The One Where Neither of Us is Ovulating Properly
What’s the opposite of burying the lede? Asking for a friend. Anyway. Welcome to this week’s installment, brought to you by Radioactive (starring Jane from Pride and Prejudice!!!), as well as paleo cornbread, iPhone storage space alerts, Marie Curie, the Hamilton soundtrack, and...generally speaking...the calm before the storm.
We’re switching around the promised acupuncture and Napro posts, because (after five doctor’s appointments and procedures this past week) the Napro stuff has been...literally all we could think about after Wednesday. We'll jump right in with a super relevant definition....
What Is PCOS?
Poly 👏 cystic 👏 ovarian 👏 syndrome.
- It's one of the most common causes of infertility in women, for starters.
- It's estimated that 5-10% of women have it, so, spoilers, I'm in good company.
- It runs in my family and I've told literally every doctor that I've gone to for the past decade that I probably have it.
- It's hard to diagnose, or so I thought.
- It's basically a whole hormonal situation that blocks ovulation? Here's a relatively concise description, courtesy NIH:
“In polycystic ovary syndrome, abnormal hormone levels prevent follicles from growing and maturing to release egg cells. Instead, these immature follicles accumulate in the ovaries.”
I suppose we can think of PCOS, on an egg level, as Extreme Failure to Launch? We'll go with that.
If you've been paying close attention to our story and are thinking holy plot twist! Rebecca ovulates, so, wtf? ... don't worry, we're gonna get there. It's been a ~week~.
How Not to Diagnose PCOS
As noted above, PCOS isn't exactly new to me. My mom had it, I was tested for it as a teen (negative), I've always exercised/eaten in PCOS-friendly ways (for the most part), and I've had friends who've had it and managed it all around me.
When I've asked my doctors (primary care, obgyns) if I should worry about it, though, they've looked me up and down, asked me if my cycles were regular (they very much are), and then said that I didn't have PCOS.
First of all, even though women with PCOS do tend to look a little larger than I do, there is such a thing as 'skinny PCOS', so, there's that.
But. Okay, so, I've been reading about and researching PCOS for years and years. And the broad consensus says that if you have PCOS, you have observable ovulatory dysfunction and weird irregular cycles.
This scared me. I like regularity and consistency. And I thanked my lucky stars that I obviously didn't have PCOS, because my cycles are boringly regular.
And that's been the past several years.
How To Diagnose PCOS
As it turns out, I was reading the wrong books, I guess. My doctors.....could have also been a lot more helpful.
I walked into my Napro's office on Tuesday, we bumped elbows and chatted for a bit, and then got to business. He asked me if there was anything I was worried about, and, as usual, I said that PCOS ran in my family, but, like, I obvi didn't have it, because I was skinny and boringly regular.
He looked at me for a moment, then pulled up a chart on his computer and swung it over to me. "If you don't mind," he said, "I'd love to dig just a little deeper into that. Have you ever heard of the Rotterdam Criteria?"
I hadn't. (I am also kicking lots of iterations of past selves.)
The Rotterdam Criteria are the three things clinicians (should) look for to diagnose PCOS. So! Already, preconception #1 shattered. PCOS. It's easy to diagnose. GAH.
Criteria are as follows.
- Oligo or anovulation. Observable most easily by irregular cycles. (Nope.)
- Hyperandrogenism, observable via bloodwork or symptoms. (Um.)
- Polycystic ovaries, observable via ultrasound or similar. (Well, duh.)
If you have two of the three, you have PCOS.
I didn't have the first, had no clue about the third, and was iffy about the second. My OBGYN had gotten some bloodwork done, and all of my androgens were in normalish ranges. However, I did have exactly one symptom of hyperandrogenism....
Hyperandrogenism: Every Woman's Favorite 'Ism'
We'll keep this one short. 'Hyper' = high. 'Androgens' = male sex hormones. Every human being has both male+female sex hormones, but women tend to have more estrogen, and men more testosterone.
Both men and women can have more androgens than they need. When women have more androgens, their cycle can get messed up, basically, and there are some other symptoms that basically sound like Puberty4Eva (fun!). Here's an overview+list of symptoms, if you're interested.
I won’t bore you with exactly what symptom I have, because a) despite everything I’ve written on here, there are some things I don’t want the Internet to know and b) most of my friends+fam probably already know because I’m suuuuper bad at hiding it sometimes. I also didn't think it was that serious tbh????
I mean, if you take a look at some of those symptoms, some of them are, like...just symptoms of being a human sometimes? Like, I know lots of people with adult acne, are they also suffering a weird rare hormonal disorder???
Whatever. Hyperandrogenism: Check. Sure.
How to Diagnose PCOS, Part Two
My Napro was like, okay, you've got one of the Rotterdam Criteria. Wanna see if you've got another?
He held out a scrip for an ultrasound and FAST FORWARD! The radiologist confirmed that I have polycystic ovaries.
So. That's it. I've got PCOS. That didn't really compute in my brain - as I noted before, the primary symptom I associated with PCOS was 'ovulatory dysfunction', and I have the most regular cycles and ovulation of all time, or so I thought. So. I did a bunch of research.
(Drinking game, but instead of anything fun, whenever I say that I did ‘a bunch of research’ we all take a sip of sad tea. I’m playing!!!!!!!!)
As it turns out, just because you look like you're ovulating doesn't mean you are.
The Weird Chaos My Brain Has Been In for a Week
After (I guess) learning to google the right things (kicks past self again), I found this article, which contains this really great table:
So. I either have ovulatory PCOS, which I cannot emphasize enough I didn't know was a thing, or anovulatory PCOS with a normal cycle, which, WHATTTTT. So, I can *not ovulate* but *look exactly like I do*?
HAHAHAHAHAHAHAHAHA what is my life.
It’s like my body has massive performance anxiety and, like, works super hard to ovulate each month, and gets ready and gets ready and does all of the right things and tries and tries so hard and tries some more, but when it just doesn’t look like it’s gonna happen it just does all the ovulation things anyway and puts its best face forwards and tries to look like everything is okay????? WHICH all sounds like something I actually do in real life????
(Looking back, that paragraph was written from an odd dissociative state. These past weeks, man. I cannot emphasize their draining weirdness for both of us)
Even if we don't count anything else happening in the US or worldwide recently, the past weeks have been frustrating and weird for us with Project Waterbear. Sooo much of what we learned in sex ed and sympto-thermal NFP classes doesn't really match reality, at least for us. More on this later.
This has been a TedTalk.
EVEN THOUGH we knew something was up with my body, we didn’t expect this. We didn’t expect to find out that I might not actually be ovulating, because that was the one thing I was sure was happening, based on arguably excessive amounts of data collection and research and charting.
Which (if you’re reading this and wondering if you’re also weird) is all research I still stand by.
- In the vast majority of cases, if you have a BBT shift, that very very likely indicates that you’ve ovulated.
- In the vast majority of cases, if you have a boringly regular cycle, you’re very very likely to be ovulating.
- In the vast majority of cases, if you have an LH peak on your ovulation predictor kit and you get the lil smiley face that says that ovulation is imminent, it very very likely is on its way.
One of the women in one of my FB groups noted that there are only two ways you can actually know with 100% certainty that you’ve ovulated: if you actually see it happening on an ultrasound, or if you’re pregnant. However, all of the above bullet points generally reflect things that should only normally happen as a result of ovulation.
Especially if you see all three of them. Especially if you see them regularly. Unless, that is, you’re a very special snowflake.
The good news? If we confirm through further tests with my doctor that I’m not actually ovulating each month, then I’ll just go on some kind of ovulation-booster (like Clomid or an alternative), and that should solve the problem. Or, at least, that particular problem. We’ll name our child ‘Femara’ and go on our merry way.
The good-but-more-frustrating news? If we confirm through further tests with my doctor that I am actually ovulating each month (and, who knows what those rando immature follicles are doing there, I guess?), it would appear that my borderline-obsessive diet and lifestyle might actually be having a beneficial effect on my health and fertility…..or, at least, I’m going to choose to believe that. In this case, we’ll be back where we thought we were a few weeks ago: That I’m still looking at a weird hormonal imbalance or something similarly subtle that’s making it difficult for me to get or stay pregnant. But we’ll have a lot more information to work with to figure out what’s going on.
And if it’s a hybrid of those two situations, like, if I’m naturally ovulating every third month or something, we’ll figure that out....and we’ll get to name our child after something that isn’t a prescription fertility drug. (Bummer.)
Our teux-deux list:
- I gotta get an HSG…..a procedure which my doctor kindly told me would not be fun, as it’s ‘somewhere between not a big deal and outright torture.’ Yay!
- We gotta get Ted tested….which, finally, we have a working plan to do so. We’ll post allllllll about that, likely once we’ve learned his results so we can package his story neatly up with a lil’ bow.
- I……..decided to go for it and learn to chart Creighton. I was SO SO SO VERY against this……..up until I learned that apparently my fun lil’ bod might create hormones that fool OPKs and ramp up my BBT for no reason because it wants to look like it ovulated so it can collect its participation trophy, or whatever. Seems like I need to collect *yet more information*, so, here go I. We’ll likely throw up a post about the differences between the main charting systems once I learn more. And, yep, still likely gonna keep BBT-ing because I like the data, am interested to see what acupuncture and Napro meds do to my cycle, and …. if I am ovulating, however infrequently, it’s still good to know approx when that might be happening.
- In a few weeks, after we’re done with summer travel, my acupuncturist wants me to do ... a cleanse. I KNOW I KNOW I’ve pretty much become conditioned to think that ‘cleanses’ and ‘detoxes’ and crap are trendy things that people on IG sell that are 83% laxatives. For safety and sanity’s sake, I confirmed with my acupuncturist: What’s he’s recommending is really just a super-clean-eating-dietary-reset akin to a Whole30. It won’t do me any harm (trust me, I did a bunch of research. *sips sad tea*) and it’ll be something fun to concentrate on that isn’t the fact that my eggs are….not doing what they should be doing.
We’ll see my doctor again in October. Until then, I think that’s more than enough to be going on with. OMGOSH. *falls asleep on keyboard*
Questions I Have:
If I’m *not* ovulating, where’s the progesterone (that drives the BBT temperature shift that I see every month) coming from?
If I *am* ovulating, what are those immature follicles doing in my ovaries?
(Questions like these cause me to wonder if it is a half-and-half situation, where I naturally ovulate some of the time, and my body just knows what to do regardless of whether the egg surfs away or no…)
If I’m *not* ovulating, or if there’s a specific month in which I’m not ovulating…I mean. Why not?
Gotta be something subtle, right? I mean, most women with PCOS don’t look like they’re ovulating. According to every (easily, at-home) observable sign, I am - which means that my hormones are likely in *almost just the right place* for ovulation, but not quite … able to make it happen. So. Is something weird wrong with my eggs? Do I have blocked tubes? Or am I not quite hitting some hormonal threshold or trigger by just a hair?
Cut to: more tests, more dietary changes, yay.
I charted when I was on Clomid, and something different did happen. (It looked like I ovulated a few days earlier, and my temp in the second half of my cycle was a little bit higher.) This makes me feel a little better - because it looks like an ovulation stimulant did something.
We probably have more of those in our future, eh?
How We’re Feeling about EVERYTHING
Oddly, I’m a little relieved. Frustrated, a little sad, but relieved. We’ve figured out that there is a good chance that I’m not going to be able to get pregnant without external help. And that…………..is a little sad, but it kinda takes a lot of pressure off me? And my overwhelming attempts to make sure that I’m a perfect specimen of health? (Which, like, I’m still gonna work towards my goals, but maybe with a little bit more grace for myself?)
We may still find out that Ted’s half of the picture renders our project a lot harder; and, of course, we’re not done finding the extent of my problems just yet. There could be much more bad news in the future for us. But! This particular chapter feels manageable. Sometimes. As weird as this revelation has been, it’s making the puzzle of ‘why the heck hasn’t this happened for us yet’ make a little more sense.
Signing off for now. We'll be talking ~a lot~ more about this in posts to come.
NEXT WEEK, we're gonna go back to that acupuncture post, because my experience with pins and needles has actually been nothing short of lovely, and that'll feel like a nice change of pace.
AFTER THAT, we're gonna talk about HSG's - what the procedure is, how much I'm looking forward to it, and what we hope to learn.
Weight loss stuff:
- Weight: was 4.93 S, is now 4.86 S
- Body fat %: was 29.2%, is now 28.9%
- Combined body measurements (arms, thighs, waist, hips): was 368.3 cm, is now 363.22
I'll make a graph and a chart and etc later, but rn we only have two data points, so, we good.
