Friday, March 5, 2010

What's up with the soy?

Tena commented that she wasn't clear about why I am taking soy or what exactly I am doing. I actually don't know how specific I've been, though I've explained it elsewhere, so allow me to rectify that!

What I'm doing is taking soy isoflavones in an effort to induce an earlier ovulation.

Soy isoflavones are a phytoestrogen, and are chemically similar to, though weaker than, Clomid. When taken as one takes Clomid, soy isoflavones can work in the same way; which is to say, they bind weakly to the estrogen receptors, blocking estrogen, which fools your body into thinking you don't have enough estrogen. In turn, that propels the body to produce more FSH (follicle stimulating hormone) to produce follicles, which in turn produce estrogen. In women who don't ovulate or ovulate late, taking Clomid (or soy isoflavones) for a short time, early in the cycle, can move up ovulation and/or produce a better quality follicle. Additionally, the sharper peak of estrogen is thought to produce a stronger ovulatory response, and in turn, a stronger progesterone response (which is why Clomid is given to women with luteal phase defects who otherwise appear to ovulate on their own).

The concern with a late ovulation can be two-fold: one, that the oocyte is weak or fragile or otherwise impaired. Ideally, the hormones in the body work in harmony and prepare the ovum within an ideal time-frame. Studies have indicated that eggs that are late in 'hatching' can have weak shells (which could potentially allow more than one sperm inside, creating a trophoblastic or molar pregnancy) or more likely to degenerate before conception can be acheived or shortly after. There are linkages being made between late ovulations and higher miscarriage rates, later implantations (which also carry higher miscarriage rates) and blighted ovums. The theory goes that the cells are too weak to copy properly, resulting in early miscarriages.

The second concern is that the uterine lining may be of insufficient quality for implantation in women who ovulate late. This could be because the estrogen is too little to properly build it up during the follicular phase, or it could be a result of being built up for too long a period of time, making it inhospitable to a blastocyst that is attempting to implant.

So most RE's will work to correct an ovulation which occurs after 21 days in the cycle, and most often will do so by attempting to correct a hormonal imbalance (which is often considered the culprit in late ovulation).

Now my OB said, when I questioned her, that late ovulation is not a concern if you are getting pregnant. And truly, late ovulations occur regularly and women routinely produce pregnancies from them. Of the four pregnancies that were conceived while trying and charting, they were all conceived from ovulations occuring between cd23 and 26 - the exception being the ectopic pregnancy, which technically occurred on cd 35 - but within the same time from the cessation of bleeding, if that makes sense.

The RE who did my shg indicated that he would have a little more concern about the late ovulation if he were treating me, but would encourage weight loss before medication.

This is because fat tissue traps and stores excess estrogen. And certainly can be a reason for the long cycles - indeed, my cycles were a few days shorter when I weighed less. What could be happening is that there are lower levels of FSH being produced in my body, because there is a constant level of estrogen being perceived in the hormone loop. In turn, this drags out the follicular phase, because it takes longer for there to be sufficient FSH to develop a follicle and trigger the remaining hormones to act accordingly. It could also mean the eggs being produced are of less than stellar quality.

I am not ready to move on to trying more intense measures or medications. I don't think I need them yet; I am hopeful we can produce a viable pregnancy without them (not to mention, insurance doesn't cover them). Getting pregnant has thus far been less of a challenge than staying pregnant. But it doesn't escape my notice that only one of the pregnancies has been viable. Certainly, there are a number of factors involved and late ovulation may not be related at all - the RE seemed to think it was more likely due to MTHFR.

But, my feeling is that if I can fix it in some way, I should try. It at least gives me one more thing to have a measure of control over and takes the sting out of ttc again. I tried Vitex for several months, but it didn't do anything for me. It works on the pituitary gland to balance estrogen and progesterone levels, and helps reduce prolactin levels. I don't think those were the real issues, and that's why I don't think it did much for me.

Soy is something which is a little controversial. There aren't good studies, but there is a lot of anecdotal evidence. It's not something to do without some research, as there can be side effects to taking soy in this manner (see: my last post). But it also isn't likely to do harm (and the pharmacist did clear it to take with my prescription medication - never mix supplements and medications without guidance!!!), though there simply isn't enough good evidence to say for certain. In fact, too much soy - at least the processed versions we tend to eat here in the West as meat-replacements - has been shown to have a negative effect on fertility, because it is a phytoestrogen. In large quantities (unlike the small quantities taken for a limited time like Clomid), it acts as excess estrogen in the body, the effects of which I describe above. Additionally, there is some evidence that soy could also have an effect on the thyroid, so women with hypothyroid conditions are advised to avoid high quantities of soy.

However, there is a fair amount of anecdotal evidence about soy out there. Certainly, it has helped women regulate their cycles or bring back ovulation - it seems to have been particularly helpful for some women with PCOS who did not respond to Clomid. And it seems to have helped women with longer cycles, like me.

It should be taken like Clomid, for a 5 day period at the beginning of a cycle. The traditional days for Clomid (1-5, 3-7, 5-9) are generally treated the same way. The theory goes that if you want more follicles, you take it earlier, if you are trying for better follicles, you take it later. As with Clomid, women who respond tend to ovulate 5-10 days after the last dose. The dosing depends on several things, but 80 to 120 mg seems to be the norm for staring out. Most people advise not taking more than 200 mg, lest you verge into the territory of too much soy. I took 120 mg on cd 4-8. Not the typical Clomid days, but the best compromise I could muster when trying to decide between 3-7 and 5-9.

Side effects are supposed to be similar to Clomid - in other words, hot flashes, irritability, mood swings, headaches, excessive sweating. Many women prefer to take soy (and Clomid) at night to avoid the worst of the symptoms. I have certainly had headaches since the third day of taking it, but in fairness, I likewise have not slept at all well this week and it could be due to fatigue. A long nap today eased the worst of my headache. Other side effects are split - some women report less fertile cm, some more. As a precaution (and because I like it), I've returned to drinking green tea, in hopes that there won't be a noticeable decline in fertile cm.

As to whether or not it will work - who knows? I usually record the first ovulatory twinges around cd 8-10. In this case, I began recording them a couple of days ago. They are getting more noticeable and are occuring in both ovaries. They are sharper today than previously, but not yet painful. I feel a little hopeful because of this, but we shall see.

I feel the need to iterate caution when pursuing supplements and herbal remedies if one is interested in ttc. I do think there is a fine place for herbs, but I think you need to do research and not simply rely on the internet for guidance. First, understand the physiological processes and pinpoint what you perceive to be wrong (remembering that your perception may be wrong) and then explore what the herbs/supplements you are interested in actually do. How do they work? What effects do they have? What happens when they don't work? It's worth noting that Vitex and SI have both thrown off cycles by a great deal in some women. Understanding how it should work hopefully minimizes that. Additionally, it's a good idea to find an herbalist or a naturopath or expert in your area to go over dosages with you if you can, and to be sure you are buying quality items.

In other words, I don't encourage anyone to do this simply because I'm doing it or to consider anything without first doing thorough research on it. I think it can be tempting (if you are like me) to try messing about with things in an effort to bring an uncontrollable and frustrating process within our grasp, but messing with nature can have unintended and unpleasant consequences. I fully admit that I am nervous about this - moreso than I was with Vitex, which has millenia of history behind its use. Soy is relatively new, and while it's been popular among ttc circles for a few years now, there is less known about it. I know I will be upset with myself if I don't ovulate at least as normal, and that is a possibility. I would encourage anyone thinking about herbal supplements or alternative therapies to consider clearing them with your doctor. Most doctors don't believe in alternative therapies, or will tell you it's fine, but it's wise to be certain they don't specifically discourage them in your particular case (and if they do, to find out why specifically - sometimes, it really is just a good old-fashioned prejudice).

But I feel like this is one thing worth trying, at least once. So I have. I took the last dose this evening and now am in the waiting game. I do like the feeling that I am doing what I can to make things work out in the best possible way (which is why I take my other supplements - to address the other potential issues the RE and OB raised). If nothing else, it will make me more confident in pursuing treatments should we not be able to produce a viable pregnancy again on our own.

I hope that lays it all out. It's a bit late, so I apologize for rambling or lack of clarity.


Caz said...

Hoping for you lady xx

MK said...

Have you ever been tested for a translocation? If you don't know what that it, look at my blog. You have a lot of the same issues that people like me do....

CottonSocks said...

That's a great question, MK. The OB did karyotyping as part of the huge round of blood work I did in November, and it came back normally. The only thing of note or concern was the MTHFR mutation, and even that is controversial. I'm taking the higher amounts of the B-vit group (b-6, b-12 and b-9, better known as folic acid) to counter-balance that now.

Tena said...

Very interesting!
Thanks for answering my question so well :-).

Mrs.Joe said...

Thanks for explaining this so well. I was wondering about it too.