Tired of Being Tired

While my sleep is certainly not as interrupted as it used to be when WZW was less than a year old, it continues to be affected thanks to him.  I think the best time was when he was a year old.  He would sleep for 12 hours a night and take 3+ hour naps during the day.  It was amazing for us parents!  As he got to about 2 years old, his sleep needs diminished and he now sleeps on the order of 10 hours at night and takes 2 hour naps.

During the work week, we are all up before 6 am.  But that also means that on weekends, WZW goes to sleep around the same time and still wakes up super early.  Even if I have an uninterrupted night, I can count on being woken up in the 6 am range, sometimes earlier.  My problem is that I need 8-9 hours to feel truly rested, so it’s hard to get to bed on time.  I usually have a bunch of things I need and want to do after WZW goes to bed.  Even if I go to bed at the reasonable time of 10 pm, getting up around 5:30 am means that I’m still feeling a little groggy.

Also, more recently WZW has been having nightmares and will start crying at night and need to be attended to.  Even though my husband takes care of him most of the time, the interruption seems to affect my sleep.

The result of all of this is that even on weekends, I’m often finding myself still feeling tired.  And having that continue chronically is tough.  Granted, I usually do get some restful nights here and there.  But still, I am tired of being tired all the time.  And then in the back of my mind, I do wonder if that is affecting my fertility.

One of the acupuncturists said that maybe 60% of her clients who are trying to conceive are those who have children already.  I’ve mentioned one friend from residency who has tried cycle after cycle of IVF and is finally well into her pregnancy with baby #2.  But I recently spoke to another friend from residency who is also having trouble conceiving baby #2, and is starting IVF.

Of course, it doesn’t help that we’re all in our late 30s and our fertility is declining.  But part of me wonders if the combination of our modern lives with the inherent stresses from work, combined with the stress and lack of sleep of having a young child, then affects our fertility.

I repeated my labs because it had been a year since I’d last done them, plus they wanted updated ones as I get set up for IVF.  The FSH, which is typically drawn on cycle day 2 or 3, was still stable around 5 and hadn’t changed since last year so that’s reassuring (lower is better).  My AMH, which is a marker of ovarian reserve, last year was 1.64 and now it’s 1.01.  Last year it was in the normal range, and now it’s on the low side (higher is better).  Many women with an AMH below 1 do still conceive with IVF.  I’m not super familiar with these labs since I’m not a fertility specialist, but my understanding is that the labs give us a general sense of the fertility potential.  In other words, is it normal, low, or clearly past the point that IVF would work?  The change in my AMH confirms that my fertility is declining thanks to age.

Part of the reason I made the decision to move to IVF is that at my particular location, the fertility docs have a backlog and it can take a few months to get in for the procedure.  I have my consultation scheduled in a couple of weeks, and from there the actual IVF procedure probably won’t happen for a few months.  So I figure I’ll continue the Clomid until then.  And if I haven’t conceived, then it’s clearly appropriate to go to IVF by that point.

This month, I decided to take a break from even the Clomid since I was tired of all the appointments and such, plus my husband was supposed to be out of town around the time ovulation was anticipated.  I have to say it’s kind of nice not having any ultrasound appointments or taking the medications.  Plus since my insurance coverage for acupuncture has maxed out, I’ve stopped that as well.  So it’s been nice not having my off days be filled with acupuncture and fertility appointments.

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Pulling Out All the Stops

Since WZW was born, I never went back to being strictly on the Paleo diet.  Initially the sleep-deprivation made a huge impact, but even as that improved (thank goodness!), other factors continued to affect my lifestyle.  Time is the biggest factor- no longer could I leisurely exercise after work and come home at 8 pm.  Nor do I have the energy to prioritize meal prepping.

Instead, I’m spent after my work days, and feel like everything else goes towards dealing with a nonstop toddler.  I’ve grown accustomed to eating lunches made by Trader Joe’s, or eating what’s offered at work.  On Mondays, which are the busiest for me and my husband, we get dinner delivered by Munchery.  While we can choose options that aren’t totally carb-laden like pasta, the meals usually involve a starchy side.

A lot of it was my mindset as well- with the stress of work, and dealing with a toddler, I just felt like prioritizing eating was something I didn’t have the capability of doing.  So I got used to comfort eating, and not trying so hard.

But I started realizing that it’s expensive to be half-assing the Paleo lifestyle.  We spend extra money getting things like Paleo crackers and gluten-free bagels from Whole Foods.  It would be one thing if I was really following the diet, but since I haven’t totally been, it’s kind of a waste of money.  It’s like buying organic produce, and then eating Hot Cheetos.

A workplace “Biggest Loser” competition has also motivated me to focus more on my eating habits again.  One of the ladies at work decided to start a Biggest Loser challenge for those who are interested.  Her intent is to promote healthy living, so although there is a cash prize for the winners who lose the most weight, the contest will last 6 months, and among other rules, no fad dieting or other unhealthy methods of weight loss are allowed.

I decided to participate, not with the intention to win (because hopefully I’ll get pregnant during the 6 months), but as a motivator to eat better and also exercise more when I can.  I also wanted to help motivate and educate our staff participating.  So far we’re one month in, and I have been better about avoiding dessert, and being less lax about the carbs.  My husband has been monumental in doing the bulk of the cooking.  The exercising is more difficult due to time constraints, but I’m doing what I can.  Sadly, at the one month weigh-in, my weight still hadn’t budged, but I’m trying not to let that get me down.  I need to focus on the fact that I’m taking better care of my health by eating better.

In addition to the lifestyle improvements, I also decided to get referred to the fertility docs, the REIs as we call them (reproductive endocrinology and infertility).  After 6 months of trying, given that my age is over 35, I qualified for referral.  At that point, I asked my doctor/colleague to check my labs.  We checked my cycle day 3 FSH, which if elevated would indicate age-related infertility.  I was concerned that’s what the issue was, especially since my mom went into menopause on the earlier side.  The FSH was in the normal range.

So that’s a relief, but then what’s the issue?  It’s hard for me not to blame myself for not eating better/being at a healthier weight, and for being under too much stress.  Ultimately, I’m doing the best I can with the situation I have, and logically I tell myself not to get down.  But it’s hard not to beat myself up.

After another 2 months passed for a total of 8 months of trying, I decided I shouldn’t waste too much time and went ahead with the referral.  I have yet to meet with the REI doc- we have to complete our labs, and then schedule the consultation.  In the meantime, I decided to look into another modality to help me with fertility- acupuncture.

My first exposure to the concept was the episode of Sex and the City where Charlotte gets acupuncture to try to help herself get pregnant.  I don’t know much about it, and hadn’t thought about it recently until one of my patients mentioned using it to get pregnant.  That reminded me that one of my OB/Gyn friends had said she used it while doing IVF, at the recommendation of her REI doc.  She wasn’t sure if it helped, but at the very least it helped her destress.

Once I started asking colleagues and friends about it, there were all these mentions of, “Oh yeah, so-and-so was having a hard time, and finally got pregnant after doing acupuncture.”  Of course, it doesn’t work for everyone, and one of my colleagues said it didn’t work for her (she later succeeded with IVF).

Given that my insurance has coverage of acupuncture, I figured I didn’t have much to lose.  I still don’t know the data regarding acupuncture and fertility.  And I’m not sure how best to find a trustworthy practitioner.  But so far, I completed my first session.

I filled out a health questionnaire with some different inquiries than you’d find on a Western medicine form- things like the color and consistency of my menstrual flow.  The practitioner checked my pulses (done for a different purpose than in your usual medical office), and my tongue.  Then she proceeded to do the needles and left me for 30 minutes, during which I started to drift off.  It was similar to what people probably experience during a massage or savasana at the end of yoga.

Though I didn’t think I fell completely asleep, I did end the session feeling more energetic.  I’d also been feeling more anxious from my general stress, and that feeling improved as well, which was a pleasant surprise.

Interestingly, she said that she recommends eating in line with the Paleo diet more or less.  Her list of foods allows quinoa and buckwheat, but mostly everything else goes with Paleo.  She recommended eating lots of eggs.

One big difference is that based on the Chinese medicine recommendations, she advocates eating only cooked foods- that means no salads, no yogurt for breakfast.  That is going to be hard- especially avoiding raw fruit.  Now, these recommendations probably aren’t for everyone trying to conceive.  It’s based on my particular constellation of issues.

In my limited understanding of Chinese medicine, I know that there are various organs that are different from the same organs in Western medicine.  My acupuncturist said my “liver” is too strong, and the “spleen” is weak, which is the reason for the dietary recommendations.  My friend said that they generally work on the “kidney” system for fertility issues.

So we’ll see how it goes.  Hopefully between the healthier eating, acupuncture, and eventually seeing the REI doc, we will finally get pregnant.