Monthly Archives: March 2012

The Body.

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I don’t have any faith in my body. In fact, for a long time, I’ve actively disliked my body. I’m not talking about my breast size, or shape, or weight, or the look of my feet, but the inner workings of my body.

You see, nothing really works like its supposed to. I dislike my body when workouts don’t reap rewards commensurate to my peers. I dislike my body when anxiety levels result in yeast infections and UTIs. I dislike my body when it stores fat like a chipmunk preparing for hibernation. I dislike my body when my hormones shift and I exhibit male pattern hair loss. I dislike my body when I get another cystic pimple on my back due to increased androgens. I dislike my body when, during a typical cycle, I exhibit multiple LH surges complete with wild mood swings. I dislike my body when another 35 days pass with a negative pregnancy test. I dislike my body when I take all the appropriate actions and precautions and still manage to produce an unhealthy egg that results in miscarriage. I dislike my body when I can’t even start bleeding as a warning of an unhealthy pregnancy. I dislike my body.

As you might have guessed, this isn’t so good for my mind-body connection. In fact, I often refer to my body as a separate being from my consciousness. It is that thing. My therapist of old would not be pleased. Or, perhaps, she wouldn’t be surprised at all.

Because of this, I also don’t trust my body. This is why I opted for the D&C in lieu of a natural miscarriage. I didn’t have any faith that my body would be able to expel an itty-bitty tiny baby. Why would it? It hasn’t done much of anything well in the past 24 months despite the cosseting, pampering, expensive treatments.

Three days ago my body surprised me. I ovulated. I was expecting this miscarriage process to throw my hormonal balance completely out of whack. I was prepared to not ovulate for months and months. But my body surprised me and I ovulated three days ago. I find myself in the odd position where I am proud of my body. Go body!

Supplements, Part II.

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Three more supplements shown to be effective in treating PCOS.  Additional supplements are covered in the post Supplements, Part I.

Inositol: Inositol is a insulin-sensitizing agent that can be described as a sugary carbohydrate that is part of the B Vitamin family.  There are up to nine different types of inositol, but two, in particular, have insulin-sensitizing capabilities: myo-inositol and d-chiro-inositol (Unfer et al, 2012).

Due to its insulin-sensitizing ability, inositol is almost as magical as NAC, if not more so. The prevalence of research studies number in the 70′s, but recent research demonstrates that myo-inositol may be more effective than d-chiro-inositol in treating PCOS (Galletta et al, 2011).  As a result, I will focus on the myo-inositol literature.

Of the 70 articles, approximately half focus on myo-inositol and of those there are six randomized control studies looking at the effect of myo-inositol on PCOS indicators such as hormonal levels, egg quality, and ovarian function.  Randomized control studies are the gold standard in evidence based research.  Across the six studies, myo-inositol was effective in reducing LH, prolactin, estradiol, testosterone, and insulin/blood sugar (Genazzani et al, 2008; Gerli et al, 2007); in restoring ovulation and decreasing the length of cycles (Constantino et al, 2009; Genazzani et al, 2008; Gerli et al, 2007; Gerli et al, 2007; Papaleo et al, 2007; Raffone et al, 2010);  and decreasing blood pressure, cholesterol and triglycerides (Constantino et al, 2009; Gerli et al, 2007,  Gerli et al, 2007).

Additionally, it should be mentioned that when compared with metformin, myo-inositol had greater success in restoring ovulation (65% v. 50%).  Of those taking myo-inositol, 30% became pregnant versus 18% within the met group (Raffone et al, 2010).  The authors of this article recommended using myo-inositol over metformin for first line treatment of PCOS. Bananas, right?

And, finally, my-inositol was also helpful in achieving weight loss and lowering BMI (Gerli et al, 2007).

The dose for the trials ranged from 2000 to 4000 mg a day.  The easiest way to get this dose is to take it as a powder.  I’ve done it, and it isn’t bad. I probably measures at about 1/2 teaspoon, and it doesn’t flavor the water.  It is slightly sweet.  You wouldn’t notice it if you popped it into a drink, breakfast cereal, yogurt, smoothie, etc. The exception to the dosage is Gerli et al, 2007.  They used a 200 mg/day dose and achieved the same results.

I’m currently taking 2250 mg/day in a capsule, but plan to switch back to the powder when I am done with the bottle.  I’ve never had an RE recommend myo-inositol, but I was turned on to it by my naturopathic doctor.

Essential Fatty Acids (EFA): EFAs used to intimidate me.   DHA, ELA, GLA, 3, 6, 9, what?! OMG, am I consuming the right amounts, during the correct time of my cycle, to gain the benefits of the EFA’s?!   I then embarked upon a journey to demystify EFAs.  I will try to do the same for you in just a few paragraphs.

EFAs are unsaturated fats that are integral to good health and come in the form of Omega 3, Omega 6 and Omega 9 fatty acids.  The former two cannot be produced by our body, and, thus, must be obtained through food consumption or supplementation.  Our bodies do have the ability to create Omega 9, so let’s focus on 3 and 6.

Omega 3 and 6 are both integral to the production of eicosanoids.  Eicosanoids are signaling molecules present in every cell of the body that control different functions related to inflammation and immunity. Ideally our consumption of EFAs would be at a ratio of 2:1 Omega 6s to Omega 3s; However, diets in the US typically consume EFAs at a ratio of 10-20: 1 (Mirkin, 2012).  Decreased levels of Omega 3s results in an imbalance of eicosanoids, which results in a host of problems including infertility.  It has been found that an increase in the level of Omega 3′s results in increased blood flow to the uterus and ovaries (Saldeen & Saldeen, 2004). Additionally, decreased levels of Omega 3s decreases insulin sensitivity and increases blood sugar levels (Mirkin, 2012).

Women with PCOS tend to have an unbalanced ratio of Omega 6s to Omega 3s, and a higher level of Omega 6s is correlated with increased androgen levels.  A cross-sectional study revealed that supplementation of Omega 3s balanced the ratio while also reducing androgens in women with PCOS (Phelan et al, 2011). Omega 3s are also conducive to reducing inflammation in women with PCOS (Liepa et al, 2008). Women with PCOS also have higher rates of non-alcoholic fatty liver disease. Omega 3s have been found effective in improving the condition and reducing cardiovascular risk factors such as triclycerides and blood pressure (Cussons et al, 2009; Sathyapalan & Atkin, 2011).

There are three types of Omega 3s – ALA, DHA, and EPA.  ALA primarily comes from plant sources, whereas DHA and EPA are found in fish.  DHA is the powerhorse that is integral to brain function, and it is recommended that pregnant women take up to 1100 mg of DHA + 800 mg of EPA daily while pregnant.   The aforementioned PCOS trials used 4000 mg of Omega 3s in the form of fish oil capsules with a ratio of 1.5:1 of EPA to DHA.

Supplementation with fish oil is a great way to consume Omega 3s, and it appears to be fairly common throughout the world of fertility and infertility.  I’ve been warned by a number of practitioners to be careful about the choice of fish oil; However, third party testing resulted in negligible levels of mercury in major brands of supplements.  I currently take 2400 mg of concentrated fish oil containing 720 mg of EPA and 480 mg of DHA.

Vitamin B Complex: The B Vitamin family is integral to cell metabolism, and the B vitamins (B1, B2, B3, B5, B6, B7, B9, and B12) are related to cellular health, metabolism, immune system, nervous system, skin, hair and muscles, mood, and, last but not least, fetal development.  Most women are fully aware of the benefits of folic acid (B9) for fetal development, especially in regards to the prevention of neural tube defects.  B vitamins are also helpful for women with PCOS. In particular, B6, B9, and B12 are helpful in addressing the unique issues surrounding PCOS due to their relationship with homocysteine (HC).

HC is an amino acid found in the blood and is typically ingested through the consumption of meat.  Increased HC is linked to low levels of B6, B9, and B12.   In addition, high levels of HC are negatively related to cardiovascular health as well as being linked to inflammation and oxidative stress. Low levels of B vitamins and high levels of homocysteine appears to be a problem with egg quality in women undergoing IVF, male factor infertility, endometriosis, and PCOS (Forges et al, 2007).  Additionally, insulin resistance, increased androgens, and increased levels of HC are correlated with one another (Yarali et al, 2001).

As a result, it should be no surprise that women with PCOS commonly have elevated levels of homocysteine and low levels of B vitamins (Forges et al, 2007; Yilmaz et al, 2005; Yarali et al, 2001).  This has been found to negatively affect women with PCOS undergoing IVF by impacting egg quality, embryo quality and fertilization rates (Berker et al, 2009).  Treatment with B vitamins improves insulin sensitivity and decreases the levels of HC (Bargiota & Diamanti-Kandarakis, 2012). With that said, it should be noted that metformin is known to be related to increased levels of HC and decreased B vitamins, possibly due to the fact that metformin creates a deficiency in folates and B12 (Vrbikova et al., 2002; Kilicdag et al., 2005).  God bless the Met.  However, this can be counteracted by supplementing with B vitamins.  The referenced studies used 500 mg of B1, 500 mg B6, and 2000 mcg B12 (Kilicdag et al., 2005), which are much higher than the levels found in prenatal vitamins.

I currently take the following amount of  B Vitamins daily from both my prenatal and a B complex vitamin.  According to the research this probably is not enough.

B1 – 102 mg

B2 – 102 mg

B3 – 120 mg

B6 – 104 mg

B9 – 1200 mcg

B12 – 120 mcg

Sad, Sad, Posts.

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Big Guy and I went to see Ryan Adams at the Walt Disney Concert Hall a couple of weeks ago.  I heart Ryan Adams. So do lots of other people, especially the woman that screamed, “I LOVE you, Ryan Adams!!!!!!” in between songs.  If you know RA, you know that his shows aren’t full of mosh pits and heavy metal guitars.  So, everyone heard this profession of love.  In fact, it echoed a bit in the rafters.

RA handled it with panache.  He said, “Thank you.  I think you love me because I write sad, sad, songs.”  It’s true. I love RA because he sings sad, sad, songs.  In fact, a close friend once commented that I like music that makes her feel as if she is dying.  I’ve also noticed that I have a penchant for musicians that either have been or currently are addicted to heroin.  Sad, sad, music, indeed.

I’ve noticed that I write sad, sad, posts, but how could I not?  Infertility is a sad, sad place to be.  With that said, I would like to apologize to the unwitting web searcher that came upon my blog after searching google for “Knitting Free Patterns For Baby 2012″.  They linked through to Fertility Free Friday: Knitting, a not so sad, sad place to be.  But still, reader beware, this is a sad, sad blog with sad, sad posts.

Miscarriage Follow-Up, Part II.

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I wrote a post concerning my follow-up appointment with my RE, post D&C.  Turns out that appointment was simply to check my uterus and hCG levels (389 at 9 days past D&C).   We finally met with my RE just this morning to review the results of the genetic testing and to discuss the next steps in getting (and staying) pregnant.

The genetic test revealed that there was an extra chromosome 22, resulting in trisomy 22.  My hCG levels are now at 16. Also, we were expecting a baby boy.

I wanted to return to the initial questions I posted for anyone that may be interested in her responses.

Given my medical history, do you think this miscarriage was a result of my specific fertility situation, or do you think it is a matter of “shit, happens?”

Definitely, shit happens.  The literature does show that women with PCOS are at higher risk for miscarriage, but this, in particular,  pertains to women who are overweight.  (I am not overweight.)  In addition, the genetic results reveal a chromosomal abnormality that “is generally incompatible with fetal survival.”  This is more likely related to my age (32) and subsequent egg health rather than PCOS.

Does the literature demonstrate a higher miscarriage rate in the PCOS population due specifically to chromosomal abnormalities?

No. Nothing has been or can be confirmed, nor is it a theory that has credibility in the infertility research world.

Do low levels of estrogen during the follicular phase, such as the case with Lucky Cycle #10, decrease egg health?

No.  It is more likely that the low level of estrogen during Lucky Cycle #10 was a result of poor egg quality, not a chronic condition.

Do you have any suggestions for improving egg health?

Yes.  Eat a plant-based diet.  This does not include processed vegan foods.  Research shows that a plant-based diet, similar to what our ancestors ate is, by far, much healthier than what the  typical American diet looks like, especially in regards to meat consumption.  This is particularly true in the US where the quality of our meat and dairy products is compromised by hormones, antibiotics, and other practices found in mass production of meat and dairy.  A plant-based diet has been shown to reduce inflammation, which is common in PCOS, as well as many other chronic illnesses and many different types of cancer.  Buy a juicer.

Do you have any suggestions for reducing the chance of a second miscarriage?

This miscarriage was a matter of chance, and there wasn’t much we could have done to change the outcomes.

Do you think it is time to run another round of hormone tests?

Not yet.  Given the fact that I just got pregnant, the need for another round of tests is not necessary.  If, after three months of medicated cycles, I am not pregnant, it will be time to reevaluate my hormone levels.

What about the HSG? How long can I expect both tubes to stay open?

A while.  My blockage was probably due to mucus, typical in women with PCOS.  In her experience, she has not found that her patients’ tubes fill up again after a period of time.  If we are not pregnant after a three medicated cycles we can reevaluate.

Given my low levels of estrogen, do you still think Clomid is the appropriate next step? If so, do you supplement with estradiol?

Again, the low levels of estrogen may have been due to the quality of the egg in that particular cycle.  She recommends Clomid for the first cycle because it is FDA approved for fertility use.  Femara is used off-label.  Tracking of my lining and estradiol levels will give an idea of how I react to the Clomid.  If it kills my lining we will switch to Femara.  She does not like to supplement with estradiol in women with PCOS because we are already at high risk for endometrial hyperplasion (aka cancer).  Estrogen promotes cancerous growth.

Can we just skip the Clomid and go to Femara?

Yes, if that is what I choose to do.

Can we try an unmedicated cycle supplemented with estradiol?

No.  See above.

Magic Eight Ball when will I get pregnant?

Three to six months.

Cosmic Love.

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And in the dark, I can hear your heartbeat
I tried to find the sound
But then it stopped, and I was in the darkness,
So darkness I became

Cosmic Love, Florence + The Machine