Eating My Way to Better Eggs

I left something big off my list of good things about having a few month delay in trying to conceive: the chance to do something to improve the quality of my aging eggs.

Do an internet search on improving egg quality, and you'll find all sorts of information - some of it good, some of it crap.  But how do you know which is which?  Much of what you'll find is based off of anecdotal reports ("I drank tincture of mouse urine steeped with bay leaves every day for a month and I got pregnant!") but there is some hard science out there.  There's not a LOT of hard science out there, but there are more and more studies that are popping up that at least can give a girl a little bit of guidance.

I'd been thinking about a lot this week about the supplements I should be taking.  But then two things made me realize I was missing a huge piece of the picture.  The first was a conversation I had with a patient today, a patient who has infertility that is likely due to a pituitary tumor causing low FSH, LH and estradiol levels. She is also slender, and we were talking about why her gyn had thought the problem was her weight.  I explained to her how being underweight can cause a woman to stop having periods.  "Reproduction is not essential for survival, so if your body is being starved, or thinks it's being starved, it will stop ovulating, and you'll stop having periods."

And the obvious suddenly became clear - my diet is likely part of the problem. Now there's no way my body thinks that I'm being starved, but I'm certainly not giving it the nutrition that I need to make good quality eggs.  I've done a decent job of cutting out fast food, but refined carbohydrates have been my best friend the past few months.  Especially this past week (candy corn, anyone?) - I'm not eating anywhere near as healthy as I could be eating.

Of course, we all know incredibly unhealthy women who follow horrible diets that get pregnant naturally...but most of them aren't 41 years old.  And none of them are me.

When I first started to think about getting pregnant on my own I read The Fertility Diet.  It's a wonderful and easy to read book, and there's a great summary here. To be clear, this is a retrospective study that looked at the effect women's diet had on their fertility.  It did not look to see if changes in diet would affect the chances of an infertile women getting pregnant.  Instead, it asked the question, does diet influence your chances of infertility?

Not surprisingly, the answer was yes.  A diet high in simple carbs, high in trans fats and high in animal proteins increased the chance of infertility, while a diet rich in complex carbs, monounsaturated fats and plant proteins increased fertility.  Huh.  The same things that increase your risk of diabetes and heart disease increase your risk of infertility.  The body is an amazing thing.

And then a friend shared these recent studies presented at the American Society of Reproductive Medicine's annual meeting - there's a summary here, and a summary with comment from the experts here. In the first study, women were asked to give a dietary recall before starting IVF.  The women who had high protein diets had more blastocysts make it to day 5 and has significantly higher pregnancy rates.  The second study actually had 12 women who had prior failed IVF cycles change their diet.  They were instructed to increase their protein intake from around 15% of their daily food intake to about 27% of their daily intake for 2 months before their next IVF cycle.  This resulted in an increase in pregnancy rates from 16% to 81%.  I could only find blurbs about the study, and not an abstract, so I don't know the details - especially if these women were increasing protein intake using animal protein, or if they were using plant protein. And it's a small study.  But it is incredibly compelling.

I find myself inspired.  Inspired to completely revamp my diet.  To cut out refined carbs.  To increase the protein in my diet - from beans and lean meats primarily.  To increase the healthy fats and cut out as many saturated fats as I can.  To eat healthy.  To be healthy.

I've felt horrible all week with a headache and a cold.  And it's candy corn season.  I've felt like crap and I've eaten like crap.  But starting Monday that's all over.  Finn and I are going grocery shopping and stocking up on all healthy stuff.  And the stash of Halloween candy I've been keeping at home is going to the office.

It's going to be hard.  Thanksgiving is soon, and so is Christmas.  There will be temptations every where, every day. I will cheat. I'm giving myself permission to do so without guilt, simply because I know that when I do cheat, I'm going to make it count, and it won't be often.

I'm doing this to improve my chances of having another child. And I can do anything if it means I'm more likely to achieve that goal.

Fertility Massage

Bee in my Garden

I had my first fertility massage tonight, with Tricia (also known as She of the Magic Hands). I wasn't really sure what to expect, but I ended up really liking it, even though it was very different from massages I've had in the past. We talked for about 5-10 minutes before we started. She asked about my headaches, we talked about my chronic hip and low back pain, then talked about my cycles and my fertility plans. Since I'm cycle day 18 today, she wanted to be sure there was no way I might be pregnant before starting. That's one benefit of doing this single, I don't have to worry about an "accidental" pregnancy!

 She started with me on my back, and rubbed castor oil on my stomach, then put a moist heating pack on top of the oil. She then did some cranial sacral holds, followed by some work on my head and neck, then my arms and legs. None if it was the deep tissue massage that I usually get, but the idea is to keep blood flow focused on the reproductive parts instead, so I just enjoyed the relaxation. That's when she went back to my abdomen. My stomach has felt very tender since Finn was born, especially my lower abdomen, so I was worried about how the massage would go, but it ended up really helping relieve a lot of the tenderness. She started off very lightly massaging my entire abdomen, and then worked on my hip bones - "the pelvic rim" and down into the psoas muscles. There were some very sore spots in there, it definitely wasn't comfortable, but I felt some relaxation of a few areas that have probably been in spasm since before Finn was conceived. She finished that up with some more lighter touches before having me turn over --- I'm pretty sure this is where I fell asleep. I hope I didn't snore.

 When I got up I could immediately tell a difference in how my hip and low back feel. And tonight I finally feel like my energy is concentrating in my pelvic area instead of on milk making. I don't have another acupuncture appointment for 5 weeks (I'm on the wait list), but I do have an appointment for another massage in about 3 weeks. I wish I had more free time during the day (and was independently wealthy) because I'd love to have another one of those massages next week.

 

My TTC Story

I wish I could say that I handled my efforts at TTC with grace and calm serenity.  But that couldn’t be further from the truth.   Trying to conceive turned me into a crazy, moody, unpleasant bitch.  I ate too much, slept too much, didn’t exercise enough, and obsessed about every single symptom during my two week wait.  I was devastated by my first two BFNs, especially since both of them occurred in the form of AF visiting days before she was due. 

My first BFN was discovered when I went to the bathroom to cry after I had to fire my nurse.  She was a sweet girl, but she couldn’t do the job and patients were being placed in harm’s way because of missed messages, so we had to fire her.  I talked to her about why we were having to fire her, feeling like I’d just kicked a puppy as I watched her cry, and then went to the bathroom for privacy while I cried myself.  And then wished I hadn’t decided to go ahead and pee while I was there. 

I’d convinced myself that I was pregnant after my second IUI, and so getting AF two days after coming home from a friend’s baby shower was devastating.  Even more disappointing was the realization that I was going to have to take the next month off, because a very dear friend of mine was having her baby shower out of town, and I had to be there for that.  I’ll never regret going to her shower, but I was miserable most of the weekend, thinking that I was ovulating that weekend, and it was all going to waste.   The misery was eased a little when Heidi got a text from her friend V, who I’d met at a party a few night’s earlier, offering to be my Baby Daddy.  He even offered to fly home with me, since I was pretty sure I was ovulating right around then, saying we could join the mile high club and get me pregnant, all at the same time. 

I know I talked about trying to get pregnant all the time.  Trying to get pregnant, and my fear that I would never be able to get pregnant were all consuming.  I’m amazed that anyone wanted to spend time with me, the miserable, obsessive, moody, crazy woman that I was. 

The one benefit of taking the month off was that I had time to meet with my RE to discuss a change in game plan.  I’d had a luteal phase defect on both of my Clomid 50mg cycles, and I only produced one follicle with each cycle, so I was ready to talk about doing something different.  He offered me the chance to go straight to IVF, but encouraged me to first try two hybrid cycle with Femara and Gonal-F.  He thought it had a good chance of working, but also thought my response would also help guide medication doses with IVF if the hybrid cycle didn’t work. 

I thought the compromise sounded reasonable, so I agreed.  On Femara 5mg and Gonal-F 75, I had two follicles.  Better than with Clomid, but not particularly impressive.  So halfway through my two week wait, I decided that if this cycle didn’t work, I was going to IVF.  I was also given Crinone, just to be on the safe side, so this time AF didn’t come early.  I managed to wait to POAS until 12dpIUI, and then I caved.  It was negative.

The next night I cried myself to sleep, and then dreaded getting up to POAS the next morning, 14dpIUI.  I was shocked when, 30 seconds after taking the test, I glanced over and saw there was only one word on the screen:  pregnant.  I was still sitting on the toilet when I called LB, Heidi and my sister to tell them the news!

You all know how things went from there.  A couple of good betas, a 7 week ultrasound that was questionable, and a 9 week ultrasound that showed no heartbeat.  Such a crazy four months of wildly variable emotions – worry and anxiety, followed by joy and worry, followed by despair.  It’s no wonder I sometimes forget much of the first part of 2010 ever happened.

The weird thing is, I didn’t experience all those crazy negative emotions with IUI #4.  I thought about it a lot, but I was pretty sure, in a way I hadn’t been before, that I was pregnant.  I was convinced from the second I was standing at the elevator after my IUI, talking to my RE, and felt the first twinges of ovulation pain that this one had worked.  I didn’t tell anyone except Heidi how sure I was, because I was afraid of looking like a fool if I was wrong.  But here I am, 26 weeks pregnant, so this time my instinct was right!

In hindsight, I realize just how easy it was for me.  I was told that I had impaired fertility – diminished ovarian reserve.  And yet I managed to conceive on 2 out of 4 cycles.  The miscarriage was horrible, that’s true, but repeated failed attempts at trying to conceive is pretty horrible, too.  I don’t think it’s possible to say that either is worse than the other, but I’m pretty sure my calm attitude going into IUI #4 was mostly because it was the first time I went into an IUI knowing that my body did know how to get pregnant.  I’d started CoEnzyme Q10 in an attempt to decrease the risk of chromosomal abnormalities (using this study protocol, which came about after studies in “elderly” mice showed decreased risk of chromosomal defects in embryos of mice given CoQ10), and that made me feel better, too. 

At any rate, I know how lucky I am right now.  There’s not a day that goes by (not even an hour) that I don’t marvel in the miracle of being pregnant, and I will never, ever take this baby for granted.  And I really hope that my neurotic behavior while TTC is something I never have to deal with again!

Final Circle and Bloom Review

Now that I'm near the end of my first 2ww with the fertility meditations by Circle and Bloom, I thought I'd give a quick update on my opinion, since I've listened to most of the meditations for the cycle.  For the most part, I really enjoyed them.  The relaxation part never fails to soothe me, but I've listened to them enough that I can actually stay awake and listen to the second part of the meditation, the part that focuses on where I am in a given cycle.  I really like the fact that there's a new mediation every day.  Not only does it keep it fresh, but it's also always right where I am in my cycle, so it's possible to focus on exactly what's happening in my body every night.  It's empowering, imagining follies growing or an embryo implanting, and relaxing, too.

I especially like the times during the 2ww where the meditation talks about negative feelings and fear.  There's a line in one of them that says something like, "negative feelings aren't going to hurt your growing embryo, but the repression of those feelings can be damaging.  So just let go."  That actually matched up with a conversation my friend Colette and I had after seeing "Eat Pray Love" last week, which made it even more powerful for me to hear it when I did.

I don't like that the meditation series I'm listening to is a combined medicated IUI/IVF cycle series, though.  I found the mentions of IVF jarring, since I'm hoping to avoid that completely, and that worked against my relaxation.  For that whole time between triggering, IUI and ovulation, the tracks just felt wrong - we weren't about to retrieve eggs from my follies, and no "bundle of cells" was about to be delivered to my uterus.  I didn't want to think about IVF, I wanted to be visualizing sperm fertilizing eggs.  I looked at the "natural cycle" meditation menu, and really wish I could have listened to some of those during that 3-4 day time period, but they're too expensive to buy the whole thing for just a couple of meditations.  So I listened to my AnjiOnline meditations on those nights.  I still don't like those anywhere near as much as the ones from C&B, but it was better than listening to IVF centered meditations for a few days.  As soon as I finish this post, I'm emailing C&B to give them my feedback - maybe they'll listen!

In my own fertility news, I POAS this morning.  Of course, it was a BFN.  I am only 10dpIUI, after all.  But I had to do it.  And now I won't POAS again...for at least another day or two.

(Bonus!  I just went to the C&B website and saw this post about a chance to win an iPad.  I'm totally linking this post to their contest! LOL)

PUPO!

I have a confession to make.  I’m hugely superstitious.  I don’t step on cracks in the sidewalk.  I walk around ladders, not under them.  I have a necklace I’ve worn for every single exam I’ve taken since the start of medical school – even my board exams. 

I’m not free of superstition in the trying to conceive arena.  For my first IUI, I wore my lucky socks, which promptly lost their lucky sock status when AF arrived 11dpIUI.  For my second IUI, I wore a fertility necklace I found online. I should have know it wasn’t going to work when I constantly cursed at it as the cute little fertility turtle kept getting caught on my sweaters and scarfs.  The day AF arrived at the start of my third IUI cycle, I was wearing a Celtic cross necklace in honor of St. Patrick’s Day, so it became my fertility charm, and I didn’t take it off until the morning of my D&C. 

Now that I’m on to try #4, I’ve got a new fertility amulet – a green silly band in the shape of a car that my nephew gave me.  I doubt it will last 9 months, but I’ll wear it as long as it holds up, or until AF comes, whichever comes first!

I had bought a new pair of lucky socks for try #3 – rainbow striped, and conveniently labeled “My Lucky Socks”.  Only, the morning of the IUI, I couldn’t find them, so I wore my black socks with shamrocks on them instead.  And until the end of May, they had been given the new designation of my lucky socks.  Last night I made sure my rainbow striped socks were out on my dresser, ready to wear this morning.

Since I did manage to conceive with IUI #3, I decided to try to do as many other things the same this time as I did last time.  So I had a massage last night, and asked the therapist to do some extra reflexology stuff to help with fertility, just like last time.  This morning I did the ovulation yoga practice from Restoring Fertility yoga DVD, just like last time.  And instead of bringing a pregnant friend (my sister) with me to my IUI like I did for my first two IUIs, I went alone with just my iPod for company.  Just like last time.

I had one of my favorite nurses perform my IUI, a different nurse than prior tries.  The IUI was easy – unlike the first two times and just like last time.  Instead of fighting with my wonky cervix, the catheter went right in without a hitch.  I had 20 minutes to relax and dream of sperm fertilizing eggs after the IUI, and then I ran into my RE in the hallway on my way out.  I left feeling hopeful and happy, which is always a good way to feel when a stranger’s swimmers are having a field day inside you.

My Lucky Socks - 2 minutes pIUI

Here’s hoping the change in socks and fertility amulets, along with higher dose of meds, better supplements before IUI and a hard working left ovary all work together to give me a BFP that sticks this time.  It’ll be two weeks before I know– but for now, I’m going to enjoy being PUPO!

Fertility Meditations

After my second failed IUI, I took a month off from trying to conceive before cycling for IUI #3.  It wasn’t part of my plan, so I was miserable about the delay, and anxious to do something to improve my fertility while I waited. Which is how I found meditations for fertility.

The first one I came across was Kathy Freston’s Visualizing Pregnancy.  It’s about 20 minutes long, and I immediately liked it because she says something near the beginning like, “This isn’t magic, we can’t make something come true, just because we wish for it.”  Not something that we who want to become pregnant want to hear, but true, and I respected her for avoiding the “The Secret”-like mumbo jumbo.  It’s a relaxing 20 minutes, but it is somewhat mystical in nature – you are guided through visualizing God or spirit surrounding you and supporting you as you imagine being pregnant and having a successful pregnancy.  The end result of this meditation is relaxation and at least a few minutes of positive thinking, which has to be a good thing.

I got bored with just one meditation, though, so I tried the Meditations for a Fertile Soul from Anji Online (warning, her website has her talking on it, and I can NOT figure out how to turn her off, so don’t click on the link if you don’t want anyone listening to know your business!)  This is a series of 3 meditations that was created with fertility guru Randine Lewis, and is for at any time in your cycle.  The first one, A New Hope, started off well, (despite the fact that the title brings to mind Jedi warriors instead of fertile ovaries) but it quickly went downhill.  There’s one part where she asks the listener to think of all the negative words she’s used to describe her fertility in the past – and then after a pause she starts offering up examples.  Really horrible, mean and hateful examples!  It felt like she was using all those words to describe what she thought of my fertility and I hated it.  Totally ruined my relaxation.  The other two were better, but did involve visualizing things like golden cords connecting you to the earth and to spirit, and pink misty light healing all the dark places inside.  I liked those parts, but they’re a lot of work, not particularly relaxing and definitely not good for me to listen to right before bed.  And they’re long, almost 30 minutes, so I rarely make time for them.

I also listened to the Medicated Cycle meditation during my third IUI cycle, which I liked because it directs the listener to first visualize the medications working in the first two weeks, and then visualize conception and implantation in the second meditation.  I found myself wishing there were more meditations to listen to, because I did get a little bored with it after a few days, though.

For my next IUI, I decided I needed something new.  I looked around, a found Circle and Bloom.  Their website says their meditations focus on tapping into the mind body connection, and there is a definite difference, at least so far.  I bought their IVF/IUI program, which has a different meditation to listen to every two days, including a special one for trigger day and IUI or ET.  There’re even three mediations to listen to precycle. 

So far, I’ve listened to just the precycle meditations.  The first one is more of an introduction to what the rest are going to be like; it really just establishes the foundation of thinking about a mind body connection.  The next two are more involved, and focus on imagining your reproductive system as being in balance, including focusing on the hypothalamus and pituitary (the two glands that are responsible for hormones like FSH and LH).  Each session begins with a directed relaxation exercise, then goes on to the real meat of the meditation.  There’s less of a focus on God or a higher being in these meditations than the other ones I’ve listened to, which doesn’t matter to me, but some might find they like these more (or less) because of that.  Best of all, they last only 15 minutes, so they’re easy to fit into the day.  I’ve listened to one almost every night for the past few weeks, and I’m really starting to look forward to having something new to listen to soon!  I’ll let you know what I think of the series once I finish it, but so far it seems like Circle and Bloom is the winner (even if her voice does occasionally irritate me).

I don’t know if all the claims on the websites are true.  I don’t know if these meditations actually do anything at all to improve my chances of conceiving.  But it helps me to know that I’m doing something, and gives me some semblance of control in a situation that is really completely out of my control.  And it’s relaxing.  As wound up as I feel lately, anything that relaxes me is a good thing.   

Forward Thinking

Puerto Rico was wonderful.  The hotel was beautiful, the beach lovely, and the pool was amazing.  It was also the perfect amount of time: just enough to be able to relax, but short enough that I didn’t feel lonely. 

I’m finding it hard to write about what this weekend did for me without sounding a little silly, so please bear with me as I struggle to put my thoughts into words.  It was nice to be able have time to think clearly about where I am right now, without distractions other than the sun and the heat.  I’ve come to the conclusion that as much as I hate having to wait another month, it was probably a good thing.  I have more time now for the supplements I’m taking to improve my egg quality, my body has another month to heal, and so does my spirit.  I was finally able to think about trying to conceive without feeling all the negative emotions associated with my miscarriage overshadowing everything.  Those emotions haven’t gone away, but they’re more manageable now, less overpowering. 

I also listened to Kathy Freston’s “Visualizing Pregnancy” meditation for the first time since April, and I did okay with it.  It’s what I listened to almost every day for the month before my successful IUI, and I’m certain that it helped to calm me down and to sleep better, especially during my 2ww.  I didn’t find as helpful this time, maybe because it just doesn’t seem to apply to me anymore, as it focuses a lot on actually believing that you can get pregnant.  I did listen to the first two “precycle” meditations from Circle and Bloom’s Meditation for IUI/IVF cycle.  These are geared towards enhancing the mind/body connection, and feel much more appropriate for me right now.  I’ll continue to listen to the “precycle” meditations over the next month, and then move on through the rest of the program as I go through my next cycle, and let you all know what I think of them then. 

For now, I’m excited that I’m able to focus on doing the right things to help make my next IUI a success, instead of still focusing exclusively on what I need to do to heal.  Looking forward – it’s a nice feeling.

Yummy in my Tummy

I'm finding it hard to readjust my brain to the thought that I'm preparing for another cycle of trying to conceive. The stress of waiting, testing, appointments and doctor's visits is overwhelming - it takes over my entire life. There are entire weeks at a time where I can't comfortably make out of town plans for fear I might need to be here for an ultrasound or an IUI. I have to cancel meetings and my patients at the last minute because we don't know until the last minute when I'll need to be at the RE's office. I have no control over much of anything except showing up on time for my appointments - appointments which I have no control over scheduling. My second thought after my BFP in April (after, "OMG, I'm going to be a mommy!") was, "Thank goodness I'm done with the IUIs." *sigh* And this time I don't have a clue when all this is going to start again, as I have no idea when AF might show up.

In an attempt to gain some semblance control, with my first three IUIs I tried all sorts of things to improve my chances, aside from just acupuncture. I'm not sure I'm ready to start back at all those things just yet, but my diet of junk food and birthday cake over the past couple of weeks has made it obvious that it's time to start working on at least one of my efforts at improving my fertility chances - my diet.

For most of the past year, I was following The Fertility Diet to the letter and being as healthy as I could be. Then I went on vacation in November, before I started trying to conceive, and never quite got back on board, though I was avoiding fast food and most junk food. I used the stress and fertility drugs as an excuse to be lazy (and it might have even been a valid one), but I was not eating as healthily as I should have been.

There's an interesting article about the fertility diet at a Canadian website for a fertility wellness center. In the article, the author points out that we already know what to eat for fertility health - it's the same things that we're supposed to be eating to decrease the risk of diabetes and heart disease. Yep, eating healthy is what you should do to improve your chances of conceiving - eating plenty of fruits and vegetables, unsaturated fats, and complex carbs, and avoiding saturated fats, trans fats and refined sugars. Chinese medicine takes that one step further, with specific recommendations based on your own symptoms, with specific foods that you should eat and foods you should avoid based on your body's energy balance, or chi. I've tried to incorporate some of the foods my acupuncturist told me I should eat, but for my own mental health I have to draw the line somewhere. Eating healthy is fairly easy, but following a super strict diet with prescribed foods is impossible, especially in the midst of the stress of trying to conceive.

I've enjoyed a couple of weeks of eating whatever I wanted - I figure I deserve it. But after all the junk food, I'm actually craving fruits and veggies! Tomorrow I'm going back to following a healthy diet. But for today, I'm living by the words of my 3 year old nephew who said, "Chocolate! Yummy in my tummy!"

Monday for Tuesday

Today was a rough day. To all those women in the discussion board universe who post that they were back at 100% just days after their D&C – how was that possible? Here it is, a week later, and I still feel bad. I’m sure today was all about post-pregnancy hormone changes, since I’ve had what feels like my usual AF related headache for the past two days. Worse than a usual headache, but it feels like the same kind of thing. Add to that a little nausea, some dizziness, and an overwhelming urge to cry, and you have a good representation of my day.

Luckily, I had an acupuncture appointment tonight, my first since my miscarriage. I started seeing Hope (that’s really her name) last August after my fertility labs came back borderline low. I have no idea if my almost weekly sessions with her have made a difference in my fertility, but I do know they have made a difference in how I feel. After my first month of sessions with her, I started to feel more balanced, both emotionally and physically, than I have in years.

Each session starts with a discussion about how I’m feeling – a discussion that usually lasts about 10 minutes. Hope asks about all the little details, and she honestly seems interested in the answers. Part of the appeal of our sessions may have something to do with just how nice it is to have someone so very interested in the minutia of how I’m feeling from day to day. She then examines my tongue, feels my pulses and has my lie on the table. The needles are teeny tiny, and don’t usually hurt (though occasionally I do get a little zing from one in a particularly tender spot). Hope leaves me under heating lamps in a quiet room for 20-30 minutes, and that’s it. I usually leave feeling relaxed, refreshed and balanced. Today was no different. My head still hurts, but it’s eased off enough to breathe, and I was actually hungry for dinner tonight. Maybe I’m really on the road to recovery, after all.

If you’re really interested in how Chinese medicine works for fertility, I highly recommend The Infertility Cure by Randine Lewis. It’s an easy and fascinating read, even if you aren’t trying to get pregnant.

Oh, a completely random aside – JJ Abrams has a new show coming up next year! Undercovers - Hart to Hart meets Alias? The previews make it look like it has potential!