What exactly is PCOS?

"What is polycystic ovary syndrome (PCOS)? Polycystic (pah-lee-SIS-tik) ovary syndrome (PCOS) is a health problem that can affect a woman's:..."

• Menstrual cycle
• Ability to have children
• Hormones
• Heart
• Blood vessels
• Appearance

With PCOS, women typically have:

• High levels of androgens (AN-druh-junz). These are sometimes called male hormones, though females also make them.
• Missed or irregular periods (monthly bleeding)
• Many small cysts (sists) (fluid-filled sacs) in their ovaries

What are the symptoms of PCOS?

The symptoms of PCOS can vary from woman to woman. Some of the symptoms of PCOS include:

• Infertility (not able to get pregnant) because of not ovulating. In fact, PCOS is the most common cause of female infertility.
• Infrequent, absent, and/or irregular menstrual periods
• Hirsutism (HER-suh-tiz-um) — increased hair growth on the face, chest, stomach, back, thumbs, or toes
• Cysts on the ovaries
• Acne, oily skin, or dandruff
• Weight gain or obesity, usually with extra weight around the waist
• Male-pattern baldness or thinning hair
• Patches of skin on the neck, arms, breasts, or thighs that are thick and dark brown or black
• Skin tags — excess flaps of skin in the armpits or neck area
• Pelvic pain
• Anxiety or depression
• Sleep apnea — when breathing stops for short periods of time while asleep

Diabetes medications. The medicine metformin (Glucophage) is used to treat type 2 diabetes. It has also been found to help with PCOS symptoms, though it isn’t approved by the U.S Food and Drug Administration (FDA) for this use. Metformin affects the way insulin controls blood glucose (sugar) and lowers testosterone production. It slows the growth of abnormal hair and, after a few months of use, may help ovulation to return. Recent research has shown metformin to have other positive effects, such as decreased body mass and improved cholesterol levels. Metformin will not cause a person to become diabetic.
Fertility medications. Lack of ovulation is usually the reason for fertility problems in women with PCOS. Several medications that stimulate ovulation can help women with PCOS become pregnant. Even so, other reasons for infertility in both the woman and man should be ruled out before fertility medications are used. Also, some fertility medications increase the risk for multiple births (twins, triplets). Treatment options include:

• Clomiphene (KLOHM-uh-feen) (Clomid, Serophene) — the first choice therapy to stimulate ovulation for most patients.
• Metformin taken with clomiphene — may be tried if clomiphene alone fails. The combination may help women with PCOS ovulate on lower doses of medication.
• Gonadotropins (goe-NAD-oh-troe-pins) — given as shots, but are more expensive and raise the risk of multiple births compared to clomiphene.

Another option is in vitro fertilization (IVF). IVF offers the best chance of becoming pregnant in any given cycle. It also gives doctors better control over the chance of multiple births. But, IVF is very costly.

How does PCOS affect a woman while pregnant?

Women with PCOS appear to have higher rates of:

• Miscarriage
• Gestational diabetes
• Pregnancy-induced high blood pressure (preeclampsia)
• Premature delivery

Does PCOS put women at risk for other health problems?

Women with PCOS have greater chances of developing several serious health conditions, including life-threatening diseases. Recent studies found that:

• More than 50 percent of women with PCOS will have diabetes or pre-diabetes (impaired glucose tolerance) before the age of 40.
• The risk of heart attack is 4 to 7 times higher in women with PCOS than women of the same age without PCOS.
• Women with PCOS are at greater risk of having high blood pressure.
• Women with PCOS have high levels of LDL (bad) cholesterol and low levels of HDL (good) cholesterol.
• Women with PCOS can develop sleep apnea. This is when breathing stops for short periods of time during sleep.

Women with PCOS may also develop anxiety and depression. It is important to talk to your doctor about treatment for these mental health conditions.
Women with PCOS are also at risk for endometrial cancer. Irregular menstrual periods and the lack of ovulation cause women to produce the hormone estrogen, but not the hormone progesterone. Progesterone causes the endometrium (lining of the womb) to shed each month as a menstrual period. Without progesterone, the endometrium becomes thick, which can cause heavy or irregular bleeding. Over time, this can lead to endometrial hyperplasia, when the lining grows too much, and cancer.

Random Rant

The anticipation has almost come to an end. The two week wait will be over in the next two days. When I first took a pregnancy test three days after the IUI, it yielded a positive result. I knew that it would be positive because of the HCG hormone in my body, but I just felt the need to see something positive though I knew that it was really a false positive. My progesterone level was checked on April 18, 2011 and it was 18.3 and they like for it to be 20 and above.  I’ll go to the doctor on April 25, 2011 for a blood pregnancy test which I pray for a positive, but I feel that it will be another big fat negative. Presently, I am bloated from one or two reasons: 1.) Aunt Flo is near or 2.)These yucky vaginal progesterone suppositories I have to use. If it is a negative, DH and I have decided to do one more round of treatments and an IUI then take a break for 3-6 months. The main reason for the break is to focus on becoming a healthier me and losing at least 30lbs. I also would like to take the chicken pox vaccination and by doing so, I cannot try to conceive for two months after the vaccination. The more I think about it, I want to take any preventative measure to keep from getting chicken pox which I have avoided for 28 years. I look at taking a break as a good thing because this is very stressful despite how hard you try not to stress about it.

As of April 20, 2011, I requested three days leave from work giving me a total of six consecutive days off with the 6^th day being a state holiday, Confederate Memorial Day. I wish I could have taken off just to kick back and relax, but I took off for my DH’s surgery. He had surgery on his nose on April 20, 2011 which consisted of having the turbinates shrank. When he woke up from the surgery, the first thing out of his mouth was “this was the worst mistake of my life”.


 He was too funny being in a loopy state of mind. I am honestly glad that it is over with and that he is doing well. On the night after the surgery, DH and I slept in the living room because he was to sleep elevated. Well needless to say, I feel that I got my first taste of having an infant. I was up throughout the night tending to “the baby” and I only slept when he slept. My reasoning for being super nervous that night was because DH had a minor scare immediately after the air tube was removed following the procedure calling for the air tube to be reinserted to aid in his obstructive airway. Overall, I was surprised of how well he did with the surgery considering the fact that he is obsessed with his nose like Michael Jackson was. On April 22, 2011, I took DH to a post-op appointment with the doc to have the packing removed from his nose and boy did it hurt him. It hurt him so bad that I feel like I felt it too. It was so nasty and unlike anything I have ever seen up close. I sat in the corner and watched in pure horror. It was so long and had a huge blood clot that came out with it(I could cringe now) and skin and boogers. Afterwards, I went to a room next door to have my ear cleaned out. It is amazing of how much crap can get stuck in an ear. I see why I could hardly hear anything. Having ear eczema sucks! Anyway, I guess I’ll update again when I get my results.

Will the third time be a charm?

I had my third IUI on Tuesday, April 12, 2011. It was my first IUI at the new clinic. My appointment was at 9:00 and DH’s was at 7:30. We drove separately and he had to leave the clinic to head to another doctor’s appointment in Trussville. The purpose of his appointment was for an x-ray for his upcoming surgery on Wednesday, April 20, 2011. As to his surgery, I somewhat dread it because my husband is obsessed with his nose and the mere thought of someone doing something to it just irks us both. He honestly thinks that just because his nose is stopped up that he is going to die, sad but true. Anyways…..I thought that I was going to panic knowing that I was at the clinic all alone doing this third IUI. I felt relieved knowing that DH had a valid excuse not being present with me. As I waited in the lobby, I played games on my phone and texted my friend Adrienne until my battery was almost dead. When I was called back, I got undressed from the waist down and waited. The nurse practitioner then came into the room and asked me if I had any questions. My first question was “what was the sperm count and motility?”

Sperm sample

 Well it was better than it was last time and I will leave it at thatJ. I laid back on the table, she inserted the speculum, and lastly the catheter filled with DH’s sperm. The process was quick and uncomfortable.

After Insemination



After Insemination



 This particular insemination felt like my first one (a piece of cake). After I was inseminated, I laid there for 15 minutes, got dressed and went to the checkout window. The IUI costed $375.00 and why I was prepared to pay more, I don’t know! I was so happy that I did not have to do any lab work. I will return to the clinic on Monday to have lab work done to check my progesterone levels. I’m not too thrilled about using the vaginal progesterone suppositories twice a day until my next appointment. Can we say disgusting! Well regardless of if this works or not, I am so excited a bout the fast moving progress.

A whole lot of stickin'

After my first vaginal ultrasound while on the Follistim, I had a series of appointments while waiting on my follicle to mature.

March 31, 2011- FSH 7.7 and Estradiol 55.3

April 4, 2011- (no appointment, just a phone call from nurse) I am non-immune to chicken pox (declined the vaccination) and Vitamin D levels are low (put on 50,000 iu’s of vitamin d for the next 6 weeks) Side note: I cannot believe that I have never had chicken pox!

April 5, 2011- Estradiol 75.7 and Progesterone 0.5

April 8, 2011- Estradiol 120 and Progesterone 0.4

April 11, 2011- Estradiol 206 and Progesterone 0.4

Originally I was supposed to do the Follistim injection for five days, but my follicle had not yet matured so I did ten consecutive days at 100 iu's.

After the vaginal ultrasound on Sunday, April 11, 2011 (7:45 am appointment) my one follicle on my right ovary was mature. It measured 1.89 cm. I was instructed to do the HCG injection on this day at 8:00pm. The nurse marked the spot on my left hip with a red Sharpie marker where the injection should be.

Erika came over to help me with the injection. Once the clock hit 8:00, I had the needle prepared and ready to inject. I did not receive the injection until 8:01 because I freaked out. It hurt, but it was not the worst thing in the world. On the picture below, the colors that I am wearing look like the late 80's early 90's, it was my Punky Brewster look.





After receiving the hcg injection



Brand New Start



As we already know, I’m not pregnant, and the first day of my cycle was Sunday, March 27, 2011.

Peek-a-boo

My first appointment with the new physician was a success. I really like the doctor and look forward to receiving my infertility treatments there. DH was very uncomfortable when we arrived at the clinic because it was packed! At my previous physician’s office, it was somewhat “low key” and quiet. The look on DH’s face was filled with shame and embarrassment for the first 20 minutes of waiting in the lobby. He eventually came around and said “man, it’s a lot of people going through this.” I think that he started feeling better when I made the comment that “infertility has many faces”. Inside the office, we saw many different kinds of people, black/white, young/middle age-ish and skinny/fat. My appointment was scheduled for 12:00 and we arrived at 11:25. I was given a folder full of new patient information about the clinic, costs, and services provided. We were then called to the receptionist’s desk to be photographed together. That was weird for me, certainly not prepared to take a photo. I then went to the lab for a urine collection.  After I finished, I went back to the lobby with DH waiting to be called back. We were called back and went into the doctor’s office. We patiently waited for about 10 minutes and the doctor came in. He introduced himself as to we did the same. Our plan of care was discussed. During the discussion, I realized that the doctor did not have any of my medical records from the previous physicians even though I signed and released all necessary forms. Luckily I had my big pink binder on hand which I keep everything related to my treatment. The doctor told me that I needed more aggressive medications and we discussed the Follistim injection. He then asked when the first day of my last period was. I said Sunday, March 27. The doc then said, you have two options: 1-start the follistim injections today or wait until the next cycle. I was shocked and overwhelmed. My response was “you’re the doctor and you know what’s best for me, so I’ll do whatever you recommend”. The doc then said “I’m antsie, let’s get this show on the roll”. He stated that I will begin with 100 IU of Follistim for the next 6 days followed by an HCG injection whenever the time is right. I will be back to the office on Tuesday April 5 for fasting blood work along with an ultrasound to measure my follicle. Lame, but I’m excited. After meeting with the doctor, I met with a nurse practitioner for a physical exam. Followed by that, the radiology person gave me a vaginal ultrasound. As usual, it was so weird and uncomfortable. DH and I both viewed the polycystic ovaries and everything else looked good. After the ultrasound, we went to meet with the nurse. She went over my plan of care and showed me how to use the Follistim pen. I was also given another prescription for Metformin 500 mg er. I hate Metformin because it gives me diarrhea (tmi) and makes my stomach bubble non-stop. While speaking with the doctor, I tried to get out of taking Metformin, but it did not work. I told him how sick it made me when I got up to 2500 mg and that I stopped taking it. He said because of my PCOS, it is in my best interest to take it. Ugh! The nurse gave us a lot of stuff, thank goodness I had my tote bag. We were given info on procedures at the office, ovulation induction, pregnancy reduction/risk of multiples and the whole nine yards. One thing that was very beneficial was the $300.00 off coupon for Follistim. She explained the fact that there is only one specialty pharmacy in the area (Irondale) which closes at 4:30, well it was 2:15 when she said it and I still had to do blood work. The pharmacy hours just totally ruined our planned dinner at Jubilee Joe’s, but whatever! Because I had some of my medical records present, I saved myself money by not having to consent to retesting. My copay for each lab test is $10.00 which adds up quickly. DH and I then went to the lab to have blood drawn. The lab tech must have magic hands because it did not hurt at all AND I looked at it. I have never been able to look at blood coming out of my arm without feeling lightheaded. We went to the desk to check out and the nurse came and asked me if I had ever had my thyroid levels checked. I told her that I did not think so. She asked me if I wanted to have them tested with the blood that was drawn, I said yes. Shortly after, the nurse told me that I would have to have blood drawn for a second time to test. I was like “sure why not”. I had my blood drawn and we left the clinic at 3:30 headed to the pharmacy. We arrived at the pharmacy at 4:00. After 30 minutes, the medications were ready and I paid $101.00 for all three prescriptions. The $300.00 coupon was a Godsend!!!!!!!!!!!!!! My insurance only covers 50% of infertility medications.





 After leaving the pharmacy we went to The Shops of Grand River in Leeds to eat dinner and we were “hon-gar-r y”. When we arrived home, my friend Erika came over so that we could exercise. I totally forgot about her coming over. Instead of walking, we played Just Dance 2 for means of working out. When 8:00p was close, DH and Erika helped me to prepare the Follistim pen. When it was time for the actual injection, I somewhat lost my cool. I was terrified to stick myself in the stomach. So I then asked Erika to do it. She said okay and after I thought about it, I knew that I needed to do it myself. I am so appreciative of having friends that are willing to help me out, but I know there are going to be times where I need to do it on my own.

Erika

 I screamed as I attempted to inject myself. I couldn’t do it. DH was getting frustrated with me though he denies it. I sat at the kitchen table for 20 minutes trying to inject myself. I finally did it and it didn’t even hurt. I have to admit, self-injecting has gotten better each day. Now that I have gotten past the Follistim, the HCG shot is still freaking me out. I just don’t want to do it. Well I can’t do it myself because it has to be done in the hip muscle. After watching the video on it, I am dreading it so much that I could actually cry thinking about it. The needle is so big and long. The thought of DH giving me the injection makes me sick to the stomach. I know that he could do it and I trust him, but I’ve never been able to size up my needles prior to getting them. Every time DH touches me, he tickles me and I don’t want it to be when he is injecting me. I hate being ticklish! In regards to my Follistim injections, I am halfway there because I just had my third injection and three more to go this cycle.

On another note, I am sick. I am full of coughing and congestion. I need to go to the doctor, but I am not going to because I don’t want to do anything to interfere with my infertility meds. As ridiculous as I sound, it’s true. Lysol is my best friend right now.

My new bestie

So that I won't mess up, I leave notes around the house that help me prior to my appointments.