If you've followed the blog for a while, you know that I have been very open about our struggles with getting pregnant with Caleb, our first. One of the reasons why we had this struggle is because I was diagnosed with PCOS. Truth be told, I was diagnosed at 18 and I never really thought much about it. I was prescribed a birth control pill to take care of the symptoms and that was that. 

Once I had Caleb and stopped breastfeeding, my cycle became pretty regular again, and I always noticed that with a good diet and exercise, my symptoms eased up. When we thought we were ready to start trying to get pregnant with our second, we went to see our reproductive endocrinologist, and I was told that I didn't have any cysts at the time and I was good to go.  

But I feel like there is always a huge question mark when it comes to PCOS. I recently had the opportunity to chat with Dr. Jennifer Schell, MD and ask her some of my (and your) most pressing questions about PCOS. I also included some questions that my followers sent me via Instagram. Keep reading for her responses. 

First of all, what does PCOS stand for? Polycystic Ovarian Syndrome

What is it?  Polycystic ovary syndrome (PCOS) is a disorder characterized by an excess of male hormones (testosterone) or symptoms like acne and excess hair around lips, nipples etc, ovulatory dysfunction, and polycystic ovaries. The cause remains unknown, and treatment is largely symptom based and on a case by case basis. PCOS patients can be at increased risk of diabetes and cardiovascular disease.

How common is PCOS? It’s debatable but some criteria say between 55-91% of women.

What are the most common symptoms of PCOS?  Irregular cycles, hirsutism (excess hair like a mustache, around nipples or belly button), and acne. Many are overweight and it’s difficult for them to lose the weight despite healthy habits.

When I was younger, my PCOS was managed by taking birth control pills.  What are some other ways that I can manage the symptoms of my PCOS? Birth control pills are probably the best way. I usually prescribe a diuretic called Spironolactone along with my go to pill Ortho Tricyclen to improve my patient’s acne and hirsutism. This combination lowers the amount of circulating testosterone. One of the most serious problems that can occur when a patient with PCOS (not on hormones) doesn’t menstruate is endometrial hyperplasia which can lead to endometrial cancer. Birth control pills and IUDs like Mirena and Kyleena help keep the endometrial lining thin and prevent this. Some people may need to take a pill (usually Provera) to induce menses before starting the above hormonal treatments.
Another medication often added to the regimen is Metformin. It’s excellent for weight loss and to decrease the risk of diabetes. PCOS patients are usually prediabetic.

I recently heard that the Keto diet can help you manage PCOS symptoms. Is this true? I think any diet can help in just helping patients lose the weight. I don’t think the Keto diet is special for this.

Is it true that PCOS can make it difficult for me to get pregnant? Unfortunately, it is true. The reason people with PCOS have irregular cycles is usually anovulation (lack of ovulation).  The good news is that it’s easily treatable with an oral medication.

Can PCOS go away on its own? Unlikely. 

Can PCOS cause miscarriages? What are safeguards that can be taken to prevent a miscarriage, if any? Not really. It’s more a problem to conceive. 

I’ve blogged before about our struggle to get pregnant the first time. Why was it so difficult for me to get pregnant the first time, and then have a happy surprise when I got pregnant again? That is a question that is not easy to answer. I’d love to know more about your circumstances back then: weight, stress level, how often you had intercourse, use of ovulation kits, etc. The majority of infertility cases are diagnosed as “unexplained infertility” and it is very frustrating to both the patient and the doctor. One of the theories is stress levels. Once you get pregnant with your first and then “relax”, boom! 😃 Another theory is that this “unexplained” infertility somehow fixes itself or “resets” after a pregnancy. The truth is: nobody really knows the answer to this common and important question. So glad your second time was easier! I have a friend who had multiple miscarriages, did ovulation induction meds (Clomid and Femara) decided to go through IVF, failed THREE cycles and then I gave her Femara (one of the ovulation induction agents) and she has TWINS now :) ​

Thanks Dr. Schell for all the information! 

How many of us have been baffled by the concept of reading our BBT (basal body temperature) when planning for or trying to avoid conception? I know I have always been. Basal body temperature is your body's temperature when it is completely at rest. In women, BBT rises during ovulation. It is a great predictor of ovulation.

If you have been following my blog for a while, you know we went through some infertility issues. When we were first trying to get pregnant, I tried tracking my BBT a couple months. First, the thermometer I purchased was broken. Then I kept forgetting to check my temperature when I first woke up. At the end of the day we knew we needed a doctor's help so we went with that. 

We aren't necessarily working on number 2 yet, but we are thinking about it. Since we are thinking about it, I wanted to make sure I had a better feel for my body and for what was going on. I had considered ordering a BBT Thermometer, but kept putting it off because I knew I would have to do some research there too. 

But a couple of months ago a friend of mine reached out to tell me about this new monitor. It's called Himama, and it was created to track your BBT. 

The oval that looks like a "button" is actually the monitor. It comes in a hard casing, which is actually its charging station. There is also what appears to be a bralette (but it isn't, because it doesn't cover a thing - which is why you don't see photos of me wearing it), and you insert the monitor into the space on the bralette, and wear it overnight. While you sleep, it records your information. 

When you wake up in the morning, open up your app, and voila! all your information syncs to the app. It is really convenient because the app tells you when you are ovulating, if you are pre-fertile or pre-menstrual. It also lets you know if you did not appear to have ovulated one month (anovulation). 

Overall, I have found it easier to use himama than to remember to check my temperature before getting up to pee every morning. I typically leave it on my pillow so I remember to put it on before I go to bed. It has been a great tool for getting to know my body and learning that I am, in fact, ovulating! 

If you are interested in ordering, visit the himama website. From now until June 30, use the code TTN15 for 15% off your purchase! 

xoxo, 

​Jenise

I have toyed with the idea of writing this post for a while now, but to be totally honest, it scares the hell out of me to put all this out there. It took several rewrites and editing sessions, and out of privacy for my family I am choosing not to include every single detail of our process. This topic leaves me raw and feeling way more vulnerable than I feel comfortable. But it is also a topic that for too many women gets swept under the rug and makes us feel isolated, with only those closest to us being privy to the hard truth of our situation. 

When I was 18, I had really irregular cycles... like every two weeks irregular. Clearly I was a raging bitch, because my dad suggested I go see a gynecologist. So I made my appointment and as soon as I told the doctor my symptoms, he told me, "I'm pretty certain you have polycystic ovary syndrome. But don't worry - it's totally treatable and 7 out of 10 women have it. It might be a little harder for you to have a baby when the time comes, but it won't be impossible." After an ultrasound confirmed this was the case, I was put on birth control and sent on my way. 

To be totally honest, I didn't think about my PCOS very much after that. Birth control pills helped me maintain my weight, controlled the weird hair growth, and controlled the awful cystic acne that was caused by the hormonal imbalances of my PCOS. 

But when Eddie and I were married, it was definitely something we discussed. We were not ready to have a baby right away and we decided we would wait. As soon as we came back from the honeymoon, though, the questions began: "When is that beautiful baby coming?" I usually laughed off the question because it seemed innocent enough. But a couple months before the four year anniversary mark, I started to get the itch in a bad way. We talked it over and decided December would be a good time to stop taking my birth control and let it work itself out of my system. That would give us a few months of wiggle room before our "deadline" (HA!). I made sure to eat really well, I worked out (something I hadn't done regularly since my teens).  

Fast forward to July, on vacation in Greece. I was late - later than I had been in my whole life. I kept attributing it to the travel and the change in our eating and schedule. But deep down, there was a little seed that kept saying, maybe you're pregnant. So when my period started six days late, I broke down. I was miserable. I looked better than I had in a long time because of my fitness routine, and I hated my body. I hated my body for what it wouldn't, and couldn't seem to, do. 

After the trip, I went back to my doctor and had her check me out. She ran a few tests and suggested I wait a few more months. In November, at my wit's end and unable to handle the disappointment that came every month, we made an appointment with a reproductive endocrinologist. After a few months of tests, he suggested we begin with the most non-invasive methods available. First would come medication, then if that didn't work after  a few cycles, we would move on to IUI (intrauterine insemination), and the last resort would be IVF. Hearing all that was the scariest thing I had ever heard. I wanted a child more than anything in the world, but spending upwards of $10,000 on treatments left a huge lump in my throat. 

All the while, people were still asking, "When is that beautiful baby coming?" I can not tell you the pain I felt each time those words were uttered. It was as if everyone was reminding me that my body couldn't do it's job. I know that wasn't the intention, but it certainly felt like it. My response went from a fun "We're working on it!" to kind of just shrugging my shoulders and casting my eyes downwards. It's so much damn harder than anyone ever imagines. In the meantime - friends are getting pregnant and announcing their pregnancies. We were, of course, elated for them, but each time someone announced their pregnancy it broke my heart a little more. 

Finally, in April, after debating for a few months, we decided to give medication a chance. We had a million things going on - we had just begun major construction on our home, I had just been hired at a new school, and my photography business was thriving.  But we had wanted this for so long. I honestly went in hoping and praying for the best, but expecting it not to work. We were pretty open with the people closest to us and we talked about what was going on. We knew that the more people knew, the more they would understand, and the more prayers would be on our side.  I know that God had his hand in just about everything - it was as if everything had been perfectly aligned for us. Fast forward two weeks later (which was really like slow motion because it felt like the longest two weeks ever) and we found out that it had worked! I know so many prayers were said for us over those two weeks - candles were lit at the Shrine of Our Lady of La Leche, prayer cards exchanged hands, prayers were said over us.  

I had an incredible pregnancy and a pretty relaxed birth. I think that was God's way of saying - I made you wait long enough, and you've paid your dues. We got lucky that things worked as they did and that we did not have to go through with more invasive treatments. 

But shortly after Caleb was born, those questions started again.
"When is number two coming?"
"You don't want an only child for too long!" 
"How about that little girl now?"
"You know, those grandparents would love to have another baby to love on." 

My response now is not quite as laughable - I tend to be curt and change the topic. Because honestly, I don't know when it will happen again. I don't know if it will take us that long to have another baby. And the older I get, the more the question seems downright rude. I don't ask you when you have sex with your husband or wife - don't ask me a question that is more personal than any other. I honestly don't care about what anyone else except my husband and I want in regards to children because I know it's none of their business. (And don't even get me started on the girl question... that one makes me blow steam out of the ears) Sometimes I think people must really be so tactless to ask some of the questions that they do - especially when they know what we went through to get our son. 

Sometimes I get sad because I don't know if my dream of having three children will ever be realized. I look at my son in wonder and awe because I know the miracles that occurred to get him here. I look at my husband with different eyes because of the patience and understanding he had in those most difficult of days, and because of the comfort his arms brought me in the biggest of my breakdowns. I pray every day for couples everywhere who are going through this. 

So the next time you feel compelled to ask a young woman when she plans on bringing a new life into the world, think again. Weigh your words. Ask gently. Because you may be causing more harm than you could ever imagine. Because when you want to be a mother, and can't, words hurt. They sting. They can feel like the weight of the world, pushing you down. 

And if you are the one being asked that question, I am with you. You are not alone. There are so many like you. It doesn't make it hurt less, but it makes it more bearable. You will never be alone. 

xo, 

Jenise