AMH and Adrenals

Ed note 5/30/09: I discovered that I mysteriously lost part of my post, so I added it back in. If you read this post before this date, you might want to read the beginning again.

Tomorrow will be day 3 of my cycle. I know it seems like yesterday when I posted on my day 3 results, but since I have the world's shortest luteal phase (a whopping 7 days this time), day 3 has come around again. I will be waiting one more cycle to do my official day 3 testing at BigShotFertilityClinic. You see, I've been holding out on you. I did have my AMH tested after all, and let me tell you, it was grim. BigShotFertilityClinic likes to see a level above 0.6, and I think that is even kinda borderline. Mine was 0.1. At least I didn't get back a result of less than 0.1, so I guess it could have been worse. AMH is used to predict resting follicle levels and sometimes IVF success. The predictive use of AMH for IVF is fairly new. Basically, what this means is that my ovaries need some serious resuscitation! Skip the CPR, and fire up the electro-shock pads!

I immediately consulted Dr. Google when I got the bad news. I wanted to know if the AMH number could change with Chinese medicine and acupuncture. I did find some information that it can change, and that women with low AMH do get pregnant! My acupuncturist EM wants to increase my kidney yin, and thereby AMH, by taking more evening primrose oil. In Chinese medicine, when they talk about an organ, like kidney or spleen or liver, they don't necessarily mean the actual organ. For example, a kidney deficiency, either kidney yin or kidney yang deficiency, usually refers to one's fertility. It can also refer to adrenal function, and the adrenal glands sit on top of the kidneys. I was comforted when EM said, "we treat the patient, not the number."

Part of my strategy of improving my fertility was to have my adrenal glands checked. I have a friend who finally had success getting pregnant at age 42 with her own eggs after battling infertility for seven years. She had one failed IVF with her own eggs and one failed IVF with donor eggs. She never gave up and kept looking for answers. Her success came when she was treated for her adrenals and sub-clinical hypothyroidism. Her thyroid numbers were normal, but she had all the symptoms of hypothyroidism. She gave birth to her daughter at age 43.

I did a test with Dr. F, my other acupuncturist, to test my "Adrenal Stress Index" through Diagnos_Techs lab. I was diagnosed with adrenal fatigue. The good news is that I have a mild case of it, so it will be fairly easy to treat. I dusted off my copy of "Adrenal_Fatigue, The_21st Century Stress Syndrome" by James_Wilson. It had some interesting things to say about taking DHEA and pregnenolone for adrenal fatigue:

"It is my clinical experience that women often do not do well on DHEA unless their adrenals are very fatigued. Levels as low as 10-25 mg have produced symptoms of excess DHEA, such as facial hair and acne. A safer and more successful way of raising DHEA levels in women is to have them take either progesterone or pregnenolone, although some studies of women with chronic fatigue syndrome or lupus have found benefit from using 200 mg of DHEA/day."

I have problems with taking DHEA. It raises my testosterone levels and gives me heart palpatations. I already have high testosterone, as expressed by my "sexy"_Lauren_Bacall voice, and I certainly don't need anymore! I take pregnenolone instead, about 60 mg a day, though I'm experimenting with taking up to 120 mg per day. When I have taken DHEA, I can only tolerate 5 mg a day, and only for about 5 or 6 weeks, before I have to switch back to pregnenolone. BigShotFertilityClinic recommends 75 mg of DHEA twice a day to improve egg quality. I would drop dead if I took this dose, or start growing a beard, neither of which appeals to me. I respond much better to the pregnenolone.

"Progesterone and pregnenolone are hormones that are manufacutred in the adrenal cascade as well as in the ovaries and testicles before they are metabolized into DHEA. Both can be converted into several other adrenal hormones besides DHEA, including the sex hormones, aldosterone and cortisol. Thus, taking replacement hormones like pregnenolone and progesterone that occur early in the adrenal cascade lets your body's wisdom choose which other hormones it will make from them, according to your body's needs. With adrenal fatigue, the sex hormone levels often fall because your adrenal glands are not able to manufacture adequate levels of hormones."

Pregnenolone is a precursor to DHEA, as you can see in the flow chart below. Pregnenolone is also a precursor to other hormones, and that's why it's safer than DHEA. Your body can determine where you need it the most. Maybe your adrenal glands have to heal before you can produce more of the sex hormones. We all know how stressful infertility can be!



I am also taking a cortisol supplement called Iso_Cort, though I have already had to cut back on that after taking it for a couple of weeks as I'm starting to get symptoms that I am getting too much cortisol, such as rapid heartbeat and anxiety.

Another strategy for me to improve my adrenal health is to go to bed by 10:00pm. This is very hard for me, and I have had to set limits on my internet use at night. In fact, I am already past my "internet bedtime"! Couple this with my busy schedule at work, and I've been a pretty lame commenter this week for ICLW. I will post more about the other supplements I have been taking to improve egg quality and to improve my mental health.

Anatomy of a Panic Attack

Or was it?

I woke up at 4:00am this morning, which is pretty typical for me. I checked in with my body. Usually, if I eat something and stretch a little, I can get back to sleep. So I got up, had a snack, popped a 5-H.T.P, just to cover all my bases, and listened to a relaxation tape to get back to sleep. I had a lot of thoughts going through my head about yesterday's events. I decided that I was going to meditate while listening to the relaxing sounds of waves, but my heart had other ideas. It was pounding. I felt like I was having the physical effects of a panic attack, without the mental freakout. I wondered if it was really a panic attack after all?

Stress
I decided to consult my book on adrenal fatigue to try to get some answers. First, I did not eat breakfast yesterday. Bad news if your adrenals are maxed out. I figure I pretty much live in a state of adrenal stress, and it will remain that way until I retire. I rarely miss breakfast, but I was rushed for my early morning appointment with Dr. G.

Second, this was my first appointment with an RE in seven months. Any trip to a fertility clinic is stressful. It didn't help that we were interrupted by a frantic knock on the door and a call for Dr. G to help a woman. I had no idea what was going on, though I made up some good, but terrifying, fantasies about it. Apparently, a woman had passed out after her bloodwork. Maybe she skipped breakfast too.

I did a pretty good job of not completely melting into a puddle of tears during my visit with Dr. G, though there were a few tear-jerking, pull-out-the-tissues moments while I was giving my background. I couldn't totally avoid my whole story. The information I was given by Dr. G was not comforting, though it was helpful. More difficult decisions will have to be made if I decide to go forward with FET or another fresh cycle. The stress from this one visit reminded me of all the anxiety I've sucked up for every RE visit, ultrasound, or bloodwork.

*insert your favorite expletive here*

Shortly after the RE visit, I had a meeting in which chocolate was available o-plenty. I had recently weaned myself of chocolate but went off the wagon as a cure for Wednesday's hangover. I decided this morning that the chocolate wasn't a good idea either for my stress.

Immediately after the choco-fest meeting, I'm faced with my co-worker's newborn. I made myself stay there, instead of doing the usual scurrying- away-before-she-sees-me tactic. It was too late to do that anyways. I also asked to hold her baby, because I wanted to see how I would react. Perhaps the timing wasn't stellar just after my RE meeting, but the Universe has an uncanny way of putting things in my face when I least expect it.

*more, but tamer, expletives*

That all added up to a lot of stress that I have not dissipated yet. I'm having lots of reminiscing about unpleasant pregnancy memories today, what ifs, and just general gloom-and-doominess. This is not a good path that I should be traveling down.

To DHEA, or not to DHEA
I was pleased that I did not get any DE lectures yesterday, but the "do you take DHEA" question came up. I told Dr. G that I was on 5 mg of DHEA. He was curious why I didn't take more, as REs kinda tow the line of taking quite a bit more than that to improve egg quality. I responded that I have high testosterone with only 5 mg. I've got a Lauren Bacall type of voice, but there is only just so much more I want my voice to get deeper anyways. As it is, I get mixed up with Magic when I answer the phone (and vice versa!). My testosterone is on the high side anyways without DHEA, and I certainly don't want any more facial hair than I already have. I went back on DHEA 12 days ago when I had another craptacular cycle, this time my second shortest at 14 days. The record breaker was three cycles before that at 13 days. It seems that I get all geared up to ovulate, and then I get my period instead. I'm completely befuddled by this, and of course did not utter word of it to Dr. G lest he throw me out of his office right then and there. I'm assuming it's due to poor egg quality and the DHEA would help. However, DHEA has an annoying side effect. I was curious if my heart pounding had anything to do with the DHEA. Dr. Google confirmed my suspicions. I also read that DHEA can cause abnormal menses. I decided I would stick with pregnenolone supplementation, which is another hormone precursor, but safer than DHEA. Pregnenolone is a precursor to progesterone as well as other important hormones, including the ones that DHEA is a precursor to.

I'm left wondering if I am experiencing some trauma reaction to yesterday's events, the side effects of DHEA, or a little of both. It's clear that I need to be more vigilant about stress in my life. Stress is the fertility killer.