Sunday, 27 July 2008

Be Careful What You Wish For ...


On Thursday I am going to the Doc's to get the official feedback on the HSG.

The consultant told me at the time the tubes seemed fine but there was a slight irregularity. He told me this as I sat up directly after the x-rays, a blue robe covering what little dignity I had managed to maintain, I had just had two different blokes and four different tubes up 'there', radioactive liquid was seeping out of me. I've regretted it ever since but I bundled myself out of the room as quickly as was possible and didn't ask for any more details. I have no idea what this might be, he told me it was nothing to loose sleep over but what does that mean? So Thursday I should get some answers.

But I will also have some questions. And I would really appreciate help from the blogosphere.
I have had regular periods (cycle between 30 - 32 days) for about six months and all recent tests have shown that the polycestic ovaries I was diagnosed with about 5 years ago (before all this ttc malarky started) has disappeared.

However, my last cycle was a staggering 83 days and that only came to an end because I was prescribed provera to enable me to have a period and then have the HSG. It is day 36 of the current cycle and there are no warning signs that suggest I'm about to start my period any day soon.

So this is where I really really need help from people who have been through this before.

What should I ask my doctor for?

I can throw a few drug names into the mix like clomid. But does anyone know if this stimulates ovulation and therefore will also help regulate my cycles or should I be looking at trying something else?

When I took provera it was made very clear that I shouldn't take it if there was a chance that I was pregnant, so I can't see how that is compatible with trying to conceive.

I know the internet has become a doctor's nemesis with people self-diagnosing and then not understanding why the doctor thinks that they just have a cold rather than a terminal tropical disease that normally affects a small tribe of indigenous Amazonians. So I will listen to what she says and take her advice as well but I would like to go in with some ideas of what to ask for and what she is likely to suggest.

Thank you in advance for any advice.




21 comments:

  1. I wanted to thank you for your wonderful feedback to my "to tell or not to tell dilemma". It's much appreciated, and I liked your spin on things.

    I also wanted to tell you that it is my understanding that, yes, Clomid helps to regulate your cycle. It didn't work exactly that way for me, however, although my doctor originally told me it should ultimately help me maintain a 28 day cycle. My cycles tend to be around 32-34 days, and they stayed that way with Clomid.

    I empathize with wanting to be prepared for your time with the doctor - I don't know how many times I've gone in there and wished I would have asked more of "the right questions".

    Best to you at your appointment. I'll be following along to see how things go.

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  2. I'm clueless when it comes to drugs that the doctor can prescribe but I have tried a few supplements which may be worth a go (apologies if you have already tried these).

    I have a friend who doesn't have periods. When she was ttc she searched the Internet for various supplements to help and came across Ovulex. She took this for about 6 months and she had a period, that period led on to the conception of her son. Obviously she has no proof that the Ovulex did the job but she is pretty confident that it helped get her periods back on track. Ovulex is available over the Internet and it is completely natural. It is quite expensive but there are often people selling it on ebay which is slightly cheaper than going direct to America.

    Two other supplements which may be worth trying are Agnus Castus and Flax Seeds.

    Good luck for Thursday.

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  3. Hi.
    I'm on Clomid and it has regulated my period. It makes me ovulate, therefore, I have a period. If you're not getting your period, it means you didn't ovulate. I'm very surprised that the doctor let you have an 83 day cycle before intervening with the provera. I was only 2 weeks late when my dr. put me on it. (Then again, it might be different in the States) Then I was able to start my Clomid, which, has consistently made me ovulate one day sooner than the cycle before. Weird. My period this month was exactly 28 days. I'm going in for an HSG tuesday. Hopefully, my tubes aren't blocked and the fluid will "clean" the tubes, thus making me more fertile this month. Wishful thinking I'm sure. Good Luck!

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  4. Hello,

    If there is an "irregularity" then your doctor SHOULD suggest a laparascopy before pursuing infertility drugs. An HCG can only show if the tubes are open, but can't show if they are healthy.

    My story for example...HSG open tubes...3 failed IUI's w/injections. New RE, did laparascopy showed L ovary adhered to uterus, and endometriosis. Pregnant very next cycle NO IUI but injectables.

    After the lap if all is well Clomid would be the first round of defense in ovulating.

    Also, you can have PCOS w/out having the cysts. The cysts are simply a bi-product of the syndrome. Like wise, you can have the cysts but none of the other symptoms such as acne, male hair growth, weight gain etc.

    So...long winded...laparascopy, then clomid then clomid or femera w/IUI then injectables...but that is a long way off.

    Good luck!

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  5. Clomid will help you ovulate which may help you have a normal cycle. My cycles were always extremely long and never ending because I never ovulated. You can still have PCOS even if your ovaries aren't cystic.

    I would definitely ask about the "irregularity" and see what that is about and what course of action the doctor suggests.

    Provera is good because it will make you have your period - but you don't want to have a period if you are pregnant, that is why they ask. It is always good to start a new cycle if it is time though.

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  6. Provera is just progesterone. It only hurts your pregnancy chances if you ARE pregnant at the time you take it. In your luteal phase (after ovulation) the corpus luteum that remains after your egg is released, pumps out progesterone. When you do not conceive, your body signals the corpus luteum to stop, it dies away, and the progesterone drops. The drop in progesterone is one of the signals for AF to start. When you take Provera, you are doing a similar thing to your body.. going through a progesterone surge, and then the withdrawal of that progesterone is what causes a period to start.

    Clomid blocks estrogen receptors in your brain to make your body think that you are not producing enough estrogen. Therefore, estrogen production increases and helps cause ovulation to begin. That's a really bare bones explanation, but there ya have it.

    And I agree.. you can have PCOS without cysts or cysts without PCOS. I currently have JUST the amount of cysts on my left ovary to qualify as PCOS, and dont' even have much proof in blood values that I have it, yet I have most of the symptoms including very very rare ovulation and periods, and 2.5 years of ttc without successful conception.

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  7. Clomid should help you ovulate; but if there is a suspicion of PCOS it might pay to ask about Metformin.

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  8. Ok, I'll share what I know. Keep in mind that my medical degree comes from Google University and Life College.

    If you are simply looking for something to regulate your menstrual cycles, typically birth control pills are what are recommended. Mostly, I think, because you won't get pregnant, therefore there's none of that "Don't take this if you are pregnant" problem. Of course, bcps make it a little hard to GET pregnant if that's your goal.

    Clomid will stimulate your ovaries, cause (in most cases) ovulation, and if no fertilization takes place, you'll have a period. However, clomid is not recommended for more than 3-6 months in most cases. Increased risk of cancer, I believe. It is typically the first line of infertility treatment if PCOS is the only problem you have because it doesn't overstimulate the ovaries. Used in combination with careful monitoring and an IUI, my RE claims that it can be highly successful for PCOS patients.

    The reason they tell you not to take provera if you are pregnant is because it would cause you to lose the pregnancy. Provera is a progesterone supplement. The way the system works is, after ovulation your estrogen production stops and your progesterone production kicks in to keep that uterine lining nice and thick. If fertilization occurs, the pregnancy hormones keeps the progesterone level up to help grow the lining and placenta. If fertilization doesn't occur, the progesterone production is supposed to stop and within a day or two...period. So, the provera artificially raises the progesterone levels in your system, mimicing post-ovulation conditions. You take it for 7-10 days, then stop. Then usually within a day or two...period...because your body senses that the progesterone levels have dropped and therefore you must not be pregnant and don't need that uterine lining.

    The problem with provera is that 1) many women lose track of how many days it's been and have a hard time remembering when to take it. Plus, I think there's often a bit of "If I wait just a little longer, I'm BOUND to start on my own."

    2) before you can start taking it, you have to have a pregnancy test. In this oh so litigious society, that means that just about every doctor requires you to come in to their office for a pregnancy test. The only time I was ever given a standing prescription for provera it was because I explained tearily to my gynecologist that I couldn't afford to come in every month since I had no health insurance and that cloistered nuns had a better chance of having sex than I did at that time. The instructions I was given with the provera was take it on the first of the month, have a period. Allow no more than 2 28-day cycles to pass before taking it again. So, basically, if I didn't have a period on my own after one round of provera, to give my body one more month to try, then induce one.

    Sorry for the novel! I hope some of that helps. Basically, when you have your next appointment, I'd explain your concerns about your irregular cycle to the doctor and asked what is the best way to manage it both long term and while you are actively trying to get pregnant. Good luck to you!

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  9. I have PCOS and my unmedicated cycles are generally 50-80 days long. I have to regulate my cycles with either BCPs or provera.

    I was successful on Clomid, and yes, it did regulate my cycles it was a cycle in which ovulation if occurred. If I ovulated without conception, then my cycle would start around day 32 or 33. If I was on Clomid and failed to ovulate, my cycle wouldn't start on it's own and not wanting to waste more time, I'd start Provera on cd 33 and would start AF around ten days later.

    I agree with familyof2 - your hormones can be lopsided enough to cause anovulation and late periods, but not bad enough to cause the tell-tale ovarian cysts.

    I'll be watching to see how things go for you!

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  10. I am on Metformin (2000mg, ER), and now my cycles come like clock work. We also do Clomid/IUI when TTC.

    I am curious what their thoughts on the irregularity might be in your uterus. I had a similiar issue in 2006 and came to find out I had a uterine septum. It has since been removed and we are moving forward with TTC again. Keep us updated on what they think.

    Good luck :)

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  11. If you are worried about Provera and pregnancy, you can ask for Prometrium. It is the natural form of progesterone. I was RX'd for LP spotting (which it corrected). I was also give prometrium when I got my BFP and my P4 was a lil low. So it is save during pregnancy. But just like provera once you stop it will cause your lining to shed. (or atleast it should) I also agree about the PCOS w/o the cyst. I would def. ask the doctor about Metformin, it has worked wonders on loads of Cysters as far as regulating their cycles and getting them to ovulate as well.

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  12. all of the previous posters pretty much said what I was going to say. Good luck and I hope you find the answers you're looking for!

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  13. Thank you all for your comments, really helpful.

    Most of you say similar things so rather than responding individually I just want to thank you all for not just answering me but most of you have clearly taken a fair amount of time to give me some really useful information and gone into detail. I really appreciate it.

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  14. I have this prob with my periods too. I can go for over a year without periods unless I have medicinal intervention. Doc thought Metformin would clear up all of my issues but in recent months he has decided that I actually have a progesterone issue (PCOS related I guess). I am on Clomid now and did not take Provera this month and I have yet to start. The one thing that has always worked best for me is to take Provera for three months (three cycles) and then off for 6 or so. My doc did assure me that if I were to get pregnant that month it would be ok. We have even decided that with the next round of Clomid we will include Provera to keep things going.

    I do have PCOS but I have never had any cysts on my ovaries. I also tend to gravitate on the really low side with my blood sugar but metformin still worked wonders for me. If you aren't on it perhaps it is something you should discuss. I will never ever ever for the rest of my life (unless my doc makes me) go off the met! There were probs I had that I didn't even realize were hormone related and it has helped so much! Just a thought.

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  15. Hi, everyone else has said pretty much everything I wanted to say. I just had a couple of things to add about Clomid: it tends to thin out your uterine lining (making implantation more difficult) and it can dry up your cervical fluid (making it more difficult for the sperm to get to the egg. More reasons why doctors don't want you taking it for too long.

    I just ovulated on a Clomid cycle (I don't ovulate on my own), and my fs countered those concerns by doing an IUI and giving me progesterone suppositories to help beef up my lining.

    The metformin is also worth asking about. It didn't help me, but I know there are lots of women who found that was all they needed.

    Good luck!

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  16. Lots of good advice in the preceding comments. Just a bit about me: I could have as many as 7 months between periods or 1 1/2. Doc put me on Provera for 6 months because, while it wouldn't cause me to ovulate, it might "jumpstart" my ovaries into doing things on their own. Didn't work. Went on Clomid for 3 months, but it didn't help me ovulate regularly. Doc thought I was probably "Clomid-resistant." I then went on Femara (Letrozole), and that helped me ovulate on CD13. I got pregnant.

    Unrelated to the fertility drugs, I lost that baby at 20 weeks due to a fatal birth defect. Five weeks after I delivered the baby, I took Provera to start another cycle. That cycle, I miraculously ovulated "on time," and got pregnant again. I'm now 7 months along. In my case, pregnancy hormones kicked my ovaries back into shape.

    Different meds work for different people. Provera will not help regulate your cycles, but it will help "restart" your cycle so you can try something that will.

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  17. wow, some great feedback on this for you.

    I, of course, can't help, so I just wanted to say good luck Thursday.

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  18. Ugg. Sorry you have to wait until Thursday for answers. The waiting part always sucks so much. I don't know a lot about PCOS but yes clomid should work to force ovulation but I know for a friend of mine she also will often end up with cysts afterwards. I don't know all the biology though that goes with it. Good luck.

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    Best of luck with the test results.

    ReplyDelete
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