Tuesday, November 3, 2009

Trying to conceive - TTC

My doctor started me on daily tablets of metformin and folic acid supplement. This was the first phase. First I had to get my body back into order - lose weight and reduce my blood pressure. Easier said than done! Metformin is actually an anti-diabetic drug and tackles the PCOS symptom of insulin resistance. It also helps in weight loss.

I started the pills along with trying to control diet and exercise. I did lose some weight, and after 6 months decided to start trying to conceive (TTC).

A normal cycle goes something like this (in layman's terms). The woman gets her period, about 7 days, then her ovaries start forming follicles. The endometrium (uterine lining) starts thickening in preparation of pregnancy. Follicles mature/grow to a certain size, then rupture to release the egg at around the 11th-15th day. This is the fertility period when the egg is available for fertilization by the sperm. A fertilized egg (now called embryo) implants in the uterine lining and attaches itself to the uterus for a successful pregnancy. Then comes a 10-12 day suspense phase when you may or may not be pregnant. At the end of this cycle, if you are not pregnant, the body will start shedding off the endometrium lining and this is the start of periods and a new cycle. The whole thing takes about 28 days. Any one thing going wrong will require abandoning the cycle and waiting for a month for the next one. Sometimes, if you have ended up with a surfeit of hormones, you might need an extra non contraceptive cycle to help your body get back to normal before trying again. So one messed up cycle could mean 3 months wasted!

This TTC business takes time. I couldn't adjust to that for a long time. I was used to a fast paced life - work hard, party hard, instant gratification, deadlines and results. Suddenly, I'm in a space where anything can go wrong, which you can't control; every small thing will send you back to square one and you have to wait for the next viable cycle; and even if you do everything right, results may not come and you won't even know it till your next cycle starts!

In my case, I faced everything. One cycle, I wouldn't have follicles. Another, the follicles wouldn't mature properly. In yet another, the follicles wouldn't rupture. Another time, my lining wasn't thick enough. A few times when everything was ok, we tried natural and artificial insemination, but the embryos wouldn't implant. In each stage I was variously on pills or injections, almost daily ultrasound monitoring, sometimes in the hospital for artificial insemination and giving blood tests to keep a check on hormone levels. Frustrating, maddening, time consuming and emotionally draining, without even taking into account the side effects of all the hormone stuff I was taking!!

I spent more than 3 years doing this, gave up my job, had a laproscopy surgery done (to make my ovaries more responsive to developing follicles), a hysteroscopy (to check my uterus and tubes) and spent 6 months in tuberculosis treatment (because 1 out of 3 tests came positive). My doctor wanted to cover all possible bases, and with failure after failure, we decided finally to go for the last option - IVF. I once sat down and made a chart. In 3yrs+ of trying, we had had only 5-6 cycles which had gone upto fertilization stage - 3 failed in IUI and the others in natural conception. Just 6 real chances in 3+ years. To say that I found the chart demoralizing would be a massive understatement.

I had given up everything, job, career, friends, interests; spent 3 years of my life in and out of doctors' offices & hospitals, and had nothing.

Incurable but not untreatable - the battle begins...

PCOS is incurable, but its symptoms are treatable. This means you CAN get pregnant, you can manage weight gain, hirsutism, acne etc. PCOS put you in a high risk category, but with medication, exercise, diet control and assisted reproductive techniques (ART), you can manage and control the symptoms. My body may have slammed a door on my face, but medical science still gave me options!!

Even more incredibly, lots of women go on to have perfectly successful natural pregnancies without even realizing they have PCOS, leave alone needing medical help!! No one knows why. Its just a really fickle syndrome! So there are natural success stories and medical workarounds, maybe not 100% successful, but definitely not a lost cause!

I was 28yrs old, had age, science, determination, optimism and a very very supportive hubby on my side. This was something I could do. This was something I would do. I've always believed that hard work and genuine effort will never go unrewarded.

I'm going to fight this. I'm going to put in everything I have. I'm going to take every chance I can get. I'm not going to look back on my life and regret that I could have done more. If destiny has other plans for me, we'll see...but it won't be because I didn't try and give it my best shot.

I have PCOS - Poly Cystic Ovarian Syndrome

I have PCOS - Poly Cystic Ovarian Syndrome. It has taken me a long long time to be able to say that without feelings of denial, embarrassment, resentment, self recriminations, guilt, depression and plain old fashioned self-pity. To accept that I have a condition that is a leading cause of infertility in women has been a really long journey...and one that is ongoing.

I had no prior warning of infertility, though the signs were there. I've always had irregular periods, but then loads of women do and go on to have perfectly normal pregnancies. I had put on a lot of weight, but I put that down to long work hours, stress, bad eating habits and no exercise. I didn't really have acne problems, though hirsutism (excessive unwanted hair) was something I'd learnt to live with. On my mother's side, I did have a family history of diabetes, but personally hadn't had blood sugar problems. In effect, I had never heard of PCOS, even though I displayed some of the classic symptoms. So when I visited the gynae, that was her first diagnosis, and she sent me for an ultrasound that confirmed bilateral (both ovaries) PCOS. Uh oh!!

Both my parents are doctors. I'd been raised in a family where sickness was limited to seasonal flus and the occasional childhood one time measles and mumps. All treatable with rest, chicken soup and the occasional medicine. I'd never been admitted in a hospital, was terrified of needles and of the firm belief that all illnesses are symptoms of known causes and were temporary and treatable. Then I learnt about PCOS.

First, there is no established cause. What???? A leading reason for infertility and people don't know what causes it?? It sounded incredible! But it doesn't stop there. There is no cure either. I have an incurable syndrome that makes me infertile! And there is more to come. It causes insulin resistance, obesity that after a tipping point goes on an upward spiral and diabetes. All this along with infertility, irregular periods, hirsutism, acne, hair loss, depression.....and NO CURE! Just in case my cup wasn't already full, it also increases risks of cardiovascular diseases, strokes, miscarriages, thyroid problems, lipid metabolism problems, high blood pressure, even endometrial cancer - each symptom and risk leading to its own set of medical complications!! And we don't know what causes it, we don't know what cures it...its a lifelong companion.

I'm not sure what I first felt on getting to know all this. Mostly numb I guess. To be told you have an incurable lifelong problem, which in turn will create a whole host of other problems, based on a set of what you thought were symptoms to just shrug off...numb and flabbergasted describes it best.

Nothing in my family history prepared me for this, except the diabetes on my mum's side. Still, no one else had PCOS. To say I was thoroughly unprepared to deal with my doctor's diagnosis would be an understatement. I had something with no cause and no cure - it seemed completely unfair, out of the blue and just unbelievable!! I hadn't done anything to deserve it. Why me???