Monday, May 9, 2011

Public Service Announcement (and friendly note to self):

After spending some time admiring my chart today (lovely temps and a clearly strong progesterone response, which is indicative of a strong ovulation), I started feeling a wee bit antsy. I mean, I know that 4 dpo is too early for symptoms, for implantation, for much of anything. But I have such a strongly positive feeling (which I've probably just jinxed) that I wanted to do something. Something other than over-analyze the soreness of my boobs and compare symptoms with previous cycles as if there were some sort of discernible pattern there.

I admit it. I went web surfing.

I reaped what I sowed. It was painful, galling, puzzling, laughable and head-shake/eye-roll worthy.

So. In the interests of clearing up some confusion (and firmly reminding myself of things I already know), allow me to go over some basics.

This occurs when the blastocyst attaches to the endometrial lining. This is often a long process. Typically it occurs between 6 and 10 dpo, on rare occasions, possibly as early as 5 dpo or as late as 12 dpo. There is some theory that earlier or later implantations are linked to a higher rate of early miscarriage, though whether that is because the embryo was slow due to developmental problems and therefore abnormal to begin with or whether it is due to a less hospitable environment (by 12 dpo, many women no longer have the progesterone support they need and the uterine lining is beginning to break down) is unclear.

Things to note about implantation:

-You will not experience pregnancy symptoms before implantation occurs (more below).

-Some women experience spotting or bleeding when implantation occurs - but most don't. Spotting or bleeding can happen for a variety of reasons, and is generally unrelated to implantation. Hormonal shifts, abrupt decrease in progesterone or estrogen, a more sensitive cervix being bumped . . . lots of reasons. Don't worry if you don't see implantation bleeding, don't get overly excited (or concerned) if you do.

-Ditto implantation dips. This is when your temperature dips .3 or more and then rises to higher luteal phase levels, typically seen between 7 and 10 dpo. While dips of this nature are seen a bit more often in pregnancy charts, they are not exactly uncommon in ovulatory only charts. In fact, I have an absolutely gorgeous example of an 'implantation' dip in one of my decidedly non-pregnant charts. Likewise, many women do not ever see such a dip and are definitely pregnant. So if it's not there, don't fret, and if it is there, don't do what I did and spend a lot of time cooing over it - it may or may not be real.

-Implantation cramping is not likely something you will feel. Not only does the process take hours into days (and frankly, is ongoing weeks into your pregnancy), but we're talking about something that is microscopic in size attaching to a thick, nerveless bit of tissue. Cramps happen through the luteal phase for a variety of reasons; I often think we simply notice them more because we are looking for signs. And yes, yes I did in fact write my husband twice today to tell him I felt crampy. What?

Symptoms - and their causes

Many people, myself included, spend a lot of time overanalyzing their bodily functions in search of determining what symptoms they are feeling and attempting to ascribe meaning to it. Sadly, one quick google search for your symptom du jour will undoubtedly inform you that it is normal/usual/found in both pregnant and non-pregnant women.

Here's are the important things to note:
-Symptoms caused by pregnancy will not be caused before implantation begins; this is because the chemicals causing these symptoms are not produced before then, or at least not produced in sufficient enough quantities before then, to cause symptoms. So whatever you think you are feeling at 4 dpo is a happy coincidence if you happen to be pregnant. Don't believe me? Well, go take a look at FF charts and compare charts for the same person. You'll find the same symptoms cropping up over time.

-Many early pregnancy symptoms are indistinguishable from non-pregnant/PMS symptoms. That's because of the above, but also because the symptoms are both caused by the same hormone: Progesterone. Progesterone is the dominant hormone in the luteal phase; it is responsible for the temperature increase that marks ovulation and for making the uterine lining spongy and receptive to an implanting blastocyst. The following are especially linked to progesterone:
*Sore/tender breasts
*Increased size/mass of breasts
*Digestive problems (including constipation, feelings of fullness, and sometimes heartburn - this is because of the relaxant effect progesterone has on muscles)
*Emotional turmoil (manifesting differently for everyone, and sometimes merely a byproduct of fluctuating hormones generally)

Hmmmmm. Do you see a pattern there? I do too - those are all common early pregnancy symptoms. Now the reason for this is that if you are pregnant, then the hormone hcg (the pregnancy hormone) kicks in after implantation and tells the corpus luteam to continue producing progesterone. Progesterone will increase during pregnancy, produced by the corpus luteam, until the placenta is developed enough to begin producing progesterone itself. When that happens, the levels tend to stabilize rather than continue to increase and pregnancy seems more stable at that point for many women. There is some speculation that the higher levels of progesterone mid-luteal phase (when progesterone peaks in a non-pregnant cycle) and again in pregnancy can affect some women by causing nausea. Just a note. . .

- I'm sure you, like me, have noted your symptoms and have some fail-safe notes to compare to. For instance, I tend to start having sore boobs around 4 dpo (when progesterone is fully established) and they tend to fade by 9/10 dpo in a non-pregnant cycle, or get worse in a pregnant cycle. One of the obvious signs of the last chemical pregnancy was going from 'dear GOD do not TOUCH them' to 'huh, achey.' That's cool and all - clearly I do it too - but remember to take it all with a grain of salt. Not only is every cycle unique, but your hormone profile can always be affected by something, making a symptom more than it is.

Ovulation, OPKs and DPO

Look, charting isn't for everyone and not everyone is inclined (or can afford) to use OPK's (especially my pricey preferred brand). I get that. I'm cool with that. But if you don't know when you ovulated by some means other than a website calendar, I'm going to be sceptical. And likely suggest you wait until you are past your longest cycle length to test - for a few good reasons. Unless you were charting or using opk's (or are familiar enough with your body to know what EWCM is and what your typical luteal phase is), you have no idea when or if you ovulated. Your symptoms don't mean much and it can cause a lot of heartache and aggravation to waste tests by testing a week too early, or conversely, being 'late' and getting negatives.

Additional notes on ovulation day, OPKs, and dpo:

-Ovulation cramps are useful for identifying a general timeframe for ovulation, but not a specific one. This is because ovulation cramps can take place anytime before, during and after ovulation. They can be caused by developing follicles competing for space in your ovaries, by the oocyte bursting through the follicle, by fluid build up in your ovaries, by fluid being released around your ovaries and irritating your abdominal cavity, and by the corpus luteam cyst that is left behind. A general guide to help you time sex (provided you consistently note ovulatory pain in advance of or in conjunction with + OPKs and charted temp shifts), sure. An accurate pinpointing of ovulation - meh.

-OPKs can be hard to read. Which is why I like the digitals (even though I still read the lines even though they say not to - I'm practiced at it after 3 years though). If digitals aren't your thing, then please remember that an OPK has to display a test line that is equal to or darker than the control line to be positive. Close enough isn't positive. Equal to or darker than. Additionally, luteinizing hormone (lh - the hormone that is being tested) synthesizes in your body in the morning; thus, you will get the most accurate reading in the afternoon. But you do need concentrated urine. If you can't hold your urine for 3-4 hours, then use them first thing in the morning. But if you aren't getting accurate readings or seeing a positive, consider testing twice a day. Some women experience long surges, some don't. I generally only see 2 day surges if I test multiple times per day and happen to catch the beginning of the surge and test through to the end.

-OPKs are a snapshot of lh. Surges can last anywhere from 12 to 48 hours. Please note: Getting a + OPK doesn't mean you are ovulating that day. You could be - as I said, if you catch a surge on the tail end, it's possible you will ovulate later that day. But typically, ovulation occurs 24-36 hours after the surge (the published times, given that you don't often know what part of the surge you capture is ovulation occurring 12-48 hours after a + OPK). FF assumes ovulation the day after a + OPK or Peak on CBEFM - that's a generally safe assumption.

-DPO, or days past ovulation. Ok, sigh. I read a thing today somewhere or other where the woman wrote out her 2ww symptoms, and started by informing the reader that she had + OPKs and ovulatory pain 2 dpo. The thing is. . . if you haven't ovulation, you can't be any days past ovulation. So. . . yeah. Sigh.

-DPO can be important. A day or two off (technically, charting is only accurate to +/- 3 days!) isn't necessarily a big deal unless you are an early tester. If you are - and god knows I am - then be realistic. No matter what you see on the internets, you will not get a positive hpt at 4 dpo. Or 5 dpo. Or, really, 6 or 7 dpo most likely. Frankly, the odds are really low on seeing them before 10 dpo, not that that has ever stopped me (and frankly, given that my most successful pregnancies have all tested positive by 10 dpo, I'm a bit superstitious about this in a completely illogical and freely admitted way). The thing is - implantation normally happens between 6 (six) and 10 (ten) dpo. And once implantation occurs, hcg begins to be produced. While hcg increases rapidly in early pregnancy (expected to double once every 48 hours or so), it takes some time to be produced in sufficient enough quantities to be detectable via bloodstream (earliest) and urine (a bit later). Early pregnancy tests are good for picking up low levels of hcg, but it can't pick up what isn't there, and even if you implant on 6 dpo, the odds of there being enough detectable hcg to register visibly on a pregnancy test are low. Does it happen? Yeah! Is it likely? No! Does it stop me? No! I'm just saying, don't expect a positive hpt at 8 dpo - it's unrealistic.

Early Pregnancy Testing
I'm the queen. I can go on at length, but I'll spare you. I'm a big fan of early testing because I would rather know as soon as possible. Healthy or wise? Meh. Probably not. But, that's me. I'm not really bothered by BFN's at this point, though faint lines drive me a little (or a lot) insane. It's an individual choice and there isn't a right or wrong answer.


-Get early pregnancy tests if you are going to test. Digitals have come a long way since I started ttc, but they are still a bit less sensitive. I wouldn't use these before 10 dpo, personally. FR are generally a good choice, but there are some reports of evaps out there. Cheapies are often a good choice for early testing because your chances of positives are lower and it feels less wasteful. However, it's worth noting that internet cheapies and $tree are frequently dinged for producing evap lines and for only providing faint lines even after clear positives are found on other brands. Caveat Emptor here, folks.

-OPKs as HPTs - yeah. It can be done. I've done it. But generally speaking, you'll already have clear positives and a digital before it shows up, so I wouldn't use this as anything other than kind of a cool thing. The reason for this is that OPKs are testing for a threshold level of lh/hcg - it doesn't turn positive until you have at least X amount of the hormone. So you could get some wonky results and if it's just stressing you out - take a pregnancy test.

-Line comparison. Again, something I do. I've found that typically tests will get darker the further into pregnancy you get into pregnancy and the higher hcg gets. However, there are a lot of factors that go into the line darkness including: amount of urine used, the concentration of the urine, the amount of dye in the test, the manufacture date of the test, etc. I've taken tests from different boxes and gotten clear positives and super faint lines. I've taken tests of different brands from the same cup of urine and had a line as dark as a control line and a really faint line. Try not to compare - I know, I do it too - but try not to. If you have reason to need to know, call your doc for a beta. Lately, I've not made it to beta; and if you get consistently fading tests, well, that can be a bad sign. But it's not conclusive. Only a quantative beta is.

-Evap Lines/Lines after time limit. Right, so my experience is that it is rare for an evap line to appear during the testing time frame. It's happened before, but close examination generally reveals it to be an indentation, rather than a real evap. Don't go back to a test. Call the test during the testing timeframe and stick with it. Even if it's got a clearly visible line fifteen minutes or an hour later. It's still negative. Certainly sometimes those faint lines you call negative will develop in a day or two into clear positives. That doesn't make the old tests positive. A line can show up later for a lot of reasons, and it usually isn't because of pregnancy. The hormones being tested for dissolve really quickly - that's why pregnancy tests are called rapid assay tests and have time limits to begin with. After that, the strip where the antibodies were can attract dye or the indentation from where the antibody strip was (or the area on either side) can collect dye and give the appearance of a positive. Likewise, disturbing the test by removing the casing can cause the test to dry oddly and create the appearance of a line that isn't a true positive.

I . . . think that covers everything I saw today. I know it's long. I know I'm guilty of falling prey to several of these things. And ultimately - go do your thing. No one need answer to me. But man . . . I needed to get that off my chest! If it helps, well, there is the benefit of approaching year 4 of ttc and extensive study before hand. Cheers.

Sunday, May 8, 2011

Happy Mother's Day, I guess

It's not that I don't wish for people to have a happy day. I only just sort of remembered myself. We always sort of said that we wouldn't celebrate Mother's/Father's Day, beyond maybe a nice card or something, and now, well. I'm good, thanks.

Actually, this year isn't so bad. I've been busy - I know, I say that every post now. Still, it's the sort of business that makes me wonder just what in the hell I was doing before when I thought I was busy. Spring has passed very quickly - blink of eye fast - and I have a feeling the summer will be the same. But because of events and bustle, despite the frequent reminders from tv, I kind of forgot that Mother's Day was approaching.

Sorry, Mom. I'm sending flowers, I swear. And calling, once I get the phone recharged.

Last year was bad. Last year I was wallowing, and it was made worse when my brother decided brilliantly to set up a conference call with my mom. It made her happy, but interrupted a crying jag, and I was sullen and surly because I just wanted to be left alone. Then I felt horribly guilty. Not a fun day.

So indifference is fine my me. I'm hopeful that there will be enough people celebrating that we will find the grocery store a bit more empty than usual. Beyond that, I intend to bask in the glory of the remaining weekend, because work next week is going to suck - budget development is open for fiscal year 12. I helped last year, but I've never been fully responsible for budget development of a unit. Let alone budget development of 2 units, one of which is fucking massive. And naturally, I cleared my calendar so that I can assist with other units in the division as needed.

Anyway - work is work. Things are a lot better for me than they were six months ago. I'm more settled, and I'm getting things on track with my departments. It's a struggle some days, believe me, but I'm feeling a lot more confident about work than I was a few months ago. Of course, my two close colleagues (one my supervisor) have both been promoted since my old boss left, and we're still short staffed, but it's been better for me. I work more naturally with them, and it's a relief, if you will; doesn't feel like the constant struggle and inability to do the right thing it did with my old boss.

I didn't apply for my supervisor's old job though - we had a long conversation about it, and everyone seemed to assume I would. I suppose in some ways it made sense, and we certainly hoped that other DBAs would (since we're the ones losing our jobs in centralization . . .) but no one did. Several people approached me after the fact and asked why I didn't apply, but it was simple. I approached both my new bosses and said "What do you think? Here's what I think. It's not a good time." I laid out my reasons - we'd have to find someone to cover my departments and they'd go through another year of turbulence. I was only just finding my feet, and I thought I served these special departments well and like what I'm doing. I'd only been in a department for a few months, and I thought it would be better if someone who'd been in a department for awhile took the job. I thought it would be better for another DBA to apply since it would mean one less position to RIF (though that didn't happen). And I didn't want it to look like my boss was just promoting her friends. Of course there would be an open search and everything, but there is always a sort of lingering doubt when that happens. We talked it over and we all felt comfortable with me not applying. Instead, I joined the search committee.

Let me just say - I learned something about myself during this stretch. I learned I do not like reading job applications, cover letters or resumes. And I have high standards and make fun of people who cannot fill these things out correctly. Seriously - if you can't proofread your job application, you can't work with me. Blog posts, message board posts, tweets - yeah, typos happen, poor grammar crops up. But a formal cover letter? I'll give just one example: don't tell me you are excellent in oral and written communication, then proceed to write an entire paragraph of incomplete sentences.


In the end though, I think we found a good applicant. It was an odd experience, because this person will be in a higher position than me, but realistically, I've been pulled into a lot of plans and know a whole lot about what is going to be happening. It'll be a bit odd, really, but I knew this person would be a good fit when she cracked a joke during her interview. Hopefully she'll be here around the beginning of June, and then we'll really get things going.

What else? Well, the March for Babies walk happened last weekend. I didn't write much going in or just after. It was really because, well, I didn't want to do it. I was feeling - and still am feeling - a whole lot of ambivalence about it. It's not that it's not a good cause (though I trust that less than I did when I started, thanks to the entire Makena debacle), it's just that I wasn't sure how I felt going into it. And I talked myself into doing it and hoped it would be a good thing, and it didn't work out for me that way, in the end. If you'd like to read more about that, I've got a post up on Glow in the Woods on the main page that details the struggle I had. I debated about posting it for awhile, given that I'd not even talked about it here. But in the end, well, it didn't feel good to me, or happy, or healing. And that's ok. It didn't necessarily have to. For all of that, I will probably do it again next year. Only I will take a much more realistic view of it and not look to get anything more out of it than I think it can give.

In other news - this having become some sort of round up post, apparently - I'm currently 3 dpo. This cycle was actually sort of good. No multiple fertile patches, hormones seeming to be right on track doing what they are supposed to (even estrogen, if my CBEFM sticks are to be believed). Our timing worked out fairly well, and now it's wait time. I feel actually pretty good about it right now. Naturally we'll see what happens in a few days, but hey, for the moment, it's good.

Well. All of that said, I'll try and get back to this more this month. Between my (fan) fiction and life, I don't have as much time. But also . . . things are good right now. All things considered anyway. It's boring. I'm ok with that though. I can do with a bit less drama.