Wednesday, August 26, 2015

Subfertility: Preemptive Worrying, Proactive Planning

I am very much a planner at heart (do I always follow through on those plans? Not always, but they will be great and comprehensive plans if I wanted to follow them!). So though we are still not even quite at the stage of trying to conceive ("TTC") (but getting quite close, now), I have already started googling childcare providers, calculating the probable timeframes for due dates and maternity leaves, and, of course, checking out medical providers. 

For the latter, I asked two coworkers who have had babies recently who they used (that would be covered by our insurance), and both of them plus another friend all recommended the same place, so I set up an initital "preconception" appointment with a certified midwife there. I wanted to first of all get a feel for whether I'd be comfortable with them for pregnancy and labor, so that when I get pregnant I can just call and make an appointment, not still be scoping them out and making a decision when I actually do need to see them on relatively short notice. 

But I also wanted to ask for any recommendations for the TTC process. I thought I'd ask about vitamins and supplements, exercise, whether it's real or a myth that guys having laptops on their laps are a problem, etc. And mention my various health conditions so they'd be aware, but didn't think that part would be a big deal.

Umm, apparently it is a big deal. Or at least, it might be. I know when I was initially diagnosed with PCOS that I was told it could potentially impact fertility (obviously, it is basically all about the reproductive hormones being out of whack). But until we start TTC, it's not something that truly has an impact on my day to day life. There certainly may be some blame that should fall on PCOS for days when I've felt fatigued and dealt with insomnia (but that also involves hypothyroidism and depression), and it's undoubtedly a part of how I got to be overweight and had a hard time losing it despite the exercise I do (but so is feeling like I've "earned" an excess amount of dessert). There's no direct line to be drawn between any specific symptom and the PCOS (as I don't actually have any of the cysts for which it's named). 

And yet, now that we are about to TTC, the midwife deemed me subfertile - i.e., having reduced changes of conceiving when we do try. It's extremely possible that PCOS is about to have a real, direct impact on my life. I can plan all I want, but this might be even more out of our control than trying to conceive is even under normal circumstances.

I think it's even still sinking in, but it definitely felt like a hard hit to have the midwife spend the bulk of our appointment addressing what I thought would just be a passing mention. There's really a problem with me, with my body. Maybe not, but possibly. Perhaps even probably. (Combined with some other genetic predispositions, such as depression and high cholesterol, I've definitely had fleeting thoughts of, perhaps nature's trying to say something here...) Even just TTC under normal conditions has such uncertainty, but now... it feels more certain than not that things won't go according to our plan.

The good news is that because of the high possibility, we're actually going to start with testing on my next cycle, before we even start trying. The kind of testing that I understood to typically not even be considered until the standard one year (under 35) or six months (over 35) of trying and not getting pregnant (with an assumption that's nothing wrong until you prove otherwise with a lack of results). I like the vibe from the midwife in general, but particularly in that she took a very proactive approach on this. There was no "well, it might be an issue, but let's have you try for a few months and see how it goes". I don't need to not be able to get pregnant to show a likely lack of ovulating, I already have symptoms that indicate that (high testosterone levels and long cycles), so we're immediately doing testing (combination of blood draws for luteinizing hormone, progesterone, and testosterone (last test for that by my primary doctor was over six months and 15 pounds ago, so may have changed), and ovulation prediction kits that are home urine tests) to see what we can confirm about that. (We'll also probably do testing on Abe's side to just make sure we're covering all the bases and not wasting time.)

If this testing confirms that I'm not ovulating, then, again, we don't have to wait the six months or year of trying and failing to conceive! We can just go straight to considering interventions. At that point, it seems this midwife might be a bit overly aggressive - she suggested clomid as the next step if I'm not ovulating on my own, but running that by a facebook group that has some experience in pregnancies and fertility treatments, it sounds like that's not necessarily the standard protocol for my specific scenario, and could be riskier than the midwife made it sound. But it's at least an option to explore and research, and at least she's willing to look at interventions once we've firmly established there's a problem.

There's not really anything we can do to create any certainty, but there are at least steps we can take to continue planning for the best possible result within the new definition of our circumstances. It may all end up being a non-issue, if the test results show better information than anticipated. Or we may be in for a long path with still no guarantee. Which I suppose is all the same for anyone TTC. 

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