point have back positive results from the NT scan we'll be having to test for Down Syndrome. It's a non-invasive sonogram and blood test that I'm having done this upcoming Wednesday, and I'm excited for another chance to see the baby. Then I'll deal with telling people at work, who may have to shift around a few things to accommodate my maternity leave, but oh well.

My friend who gave birth recently sent me a sweet gift of a pregnancy planner the other day. Not only was it a thoughtful gesture, but she included a wonderful card that says the following on the front: "She had never considered herself exactly perfect until right now." "She glowed pleasantly with strength and happiness." Exactly.

Preggers!

Somehow I have kept myself from posting this for almost six weeks, but I am obviously beyond elated to report that I am nine and a half weeks pregnant!

I have resisted the urge to celebrate too hard at this point, but some of my nerves were eased nearly two weeks ago when we got to see the heartbeat. The scary thought of miscarriage is still something I think about every day (though thankfully I am thinking about it less and less and generally keeping myself calm and occupied). But, the good news is that once you hear a heartbeat, the chance of miscarriage drops from 20-30 percent down to approximately 5 percent. It goes even further down after the 10th or 11th week, so I am just crossing my fingers that little Matt Jr. stays in place for the time being and emerges from the womb around his January 2, 2012 due date!

I want to share all kinds of details related to discovering I was pregnant to how I'm feeling to changing doctors and everything else, but for now I thought I would compile my list of what worked for me into one spot. Of course, I can never be sure that any single thing or even combination of things led to my BFP (big fat positive, for those uninitiated in the world of POAS [peeing on a stick = pregnancy test]). Still, I know that my cycles decreased in length every month, and I went from the extremely long cycle to the cycle where I ovulated on CD35 in about four months, and that was the cycle that did the trick.

Here's what I did in a nutshell:

• Fertility Friend daily charting -- I charted not only my basal body temperature before I got out of bed each morning, but I also tracked my cervical fluid (TMI, I know, but necessary if you're serious about TTC) and cervical position as I assumed I was getting closer to ovulating. I would even wake up at virtually the same time on the weekends as during the weekdays. I think my body was so stressed about conceiving that I had an internal clock that would jolt me awake at the same ridiculously early time of 5:15 Monday through Sunday. (Now that I am pregnant I am not temping nor am I waking up early on the weekends, thank God.)
• Daily exercise -- at least 30 minutes of aerobics, sometimes more, plus strength training 2-3 times per week
• Gluten-free diet with an emphasis on no processed foods, lots of protein, plenty of fresh veggies and fruit and minimal sugar
• Green tea a few times a week
• Pomegranate juice a few times a week
• No caffeine
• Extremely limited alcohol (I will admit that this past cycle when I got pregnant was the cycle when I drank the most alcohol -- granted, "most" means I had approximately 5 drinks in the 35 days, but still....)
• Herbal supplements: vitex, red raspberry leaf (capsules, not tea)
• Vitamins: prenantal vitamin, B6, B12, D, E, cod liver oil, evening primrose oil (before ovulation)/flaxseed oil (after ovulation)
• Ate raw pineapple core from 1DPO (day past ovulation) to 5DPO to assist implantation (Who knows if this is a crazy witch-doctor thing or not, but I had a pineapple on hand after I ovulated with a pineapple core divided into five even sections because I didn't want to risk being wrong on this one.)

If this sounds like a lot....well, you're right, it is a lot. I felt really healthy, though, so even if it hadn't worked for TTC purposes I think it was the right choice for a healthy lifestyle that happened to give Matt Jr. a good start at life. Now that I am battling some serious food aversions (more on that later) I wish I could eat the kinds of foods I was eating when I was TTC, but right now my strategy is to eat whatever will stay in my stomach.

The emotional investment of TTC was severe for me. Even though now I have pregnancy hormones for sure and get more easily emotional than I would before (nothing severe....my husband will tell you I am a level-headed pregnant woman), right now I am nothing compared to how emotional I was during TTC. I have never felt so out of control and so alone in my entire life. I would cry myself to sleep on many occasions (when I wasn't having sex....we had A LOT of sex to get to where we are today) and I would cry many times on the way to work (one time causing me to almost get my first traffic ticket of my life) and I would cry when I found out other people were having children. I was not myself. If it had lasted much longer I think therapy would have been the next step because for the first time in my life I couldn't fix what was wrong with me and I didn't know what to do.

Thankfully, because the emotional investment was so severe at least the financial investment was extremely minimal. Because we chose to hold off on the medical intervention route at least for a little while, virtually everything I did to achieve pregnancy was inexpensive. Yes, I bought a bunch of OPKs and HPTs and more expensive food overall and some extra vitamins, but that's all a drop in the bucket compared to what I would have paid for fertility treatment. I'm not saying I wouldn't pay for fertility treatment. Instead, I simply feel exceptionally lucky that this happened the way it did.

I share this information in the spirit of this blog, to share with close friends and hopefully future friends who struggle with fertility problems the hope that you too can take back some of that control that you resigned, advocate for yourself even when your doctor (as mine did) tells you it will be extremely difficult to down right impossible for you to get pregnant on your own. The vast majority of women who want babies eventually have them. We all come about it a different way, and what works for me won't necessarily work for you, but I have faith that something will.

Most importantly, know that you are not alone.

Making Babies review

Many months (Ok, let's be real here, years!) before we started TTC I read several pregnancy books. While I'm happy that I'm already so well informed regarding, well, What to Expect, I did not do any fertility reading before TTC. My philosophy: if approximately 20 percent of couples face fertility issues, the odds were good that we would not and I would get pregnant the first month of trying, just like my mom did with all her pregnancies.

In retrospect, I obviously wished I had read several fertility-related books in the early stages of TTC, or even before we started TTC. I've read a couple PCOS TTC books, but whenever I would go to the bookstore to peruse the shelves I was always disappointed by the regular books about TTC. They are seemed rather simple. I needed something more in between books about IVF and books about the basics of getting pregnant. That's why I was thrilled to find Making Babies. It's written by a reproductive endocrinologist and a licensed acupuncturist, so it takes a balanced approach between Eastern and Western medicine. It leans more toward the side of avoiding expensive and invasive fertility treatments for as long as possible, which appeals to me.

It's almost time for me to return this book to the library (after I renewed it!) so I thought it was about time I shared these insights from the book before I lose them forever.

The book captured my experience from the beginning of the introduction, on page ix, where the authors write:
You want to do everything you can, but you want to be smart about it. You don't want to rush into expensive treatments with their inherent risks and side effects. You don't want to waste your time any more than you want to waste your money. You don't want to be guided by unproven old wives' tales, but you don't want to dismiss something that might work either. Truth be told, you'd try just about anything if it meant having a baby.

OK, that's me, this book is made for me.

As I kept reading, I used pink and yellow Post It flags. Yellow is for general fertility; pink is for PCOS fertility. Here's what I came up with.

Yellow general fertility flags:

• Self massage: The acupuncturist recommends self massage techniques in four stages to encourage the repositioning of the uterus to increase blood flow: menstruation, pre-ovulation, ovulation, and potential implantation. I have not tested these out, but the techniques sound simple and appealing (92-97).
• Beta-carotene: "The corpus luteum, which helps produce progesterone necessary to sustain a pregnancy, has very high levels of beta-carotene. Research shows that cows deprived of beta-carotene develop ovarian cysts and are slow to ovulate, and their fellow mammals -- humans -- work much the same way. You get beta-carotene in your diet from yellow and orange foods (including carrots, cantaloupe, and sweet potatoes), as well as from broccoli and leafy greens such as spinach" (102-103).
• Omega-3s: "Omega-3 fatty acids have a broad range of benefits, including increasing blood flow to the uterus, thereby increasing the chances of implantation and pregnancy. They also fight inflammation and can soothe menstrual pain and help with other problems that can interfere with conception. Increased blood flow also benefits the placenta, supporting optimum growth of a fetus and ultimately reducing the risks of premature birth and low birth weight" (105).
• Tea: "Women who drank tea every day [in a Kaiser Permanente study of 210 women] -- even just half a cup -- were twice as likely to conceive as women who never drank tea....Scientists suggest that tea might promote fertility in two ways. First, the hypoxanthine in tea might be necessary for the follicular fluid that helps eggs mature and get ready for fertilization. Second, powerful antioxidant polyphenols in tea might help prevent chromosomal abnormalities that can cause an embryo to miscarry or fail to implant...The study did not get into what kind of tea the women drank, but we recommend green tea to our patients. Green tea has up to ten time more polyphenols than black tea and only about half the caffeine. Three cups of green tea a day will keep you within our caffeine guidelines" (109).
• Eating through your cycle: Menstruation = foods rich in iron, vitamin C, protein. Pre-ovulation = protein, foods rich in vitamin E. Ovulation = B vitamins, zinc, vitamin C. Potential implantation = pineapple (or pineapple core, which has the most bromelain and helps with implantation), eat warming foods and avoid cold foods (111-112).
• Essential Fatty Acids (EFAs): "This is the most important supplement after the prenatal multivitamin. Ideally, women should take EFAs for at least three months before they conceive to allow time for them to be fully incorporated into all the tissues. EFAs help ensure that follicles have all the resources they need. They are key to cell membranes and growth in the ovaries. They help form body tissue, including tissue in eggs and in a developing fetus, and are essential for brain development in the fetus. Fish oils, a prime source of EFAs, are natural clot busters and so may be particularly useful to anyone who has had recurrent miscarriages" (125).
• Prenatal vitamin content recommendations and other fertility supplements recommendations for women handy-dandy chart on pages 132-133.
• What's your fertility type??? The authors believe women facing fertility issues fall into one of five types: tired, dry, stuck, pale, waterlogged. If you want to find out your type, you can answer questions in the book, or, in my opinion it's much easier to take the online quiz at www.makingbabies.com. If you take the online quiz, the authors recommend you still read through the five descriptions in the book to see what makes the most sense for you.
• Finding an acupuncturist: The National Certification Commission for Acupuncture and Oriental Medicine "tests practitioners to ensure they are knowledgeable about Chinese medicine and appropriate sterile technique" (287).

Pink PCOS fertility flags:

• Trans fats: Even though I think most of us have eliminated trans fats from our diets, here's further reason to do so: "Eliminate trans fats altogether, because, among other things, they can cause of exacerbate insulin resistance and ovulatory dysfunction and interfere with hormone production and balance. There is no safe level of trans fats in your diet. Eliminating trans fats is crucial for women with PCOS" (104).
• Unsaturated fats: "Unsaturated fats are the way to go: olive oil, nuts and seeds (and their oils), and avocados are the most nutritious sources. These are important for everyone, especially women with PCOS" (105).
• Vitamin-D deficiency: "Vitamin D is an antioxidant, so it helps protect sperm and eggs against genetic damage. Vitamin D also supports the production of estrogen. In some cases, bumping up vitamin D intake to adequate level can restore ovulation in women with PCOS" (119).
• NAC: "Take N-acetyl cysteine (NAC) supplements to help reduce circulating testosterone, cholesterol, plasma triglycerides, low-density lipoproteins, and insulin. NAC included in a multivitamin is fine. Nutrient 950 with NAC by Pure Encapsulations is also good" (207).
• Three-month plan: The authors recommend treatment (diet, 30 minutes of exercise daily, stress management, supplements) for three months before trying to conceive. "Follicles exposed to excess androgens will be of poor quality and lead to a higher risk of miscarriage" (207).
• Give up yams?!: OK, I eat yams at least once a week (not even sweet potatoes, even though I always call them sweet potatoes, we're actually big yam eaters). "Although yams are often touted as fertility boosters, they have too many carbs for PCOS bodies" (315).
• Clomid: "For patients with PCOS who have high or high normal levels of male hormones, I prescribe dexamethasone, too, to enhance the effectiveness of the clomiphene by suppressing the production of male hormones" (321).

 For me, these were the highlights. Because I'd already done a decent amount of fertility reading by the time I read Making Babies, it wasn't as revelationary as it would have been had I read this three months before starting TTC. In retrospect, I wish I had read this in April 2010, three months before we started TTC, rather than April 2011. Oh well, now I know! At least it's reassuring that all my other research revealed a lot of the information I found in this book. This book is just a good one-stop shop for fertility info, and I wish I had started here!

Amazing Google commercial

It would be weird to post this on my public blog, so I thought I would post it on my private blog. I saw this commercial for the first time a couple nights ago (thanks to the DVR I hardly ever see commercials, but I somehow managed to sneak a peak at this one). I can't watch it without crying. It is just so sweet.

Progress!

Last month I said that if I could get a positive OPK on CD35 that would be amazing. Well folks, it actually happened. I am taking a break from my normal morning routine to report this positive progress. Maybe exercise, vitamins, diet and a (slightly more) positive attitude is helping.

I AM SO EXCITED. THIS IS THE BEST THING THAT HAS HAPPENED TO ME IN A LONG TIME!

In other news, I started taking a bunch of herbal supplements last weekend. And that will be the subject of a future post.

Cheating

This week I thought a miracle was happening. On CD21 and 22, I got OPKs that were so close to positive that I nearly borrowed a plane so I could write a celebratory message in the sky.

But the OPKs never turned positive. I was silently willing them positive with all my being, but I got nothing but a really clearly negative the following days, and my temps did not change to indicate any sort of ovulation that the OPKs may have missed, so I am pretty certain nothing happened and nothing is currently going on.

Even though a CD21 or 22 ovulation would be highly unlikely for me to the point that it's the stuff of out-of-this-world fiction, I was still disappointed. I want so desperately to be normal that I'll believe in miracles.

So, this weekend I went wild. Friday night I had a glass of red wine and about five crackers. Saturday I had half a cookie and a salad with croutons. (Of course I ate more than this; just trying to highlight my decadent sinning.) They were divine. Although I've never been a huge bread/general glutten product eater, these little breaks from my strict diet were an awesome indulgence.

Now, though, I'm back to the straight and narrow, and I'm trying to keep the optimism alive.

Eggs for eggs

Ironically, this past year I have finally gotten really good about having a full breakfast every morning, and at the center of that breakfast has been cereal and milk. I grew up absolutely hating milk, so adding it to my cereal has been a big move. Now that I am finally into a routine of getting up even earlier than I used to and having cereal, milk, fruit, orange juice and usually tea/coffee/hot chocolate, I have to adjust again. Cereal doesn't keep with the gluten-free diet I am trying to keep. So, I am learning to love eggs.

When you cut out bread and cereal, that really reduces the number of breakfast foods you can eat. It basically leaves eggs, meat and fruit. So, I am still eating the blueberries I started adding to my cereal, just sans cereal, and I am still drinking my hot chocolate, just with whole milk rather than skim milk, and now I am trying to give myself a few more minutes each morning to scramble up a couple eggs. If we have any bacon in the house, which we sometimes do, depending on our dinner menu for the week, I might make a couple strips of bacon as well.

To keep up the protein kick, I am also eating almonds and walnuts as part of my daily lunch. These aren't my favorites, but they're good for me and they keep me from snacking on something gluten-filled that I really like, such as Cheez-Itz, which ultimately have limited if any nutritional value.

Finally, although my husband and I have become what I would call flexitarians -- we've been known to eliminate meat from about two or three meals a week -- I've moved us back to having meat with every dinner we make. I am even trying to get him to add a little more red meat to our diet, no more than once a week.

It's hard to go against conventional wisdom, it's hard to give up pasta and pizza and alcohol, but my digestive system is thanking me (it's in GREAT shape these days -- sorry for the TMI, but it's worth noting). So, I hope that the more seriously I stick to my new food habits, the more my body will start to change soon.

A vitamin store in my bedside table

After doing some more independent research, I officially decided to up my vitamin intake this week. Even though the prenatal vitamin that I've been taking for a year claims to give me 100 percent of everything I could need for baby-making purposes, I've read enough/heard enough about other people's experiences with pregnancy and vitamins that I figure more of a good thing can't be bad. (Yes, I realize this is sort of a self-diagnosis, but you don't exactly need a prescription for vitamins.)

So, now in addition to my prenatal vitamin, I am also taking separate helpings of vitamin B6, B12, D and E. For what it's worth, my regular physician actually encouraged me to take more vitamin D at my appointment last year. I did not heed her advice because it was 1) generic advice that she gives everyone because she believes everyone in modern America is vitamin D deficient (her words) and 2) the appointment was in the summer when I was always in the sun, so I figured this didn't apply to me.

As my period got started last week I also promised myself that I would exercise daily. So far, so good. It's becoming a bit of a game for me, a competition with myself in a way, to see if I can keep up with this routine. I'm doing a combination of long walks with the dogs and my husband (and even a buddy of mine who wants to join me in my efforts to get more exercise! Hooray for healthy girl time!), as well as 30-minutes of aerobics each day with 30-minutes of strength exercise a few days a week.

I've also decided with the start of this new cycle to entirely stop drinking caffeine and alcohol. Although I drank both in total moderation (aside from one party I was at in January when I was getting my period and decided to drink rather heavily), I figure I can make the sacrifice. So, that one cup of coffee I drank about three times a week is no more, and I am not drinking any soda (though I did that rarely if ever). I had my last alcoholic drink at my friend's birthday party last weekend, and I'm happy to give that up entirely now as well.

Finally, I am going to give the gluten-free diet a shot. I bought a book about going gluten-free over the weekend. Although it's geared toward people with Celiac's disease (because those are the main people who would purchase such a book) I think I can make it work for me. This means giving up pizza, which my husband and I would probably eat once a week or every other week (almost always homemade on the grill) and whole-wheat pasta we would also eat with the same regularity. I think it would be nearly impossible to be entirely gluten-free, seeing as gluten exists in incredibly small amounts in products even such as soy sauce, I am at least going to cut down all bread, pasta, and cracker products (as well as beer, which falls in both the gluten and alcohol categories).

Oh, and because several studies suggest it is good for fertility, I am now drinking whole milk. Yes, whole milk. After a childhood spent with 2% milk, I learned to love skim as a teenager, and now I am going hardcore all the way past 2% to whole. I wouldn't pick whole milk, but I'll try anything.

I plan to keep this up at least until July. If I don't see improvements in my ovulation dates within four months then I probably won't see any changes from these lifestyle choices after that. By July we will have been trying for one year officially. Seeing as how I ovulated last cycle on CD39, I am really hopeful at this moment that I can bring that ovulation date down even further. CD35 would be amazing, CD30 would be absolutely divine.

CD1

And so it begins, again. With the start of today's period came one more little punch in the gut from Mother Nature, another reminder that I am still not pregnant. As we approach April, we'll be entering month nine of trying. In the amount of time we've been trying, we could have a baby by now.

I know there are women out there who have been trying for four years or more. My heart breaks for them. I don't know how they go through this for so long. I'm not even at the year mark and I'm starting to find the ups and downs of all this mildly unbearable.

Because I'm attempting to be more optimistic (when the spirit moves me) I thought it was relevant to share the stats of my most recent three cycles:

2 cycles ago --
O'ed on CD70
Luteal phase: 7 days
Total length: 77 days

Last cycle --
O'ed on CD53
Luteal phase: 12 days
Total length: 65 days

The cycle I just ended today --
O'ed on CD 39 (!!!!)
Luteal phase: 11 days
Total length: 50 days

I am happy that the two most recent cycles I've ovulated earlier than I did the previous round. Also, I am happy that after one cycle with a short luteal phase (that would be too short to sustain a pregnancy) I have at least got my luteal phase up to a normal length.

I am going to exercise every single day. This is my new promise to myself (starting tomorrow). I think my increased exercise regiment is what I can thank for my earlier ovulation dates. I'm also going to reevaluate my vitamins and probably start taking more as well as looking into my diet more, even considering a gluten-free diet. At this point, I feel like I'm getting desperate, and I'm willing to try anything within reason.

Deactivated

This morning I did what I had been considering for a long time. Like ripping off a Band-Aid, I finally deactivated Facebook.

Yes, like virtually everyone else, I can say that Facebook is making me dumb. It's wasting my time, keeping me from doing things I could be doing that are way more productive, like exercising or getting my news from an actual newspaper rather than from my politically active friends' status updates. This is all true.

But the main reason I deactivated, which I will only share with those few of you who even know about the existence of this blog, is that I am tired of all the babies on Facebook. In keeping with my last post, I am tired of people's sonogram pictures as their profile pictures, updates about their babies' every moves in their status updates, complaints about being pregnant, and baby-belly photos of people who I frankly (in the worst part of myself) can't understand why they deserve to procreate and I do not.

So, if you used to be friends with me on Facebook and I no longer appear in your list of friends, never fear. I still like you, and my husband I are still married (though he is now simply listed as "married" instead of specifically married to me, a fact even he does not yet realize [that I will share with him after he wakes up from his nap]).

It's not that I'm not happy for my genuinely close friends and family who recently had babies or who are currently pregnant. I'm thrilled for them, and I want to share their happiness over email, over the phone and in person, and I do. I'm amazed by friends who had babies recently and then give up two straight hours to talk to me over the phone while their baby sleeps. But I really couldn't care less about the girl I vaguely know from work or from middle school who's about to pop one out. And such knowledge is simply not good for my psyche, nor is it good for my time management. Like one of my closest friends recently said to me over a tear-filled dinner, the problem with Facebook is that it's a place where your 300 "closest friends" post only the happy stuff about their lives -- their recent trips, new job offers or promotions, house purchases, pregnancies, births, dog adoptions, TV show and book recommendations, latest business ventures. No one posts about their most recent miscarriage, their impending divorce, their heart-breaking layoff. It gives us all a false sense that everyone else's lives are perfect and only our own contains stress and anxiety and disappointment.

So, goodbye Facebook. Maybe now I can, ironically, be surrounded by more positive energy than I ever was through everyone's overly positive status updates.

Then again, maybe I won't...

...which is ANOTHER Judy Blume book title reference, which makes two solid Judy Blume title references in one as-of-now very short blog.

So, in case you haven't guessed, I have decided not to pursue fertility treatment with my current (and now technically former) OB/GYN. After talking to more ladies who've been on Clomid themselves and posting a question on a PCOS community forum (and receiving many response), I've discovered that my doctor was being entirely too "by the book" with me, basically meaning that most other ladies' doctors prescribe them Clomid without any expensive tests and without labeling them as "infertile." This also means that these women do not have to pay expensive out-of-pocket costs. See, if you have a "period problem" and your doctor gives you Clomid to induce ovulation/maintain regular cycles, insurance covers the cost, but as soon as you slap "infertility" on that bad boy, get ready to shell out the dough. More specifically, both my doctor and her nurse had warned me that I would be spending $500-$1,000 just to START Clomid treatments. Apparently lots of other women can get away with  a free doctor's visit and a trip to Walmart for a $9 Clomid prescription. Maybe my doctor is being thorough, one might argue, but I would argue that I stand by my statement that my doctor isn't looking at me as an individual and just wants to give me the most popular drug and call it a day.

Yesterday I called the nurse at my doctor's office and said I wanted to cancel my appointment. When she said, "You mean you want to reschedule for another time?" I said, "No, I mean cancel. I am not ready to be labeled infertile when I am ovulating on my own." She reminded me that she would be happy to schedule me for another appointment as soon as I'm ready. I held my tongue, and I guess I can't say never, but it will take something significant for me to return to my now-former doctor. I have a recommendation from a good friend for a doctor who works down the street from my house, so should I decide to schedule an appointment down the road, this new doctor would be even closer by than my former doctor.

On a totally different note....
I've been thinking about parenting a lot lately. After being on a plane ride heading some place tropical with three toddlers -- who were screaming the entire three-hour flight -- all owned by one mother in the row in front of me, and then coming back some place tropical listening to another toddler actually screaming bloody murder for a solid 30 minutes (honestly, I assumed someone must be killing this child) I've thought a lot about licenses for parenting. If I had my way, people would all be infertile until they were granted a license to reproduce, and only once they received their reproductive license would their natural reproductive abilities commence (this would also benefit society by preventing unplanned/unwanted pregnancies...see, I'm looking out for everyone! No one would have to worry about birth control!). This wouldn't be an elitist system -- you can have any IQ, any job, any income and be a good parent. You cannot, though, lack common sense and be a good parent. Unfortunately, anecdotal evidence of the most fertile people I know in the world would indicate that people with the least common sense are the ones who can look at their husbands and miraculously conceive.

Realizing that reproductive licenses aren't in our nation's future, I would like to make my pledge that I promise not to be an obnoxious parent should I ever be lucky enough to procreate. Here are my rules, in no particular order:

1) I promise not to make status updates, blog posts, tweets, texts, email messages, etc. about my child's bodily functions. I already know no one cares, and it's kind of gross. This will not change if I suddenly have a child.

2) I promise to make time for childless friends. I will remember that there is so much more to life than my baby. I will also remember that my friends care about me, not just my baby (though I'm sure he/she will be great if he/she ever gets a chance at life).

3) I promise to remember that people have been raising children for thousands of years and children have been developing for thousands of years; therefore, every time my child eats, talks, moves, etc. it is not something everyone I know really cares about. We've all been there, literally.

Those are the items that I've found most annoying lately. I'm sure I'll make more discoveries the longer I stay "infertile" and the longer I can judge the moms and dads of the world. If this all comes back to bite me in the ass one day...well, I would absolutely love it.

Making the first decision

After a long series of emails back and forth between myself and my doctor and a refreshing five days in the tropics, I did some soul searching and have made some decisions.

First, though, a little background.

I am grateful for the fact that even though I may not love my OB/GYN, I can at least email her and she will respond quickly and deal with my crap. You may remember that I was arming myself with a series of questions to ask my doctor. I now have answers to everything I need to know for the time being. Specifically, in my doctor's words...

Regarding being thin with PCOS and taking Clomid:
You are correct that a large number of women with PCOS are overweight. It is good that you are not overweight, but the treatment would be the same even if you were. However, though I don't have any hard numbers for you, the Clomid will probably be more effective for you since you are not overweight. 

Regarding insulin resistance:
We did not check to see if you are insulin resistant because it is no longer recommended to do so routinely. This is because the insulin resistance tests are not reliable. And even if they were reliable, the treatment would not change based upon the results. Sometimes we screen for diabetes in overweight patients with PCOS. You had a normal diabetes screening test less than 18 months ago. Since you are not overweight and do not have a family history of diabetes (please let me know if this has changed recently), you do not need to repeat the test at this time. I can check it if you want, but it is not necessary now.

Regarding Metformin vs. Clomid:
Metformin has fallen out of favor as routine treatment for PCOS. We used to use it as a first line treatment for PCOS in women not desiring pregnancy, but it was not very good at regulating periods. We used to use it in conjunction with Clomid to improve ovulation, though this never panned out. So, currently it is not recommended to use Metformin routinely in women with PCOS. The exception is in women with abnormal fasting glucose, which you do not have. So, the Metformin would not be helpful for you for fertility treatment.

Regarding lifestyle/diet changes:
Since you are not overweight, there are no lifestyle changes that you would need to make prior to taking fertility medication. 

Now, maybe my doctor doesn't have all the answers. In fact, I am convinced she doesn't, but I'm also now convinced that no one has all the answers to the situation I'm dealing with. She's not a fertility specialist, and I shouldn't expect her to be one. For now she seems knowledgeable enough, and nothing in our recent correspondence has been out of sync with the copious amounts of information I've been reading lately from other sources, so this is a good sign.

Now, for the decisions:
I've decided that I am willing to try Clomid. I'll give it a shot in June when I am not working, and provided it doesn't work on the first try (unlikely, the pessimist in me says) and depending on how it makes me feel, I'll either stick it out through the three rounds back-to-back in the summer or choose the take the Clomid in between attempts to get my body to ovulate on its own or even quit the Clomid if I have too many intense side effects. Even though my doctor will only prescribe me three rounds of Clomid, that doesn't mean I have to take the drug for three continuous months.

This does mean that I have to go in for some expensive appointments and additional tests before I can start the Clomid. Goodbye, $15 co-pays and free lab work. Hello, ridiculously expensive visits and tests because anything with the "infertility" label stamped on it means big business and minimal, if any, insurance coverage. (I would like to point out the irony here: that I have cost our nation's medical establishment and insurance companies virtually nothing in my entire life thanks to my perfect health and general fear of doctors, and yet the ONE TIME in my almost 30 years of existence that I ACTUALLY NEED intervention is the ONE TIME I can't get coverage. This is the salt in the wound of infertility.)

The next step:
So today I officially made my first infertility appointment, an infertility consult. This is a 20-minute in-person appointment where my doctor gets to tell me answers to the questions I've already asked over email for free, expect now I get to pay $75 for the in-person greeting and several hundred dollars for another blood test she'll schedule after my appointment for whenever day 3 of my next cycle should be (your guess is as good as mine!!! -- right now I'm at CD 38 with no signs of ovulation close by). If you're surprised about this required visit, so am I. I figured that because I already have a diagnosis -- that is remarkably accurate given my symptoms -- that I wouldn't need to go in for a consult. Turns out this is the first of no doubt many hoops I'll need to jump through before I can get what I want.

Here's the info, straight from my doctor:
Though your diagnosis is accurate, the infertility consult is necessary to get the ball rolling so to speak. I can't order your lab work or HSG without it. The infertility consult is the beginning of the process, during which we discuss the parts of you and your husband's medical history that may relate to fertility. There will be an additional co-pay of about $75 for the visit. Husband's often attend this visit, though it is not required. All I need to know from him is if he ever got anyone pregnant in the past, if he has ever had the mumps, if he has ever had pelvic or genital surgery, if he has any medical problems or takes any medication for any reason and what he does for a living. If you can answer those questions for him, then he does not need to come. Though, he is welcome if he wants to come. 

Of course, my doctor already has my complete (and extremely limited) medical history, and I've asked every question in the book, and my husband has no prior medical problems or other concerns listed above that would be interfering with our ability to conceive. All this she already knows, but I have to tell her in person so she can check a box. Now I'm starting to understand why people get annoyed with the medical establishment.

But I will suck it up. I am a fighter, but I am not in the mood to bring down the system. I will quietly show up at my March 8 appointment, pay my $75, and hope that all this will be worth it in the end. Because right now I have to believe it will be.

Self esteem

The thing I have the most of in my life is self esteem. I really like myself. I think I'm smart, and funny, and talented in many areas. I'm a good friend and wife. I also love my body. I love my figure and my hair and my eyes. According to one book I just read, with a BMI of 21 I have a "perfect" height-to-weight ratio which is also considered ideal for baby making.

Loving my body in particular puts me in the extreme minority of women. A 2003 survey by the Women's Channel of AOL found that only 4 percent of 45,000 women polled were happy with their looks.

In the last two weeks, though, since being diagnosed with PCOS, and in the months leading up to my diagnosis when I suspected a problem, I've started to dislike my body from an internal perspective. On the outside, I still look the same. I'm happy with everything I see in the mirror, including the little bit of jiggle I see on my thighs and butt (where I tend to carry my weight). On the inside, I feel like my body isn't doing what it's supposed to do.

These recent feelings seem very un-PC and very 1950s housewife of me. All my life I've been an exceptionally strong woman. I've scoffed at people who've told me I need to learn to cook for my husband. I've been (and continue to be) staunchly pro-choice, believing that no one should be able to tell me or any other women what to do with our bodies. Yet at this moment when what I am completely ready for in life is a baby, I feel like my body is failing me.

After reading my ever-going-pile of books, I know I am not alone in these feelings. Still, it is a blow to my ego, which up until this point has been stronger than probably any other woman's in history, besides maybe Cleopatra. Even when my parents virtually disowned me and refused to attend my wedding, I knew it didn't matter and I brushed it off and moved on. This latest problem, though, is not so easy to brush off.

One of my good friends just told me that when she thinks of me, she thinks of a strong woman who just attacks whatever problem is in front of her. She even envisioned me giving myself hormone injections, shouting at the top of my lungs, fists clenched, "BRING IT ON!" Yes, to some extent, that is true of me, but at this moment I'm not quite there.

At this moment, though, I am in the process of formulating my plan of attack, which is getting further solidified each day and which I will share with you shortly. For the time being, though, I am trying to remember these words contained in chapter 7 of the book PCOS and Your Fertility titled "Riding the PCOS Emotional Roller Coaster...":

An assertive woman knows what she wants, respects her own wishes, believes she can make things happen -- and does, isn't afraid to say no or take a chance, accepts responsibility for her actions, expresses her true feeling, and respects and values the feelings of others. Above all, she values herself.

This quotation describes me to a T. Just because I now have the PCOS label for my condition does not mean I need to suddenly change my personality. This is something I need to remember each day as I move forward.

Finding a friend

If up to one out of 10 women has PCOS, then I have to know some women who have it, right? Obviously I do, but how to find out? Well, I have officially found that friend because I recalled her trouble conceiving and that her symptoms were similar to mine. Turns out, I was right.

Although this is a time where I realize this isn't exactly something to celebrate as I wouldn't wish PCOS on anyone -- except maybe an enemy? Am I going to hell for that? -- it is comforting to know someone else who has been through this. Even if it's just one person.

As a seasoned veteran of the PCOS world, my friend has already shared a little bit of positive information with me. I already knew that she managed to get pregnant, but what I didn't really know is how. She also has a couple friends with PCOS, and each of them has two children. Each of these three women with PCOS got pregnant in different ways: Metformin, Fermara (a breast cancer drug that can actually help women with PCOS ovulate), herb supplements and acupuncture, and IVF. Not one of  the three ever got pregnant on Clomid. This is of particular interest seeing as this is the solution my doctor immediately offered.

My friend said her friends recommended she read The Fertility Diet. She said she never got around to it because she just happened to get pregnant, somewhat miraculously and unexpectedly. Oddly enough, by the time my friend told me about The Fertility Diet recommendation I was already partway through the book. It's one of the two books I picked up this weekend at the library.

I am hoping to learn a lot more details from my friend in the near future. In the meantime, I've finished reading A Patient's Guide to PCOS: Understanding and Reversing Polycystic Ovary Syndrome, I am blazing through The Fertility Diet and I am awaiting the arrival of my other book PCOS and Your Fertility. Once I'm done with this reading, I'll post some book reviews, and I hope I'll be one step closer to figuring out what I should do. Right now I don't feel much of a sense of urgency because I'm on CD 23 with no sign of ovulation in sight, and I know that if I decide to go on a medication I can't start it until I get my next period, which probably won't happen until early April.

At least while I wait I know one person who's been down this road and who I can seek out for support.

Moment of irony

A couple days ago I needed to order a new baby gate to keep our dogs contained inside our house while we're away. This is, of course, ironic that I need to make this purchase the same week I find out I've been diagnosed with a disorder that will make it much more difficult (if not impossible) to get pregnant.

This simple fact would be sadly hilarious enough on its own. It's even more ridiculous, though, that I went ahead and added to the Amazon order the PCOS fertility book I've been unsuccessful at finding in local bookstores and at our local library. (You know, take advantage of free shipping.)

So, my finished order looked like this:

Good thing I still have my sense of humor.

Thin cyster

OK, now I know where I fall on the PCOS spectrum: I'm a thin cyster.

I can appreciate the pun here (for community support purposes). I can also appreciate that I found a virtual community of women with PCOS who are also thin here at the PCOS Support site.

Even though the following message below cut-and-pasted from the site may look bad, it gives me some questions to ask my doctor (also, this woman below just sounds a lot like me).

This is kind of negative, but this is what my RE said to me today:

Saw my RE today and this is what he said:
"About 33% of women have thin PCOS. Since you are thin, there is no environmental factor to it. You can't just lose 50 lbs and increase your chances of pregnancy like the other 66% of women with PCOS that have that environmental factors (weight, diet, etc.). So with thin PCOS, your infertility is all genetic. Therefore, it is a strong genetic factor against you vs. environment. Environment you can change, Genetics you can't. Most women with thin PCOS require more than fertility drugs."

I thought it was advantage being thin. I thought that automatically gave us that increased chance of getting pregnant that the overweight PCOSers get when they lose weight and that it was one less thing to worry about and one more thing on our side. Guess I was wrong!

So, even though I haven't reached any decisions yet about the next course of action to take, here is my list of questions I'm formulating to ask my doctor:

• What is my insulin level? Am I insulin resistant? If we don't know, if there a way to know based on blood work?
• Is my glucose high?
• If I am insulin resistant and/or have high glucose, can I control either of these factors by changing my diet, such as pursuing a gluten-free diet? Or is it better for me to go on a drug like Metformin? Or will changing my diet not really affect my chances of getting pregnant because I don't need to lose weight?
• What are the differences between Clomid and Letrozele/Femara (another ovulation-stimulating drug) for thin women? Is there any evidence that Femara is better at inducing ovulation in thin women than Clomid is?
• Is extended Clomid (an 8-10 day dose as opposed to 5-day) a possibility for someone like me, or is it necessary to start with a regular Clomid dose?

There is so much to learn, and I wound up getting two books yesterday at the library and ordering another book on Amazon. I want to be fully informed before I make any decisions, but at times like this I am grateful for the fact that I can email my doctor and she will respond to me quickly.

Where do I fall in the PCOS spectrum?

Seeing as it's 6 a.m. on a Saturday and I've been awake since 3:45, I obviously am preoccupied with this week's PCOS diagnosis. I am now in the hard-core researching stage, and I'm loving the fact that today I can go to my local library to pick up A Patient's Guide to PCOS: Understanding -- and Reversing -- PCOS. Because all the branches of my extensive local library system only carry three books about PCOS -- this one and then two other books that look rather out-dated -- I'm also considering purchasing PCOS and Your Fertility from Amazon. This book may be a nice complement to the book I'll check out at the library because this one combines anecdotes from patients and the author's personal experience to supplement the story.

I have been enjoying the fact that I can preview so much of each book I've been finding on Amazon -- I absolutely love this site feature. While scanning through about 20 books so far online, I've started to formulate a few observations, but there is one that stands out most particularly in my mind: I do not sound like the typical woman suffering from PCOS.

But before I go there, here are the things that make me typical:
1) I have the most tell-tale sign, irregular cycles.
2) I have high levels of testosterone (I still hate saying that).
3) I have been battling acne ever since I went off the pill.

And then there are the differences:
1) The first most obvious difference between me and the majority of PCOS sufferers is that they are overweight. Approximately 50 percent of women with PCOS are even labeled obese. My entire life I have been fortunate to have normal weight/I've watched myself to help maintain a healthy weight. (I give these two distinctions because while I may be genetically predisposed to be on the thin side, I am not just "lucky" in this regard -- I've also worked for it with careful eating habits and exercise through most of my life [until when I thought exercise could hinder my ability to conceive and I took a 5-month hiatus].)

2) Women with PCOS also write about how their diagnosis helped them finally understand their lack of energy. In previews I've read from PCOS and Your Fertility, the author asks you to check your energy level by asking if you are tired after a brisk 10-minute walk or if you're out of breath after walking up a flight of stairs. If we're using this as the measurement tool, then I can say I have plenty of energy. Even if the measurement was more rigorous, I guess I've always felt like I have more energy than the average woman I know.

3) A lot of women with PCOS report being incredibly moody and having severe mood swings. Maybe I'm giving myself too much credit, but I think I'm about as un-moody as they come. Yes, I have my moments like we all do, but I don't face extreme emotional ups and downs (except for, you know, the week I find out I have a serious medical condition).

So far I can relate to all PCOS sufferers when it comes to irregular periods. Even then, at this point, I'm glad to know that I am not like some women who go from 6 to 12 months or more without getting a period. I cannot relate to the weight control issues, lack of energy or moodiness. A lot of what I'm reading in book excerpts has to do with regaining normal menstruation by changing your diet. The main issue here is that I already abide by the general PCOS diet directions. There are, though, some people with PCOS who go so far as to follow a completely gluten-free diet. I definitely am not gluten-free, so that's something else I'll continue to investigate. Before I can really consider a gluten-free diet, though, I really want to know if I have insulin resistance. Some but not all women with PCOS are insulin resistant, so if I'm normal in this regard then going gluten-free probably won't help me restore regular ovulation. Looks like I have my first post-diagnosis question for my doctor.

The silver lining

After having myself a fantastic pity party last night following my official PCOS diagnosis, I woke up this morning a little more optimistic. (This appears to be a trend -- pessimism at night, optimism in the morning.)

Here's the good news:

• I now officially know what my condition is.
• My doctor took me seriously. A lot of women under the age of 35 can't even get their doctors to hear them or see them until they've been officially trying to conceive for a year. My doctor diagnosed my problem after 6 months of TTC.
• My doctor is ready and willing to put me on Clomid provided I am ready for that.

I guess in some small sense I am fortunate when I consider the fact that so many other women spend two to three times as much time as me stuck in a TTC rut before they can reach any sort of diagnosis. Knowledge really is power, and I hope to use the coming days and weeks to figure out what's best for me now that I'm armed with new knowledge.

Diagnosis

Today my doctor told me what I was about 90 percent sure I'd hear: I have PCOS (polycystic ovarian syndrome).

For a while now I've feared this is what I have and what's keeping me from getting pregnant. With anywhere from 5-10 percent of women of child-bearing age being diagnosed with this condition, it is the leading cause of female infertility. If you read message boards on sites like The Bump or Baby Center you quickly discover all these women talking about their PCOS diagnosis and how many rounds of Clomid their doctor has prescribed.

The thing that tipped me off to the fact that I probably have PCOS is the fact that I have such horribly irregular periods. Even though my periods were fairly regular before going on birth control, there is no known link between PCOS and the pill or any other type of birth control. PCOS can develop at any time for inexplicable reasons, and there's nothing you can do to prevent it. Irregular periods are a tell-tale sign of PCOS. Another sign of PCOS is elevated testosterone levels. Well, guess what: I have really high testosterone levels. This is not the kind of thing you want to find out about yourself at 5 a.m. It makes you feel, well, ugly and unfeminine. So, add high testosterone to infertility and you feel rather man-ish. (Also, women with high testosterone and PCOS tend to have trouble with adult acne -- which is true for me -- and tend to be confident, Type A characters -- which is painfully true for me.)

As I was going through almost all the stages of grief during my 15-minute phone conversation with my doctor and I was in my denial/bargaining stage, I asked her if my elevated testosterone levels could still be a sign of the birth control hormones exiting my body. She said that I am officially past the point of being affected by my birth control pills (which also contradicts the point about birth control maybe taking one year to exit my body). So, as much as I would now like to say that my body is still adjusting to being off birth control, it really does seem that I have PCOS.

There is no way to cure or even really treatment for PCOS. My doctor told me that her goal for me is to get a period once every three months, and if I don't get that, then I could face even more serious health issues. I have two main choices at this moment: I can do nothing and continue on with my irregular but not medically concerning long cycles, or I can start taking a medication called Clomid.

Clomid is a drug that increases ovulation. You take it five days in a row at a certain time in your cycle to stimulate ovulation. My doctor told me that I could try it for three cycles, and if the medicine didn't help me get pregnant in three cycles, then she would have me visit a reproductive endocrinologist. After that she mentioned scary acronyms like IUI and IVF which just made me break down and cry while talking to her. But, my doctor added that the chances of conceiving on Clomid are quite good -- and I've read reports that say anywhere from 50 to 75 percent of women with PCOS achieve pregnancy on Clomid -- but maybe she just wanted me to stop crying.

As with any other drug, though, Clomid does not come without costs. Besides the monetary costs, which wouldn't be that substantial (yet), there is a 5 percent increased chance of having multiples conceived while on Clomid. Additionally, because women on Clomid often do what my doctor referred to as "super ovulate" it can actually increase your risk of developing uterine cancer. It also sounds like -- through some anecdotal accounts I've read on message boards -- that many women who are on Clomid also face extreme mood swings and hot flashes, though obviously everyone reacts differently.

At this moment, I am just trying to process this information. I don't know if I want to take Clomid quite yet. My doctor told me that I can still get pregnant without Clomid, but with PCOS the chances of conceiving on your own are really, really low. For people with normal fertility, the chances of conceiving on any given cycle are only 20 percent, so when you ovulate as irregularly as I do, that just means I get about as third as many chances to conceive as the average woman. I also want to research insulin resistance, because that is a side effect of PCOS and some doctors prescribe drugs to decrease insulin resistance which can also assist in restoring ovulation.

Obviously, I need to sleep on this information (for probably more than just a night) and figure out what's right for me. My husband is totally supportive of whatever I decide; he's truly a great man, and I'm so fortunate to have him.

Are You There God?...

...It's Me.

For the past year or so I have been highly preoccupied with my periods, so much so, in fact, that I feel like I'm writing my own adult-version of a Judy Blume novel.

I guess the good news is that my husband also read the book when he was in elementary school, so he's been totally informed regarding female concerns for most of his life.

The other good news is that I have not yet resorted to chanting, "We must, we must, we must increase our bust."

The fertility diet: myths vs. realities?

When you're trying to conceive you come across a lot of information -- from books, from friends, from the Internet. I am a skeptic by nature, so I have a hard time believing that any single lifestyle choice in general or dietary choice in particular is going to be the secret ingredient for conception. After all, people have been conceiving babies since the dawn of humanity, and most of those people conceived without prenatal vitamins and dietary supplements and even particularly good general nutrition.

So, it can be a little maddening to read about all the dietary choices a woman can try to help her conceive. I'll admit, I've tried some of these, but mostly because I like the food's taste and general nutritional benefits. And, if drinking something or eating something were magically the secret to conception, well, I would have been pregnant in July.

What are some so-called fertility foods?

• Green tea typically tops the list -- I drink de-caf green tea a few times a week now, mostly because I like something warm to drink in the morning, and I've reduced my coffee intake.
• Yogurt and full-fat dairy are also frequently mentioned -- Good news is that I eat yogurt every day at lunch; but full-fat dairy, seriously? I can't stomach whole milk, but instead I go between skim milk and 2% milk. Oh, and I eat A LOT of cheese.
• Folic-acid fortified cereals -- Yup, Kashi, I consume you daily.
• Whole grains, fresh fruits and veggies, and foods with "good" fats, like salmon, have been a major part of my diet for as long as I can remember
• Pomegranate juice has been in the news for the past several years. While lots of women anecdotally claim it helps female fertility, there is one study that links better sperm quality to pomegranate juice (and Lance Armstrong seems to agree). I'll drink some pomegranate juice a couple times a week because I like the taste.
• You can even listen to those who claim consuming cough syrup will help you conceive.
• Eat pineapple core between 1DPO and 5DPO to assist implantation.
• Take any combination of vitamins (B, D and E appear to be popular ones) in addition to your standard prenatal vitamin that already contains plenty of folic acid to help you get pregnant.

The point of everything above is that there may be one or two studies that add validity to claims of linking fertility to these foods. There may be just as many studies -- if not more -- that negate such claims. My belief continues to be that I'll continue to eat a healthy diet overall. Right now I'm probably eating better than I ever have before. One single food is not going to get me pregnant, and the chances of a single food I eat or choice I make increasing my chances of achieving pregnancy seems dubious at best. And, at a time when I am trying to keep as many chemicals as possible out of my body, I will not be ingesting cough syrup.

OPKs: Easier than charting

If and when you read Taking Control of Your Fertility, you'll discover that the author, Toni Weschler, is semi-opposed to ovulation predictor kits (OPKs). If and when you talk to my doctor, you'll discover she's highly opposed to OPKs. But I'm here to tell you that OPKs for me have been a perfectly fine supplement to charting, and I'd even go so far as to say these can be just as helpful as charting.

What is an OPK?
The term ovulation predictor kit is a bit of a misnomer. When I first learned about them, I imagined a small microscope with lots of slides where I could perform my own little biology experiments. While it is true that I often feel like TTC has been a series of science experiments, OPKs are nothing more than little strips you dip in your urine that detect the surge of lutenizing hormone (LH). Your body always has LH present, but the surge in LH typically occurs between 12 and 48 hours before you ovulate.

Why are Weschler and my doctor opposed to OPKs?
In a word, cost. They claim they are too expensive for what they do and that a woman with irregular cycles has lots of difficulty using them correctly. (This assumes, though, you buy them at drug stores.) Additionally, some women test at the wrong time and miss the surge. Also, sometimes the OPK will detect an LH surge and ovulation does not actually occur.

Why do I like OPKs?
I like them because I found the cheap ones on Amazon that work as well as any more expensive ones you could buy in a drug store. When I got my period most recently and I was running low on OPKs, the first thing I did after my temperature dropped was order 120 OPKs and 40 accompanying home pregnancy tests (HPTs). (I did this, of course, because they come in packs of 40 OPKs and 10 HPTs for a little more than $9 total, and I was going for free shipping on orders of $25 or more.) Now, I have the most irregular periods on the planet, but I do not consider these OPKs to be a very significant investment. Additionally, even though I have incredibly irregular periods, I can still use as many of these as I want at a relatively insignificant cost, compared to the 7-20 strips that come in your standard store-bought OPK and cost approximately $24.

So far, these cheap OPKs have perfectly caught each of my LH surges. At first I was using the OPKs only in the morning, and then I read that they do a better job detecting the LH surge when used in the afternoon -- for some reason, 3-5 p.m. appears to be the average woman's best time for detecting the LH surge.  A positive test has a test line that is as dark or darker than the control line. This the one downside to this particular OPK: you will almost always have two lines present, but the test line will only achieve proper darkness when you're about to ovulate.

The first time I used these strips I got a positive reading one time, even though I was testing daily. Most recently, after I learned to test in both the morning and afternoon around the time I think I might be ovulating, I got three positive tests and one almost-positive test (one afternoon positive, still positive the next morning, still positive the following afternoon, and close-to-positive the following morning). So, with these tests I recommend testing in morning and afternoon around the time you think you could be ovulating. Of course, for me, that means testing for about 20 days, but with these super-cheap tests I really don't mind.

My verdict? If you decide that charting is too complicated or too crazy for you, you can get the same, or very similar, results by using these cheap OPKs.

Why I don't trust Fertility Friend VIP

So yesterday when I introduced you to my charting world, I told you about a free site called Fertility Friend where you can enter your daily BBT and other fertility signs. What I didn't tell you is why I've learned to beware of the VIP site.

When you first sign up for Fertility Friend, you are automatically offered 30-day free access to the VIP site. This site includes a number of special features, including a fertility analyzer -- a little stop light that pops up next to your calendar and tells you that you are "most likely not fertile" (which totally freaked me out when I signed up -- I'M INFERTILE???!!! FYI, that's not what it means) or "possibly fertile" or "most likely fertile." This feature, while a little silly, is not the big problem. The big problem is the Pregnancy Monitor. This thing is such a pot of bullshit.

Here's how the Pregnancy Monitor works. After ovulation has been detected and you've entered your luteal phase (LP) the Pregnancy Monitor kicks in. (Side note: this time is also known as the Two Week Wait [TWW] between ovulation and your period during which you've hoping you'll be able to get a big fat positive pregnancy test [BFP]). The Pregnancy Monitor compares all your symptoms to the symptoms of all the other charts on the site where women have achieved pregnancy that cycle. So, if you had cramping on 5 days past ovulation (DPO) and lots of pregnant women also had cramping at 5DPO, you essentially score points on the Early Pregnancy Signs chart.

The Pregnancy Monitor also scores your Intercourse Timing, looking at whether or not you had sex three days before, two days before and one day before ovulation as well as on the day of ovulation itself and even the day after ovulation. If you have sex two of those days you've rated as having a "good" chance of having achieved pregnancy this cycle.

This all sounds like it could possibly be useful information, right? I thought so too. Last cycle, I eagerly entered my symptoms each day during my LP. I had 70 points out of 100 in the Early Pregnancy Signs scale. My temps were high and even seemed triphasic (where after the initial post-ovulatory spike you have a second spike of temps that may indicate implantation and pregnancy). And, according to the Intercourse Timing analyzer, I had a "High" score.

This is why, when my period came 12 DPO, I felt especially crushed. We had "done everything right." I even had the "scores" to prove it this time.

The ray of sunshine in this experience is that my 30-day free trial of the Fertility Friend VIP site ended while I was in the middle of my last period, and I gladly refused all the site's attempts to sign up for the VIP membership at a reduced price. Now I simply have the basic site access for free, where I can still enter my temps and signs, but I don't have the luxury of comparing all my signs to all the other charts. And I am much happier.

Learning to love charting

Back in the days before my neighbor (and good friend) knew I was TTC, she recommended I read the book Taking Charge of Your Fertility. My friend kept telling me it was full of useful information that -- as the name suggests -- allows you to have a better sense of what goes on inside your body every cycle. I kept thanking her for the suggestion, saying, "Yeah, I'm not quite there yet," honestly figuring that I'd be pregnant within the next month, so why bother with the investment and add another thing to the list of items that could potentially stress me out. In hindsight, I was totally wrong, and I wish I had read the book several months before we started TTC.

If you've got any knowledge of the TTC world, you've no doubt heard of -- or, even more likely, read -- this book. If you're brand new to this game, though, I'll offer a quick summary. (If you're already familiar with this information, you should skip down to the My Experience subheading!)

Crash course:
The premise of the book is that women can use basic physiological signs to keep track of where they are throughout the course of their monthly cycles, from menstruation to the fertile phase to ovulation and then to the phase between ovulation and menstruation called the luteal phase. Here's the most important disclaimer: this book is NOT about the Rhythm Method, a totally outmoded and completely ineffective method for those practicing birth control and those hoping for pregnancy achievement alike. The Rhythm Method follows the premise that all women have 28-day cycles, with ovulation occurring like clockwork at day 14. This is false for the vast majority of women, which is why Taking Charge of Your Fertility preaches an entirely different gospel based on a woman's individual physiological signs.

There are two main signs women can track: basal body temperature (BBT) and cervical mucus (or, more preferably, as the author points out, cervical fluid, which sounds a lot nicer). We'll stick to CF for that one.

Your BBT changes during the course of the month: traditionally we have low readings during menstruation up until ovulation (97-97.8 degrees), and then at ovulation most women see a spike in temperatures that remain high (97.9 and up) until the day that your period is destined to arrive, when temperatures typically plummet again. Your CF also changes accordingly, with it being most present and sperm-friendly when you are in your most fertile phase.

The trick to using this Fertility Awareness Method (FAM) for pregnancy achievement is to time intercourse during your most fertile phase based on your CF. You use your BBT, and its spike around ovulation time in particular, mostly as proof that you are in fact ovulating and not having anovulatory cycles. Once your BBT has spiked, the egg has already been released and your chances of fertilization are incredibly low, so if you wait for your temps to change to help you time intercourse, it won't work. (And, if you follow this FAM process religiously, you can also use it as fairly effective hormone-free birth control if you simply avoid intercourse during the window in your cycle when you are close to ovulation -- though I have no experience with that.)

You're supposed to take your BBT each morning when you wake up at approximately the same time while you're still under the covers. You're also supposed to do this for a few cycles to notice patterns and help you determine when you're ovulating. Of course, this is way more tricky when you're like me and have highly irregular periods, so your charts from one month to the next are not that helpful in allowing you to predict ovulation. You're also supposed to start charting on cycle day (CD) 1, the first day you get your period, but really you can start at any time as long as you know how many days you are into your cycle.

My experience:
After almost five months of actively deciding not to read the book, I ordered it on Amazon and devoured the entire thing in a few hours. I got out my trusty digital thermometer and gave it a new home next to my bedside table. I signed up for a free account on fertilityfriend.com. (There's even a mobile site that allows me to enter my temps from my phone while I'm still in bed.) I started charting in the middle of my last (really long) cycle, and you know what? It really works. Like clockwork. I could see exactly when I ovulated based on BBT, CF and my ovulation predictor kit (OPK) to boot as double back-up proof. The upside to this is that my husband and I timed intercourse as well as we possibly could. The bad news is that after 11 days of high temperatures after ovulation the next morning I woke up and my temperature plummeted to my pre-ovulatory temperatures. And I started crying as soon as I put the thermometer down -- I had been convinced this would be the month that it worked.

But then I got out of bed and put on my big-girl pants and I realized, hey, now that I know I am going to get my period today, it won't be such a shock. A few hours later when the dreaded period arrived, I simply shrugged and thought, "I was expecting you."

Even though my irregular periods make my charting experience less than ideal, I will say that there's a sense of empowerment that comes along with knowing that despite all the uncertainty I'm dealing with, at least I know I'm ovulating, and at least I know when my period is going to arrive. Although I'm resigning control to determining when my body will allow me to get pregnant, I now at least know when to throw some tampons in my purse.

Really hungry: blood test edition

Yesterday I told you about the planning I went through leading up to going off birth control, and now that I am past the six-month mark of TTC, clearly things have not been moving like clockwork. Today I am going in for a blood test (finally) to figure out what's going on, and I'm really hungry because I normally eat a big breakfast every morning when I first wake up. All in all, though, I'm thrilled to be getting blood drawn today.

Here's what got me to this point.

I went on birth control in March 2004, and up until that point in my life I had pretty normal periods. No, I wouldn't get my period every 28 days, but so few women actually do. I fell in the "normal" range because I would get my period every 30-35 days. In college I was definitely influenced by the hormones of all the girls I'd live with -- I was clearly not the alpha female -- so my body and my cycles would naturally adjust to the bodies of the women around me.

Throughout my life I have never had any gynecological problems -- no STDs, no pregnancy scares, no abnormal test results. I also have a clean bill of health -- I have no known diseases, regular blood pressure, ideal BMI. I've never been hospitalized. I have been on antibiotics twice in my life, once for a wisdom tooth that got infected and once when I got a big splinter. Besides that, the only medication I've ever taken is birth control. I've never smoked or done drugs, I drink both alcohol and caffeine moderately, I eat a well-balanced diet with lots of delicious and healthy home cooking, and I get moderate exercise. I even go to the dentist every 6 months.

So, after I went off birth control in July 2010 and got the bleeding (a.k.a. "fake period") that follows finishing a pack, I was a little surprised that it took me 45 more days until my next cycle began.

Then cycle 2 was never ending.

On day 60 of cycle 2 in late October I called the nurse at my doctor's office. I told her I'd been concerned that I was neither getting my period nor did I appear to be ovulating.

The first nurse I talked to asked, "Oh my, now are you sure you're not pregnant?"

"Well, five negative pregnancy tests and no symptoms would suggest that I'm not pregnant," I said.

She still said she thought I should come in immediately. "Can you be here in a couple hours?"

Well, no, my job is totally inflexible, so that wasn't happening, but I told her I could come in tomorrow late afternoon. She said she would have another nurse set up the appointment and call me back.

Twenty minutes later when nurse number 2 called, she asked, "Are you running many miles a week? [No.] Are you drinking daily? [No.] Did you have abnormal periods before you went on birth control? [No.] Are you sure you're not pregnant? [Yes.]." And then, the real kicker, "Honey, you're young and you have nothing to worry about. It can take up for a year after going off birth control for your cycles to regulate themselves."

I expressed dismay, seeing as this was not the same information my doctor shared with me in August 2009 when I did my pre-conception visit. Pretty obnoxious. I knew, based on some research, that it could take a few months for my cycles to be more normal, but even then I felt I was way outside the normal range. The nurse did tell me, though, that I was overdue for my annual appointment, so she scheduled me for one in early December. (Funny side note: when the OB thinks you might be pregnant, they can get you into the office that day, but for any other concern you have to wait six weeks.)

Fortunately, my ovulation predictor kit indicated that I finally ovulated on day 69 of cycle 2, and I got my period on CD 76 (which also indicates a short luteal phase, but I'll take it for now....more on that later.)

Cycle 3 lasted 65 days and I ovulated on day 54 (meaning I achieved an 11-day luteal phase...go me!). Cycle 3 is also when I got serious about fertility charting. (That's the subject of a whole different post.)

In the midst of cycle 3 I had that annual exam in early December. My doctor assured me that I needed to time sex appropriately for pregnancy achievement. Well, duh. Trust me, we are. Then she instructed me to email her as soon as I got my next period and she would be able to somehow miraculously pinpoint the 10-day window during which I am most fertile and therefore, according to her, we should be having sex every other day (we were already having sex every other day, and every day during my most fertile phase around ovulation). Somehow someone with a 45-day cycle, followed by a 76-day cycle, followed by a 65-day cycle could be told what days to have sex and it would magically work? I internally rolled my eyes and promised to email. In the meantime, she told me it wouldn't hurt to check my thyroid function just in case, so she ordered up the blood work and I headed down to the lab. Good news: normal thyroid function.

So, a week and a half ago when cycle 3 ended I emailed my doctor my cycle history since going off BC pills. She wrote back and told me, somewhat to my disbelief, that we need to get to the bottom of what is causing me to have such irregular cycles. FINALLY. So, she ordered up some blood work and told me to go to the lab as soon as I could.

That brings me to today, waiting here for the lab to open so I can get my blood drawn and then eat. I feel like today is a bit of a milestone in the TTC process because my doctor has actually acknowledged that something may be wrong. Yes, I've been a little annoyed that she hasn't taken me too seriously up to this point, and I'm still considering switching OBs, but perhaps showing her that I have been charting my information has convinced her that I mean business. Maybe, in small way, I've managed to take back a little control.

Introducing me, planning to TTC

OK, now for the real back story:

I'm a hyper organized person, so I thought I could approach TTC with the same gusto I approach most projects in my life: make a careful plan, reap the fruits of my hard work. Everything in life has been ths way for me. I worked hard as a child, got excellent grades that got me into excellent schools, where I got more excellent grades and internships that resulted in an excellent job. I work hard and excel in my job, make decent money, found an outstanding man who became my husband, and together we bought a beautiful house and have raised two adorable dogs. I have so much going for me in my life, and I am a great example of how those who work hard can achieve success.

Sound familiar? Chances are, if you're reading my blog, you are also probably a person who has controlled much of your destiny up until this point.

So, in August 2009, 11 months before my husband and I were planning to start TTC, I used my annual OB appointment as an opportunity to drill my doctor on everything I should know/should be doing before we started to TTC. I'd already read What to Expect When You're Excepting back in 2008, so I came armed with questions. She told me that because I'm young (I'm now 29 with a 30-year-old husband) with a history of perfect health, I would get pregnant immediately after I went off birth control. This is, of course, in retrospect now in the Hall of Fame of Worst Advice I've Ever Received. She added that I should finish my last pack of birth control pills, and then I could start TTC immediately -- she did not recommend any wait time as some other doctors recommend because, in her words, I would be most fertile right after ditching the BC pills.

Oh, and she said I should cut down on alcohol, caffeine and mercury-laden fish, which is simply her generic advice she gives all women. I do not consume a ton of any of those items, so I didn't need to make much in the way of a lifestyle adjustment. And, in keeping with her generic advice, she also told me to start taking a prenatal vitamin three months before I started TTC.

During that August 2009 appointment she did decide to have me run down to the lab to have my blood drawn to test for Cystic fibrosis, and the test revealed I'm not a carrier, so the odds of my husband and I having a child with this disorder are exceptionally low.

After the appointment I planned our big summer trip around my periods and the date that I wanted to ditch my birth control. My husband and I picked the date we wanted to start TTC around the date that I wanted to give birth, figuring (so shockingly naively) that I would get pregnant on the first try because that's what the doctor told me would happen.

I marked my calendar religiously: start taking prenatal vitamin on April 1; finish BC pills on July 15. Then, of course, have a baby born in March or April. I started imagining the conversations I'd have with coworkers when I'd announce in October that I'd be giving birth in March, the time of year that my job becomes most insane. Frankly, I couldn't wait to abandon my work and take care of a newborn.

As you can imagine, October (and November and December and now January) came and went with lots of big fat negatives on the pregnancy tests, and lots of other annoying surprises about my body to boot.

I've named this site Resigning Control because that's been the biggest lesson I've had to learn in the six months so far my husband and I have been TTC. Up until this point, I have controlled everything in my life and gotten everything I've ever wanted. Clearly the process of having a baby is something I cannot control, no matter how much I would like to.

Deciding to share my story

When my husband and I decided a year and a half ago that having kids would be in our not-too-distant future, I decided we wouldn't tell anyone. What if we found out we were infertile? How embarrassing would it be for so many people to know that about us?

Then, about a year ago, I decided to tell one of my best friends when we were out to lunch. She was thrilled and eager to know more since she also has not had any children.

Then I told a few of my best friends from high school.

Then I told a close co-worker.

Then I told a neighbor.

By this point, some of the closest women in the world to me knew about this latest project my husband and I had decided to take on.

Finally, I had to rein myself in. Although I do not any longer view infertility as something anyone should be embarrassed about -- and I frankly have no idea right now if my husband and I are truly struggling with infertility or not -- I felt like I needed to stop telling my friends that we were TTC. I don't want to be annoying and self-centered. Perhaps more importantly, though, I don't want people at work to even suspect that I might be TTC and therefore treat me any differently. (In a perfect world a woman would not have to worry about discrimination in the workplace, and while I have not experienced overt discrimination, I know too many instances of women who've faced subtle discrimination when it comes to their choice to have children.)

So, I decided this blog could be a place for me to (mostly) vent my frustrations and share my story in hopes that anything from my experience could potentially help someone else. For a while there (aka last month, and the month before that, and then earlier in the fall...) I was spending entirely too much time scouring the Internet looking for answers my doctor seemed incapable of providing. I do not claim for this blog to possess medical wisdom, but I do think that when you're faced with TTC, something you've never worried about in your entire life -- except those times you prayed you WERE NOT pregnant -- it's good to know as many stories as possible to arm yourself with knowledge, however anecdotal.

I give you my personal story, nothing more, nothing less, and I hope the window into my world will open doors within your own. Good luck!