Photos by Lindsey Lowe Photography
I blinked and my pregnancy is already almost half over! I had my twenty-week anatomy ultrasound on Monday, and can feel the baby wiggling around in my belly almost constantly. For those of you that are interested, I wanted to pop in and share a bit about our journey to pregnancy. If you’re just hungry for a new recipe, swing back by in a few days!
I mentioned in my baba ganoush post a couple weeks ago that I received an infertility diagnosis just a few months before I got pregnant, and wanted to share more about it in case anyone else is going through something similar and also to help end the silence in which infertility issues are often shrouded.
For the past several years, my period has been irregular. It started when we moved from MA to TN in the late summer of 2015, and at first I thought it was due to stress from the move. Fast forward a year or so, and I had missed two entire periods (although not consecutively) in a year. I mentioned this to my primary care doctor, who cavalierly suggested I lose 10-15 pounds. She explained that fat was estrogenic, and that extra hormones from fat stores could be throwing things off.
I lost over 20 pounds in the following year, but my cycles were more sporadic than ever. In July of 2017 I went to an OB-GYN to have my hormones tested, and everything came back normal. He offered no explanation for the irregular cycles and did not seem concerned about my prospects for future pregnancy. Right after our wedding in September, we stopped using protection and started trying to conceive. I missed two periods in a row, but wasn’t pregnant. I also started having hot flashes at the beginning of January 2018. They happened many times each day and were extremely unsettling as well as uncomfortable. Since we wanted to have a baby soon, I was nervous. Suddenly I was desperately worried that we’d missed our chance.
I went back to my OB in February. He was extremely dismissive (noticing a pattern here?) and said he didn’t think there was any way I was going through an “early change”. (Someone must have told him never to actually say the word “menopause”.) When I asked why, pointing out that my symptoms (missing periods, hot flashes) aligned with early menopause, he said that at 32 I was just too young. That’s the thing about early menopause, though–it’s EARLY. Although doctors like to call it something different in women under 40, it can actually happen at any age!
He begrudgingly agreed to test my hormone levels again. I had my blood taken and left his office feeling angry and patronized. Needless to say, I never went to see him again–but I did have to take a phone call from him a week or so later with my results. My TSH (thyroid-stimulating hormone) and prolactin came back normal, but my FSH, or follicle-stimulating horomone, was 98–a sky-high, menopausal level. In healthy women of reproductive age, FSH should never go above 20 or so. It rises a bit once each month to encourage your ovaries to grow egg follicles, and then goes back down. A high FSH level is indicative of a decline in ovarian function, and usually happens when you’re not ovulating. FSH goes up but an egg still isn’t released, so the body keeps producing more and more and more of the hormone, often to no avail. Not only is high FSH an indicator of ovarian failure, but also likely means that you’ll be a poor candidate for fertility treatments like IVF, which use artificial hormones similar to FSH to stimulate the growth of eggs. If your body isn’t responding to increasing levels of FSH, it probably won’t respond to artificial hormones either.
I was heartbroken. I tried and failed not to start crying on the phone with that stupid doctor, and spent the rest of the day crying on the phone with my parents and close friends and being somewhat comforted by my sweet and amazingly level-headed husband. My stepmother’s brother, who is a much better OB-GYN than the one I had been seeing, spoke to me on the phone and recommended that I see a fertility specialist and get my levels tested again in case something had gone wrong in the testing process. I went to see Dr. Scotchie at Tennessee Reproductive Medicine, and although she was much nicer and more informative than my OB, the results came back the same (my FSH was slightly lower at 72, but she said a small decrease like that did not mean much). She explained that for women like me, the options were generally adoption, donor eggs, or donor embryos. My estrogen was still normal, but she explained it would likely decline, and then she would prescribe hormone replacement therapy to mitigate the effects of menopause (which include fun things like a drastic increase in osteoporosis risk). My diagnosis was premature ovarian failure or primary ovarian insufficiency, which is the name given to the condition in which your ovaries stop working before age 40.
Ben and I decided we would try for a while to get pregnant on our own anyway, perhaps even with an experimental protocol of hormone therapy to reduce FSH and hopefully kick-start ovulation that Dr. Scotchie had agreed to try with us. She did say, however, that she did not have experience with the protocol and that it was a “hail mary”. If we didn’t manage to get pregnant within a year or so, we would look into donor embryos, which are much cheaper and faster to get than donor eggs.
I asked both my OB-GYN and Dr. Scotchie if there was anything I could do in terms of diet or lifestyle to regulate my cycles, increase my fertility, or improve my chances of getting pregnant. They said no, although Dr. Scotchie did point out that losing some weight would make pregnancy easier and reduce the risk of complications. I thought they were probably wrong. Even before seeing either of those doctors, I had read WomanCode by Alisa Vitti and started following some of the advice in her Flo Living protocol, including giving up caffeine and limiting sugar. Although this hadn’t regulated my cycles, it had helped me lose weight and feel better. Also, the book makes an important point, which I had suspected all along: irregular cycles are NOT normal. They are a symptom of some kind of problem, and can and should be addressed right away. Alisa refers to menstrual cycles as an additional vital sign for women’s health, and encourages women to get to the bottom of period issues in order to improve their overall health.
I did more research into dietary changes and supplements for fertility, and came across the website To Make a Mommy, which is written by a woman named Anna Rapp with high FSH like me who had two children naturally. Anna recommended many dietary and lifestyle changes, as well as supplements and additional resources. At her recommendation, I read the book It Starts with the Egg, which outlines how to avoid toxins, eat right, and supplement wisely to improve egg quality, which most doctors will tell you just declines with age and can’t be changed.
After all my research, I implemented the following changes as much as I could (I was not 100% perfect!). I avoided caffeine, dairy, alcohol, sugar, and gluten. I included plenty of protein and vegetables with each meal and chose low-sugar fruits. I avoided exposure to toxins like BPA by limiting my use of plastics. I started supplementing with wheatgrass powder (to lower FSH) and maca root powder (to regulate cycles) in my morning smoothies, and took co-enzyme Q10 pills to improve egg quality. I was already taking prenatal vitamins, and started taking additional Vitamin D3 and magnesium glycinate. I did a little yoga every single day, even if it was just a few quick sun salutations in the morning that took literally three minutes.
Less than two months after implementing most of these changes, I got my first period of 2018 at the end of March. I was overjoyed! I’ve always dreaded my period and the painful cramps that come with it, but being worried I’d never have a period again completely changed my outlook. On Day 3 of my cycle, I headed to Tennessee Reproductive Medicine for another blood test and an antral follicle count via ultrasound. Doctors like to test hormones on Day 3 and then compare those Day 3 levels to each other over time, because levels vary so much at different points in a woman’s cycle. Since my period was missing I hadn’t been able to get Day 3 testing yet, which meant I didn’t really know my “true” hormone levels. My FSH came back at 15, which is much closer to the normal range than before (although on Day 3, it should be below 10 or so).
In an antral follicle count, all your mature follicles are counted during a transvaginal ultrasound. Although only one egg is typically released each month when a woman ovulates, many follicles grow and mature as candidates each cycle. One follicle is chosen to eventually release its egg. Normal, healthy women should have a total of twenty to thirty mature follicles on Day 3. Antral follicle count is believed to be an indicator of ovarian reserve, or how many viable eggs a woman has left. (True ovarian reserve cannot be quantified, because most of a woman’s eggs are too tiny to be seen on an ultrasound. Only the ones that have grown over the past couple of months as candidates for ovulation can be seen and counted.)
My antral follicle count was dismal: the doctor could see one follicle on one ovary and none on the other. Nevertheless, I tried to remain hopeful. When you are conceiving naturally, it only takes one good egg.
As soon as that period ended, we got busy trying to conceive (when your cycle is irregular, you never know when you’ll ovulate!). I ordered a cheap kit of 20 pregnancy tests and 50 ovulation predictor kits on Amazon. Ovulation predictions kits (OPKs) work by measuring the level of LH, or luteinizing hormone, in your urine. This hormone spikes right before ovulation and then goes back down for the rest of the month. I’d tried OPKs in the months after our wedding, but had never gotten a positive.
The kits arrived on April 6th, which was day 11 of my cycle. I started using them right away, and about a week later, on April 12th or cycle day 17, I was excited to get a positive! However, then I got another positive, and another. Usually LH only spikes briefly and then goes back down once you’ve ovulated, so it is unusual to have positive OPKs for several days in a row. I also didn’t feel like I was ovulating since I hadn’t noticed any of the other signs, like changes in cervical mucus. I did some research about why ovulation predictors would come back positive if you were not in fact ovulating, and some sources said that pregnant women can test positive on OPKs because HcG, the pregnancy hormone, is similar in structure to LH. (Don’t worry, though, because the reverse is not true–you will not get a positive pregnancy test just because you’re ovulating!).
I waited until the next morning so I could take advantage of the higher hormone levels in first morning urine, and on Sunday, April 15th, I took a pregnancy test. I was sure it would be negative. I remember giving the test the side eye when the requisite two minutes still hadn’t passed, and spotting a second line. I was shocked! Although false negatives are common in early pregnancy, false positives are not: that second line means you’re pregnant. Somehow, we had managed to catch that one good egg. For those of you paying close attention to cycle dates, this means I ovulated very early, right after my period. My period began March 27 and since I kept track of of all baby-making attempts, I know we conceived on March 31st (cycle day 5) or April 3rd (cycle day 8).
Would we have been able to conceive even if I hadn’t gotten the infertility diagnosis that led me to clean up my lifestyle? It’s hard to know, but I like to think all the changes I made really helped!
It’s been 20 weeks and a few days of growing this baby girl so far, and I am so excited and happy. Since this post ended up being so long, I’ll plan to share a separate post with a recap of my first trimester (it’s up now, right here!). Are you interested in pregnancy posts, or will you just be waiting for the next piece of edible content? Have you had any infertility struggles or difficulty getting pregnant? I’d love to hear from you in the comments!
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