Hi Everyone!

I'm new and hoping you guys can help me out. My husband and I have been TTC for a year without success. Though not pregnant, I haven't had a period since I stopped birth control pills last year. I'm somewhat thin (BMI of 18) and I have a high-stress job working 12 hours a day with a three hour commute; maybe that's part of the problem?! Anyway, next month I have an appt with a fertility doctor. What do you think he will recommend? I have heard a lot about Clomid. How does that work? Any other advice or recommendations?

Thanks for all your help, ladies!

Hugs,
Ali

Welcome:wave:
I have heard that many REs will give medicine to induce a period if people don't get them on their own. Your new RE will probably run many tests and then see where to go from there. Your BMI is low so that could be the problem and I am sure that the stressful job and commute doesn't help the situation, plus add in there the stress of TTC for 1 year;) Clomid is usually one of the first steps in trying to achieve pregnancy because it is pretty simple. You take a the pill for 5 days. I actually took Clomid and got pregnant the second month, unfortunately I miscarried:( So there are lots of things available out there to help you get pregnant so that is good! I wish you the best of luck and I hope that 2007 brings you your little miracle! You will find this board so very helpful and supportive, I just love all the ladies here!!!!!
cmarie

Hi Tobysgirl1

Welcome to the board. She's right, they will probably need to force a period before you start the Clomid. Be careful in going so long without a period, I have always been irregular, sometimes ony 3 times a year. My gyn told me that cancerous cells can build up if you don't shed your lining at least once every 3 months. She used to give me Provera to force a cycle.

I also used Clomid, you take it a couple of days after your cycle starts. No biggie with side effects, just pills each day.

Good luck, ask your dr about the cancerous thing.

Your BMI sounds like it's the problem. I was 5'4'' 108 (BMI was 18.9) and I lost my AF. I'm up to 120-122 now and still waiting for it to come back. This is called hypothalamic amenorrhea. Your body probably thinks you are starving and has shut down your reproductive system. You may try gaining weight? Do you restrict your food or overexercise?

Wow, thanks for all your great responses. I really appreciate your support. My appointment next month really couldn't come soon enough (why does it always take sooo long to get an appt with your doctor?) and with your help I hope I will come in with a better idea of what to expect. Anyway, I think you guys made a lot of good observations and maybe it's not just one thing but my entire lifestyle that makes it hard to conceive (not the least of which is both of us being too tired for sex :dizzy: ). My job keeps me pretty busy and sometimes there isn't time to eat well, and by the time I come home I just want to relax so I don't exercise (except for walking to/from the train station). I have been trying to put on some weight but it can take some time.

That's really freaky about the cancerous cells, Hopeful! At least when I was on BC pills I got a monthly period. Now of course I can't use those to regulate my cycle, can I?

So maybe Clomid is an option for me. I just worry that it can make an egg or two pop out, but they won't necessarily take in my uterus, or maybe later on they will give up and I'll miscarry. So many unknowns!

Oh, and I just realized I forgot to mention my ovaries have multiple cysts (but I don't have the syndrome!! No acne, baldness, skin patches or all that other stuff--just multiple cysts on each ovary.) I had an ultrasound done a while ago that showed that. Anyway, more food for thought!

Thanks again for all your support and for sharing your stories. I really appreciate it! :angel: Trying to stay positive!

I too had multicystic ovaries w/o the syndrome. It is a consequence of anovulation. Honestly, I would bet you have HA b/c of your low weight. Your problems sounds very similar to mine. You should definately get some b/w done.

ngolden--

It sounds like we're in the same boat. Did you have any luck with the treatments your RE offered? What will they need ot measure in the b/w?

Merry Christmas everyone! :)

The Re will measure FSH, LH, Prolactin, TSH, and E2 (estradiol). Most likely, I would guess that all of your #s will be normal aside from estrogen. He/she may not measure estrogen but instead give you a progesterone challenge (a 10 day course of progesterone to see if you get a period from it). If you do it means you have enough estrogen but are not ovulating.

As for me, none of the treatments have worked. Admittedly, I have only been on clomid so far (I might as well have been taking sugar pills). However, clomid doesn't usually make gals with hypothalamic amenorrhea ovulate. We usually need to either gain weight and wait things out or go right to injectibles. I have a 2 year old son and DH is in medical school. We can't afford anything but clomid for 2 more years so i have no choice but to wait.

Good luck and let me know how things turn out.

It sounds like doctors tend to prescribe Clomid pretty liberally but it may not be that effective. It's too bad that there aren't any fertility drug trials you could be in since your hubby is at the medical school. My hubby is a doctor , but reproduction is not his specialty so all he is good for is in bed (j/k!). Really though, I'm not even bothering going to the OB/GYN and going staight to the gang at the fertility clinic. Their whole life is about getting women pregnant.

This sounds like it could get expensive, with all these drugs and tests! Not like raising children saves you money, but at least you can trick yourself into believing that they can't be that expensive--they half the size and eat half as much as adults (and the first year of food is free).

This will be pretty interesting to see what the RE actual ends up doing after getting all of your input. I will keep you guys updated.

Any of you try charting your basal body temp?

Hi Ali,

I am a bit late but I wanted to welcome you to the board!!!! It does take forever to get an RE appt but once your "in" the f/u should take a lot less time. I agree with the other girls that gaining weight may help increase your chances of pregnancy. With the hustle and bustle of working it's always hard to find time to eat. Perhaps you can discuss with your RE or a nutrionist on how you can gain healthy weight with a diet that can also assist your reproductive system. As for clomid, my OBGYN had put me on it but my RE took me off of it and put me on Femara. Neither of them worked for me. But before even seeing a specialist and taking any kind of drug, I was charting my basal temperature and that did work for me after 3 months of using it. It is important to do it at the same time everyday and starting taking your temperature the day your cycle starts. My pregnancy ended in miscarriage but it did work per say. Some say charting is less accurate than having the u/s and b/w with RE and well having RE tell you when to TTC is easier that having to take temperature every day. Just make sure if you do chart that you do not wait a week TTC make sure you "practice" at least 3 days before you think you temp will rise. This can decrease your chance of miscarriage, you may know this but I did not know that then. At the time we were TTC we waited a week to try "thinking it was better to do, not worse." After 3 months you should have an idea of when you ovulate. But again the u/s and b/w w/ RE can tell you that as well. Anyway now I am rambling. I just want to wish you lot's of luck on your appt. and I hope this next step will bring you a BFP in 2007!!!! Please keep us posted, you will find a lot of support here :)

kathy

I'm a little late here. too! Welcome to the board. I went over 2 years without AF. Went to my OBGYN in February '06 and he put me on Provera to start AF and then clomid. I was on all that for a few months (without looking at my chart I don't know exact times) then he sent me to the Fertility clinic in June (I think) I was diag. with PCOS and am now on Provera (if I don't start normally), Clomid, Dexamethazone, Metformin, estrodal, and something else. I had my first big egg this month and surged and took my shot Saturday. I go in Friday for b/w to check my progesterone level and then it is a waiting game until I test January 12. All of this was to say Clomid does work, but not on everyone and not all the time. There were a few months that I didn't O at all. Don't loose faith. Hang in there.

Sending baby dust your way! !

Leslie

Thanks for the baby dust! In a week we are going on a vacation to Hawaii and the week after we get back I have my appointment, so I'll be nice and relaxed and ready for Baby Time. I'll ask the RE about gaining weight in a healthy way and I'll be sure to tell you guys what he recommends for treatment. Until then, baby wishes to all of you!

Hi Everyone!

Well, I had my first Dr. appt today to begin investigating why I haven't had a period for a year and hopefully what can be done about it! You guys were so right! Such smarties :) He has me taking Provera for 10 days and then getting bloodwork on day 3 of the period that it will induce. They will measure estrogen, FSH, LH, Testosterone, and Prolactin, among others. According to him it is likely that I either have hypothalamic amenorrhea (mainly caused by low weight and/or stress) or a result of having polycystic ovaries. He took an ultrasound to confirm that my ovaries were still polycystic, and indeed they looked like two pizza pies loaded with pepperoni. So in about 2 weeks we'll have all the labwork done and hopefully the hormone levels will tell him which one of these (or both?) is my problem.

Anyone know how you treat hypothalamic amenorrhea or polycystic ovaries? I've already gained a little less than 5 lbs while on vacation and am aiming to gain about another 5 or 6, so hopefully that should help. Also, I'm trying some relaxation techniques at work, but it's not easy!

Hugs and thanks!

Hi I was curious if you have ever had a period on your own without taking the birth control first.I have primary amenorhea.I have never had a period on my own.But of course if I take birth control pills I do.But its is kinda hard to conceive on birth control.Any ways if this sound familiar let me know and I will tell you how I achieved having twin boys.Good luck!!!!

I'm glad you finally got to the Drs.

I think you have hypothalamic amenorrhea. I was also misdiagnosed with PCOS based on only ultrasound findings. However, after going on estrogen shots for 6 weeks my cysts totally disappeared. PCOS cysts don't disappear that quickly.

Don't be suprised if the provera does not induce bleeding. This is very common with HA because our estrogen levels are low. Unfortunately (or fortunately) the condition can only be reversed by replacing the missing metabolic signals to your brain (gaining a lot of weight and eating properly, etc).

You said your BMI is 18, right? Your BMI should be more like 21-22 for AF to come back. Did you get regular cycles before the pill? Did you weigh more then?

Clomid works in some cases of HA but not all. Your RE may want you to start right away with injections. I'm still holding off and seeing if my cycle returns on its own (clomid does nothing for me). I still struggle with weight gain because I'm recoving from bulimia/anorexia. It is psychologically very traumatizing to me to gain weight but I've put on about 12-15 pounds in hope of restoring AF.

Best of luck to you. Like I said, HA is reversible it just takes time and effort.

Hey Sunflower--interesting...yes I did have normal periods for a while, but I had been on BC pills for many years before stopping last year, so I don't have a good idea of whether or not they would have been normal during those years. How did you conceive twins? I want twins!!!

ngolden, thank you for your very helpful information about HA. My bmi was 18 before I went on vacation, but now I've put on 5 or 6 lbs and should probably put on another 2 or 3. I empathize with your struggle, but trust that God will help me readjust to a higher weight. I also try to remind myself that God created my body for his glorification, and any self-deprecating thought only hinders His will (and hopes of making a baby). Also remember that with time you will grow accustomed to your new body, but like any transformation it takes time. GL and big hug :)

I'm on day 2 w/o Provera and still nooo period. Waiting...

there were some months that AF wouldn't show up until a week or more after the provera. All this stuff does work. I am 7 wks now and hoping for a noneventful pregnancy.

Finally--this morning!!! My body has no sense of punctuality.

Glad to hear it!! I know you can't wait to get started!!

WOW finally... you girls sound so much like me! I was diagnosed last week with PCOS but I really dont have many of the symptoms. He did a sonogram and said I have not been ovulating... then some blood work that confirmed my levels are out of wack.

But I am not overweight, I do not have acne and really dont have excess hair growth either. Do you think maybe Ive been misdiagnosed???

The doctor didnt seem concerned with my weight at all. I have teeny bones (size 5 shoe and the smallest wrists) and am 5'1 and weigh 97lbs. Believe it or not thats up from 94.5 a few months ago. I went off the pill in June and my weight literally fell off me from 102 to 94.5. I guess because of my bone structure the gyn wasnt concerned about that though. Maybe he should be????

Like you guys my FI is in the medical profession too. Hes PGY3 in ortho surgery. Still a long ways to go so I feel your pain about the no money thing. I did 5 days Provera at 10mg and just got my period but only for 1 day... which seemed really weird for me. My gyn has me starting Chlomid saturday (day 5) and taking 50mg for 5 days to see if I ovulate. If nothing happens my FI is coming with me back to the gyn on day 30 (march 1) to decide what our course of action will be for the future. We may decide to go straight to the RE.

Im glad to see people are in a similar boat to me :-) ANd i am wishing us all goodluck.

Toby's girl- (or anyone else who can help me) I'm curious about your horomone levels- did they come back normal? If not, what did your doc do for you?

Haven't gottent the #'s yet...will know on Thursday.

Need some xanax so I can chill out until then. Also feeling guilty about coming into work late for the third time in three weeks.

Aymie--you should try putting on a couple of pounds. My doctore recommended I become a 19 or 20 BMI.

Im working on it!!! Lucky or unlucky however you want to view it i am one of those people who do not put on weight easily. Ive never been on a diet and live on carbs and junkfood. Ive cut out caffiene as that stimulates the metabolism. Needless to say another 3 pounds would be great i think but the doctor doesnt even think itll make a difference sadly :-(

I got my results!!!

Everything is completely normal EXCEPT my estrogen and progresterone levels which were so low they were off the charts. Who knew? I'm otherwise healthy and normal looking. My doctor hubby doesn't know why they would be so low, so I guess I'll wait and see what the RE has to say about this.

Anyone know why I have such low progesterone and estrogen levels? What is the treatment?

hmmm...
let me know what the RE says. Im on day 4 of the chlomid (cd8) and am handling it pretty well. A little nauc but nothing i cant handle

what kind of dr is your husband?

Tobysgirl-

That is classic hypothalamic amenorrhea bloodwork. I can almost guarantee it is related to your weight/exercise/eating habits. If you put on weight the estrogen will come up. Your progesterone is low because you aren't ovulating- no ovulation=no progesterone. How much of an AF did you get after the provera? Was it full on bleeding or just spotting?

Luckily this type of infertility is 100% reversible if you make the appropriate changes. If you aren't ready to gain the weight, etc, your RE can probably try you on clomid (if you got AF from provera) and if that doesn't work- move to injectibles.

I would like you to check out this forum on HA:

http://www3.fertilethoughts.com/forums/showthread.php?t=343535&page=1&pp=40

All of the girls on it are in the same boat as you. Good luck.

Amy-

I know countless women whose DRs said the weight had nothing to do with their AF and it is completely not true.

My DH is in medical school and he said they taught this next round of doctors that weight has A LOT to do with reproductive function.

In fact, I knew a girl who was 93 lbs at 5'3'' and her doctor said her weight was normal and had nothing to do with her amenorrhea. She gained 50 lbs and miraculously- she got her AF back and got pg.

What kind of DRs are all of your DHs? Mine is about to go into emergency medicine. Isn't being a medical wife so much fun LOL.

Hi Golden,

My Fiance is a 3rd year orthopeadic surgery resident. Residency is NOT fun!!! Not for the guy and def not for the woman behind him. But... hes passionate as Im sure your DH is and thats all that matters. We still have 2.5 years more of residency and then a year of fellowship before hes completely done. So by my figures he will make a real paycheck at the end of 2010. LOL

As for the weight... id normally agree with you but I really am one of those people who just dont gain weight. My bones are teeny (shoe size barely a 5) and I never made the charts growing up for weight. Actually my whole family is underweight or just barely normal weight. Oddly enough i think because of my bone structure I really dont even look skinny... just petite.

Needless to say I really am trying to gain a few pounds but everytime I try it seems I wind up losing... go figure. I eat nothing but carbs and junkfood and have been throwing in an extra peanut butter and jelly sandwich everyday which my fiance says is a good source of protein and calories. At least im not at my lowest now.


As for you... I really think its great that as hard as it is emotionally for you to gain weight you are sticking to it. My cousin who is like my little sister is now in inpatient treatment for anorexia and bulemia. Its heartbreaking to watch her go to dinner and eat nothing or pick at a few carrots. She is like a totally different person than she was 1.5 years ago. Im really hoping it works for her since she is only 18 and although i know shell battle her whole life I just hope for the best. I even tell her how shes doing such damage and itll make it harder for her to have kids one day but she doesnt listen. (she actually was diagnosed with PCOS when she was 14).

Are you trying anything other than the weight gain?

ngolden, I think you've hit it on the nose with the hypothalamic amenorrhea. The puzzling thing is that, although I'm slim, I'm not "skinny" and I definitely have curves. In trying to get pregnant I've put on about 8lbs or so, and now wear a size 29 jeans (not skinny!). I just thought HA was a problem for women with eating disorders, not someone like me who is within the healthy weight range.

I did respond to the provera challenge with about 5 days of bleeding (moderate the first three days and v. light the next two). The doc will probably put me on Clomid, which frankly scares me. I would like to have a normal period again and thus allow for the possibility of pregnancy, but to deliberately take a medicine that could very well make me pregnant is a tad frightening. Although I look forward to having a little baby and being a mom, part of me is scared to be so proactive about getting pregnant.

By the way, I took a reproductive endicrinology course in college and remember MANY studies indicating that even a minor weight gain (like 5lbs) tremendously improves a woman's odds of getting pregnant. You're absolutely right that there's a correlation. It's just weird how some very skinny women get pregnant easily and have these "basketball" bellies, while other women who are normal weight can have so much trouble.

My hubby is chief resident of surgery, and then he starts his fellowship in June (so he'll get a real paycheck in 2008!). I adore him, but residency is a PAIN! Especially when he's getting phone calls all hours of the night, or when he's on-call an entire weekend and comes home Sunday night and just sleeps. All of his friends are doctors too, so even when we go out and socialize it's all about work! He is doing important work though and I'm proud of him. His thoughts on all of this? He was about as surprised and bewildered as I am. Good thing we have specialists.

Thanks for the link to HA, ngolden. Very helpful!

Ahh Toby you are 2 years ahead of me! WHat is he doing his fellowship in? My FI will be chief starting July 08 (right around the time youll start seeing some real cash) and then he will do a fellowship in Sports Injuries. He is hoping to do his either in NYC or LA.

Too bad hes not in RE or gyn.. something that could help us right about now :-)

do you guys always feel a bit more comforted by the fact that your men can really read up and understand what all this is about or does it make you nervous that he might read or hear things and not be telling you everything?

I have a little bit of both. Right after I started the 1st chlomid pill he spoke to the head of gyn at his hospital and then came backt o me and was like "im going with you next time... i dont think we should just be jumping into this without going to a specialist. theres a lot that chlomid is good for and stuff its not good for ... blah blah" and then he made me nervous.

I have a relative with the same problem. She has been trying since 2002 and she never really gets a period unless she is on the pill which of course then stops her from conceiving. She told me she was told that she has PCOS. She does not discuss it anymore as she is very unhappy with this. I do not know if she has done anything else to get pregnant. I hope you are more successful then her. Good Luck.

I am SUCH a dork.

I jumped the gun--my estrogen and progesterone levels are NORMAL for day three of your period, my RE told me after I wrote all of the above. I had the report faxed to me before my RE appt so when I read "<32" indicating in the range of post-menopausal, I didn't realize that they dropped that low right after you get your period. LOL! Any, I still have HA he said, the disease of athletes, models and stress-cases (starting to think I may be part of the latter group, and it's not helping that I'm not pregnant. Plus I think my boss thinks all these "Dr. appointments" are really interviews for another job, but he is paranoid. Makes me hate him and my job more.).

Next steps: see if I ovulate in the next two weeks on my own (I doubt it--a quick look at my ovaries Thursday morning showed they were quiet. Boo). Do the provera to get a period and set my egg timer back. Then take Clomid. Aymie, what are the problems w/ Clomid?

My hubby will do endocrine surgery next year, which I am happy about because he tells me there aren't any unplanned surgeries. So far it sounds like he'll be able to take more vacation than I will next year, unless of course I get preggers and quit my job. I think I have the opposite problem as you do, Aymie. Dear hubby's in the camp of "under diagnose" when it comes to treating me. The other night I got terribly sick--nausea, stomach pains, and a strange itchy rash. After what seemed an eternity begging him to do something, he finally roused himself and told me to lie on the floor. I obeyed, thrilled that I would finally get some help from him. He starts pushing and prodding my belly and then finally he says, "You're fine. Go back to bed." Excuse me, but I don't think I am fine. Just because he didn't find my appendix to be the size of an obese gerbil, doesn't mean I'm not sick! You see, as a surgeon, unless he can find something to cut or cauterize, I'm not sick LOL! So funny. I know some doctors are the exact opposite with their families, obsessively worrying about every little thing. I don't know which is better to have, but I'm certainly happy that I have my own RE!

Have a great Sat, Ladies!

hahhaha your DH sounds like my FI... when im sick he says "go to a dr" and when i say "but YOURE a dr" he responds with "do you have any broken bones? No? great... go to a dr" Hes going into sports partially for the same reason... no emergencies in sports and no sick people.

but since he really wants kids he has been researching for me and asking around. He has heard that there is a school of thought that says chlomid usage increases the risk for ovarian cancer (i think... or was it cervical??) and hes skeptical about me ever taking it more than 3 times.

i dont know more than that. my ovulation tests are still coming back positive everyday. Im cd12 now but doubt i will ovulate (who knows though maybe i will). after this though we will go to a RE and decide what to do for after the wedding. I normally have pretty good skin and this chlomid has NOT been good for it. I dont think i want to screw with hormones much after this cycle until May. Selfish as it may sound... i need to look (feel) pretty for my wedding!