Consumed

Okay, ladies, hold onto your hats because this is going to be a(nother) long one…

Lately, I’ve been worrying. Like, a lot. This is nothing new for me really. I’m a worrier by nature. But up until now, I’ve been feeling pretty calm and steady. Just put it in God’s hands, has been my frequent mantra (though I have certainly struggled with this particular motto — see my last post for details). I’ve felt fairly at peace, knowing that I just have to get through my current cycle in order to have a pretty damn good chance at my next cycle (as the 2nd cycle of 100mg of Clomid has never failed me yet).

But that all went up in smoke some time last Friday.

Because while I believe that the Clomid may do its job next month and I may even conceive, I have zero confidence that the pregnancy will actually stick around. My big fear is late ovulation. With my daughter (the pregnancy that did stick!), I ovulated on CD19. With my most recent pregnancy (the one that failed), I ovulated on CD22. I have no idea if late ovulation caused my miscarriage (my OB says probably not), but I just can’t shake the fear that it did. And if it did…what if I ovulate late again? And what if I lose again? I know there are so many women who have recurrent miscarriages and my heart goes out to every one of them, but I don’t know if I will ever be strong enough to handle that. I really don’t.

So I have considered contacting my OB (I don’t see an RE) to request that he increase my Clomid to 150mg, but I know that high dosage is unusual and can cause adverse side effects (which I have been mostly spared so far). Yet my hope would be that the increased dosage would help my little ol’ ovaries to respond faster and move up the ovulation day. I keep telling myself that, if my next cycle (#2) doesn’t work at 100mg, then I will definitely contact my doc…but what if I conceive before that and what if it’s late in my cycle and what if I lose again? WHAT IF???

The other thing that I have been worrying about is PCOS. I have been tested for it, but never diagnosed with it, and yet sometimes I am convinced that I have it. Here are the things I know (get ready to know more about the private areas of my body than anyone IRL does!):

  • I have irregular (nearly absent) cycles.
  • I have very mild acne…just a few zits on my chin and forehead (although it used to be much worse).
  • I have a little extra body hair (embarrassed to admit to this…but I have quite a few dark hairs around my nips as well as just below my belly button).
  • I have two skin tags on my neck.
  • I am not overweight, but do sometimes have trouble losing weight. (It’s not impossible for me, but does require some hard work.)
  • The last time I had an ultrasound, I had just a single, very small ovarian cyst…but that u/s was during my miscarriage and I’m not sure if being essentially pregnant would change the results.
  • All of my lab tests (LH, FSH, prolactin, fasting glucose, fasting insulin, and testosterone) have come back normal…BUT the last time I tested them, it was not on CD3 as is typical, but during my m/c when my beta levels were still positive for pregnancy, so again…not sure if that would throw everything off.
  • I have taken a lot of OPKs in the last couple years and there has only been two months in which I got a false-positive, so I know my LH isn’t tooooooo out-of-whack. (However, that 2nd OPK line has been getting darker in the last few days and yesterday was very close to being positive. Do I think I actually ovulated? No. I’m taking progesterone. It’s unlikely. So now I’m feeling extra-concerned and anxious!)

To sum up: I have a few of the superficial symptoms of PCOS but not any of the most obvious ones (except those irregular cycles, of course!). And to be frank, I really don’t want to a PCOS diagnosis. It scares me…especially with the increased risk of m/c (though my OB also denies there is a clear link).  In case you can’t tell, I’m very afraid of a repeat miscarriage. But if I do have PCOS, I want to know so I can take action. I want Metformin! Or dexamethasone! Anything that will help the Clomid I’m taking to act faster and cause me to ovulate around CD14 like a normal woman.

And maybe I’m worrying unnecessarily. It has been known to happen. Maybe losing our last baby was a fluke and it won’t happen again. After all, we know I’m at least capable of carrying a pregnancy to term (see Introducing…Cupcake! for proof), but the worries have taken over my brain and I’m consumed. I feel myself starting to spiral a little out of control.

So what do I do? At this point, I’m still thinking I’ll wait it out. See what happens on my next cycle and go from there. If there is no BFP, then I will definitely call to harass my OB (as I’m not yet prepared to see an RE). I will be requesting to increase my Clomid dosage, retake all my lab tests, and perhaps start Metformin.

But should I be doing something now? What would each of you do? Any advice? I know PCOS is rampant in this community. Is it possible to have PCOS with a normal u/s and bloodwork? Should I have my hormone levels re-checked? (I really don’t want to yet as taking an active toddler to a lab where you end up waiting forever is not my idea of fun, but I’ll do it…if I have to.) And while I’m asking a bunch of random questions…can someone please tell me why all of this has to be so hard? There are so many decisions to make and I’m scared to make the wrong one. It’s paralyzing me with fear! Please help.

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13 thoughts on “Consumed

  1. First: If you’re still on the progesterone trying to kick start a period and you have an OPK getting darker on you, you really ought to take another pregnancy test, or have one drawn by your OB. OPK’s measure LH which is chemically very similar to HcG. So, HcG will register on an OPK, but LH won’t register on an HPT. I know you don’t think you O’d, but since you aren’t being monitored, better safe than sorry…

    Also, if at all possible, you ought to consider being monitored next cycle. They start looking at your follies around CD 14 and keep a watch until they are the right size, then give you an Ovidrel shot to force the follies to rupture. It’s much sure-er than the OPK’s for those of us with odd ovulation. Also, you will KNOW if you did or not and how many follies. Which will tell you how you’re responding. Of course, I did this through my RE. Who I love. I highly recommend not waiting on getting an RE…

    It’s perfectly normal to be worried about losing another baby. Most of the time, though, it is a one time deal. PCOS does carry a higher than average miscarriage risk, because of the insulin resistance. If your fasting insulin is good, you probably don’t have PCOS and even if you do, you probably don’t need to be worried about the miscarriage associations with it.

    Also, I wouldn’t consider CD22 all of that late for ovulation. Especially not compared to CD19.

    Upping your Clomid might cause more follies to form, but it unlikely to cause them to mature faster, It is likely to turn you into a hot, psychotic bitch, though 🙂 Not that I speak from experience or anything…

    If you’re worried about your Clomid response you could ask for Femara. Baby G is a Femera baby.

    What would I do? Get a Beta drawn, if negative proceed with the next cycle. If BFP (now or next cycle), get beta’s drawn every other day until the viability scan. If BFN, get an RE.

  2. I took 50, 100 and 150mg of Clomid over various cycles. 150mg didn’t make me ovulate any earlier (I averaged ovulation around day 21 on Clomid) but it did give me really nasty side effects. I share a lot of the same PCOS symptoms as you and have also not been diagnosed as PCOS. Doc says he understands why I think that but nothing in my test results points to it. I know how frustrating it can be to not have answers.

  3. Apparently some doctors or scientists are starting to think that PCOS is mostly about not ovulating regularly and wacky hormone levels – as opposed to the “string of pearls”. Your symptoms suggest that something is up, so I would suggest more CD3 and CD21 blood tests. I agree that you should get some answers so you can do something about it.

    ICLW #33

  4. One of the things that I’ve learnt the hard way through my loss/TTC journey is to call and ask my specialist any questions at all that are on my mind and/or get a second opinion. Never be hesitant to call… ask as many questions as you need to to get peace of mind. It’s their job and we pay them a small fortune. Thinking of you and hope your answers come soon. Love always xoxo

  5. I had the same fear about late ovulation. With my miscarriage I O’d on CD 22 as well. This time the month I got pregnant I ovulated on CD 16! I did this thanks to Vitex. I found it at a health food store and read a lot of reviews and decided to give it a go. I absolutely feel it has made a difference for me. But look into it first, decided what is right for you. *Hugs*

    • I’ve actually considered Vitex, especially after hearing how well it worked for you. I forget, though…how long did you take it before you started seeing a change? I’ve heard it can take two or three months before it starts working, and I’m a little impatient. I would hate to try something I’m not sure will work for me when I know Clomid does (though causes a slightly later-than-normal ovulation). I do have plans to try it when TTC our THIRD living child (aren’t I feeling confident?)…but I know there will come a point with this time of TTC, where I will be willing to try anything. 🙂 Thanks!

  6. Hi from ICLW!
    I was diagnosed with PCOS at my first visit to the RE. My only symptoms were irregular cycles. Not a bunch of extra hair, no skin tags, I’m an average weight (though do exercise regularly). My labs were normal. But the RE found the “pearl” pattern on my ovaries that often indicates PCOS. My point is even though your labs are normal, you just never know.

  7. I have no idea about any of this either. But, I dp know how hard it is to feel like all you have are questions and fears and no answers or assurances.

  8. I wish I could remember how I was diagnosed but it was over 10 years ago. I didn’t have much luck with Clomid in terms of ovulating sooner (or a BFP) but Femara seemed to help me ovulate a week early! I love how well my body tolerated it, compared to the craziness of Clomid. Wishing you all the best!

  9. PCOS is very confusing. I know of a lot of women – myself included – in the do-I-or-don’t-I-have-it camp. Apparently you can have PCOS without having polycystic ovaries. I was diagnosed with it in 2007 based on my history of irregular periods, excess body hair, and slightly elevated testosterone levels. My ovaries, however, looked normal and I passed the fasting glucose test with flying colours. But since then my periods have become regular and my hormones are all within normal ranges. (I still have the excess hair. Ugh.) Now my RE thinks that I don’t have it.

    My advice would be to ask for a repeat ultrasound and cd3 blood work, just to be sure. Unless you have to pay for it, I don’t think it would hurt to talk to an RE. They tend to be MUCH more knowledgable about these things than ob/gyns and they would be the best to help you if you do have PCOS.

    I also agree with the pp who suggested you ask to be monitored while on clomid and that you get a trigger shot for ovulation. I think this would go a long way towards giving you peace of mind. That way you’d know exactly what’s happening in there. 🙂

    Good luck!

  10. PCOS is diagnosed by: irregular or long cycles AND either laboratory (testosterone above 40) or clinical (acne or extra hair) evidence of hyperandrogenism (too much male hormone). The LH/FSH ratio isn’t needed anymore, nor are the ultrasound finding, and yes–your pregnancy may have altered your test results. Eighty percent of patients who have problems ovulating have PCOS (get a fasting morning follicular phase 17-hydroxy-progesterone level to rule out late onset congenital hyperplasia which can also cause problems with ovulation and extra hair). Normal fasting insulin levels do not rule out PCOS or a need for metformin–in fact, women with PCOS who have lower insulin levels (and are usually of normal weight), actually respond better to metformin. I’m not sure why your doctor disputes the connection between miscarriage and PCOS. It is well documented and I’m living proof–I have PCOS and have had four miscarriages (but also three healthy kids).

  11. I have often thought that I might have PCOS too, even though my RE doesn’t think I do. I have long and irregular cycles, hair in places I would rather not have it, multiple m/cs, and I seem to get cysts every cycle these days. I think because I am not overweight, they have never tested me for it. After reading this post, I think I am going to mention it to my new doctor when I get my second opinion!

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