Swaying again after my successful 2020 sway

[atomic sagebrush]

Please don't go down the "weak ovulation" rabbithole. This is one of those terms that gets bandied about a lot without any medical agreement on what it even means (is it the egg being released too soon? Too late? Without enough force to push it into the Fallopian tube? Is it the hormones being off before O, during, or after O?) Whenever there's a term that is used so wildly and to describe so many different things, it starts to take on an air of being a convenient scapegoat; docs will sometimes use it when they don't know why a person has gotten pregnant and/or to convince a person who is reticent to use medication, to use it, and then herb peddlers use it to sell herbs. People who are TTC will grab onto any descriptive terminology because it's human nature to like to have words to describe things that we are going through. Long story short, people are tossing about a term that is ill-defined and all but certainly being misused, not to mention isn't really proven that it's even a real thing.

It is normal and natural for the menstrual cycle to change over time. This can be reflected in temps, or changes in temps can have to do with other, completely unrelated reasons. Many, many people have these types of cycles - delayed O, short LP, sluggish temps even when they're 22 years old and popping out eggs like their ovaries are wee little tommyguns, so assuming that changes in your cycle at any point are "age related weak ovulation" is really not warranted. And the opposite is equally true I had extremely normal, regular, clockwork cycles till just this past year (I'm 51) and my eggs had been cooked long before that.

Just keep plugging away, with your history of proven fertility I have every confidence you'll get pregnant within short order.

[Kiwimaz]

Sorry Atomic it was probably the wrong choice of word. I guess I meant more that the ovulation is sometimes uncoordinated or disorganized because of PCOS which I do think has got worse as I've got older, like my estrogen is lower than it was in my 20s and early 30s and more hirsutism. The cycle before I conceived #4 was longer still than the one I just finished (I was thinner though), and my LP was 12 days (as it was this time) instead of my usual 14/15 . The cycle before I conceived #3 was my first post partum, and we conceived but I had an early mc, and my betas never got off the ground so I think the pregnancy was never really viable. I guess in my mind, whether there's any evidence of it, when the follicles are sitting there trying to grow, but getting mixed messages from the brain and making multiple attempts to ovulate in a cycle and failing before eventually succeeding, this could result in a poor quality/poorly matured egg and the lining may not be optimal. I was told the estrogen patch wouldn't stop me ovulating at that low dose, but given the relationship between my brain and my ovaries is already tenuous, it was probably enough to suppress fsh etc to a degree to muck it up. I ovulated a week after stopping the patch but felt much better on it.
I conceived my kids on CD28, CD22, CD15 and CD28 (femara cycle with 2 rounds) so I guess I feel that the cycles that have been longer than that where we didn't conceive or I had an early mc were not synchronized enough to result in a pregnancy.
I know Femara helps with a pink sway, so do you think its still worth obtaining it?
I wasn't expecting to get in so soon but it'll be CD17 when I see the Dr so I'm not sure he'll want to start a course mid cycle or wait for the next AF, in which case it'd be better to push it out a bit in case this cycle is successful.

[atomic sagebrush]

First and MOST IMPORTANT - unless your doctor does blood tests and/or ultrasound to confirm where you are in the cycle, DO NOT start the Femara/letrozole in the middle of the cycle. If you start taking the medication at the wrong time (say, right before you were about to ovulate) you can stop an egg in its tracks and even cause a cyst to form. So it is IMPERATIVE that you either wait for a period (and a negative pregnancy test if there is any chance you could be pregnant) or else have a blood test and hopefully an ultrasound as well to ensure you're not just about to ovulate.

No not at all, there's no way for you to know that "weak ovulation" is not a good term. My whole point is that the term "weak ovulation" is tossed about in online spaces with absolutely no agreement about what it even really means, not that any of you are wrong for doing that...how would you know, if someone didn't tell you?

"Weak ovulation" is like "hysteria" - doctors used to slap that label on any difficult patient they had, and it was even in medical books, but it wasn't ever an actual thing. Certainly there are people who have mental illness, and others who seem to be having trouble conceiving, but neither "hysteria" nor "weak ovulation" are acceptable terms for medical professionals to use. Nor are they helpful to use to describe ourselves, because they are not properly defined and were/are basically so widely used that they had no real meaning.

I just hate to see anyone telling themselves they have a "medical condition" when there is absolutely no agreement from anyone at all about what the definition of that even means. People then start applying terms that are just this side of made up and making assumptions based on themselves having issues that are not unusual or abnormal in any way. I don't like seeing people do that, because not only is it discouraging, it causes them to take steps such as adding in medications that they do not need, that can cause a whole different set of issues to suddenly begin (since all these things have side effects).

I need to address a couple things here. Kiwi, I don't mean to quibble with you, truly. I know that nothing I say will change your firmly held beliefs about the way your body works, and that you're probably going to believe whatever person tells you that meshes best with the beliefs you prefer. But I have to push back when I see people suffering under beliefs that are simply not true, because it's my job to do so. If you don't like my reply, let's just leave it at that because I cannot leave information I find both inaccurate and harmful uncorrected on these forums. I would not be doing you, or any of the others who might read this, any favors if I did.

- It is perfectly normal to have a LP of 12 days and to go back and forth from 12-14/15 day LP. That is not indicative of any issue. 12-14 day LP is a normal LP. Happens all the time, even to people who have absolutely no PCO-tendencies. This idea that women all "should" have 28 day cycles with 14 day LP or else there is something "wrong" with them has caused more unnecessary concern and anxiety for people and it's just not warranted. good explanation here: https://qz.com/1706398/the-average-m...s-not-28-days/

It is very very common, and indeed, normal, to see cycles that vary from 21-35 days, equally normal to have cycles that change lengths every month. Even cycles that are more like every six weeks (either always or occasionally) are so common that we have people with that pattern all the time. Again, it doesn't mean anything.

- Most pregnancies that are not viable and end early after low betas have something wrong with them either from egg, sperm, or the way they combined very early on. This happens all the time, whether or not you have PCOS; most of us on here with more than 2 pregnancies have at least 1 loss and some people have several yet still have healthy kids too. Yes, PCOS can lead to wonky cycles and ~slightly~ poorer egg quality (controlled PCOS likely affects egg quality very little, if at all), but that doesn't mean that the fact that you had one loss means your PCO is raging out of control. Especially with the metformin, since high blood sugar is the main reason why PCOS affects egg quality negatively, this should not be any more of an issue for you than anyone.

- When your body gears up to ovulate and doesn't, that is not happening because your ovaries are getting mixed messages from your brain. I don't think that's exactly what you mean to say there, but I just want to be very clear on that for the sake of everyone who may read this. Sure, the hypothalamus is part of the brain, but it is really more to do with the endocrine system (hormones) than "getting mixed messages from the brain" which people generally think of having to do with more like thoughts and feelings, stress, anxiety, etc if that makes sense.

The reason why your body gears up to ovulate and then doesn't is because something hormonally just wasn't ideal at that time. Your body is attuned to itself and its condition via a variety of metrics and if something seems amiss, it hangs onto the egg a bit longer. This is actually to give you BETTER chances of conception, not worse ones. If your body just roared ahead when it saw a date on a calendar, shooting out an egg that maybe wasn't ready yet, or had something "off" about it (in which case it would be reabsorbed, and a different egg would begin developing faster), or at a time your body didn't seem like it was able to successfully stay pregnant for whatever reason, that would be a disaster. We'd all be conceiving babies left and right that had no chance of surviving if we just popped out an egg like clockwork on a particular cycle day, even when things in our environment seemed less than ideal. So our bodies then "decide" just to hold on to the egg a little longer.

When you stop to think about it, doesn't it make sense that your body would have some way to do that? Instead of conceiving a doomed pregnancy or wasting an entire cycle's eggs (because eggs are scarce and precious and we have only a limited number, our bodies dont want to squander them) wouldn't it make a lot more sense that your body would have a "pause" button it could hit for a few days or a week or even two?

Virtually everyone has months where they gear up to O and then don't, and many people have that just as a pattern that seems to happen monthly or most months. Sometimes it takes 2-3 surges or even more, before the egg is released. We have people who are having this situation from PCOS, people who have this situation when they didn't eat enough, people who got sick, were stressed, exercising a lot even when eating a lot of food, took herbs or medication or vitamins that delayed O, people who have no idea why but their O was just late that month. It is by no means rare to gear up and not ovulate, and then to ovulate a few days or a week or even longer. It just doesn't mean anything, even if it happens every month (as it does for many people).

And you know what? These people still get pregnant, even in cycles their ovulation has been delayed, even repeatedly delayed, even delayed by MONTHS! They are not broken, damaged, or infertile. The connection between their ovaries and their hypothalamus is just fine! Indeed, the fact that they don't ovulate when things are not ideal is a likely sign that these women's bodies are actually working just great, that their bodies are responding to cues from the environment and waiting till everything is just right to sustain a pregnancy.

- Setting all that aside, you are already on metformin. Metformin lowers blood sugar, which lowers testosterone, and gives you a better hormonal balance for conception. So all these assumptions you're making about there being something wrong with the link between your brain and your ovaries not only has no evidence to support it, but it literally cannot be true because you're on the medication that fixes the PCO-related issue in the first place.

- I would just like to point something out here. This is in NO WAY a "told you so" thing but I bring it up because you appear to be blaming yourself for the estrogen patch thing instead of the medical provider who prescribed it to you without adequate warning. If you recall, based on what I have witnessed happening to other people, I mentioned that hypothetically, using an estrogen patch could delay your ovulation. This was IN NO WAY caused by something being wrong with YOU making you respond badly to the estrogen, but because estrogen can delay O, particularly at first. (it has happened to other people!! That's how I knew it could happen in the first place!) It's not a you thing, it's a "messing with hormones" thing - whenever we do things that may alter hormones, even with the best of intentions, we can see this happening. The solution is to stop the estrogen OR to stay on it long enough so you get used to it. Do not now tell yourself that your ovulation was only delayed because of the failings of your body. It simply isn't true. Now, in the future, if you need this for PMDD type symptoms, that's something that can be revisited (and like I mention, if you stay on it longer the negative effects may wane) but I don't want you headed forth assuming that there's something wrong with you that makes you respond differently than other people do. There is nothing wrong with you, all is well, it's just a side effect that can happen.

[Kiwimaz]

Thanks Atomic, I really do appreciate the time you put into your answers here, and that this forum is public and therefore you don't want to perpetuate misinformation.
I think you hit the nail on the head that I fundamentally think there is something wrong with my body. I didn't get my first period until I was 24yrs old and that was after taking vitex. It was difficult seeing my friends start their periods but never me. I was ashamed of that and confused as I had breasts, acne and hair in the right places but no AF and I'd see them wear their menstruating badge with pride and feeling honestly defective yep. I didn't know one other girl my age who didn't have their AF and I wasn't overweight by any means.
In my late 20s I was spotting alot from about CD16 to CD 26 ish then ovulating. I saw an RE about it (she prescribed estrogen cream vaginally) and also that my partner and I had been NTNP for 5yrs but only 2 early mcs in that time. She said, if it hasn't happened by now, it probably never will. So that reinforced it. Nevermind the fact my partner was a pack a day smoker, I assumed it was down to my defective body. I conceived my eldest not that long after that but my other three children are to my now husband, who clearly has better quality sperm.

My cycles range in length 5-8wks and are never the same from one cycle to the next. 6wks is probably my most common, with a 14/15 day LP being my usual 90% of the time. I am very analytical and a bit anxious, so it is probably my own fault, but I have found those extra long cycles (those beyond 6wks), very draining mentally when ttc down to being afraid of missing O altogether and just the fact you're getting one shot in two months, instead of 2 shots if you were on the obligatory textbook 28 day cycle. There are also other supps I'd be taking to help myself (in general) right now, that I'm not due to swaying pink.

Metformin reduces the pain in my ovaries and during intercourse, and the first one or two cycles after I start it I see an earlier O, but after that I seem to go back to Oing all over the place. I guess the expectation was with metformin, diet, exercise and a healthy BMI, I'd get my cycles down to 5wks regularly. Like I expected to get my period in high school. But to my disappointment no.
So you're right, the belief is my hypothalamic/ovarian axis is wonky for any number of reasons and maybe it's better to be 'managed'. Which is ironic cz I hate patriarchal values underpinning a lot of medicine and the reason I think I'm broken is because the textbooks say a normal cycle is 21-35 days or whatever and menarche should occur by X age and if it doesn't its CAH or obestiy related PCOS or a tumor etc etc.

Thanks for your input Atomic, I have a lot of respect for you and also understand this is a swaying forum, not pcos support, or ttc support or adolescent trauma suppport so I will try manage this the best that I can and keep on track with the LE PCOS diet and exercise while waiting to O again.

[treens]

Big hug. I am sorry you have had such a tough time over the years. I am sure you will get the perfect bundle to extend your family )))

[atomic sagebrush]

Kiwi, I wanted to touch base with you and see how you're getting along??

[Kiwimaz]

The specialist was ok with prescribing letrozole but said I need to have a period first, he's also prescribed 10 days Provera too if I want/need it but I'm nervous about it cz of PMDD I don't tend to react well to progesterones. He thought could just as well wait for natural O.
Still waiting to ovulate though on current cycle. Up to CD26. I thought i might give it til next Monday for natural O. We've kinda given up on this cycle I think cz I find the one attempt plus a very unpredictable O is causing me stress.
In general though I feel really fatigued I can't wait to get pregnant and wean off met, take some extra vitamins & eat as much protein as I want

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[treens]

Hoping what the doctor has said will help you
Best of luck!

[atomic sagebrush]

Oh ok good I'm glad he wants you to wait. We've had a real issue with doctors just giving it out whenever without any ultrasound or bloodwork to see if it's the right time of the cycle to get any benefit.

The longer you wait, the more likely it is to happen naturally. So I'd not wait till a certain day and then start the Provera unless you think it's possible it will be months before O happens. What I'd not want to see is you waiting till you were just about to O, then starting the Provera at that point, then stopping ovulation. This seems like it could potentially mess things up even worse!

We can absolutely do e4d if you'd prefer.

[Kiwimaz]

Ok so yeah I keep putting the Provera off cz I keep thinking/feeling O is still trying to happen naturally & I thought the same about messing with things.
I felt like jumping my husband today for the 1st time in a while, it's CD30 so it's possibly coming.
My question is, would you have me attempt now, no meds, or put off til next cycle with femara? Is there much difference in success rate?
Been on diet 3mths now but slipping here & there with fat, craving alot.
Weight mostly steady, losing about a 100g a week on average.
I have picked up both the Provera & the femara already but they've told me it's $425 for the monitoring next cycle (had to pay that twice with my daughter cz the starting dose was too low but not starting that low this time).

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