Preconception Charting

As I mentioned in my last post, after a long period of titrating down my medications and some visits with my new doctor, who is a specialist in reproductive psychiatry, we are officially trying to conceive (TTC).

One of the concerns that my doctor expressed is that just the process of trying to conceive itself can be very stressful. I can already see why, but then I’d say for us the process of getting ready to try was also very stressful, so this is just a different phase of the experience of planning to and trying to expand our family.

As I was trying to find out about the risks of antidepressants and depression on pregnancy, I read some books on pre-conception health. My favorite was The Impatient Woman’s Guide to Getting Pregnant, because it felt more like advice from a girlfriend than clinical lessons from a doctor.

I also have read portions of Before Your Pregnancy, which is practically a textbook, and Get Ready to Get Pregnant, written by a male ob-gyn. While both are filled with great information, they are also filled with do’s and don’ts that can make a woman worry that she is never going to live up to the health standards they recommend. The suggestion is that you practice these healthy behaviors for at least 3 months before TTC and then throughout the process of TTC and pregnancy. If you’re lucky that adds up to a little over a year but it wouldn’t be unusual to be 2 or more years.

One of the things I read about is charting, the practice of observing your body’s fertility signs daily so that you can tell if and when you ovulate and when to expect your period. Usually this involves taking your basal body temperature (BBT) each morning upon waking and checking the consistency of your cervical fluid. It may also include taking ovulation predictor kit tests (OPK) and checking your cervix position. Using these techniques you can usually pinpoint your ovulation day, and then you can assess whether you had an optimal intercourse pattern and a healthy luteal phase (time between ovulation and period) length.

It’s not too useful to track this while you are on hormonal contraception, such as the birth control pill (BCP), because that regulates things for you. Additionally, I learned that it’s not uncommon to have irregular cycles or to not ovulate for a few months after BCP.

So even though we weren’t yet TTC, in January I stopped BCP and began charting. I didn’t really know what to expect and braced myself for the possibility that I wouldn’t ovulate for a while. While I had no real reason to believe that I didn’t have a healthy reproductive system, in the past I had experienced some very painful cysts and had vaginal ultrasounds done (not fun!), so I was looking forward to more information about my cycles and hopefully evidence that everything really was fine.

The charting was complicated a bit because a dr I saw at the time put me on levothyroxine as an addition to my antidepressants; I am often so low on energy and she has found success with that as treatment before. It’s a thyroid medication, and might affect basal body temperature. So it may have affected my chart; I think it raised my BBT a few tenths of a degree. I stopped taking it at the end of that cycle. I had a high amount of temperature fluctuations and no fertile cervical fluid (also something that takes a little while to return to normal after BCPs).

During the cycle, as I tried to track my waking temp and check and classify my cervical fluid, I experienced anxiety and confusion. At first the software I used (FertilityFriend.com) thought that I ovulated on the 8th day, which meant that some of the unprotected sex we had thinking I wasn’t fertile yet was actually during my fertile period. As I watched my temp after that, it later went up again and the software suggested it might be triphasic, which while not a guarantee of pregnancy, does occur more often with pregnancy than without. So for a couple of days I thought we may have already gotten pregnant, and somewhat anxiously told my husband of my concerns. The next day I tested negative and the tool moved my ovulation from day 8 to day 21, the point that it had originally thought was a triphasic shift. So there ended that.

Fluctuating temperatures and scant cervical fluid aside, I was able to pinpoint ovulation on the 21st day of my cycle and calculate a 12 day luteal phase. I was excited and happy to see that even after about 11 years of hormonal contraception usage, I was one of the lucky ones with ovulation and a pretty normal cycle. By the end I felt better, having charted and learned about my body, than I had before the cycle began.

But how would this experience change once we were actually trying to conceive? I’m just now finding out.

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We’re finally ready to start a new journey

It’s been a while since I’ve posted here, but I’ve been feeling the need to write again lately, and today feels like a great day to start.

So much is different from the last time I wrote. About a year ago I got my energy up and my resume together and started applying to jobs. I got a good amount of interest and interviews and ended up with opportunities at several places, most of which were great and 2 of which seemed like dream jobs. After consideration I picked one, putting the opportunity to work on a team of people who I could learn from above my initial interest in the industry, and also keeping in mind how well the role and culture would likely work with our plans to start a family.

Almost a year ago now I started there, and I couldn’t be more happy about it. I’ve grown tremendously, get to do important work for the company, and really enjoy the company of my coworkers, who are smart, hard working, and fun. On top of that my income has nearly doubled! (I’m still amazed to be able to say that!)

It’s the best job I’ve ever had, and I feel so lucky.

During this year, we continued working on lowering my antidepressants, because we wanted me to try going off them before getting pregnant. At the time I was on a significant dose of both Wellbutrin and Prozac. All told I think I’ve been working on reducing that for over 2 years! As I got to a minimal dose of both and then just one, I realized I was struggling again. But when I saw my doctor in the fall in that state of mind, I didn’t have the strength to tell him no when he, not bothering to ask how I was feeling, suggested we take the final step and drop it altogether.

As the fall continued I slipped further, having a harder time talking to my husband about what was on my mind, worrying more and more, ruminating often. Life was stressful as we filed to sue his former client and my former employer for nonpayment of a considerable sum, and as he worked less while dealing with the case money was getting tight again, but I didn’t share my fears of being broke again. Instead, I stayed in my head, worried and sad.

As fall turned to winter I stopped getting up to go to the rink. Still loving work, I managed to keep it from affecting my job performance more than a little, but it definitely affected my relationship and my marriage.

One day it came to a head, and I realized I could and should do something about it. So I went back to the doc and told him this wasn’t working, and I wanted some meds again. He gave me meds but sighed and acted like he didnt want to, and he didn’t consider that we should try the safest one because I might need to stay on it. He just said, “This is going to delay you further. You will need time to get this out of your system again before you start.”

I started crying, quietly, and he either didn’t notice or didn’t care, because he said nothing. So I left with my prescription and a plan to find a new doctor, crying on the train and in the park before collecting myself to go back to the office.

That’s when I found a reproductive psychiatrist – someone who specializes in mental health and medication during events like pregnancy and breast feeding. She has deep knowledge in the area and gave me lots of information about all of the studies on both SSRI’s and Wellbutrin during pregnancy. I am so glad to have her to work with me, and with her guidance we’ve switched me to Zoloft, as it has less accumulation in the baby’s system than Prozac and is better for breast feeding than Wellbutrin.

If you check my archives you’ll see that I had baby fever over 6 years ago, and I’m elated that everything is in place now. I have no depression symptoms, am happy with my job, we moved to a nicer, more baby-friendly apartment and neighborhood, and husband is ready and excited too.

So, I’m super excited to say that as of tomorrow, I will have completed my medication transition plan, and we are ready to try to conceive!