To Run or Not to Run

I mentioned in my last post that I am a pretty consistent runner. And I have some words to say about that, specifically with being a runner and infertility.

As much pressure as there is out there to eat healthy and lose weight, I think there is also some amount of pressure to eat junky foods and park your butt on the couch. I'm talking about turning down dessert, or refraining from a doughnut or cheese dip during office potlucks. People look at me like I'm crazy if I don't attack the sweets and stuff my face.

The same can be said about my running. "You're running again?" "I only run when I'm being chased!" "you must be crazy!" and, my favorite: "Do you think the running has anything to do with.... [insert euphemism for infertility here]?"

I know with that last question that the people who ask it are probably genuinely trying to help. And it is a fair enough question - there is a lot of information (and misinformation) about exercise and infertility. So I've decided to do a bit of investigation to ensure I'm making an informed decision when I go out for a run... and also to have a well-researched response to folks who suggest that being active has somehow hurt my chances for baby.

General Guidelines for Exercise
The CDC recommends at least 2.5 hours of moderate-intensity aerobic activity or 1.25 hours of vigorous aerobic activity every week for good health benefits. For even BETTER health benefits, the CDC recommends 5 hours of moderate intensity aerobic activity or 2.5 hours at vigorous intensity per week. There's more info about what constitutes moderate and vigorous activity, but jogging / running falls into the vigorous category.

Another CDC page (here) says that people who are active "about 7 hours a week have a 40 percent lower risk of dying early than those who are active for less than 30 minutes a week." So, in general, exercise = good.

Exercise + Fertility
The Mayo Clinic states that more than 7 hours a week of aerobic exercise is associated with infertility.

After a little more digging, I happened upon this article from the American Journal of Public Health. It's called "Exercise as a risk factor for infertility with ovulatory dysfunction." The study looks at a bunch of women who have an infertility problem - specifically with ovulatory issues (ahem, me) - next to a control group of women without infertility problems, and compares their exercise habits, with other controls for all sorts of stuff. Here's the result I care about the most:

Compared with non-exercisers (who they define as people who exercise vigorously for fewer than 7 minutes per day), with a baseline risk of "1":

• people who exercise on average between 8 and 60 minutes per day have a lower risk at 0.6
• people who exercise on average more than 60 minutes per day have a higher risk at 1.9

Another study, for which I only had access to the abstract,I discusses an increased risk for ovulatory infertility when there is a BMI (body mass index - figure out yours here) below 20 or above 24. The study also finds that an increase in vigorous activity (NOT moderate activity) reduces relative risk of ovulatory infertility. In fact, the more hours of activity, the less the risk. Their results suggest that ovulatory infertility is caused more by being overweight and underactive than to being underweight and overexertion. 

Exercise + Premature Ovarian Failure
Here's where my research hits a dead end. From what I can find, there has been approximately zero research done on whether or not exercise, vigorous or moderate, regardless of minutes/hours spent, affects your ability to conceive if you have POF. Bummer.

My Situation

I started running three years ago. And I absolutely hated it. Getting in shape sucks a LOT. I remember not being able to run a single mile. Every muscle hurt. I had a cramp. I couldn't breathe. My heart rate was crazy. But I kept at it, as suck-tastic as I was, and slowly, over time, I started to get better. I could run longer and harder while feeling stronger. And one day I started to not hate it. Not long after that, I started to like it. And now I love it. Now I need it, to maintain my sanity. Without running: I'm grumpy, negative, and stressed to the max (including an obnoxious persistent eye twitch). With running: slightly less grumpy, more hopeful, less irritated by everyone in the world, more productive, better in general.

My cat loves stinky running shoes

I would classify myself as a moderate exerciser. I exercise way fewer than 7 hours a week, but I do run every single day (at least a mile. Usually two to five miles. Sometimes a lot more if I'm training for something). One mile for me = about 10 minutes. So on a typical day, I'll run for about 20 - 50 minutes. Sometimes less. Sometimes more. Last week, I ran 24 miles from Monday to Sunday, so a little more than 5 hours. It averages out to 36 minutes per day.

I'm in relatively good shape. My resting heart rate is usually around 60-65. I can run 5 miles without feeling super winded (although it's all about pacing!). I'm at a healthy weight. My BMI is somewhere around a 22-24 (I should get this checked out at my gym next time I'm there... the little online calculator only works if you don't have a lot of muscle. And while I'm not ripped, I think I probably have more muscle than a typical gal, due to the running).

The Question: To Run or Not to Run
I've been training for a half marathon for the past 6 weeks and I'm making great progress. However. I am getting a serious itch to do a full marathon. My friend from college has enthusiastically agreed to train with me for a full marathon in 12 weeks. We checked out some training plans and are now tentatively working on one. Tentatively because while I am a huge endorser of running and maintaining a healthy lifestyle, I don't want to do anything that might, even in the slightest, hurt my chances of conceiving. Granted, my chances of conceiving in the next 12 weeks are about .0001% (made up stat), but why put any obstacles in my way, right?

Except. What if I wasn't going to conceive in the next 12 weeks anyway? "Run a full marathon" is in the top three on my "MUST DO" bucket list. Should I just wait forever? Clearly, I would rather get pregnant than run a full marathon, but does this also mean I just have to wait until the end of time? It's not like if I do get pregnant, I'll be able to run a full marathon any time in the next... oh, I don't know... 10 years... From what I hear, having a kid is pretty time consuming.

I know this is a stupid dilemma. Because the difference between "not running a marathon" and "not having a baby" are so ridiculously incomparable that it should be an absolute no-brainer. But it's not. Because I don't think it's an either/or problem. It's probably a marathon and no baby... or no baby and no marathon. And it's just one more thing to withhold from myself (because gluten, refined sugar, and most dairy just isn't enough, right?).

I know. I'm being very pessimistic. But my decision now is to just talk to my doctor about it. I'm going back in a couple of days so hopefully I will figure this out soon. I would like to note, however, that after a few simple calculations according to my training plan for a marathon, my very highest week of mileage would have me exercising an average of 69 minutes per day. For one week. The rest would stay under 60 minutes / day.

What do you think? Where do you draw the line with exercise? Any advice on whether or not I should go for the marathon?

Intuition

Number of medications my RE has prescribed for me: 6
Number of dollars I've spend on said medications (out of pocket): $1,614.79
Number of prescribed medications I've actually taken: 1

It seems like every time I go to my Reproductive Endocrinologist, I come home with another prescription. At first it was Clomid, with instructions to wait until my bloodwork came back. Blood work sucked. No dice.

Then it was Menopur, prescribed after an annovulatory cycle to stimulate the ovaries... but I was told to wait first for blood work results. The doctor didn't listen to / believe me that the cycle was annovulatory and said I should get the meds while I was in this "window of opportunity." I had a bad feeling about it, but decided to go for it and paid 1500 big ones for it (desperation). Lo and behold: blood work sucked. Again, no dice. $1500 down the drain (although, there's a chance I could use it in the next year before it expired... should have listened to my gut feeling and NOT GOTTEN IT).

More recently, the doc gave me Hormone Replacement Therapy in the form of 1 mg of Estradiol every day and then 12 days of progesterone every other month to "control my symptoms". I filled the prescription but decided something didn't feel right about it. My biggest symptom was the hot flashes and those have been under control for months. Bone loss is another issue, but I am a very active runner and cross trainer, so I felt like the HRT could wait a while. Also, I like being able to "read" my body and I was worried that HRT would take that away from me. Not too mention risky side effects I could avoid by staying off the meds.

Last week, the doctor gave me two prescriptions - one for Birth Control Pills and one for Ovadrill. He said he'd let me know later that day which one to fill, after my blood work came back. Blood work DIDN'T SUCK! So I filled the Ovadrill, per his instructions, and for the first time in almost more than four months, I have actually taken a medication meant to improve my chances for conceiving! FINALLY!

I have had approximately zero experience being my own advocate for my health until this Ovarian Failure diagnosis. In the past, the doctor would tell me what to do and I would do it. But something is so different about infertility. It's not just my health I care about. And I think especially with POF, there is so little research, so little known about how to optimize chances, it's difficult to trust the doctors like I used to. Even the Ovadrill I just injected into my stomach a few days ago lists on the instructions that Ovadrill is not for patients who have Primary Ovarian Failure (because nothing helps with POF). The doc says I'm in intermittent ovarian failure, so I decided to go for it.

My point is this: I'm beginning to trust my intuition. The doc told me in several appointments that it's actually good I didn't start the HRT he prescribed, because we could see that my body was able to produce follicles without the hormonal help. If I had trusted my intuition instead of the doctor, I wouldn't have dropped 1,500 bones on a medication I probably will never use. I'm hoping that my intuition about the Ovadrill is also correct - not that it will WORK, per se, but that it at least won't hurt my chances in any way. The most likely outcome is that I'll start my period in a week and a half and at least then I can get moving with a new cycle. This one has officially gotten old, at nearly 60 days without a period.

I'm making it a point now to absolutely make sure my voice is heard with my doctor and to make sure that any treatments for me are treatments we BOTH support and are what I feel comfortable with. I wish I'd been trusting my intuition all along. But here's to making it count as I move forward.

Side note: My uterus (maybe?) has been twitching today. Like an eye twitch, but down in the general uterine area. Any idea if that means anything?

Secondary Effects

There's been another casualty of my infertility. Since my diagnosis just four short months ago, the wrinkle on my forehead has deepened from a barely perceptible annoyance to a glaringly obvious permanent crease on my head. I am not okay with this.

Here is a picture of my forehead at my sister's bridal shower, taken about six weeks before learning I had Premature Ovarian Failure:

And here is a picture of my forehead a couple weeks ago, at Superbowl Village in Indianapolis:

What. The. Heck. In less than six months, I have developed a full blown CANYON on my forehead. I am attributing this directly to an obscene amount of crying and worrying and furrowing my brow. Must learn to better cope with emotions and constant state of worry.

Does anyone have any tips for how to make this go away in a safe and natural non-botox, non-surgical way?   Please?

In other news, I have identified the culprit to my stomach issues as discussed here. 

A few not-at-all scientific experiments have led me to this conclusion. Namely, the one where I stopped taking this supplement and the diarrhea stopped. Then when I took it again the diarrhea came back. Sooo... yeah. I spoke to my acupuncturist about this herb and she suggested that I try starting it again in very small doses and work up after a few weeks to a regular dose. So I'm going to start 1/4 teaspoon a day tomorrow, and next week I will up it to 1/2 teaspoon. We shall see how it goes.

I am taking this concoction upon the recommendation of Randine Lewis in her book The Infertility Cure, in which she discusses this Four-Substance Decoction as the Chinese Herb to try for Premature Ovarian Failure patients. I highly recommend the book. It's the first thing I read after diagnosis that gave me a feeling of a small amount of control over my situation.

My Body: The Enigma

Went to my specialist, or "Reproductive Endocrinologist," or "RE" the other day. He called a couple weeks ago with my progesterone results and said that I had probably started my period, according to the numbers. Um, nope. No period. So he said wait a week and call him back. Still nada. Zip. Not a thing. So he had me in this week to see what the eff is up.

Short back story here: we thought I may have ovulated in January. I had one follicle on the left ovary that seemed to be active according to my estrogen numbers. I never had a temperature shift or the "good" kind of cervical mucus (omg. I can't believe I'm talking about my cervical mucus on the internet.) so who knows. A pregnancy test came back negative, so I should have had a period a while ago. Like certainly before Day 46 of my cycle, which is today, and with no sign of my old gal pal, Red.

Anyway, a pelvic ultrasound showed up nothing on the left and three follicles on the right. Whaa? My lining is at about 4 mm and it needs to be at about 7 mm for ovulation, so that's not great...but the doc was very surprised to see those little follicles. I asked him what it meant and he said "Honestly? I don't know. Your body is not following the normal logic for Ovarian Failure." That could be good, right? Good that I'm not following this condition that basically shoots all but the slightest hopes of pregnancy down? Not great that the doctor has no idea what my body is up to, but hey, I'll take the smallest of victories here.

Blood tests showed that the follicles probably aren't active. But there's good news, too. My FSH is down to 10!!! With Estradiol numbers at 78.. which basically means my FSH might be low on its own, not being artificially suppressed by cysts on Day 3. Woohoo!

Physically, I am loving how I feel right now. No hot flashes or flushes (that feel like suppressed hot flashes) due to FSH and no emotional outbursts due to high estrogen. Not that those are ideal numbers for getting knocked up, but man it's nice to not feel all out of whack for a few days.

Side note: Acupuncture today was a.maz.ing. How did I ever live without it????

Dr. Meanie Pants

It's about to get real personal.

I've been experiencing some bowel problems lately. Like I need to run to the bathroom about 30 minutes after eating anything. That started last Saturday and just kept happening. Like clockwork. So finally by Wednesday, after having lost 4.5 pounds in 5 days, I made an appointment to see my family doctor.

I hadn't seen this guy since before the whole infertility-ovarian failure thing, so I had a lot to tell him at my appointment. I brought in my list of herbal supplements (admittedly, it's ridiculous), informed him of my dietary changes (gluten free, reduced dairy and sugar), and told him my Premature Ovarian Failure story. Half hour later, I left in tears.

In fairness, I know this guy has about the worst bedside manner of any doctor I've seen. He's got the empathy of a slug and I know this. My whole fam goes to this doc and we talk about the insensitive or downright mean stuff he's said. An obvious question arises: why the heck do I keep going to this guy? Yeah, fair point. The thing is, he really knows his stuff. He's a great diagnostics guy, he's super thorough and every time I've been there, he's given me at least 30 minutes of time instead of the usual 3-5 minutes. After my appointment last week, I'm not sure how long I'll consider this list of pros as outweighing the cons, but hopefully I have some time to figure it out before I get sick enough to go back.

Anyway, there are a lot of things that could be causing this bowel issue. Here were my initial thoughts:

• One of my supplements: my "newest" supplement was one I had started about four weeks prior, and hadn't caused any problems... but maybe something was taking a long time to act? 
• Gluten: maybe I had accidentally eaten something with gluten in it... after being Gluten free for about five weeks, could my body reject gluten now??? I have no idea. 
• Stomach Bug: could just be I picked up a little virus. No fever or anything, but I did have eight days of diarrhea in 2008 that I think was just a bug. 

So I went over this with the doctor and he was SO UNSUPPORTIVE of the infertility. He looked at my list of supplements and said with disgust (which is key, here), "WHY are you doing all of this? I mean you don't even know if this is effective; there's no science." 

At that point, I remained calm and explained to him that Western Medicine can really do nothing for me in my situation. That there isn't a fix, no way to make it better. And if you're in my situation, you're willing to try anything. 

Then he said, and I quote, "You know, women in your situation often try for a couple of years and then realize, you know, you just have to turn the page. Move on."

Um, okay. Thanks for the vote of confidence. It's not like my entire life to this point has been laying the foundation for someday being a mom. No big deal. I haven't really thought about it anyway. Getting pregnant was just a whim. I hope you sense my sarcasm. 

I wanted to tell him: I've changed my whole life because I need to be a mother. I will do every single thing I can to get there. The alternative is so crushing I feel suffocated by the air I'm breathing when I even think about it. I understand there might be risks along the way and I am willing to take those risks. And I have to take those risks. I am not ready to give up or to "turn a page" now or maybe ever. And doc, what do you know about the heavy weight of inadequacy as a woman? Of wanting something so much that it shakes your core when you realize you can't have it? Especially when to everyone around you, it seems to come so damn easily? 

But I didn't say any of that. I shook my head, through tears. He asked what they've said my options are and I told him my chances of getting pregnant on my own and the recommended treatment of donor eggs. I was crying hard then, and had to get up to get the box of tissues. He ran some blood tests, and I walked out of there as fast as I could. 

No word yet on the blood test results, but the bowel issue seems to be getting better. I'll keep you posted. 

What if?

The Hubs' ex-girlfriend is pregnant.

We found out a while ago but I have been thinking about it a lot lately. Obviously. I don't really know this chick. She dated Hubs in college for two years then broke up with him in the winter of our senior year, just in time for me to meet and fall in love with him. Their relationship wasn't great and I have no doubt that Hubs is happy things turned out the way they did.

Mostly.

We haven't spoken about this and I know he would assure me that it's not the case, but doesn't there have to be some part of him that wonders "what if"? If he would have ended up with this ex-girlfriend of his, he'd be on his way to being a father. He wouldn't be consoling his depressed wife every week about her bum ovaries. He'd be painting a nursery and putting together a crib. He'd be reading daddy-to-be books and making guesses on the gender of his first child.

And even if he didn't end up with ex-girlfriend, there has to be a part of him that is disappointed in me. Not in the way that you're disappointed when someone didn't do the dishes or who let you down in some way, but in the small voice in the back of your head that you try to bury. "What if?" What if he had found someone just as great as me, with just as good chemistry and connection, who loved him just as much, but who didn't have premature ovarian failure? Why did it have to be me? His sperm analysis was fantastic. The guy has super swimmers. Why doesn't he get to be a dad?

Because of me. Because my body isn't doing what a woman's body is designed to do.

I am trying desperately to keep my head above water dealing with my own disappointment in myself. When I start to think about how I am letting Hubs down too, it's crushing.

The thing is, he would never admit to ever second guessing his choice to be with me. Ever. But I can't imagine it's not there.

Roller Coaster Ride

Since November 6, the day I found out about my Premature Ovarian Failure (yuck, I hate even typing those words), my emotions have been riding a bit of a roller coaster. Some days I think I can handle this stuff, that I was given this obstacle because I can handle it. Other days... yeah notsomuch. But. The crying spells have gotten better. I usually only have a good, quality breakdown every other week or so. And I can get through a work day without people asking me if everything is okay. So all-in-all, an improvement over where I started (read: eight hours of sobbing at a time).

What I'm finding lately is that I am pretending a lot. I'm putting on a positive face and acting like I'm fine. I'm going through the proverbial motions. And I have to be honest - it. is. exhausting. I get home from a long day of my very people-focused job that requires me to be "on" a LOT, and then go home to Hubs, where I try to pretend everything's fine so he doesn't worry about me, and by 8:30 or 9 pm I am ready for BED. 

Being a reasonable person with a good education, I am aware that this is not exactly healthy behavior. So a few days ago, I decided to let it all out to my husband and clue him in on what is going on in my head. And he was shocked that I have been doing so much pretending. Fair enough. I know he's not a mind reader. But I find it so nuts that I can hide things from the person I'm closest to that easily. I mean, in any given moment, my head is a jumbled mess of freaking out and worrying and wondering and grieving and as long as I go about my business in a way that seems normal... no one knows that I am a mess.

In case you were wondering, talking to Hubs helped about the pretending. He was, as he always is, very supportive and understanding. He's starting to "get it" that he can't fix this with a "well have you tried this?" strategy. But for me, it helps to know that someone else at least knows that I'm a mess inside, even when I'm pretending not to be.