I will get the bad news out of the way. The first round Clomid did not work. Last week, I met with my nurse practitioner (NP) to discuss my next steps. The appointment did not go to my liking. In short, she did not want to prescribe round 2 of Clomid for me because she wants me to be monitored by a doctor who can also apply complementary treatment to Clomid such as intrauterine insemination (IUI) or booster shots (whatever that is), etc. My NP can’t do these supplemental treatments for me, and since Clomid is not typically prescribed for more than six cycles, she did not want me to waste another cycle without any of these beneficial treatment plans that only a doctor can implement. She recommended I schedule an appointment with a doctor for my 9th cycle (which I’m currently enduring) and discuss next steps. Initially I was frustrated to hear she would not prescribe me a 2nd round of Clomid when evidently my body can’t have a successful ovulation on its own. It was also disconcerting to watch her shrug her shoulders apologetically when I asked, “well......why am I having low progesterone?”. This seems to be the general consensus from anyone I ask. You’re telling me that we can perform open heart surgery with the greatest of precision on newborns that are only a few days old, and we can map out the human genome to predict who is more prone to certain diseases and conditions, yet we haven’t figured out why some bodies produce more or less progesterone?
I left that appointment feeling defeated knowing that this cycle my body was on its own to try and produce higher levels of progesterone. I went for a run on the treadmill at our gym afterwards thinking very carefully about how I felt about my appointment. I decided that I wasn’t going to sit this entire cycle feeling that I lacked any control over this situation. I was going to take matters into my own hands.
And that’s how I wound up at the acupuncturist. Acupuncture is considered an alternative medicine that like most of Chinese medicine, has not been widely understood in our western scientific culture. There are some that suffer from chronic pain, stress, or infertility (to name a few) that swear by it labeling it, “medicine’s best kept secret” and then the other end of the spectrum filled with people that know absolutely nothing about it. You have western medicine to thank for that. I’ve heard several stories of patients that are in chronic pain who finally realize that all of the medicine in the world wouldn’t heal their pain and that it was acupuncture that swept in and miraculously cured them. I spent a few days researching the benefits of acupuncture in relations to infertility only to find that while the general consensus deems it beneficial, most scientific studies are inconclusive. The reason is largely twofold; the first being that by the time a girl resorts to acupuncture for infertility she is likely undergoing acupuncture as a complementary treatment with other western medicines so it's hard to pinpoint which treatment was more beneficial (in America, we'll probably say it was the medicine). Secondly, acupuncture isn’t beneficial for certain types of infertility such as fallopian tube blockages or men that have low or poor quality sperm so it obviously won’t work for some. However, the common conclusion is that, “it’s been around for 3,000 years--they must be doing something right!”. Chinese medicine focuses on energy and how negative energy harms the body. From what I understand, acupuncture needles help trigger energy to certain parts of the body that are in ailment. The needles help increase the blood flow to those areas. For fertility, for example, needles in the lower abdomen will increase the blood flow to that area thus carrying the hormones necessary to aid ovulation.
Within a few days of my appointment with the NP, I called a nearby acupuncture office to inquire about cost and insurance. I learned that it would cost $70/session and that some insurance covered it and it often depended on the reason. She suggested I come in for an appointment with Pat and they would determine what sorts of conditions I had and then determine if my own insurance would cover it. My chief complaint was low progesterone, yet when Pat inquired about other ailments such as pain, I brought up the leg pain I’ve experienced since I took up long distance running 8 years ago. It only pops up at certain times and depending on how I’m sitting, I can predict when there will be pain once I stand up. I’ve never done anything to treat it because it goes away once I stand up and walk around for a few minutes, but I know that it’s not normal. Pat explained they would try to bill my insurance for my “chronic pain”, but she would also treat infertility.
So there I lay on the healing bench. My sleeves rolled up, the waistband of my pants rolled down. “This will hurt like a mosquito bite, but the pinch will go away quickly”. I nodded and anticipated the pokes of needles in my belly, wrists, knees and ankles. Just as she described, I felt the pinch as the needle went in. Not surprisingly, the needle discomfort was more prominent when inserted into the thinner skinned areas like my wrists and ankles, and I barely felt it in my belly. When she finished, she said she was going to leave the room, leaving a bell on top of my belly if I needed anything I could ring her. “Feel free to fall asleep, and I’ll be back in about 20 minutes to take the needles out”. Yeah right.....fall asleep? What happens when I fall asleep and I try to inadvertently roll over? Ouch. I could only imagine all the things the could go wrong during these next 20 minutes. I tried to relax, but then I lifted my head up and watched my belly rise as I breathed out and there I saw in my line of horizontal vision 7 needles bobbing slowly upward and then back down. Well that is a site to see--I had actual needles sticking straight out of my body...all over. What if I sneezed? Would I ring the bell and ask for her to wipe my nose so I didn’t inadvertently poke my eye with the end of the needle when I try to wipe my nose? What if there was a fire and we had to get out immediately? Would she come running in and remove the needles first or would I have to run around with needles sitting perpendicular to body bobbing around with every step I took?
Needless to say, the experience was awkward--and not in a bad way. I just needed to get used to the idea that I would come in every week and try to find a way to relax when there are 20 needles sticking out of my body. She said it would take a few sessions for me to start feel its positive effects such as the upsurge of energy that often coincides with the treatment. To my surprise, my insurance will cover acupuncture once I reach my deductible so I’ve decided to give this treatment a try for a few months.
Perhaps the most enlightening moment of this experience was after Pat had taken a full history on my health. After sitting with me for a full 20 minutes asking me questions about my stress, sleeping habits, diet, and level of activity at work (questions that my physician has never had the time sit and disect with me) she told me that she had two concerns worth taking a more in depth look at. The first being that I’m always cold. When she took my pulse she felt my hands and how cold they were. She explained that my body is using so much energy to regulate my internal body temperature that it can sometimes throw my hormonal balance off track. She said that I should try to eat more hot foods so that my body doesn’t have to work so hard to warm up cold foods that are ingested. Secondly, she told me that she was curious how my work out routine which consists of 4-5 days a week and also long distance running were impacting my hormonal balance. I was shocked. Countless research and articles have showed the benefits of exercising while you are TTC, and never has it been discouraged except when it’s extreme causing undue stress on your body. She explained that the type of exercise I am doing can cause stress to certain areas of my body, and in turn, the body must overcompensate to the stressed areas by decreasing blood flow to other areas that are less vital--the reproductive area being the first to lose the battle given you don’t need these organs to survive. She suggested I supplement some of my work-outs with Yoga or Tai Chi which focus on enhancing internal energy and cause less stress.
I took her suggestion with a degree of skepticism because this is not what the literature says. Plus, plenty of girls get pregnant that work out regularly. I spent the next day thinking about it with a certain amount of doubt. So I did what any normal girl would do--I Googled it. “Exercise and low progesterone”. To my astonishment, it yielded countless articles, even scientific journal articles showing the association between exercise and hormonal imbalance in women of fertile age. It takes 10 years for scientific medical evidence to translate to practice. Is this just not generally accepted in the medical field? Or have we gone on for so long believing that exercise is a cure all that no one dares to say otherwise? Because exercise is obviously so beneficial within many realms of our lives, the medical field doesn’t consider how it could possibly harm you.
If the association between high intensity exercise and hormonal imbalance is indeed true (and I’m not saying it is at this point), its easy to see how this insight can be overlooked. First, most studies I found look at extreme athletes who had low body fat percentages and amenorrhea (the absence of a period). Of course no one cares about that because most of us aren’t athletes. As I dug deeper, I found more articles done on women of average body weight who had exercised for several years and were not looking to lose weight. I also found evidence that although exercising was not disrupting their cycles to the point of irregularity, it was lowering their progesterone and estrogen levels so that ovulation was not very productive (that’s my situation). Secondly, studying women who suffer from infertility to determine if exercise is associated is a very difficult to do. Once women find out they have cycle disruptions that are causing them to be infertile to some degree, most seek out treatments to help regulate their hormones. There are so many confounding factors that regulate or de-regulate the hormones, therefore isolating exercise as the culprit is hard to do.
What I do know is that there are studies out there that are showing this association in women with my body type that work out to the intensity that I do (moderate-high). My acupuncturist is the first to try and explain my infertility. What she says seems plausible, yet I understand I need to take it with a grain of salt. Since I’m not taking Clomid this month, I’ve decided to take the advice of my acupuncturist and replace some of my high intensity workouts with Yoga for a few weeks to see if that helps with this cycle. I have absolutely nothing to lose (except that I burn fewer calories thus I have to eat less).
Here we go. Calendar day 7 with anticipated ovulation slated for January 20th (which coincidently is the same day as my appointment with the OB doctor). Here’s to cycle #9!
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