Monthly Archives

April 2017

Babe In My Heart, Blogs


April 25, 2017

So it’s time to go off birth control and expand your family. You’ve got all your ducks in a row… a hot career… check. Taking the stairs, not the elevator… check. Dropped the McDouble, because you know #healthy…check, check. Those ducks haven’t moved and still… nothing. This is an all too common tale in the IF world, but Amanda Fagan is proof that there is light at the end of the tunnel. Amanda (wh0 just happens to be a Doctor) helps us figure out what the heck PCOS is and explains what she did to get her body back on track.  SPOILER ALERT! Amanda is pregnant with not one, but TWO baby boys, due this summer.

Polycystic Ovarian Syndrome- poorly understood and under diagnosed. But most importantly in my mind, it’s definitely miss-treated.  I was diagnosed with PCOS at the age of 25, after just finishing 4 years of Medical School and learning all about this “disease”.  I was confused, as most other females are when they are initially diagnosed. The biased conception is that all PCOS woman are overweight, diabetic, hairy, and are unable to bear their own children. I’m here to paint a different picture for you, and to give my experience of dealing with PCOS.

The actual medical definition of PCOS is defined by something called the Rotterdam criteria. You need 2 of the following 3 criteria to be diagnosed:

  • Oligo/anovulation (irregular or absent peroids)
  • Hyperandrogenism
    • Clinically- through increased hair growth
    • Biochemical- through blood work showing increased testosterone
  • Polycystic ovaries on ultrasounds

It’s a big misconception that obesity and diabetes is a criteria for PCOS, neither of which I have. I have personally never struggled with weight. I grew up a dancer, and once I got into college I found a love for fitness and staying active. I’ve maintained a BMI around 19-20 most of my entire life and spent 8 years on hormonal birth control pills for control of my hormonal acne.  Little did I know, I was masking a problem that would eventually become noticeable once I stopped the pill in 2015.

Knowing that we wanted to start a family while I was in my Family Medicine residency post- Med School, I stopped the pill in 2015 only to watch the months go by with no bleeding. It took me 8 months before I took the situation in my own hands and decided to seek a different opinion. My OBGYN constantly told me to keep giving it more time, and that it would return on its own, but I knew deep down that 8 months was not normal. It can take 1-3 months for your cycles to return after cessation of a birth control pill, I was almost 3x past that period of “normal”. This is when I decided to seek care of an Infertility Endocrinologist, who performed an ultrasound and lab workup on my very first visit and had my diagnosis that very week. My ultrasound showed 40+ follicles in each ovary, and my labs showed an elevated testosterone level. I actually had met all 3 criteria for PCOS, something I never thought I could actually ever have.

I have a fairly long blog post regarding my infertility journey that you can find here, it’s definitely worth the read if you’re struggling! But one thing I didn’t touch on in my post was the treatment I’ve done to help my PCOS.

  1. Metformin. This has to be prescribed by a physician, and is confusing when you read that it’s a medication for diabetics. Truth be told, PCOS patients typically do have insulin sensitivity, but this does not mean they are diabetic. Insulin is in our bodies to help lower our blood sugar levels. When we have elevated insulin levels, it’s a sign that your body has to work a little harder to lower your sugar compared to the normal individual. Yes, this technically gives you an increased risk of diabetes in the future if you fail to watch your diet, but it by no means makes it a guarantee you’ll get it. High insulin levels signals your body to produce more testosterone, which coincidentally leads to decrease in estrogen levels.  This is where Metformin comes in. Metformin is designed to increase insulin sensitivity, thereby lowering our insulin level over time. Therefore many specialists use Metformin as a first line treatment for PCOS. By decreasing insulin level, decreasing testosterone, and increasing our estrogen- our bodies start to ovulate again and menstrual cycles come back. I’m not saying everyone with PCOS should be on this medication, but it’s considered first line therapy and something that personally helped me regulate cycles.
  2. Diet. It’s all about the lifestyle you choose to live. When I found out about PCOS and the recommendation to try more of a low carb higher fat diet, I did a lot of research before giving it a try. Research shows that healthy monosaturated fats actually help aid in fertility, and following a low carb/higher fat diet results in lower sugar intake. Did you know the American Heart Association recommends a max of 25g of sugar daily for women? I really focused on my sugar intake, consuming only those in natural fruits and veggies. Focusing on a whole foods diet alone is definitely key in my opinion, and I firmly believe it helped regulate my body as a whole to prepare me for conception and pregnancy.
  3. Regular Exercise. Something I always practiced, but I firmly believe increasing your endorphins daily helps significantly with mood and the way you feel. Not to mention, it helps keep your body at a healthy weight! I bounce between Tone it Up, Beach Body, and BBG by Kayla Itsines. I love them all, and I love the variety they all put in my routine.
  4. Educate yourself! This is key. Find forums, talk to your physician, talk with your spouse. Do what you can to educate yourself and those around you, especially if your PCOS is affecting fertility.  Having open communication is key, and your spouse should always be your biggest supporter. I’m so thankful Jason has always been there to listen to my worries, my fears, and support me through all my appointments and struggles.

I hope opening up gives others out there a better insight on PCOS. But most importantly, if you as well are also a PCOS fighter- I want you to realize that it’s not life limiting. I’ve fought it, I’ve worked around it, and found ways to make myself healthier because of it. I’m currently in my second trimester with my first pregnancy, and I couldn’t feel more blessed to be carrying two babies. Learn to love yourself, have the motivation to better yourself, and PCOS won’t seem like such a setback! – Dr. Amanda Fagan

Babe In My Heart, Blogs

Girlfriends’ Guide to Diagnosis

April 20, 2017

It was a Tuesday night at 9 pm when I got the email saying my test results were in. Without giving it a second thought, I signed in to review and check them out  before my appointment with my OB/GYN (mistake number one). I read through the results and they all looked as though they were within a normal range except my estradiol, which was flagged abnormal. Naturally, I did what every red blooded, 30 year old, newlywed, ovulation tracking, pregnancy test taking, baby wanting lady would do. I headed straight to Google (oops…mistake numero dos). The first article I came across explained  I had “low ovarian reserve” and that I “may have the best results with IVF and a donor egg”. And this is where I crumbled, googled, crumbled some more, googled some more… you get the point. The more I read, the worse my prognosis got. I was devastated. But I quickly realized sitting in my depression wasn’t going to get me anywhere and  I needed to pull myself up by my bootstraps and do something about it. Granted, everyone is different and what worked for me might not work for the next person. But sitting in bed crying, watching Full House reruns and eating Ben and Jerry’s Chunky Monkey ice cream most definitely isn’t going be the magic combination. (Total hypothetical btw, I never did that.)

1.Get Informed

Nope, I don’t mean google. I quickly ditched the internet search engines for Amazon. I bought an array of books that could help educate me on how to deal, how to heal and how to treat. I filled my brain with knowledge as opposed to what Stephanie from Kansas City posted on a infertility forum. The more I read, the more I understood and I was able to come up with a list of questions and concerns for my doctor (heck yea I brought a notebook to my appointment).  One book I highly recommend is, “It Starts with the Egg,” by Rebecca Fett.

2.Talk the Talk (or Don’t)

Some days I would talk, some days I HAD to talk (I may or may not have told total strangers at Target…in the baby section), and some days I couldn’t think about it let alone talk about it. I think the important part is letting your partner, family and friends know where you stand that day. There were mornings I would start the day by telling my husband, “I can’t talk about it today. Let’s see how I am doing tomorrow,” and the next day we would reassess. You are entitled to a day off, but don’t let your day off turn into suppressing your feelings.

3.Take Care of Yourself

I turned my health and well being into my job by coming up with a lifestyle makeover tailored to my diagnosis. I drank the water, ate the greens and my favorite part… got the ZZZs. I tossed the plastic containers, ditched the fragrances and changed my cosmetics. There are so many elements we can’t change as individuals, but I changed the ones I could.

4.Take Control

I needed to find things that made me feel like I had a handle on this. I immediately started acupuncture (per my Doctor’s approval) and began taking a regimen of supplements the acupuncturist recommended. I ordered fertility crystals (hey, don’t knock it till you’ve tried it) and meditated with them for 10 minutes a day and then slept with them under my pillow. I consulted with different Reproductive Endocrinologists throughout the state, coming up with a game plan if we ended up having to go that route. This all gave me a sense of empowerment and made me feel like I can and I will hold my baby at the end of this bumpy road.

Babe In My Arms, Blogs

When Your RE is #SquadGoals

April 19, 2017


When you’re stuck in the trenches of infertility, your RE basically becomes your bestie. Am I right? You stalk them to get follicle updates, you know the type of car they drive (LOL, but seriously) and they’re a shoulder to cry on when times are tough. It’s pretty much the most important relationship in your life next to your semi-serious romance with The Bachelor on Monday nights. (Oh yeah and the hubs too!) Your Doc knows everything about you (seriously like ev-ery-thing) but what do you really know about them? Meet Dr. Natalie Crawford. She’s one of the newest RE’s in the industry, making babies in Austin, Texas since 2016, but this Doc is going places! Dr. C is quite possibly the coolest Doc we know, I mean have you seen her Instagram page? She’s as smart as she is gorgeous and as down to earth as she is passionate about her job! Dr. C even struggled with infertility herself so she totally GETS IT! This is definitely the type of Doc you want on your baby making squad and we’re pretty much obsessed! So we sat down with Dr. C to find out what’s new in IF treatments and how to know when it’s time to see a specialist and how to optimize our chances for success!

What The Fertility: Why did you decide to become an Infertility Physician?

Dr. Crawford: I loved women’s health and was drawn to the complexity of the endocrine system and the technology with infertility care. In addition, I love knowing a patient’s story – and becoming a part of their life. To me, this relationship with patients is part of why I became a physician.

WTF: Any steps you recommend taking before couples start trying to conceive and before they seek medical advice?

Dr. C: I think optimizing your health before you get pregnant is always important, as this is the last time to just focus on you. Lose weight that may be nagging – work on improving dietary habits. I encourage my patients to drink plenty of water, no soda, limit sugar, whole grain breads over white breads, and a mostly plant based diet (limiting meat and focusing on lean meats). I also recommend 30 minutes of exercise five times a week. Women need to take a daily prenatal vitamin with at least 400 mcg folic acid and 600 IU vitamin D3. Stop smoking (both partners). Other recommended preconception evaluations include: knowing your blood type, proving immunity to rubella and varicella (chicken pox), thyroid screening, and genetic carrier screening. Your OB/GYN or a fertility doctor should be able to talk to you about all of these before you get pregnant.

WTF: When is it time to see a Reproductive Endocrinologist?

Dr. C: In general, if you have no known issues with fertility, it is recommended to see a specialist after 12 months of unprotected intercourse if you are under 35 years old, and six months if you are over 35 years. However, in some situations it is best to see an REI early. For example, if you have: irregular periods, difficulty having intercourse, a male partner who has used testosterone or other steroids, known history of gonorrhea/chlamydia, prior ectopic pregnancy, or multiple pregnancy losses then an earlier evaluation is needed. I also always say that it is never too early. If you are concerned about your fertility, you will only feel better after talking to a specialist and understanding where you stand. The truth is, many couples with no risk factors have difficulty conceiving. Being proactive is never a bad thing.

WTF: What are the first steps one should take after an infertility diagnosis?

Dr. C: I think the most important first step is to talk to your partner and make sure you are both on the same page about how you want to proceed. Is the goal to become pregnant the fastest? To do the least invasive treatment? How many children (in an ideal world) do you envision for your family. Having clear “goals” will help your physician navigate you through the most appropriate treatment.

WTF: What is the most important question to ask at your first appointment with a RE?

Dr. C: I think the most important question to ask is “why?” Why are we doing that test? Why do you recommend that treatment? As a patient, make sure you understand the process, the next steps, and why things are being done. I think it is important to trust your infertility physician – and often, trust comes with understanding.

WTF: Any new and noteworthy developments in treating infertility?

Dr. C: I think the most interesting technology includes the 2 different types of preimplantation genetic testing can be done with IVF.

PGS – Preimplantation genetic screening: this is where embryos after IVF are biopsied before being transferred into the uterus and are screened for random genetic abnormalities which are more common with aging (like Trisomy 21, or Downs syndrome)

PGD – Preimplantation genetic diagnosis: this is where embryos after IVF are biopsied before being transferred into the uterus and are screened for specific single gene disorders which the parents are carriers for (like cystic fibrosis).

WTF: How did becoming a mother change how you deal with your patients?

Dr. C: I struggled with infertility myself, and I know how difficult the process can be. I was afraid that being pregnant would make it hard for my patients with infertility to relate to me. However, I have been fortunate to have the most gracious, supporting, and encouraging patients. The grace exhibited by those suffering with infertility while I was pregnant was inspiring. I love my kids endlessly and I love (love love) being a mom. Becoming a mother has been the greatest gift, and I leave home each day to try and help others experience this same joy. I understand how hard it can be for those dealing with infertility – and I try to make sure my patients know that I understand their struggle. For me, being a mom makes this job even more satisfying, because I know the true gift my patients are getting when we are able to help them grow their family.

You can find out more about Dr. Crawford and her practice here and don’t forget to check out her Instagram @nataliecrawfordmd!



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