Secondary Infertility Sucks!

Almost 2 years ago, Mark and I decided we wanted to have another baby.  We had no idea what the next twenty four months would have in store for us.  After a year of trying, I decided to have some tests done to make sure my baby-maker still worked.  Everything came back good, which was a relief and a burden at the same time.  I had thought that if they found something wrong, they could treat it and I’d get pregnant soon after.  But nothing was wrong.

About six months later, Mark got tested as well.  We worried for weeks when there was no call from the doc.  Turns out the had figured they didn’t need to call because they didn’t find anything abnormal.  Meanwhile we were looking into treatments for issues we didn’t even have.

May 29th, to my absolute delight, I found out i was five weeks pregnant.  Mark and I were beside ourselves with joy!  We called out parents and my siblings, then decided to keep the news a secret from everyone else “just in case”.

Well two days of joyous bliss came to a screeching halt when I awoke to some serious bleeding.  I spent the next two days crying and feeling sorry for myself, distancing myself from everyone and letting the machine pick up all my phone calls.  The two most wonderful days had been followed by the most horrible day imaginable to a woman who wants nothing more than to have another baby.

After several visits with my OB (many of which have been diagnosing my high blood pressure) we’ve yet to come to a decision as to where we wish to go from here.  I truly want another baby, but I’m not sure if I can put myself through another two years (or more, who knows?) of trying with the possibility of another miscarriage looming overhead.

I had yet another set of blood tests run today, and a discussion with my doc about various medications I could go on to help me get pregnant.  There is Chlomid, but with a high chance risk of multiples, I don’t want to try that out.  I have Poly Cystic Ovarian Syndrome (PCOS) and she mentioned that they is a great success rate for women with PCOS who use Metformin.  I have heard of the drug, but know very little about it.  I know it is far less costly than Chlomid, which will run you $200 out of pocket initially, plus refills and monthly check ups.  So I did a little research, mostly concerned with side effects.  Here is what I’ve found so far:

MALAISE. 10%- 25% of women who take Glucophage just don’t feel well. They experience a general malaise, fatigue and occasional achiness that lasts for varying lengths of time. Malaise a signal for the physician to closely monitor body systems affected by metformin, including liver, kidneys, and GI tract. A blood count should be taken from time to time, because metformin can induce B vitamin insufficiencies that can lead to a form of anemia.   (this doesn’t scare me, I can deal with being a little tired)

GI DISTURBANCE. About one third of women on metformin experience gastrointestinal disturbances, including nausea, occasional vomiting and loose, more frequent bowel movements, or diarrhea. This problem occurs more often after meals rich in fats or sugars. The symptoms lessen over time, so if you can tolerate the GI upset for a few weeks, it may go away. Some women have found it helps to start with a very low dose and gradually increase it. One “benefit” of these unpleasant symptoms is that you find yourself eating less and thus losing some weight.  (I wouldn’t mind losing a few pounds!)

VITAMIN B12 MALABSORPTION. Of patients who take this drug, 10%-30% show evidence of reduced vitamin B12 absorption. A substance formed in the stomach called “intrinsic factor” combines with B12 so that it can be transferred into the blood. Metformin interferes with the ability of your cells to absorb this intrinsic factor-vitamin B12 complex. (so I take extra vitamins, right?)

ELEVATED HOMOCYSTEINE. People who take Glucophage tend to have higher homocysteine levels.(14) Women with PCOS also tend to have elevated homocysteine.(15)

Homocysteine is an amino acid in the blood. A normal amount is OK. But an elevated level means that your metabolic processes are not working properly. Elevated homocysteine is associated with coronary artery disease, heart attack, chronic fatigue, fibromyalgia,(16) cognitive impairment.(17), and cervical cancer. (18) (this on sounds a little scarey, i may need to find out how high the chances of this are)

ANEMIA. By preventing optimal absorption of vitamins B12 and folic acid, metformin could induce or contribute to megaloblastic anemia.(23) Megaloblastic anemia occurs when your bone marrow doesn’t have enough B vitamins to manufacture red blood cells. Your bone marrow then releases immature and dysfunctional red blood cells into circulation.

LIVER OR KIDNEY PROBLEMS. If you have liver or kidney problems of any kind, metformin could pose a problem, because it alters liver function and is excreted through the kidneys. A healthy liver and kidneys will improve your outcome with metformin. Liver and kidney function should be assessed before starting metformin and rechecked at least once a year while taking it. A blood chemistry screen and a complete blood count will tell your physician how well your system is doing with this drug

HAIR LOSS. Metformin may contribute to male pattern hair loss at the temples and top of head. Although there’s nothing in the medical literature to support this linkage, some women have reported that hair loss was made worse by metformin.(24)  (I have a lot of hair, but i don’t want to loose much of it)

LACTIC ACIDOSIS. About 3 of every 100,000 people who take metformin will develop a medical emergency called “lactic acidosis”. Lactic acid is a metabolic byproduct that can become toxic if it builds up faster than it is neutralized. Lactic acidosis is most likely to occur in people who with diabetes, kidney or liver disease, multiple medications, dehydration, or severe chronic stress.

BILE ABNORMALITIES. Bile is produced by the liver, stored in the gallbladder, and secreted into the intestines in order to absorb fats into the bloodstream. One possible reason for the GI problems is that metformin reduces normal reabsorption of bile from the intestines back into the bloodstream, which causes elevated bile salt concentrations in the colon.(25) Most studies suggest that colonic bile salts cause free radical damage to DNA and may contribute to colon cancer.(26,27)   (EEEW!)

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