Vitamin D - is a supplement needed for pregnancy?

The nurse had mentioned to me about starting vitamin D supplement, along with folic acid. According to her, women planning to have a baby should take both vitamin D and folic acid.

While the importance of folic acid is undisputed, vitamin D is a new thing to me.

Why do pregnant women need to take vitamin D?
Studies have shown that a lack of vitamin D may be associated with premature birth.

Does that mean I need to take a pill? Can't I just get it from a few hours of sunshine?
The advice about whether taking Vitamin D pills is necessary or not is conflicting (UK does not recommend that pregnant women should taking vitamin D) A main reason is how easy it is to obtain this vitamin - just get some sunshine. However, that may not be the case in the long winter months, or if you dress in a way that minimise exposure to the sun.

Other than the sun, we also get vitamin D from food, such as oily fish like salmon and mackerel ( which also supplies the DHA and EPAs!).

Other reasons to have enough vitamin D when preggie:
Vitamin D is involved in the proper regulation of calcium and phosphate in the body - which is necessary not only for the development of the baby's bone  and healthy development of muscles etc. You also need it to make sure that your own bones and teeth are well maintained.

going down the slippery slope.. IVF?

First of all, let me declare - I have nothing against IVF. It is a choice that people make, but it a choice that I always thought will never be mine.

I have always preferred adoption. When there are millions and millions of children in the world requiring a better home and love from a family, why should I spend thousands of $$$$ to go through the trauma, just to create my own progeny, my Mini Me?  In a funny way, I don't see myself  as having genes that are special enough. I almost have a Darwinian mindset at times, survival of the fittest. If I can't have a baby, then perhaps I should get the message that my genes are not meant to be passed down. Period.   If only that is so simple.

I don't feel that special. My other half is special to me, but is he really really special? That is when the guilt kicks in. If only he found another woman whose genes could have been passed down, he would have passed on his genes too! But he chose me. You can argue lack of foresight in choosing a mate as a fatal blow to his chances - he doesn't deserve to get his genes passed on either, but then again, is this stupidity on his part or loyalty and love?

After a few days of not thinking or doing anything about baby making - the sight of japanese kids looking for their parents depressed me, I went to google "fertility clinic" and    taaa daaa saw a long long list!  ARGC in London is the one that I found most impressive! The statistics page (http://www.argc.co.uk/statistics.html) really made me feel like "what are you waiting for!!!", but the prices... sigh.

Last night, I showed hubby the "price" page: http://www.argc.co.uk/prices.html
'His response was, "We should try harder for a while more. Let's see what the doc says. I don't think we have that kind of money to spend. "

I agree....that kind of money is enough to set up a very comfortable room for a child, and provide a child with a home with us.

Then again.. you will never know. The wonders of biology. My urge to pass on my genes may obliterate the belief I had for the past 30 years or so! The next thing I know, I might be hunting for the best fertility specialist in town.

Vitamin B1: Trying to conceive, pregnancy, PCOS

Vitamin B1:  For energy and brains

Vitamin B1, is usually not mentioned in the same breath as its cousin, folic acid which is well known for its importance in preventing spina bifida. However, thiamin is a key component in the normal metabolism which converts sugar, and carbohydrate into energy, and not just energy for running around. Our brains depend on glucose metabolism for energy, and thiamine pyrphosphate (TPP), is required for carbohydrate metabolism. 

What to watch out

Thiamine deficiency leads can cause beriberi, but deficiency of vitamin B1 is really rare. It is more of a problem if the main source of carbohydrate in your diet is processed, ie "polished" rice.

The most common cause of deficiency is alcohol abuse. If you have been a serious alcoholic, you might want to watch this!

Also, the wikipedia article there mentioned that people are normally encourages to take vitamin B complex supplements ( i.e. all the vitamin Bs), rather than a single vit B, because it can cause imbalance? I am not sure how much truth there is there. 

How much Vitamin B1 is needed?

Breast feeding and pregnant mums need about 1.4 mg per day.  

Because cereals are fortified, a typical 3/4 cup of cornflakes more have about 1.5mg - more than required!

Practical stuff:

1. No worries, unless you have been an alcoholic!
2. You need B1 for the normal development of nerves, heart and brains + energy!
3. This is a water soluble vitamin, ie not stored in the body. Need a consistent supply. Low risk of overdose, since it is not accumulated in the body.
4. Could not find anything related to PCOS, apart from those sites that try to sell you something :P.

More info: check out wikipedia, enter "thiamine"! Lots of info there. 

Vitamin A: Trying to conceive, pregnancy & PCOS

Vitamin A: Friend or foe for TTC, baby and PCOS?

Vitamin A is important for the normal development of the baby, and also helps with infection resistance and fat metabolism.

However, we have to avoid taking too much vitamin A, especially in the form of  retinol in the early stages of pregnancy because it can increase the risk of birth defects at high doses.   

However, the other form of vitamin A - beta carotenoids found in fruits and vegetables does not seem to cause the same problems (ok to eat fruits/vege). 

What to watch out

The potential for birth defects is one reason to be very careful when taking multivitamins, or fish oil supplements to make baby smarter (read the label!). The advise is to also avoid eating food with particularly high vitamin A contents, such as liver, sausages ( that contain liver) and cod liver oil. 

For women with PCOS, Vitamin A is commonly used to make us look prettier ( get rid of the acne), either through prescription by doctor in the from of a capsule(Accutane or Roaccutane), or as a creams to apply on the face. However, those contains various forms of vitamin A and should be avoided if you are trying to get pregnant or already pregnant! 

In fact, since Vitamin A is stored in the body, you should stop taking Accutane for a few months before trying to conceive. 

How much Vitamin A is needed?

Pregnant women, 19 and older: about 770 micrograms RAE of vitamin A (approximately 2,565 IU) per day
Pregnant, 18 and younger: 750 mg (2,500 IU)

Breastfeeding women, 19 and older: 1,300 mcg RAE (4,330 IU)
Breastfeeding, 18 and younger: 1,200 mcg RAE (4,000 IU)

Practical stuff:

1. Fruits & vege good. Liver and cod liver oil bad.  Watch out for those sausages (even the organic ones), you don't really know what they had stuffed in it!
2. Read supplement labels, especially multivitamins - that is why I am paying so much for pre-pregnancy one!
3. Check acne products - acne has to be tolerated (??) for baby :(  [that is so unfair!!!!!!]

More info: There is an excellent article from the babycenter.com. 

Vitamins for trying to conceive & PCOS

I had learned this a long time ago during our biology lessons about vitamins, and have read bits and bobs here and there. Now that it is time to create a new life, I bet a bit of refreshing will do no harm.  Time to make some notes...will start from A to Z, but will just focus on what is relevant to me ( PCOS, TTC)


Notes about vitamins... and the likes. 

• A
• B1: Vitamin B1 for trying to conceive, pregnancy and PCOS
• C
• D:Vitamin D - is a supplement needed for pregnancy?
• E
• F??
• G?
• H
• I -
• J
• K
• L -
• M -
• N
• O
• P
• Q
• R
• S
• T
• U
• V
• W
• X
• Y
• Z

Metformin and Vitamin B deficiency

I found the original publications in BMJ (link here) about risk of folic acid deficiency for metformin users, and had a sigh of relief.  It is not as bad as it sound in the popular press.  The difference in concentration between people who  take metformin and  those who don't take is only about 5% - still important for us who are trying to conceive to take not, but nothing to worry about if we have a healthy diet and a folic acid supplement. 

The risk for vitamin B12 (thiamine) deficiency is higher though. I found this paragraph from the article most relevant to people with PCOS:

"There are few disadvantages to the use of metformin. Metformin does, however, induce vitamin B-12 malabsorption, which may increase the risk of developing vitamin B-12 deficiency5 6 7—a clinically important and treatable condition. In addition, metformin treatment has been reported to be associated with decreased folate concentration, although the mechanism of this effect has not been elucidated.8 Finally, decreases in both folate and vitamin B-12 concentrations might, in turn, result in an increase in homocysteine concentrations (web figure A), an independent risk factor for cardiovascular disease, especially among individuals with type 2 diabetes"

Basically it says, keep your vitamin B levels high while you are on metformin! Having PCOS already increase your risk of heart problems - don't add to it.  And the longer you take metformin, the higher your risk of low B12 levels, because metformin stopped it from being properly absorbed.

Lets fight the fats!!!!

I found a really great blog  called "becoming obesity's worse nightmare!" That is so inspirational - I can see shed loads of determination there! I like the photos of those numbers on the scale between nicely painted toes  :) I dont think that I can do it. I have really ugly toes. 

That inspired me to immediately do a stock take of what I have done since 1st January, and what I continue to do:

Since 1st January:

1. get off the train one station earlier  on the way to work
2.  walk to the further train station, if I am not too tired by the time I go home
3.  substitute more pasta/noodles meals with konyaku/shirataki noodles! These noodles helped lose 1kg this winter, instead of gaining the typical 3-7kg!!!
4.  Only eat things that are really delicious, especially if it is "bad". No more cheap cakes and chocolates
5. Two size 14 trousers joined the "being worn" category. These replaced  2 pieces of  totally worn out size 16 trousers (ie there are holes there). They started off really tight and ugly, but a good reminded to stay away from biscuits and cookies in the office!
6. Started metformin

Continued from last year

1.  Xenical - no longer needed daily, since I am mostly "good". Only take when eating out (and suffered the consequences)
2. Walk, walk walk.. whenever there is an opportunity, I walk.
3. Ensure there is at least an "active day" a week - be it some time in the gym, or a few hours spent window shopping
4. Water... & fruit teas, avoiding juices 
5. Increased salads, reduced carbs!
6. TOTALLY refuse to purchase even 1 more piece of size 16. Size 16 is obese for my height. If I remain on this size, I might as well get naked or lose those bits.

Folic acid deficiency risk with metformin

Seeing the Pregnacare vitamin advert flashed on this site reminded me about an important topic - take folic acid if you are planning to become pregnant or already pregnant. Taking folic acid is particularly important when you use metformin. I just read a report a few weeks ago that metformin users are at a risk of folic acid deficiency. Folic acid deficiency during pregnancy put the baby at higher risk of spina bifida - one of those conditions I would described as " it is unlikely to happen, but if it happens, it is a tragedy".

The report I read gave too little info to tell whether you can prevent that by taking the usual recommended preconception dose, or you need an even larger dose. Yupp, another pill for me.

Restarting metformin

Confession, more than 10 days, and only 6 tablets taken.  Metformin had been quite impossible for the first few days, and I had to stop taking it for a few days. Then I started to take every other day, just 500 mg each time. Now that I am beginning to ease into it, I am hoping that this is the first week that I can take it every day!

No fun, if you ask me what I think about metformin. If you can, you might want to start it when you have a few days break from any work or social life. The bloating, toilet trips and errr farting just wont't do!

I still have this funny metallic taste in my mouth, which makes me feel like grabbing a nibble or having some juice to lessen it. Have been allowing myself these indulgences just to get through the first week or so. I know I better stop these or else I will put on more weight! Sigh... to cheer myself up, I can only think that gals like me are  most likely to survive in a famine. Those stick insects will be long gone before I loose a pound!

p/s If i ever have a kid, I let him/her read these one day. Kids these days view life too lightly. They should know what the hell mums go through to conceive and bring them to this world. 

Metformin makes me look pregnant

.. not just pregnant, but very pregnant. In fact I look more pregnant that my 6 month pregnant colleague. The first day started off with really bad diarrhoea, and now I am still having this terrible bloating, and nausea.

I need to convince myself to stick to it. It is probably my best bet before starting other options.  Of all the treatments available, this is the one that works on insulin resistance, the root of the problem. Hopefully this will balance out the hormones and make weight loss possible.

I hear the loud "tick tock tick tock" and I know I have to "up my game".  I will have to bear with the lousy side effects. The most difficult part is telling people why I have diarrhoea and bloating, and getting the concerned look from my colleagues.  There is no way I can tell them I am on metformin and I hate evading the questions or telling some little lies there. Sigh....

Do you think they will be happy to pay for your fertility treatment..

once they hold the budget?

I know mine won't. ZERO confidence.

Forget about big things like IVF. There will be a real problem even getting them to do referrals or doing tests. It is a £££ oriented practice - totally different from my previous GP practice, which was made up of lovely people who cared about patients.   I have to find a better practice. 

Tick tock TICK TOCK...

Can you hear it? I can.

In case you are wondering whether I am becoming schizophrenic, NO, I am not.  I am merely hearing my own biological clock, TICKing away.  This year, will be my last logical chance, and here I am facing multiple problems:

1. overweight - still not successful. My improvement is NO weight gain (yet) this winter. The past few winters added an average of 5 kg per season
2. Where is my regular period?????
3. Am I ovulating? AT all?
4. PCOS - is still by "best friend"

I have not been not keen on "drastic" moves, preferring to lose weight and conceive naturally. However, after a few years of trying, that is clearly not happening. 

Time to wake up, and face the truth. And take action quick. It is time to negotiate and sharpen the elbows when it comes to dealing with my current GP.  Sigh.... the sad news is if I don't do things quick, i will soon have not only my age against me, but  the healthcare system. If my current GP has to pay for my fertility treatment, I can jolly well forget about it. 

how did they do it - the stamina in baby dancing

Those women surprised me. And those men impressed him. How did they do it?  Sustained periods of baby dancing (weird term). I am very happy for Posh & David Beckham.  I read from the ever entertaining daily mail that David had to stick to a schedule that Victoria Beckham ordered . They have to stick strictly to it. Do it every few hours when she is fertile. OMG!!! I know that he is fit & healthy, but that is still many times a day! Hmmmm... her period is hopefully some sort of clockwork.Otherwise, there will be a longer to try for many days!

The papers had lots of comments about what she could have done to choose the sex of the baby.
Why is it their bussiness - I don't know. Anyway, here is what they think she should have done to get a girl.

These journos have no ideas how precious a baby is for people with pcos. I wish they would have spent that energy to find out how we pcos women can follow a similar step?

damn... not today

I was going to bed in my hotel room when I sudden felt a sharp pain on my left abdomen.  Damn, having read that Taking Charge of Your Fertility book almost cover to cover, I think i know what it was, despite my menstruation not being very regular. The signs were pretty obvious this time. 

I was happy, as it kind of reassured me that it is still "working", but unfortunately, hubby was miles away and I could not see him for another week!

Another missed opportunity, which is a big thing if you are my age!

Is anyone keeping track of the cost of trying for a baby?

How much does it cost to get a baby? Err, those things like the cost of drinks in a bar and taxi fare home after a one night stand doesn't  really count here.

What I am thinking of is, how much does it cost? Those pre-conception stuff. Vitamin pills, lubricants (yes, there are special lubricants for the purpose), ovulation test kits, pregnancy test kits, basal temperature monitors.. etc etc. Oh yes, how about books? Books about fertility, books about how to do it, books about how to determine your baby's sex etc etc. There is a whole industry there going after our money! There are so many economic studies about how much it cost to raise a child. Anyone costed how much it cost to "create" on in the first place?

Unexpected excitement

I have been nauseous for two days. Maybe it is the Xenical which I had just started to help with my weight loss. Perhaps it is just a stomach bug.  I spent the weekend in bed, tired and have no appetite for food.


Despite the tiredness, I still spotted the continuous and not so subtle hint from the other half.  His "baby radar" was turned on! He had been asking me "jokingly" whether I was pregnant. I told him "in your dreams, I just tested yesterday",  but he was still not convinced.


I was reminded that have I have stocked up some really cheap pregnancy test kits; all I have to do is just to test (again!). Fine, to have some peace, I tested, again.  Negative.


He totally surprised me when he told me that the best time to test is in the morning. And apparently, although the strips are cheap, they are just as good if used correctly since it these are high sensitivity tests!!  Wow! I wonder where and when he learned this. He is a biology idiot.


I can smell baby desperation in my hubby, and I am not sure whether I like it.

period

received with mixed feeling of joy and disappointment.
The feeling that the period is here (yay, I am normal again) is quickly giving way to disappointment.  Another month goes by.

breast tenderness

I have been having horrible breast tenderness since a couple of days ago. That is funny, because I have not been getting any breast tenderness for quite some time - years?

Hormonal imbalance? or.....I don't even dare to think about it.

The temptation to take out one of those sticks is so high!

Review: Cheap pregnancy test - worth it?

Product: Ultra Early Highly Sensitive 10miu Pregnancy Strip Tests

Price:

£4.48 for 25 tests, £14.19 for 100 tests ( correct as at 11th May2010). 

Free super saver delivery ( mine arrived in 2 days)

Quality:

CE marked and FDA cleared.  10mIU/ml sensitivity

Ease of use:

The instructions are clearly written with a diagram to show the how the test results should look like.

Main advantages:

1. Cheap! Less than 20pence per test, that works out to 5% of the cost of a typical test (around £6)
2. Sensitive (can detect early pregnancy), since it is at 10mIU/ml level, which is comparable and even more sensitive than most top brands. There are more information about sensitivity of pregnancy tests here: http://www.fertilityplus.org/faq/hpt.html#faq
3. Small,discrete individual package (12 x 6cm). Can keep in my bag, just in case I want to have sushi for dinner.
4. Discrete, fast delivery from Amazon.
5. Collecting urine in a small cup is easier than imagined after 1-2 tries.

Main disadvantages:

1. Short strips, about 6-7cm, and you should only expose the area of about 2 cm to urine. This makes it quite challenging "aiming". If you expose the area above the "Mark line" (see diagram), you may void the test. The easiest is to collect a small amount into a small clean disposable cup, and "dunk" the strip there. This is easy after 1-2 tries.
2. If you carry the test in your bag, be careful not  to fold the strips. 
3. Addictive. Because it is so easy and cheap, you might want to do it even before another ibuprofen for your headache.

Will I use/buy it again?
Yes! If testing is so cheap, I see no reason not too test.


It spares me from having to avoid "risky" behaviours such as having a glass of champagne or having a spa session which involves soaking in a jacuzzi or a nice meal of sushi. 


I was put off by the urine collection step, but learned how to do it easily after 1-2 tries. Very easy.  Worth the trouble for a fraction of the usual price.


I am going to buy the ovulation test kit next. 

Pregnancy test kits - what if you do not have a regular period?

I have no regular period, ie no indicator of "this is when you test".  Since I don't drink or smoke, I thought this was alright. However, I needed some medicines when I feel ill. Was I going to stop taking that just in case  I am pregnant? My job would be at risk if I decide to happily call in sick for so many days!  


Testing for pregnancy is an expensive business. Those test kits on the pharmacy shelves compete on the basis of their accuracy after X day of missing period. These are not relevant information for me. I have no regular period, so what is the value of a test that offer 99% accuracy after 1 day? Leading brands like Clearblue Pregnancy Test costs about £10 a pop in the pharmacy and offer fancy things like colour changing tip (so that you know your urine has hit the tip) or saying the results in English "Pregnant" shown  instead of crosses or lines (so that there is no way you misread your test). I concluded that their target markets must be teenagers who have regular periods and want to know if they are in trouble after some hanky panky in the school park. That is why they charge a lot more for than extra bit of accuracy and reassurance - price for a peace of mind.


Just for the sake of ensuring I am not pregnant whenever I pop some medicines or actually allow myself to indulge in some bubblies, I will have to test. How often would that be? Unlike lucky women who could do a couple of tests a month, I have no "missing period" as an indicator and needed cheaper options. Imagine my delight when I found Amazon sells a pack of Ultra Early Highly Sensitive 10miu Pregnancy Strip Tests (25 strips) for less than £5. I quickly bought a pack to "try", and have been using it for about 1 week. I am so impressed that I am posting a review on the pregnancy test.