Monday, March 28, 2016

Puzzle Pieces: Part 1



     “What is wrong with me?” This is a question that I forlornly asked myself over and over again during the 30 months that I tried to conceive my son. It is a common lament for anyone who finds him or herself in this frustrating position in their life. When dealing with infertility for any span of time, you begin to feel a total loss of control over your own body and your own life. You feel like there are no answers to be had. That is, until the day comes when you gleefully learn that there is, in fact something wrong with you!!!! This sounds like it should be bad news and in any other situation it would be. But not after having unexplained infertility. I was thrilled to discover a real problem because with problems come solutions and I love a puzzle.

     I will begin this post by stating the obvious. I am not a doctor or a specialist in fertility in any way, shape or form. I am not an expert in this field by any measure. So please do not take my words or recommendations ahead of those provided to you by your health care provider. I am merely sharing my experience, in hopes that it can possibly point someone out there with similar symptoms in a direction that may provide them with some answers too. This is simply what helped me.

     Anytime anyone asks me what finally worked for Jim and I, I always give the same answer. “Charting.” I completely attribute my eventual success at achieving and maintaining pregnancy to charting. It made all of the difference. Often, people are expecting to hear something different. They want to hear about a pill or cream or supplement that was the magic key for us and the truth is, while I did end up coming across a miracle cure for myself, it not only wouldn't work for everyone but it could also have the exact opposite effect if you are suffering from a different issue than I do. That is why charting is always my suggestion. While charting won't necessarily get you pregnant, it can give you an excellent picture of what is going on inside of your body and allow you to identify your own personal obstacles to getting there.

     A word of warning... I'm about to get into some big girl topics, so dad, this may be a post to skip...

     In early spring after two full years of trying to conceive, I started to recognize a worrisome pattern standing out in my chart. My periods, that had never been even a day late and were usually a few days early started to signal a huge problem. I had always assumed that as soon as I saw any blood, that would indicate my period starting. However, this is not the case. When charting you learn that in fact, your period starts and your new cycle begins only after a temperature drop. It doesn't matter how much blood you are seeing, if your temperature remains high, then that blood is not a period. It is called spotting and it is a big problem. Here comes a little biology lesson...

     After ovulation, your temperature will spike and remain elevated throughout your Luteal phase. The Luteal phase is that tricky time between ovulation and the start of your next period. Those are the two or so weeks that just pass silently by under the radar of daily life for most women, but become a battleground for those of us trying to conceive. Most women think of their cycle as a whole. A unit of time between periods. But it actually is not. It's actually two distinct phases of one larger unit, and both have very different jobs.

     The first half of your cycle is known as the Follicular phase, which is when your body prepares to release an egg. Your hormones are all working toward that end. Everything is gearing up for the really big O and the only O that actually matters two years into trying to get pregnant... ovulation. This phase varies even in an individual woman and is the reason that your cycle is rarely exactly the same number of days long each month. A lot of different life factors can throw this phase off by a day or even a number of days. These include stress, travel, diet, exercise, illness and about a million other things. You can even have false hormone spikes where your body attempts but fails to release an egg for one reason or another and your hormones will again drop back to your baseline only for them to make another attempt a few days later. It is often a largely unpredictable phase.

     Once an egg is released, you have graduated to the second phase, the Luteal phase which is pretty much a set amount of time for each individual woman every month and usually ranges from 13 to 15 days for most healthy women. For the most part, this phase stays the same length from month to month. You may lose or gain a day over time, but for the most part you can predict the length of this phase. It doesn't usually change. During this phase, the egg has that set number of days to become fertilized, make the long journey to the endometrium and implant there. At that point... Ta Da!!!! A pregnancy. If the egg is not fertilized or is fertilized but fails to implant, then a hormone change occurs signaling for a normal period to begin and you end up with yet another big fat negative on your home pregnancy test.

     A problem develops however, if that Luteal phase is too short. You're pretty much okay with 12 or more days and it isn't unheard of get pregnant with as short as a 10 day Luteal phase (although it is far from ideal.) But less than that and you have a timing issue in your uterus because it takes on average at least 10 to 12 days for the egg to even arrive at an appropriate landing site to implant. They are small and move slowly with a lot of ground to cover to get where they need to be. If you begin to lose blood before that, then the egg doesn't have an adequate surface on which to implant and will be lost during menstruation.

     I studied my chart closely and realized with horror that I was consistently looking at an eight to nine day Luteal phase depending on the month. These ovaries, that had done so well in college and life in general, were now too impatient to give me an extra damn day or two?! I am late for ABSOLUTELY EVERYTHING! How could I consistently be early for this???! But, at least I finally had a possible answer to the question that I had been asking for so long. What is going wrong?

     Luteal Phase disorders are usually related to progesterone. Estrogen rules the beginning, Follicular phase of your cycle, but progesterone calls the shots in the Luteal Phase. Generally, your progesterone levels start to drop as your body signals that fertilization has not occurred. As it drops, it lets your period know that it is okay to start flowing. There is no egg to nurture. Your work here is done, thanks for the help, you can go. Issues arise if this signal happens too early, before an egg even has a chance to become fertilized and implant. Low progesterone levels are a primary cause for the spotting that I was seeing month after month.

     This hormone deficiency can cause a number of issues including recurrent early miscarriage, endometriosis, obesity, depression, low thyroid, PCOS, irregular or consistently low basal body temperature and fibrocystic breasts among many other things.

     You may be wondering if a doctor can test you for low progesterone to avoid having to chart. The answer to that is yes they can, but their testing is remarkably inaccurate. This is because the majority of doctors use a basic equation to determine at what point you are in your cycle. This formula utilizes a four week month, and a twenty eight day cycle, with ovulation occurring on the fifteenth day. Progesterone levels peak around the seventh day after ovulation. So this is the ideal day to test ones progesterone levels. The problem is that most women are not typical and do not have a standard twenty eight day cycle. Even those who do may not ovulate on the fifteenth day and thus, will not be ready for progesterone testing seven days later. Unless you chart, you will not know when the optimum time is for you to be tested. I noticed that even if you do chart, doctors cannot always accommodate scheduling you on that exact day and you will again be forced to sacrifice the accuracy of your test results.

     I was able to determine from my chart however, that progesterone was at least a part of my issue and as month after month passed by with the same concerning pattern I was fairly certain that this was a huge problem and a major piece to my infertility puzzle.

     Armed with that information, I began to research my options for solving this problem. To my delight, there was a relatively quick, easy and inexpensive fix that I could do within the privacy of my own home that could get my Luteal phase back on track. Finally, I felt like I had a real plan but I was going to need my chart now more than ever...


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