My PCOS Journey Pt 3

Behold, the fond memories of reliving initially being unemployed. As the economic bubble burst, my entire office was laid off. I felt like such a cliché carrying my crap out to my car in a cardboard box, worrying about how we were going to make next month's car payment. Or, you know, rent.

So I put a pin in the medical side of making a baby for the moment. I looked for work, but we were struggling with a whole different can of worms at home. While my odds of finding a job decreased with every news broadcast about the financial meltdown, my mom was having an epic psychiatric breakdown of her own. We're talking San Andreas fault line in my house.

Within the last year or two, my husband and I had committed to inviting my parents to move up from South Florida to live with us. The job my dad had was about to go under as the owner was going to close up shop. So we didn't renew the lease on our apartment and rented a house nearby with my parents. As time progressed, my mom's mental state went off the rails. A psychiatrist at the time argued that she was quite stable and that she didn't need any medication. He told her she needed to color her hair and try something new, as though she was a middle-age woman having a midlife crisis. In the end, I was where I was needed, at home taking care of my mom so my dad could work to keep them covered with insurance and together we could afford to keep a roof over our heads. Something I know too many people over the coming years were not as fortunate to do.

In the years that followed, my husband's insurance improved to the point we could actually use it. Which was important because I was feeling like hell. I had gained more weight, in addition to the weight I had already gained immediately after college. I couldn't sleep, so I stayed up and wrote my first complete manuscript. My periods were still months upon months apart. My primary care doctor's demeanor toward me began to change. She'd tell me embarrassing stories about her overweight sister. She had her office call and schedule me to come in, as though there had been some problem with my recent blood work that couldn't be discussed over the phone or wait until my next appointment. I came in, concerned, paid my co-pay and was told to start pushing away from the table and stop eating so much. She threatened me that diabetes would be in my future if I didn't get myself under control. I was livid. I was hurt. I made up my mind to see an endocrinologist since she refused to send me to one at a previous request. Luckily, our insurance at the time didn't require referrals. Unfortunately, the endo I knew and trusted only accepted patients referred directly by other doctors. Fortunately, she was treating one of the parental units in my life. I mustered up the courage at a visit and asked if she treated PCOS. Oh yes, she told me. I explained the situation and she allowed me into her practice and I set up my first appointment that day.

At the same time, I found a gyno in the area that I was comfortable with. After the change in tone from my primary, I didn't feel comfortable having her do my complete annual well woman exam any longer. It was with this gyno, while I waited for my endo appointment, that I discussed starting metformin, a super common, super inexpensive medication commonly used for diabetes treatment. Off label (prescribed for something other than what it is specifically marketed for), there has been a lot of success in using it to treat PCOS, not necessarily for fertility, but in other aspects and with some improved fertility. She pulled out a medical journal where she had just read an article about it. It was such a relief not just to be taken seriously, but to have a doctor admit she was still learning about it and sharing what she had. She settled on a dose, based on the article, and I was back in the world of transvaginal ultrasounds. My baseline for the gyno showed the 'strands' of cysts I had all across both my ovaries. I also had 2 large cysts that could have damaged my ovaries. After using the medication for several months, all the cysts were gone, even the potentially dangerous ones. I was also down more than 30 pounds, without changing a single other thing in my lifestyle.

By now I had seen the endo, who was pleased with the progress from the metformin (since she would have prescribed it first anyway). She ordered a battery of other blood tests, which was a relief because no one I've come across since has been as familiar as she was with what to look for and how to really understand the results. What I learned from her was invaluable. My primary doctor was less happy. She all but called me a liar when I told her the weight loss was because of this one pill, prescribed off label. She told me that was impossible.

My blood tests from the endo came back and she added an extra medication, again off label and commonly prescribed for diabetes and with the added side effect listed on the bottle that it may increase ovulation/chance of pregnancy. For the record, I was not and am not currently diabetic - and I make that distinction only because of the confusion I've experienced from other medical professionals because of these prescriptions. But what does appear to go along PCOS as they learn more about it is insulin resistance, which can eventually lead to type II diabetes. If you treat the insulin resistance, you seem to treat or at least gain ground on PCOS. It's a chicken or the egg situation, as so far, there isn't proof which ones comes first or causes the other. Anyway, she also added a temporary weight loss medication to help me lose weight but to also help combat the weight gain associated with the other new medication. Temporary because after the first few months you use it, you build up a tolerance and it doesn't ever really help again. All systems go, I lost more than 60 lbs in a matter of months. My ovaries were clean as a whistle, my periods were starting to become more regular, it was almost time to be handed off to a reproductive endo.

In the mean time, my regular gyno prescribed me the golden ticket - clomid. Clomid is the fertility medication I was on the brink of getting years earlier from my first fertility doc, who had all but guaranteed I would respond to this prescription and have a baby in no time. This medication stimulates the body to ovulate and has an increased incidence of multiple births when it works a little too well. I could barely contain my excitement. I took the tiny pills on the specified days of my cycle and began peeing on ovulation test sticks to a near obsessive degree. Because nothing brings out stress-induced OCD quite like peeing on a series of test sticks where the result is based on the depth of color between the test and control lines. Is it dark enough now? Today? Did I miss it? I think I see a difference this time. Maybe if I test again in a few hours... Expected/optimum ovulation window came and went. I had failed my first clomid challenge. My body had not responded. On the next visit, my gyno doubled the dose. Once again, nothing. My gyno increased the dose one more time, but this time warned me that if I didn't respond to this last attempt, further treatment would be at the hands of an infertility specialist. Well color me surprised, that dose didn't work either.

For a while now, since I had started with the gyno and endo in earnest, I had been charting. For the uninitiated, this is when you track a variety of fertility signs (including your menstrual cycle) as well as your basal body temperature (your baseline temperature upon waking before you even get out of bed). The idea is that while you may not be able to see that you've ovulated or conceived, the fluctuation of hormones impacts your temperature (seriously, it really does) that can be tracked on a chart. And on a random month, well after the clomid was out of my system, I ovulated. All on my own. And then a few months later, it happened again.

To be continued...