Is it time for help?

[jr'smom]

I'm 35 years old and have been TTC for 6 cycles. I believe I may have had a chemical pregnancy on the second cycle. I have a DS 12/04 and DS 6/06. I'm still nursing the 20 month old. The three year old stopped nursing a couple months ago. My period has been back and regular for over a year. I'm charting and can't point to any problem there. I'm very regular.

I think my nutrition is good. I started acupuncture a couple months ago for fertility. I just had a bllod test to test my thyroid specifically--no results back yet. I have been taking armour hyroid since before the second baby was conceived.

Is it time to seek testing? Where do we go and what do we do first? Is it too soon?

I want to have at least two more children (God willing.) I'm definately starting to feel the time pressure--not so much that I think that's what's affecting my fertility, but I don't want to look back and think I waited too long.

I appreciate any advice and guidance! Thanks!

[YummyYarnAddict]

Strictly speaking, 35yo and six months of ttc "qualifies" you for a trip to an RE if you're concerned. However, since you just started with acupuncture, my inclination would be to check in with your acu -- especially if your acu has experience w/(in)fertility -- and give that a while longer. What does s/he say? I'd also be inclined to wait on those thyroid test results.

[wannabe]

I think it's a bit soon since you're still nursing the 20 month old. Those first few months you were nursing a 14 month old, so I'd expect your hormones to be a little wonky still.

Most IF docs will tell you to wean before anything else, or not take you seriously because you're nursing.

[YummyYarnAddict]

Originally Posted by wannabe

I think it's a bit soon since you're still nursing the 20 month old. Those first few months you were nursing a 14 month old, so I'd expect your hormones to be a little wonky still.

Most IF docs will tell you to wean before anything else, or not take you seriously because you're nursing.

Prolactin levels usually (but not always, but ususally) return to the "normal, non-pregnant, non-lactating" range by the time the nursling is 9-10 months old. Also, she said that her AF has been regular for a year which is what they're looking for. If you search the threads here in this forum, you will see that several women (myself included) have gone through ART cycles while breastfeeding and breastfeeding is not a foolproof method of birth control. If her cycles were irregular and not normal (for her) I would take the breastfeeding into consideration, but that is not the case.

The reason that REs are hesitant to allow women to cycle while breastfeeding is because they don't know about breastfeeding and medications. They just err on the side of caution and don't take the time to educate themselves on the issue. When they run tests, they cannot tell a lactating woman from a non-lactating woman, so that's not the issue. It's about CYA with regard to the nursling. Those of us who do the research have found that the meds are safe -- the only side effect my dd experienced from all the meds from 4 fresh anad 3 frozen IVF cycles was a mild breakout from pogesterone (a naturally occurring hormone) in one of my cycles.

[jr'smom]

I so appreciate the input. Thanks!

I don't think BFing is part of the problem. Since my cycles are regular and I had no problem getting pregnant while nursing and nursed the entire pregnancy and beyond last time.

I will certainly stick with acupuncture. The acupuncturist has no feedback--and I'm not sure what kind of feedback he could have. My charting shows regular cycles so there's not really anything I could point to to want to see a change in. (Other than achieving pregnancy of course.)

Where do I go first? (I don't even know what RE stands for--is that where I start?) Are there certain tests I should request? I'm really not looking to jump into meds if I can avoid them. (I'm sure many of you feel the same way.) But I'll do whatever is reasonable.

One more question. Are there places that can help with fertility who don't insist on a ton of monitoring or intervention once pregnancy is achieved?

I'm really a newbie and I'm sorry if my questions are over-asked or annoying to you more experienced ladies.

[jr'smom]

Okay, so I read the sticky...RE means reproductive endocrinologist. Do you self-refer or start with your GP?

My insurance sucks--high deductable! It cost me $341 for an office visit and thyroid test. I like my GPs because they specialize in homebirth recommend no vax and are on the conservative side with everything (as much as MDs can be.)

His answer to possible infertility though, was that it may not be God's plan for us to be pg right now. That may be the case, but what can I do next?

[YummyYarnAddict]

Originally Posted by jr'smom

I will certainly stick with acupuncture. The acupuncturist has no feedback--and I'm not sure what kind of feedback he could have. My charting shows regular cycles so there's not really anything I could point to to want to see a change in. (Other than achieving pregnancy of course.)

Hmm... has the acu you're seeing given you a TCM diagnosis? Does he have any training/experience in fertility issues? Does your treatment vary depending on what point you are in your cycle? Are you getting herbs that also vary depending on where you are in your cycle? These are things I would be looking for and expecting. The acu I saw never looked at a single chart but gave me a TCM diagosis and went from there. She also had 20 years of experience w/fertility issues.

Originally Posted by jr'smom

Are there certain tests I should request? I'm really not looking to jump into meds if I can avoid them. (I'm sure many of you feel the same way.) But I'll do whatever is reasonable.

Right now it seems like you need more info before you need to jump into meds. I might consider the next "low tech" step of using OPKs in addition to charting to confirm that you're ovulating for a couple of months before going to the doc if you don't mind waiting another cycle or two.

Originally Posted by jr'smom

One more question. Are there places that can help with fertility who don't insist on a ton of monitoring or intervention once pregnancy is achieved?

You're usually "released" from the RE once the heartbeat is confirmed around 6-8 weeks. Of course, you're free to leave the RE's care at any point you choose and go to the doctor of your choice.

Originally Posted by jr'smom

Okay, so I read the sticky...RE means reproductive endocrinologist. Do you self-refer or start with your GP?

It depends on your insurance and personal choice. I self-referred because I have a PPO and I knew what I needed and who I wanted to see. I think most people see their OB/GYN first and go the referral route but I knew the RE my OB/GYN referred women to and I didn't like him.

Originally Posted by jr'smom

His answer to possible infertility though, was that it may not be God's plan for us to be pg right now. That may be the case, but what can I do next?

It could just be a matter of waiting a couple more cycles. Sometimes things just aren't in our hands and on our timelines. I know I wanted my kids to be three years apart and went back to my RE just after my dd's 2nd birthday only to suffer several miscarriages. My kids are 4.5 years apart. If you don't really feel that there's anything amiss and that it might just be a matter of time, you might just want to try using OPKs to confirm that you're ovulating for a couple more cycles and then if you still do not conceive, ask your GP to do cd3 (cycle day 3) labs (estrogen [e2], fsh, and leutenizing hormone [lh]) as a starting point just to get those done (which is where an RE would start but it'd probably be cheaper to have your GP do them).

[wannabe]

Originally Posted by YummyYarnAddict

Prolactin levels usually (but not always, but ususally) return to the "normal, non-pregnant, non-lactating" range by the time the nursling is 9-10 months old. Also, she said that her AF has been regular for a year which is what they're looking for. If you search the threads here in this forum, you will see that several women (myself included) have gone through ART cycles while breastfeeding and breastfeeding is not a foolproof method of birth control. If her cycles were irregular and not normal (for her) I would take the breastfeeding into consideration, but that is not the case.

The reason that REs are hesitant to allow women to cycle while breastfeeding is because they don't know about breastfeeding and medications. They just err on the side of caution and don't take the time to educate themselves on the issue. When they run tests, they cannot tell a lactating woman from a non-lactating woman, so that's not the issue. It's about CYA with regard to the nursling. Those of us who do the research have found that the meds are safe -- the only side effect my dd experienced from all the meds from 4 fresh anad 3 frozen IVF cycles was a mild breakout from pogesterone (a naturally occurring hormone) in one of my cycles.

Yeah, but walk into your friendly neighbourhood OB office for a referral to an RE and they won't know that. Yes, you could get some docs to order your CD3 bloodwork and a scan and HSG, but some'll get bolshy.

I think the reluctance to let nursing mothers cycle has a hefty dose of cover your success rates, too.

[YummyYarnAddict]

Originally Posted by wannabe

Yeah, but walk into your friendly neighbourhood OB office for a referral to an RE and they won't know that. Yes, you could get some docs to order your CD3 bloodwork and a scan and HSG, but some'll get bolshy.

I think the reluctance to let nursing mothers cycle has a hefty dose of cover your success rates, too.

That's why it's important to be your own advocate and do your homework. That's why it's important to ask questions and not assume that doctors always 100% of the time know the right answer. That's why I read the medical journals myself on Medline and PubMed and the first RE I cycled with is a researcher and actually one of the doctors on the team that developed Pergonal way back when and his wife is an OB/GYN who gave the thumbs up to my breastfeeding my dd through the two cycles I did with him to ttc#2. Then the second RE I moved to (because RE #1 wasn't well versed in recurrent pregnancy loss) was part of a "chain" so to speak -- but a rather well known one -- and was not a researcher and I was very unhappy there and left after one cycle. The RE I have now is a researcher and I can (and did!) go to her office with a handful of journal articles and spent over an hour discussing my options for medications and protocol choices and procedures and I had a list of questions and she took me seriously. Then after I left she did her own research and called me back with the answers to my questions. A lot of it is not being a passive patient -- and because we're all here, I don't think any of us are -- and asking questions and expecting respect and nothing less.

I think that if you go in and act as if you know what you need and want, that they'll treat you differently than if you act as if you're helpless and don't know what to do. I've had this happen over and over again, be it with my orthopedists, rheumatologist, neurologist, RE, or the kids' pediatrician. -

I know that as a clinical massage therapist I've had different responses to clients when they've said "my back sorta aches" vs. "I think I pulled a hamstring" (so I give them more focused care) vs. "I did some research and based on my symptoms and what happens when I lift my leg this way and what my doctor said, I think I have sciatica with a muscular impingement" (in which case they get an entirely different level of care). It's not my being lazy, it's my response to the client's ability to communicate what they need from me and what level of understanding they have about their own problem and their expectations.

As far as breastfeeding impacting success rates, I haven't found any studies to substantiate that. The concern is with regard to prolactin levels (unless there's something I don't know about) and if you don't tell your doctor you're breastfeeding (and most women choose not to) they can't tell that you're breastfeeding based on your labs because the prolactin levels are normal most of the time and if they aren't normal, it's usually attributable to something other than the breastfeeding unless the nursling is under the age of 10 months old.

[jr'smom]

I really appreciate the thorough responses and the time you put into them. Thanks!

I have used OPKs for several months to help to confirm my ovulation.

My acupuncturist doesn't communicate with me as much as I'd like, but he does vary herbs and treatment based on where I am in my cycle and how I respond to some questions he asks like being hot or cold at night. I have no idea what TCM means?