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.

1 comment:

Sissy said...

just wondering what the outcome was......