tagging old posts

I've needing to zone out on something today so I've been going through more old posts and adding in tags so those posts are more available. I've still got a lot more to do but every little bit helps.

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I'm so beat. I think I'm a bit sleep deprived and then my body is close to ovulation which seems to be taking every little bit of energy from me. I asked my partner to take the baby away for a while to let me rest so he drove over to his brother's house.

I wonder if my body might not be up to nursing much longer. I feel so tapped out.

Fertility While Nursing

I found this a couple weeks ago and it explains rather reasonably how fertility returns post-partum, while breastfeeding:

The greatest level of suppression is not ovulating, but as your prolactin levels go up, your fertility will gradually return. First you will ovulate, but not have the proper hormone levels for fertilization; then you will ovulate and fertilization may occur, but you still may not have the proper hormone levels for implantation; finally, you may ovulate, be fertilized, and implant, but not have the proper hormone levels for continuing the pregnancy, so you have a very early miscarriage, probably along the lines of minutes or hours after implantation, so you wouldn't know you had been pregnant. It is also possible to ovulate without having the right hormonal levels in the right combinations for the uterus to have been preparing for implantation, so yes, it is possible to ovulate without menstruating. For all of these stages, there seems to be incredible individual variation between women. Some women get pregnant again the first time they ovulate, with no intervening menstrual periods. I knew a woman in Indiana years ago who had three children in six years with no menstrual periods! Her doctor couldn't figure out when to predict her due date
From: http://www.kathydettwyler.org/detfert.html

The author, Kathy Dettwyler, has studied a lot of different aspect of nursing. Her site is pretty interesting to poke around:
http://www.kathydettwyler.org/

I found her mentions about the natural ages of weaning amongst other large mammals to be affirming of what I have been observing with my little one.

Behold the Wonders of the Cervix

The Behaviour of the Cervix over the Phases of the Ovulatory Cycle

The Discovery of Different Types of Cervical Mucus and the Billings Ovulation Method

There are several methods of tracking your fertility that exist, the newer methods are actually more sophisticated than just counting days as in the Rhythm Method. Now we have charts, and even software to help us track our cycles and fertility patterns.

The ones I know of include:

Billings Method -- pioneered by Dr Evelyn Billings and promoted in the US by Billings Ovulation Method Association - USA

Fertility Awareness Method -- as described in Taking Charge of Your Fertility by Toni Weschler and incorporated into the Ovusoft/TCOYF ovulation calendar software

Creighton Model Fertility Care System -- promoted by Fertility Care Centers and the Pope Paul VI Institute and referenced in this article "Infertility Care and the Role of the Compounding Pharmacist" (PDF)

About Home Pregnancy Tests

These are great to refer to when you are trying to figure out which test to buy, when to test, etc.

Pregnancy Test Sensitivity and Early-Detection Testing

Home Pregnancy Test hCG Levels and FAQ

Peeonastick.com - The Secret of the Digital

Pregancy and Ovulation Testing Tips

Pregnancy Test - Sensitivity Comparison

Home Pregancy Test Information

Folliculogenesis and ovulation

I learned from my reproductive endocrinology text that eggs are constantly moving from stasis into a maturation process. The lucky ones synch up correctly with the hormonal cycle and have a chance at ovulation. The other eggs are just reabsorbed.

Oocytes (unmatured eggs) are held in stasis by hormones, and the micro-environment of the follicle needs to move from testoterone-dominant to an estrogen-dominent in order to be considered for ovulation. Often women with PCOS or thyroid problems have issues with their hormones that might impair this process such as high levels of androgens.

It might be possible that prolonged development of the follicle might cause the egg not to mature as well as a tighter hormonal cycle but I haven't read anything to that effect -- mind you I haven't researched that specifically though.

So anyway, your ovaries are constantly maturing eggs regardless of your hormonal cycle. This might also explain why women can sometimes get pg at odd times in their cycle -- such as WWII wives who supposedly got pregnant when their husbands were on leave.

Here are some links to reference maturation of the oocyte:

FOLLICULOGENESIS AND OVULATION

Section 13: Female Reproductive System

During a woman's reproductive years, several follicles in the growing pool are recruited each cycle, and only one is usually selected for ovulation (see Fig. 234-4). It develops into a graafian (preovulatory) follicle, which can respond to the midcycle LH surge. The mechanism of selection is unknown.

The graafian follicle contains an antrum (fluid-filled cavity), created by proliferating granulosa cells, which secrete fluid and mucopolysaccharides. The increase in the follicle's size is due primarily to accumulation of follicular fluid under the control of FSH, which also induces the development of specific LH receptors on granulosa cells. LH receptors are responsible for the stimulation of progesterone secretion before ovulation and for continued production of progesterone in the luteal phase. The granulosa cells in the follicle also develop specific membrane receptors for prolactin, which decrease in number as the follicle matures; their physiologic role is unclear.
Merck Manual Chapter 234. Reproductive Endocrinology

Diagram of folliculogenesis

Training my fertility monitor

My last cycle using my fertility monitor, the third cycle using it, was unusual and it threw the monitor off a bit. As you might recall I had high estradiol and a delayed ovulation (CD22) brought on by vitex that cycle, the same cycle I got pregnant.

I wanted to use my monitor this cycle to see how my hormones were doing and see if everything was back on track finally. Today was CD9 and finally it asked me for a test; usually I would start testing on CD6 or so. Today's test registered at a high day, pretty normal for mid-follicular phase. I'm due to ovulate next Monday/Tuesday (CD15/16) and hopefully it will be less hormonally challenging and with a lot less discomfort this time around.

Hopefully a more normal cycle will get this monitor back on track with me and then next cycle when we consider trying again it might be of some use. (It's so hard not to try this cycle speaking only from an opportunistic and competitive standpoint but really I need to have a rest for a little while longer and I would not do well with another loss right now so I'll just continue to bench myself for a while longer.)

Today's my birthday. I'm 35 now. That means that in Western medicine I'm now considered advanced maternal age. Whatever! I can't believe I'm 35 and I don't have any children. Life just pulls you along sometimes and there you are, not where you expected to be.

My partner got in the "mood" this morning so I thought why not. I don't really have any sex drive right now but that shouldn't stop everyone from having a good time. In the middle of it though I started crying, tears kept running down my cheeks. It wasn't anything in particular, just happened. I think it is everything starting with having to use a condom during BD to prevent pregnancy, yeah that's what I want to do right now. I have to manage my fertility. Why, because the rational part of me knows that my body needs a break and I need to make sure that I'm not hurting myself by throwing a possible pregnancy at my tired body right now. I need to wait. But waiting just makes things feel even less normal right now. Then there's so much else hovering. Like all the people who don't know. I feel like I'm putting up a brave face and all but I want everyone to know what hell I've been through. Hardly anyone IRL knows the challenges we've been through in our pursuit of a child. And now, losing my second pregnancy, I just want a little more love and kindness. But I don't want to have to tell them. Can't they just know?

I've continued feeling weepy all day and my right ovary is aching; I fairly feel like I'm going to explode somewhere inside. I think the crying is the hormones, probably the biggest drop in my estrogen level that I've had in a couple months as my body prepares to ovulate. I've got to just ride out the hormones, wave by wave, somehow. But mostly I just feel like I wish I didn't have to feel it at all.

Intercourse Frequency -- Why more might be better

[I hadn't posted this info before and I want to get it out there. I know its not entirely topical at the moment but I hope you don't mind the diversion]

Since we have a bit of a sperm morphology issue we first tried the every other day routine recommended for MFI. But after having no success and then playing around with the numbers it seemed to us that loading up the EWCF with sperm prior to ovulation would help get more swimmers in there and ready to catch the egg. We've used this strategy both times we have gotten pregnant.

I looked up more research and articles related to ejaculatory frequency and I found some interesting things that I thought I would share:

"The characteristics were examined of 87 consecutive semen samples obtained from participants of an intra-uterine insemination (IUI) programme. The population investigated comprised 65 normozoospermic, 13 moderately oligozoospermic and nine severely oligozoospermic individuals. The samples were produced after 4 days abstinence for the first IUI and after a further day of abstinence for the second IUI. Semen volume, sperm concentration, total sperm count and total motile sperm count for the whole population decreased significantly between the first and second samples. [b]The characteristics of the second sample were significantly decreased only for the normozoospermic group.[/b]"
The effect of ejaculatory frequency on semen characteristics of normozoospermic and oligozoospermic men from an infertile population.
Matilsky M, Battino S, Ben-Ami M, Geslevich Y, Eyali V, Shalev E.
[Note: Normozoospermic is normal counts, oligozoospermic is low counts. The numbers seems to jump down more if you have normal counts -- the higher you are the harder you fall.]

"there was a significant positive relationship between the time taken to produce a specimen and sperm concentration. We conclude that the duration of preejaculatory sexual arousal is an important predictor of ejaculate quality for specimens produced by masturbation and that variation in the duration of preejaculatory arousal may contribute to within-male fluctuations in semen parameters over time."
Duration of sexual arousal predicts semen parameters for masturbatory ejaculates.
Pound N, Javed MH, Ruberto C, Shaikh MA, Del Valle AP.
[Note: we should be doing our best to get our guy intersted evidently if we want his best "effort"]

"Sperm numbers and semen volume increased with duration of abstinence. Abstinence did not influence pH, viability, morphology, total or grade A motility, or sperm DNA fragmentation. A short (24-hour) abstinence period negatively influenced chromatin quality."
Influence of the abstinence period on human sperm quality.
De Jonge C, LaFromboise M, Bosmans E, Ombelet W, Cox A, Nijs M.
[Note: Chromatin is what they are testing for in the SCSA test]

"The results have demonstrated that the motility and normal morphology of spermatozoa do not change significantly with ejaculation frequency. Also, while the volume of the ejaculate and the total number of spermatozoa decreased during a period of frequent coitus, an individual's depletion and recovery of his spermatozoal reserve could not be accurately predicted. It is suggested that coital frequency during the woman's periovulatory period could be modified by the partner's response to this test. Furthermore, while it is acknowledged that the variation in results from a 'routine' semen analysis is large, data obtained after depletion of the extra-gonadal reserve and recovery over a set time may have more value and could be the method of choice for the future."
Studies of human seminal parameters with frequent ejaculation. I. Clinical characteristics.
Matilsky M, Battino S, Ben-Ami M, Geslevich Y, Eyali V, Shalev E.

It just seems to me that the every other day BD routine might not be right for all MFI folks and that it is worth it to try upping frequency to see if it helps improve things for you. Since morphology and motility don't really necessarily seem to be affected it might be better to try out some sexy lingerie and a strip tease and learn some tantric breathing techiques to slow him down a little.

It's worth a thought.

Here's a chart showing why this might work:



I took two different hypothetical total counts and then reduced subsequent by 30%, just a random level that I pulled out of the air. Obviously real life generation rates could be better or worse than that, but note that based on this model having more sex results in a greater number of total sperm deposited.

Two other gals that I know online who were TTC post vasectomy reversal both tried this strategy and it worked for them the first try as well.

Some other random bits of info:

• The best sperm can live in a test tube at room temperature for a week
  
• it takes about 20 sperm to help weaken the zona pellucida enough to have one be able to penetrate the egg to fertiize it
  
• on the day of ovulation your body has already produced some progesterone which helps ripen the follicle. This progesterone can change the quality of your CF so that it is less hospitible to sperm so timing BD on the day of your peak day (the gooey EW day) or prior is probably the best.
  

So, over the past couple of years I noted that a couple times a year I was in a lot of pain around ovulation. At first I thought it was my fibroid causing it, actually it was partially due to this pain that my fibroid was diagnosed. It it focalized on the right side and if I press on the area it feels worse. In the past I've noted that ibuprofen wouldn't help the pain at all.

When I had u/s to check it out after the fact and always they have seen that I have ovulated on the opposite side (which was opposite from my fibroid as well) and that there was some fluid in my cul de sac consistent with ovulation, but nothing else.

Last night I was in so much pain that I couldn't sleep and I finally broke down and took some percocet I had left over from my surgery in November. I fell asleep around 3am. This morning I still have dull pain, but it is a lot less intense then last night. I put a call into the REs office for advisement, it seems like I should at least ask since it was painful enough to keep me up.

Part of me wonders if it was an ovarian cyst rupturing and not just a regular follicle. I didn't have such a great ovulation last cycle -- hardly any EWCM, and dry generally -- I wonder if I didn't actually ovulate or else just had a cyst. Still, the u/s when I've had this pain before showed just a single ruptured follicle on the other side.

You must have heard about all the babies that got conceived during WWII when the husbands were on leave. Evidently enough interest and excitement can cause our bodies to break with the standard cycle. Even if you have regular cycles your ovaries are constantly recruiting new eggs into the maturity cycle so with proper motivation (husband back in town) there is a chance that things might be able to happen regardless of where you are in your cycle (except maybe during your period, it seems less likely).

About Ovulation

The ovaries are full of thousands of eggs held in hormonal stasis in their "primordial follicle" which is a androgen dominant environment. This is the pool from which follicles are constantly being recruited into the maturation process which can take 3 months from early maturation up until the time of ovulation. Maturation of the egg/follicle requires changing the environment within the follicle from androgen dominant to estrogen dominant.

Not all eggs that start the maturation process are developed all the way that you might see them on an u/s prior to ovulation, these ones were lucky and their development synched up with the hormonal cycle perfectly so they could mature up to the point of ovulation.

Ovulation itself is a series of hormonal events the LH, a little progesterone to ripen the follicle, a drop in estrogen are some of these changes. Hormonal imbalances can interfere with this process, as evidenced by women with PCOS whose follicles don't properly mature.

So, if there are imbalances that are interfering with hormones on subtle levels it can throw off the follicular development and you might end up with an functional ovarian cyst, a partially ruptured follicle, no ovulation, or maybe delayed ovulation. If ovulation doesn't happen normally then there's a good chance that even if you release the egg then the follicle isn't going to change over as well into the corpus luteum, the structure that produces the progesterone which causes a lot of changes in our bodies that make it receptive to accept a tiny embryo (I have a lot of information about progesterone but that will have to be a different post if you are interested)

Here are some links about ovulation, you also might check out The Infertility Cure by Randine Lewis which has an interesting chinese medicine explanation of ovulation through the cycle phases that I enjoyed.

http://www.merck.com/mrkshared/mmanual/figures/234fig4.jsp

http://www.merck.com/mrkshared/mmanual/section18/chapter234/234a.jsp

http://www.emedicine.com/med/topic1340.htm

A message to another woman with fibroids

I have low progesterone as well, I haven't had my DHEA tested though.

Low progesterone is linked to several things which can happen in any combination (and I'm sure there are more than I'm listing here):

* poor ovulation -- the follicle doesn't develop as well as it should and the remaining corpus luteum doesn't produce enough progesterone. also, progesterone is produced by the ovary prior to ovulation which helps to mature the follicle granulosa cells and helps set the stage for ovulation to occur. If you are low progesterone I suppose that this process can be somewhat compromised.

* annovulation -- your aren't ovulating and therefore aren't having the corpus luteum available to produce progesterone. The more cycles without ovulating the higher your estrogen to progesterone ratio rises furthering the imbalance. Polycystic ovaries can also cause annovulation I think.

* stress -- when you are under prolonged stress your adrenal glands go from producing adrenaline to producing cortisol. Cortisol is made in the body from progesterone and I've heard mention that this reduces the availabilty of progesterone in the body. Also, cortisol will bind to progesterone receptors in the body so that they aren't able to do their progesterone related actions.

Working too much, not eating regular meals, consuming too many simple carbohydrates and sugars -- basic the equivalent of running your body on empty (and we all know that feeling) -- creates additional stress in your body and stresses the adrenals and further promotes adrenal exhaustion and cortisol production. If you get tired easily then this might be a contributing factor.

This page/site is rather interesting in how it talks about symptoms of low progesterone/estrogen dominance, and other endocrinological imbalances:

http://www.digitalnaturopath.com/cond/C8769.html

Things to do:

* Eat regular meals
* Make sure you are getting enough nutrients from your diet and supplement when needed
* Cut back on caffeine (bad for adrenals) and simple sugars (don't give in to the sweets in the late afternoon -- eat something healthy like nuts if your energy starts to lag)
* get enough rest -- sleep deprivation is stressful on your body
* drink 6 glasses of water a day
* consider consulting with an herbalist, naturopath or chinese medicine practitioner for assistance with a customize herbal regime

Also, I used natural progesterone cream for a few cycles with some good results (even mood, less sore breasts among other things). This may be beneficial although treatment with progesterone has had mixed results in randomized medical trials and might for some women be linked to increased fibroid growth.

This actually goes back to my cake metaphor for hormones (I think I posted a couple months ago about it on the uterinefibroids list), a cake takes all of its ingredients in their proper measure, adding more salt won't make up for too little sugar -- it only makes it worse. Our hormones are a complicated, individual "symphony" (I think that is what Dr John Lee referred to it as). The more stories we hear from the list members and from the studies we read, etc. that while pregnancy can make fibroids grow, that for some other pregnant women they shrink. Fibroids are thought to be a condition of peri-menopausal women and yet we've seen young women of 19 and 20 show up with fibroids in our groups. Obviously there is a lot at play and the more we each learn the more we start to realize that our behavior and lifestyles have contributed to our hormonal imbalances which in turn has helped activate our genes to start developing fibroids.