Wednesday, April 11, 2012

Calling all Infertiles with PCOS

Today I met with our new RE, Dr Dub. I could not have imagined how well today's appointment would go. In fact, when I scheduled appointments with Dr Dub and Dr H, I had predetermined that if we did any cycles, they would be with Dr H. Dr Dub was just the third opinion.

That plan has changed.

Dr Dub is an older guy. He's been in the Reproductive business for a long time. It didn't take him long to realize I had been in the ring for a long time too (going on 6 years this year). I started out by giving him a full run down of my fertility history. Then we got down to business. In all of my years of seeing REs, I can't believe none of them ever spelled out things for me the way Dr Dub did today. He didn't sugar-coat anything, and he treated me like what I am, an infertile pro. So he didn't waste time going over the information I already knew from my own past experience.

He was quite unimpressed that Dr D had "lost" my images because he really needed to see them to get a better idea of what the inside of the uterus looks like, specifically the endometrium. He says it is possible there are endometrial growths in the uterus that can inhibit in implantation. If I have any, we will want to take care of them. He also had wanted to see the extent of the scar tissue around the ovary and fallopian tube.

But all of that aside, Dr Dub laid it all out on the table for me.If you have endometriosis, you most likely have PCOS. Now here is where I got new information that I had never heard before. Typically women with PCOS have it because they are insulin resistant. He drew me a picture of how insulin is supposed to work in a normal person, and how it works in patients with PCOS. Basically I don't use my insulin correctly and it affects my hormones and this in turn affects my eggs by either making them unhealthy or by killing them off before ovulation. If the egg is dead before ovulation, all that is left is a fluid-filled sac, or cyst. Sometimes they don't go away, so they build up and build up, which is how you get polycystic ovarian syndrome. He put together all of the pieces of information that were missing from my puzzle.

PCOS and endometriosis contribute to low estrogen and low progesterone. So you have to fight to get a good egg, and then you have to fight to make that egg a comfy place to hang out for 9 months.

When he started talking about insulin resistance, I told him my older brother is a Type 1 diabetic. He shook his head. Then he asked if I had gotten gestational diabetes. We kind of chuckled when I told him I had and that my sister had too. He told me I have what is called "thin PCOS" where my sister has "thick PCOS" because her cycles are irregular, and mine are not.

So my PCOS/Endo issues combined with my husband's low morphology pretty much leaves us with only a couple of options, IUI, IVF, IVF w/ICSI. Dr Dub wants to start right away with a medicated cycle, but not with chlomid or letrozole, he wants to do it with FSH and HCM shots. I told him the injectibles made me bat chit crazy and he said, "Really?! But you handle chlomid fine?" (That is the 3rd dr who has said that to me.) He said usually the chlomid is what makes us women wacky.

He said chlomid has a half life of two weeks, so he never lets patients do more than 2 cycles at a time because it takes an extra month to get the chlomid out of your system. You don't want to build it up too high, or it becomes detrimental.

I told him we had done a cycle with two shots of FSH and one shot of HCG, and I went psycho on my husband. As I finished telling him that, I started to smile and said, "We had done 6 rounds of chlomid by the time I went crazy." Dr Dub laughed and said, "It was the chlomid. It wasn't the shots."

I had never put that together until today!

He answered the questions Dr D wouldn't or couldn't. like why is my estrogen so low: PCOS. How do we fix it: Metformin.

It was a nice, long appointment, and I felt so comfortable talking to Dr Dub. I liked that he didn't treat me like a newby, and that he could tell I had some experience under my belt. I walked out of there going, "Crap! Now what do I do?" I was going to go with Dr H, and since I am on CD1, I was going to call him today to set up appointments for monitoring. But after meeting Dr Dub, I think I want to start the metformin tomorrow and have him do the hysteroscopy.

I don't really have a big plan set out this time. The only thing on my plate right now is metformin, hysteroscopy, and possibly IUI with FSH/HCM.

It is so weird being where I am mentally right now. I'm looking at doing things I didn't think I wanted to do ever again, but that was because I had my information mixed up. It was the chlomid, not the shots. I just kind of feel like I am floating through all of this information and the decisions that need to be made.

I am supposed to hear back from his office on Friday, so I think I will discuss which way to go at that time. I know he already laid out three battle plans for us, but I want to see if we can tweak them just a bit.

 Holy cow. I'm getting back on the horse. And not even the pony. Oh no, I'm getting on the brumby. We're headed for the big leagues.
Getting on the Medicated IF Horse
 The Metformin starts tomorrow, and on Friday I will know if we are going to try to do a cycle with FSH/HCM this month. I kind of hope we do. I want to get the ball rolling. Its time to kick all of this crap into gear and get a baby out of it!

What has this world come to?! This is all so surreal and crazy!


Kahla said...

Very excited for you!!!!

Melissa N. said...

I hope you tolerate metformin better than I did/do. here's a tip: eat LOTS and I mean LOTS of protein, and take your MET with milk.

As you know, I have PCOS and was just told yesterday for the second time (the first was 2 yrs ago) that if this next cycle doesn't work, I will need IVF. (Doesn't mean it will be that way for you, but that's what's in store for me. Yay) In my case, my pcos is a mystery. I am what is called a "skinny cyster" meaning I don't have the weight gain typically associated with PCOS patients. Also, my hormone levels are all borderline. Basically, at this point, everything is being controlled by medications (egg production, ovulation) and we are doing IUI's and yet...nothing. In short, there is no good reason why I shouldn't be getting pregnant, so my pcos is now pushing me into the "unknown infertility" category. It's an ugly beast, but it can be controlled. I hope, for your sake, that this is the key to your success!!

Life Happens said...

I'm glad the dr. Was able to provide answers!!! I was on meetbfor in for years. Trying to figure out what our next steps are for baby #2 too!

Good luck!

Erika said...

I'm so glad you go some answers and shared some information! It was so informative to read! Good luck moving forward!

Leah said...

So glad you liked the doctor! That means everything! And Chlomid made me nuts, and injectables didn't. And me personally, I just like the odds better with injectables. Thinking of you! :)

Alex said...

Wow - how exciting! I'm so glad you like this doctor. Being able to trust and rely on your doc makes ALL the difference in the world! I'm so excited for your new plan - this is so cool!!!

Mazzy said...

I'm surprised you did not get this information before, about the insulin resistance and PCOS. Your previous dr really sucks. I assumed you knew!

I tried the metformin on my first cycle with Dr C but it made me incredibly sick to my stomach and have all kinds of digestive issues. Did he offer to check your insulin and hormone levels for a baseline? We ended up using a low dose of oral estrogen for me because while my insulin resistance showed to not be terribly abnormal, my testosterone levels were def too high. That was the key for me, to help combat the issues that PCOS cause on the hormones.

Random, but did he suggest anything for the low morphology issue? My husband took a low dose of clomid himself, random I know, and some stuff we bought online called proxeed.

Im so glad you like both drs and have hope. You sound awesome and I cannot wait to see how things go!

Barb said...

PS. Per the above comment... the fact that Met helps regulate the whole base issue of the problem means the other hormones fall in line once that happens. It worked for me. My cholesterol/triglyceride levels even evened out. All my problems stemmed from insulin/PCOS related issues. And my glucose numbers are never terribly out of whack either. But the only TRUE negative for IR is done in a special clinic for hours and hours. It's a very hard thing to detect for sure. If you have it, it's true. If it comes out negative, you can never be sure. And I had all the classic signs. Met even evens out my mood and energy levels. Diabetics can tell you how sugar levels affect that as well.

Barb said...

I left another Met support comment but dont' see it here. In short. I sympathize. You can adjust. It just takes months. Let me know if you need advice. :)

-Kindra said...

Yeah, a smart doc who's doing something. I love it. Clomid made me a looney toon too, hot flashes, super angry, everything. I'm so excited for you lovely lady!!

Carrie said...

I adored my Metformin, was on it for over 5 years and always did fabulous with it, though I think the majority of people do have stomach problems on it.

However, if you don't tolerate it well even after trying any tricks you can find, you can also do a low carb diet and it will basically do the same thing. (You don't have to go crazy low carb, just watch your carbs and try to keep them under 200 to start with. I was shocked when I tracked my carbs once and realized I was getting like 600 grams a day!)

Heather said...

I assumed you knew about insulin resistance in PCOS too! I was already on metformin for diabetes when I was diagnosed but they were clear that one of the treatments for PCOS was metformin and I was already on it so they just added the pill to the cycle. You should have been told! You need to stick to the newest doc, seriously.

AL said...

this was a good read...and scary for someone who did 6 cycles of clomid :-(

Best of luck to you!!!