My husband and I have been trying to conceive for about a year now. Despite tracking my cycles with the Kindara app, which I highly recommend, it wasn’t working. After a long battle with a B-vitamin deficiency I wondered how could anything else be wrong with my body. When the realization hit me that I just wasn’t getting pregnant I made an appointment with my gynecologist. I told her about my long (sometimes 40+) day cycles that were never consistent. Every month was a guessing game as to when my period would start, and when it would come my symptoms were horrendous. Severe cramps, lower abdomen bloating, heavy flow with clots, migraines, fatigue and hypoglycemia that was worse than normal.
The first steps with fertility treatment are typically an exam and blood work. My gynecologist ran some important fertility tests known as Day 3 and Day 21 tests. These are specific blood tests taken during different phases of a woman’s menstrual cycle. Day 3 is part of the Follicular phase when the body is telling the ovaries to mature follicles, only 1 of which should reach maturity and be released during ovulation. Day 21 of the menstrual cycle is normally part of the Luteal phase. This phase is between ovulation and menstruation. Blood tests taken during these key phases are very important indicators of how healthy a woman’s hormonal cycle is working.
On my day 3 lab she tested my estradiol, TSH (thyroid stimulating hormone), FSH (follicular stimulating hormone), LH (leutenizing hormone), and prolactin. For thoes of you that want to compare, my results are as follows:
TSH: 1.18 mIU/L
Estradiol: 41 pg/mL (range for Follicular Phase: 19-144)
FSH: 10.1 mIU/mL (range for Follicular Phase 2.5-10.2)
LH: 3.1 mIU/mL (range for Follicular Phase 1.9-12.5)
Prolactin: 12.8 ng/mL (range for non-pregnant females 3.0-30.0)
On day 21 my progesterone levels were tested to see if ovulation had occurred. My results were:
Progesterone: 4.5 ng/mL (range for Luteal Phase 2.6-21.5)
What does this all mean? My doctor said my FSH was borderline high and my progesterone was low but still in range. High FSH indicates that the pituitary is having to “yell” louder at the ovaries to stimulate follicles for maturation into eggs. During this particular cycle, my doctor suspected that I ovulated but there may be issues that required more testing. So she referred me to a fertility clinic. More tests!
My first round of tests at the fertility clinic included blood work to measure more hormones, an ultrasound of my ovaries, and HSG. The ultrasound and blood work are done between day 3-5 of a new cycle. It was strange having the ultrasound done while on my period because it’s a vaginal ultrasound. It was uncomfortable for that reason but it didn’t hurt. I was comforted by my husband who was there to hold my hand while the nurse looked at both ovaries. She saw lots of follicles, which can be a good thing or a bad thing depending on my blood work. My husband was able to see the screen and I couldn’t wait to probe him for what he saw. All he said was, “there were lots of dots.” Great. Lots of dots….
The blood work was done right after the ultrasound. I had the same things measured during the day 3 labs and additionally my AMH (ovarian reserve) and androgens tested (for PCOS). They took like 4, maybe 5 vials of blood. My husband was there for support but doesn’t do well with blood and was uncomfortable with the amount of blood being drawn from my body. It’s good thing that he’s not a female. He had to give only 1 vial. Lucky him.
The HSG test was definitely the most uncomfortable test. I had to down a round of antibiotics the morning of the test and I regretted every second after that. I was already nervous but my stomach was on the war path thanks to all kinds of bacteria death happening in my gut. But I suppose it prevented possible infection from the procedure…. On a happier note I took an Aleve and a Valium about 45 minutes before the procedure, which were to help with pain and freaking out, respectively:) I highly recommend if you are to have this procedure to ask for a Valium. It really did help me to relax during the procedure, which was uncomfortable but not unbearable. My husband and this really nice nurse were by my side for support. And the doctor doing the procedure was HOT (you are too hubby but if I’m going to have a man stick a tube up my cash and prizes it’s nice that he was good looking). As for the nitty gritty details, I felt some uncomfortable pinching and fullness, and 1 or 2 strong cramps. But it was over before I knew it (maybe 30-45 seconds?) and I was able to see my results right away, which were completely normal. No malformed ovaries or blockages! Phew.
After 3 weeks of waiting (the worst part really) my results were ready. At my follow-up appointment my doctor told me I had a mild case of PCOS. Skinny PCOS, more specifically. All the little dots in my ultrasound were follicles from previous cycles that were hanging around. Also my blood work revealed I had elevated AMH and androgens. From what I understand PCOS is the result of a hormone imbalance making it so a female doesn’t ovulate or ovulate regularly. These failed follicle “cysts” (characteristic of PCOS) remain in the ovaries and continue to produce androgens (like testosterone) further upsetting the hormone imbalance.
You might wonder what causes the initial hormone imbalance. The culprit that causes women not to ovulate in the first place. My doctor said there was no known cause.
Good she read the textbook from 10 years ago but I wanted more answers.
So I turned to the Internet. Oh the Internet. How I love thee. From my researching I found many doctors believe there is a connection between Insulin problems and PCOS. For me an insulin issue made so much sense. My mom’s brother has Type 2 diabetes, she is pre-diabetic, and I have reactive hypoglycemia when I eat carbs or sugar (I was diagnosed with reactive hypoglycemia in college when I failed a glucose tolerance test).
I’ve long known to avoid sugars and simple carbohydrates. Not because any doctor told me, but because I felt terrible when I ate them. My blood sugar would plummet and I’d be back for more food. I’ve always leaned towards salts, fats and proteins rather than carbs and sugar but I wasn’t perfect. I’d eat sweets at a party. I’d order a sweet coffee from Starbucks. I’d endulge in warm, yummy bread at a restaurant. Perhaps my occasional stint with carbs is why I have a mild case of PCOS, but I still have it. I’m more sensitive to insulin that other people. When I eat sugars or carbohydrates my body releases too much insulin. Why? Who knows. I’m wondering if it is related to the MTHFR gene mutation I was diagnosed with in 2015. It has to be, right? I can’t have all these crazy things wrong with me. The simplest case is that they are related. I’m a firm believer in Occam’s razor.
The diagnosis of PCOS made me change my diet completely. I know now for certain that I can’t eat any sugar and I’ve completely done away with bread, pasta, cereal, cookies, crackers, white rice, flour….anything with simple carbs. Because even 2 pieces of whole wheat bread is the same thing to the body as a snickers bar carbohydrate-wise. They both breakdown into glucose and the body responds to glucose with insulin. In my case, too much insulin. Enough to cause a disrupt in my hormones. I may not have all the classic symptoms of PCOS, but perhaps we don’t know all the different causes or variations of this disorder. Below I’ve listed my symptoms of PCOS to help you better understand if you share any similarities:
- normal BMI (21.5)
- no hirsutism
- no acne
- no darkened skin patches
- long-standing reactive hypoglycemia after eating sugar/carbs
- tummy fat
- painful, heavy, infrequent, unpredictable periods
- elevated FSH, AMH, and androgens
- cysts observed during vaginal ultrasound
- crazy BBT (basal body temperatures)
- family history of diabetes, insulin resistance, hypoglycemia, metabolic syndrome
- MTHFR 677tt mutation (don’t know if related but I have this as well)
This is a frustrating and difficult diagnosis and I want to hear your stories with PCOS. I am so confident that we can overcome this with diet. Follow my next post on my diet changes and what I’ve learned about PCOS. Stay tuned for recipes and the emotional burden of dealing with this diagnosis.