[If you haven't read part 1, click here.]
A little disclaimer before we get into the nitty gritty: I'm not a medical professional so anything you read here should be double checked by your primary care doctor or gynecologist. My main goal in sharing this information is for the women who, like me, know something just isn't right with their reproductive system but they just don't have words for it quite yet. I hope this helps shed light on the occurrence of PCOS and the options you have for growing your families!
Now let's dive back in!
PCOS and Fertility
Polycystic ovary syndrome (PCOS) is a health problem that affects one in 10 women of childbearing age. For comparison, breast cancer affects up to one in 8 women. In talking with other women who deal with infertility, I have realized PCOS is a lot more common than I initially thought. The main way PCOS impacts fertility is through affecting ovulation. For women with PCOS, there is typically an increased amount androgens (male hormones). According to Womenshealth.com:
- Higher than normal androgen levels in women can prevent the ovaries from releasing an egg (ovulation) during each menstrual cycle, and can cause extra hair growth and acne, two signs of PCOS...PCOS is one of the most common, but treatable, causes of infertility in women. In women with PCOS, the hormonal imbalance interferes with the growth and release of eggs from the ovaries (ovulation). (See more here)
The hormonal imbalance caused by PCOS can sometimes be addressed through medication, diet, and certain supplements (see FloLiving for more). At our initial fertility consult, my doctor was pretty confident that I would get pregnant as long as I responded well to the meds. I was prescribed Provera, a synthetic version of the hormone progesterone, to induce a period, and then I started with 50 mg of Clomid which progressively increased by 50mg each cycle.
The first two cycles I didn't get pregnant; I quickly decided the third round of meds would be my last. I hated the whole process of trying to conceive. I didn't like feeling like a science experiment, or a faulty piece of machinery being troubleshooted. I hated scheduled sex. It crushed me every morning to see one negative ovulation predictor kit after another. And at the end of the month of trying, all our efforts were met with the fateful BFN (big fat negative) pregnancy test. On my 29th birthday, I told myself that if the medicine didn't work that cycle we would take a break from trying and focus on getting healthier as a whole. Lo and behold, I got pregnant that cycle! We were shocked, and filled with so much excitement for our child. For the most part, I had an uneventful pregnancy, aside from a bleed at 10 weeks that ended up being nothing concerning.
Cervical Malfunction
At my anatomy scan, the ultrasound tech detected that my cervix was shorter than it should have been at that point (19 weeks). My doctor explained the likelihood that I could go into labor early, and emphasized the importance that I make it to 24 weeks before doing so. I left her office with an eery feeling. As I clutched a sealed envelope I would later open with Victor to see if we were having a boy or girl, in the pit of my stomach I couldn't help but hold a tiny bit of fear at the potential of losing our child just as soon as we figured out who he was.
To our dismay, my water broke two weeks later at 21 weeks and 2 days. Xavier was born two days later and lived for 10 minutes. To say we were devastated is an understatement; our worlds were turned upside down and after trying for so long, we found ourselves back at the starting line. However, this time we started back on the grueling marathon of TTC with a significant handicap: grief.
At my 6 week follow up with my doctor, she asked what our plans for birth control were. The only decision I could make at that time was to not make a decision. We weren't preventing, but with my PCOS diagnosis, I was pretty sure things would go back to the way the were before the pregnancy. I figured we'd give ourselves time to grieve and finish out the year before bringing that conversation up again.
And then I got a period. Naturally.
She's Baaaaaack
*Record scratch*
I was completely dumbstruck. I hadn't had a period without being on Provera or birth control since I was about 16 years old. Apparently, pregnancy can cause a shift in your body's norms and "reset" things in your reproductive system. As strange as it was, my period was back...every 2-3 months, there she was. During those skipped months I went through the torture of thinking I was pregnant. I was aware of every twitch and tinge in my body, ever sensitive to the way my sense of smell seemed to change, food aversions, breast soreness, and any other obscure symptom of pregnancy. And every month the result was the same: BFN. At the suggestion of some friends who had done the same, I made an appointment with a reproductive endocrinologist this past August. After ruling out male infertility factors, then doing some additional blood work, a hysterosalpingography (HSG), and a transvaginal ultrasound on me, our doctor confirmed my PCOS diagnosis and we came up with a new game plan.
I was completely dumbstruck. I hadn't had a period without being on Provera or birth control since I was about 16 years old. Apparently, pregnancy can cause a shift in your body's norms and "reset" things in your reproductive system. As strange as it was, my period was back...every 2-3 months, there she was. During those skipped months I went through the torture of thinking I was pregnant. I was aware of every twitch and tinge in my body, ever sensitive to the way my sense of smell seemed to change, food aversions, breast soreness, and any other obscure symptom of pregnancy. And every month the result was the same: BFN. At the suggestion of some friends who had done the same, I made an appointment with a reproductive endocrinologist this past August. After ruling out male infertility factors, then doing some additional blood work, a hysterosalpingography (HSG), and a transvaginal ultrasound on me, our doctor confirmed my PCOS diagnosis and we came up with a new game plan.
Where We Are Now
- Take Provera for 10 days to induce a period
- Take a medicine to induce ovulation called Letrazole on cycle days (CD) 3-7
- Ovulate (hopefully) somewhere around CD 14-19.
- Do the baby making stuff 🙈 during fertile window (5 days before and after ovulation).
- TWW=Two week wait, aka the longest 14 days ever!
- Take a pregnancy test the day of my missed period and pray for a BFP (big fat POSITIVE!)
If the test is negative, the process starts all over. In the occurrence of a positive test I will be closely monitored, as I will now and forever be considered a "high risk" pregnancy. At around 12 weeks, I'll go in for a cerclage, which is a stitch on the cervix to hopefully keep things closed and secure for longer than last time. Provided I make it through the three trimesters without issue, once baby is considered full term (around 37 weeks) I'll go in, have the stitch removed, and then wait for baby to come. A lot of times labor starts pretty soon after that. Note: I realize this little paragraph makes getting a cerclage sound like an easy-breezy-fix-all, but it's doesn't come without it's own risks. These include infection, ruptured membranes, premature contractions, and miscarriage, among others.
We haven't really discussed how many rounds we're going to try, and we are still weighing out other options (intrauterine insemination, IVF, adoption). We'll cross those bridges if and when we get there.
Phew!
Getting pregnant is a lot harder than it looks on the movies, guys.
Thanks for bearing with me as I laid out what we've been through so far and where we're going. If anything, I hope to shed a little light on the TTC world for those who aren't in it, and offer some comfort and solidarity to those who are. And lastly, if you see any similarities in our stories and you have not yet seen your gynecologist or a fertility specialist, get checked out sooner than later. Everyone's body is different, but yours will signal you when something's not right. May we all be good stewards of these earthly vessels.
Thanks for bearing with me as I laid out what we've been through so far and where we're going. If anything, I hope to shed a little light on the TTC world for those who aren't in it, and offer some comfort and solidarity to those who are. And lastly, if you see any similarities in our stories and you have not yet seen your gynecologist or a fertility specialist, get checked out sooner than later. Everyone's body is different, but yours will signal you when something's not right. May we all be good stewards of these earthly vessels.
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