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.
Sunday, March 20, 2011
Wednesday, March 16, 2011
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.
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.
Thursday, March 10, 2011
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.
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.
Sunday, March 6, 2011
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.
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.
Wednesday, March 2, 2011
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.
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.
Thursday, February 24, 2011
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.
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.
Sunday, February 13, 2011
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...":
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.
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.
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