We moved into our lovely house and garden about a year ago. Raised vegetable gardens were already installed, which was nice. Unfortunately when I scraped back the mulch on these beds I could see that the soil quality underneath was pretty poor. I suspect this was because old standbys such as tomato plants may have been over-utilised. In other words, the beds had been sucked dry of nutrients by hungry plants.
Therefore, I made sure to plant beans over the winter to add some nitrogen back into the soil.
check out all those nodules! brilliant
We’ve enjoyed the broad beans, so it was time to remove the plants from this bed. It looks like they did a good job with the soil amendment, with lots of white nodules visible on the roots.
While the bean plants were growing, some buried bokashi waste was continuing to break down in another raised bed, along with some autumn leaves and potting mix. After ignoring that for about 6 months we dug it up again. Now it’s beautiful rich soil with lots of organic matter incorporated, perfect for growing vegies in.
The newly created soil was dumped on top of the rest, and then we were all set to plant some kale, with tomatillo seedlings to come. After a little bit of care and attention to establish the new seedlings (lots of watering, and some seaweed fertilizer), the top quality soil should make for an easy and very productive vegie patch.
There have been plenty of times when I’ve been disappointed with my body. I have ovarian insufficiency, meaning my body is unreliable at producing eggs and hormones. Most recently, I suffered a urinary tract infection over the weekend. Not much fun at all. I have some other vague and intermittent complaints that I wonder might be attributable to endometriosis (which might be an underlying factor in the ovarian insufficiency?). I’ll ask a doctor about that last issue soon.
And I don’t think i’ve ever been fit. That can’t be right, there must have been a length of time when I was a child that i was fit. I’m sure I jumped and climbed and skipped back then without thinking twice. But I was also a bookworm, with long periods of inactivity. And I was always the slowest and least skilled kid when it came to sports.
However, lately I’ve been trying to increase my fitness, and I’ve had a better mental attitude to being active too. In fact, I’ve been trying so much that I’m prone to being disappointed that progress is so slow. That’s why I really enjoyed noticing this concrete measure of improvement:
The black cotton singlet/tank top is just a cheap one that I bought a few years ago but it’s so comfortable that I practically lived in it the summer that I bought it. It has a racer-style back and is generously cut down below, so it doesn’t cling to your mid-section on a hot Australian day. The thing is, I didn’t wear it at all last summer. As you can tell, I have a small A-cup chest, and last summer I had a bloated belly that stuck out much further than that. I was convinced that, in this top especially, I looked about 6 months pregnant (or more on a bad day). It’s vain to be too concerned with this, I know, but there is also the odd situation of simultaneously being infertile and looking pregnant that I’d rather avoid.
I know that I’ve been slowly, slowly toning up all over, and reducing that belly. Sometimes a black and white difference really brings the message home though. This time it was ‘not wearing this super-comfy top during summer’ vs. ‘hooray! wearing the comfortable top and not worrying about buying something new to appease my vanity’. It also reminds me that the good work that i’ve been putting into my body for great reasons (not just vanity) is paying off. Slow and steady is winning the race and I couldn’t be happier with that.
These days when browsing news anything to do with ‘women’s health’ or reproduction (involves males too!) is likely to catch my eye. Including this piece about ‘virgin births’(!) Spoiler: virgin births are still impossible (in humans), this may be disappointing to some single women, sorry. What really got my attention wasn’t the possibility of some amazing biological discovery, but the sad insight into the lack of sex education and its consequences. If there is one thing that is sadder than infertility, it is an unwanted child (I realise this might prompt questions of “why don’t you adopt?”, but that’s a question that deserves its own blog post). In the study, parents of girls with ‘virgin pregnancies/births’ were more likely to state that they “didn’t have enough knowledge to discuss sex and contraception with their daughters”. For me this was a bit of a WTF?! moment, but then I’ve had the privilege of a good sex education. Growing up in Australia I received formal sex education in grade 5 (age 9/10); year 7 (age 11/12); year 9 (age 13/14) and a bit more thrown in for good measure in the last few years of high school. I’m sure the classes are even higher quality now than they were when I was growing up in the 80s/90s.
This made me think of something that is even dearer to my heart than women’s health, and that is science communication. I’m qualified as a scientist, but I’m not currently in paid employment as a scientist. There are just not enough research jobs to go around. And there is a lack of jobs because there is a lack of funding. I personally believe that there should be increased funding for scientific research, both from governments and industry. It is not just that I’d like a job, I genuinely believe that more money for better research, leads to new technologies/methods/insights that can improve quality of life for us all (non-scientists included, even non-humans included). The whole thing is obviously hugely more complicated than that, and I could rave on this topic for a long time, but basically if more people were interested at looking at things in a scientific way (aka with increased scientific literacy) then we can all get more out of this useful tool we call science.
But how to get people interested in something that they’re not really interested in (for a whole bunch of reasons)? It’s really tricky.
I often wonder if ‘making it personal’ might make a difference? It sounds shallow but most of us are mostly interested in things that directly affect/are involved in our day to day lives. It’s nothing to be ashamed of, especially with the hugely busy lives that most of us lead these days. Sitting down to read the newspaper over a relaxed morning has largely been replaced by quickly reading some headlines on social media, for example. If you have an issue that affects your daily comfort/enjoyment in life would you be more willing to learn a little of the relevant background science? As an example, I’m not a botanist but I have a friend who teaches Botany at University and I’m always impressed with her recall of Latin plant names. Then I got my very own garden for the first time (after many years of renting, and often in apartments), and I got the chance to choose some new plants for the garden. I chose native plants for various different reasons. Not on my mind however, was learning about the botany of Australian plant groups, but along the way I have anyway, and my knowledge of Australian plant families has recently doubled or even more. Who knew Eremophila species were so varied? Knowing more names, and being able to recognise these plants in other gardens has made the whole thing more enjoyable for me. And now that I have personal involvement in the area, it’s easy.
To get back to the topic above, what could be more personal than sex? Haha. Really though, I’m a strong believer that sex is an important part of enjoying life. Anyone reading this who is half of an infertile couple will know that your sex life is bound to suffer, ours certainly has along the way. It can be as simple as a lack of spontaneity due to timed copulation or more serious emotional damage based on feelings of failure etc. And because it’s an emotional topic, it can be hard to talk about. That goes for sex, and even more so for infertility. Anyway, science really can help, I promise. One of my favourite science communication examples is how much more we know about the clitoris these days. It boggles the mind to think that we didn’t even properly know the structure of the clitoris until recently! Finding this out really reinforced for me the importance of knowing my own anatomy and how that knowledge can lead to a more pleasurable life 🙂
Last night we went out to a show, to see Stephen Fry on stage ‘telling tales’ (as the show was called). Admirably, Mr. Fry begun his show with a show of empathy for France, following the terrorist attacks in Paris this weekend. He said that it would not be right to proceed with an entertaining show without first acknowledging the atrocities and the outpouring of grief that is happening worldwide. I feel the same way about my blog, it would not be right for me to write about my dysfunctional reproductive system or my otherwise lovely life without mentioning the dark events going on in the world. Of course, dark and horrible things are always going on somewhere, and have been prevailing in Syria, especially, and elsewhere. But Mr Fry, being the intelligent and word-wise gentleman he is, acknowledged these events in a moving way while also sharing the sentiment of ‘life goes on’. To begin his show, he read the last two verses of a W.H. Auden poem ‘September 1, 1939’. I’d encourage anyone to read the poem, even if you don’t understand it’s full meaning, you can read it here. To me, the poem speaks of ‘being the good you want to see in the world’. That phrase may be a cliche but for good reason, because what else can we really do?
So i’ll keep living my lovely life, and aim not to step on anyone’s toes, and remember to be empathetic as often as possible, and help out when i can. And maybe if we all do that then we can avoid world war 3.
Salad is not what it used to be. It wasn’t long ago that all I would expect of (green) salad was iceberg lettuce, wedges of squishy tomato, rounds of cucumber and if you’re lucky cubes of cheddar/tasty cheese and/or Paul Newman dressing of one variety or another.
Green, leafy vegetables are some of the healthiest things you can eat, and it turns out that all you have to do to make them delicious is add a few more ingredients and you have half a meal. Ok, salad can be a whole meal in itself… sometimes, but you usually need an extra flavourful ingredient to make it so.
My criteria for wonderful salads:
more ingredients! I know i just said ‘all you have to do is add a few more ingredients’, but I really love salads where there is variety in each bite.
fresh herbs. Don’t just think parsley, basil, coriander etc either, the ‘woodier’ herbs such as pineapple sage, or even kaffir lime leaves can be added if sliced really finely first.
Add (cooked) veggies! Putting a little effort in beforehand to steam some broccoli or roast some pumpkin etc always pays off.
Mix it up with different nuts/seeds/cheeses
Add something sweet! I used to think this was sacrilegious, seeing as salad is supposed to be healthy. Turns out a scattering of dried cranberries or candied nuts etc is actually fabulously tasty and balances some of the bitter tastes you might get with the greens, so there is nothing wrong with that!
Think about ingredient pairing. My favourite recently is pear and walnut, and pear slices in balsamic vinegar are heavenly.
Basically, there are I don’t know how many combinations of fantastic ingredients out there to make really tasty salads. I’ve been experimenting and it usually pays off.
One trick though, if you don’t have any great fruit/nuts/cheese on hand, is to dress your salad greens with some fancy vinegar. For some reason i’m happy to steam/roast some additional veg, but find mixing up dressing a bit of a chore. That’s no problem when your local farmer’s market has a selection of exotic vinegars. Splash this on, along with a top quality olive oil, and that is actually all you need.
Yesterday, I was really glad to be writing an upbeat post about my chances of reproduction. Before I started writing this blog I searched around and read lots of other blogs. I was on a mission back then, I wanted to hear about someone in my situation, and I also wanted to hear that it can turn out just fine. Although, I was conflicted. I do want a family. I think that hubby and I would be good parents. Not only would we enjoy seeing our child grow and develop, we would strive to raise a good kid (or two) and therefore have a positive influence on the world. On the other hand, I’ve never felt desperate to have a child. I know that there are other contributions that I can make to the world, and find fulfilment in doing so. So it has been challenging to unpick the feelings and thoughts that come along with this ‘condition’ of ovarian insufficiency.
Early on in my ‘journey of discovery’ learning about this condition I found the editorial-style review by Dr. Nelson (1). He states “loss of a sense of purpose in life is the major emotional impact of the diagnosis for most of these women”. I completely baulked when I first read this, in fact I was insulted. The feminist inside my head ranted at me “That’s ridiculous! As if my only purpose in life is to have children!”. But gradually I’ve come to accept that it is something that bothers me. I wouldn’t say that my low hormone levels and lack of ovulation have ‘shattered’ my sense of identity, but the whole thing has certainly exacerbated an underlying concern about my identity, and my sense of purpose. So when I was searching for other women’s stories I wanted to see a good outcome. One good outcome is obviously a successful pregnancy. Even more important though, is the good outcome of leading a good life, a fulfilling life that you’re happy with and that enables you to be productive so that you can give back to your family and hopefully to others too. That all sounds like a good basis for a parent anyway! (or a supportive family member, or a good friend, or a nice colleague etc etc).
What I’m trying to say is that this diagnosis comes with the disappointment of “sorry, no babies for you”. That’s a big one, it’s one that has made me sad even though I know that I can have a good life without raising my own child, and it’s obviously devastating for women who are committed to raising a family and who have looked forward to it for a long time. But the diagnosis of ovarian insufficiency also comes with other warnings/threats. Depending on what you read and what your doctor(s) tell you, you might learn that this is a ‘devastating’ condition which effects so many other aspects of your life than just your ovulation. Things like “your bones will begin to crumble, you are at high risk of osteoporosis”, “your heart health will decline early”, “you’ll generally feel menopausal (whatever that means! Although some take it to mean afflicted by all sorts of annoyances that can interfere with your daily life, let alone grumpiness that comes along with all of that!)”, and the scariest one of all “your cognition will be affected”. Some women might even be concerned that their lack of oestrogen will have them ageing prematurely, with wrinkles and lack of skin tone. If a lack of producing babies doesn’t make you feel like less of a woman, and less than a productive member of society, then all of this garbage (IMHO) surely can! The thing is, a lot of these ‘associations’ between oestrogen levels and other aspects of health are controversial at normal menopause age. Yet some are happy to extrapolate what little is known about the whole deal to younger women like me. And this based on very little knowledge of what is actually happening in my body!
I’ve been much more wary of my general health since finding out I have ovarian insufficiency. You might think this is a good thing but I don’t think it has been. Before we tried conceiving I wanted to be more fit and healthy anyway (I think that happens to a lot of us in our 30s! especially if we got a bit of a ‘free ride’ in our 20s by being genetically thin!). I enjoy cooking and learning new recipes, so eating healthier has been a good challenge. Historically I haven’t enjoyed exercising, but I’m slowly gaining an appreciation for the benefits that it brings to body and mind. But then I found out my ovaries were inactive and the negativity got to me a bit and worked to undermine my new healthy attitude. When I was feeling lethargic or low energy or bloaty or tired, I couldn’t help thinking “Is this what ovarian insufficiency is?”. The thing is, there is always another reason! (did I drink too much the night before? Did I forget to drink enough water again? Have I skipped some regular exercise? Etc etc). So, no, I still don’t have any ‘symptoms’ that I can attribute to my ovarian insufficiency. I certainly don’t have hot flushes or night sweats.
Although… something has been bugging me over the past couple of weeks. I mentioned bloating above, and my digestion has been ‘off’ lately and I’ve been getting some pains in my pelvic area, usually just like mild cramping. It’s nothing that really effects my day, and in fact if I’m busy doing something I quickly forget about it. Still, it’s annoying, and I would like to know if it has anything to do with my reproductive issues. So the other week I took notice of this new article (2), that aimed to link endometriosis with reduced AMH. In my email alerts about new research I see plenty relating to endometriosis but I generally ignore them because I don’t have endometriosis. Or do I? That’s the kind of question a hypochondriac would ask themselves, right? I could list all the little reasons why I think I might have some endometriosis (albeit fairly asymptomatic), but the most convincing is that I do have a history of menstrual cramping, sometimes quite severe but then sometimes not at all. But I know that endometriosis can be asymptomatic so I became curious to know if there was a possibility that some cases of ovarian insufficiency could be due to endometriosis.
I spent a whole day (9am to 5pm), scanning through the literature and it turned out to be an un-fun learning day, which was a shame. The article that caught my eye (2) turned out to be not well written and they appear to cite work from ‘Streuli et al.’ but no such reference can be found in their list of references. It appears they changed their mind about which work to cite. Probably because the work by Streuli et al. (3) contradicts their finding. And the publication by Streuli et al. admits that any association between endometriosis and reduced ovarian reserve/lowered AMH is controversial. I checked quite a few other studies throughout my little research day, but that conclusion (of controversy) is still valid. So it was an un-fun day considering that I didn’t have even the hint of an answer after a bit of hard work. But mostly because I don’t want to be a hypochondriac! (really!) and I don’t want to dwell on the thought that there is ‘something wrong with me’. And that’s important to keep in mind, because even if some undiagnosed endometriosis is inhibiting my ovarian function, there is not an easy medical solution to that anyway.
I usually make an effort to end these posts on a positive note, even if I’ve been venting about infertility being sad, or worrying about health stuff. That’s because most days I’m totally fine, loving life. This time I don’t have to be vague though! I was a bit fed up with the fact that I had been having mild cramps for weeks now. I wrote most of this post this morning, then did some things around the house, then discovered that I had started my period! Hooray! only 37 days since the last one which is close enough to ‘normal’. And with any luck it will resolve the PMS-type symptoms that I’ve had for the past few weeks 🙂
Nelson, L. M., 2011 ‘One world, one woman: a transformational leader’s approach to primary ovarian insufficiency’. Menopause. 18(5): 480-487; DOI 10.1097/GME.0b013e318213f250
Harharah, N., et al. 2015 ‘Ovarian reserve in infertile women with and without endometriosis measured with Anti Mullerian hormone’. Indonesian Journal of Obstetrics and Gynecology. 2(4): 188-192.
Streuli, I., et al. 2012 ‘In women with endometriosis anti-Mullerian hormone levels are decreased only with those with previous endometrioma surgery’. Human reproduction. 27(11): 3294-3303; DOI 10.1093/humrep/des274
Wow. I’m definitely tagging this post ‘emotional rollercoaster’. I thought my next post was going to be a list of the reasons that I’m fine with our child-free lifestyle, but right now I’m excited to be contemplating assisted reproduction as an option for the first time ever. All due to a fairly amazing article that was published this week. I managed to get a full-text copy of the article today and just finished reading the whole thing right now. Hopefully I can quickly get all of my swirling thoughts down in this blog post, because my head is buzzing right now!
First, let’s just back-track to over a year ago when I first got my AMH (anti-mullerian hormone) tested. We’d been ‘trying to conceive’ or at least not worrying about contraception for a while, so we suspected something was not quite right. I was reluctant to bother with a specialist. In the end my curiosity got the better of me. I was soon hit with the ‘whammy’ of an undetectable AMH result*, with my doctor concluding that I was very unlikely to have my own kids, although donor eggs may be an option (something I had never considered, or even thought about in general). Along the way I’ve had various feelings about the way that that piece of news was broken to me. These have ranged from disappointment to some degree of respect for the doctor’s professionalism. The one thing I wouldn’t want would be false hope.
In the mean time I’ve done lots and lots of learning, trying to understand what my own personal situation might be. There have not been many answers. There have certainly been times when I’ve thought my efforts have been for very little gain. There is a mountain of material to sort through and I kept reading and I kept coming back to the same conclusion: “Well, I don’t know why my ovaries are inactive, it could be various reasons, I don’t have any of the proven causes, but I know that this is not menopause and that there is the potential of a healthy egg developing”. I know that I’ve learnt more than my doctor about this particular situation. That’s a politically contentious thing to say right there, but it’s true that sometimes patients can be their own advocates. Anyway her attitude was that I should consider my ovaries done and dusted. During my learning I’ve constantly reminded myself that this may be the case (even though I still have the occasional period). I also didn’t want to be too cynical and just assume that I was turned away from the clinic so as not to harm their success rates.
Therefore, reading the new article from Seifer et al. was somewhat of a revelation. They looked at women with ultralow AMH results (what used to be classed as ‘undetectable’), just like me. And found that the success of a live birth from an ART cycle (using Assisted Reproductive Technology, such as IVF), was 9.5%. What?!? The authors state this is a surprising finding, and on the one hand I am surprised and on the other hand I am not at all surprised.
9.5% is a favourable number. Right now it seems like a huge number to me. Perhaps after I let this all sink in I’ll feel differently. But this is the comparison that should be made: These results (from the US) are from 2012-2013. In 2012 the comparable success rate for ANY woman in my age range (35-39) in Australia or New Zealand undergoing ART was 17%. I’d been led to believe that my chances were much much lower than other women (with normal AMH levels), but in fact they might be a little more than half of the normal success rate. It seems to come down to clinics thinking ‘more eggs are better’. Seifer et al. confirm that women like me have pretty unresponsive ovaries and if we try to stimulate them we’d be lucky to get one or two eggs out. More than a third of the cycles (38.6%) that they looked at were cancelled prior to retrieval. In other words, follicles did not grow to a big enough size to suspect that a mature egg was available. This is certainly much more likely to happen to women like me. And because not many eggs are produced from women like me, not many of the women had ‘spare’ embryos available to freeze for future transfer attempts. But when some women did continue cycles with frozen embryos the success rates were totally comparable to women of a similar age. This point was not surprising to me, but it provides evidence that our problem is spitting out enough eggs, and not anything else (eg. our eggs are not ‘aged’). And historically there has been an emphasis on ‘the more eggs the better’. Thankfully the message is now shifting to ‘you only need one’.
Next steps: I need to get a new appointment with my doctor and she what she thinks of all this. If I get any funny answers I’m getting a second opinion. Some people have urged me to get one before now, but I’ve known that good data to show I have a chance has not been available (till now!). Then I need to confirm the costing side of things. Yes, the money aspect is important to me, but no, I don’t think it’s shallow or selfish.
What do you think? Is an almost 1 in 10 shot worth it? Oh, and one kind of funny thing that I noticed in the article: Of the cycles that resulted in live births (they had a baby!) those women were, on average, 36.8 years old. Age has always been known to be the most important indicator of success. My birthday is a little less than two months away, so I’m just over 36.8 years old 🙂
Side-note: clinics in Australia are not obliged to make their success rates public. If you check the websites of the major clinics here they’ll proudly claim their success rates, but beware!, they usually state ‘chances of clinical pregnancy/live birth per transfer’. The success rates I have quoted above are per cycle start. This captures the data on how successful the stimulation part of the procedure is. There are many types of stimulation routines these days, and some will work for some women and not others. My chance of success ‘per transfer’ would be similar to a woman of my age with unexplained subfertility/normal AMH levels.
*To recap; ‘undetectable AMH’ used to refer to < 0.16 ng/mL (unit of measurement used in the US) or < 1 pmol (unit of measurement used in the UK, Australia and elsewhere, also written as pmole/L). The conversion between the two units is about 7.14, i.e. 0.16 ng/mL = 1.14 pmol. Now there are more sensitive assays that measure lower amounts of AMH in your blood, but anything below the old limits of detection is very very low (unless you are over 50, in which case it’s totally normal).