August 02, 2016

Pregnancy Journal: From PCOS to Pregnant to Missed Miscarriage

Blogger's Note: As an attempt to make this post as informative as possible, I will be using terms that may be scandalous to the conservative mind. I tell you now: There is no shame in using the proper terms for the human reproductive system, and whatever actions associated to it. We are only able to understand something by accepting it first for what it is. 

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GLOSSARY

PCOS (Polycystic Ovary Syndrome): Polycystic ovarian syndrome, or PCOS, is a condition in which a woman’s levels of the sex hormones estrogen and progesterone are out of balance. This leads to the growth of ovarian cysts (benign masses on the ovaries). PCOS can cause problems with a women’s menstrual cycle, fertility, cardiac function, and appearance. [Source]

Pregnancy: See video below.

Missed Miscarriage: A missed miscarriage, also known as a missed abortion or a silent miscarriage, occurs when a fetus dies, but the body does not recognize the pregnancy loss or expel the pregnancy tissue. As a result, the placenta may still continue to release hormones, so the woman may continue to experience signs of pregnancy. [Source]

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Blogger's Note: The text below was written during the early stages of my pregnancy, before I knew the demise of my baby. As I want to document my emotions as accurate as possible, I will not be editing anything below (except for linking to the Part 2 of my story); I want to acknowledge my happiness no matter how short-lived it was.

Six months ago, I wrote about my Polycystic Ovarian Syndrome (PCOS). In a nutshell: For the last half of 2015 I was under birth control pills to balance out my hormones, as a means to control my PCOS. Then at the start of 2016, I was given fertility pills to aid in my ovulation, as a means to get pregnant.

Six months since then, I did get pregnant. Finally, after a year of medically tweaking my hormones, My husband and I were able to create life. Huzza!

BUT FIRST!!! HOW DO HUMANS GET PREGNANT?

For this, let me direct you to Crash Course Anatomy & Physiology Episode 42:


It is important to note, however, that there are a LOT of prerequisites for a successful conception:

  1. The female should be in her fertile phase, i.e. she has ovulated within two to five days since copulation
  2. The male should have produced good sperm quantity and quality, ejaculated into the female during copulation
  3. The sperm should fertilize the egg no later than 48 hours from ovulation, ideally in the Fallopian tubes. Anything after that is a risk to implantation
  4. The fertilized egg should be able to travel down the Fallopian tubes to the uterus, and implant itself securely

What is even more challenging is that, as we age, the body starts to lose its hormonal balance, negatively affecting the chances of a successful conception. This is why you see a lot of young couples getting pregnant, albeit accidentally, and older couples unable to produce an offspring.

Having said that, I would like to make kwento about my journey for the past six months. Some of you might be going through the same thing as I; these insights might help you in your own journey to pregnancy.

Attempt #1: Clomifene + "Counting" Method

The Christmas holidays just finished during that time, so we weren't masipag enough to set up the needed appointments to monitor my ovulation. During that time, my OB prescribed the lowest dosage of fertility pills, and then gave me ideal dates on when to make contact (i.e. have sex). I was responsible for tracking down my cycle to check if I have indeed ovulated.

FAQ: What is Clomifene?

Clomifene is a synthetic hormone used to inhibit the brain's reception of estrogen, causing the body to induce ovulation. Clomifene is taken in the early phase of a woman's ovulatory cycle (around Day 2 to 10), with increasing dosage per cycle. Once a patient has reached maximum dosage, there is a possibility of immunity to the drug, negatively affecting ovulation.

FAQ: What is the "Counting" Method?

This is when you predict your ovulation window, based on your previous cycle history. I once thought that ovulation occurs two weeks after the last day of your menstrual period, but the more accurate way (as per OB) of counting is to count two weeks (i.e. 14 days) back from the first day of your last menstrual period. I learned that the days between ovulation to your next period is more consistent than the days between your period to ovulation. There are also smartphone apps that aid cycle tracking.

So, did I get pregnant? No.

Attempt #2: Clomifene + OTC Ovulation Tests

We still weren't ready to take lab exams to monitor my ovulation, so I tried additional ways of tracking my ovulation. The three methods I used were:

1. Basal Body Temperature (BBT)

For this method, you will have to record your body temperature following a resting period (usually sleep). This is supposed to be the lowest body temperature within the day, as you haven't done any physical activity to raise your body temperature. Then, chart these temperatures throughout the month. There will be a significant dip in temperature, following a spike. The period between the dip and the spike is when ovulation happens.

2. Cervical Mucus

Ideally, you would have to "harvest" this from inside you (similar to pap smear, I assume), but I wasn't too keen about doing that so I just settled with whatever discharge I got while cleaning myself up. Supposedly, as you near ovulation, the discharges coming from your cervix  change in consistency. From tacky paste-y consistency to watery saliva-y consistency. This change in consistency actually helps you be more receptive to intercourse, as it adds to vaginal lubrication.

IMPORTANT!!! Speaking of lubrication, it was around this time when I learned that one should go as natural as possible, when trying for a baby. Admittedly, scheduling sexytime during your ovulation period kinda diminishes the passion in your act of sex, so much so that when it is time to do the deed, you aren't always "good to go". To facilitate this, we were using KY for the first couple of times, but then I learned that there are some lubricants (which includes KY) that reduce the motility of the sperm post ejaculation, and even alter the acidity of the vagina.

3. Ovulation Predictor Kits (OPK)

These kits are readily available in drugstores like Watsons or Mercury Drug. OPKs are urine-based tests, similar to pee-on-a-stick Pregnancy Tests. These tests monitor the level of the Luteinising Hormone (LH), which surges a couple of days before ovulation.

Notice how the T-line darkens as you approach ovulation.
A positive result is when the T-line is as dark (or darker) than the C-line.

So, did I get pregnant? Nope.

Attempt #3: Clomifene + Follicle Monitoring + Pregnyl

Following the past two failed attempts, we decided to give follicle monitoring a chance. See, in the past two attempts we were only able to monitor symptoms of ovulation (i.e. BBT, cervical mucus, LH surge), but we weren't able to witness ovulation itself. Agreeing to follicle monitoring makes ovulation tracking significantly more accurate.

FAQ: What is Follicle Monitoring?

Follicle monitoring is a series of trans-vaginal ultrasound which aims to track a follicle (i.e. egg) as it approaches maturity. The first ultrasound is usually recommended a couple of days before the predicted ovulation date. Ideally, there will be one dominant follicle that will be the candidate egg to mature into ovulation. The ideal diameter of this dominant follicle is 20mm.

Baseline ultrasound for the follicle monitoring.
Notice that the diameters of the follicles (right screen) range from 8mm to 12mm. 

Since I have PCOS, there are multiple growing follicles in my ovaries, but none would grow big enough to become the dominant follicle. The fertility pills that I was taking aim to push one follicle into maturity. Clomifene did well in growing my eggs, albeit slowly. It was already Day 16 when one was ripe for maturation, so my OB had to induce ovulation by injecting me with Pregnyl.

FAQ: What is Pregnyl?

Pregnyl is a synthetic chorionic gonadotropin hormone, which induces the mature follicle to burst out of the ovaries into the Fallopian tube, consequently inducing ovulation.

After the OB gave a "go" signal for contact, a follow-up ultrasound was done to confirm ovulation. Evidence of a corpus luteum (i.e. the "shell" of the follicle after ovulation) was performed in this ultrasound.

At the bottom part of the right screen, there is a small caption saying "C. LUTEUM", which indicated that I ovulated.

So, did I get pregnant? Nada.

Attempt #4: Letrozole + Follicle Monitoring

By this time, I believe that I have reached the maximum dosage of Clomifene. Thus, I was prescribed with another type of fertility pills.

FAQ: What is Letrozole?

Unlike Clomifene that blocks estrogen receptors in the brain, Letrozole inhibits estrogen production itself. Letrozole is the "safer" alternative to Clomifene since it has less side effects than the former. However, I observed that it pushed my acne to overdrive, as I had significantly more breakouts when I was taking it. Also, ovulation cramps (AKA Mittelschmerz) were more intense under Letrozole. On a positive note, I already had a mature follicle (24mm in diameter) by Day 13, thus no need for a shot of Pregyl.

Notice the significant difference in the size of the follicles. One even grew to almost 25mm!
The image in the left screen measures the thickness of the endometrial lining. I think 10.5mm is still a bit thin.

So, did I get pregnant? Still, no.

Attempt #5: "On a Break" + Hysterosalpingogram (HSG)

It was already Day 5 of my cycle when I visited my OB for a consult, too late to start the fertility regimen. So, we decided instead to spend the cycle conducting additional tests to see if my lady bits are working properly.

FAQ: What is Hysterosalingogram?

Abbreviated to hysterogram, or HSG, this procedure checks for blockage in the Fallopian tubes. Dye is squirted into the patient's cervix via the vagina, and the flow is captured via x-ray. The dye shows up as contrast in the x-ray; this way the OB can check if there are blocked tubes or whatnots. The OB recommended that I be placed under anesthesia so that if in case a blockage is found, she can apply pressure to successfully clear the area. When the dye is able to spill out of the tubes, into the abdominal cavity, and eventually out of the body via the vagina, then the procedure is a success.

I was asleep for the duration of the process, but I remember feeling very sore for at least two days after the procedure. The feeling was like a mix of dysmenorrhoea and kabag, and I was bedridden for one full day.

But I think that sacrifice paid off, big time. Considering that I wasn't taking fertility pills during that cycle, that was the only time when I got a positive result on my pregnancy test.

Behold!


To be sure, I bought two brands of Pregnancy Test Kits.
Blue Cross (right) was a sulit option as it already came with a container to hold your pee.

So, did I get pregnant? A BIG FAT POSITIVE!

My gut feeling tells me that the HSG did something to cleanse the tubes and uterus, which facilitated the successful fertilization of the egg and the successful implantation of the embryo.

I was really hesitant at first to take the Pregnancy Test, because the past cycles always show a negative result, followed immediately by my first day of bleeding. I started to have this irrational fear that taking the test will trigger my body to bleed, so much so I delayed taking the test until a week after my missed period. Siguro naman dahil isang linggo na ang nakaraan, magiging positive na ang result, I said to myself. Thank goodness it was true. I AM A CO-CREATOR!!!

Still, I consider this as a partial unofficial result (this is why I am not yet publishing this post as of writing); I need to wait until my ultrasound to confirm the existence of a life form inside me.

Alas, this post is getting too long, I shall continue on the next post.

1 comment:

  1. I first had symptoms when i was 17 and was told that i had PCOS (thin people type PCOS) and was officially diagnosed at 22 ans now i am 35. I have always had regular periods and unless on birth control pills were they irregular at times and I had a hard time getting pregnant because of the absent periods. I was always told by doctors that I would have a hard time conceiving so I would only go on the pill periodically which i did for more than 4 years, not for protection against getting pregnant, but just to get a period (since I was told it's not healthy to have less than 4 or so periods a year). Last time I went on a 3 month birth control pill and then stopped again because the medicine was not curing my pcos nor making me get pregnant. I went in search for a cure and ended up with so many drugs, medicine and even soaps that didn't work. I actually thought at a point that i was cursed that there is no cure for it, i was prepared to live like that till i read a testimony of a patient who suffered from pcos whose case was even worse than mine and how she was cured completely, I was amazed and at thesame time anxious and curious so i had to contact the doctor with the contact details that she left on the note. The doctor gave me so much hope and confidence with her kind words of encouragement to believe in myself and i was lifted because no one has ever given me hope like that before. I ordered the medicine, took it for 8 weeks and to my complete surprise, all the facial hairs, weight gain and all disappeared within 4 weeks and I ended up getting pregnant within a few weeks of completing the treatment! I was in shock. I think the main reasons it happened was that I never gave up and was ready to try alternative treatment so my body was back to normal. Before now i never enjoyed sex because it was very painful but now i do and my husband is the best thing that ever happened to me.. I hope this inspires some of you because I never in a million years would have thought that I would get pregnant and was getting frustrated and now our baby is due next month! Here is her contact aletedwin@gmail.com if you are experiencing a similar case.

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