Thursday, November 29, 2007

Decision 2007

The birth of Emma was the most beautiful, amazing experience of my life that left me wanting to go through it again and again. Then the post delievery care came in and that was the worst of it all. I remember telling Phillip one night, "I hope you are okay with just one child because that's all we are going to have." He was so gracious and went with it.

Several months later passed and I was getting into a routine and was able to handle everyday life. We had somewhat of a schedule and I was actually getting a little bit more sleep. (I require atleast 9 hours of sleep to be fully functional.) My zomby state was slowly lifting. I began thinking about the possiblity of another child. We slowly began talking about it and when Emma was 6 months we new we wanted to have another child but weren't sure when. Now that we established that we wanted another child the big question on our minds was WHEN? We knew what we would have to go through to get pregnant. Looking back the process was fairly easy. Once we were ready to go forward we REALLY had to be ready because it happened to fast with Emma. So we talked and prayed about it and we figured we would start by talking to my OB/GYN on my next visit which was scheduled for January 2007.

I went in to talk to Dr. Damrich about wanting to have another baby and that I was diagnosed with PCOS at the Reproductive Endocrinology Clinic. We weren't 100% about the timing but we wanted to discuss options so we could mull it over. Dr. Damrich suggested that he try his protocol for PCOS before releasing me back to the infertility Dr. I was up for trying anything that would help us to concieve naturally. He started me on 500mg of Metformin and we would do a blood test in 21 days to measure the progesterone to see if I ovulated.

WebMd explains Metformin for PCOS:

How It Works

Metformin lowers blood sugar levels by:

Decreasing the amount of sugar produced by the liver.

Increasing the amount of sugar absorbed by muscle cells and decreasing the body's resistance to insulin (insulin resistance).

Lower blood sugar leads to a lesser need for insulin. The body then makes less insulin. Lower insulin leads to lower androgen ("male" hormone) production.

Why It Is Used

Metformin is a diabetes medicine sometimes used for lowering insulin and blood sugar levels in women with polycystic ovary syndrome (PCOS). This helps regulate menstrual cycles, start ovulation, and lower the risk of miscarriage in women with PCOS. Long-term use also lowers diabetes and heart disease risk related to high insulin levels.1

Metformin:1
Does not cause the pancreas to make more insulin. When taken alone, it will not cause low blood sugar (hypoglycemia).

Lowers the amount of fat (lipids) in the bloodstream and lowers (lipid and triglyceride) levels.

Reduces abnormal clotting factors and markers of inflammation that can lead to hardening of the arteries (atherosclerosis).

Decreases the level of androgens.

Metformin can be used to treat women with polycystic ovary syndrome (PCOS) to reduce insulin levels and promote normal ovarian function. Metformin is best used in addition to eating a healthy diet, losing weight, and exercising regularly.

How Well It Works

Metformin lowers insulin, androgen, and cholesterol levels. It also improves metabolism in women who are insulin-resistant.

Metformin treatment triggers ovulation in about 45% of women with PCOS.2

Metformin with clomiphene (Clomid) is more likely to start ovulation than either treatment alone.2 This combination treatment triggers ovulation in about 75% of women with PCOS.

Metformin may lower the risk of miscarriage and gestational diabetes in women with PCOS.1 But the safety of using metformin throughout pregnancy is not known.

January on 500mg (1 pill) of Metformin produced no ovulation. 5 days of Prometrium to start period

February bumped up to 1000mg (2 pills) of Metformin and day 21 come in for progesterone level test.
No ovulation. 5 days of Prometrium to start period.

March bumped up to 1500mg (3 pills) of Metformin and day 21 come in for progesterone level test.
No ovulation. 5 days of Prometrium to start period.

April we stayed on the same protocol as March. 5 days of Prometrium to start period.

May I still took 1500mg (3pills) of Metformin daily and added 50mg of Clomid for 5 days.
No ovulation.

The past several months taking the Metformin has caused my Interstitial Cystitis to flare up.

Webmd describes interstitial cystitis:

What is IC / PBS?

Interstitial cystitis (IC) is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate (urgency), a frequent need to urinate (frequency), or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women's symptoms often get worse during menstruation.


or

Interstitial cystitis is a chronic, painful inflammatory condition of the bladder wall characterized by pressure and pain above the pubic area along with increased frequency and urgency of urination. This occurs because of chronic inflammation of the lining of the bladder and swelling of the interior walls of the bladder. Affected individuals urinate frequently with pain even though there is no diagnosed bladder infection. In a small percentage of cases, people with interstitial cystitis also have scarring and ulcerations on the membranes that line the bladder. Interstitial cystitis typically affects young and middle-aged women, although men can also have this disorder. The exact cause of interstitial cystitis is not known.

Many things trigger flare ups for me such as particular medications like Metformin. It was getting worse by the day and Phillip and I discussed what we should do. I could not continue this protocol because it was making me physically miserable. If we were to conceive it was not going to be through Metformin. It was time to consult my Reproductive Endocrinologist.

May 31st we went back to see Dr. Lucas. We were a bit nervous but excited to see him again knowing how fast things went and how confident he was the first time around. He ran my bloodwork again and told me to come back in two weeks for the results and we would go from there.

June 14 we met with Dr. Lucas again. Great news! My hormone levels were normal! Praise the Lord! One thing normal on me now that wasn't back then. What made things change? He said if he knew that answer he could bottle it up and make millions! There was no need to take Prednisone and wait 30 days for that to get into my system. We could start the shots again right away! Woo Hoo! I went home with a prescription for Prometrium to start my period and one for the shots. We are on our way!

2 comments:

Searching said...

I'm newish to PCOS, just dx'ed a month and a half ago and started on 1000mg of met. Thanks for the awesome explanation! I'm going to copy and paste parts of it to my mom since you said it so well! Thanks!

ps- Emma is my fav name. :)

Jeffrey Dach MD said...

PCOS, the Hidden Epidemic

The fundamental problem with PCOS is anovulation and not making progesterone for two weeks every cycle.

This lack of progesterone leads to hormonal imbalance in the ovary, causes the ovary to produce testosterone and leads to the irregular menstrual cycles and infertility. This is aggravated by obesity and insulin resistance.

Progesterone is missing, therefore replacing it makes sense.

To read more, click here:

Understanding PCOS, the Hidden Epidemic by Jeffrey Dach MD

my web site