So All Those Years of Contraception Were Worthwhile

I never expected falling pregnant to be easy.

In fact, I thought it would be downright tough. I’ve seen enough people struggle to conceive, and heard all to often about women who’ve spent the first half of their adult lives desperately trying not to get pregnant, only to spend the next five or more years doing absolutely everything they can to do exactly that. And I really thought that would apply to me.

It’s not that I’m a pessimist by nature. I had some pretty strong reasons to doubt my fertility.

Apart from anything else, I’ve got more than 25 years of type 1 diabetes under my belt. Whilst diabetes doesn’t, as far as I’m aware, specifically contribute to decreased fertility, it certainly doesn’t make things easier. When I was diagnosed, there were many doctors who specifically advised diabetic women against pregnancy. And I’d always been warned that diabetes could affect my menstrual cycles. That pregnancy, if achieved, would carry additional risks for both me and the baby. It wasn’t something that bothered me all that much though.

Then, in my early twenties my periods, always irregular, stopped altogether. I had an IUD at the time and I, and my doctors, assumed this was the reason. But after I had it removed, they still did not return. In two years, I had two periods. I was not particularly bothered. Relieved more at the absence of pre-menstrrual bad moods and bloating and of dealing with the whole messy business, not to mention the cyclical screwiness of hormonal effects on my blood sugars. Plus, I had more space in my bathroom cabinet without the need for tampons! It took me those two years to actually ask for the reasons to be investigated. I was given a diagnosis of premature ovarian failure and told I wouldn’t be able to have children. The diagnosis was, quickly, proved to be false when my periods re-started of their own accord. I was, however, found to be oestrogen deficient and having anovulatory cycles. When my autoimmune pituitary issue was diagnosed, my gynaecologist was adamant that probably played a role too. I was told it was still unlikely that I would fall pregnant, at least without assistance.

I still wasn’t all that bothered. It certainly crossed my mind that this meant I didn’t actually have a choice about things, so it meant I wasn’t really making a conscious “decision” not to have children. I guess it probably did cross my mind for the first time that there was a tiny possibility that my feelings about motherhood may change in the future. But just as quickly I realised that now they couldn’t. I’d never have to feel judged about “not wanting” children if I couldn’t have them anyway.

I began using hormonal contraceptive patches to boost my hormone levels and regulate my cycles. I felt an awful lot better for it. And the plus side was that I was protected against pregnancy should any of the things I’d been told turn out not to be true. One thing you don’t want as a diabetic is an unplanned pregnancy, as the only way to mitigate the risks that diabetes carries is to ensure it’s under the very tightest control possible before you even conceive. Obviously I strive for tight control all the time, but I’m a human, not a machine. And the targets for pregnancy are even tighter than normal. Without contraception, I think I’d always have been wondering about pregnancy at the back of my mind. With deeply irregular cycles, I’d probably have been peeing on a stick every so often, just to make sure. So contraception was covered, even though I didn’t think it was totally necessary.

And then things changed in my life.

Once the decision was made that we wanted a baby, a lot more things changed. I started taking a pre-natal vitamin and later added high-dose folic acid. (The pre-natal vitamin includes the standard 400 microgram dose, but given that I have two of the factors that increase risk for neural tube defects – diabetes and taking anti-convulsants – I was definitely rocking the 5 milligram dose.) I cut down on caffeine and alcohol. I maximised the fruit and vegetable content of my diet, and began minimising the carbs in pursuit of lower post-prandial blood sugars. I stepped up all my efforts to achieve the tightest blood glucose control possible. I increased blood glucose testing from 8-10 times a day to 12 or more. I was using Continuous Glucose Monitoring… well, continuously. I moved to a once a month schedule at the diabetes centre, and eventually began attending official pre-conception appointments at the pregnancy clinic. I was religiously logging numbers: blood sugars, boluses and carbs. I was stalking the highs, tightening my targets and correcting with vigour.

I wanted to reach a point where we could be given the go ahead to try to conceive. But all the while I was pushing to the back of my head that little niggling worry that I wouldn’t be able to conceive. While I was so focused on blood glucose management, it was easier to suppress the worry that my body wouldn’t work the way it was supposed to.

Eventually I made the decision to discontinue the artificial hormones. We didn’t stop using contraception entirely, but I knew that I needed to see what my body would do without the hormones. Six weeks later, I had my first proper period. And just over four weeks after that, another one. And then a third. I began to let myself hope. Maybe the years of hormones, and the treatment for all my underlying health problems, had somehow kick started my body.

And so obviously, we were desperate to try, and see what happened. In other words, ditch the contraception and have lots of sex!

Then came a disappointing blow. Despite all my changes and efforts, I received an A1c that didn’t shift in the downward direction I wanted. The A1c test is a reflection of how well controlled your blood sugars have been over the last 2-3 months. In a normal, non-diabetic, the level will be between 4 and 6%. The target for people with diabetes is to keep it below 7.5%, preferably lower, to reduce the risk of long term complications. For women who want to become pregnant, the target is below 6.5%, or even below 6%.

The number I received wasn’t terrible. It was 7.1%. But it wasn’t good enough for pregnancy. Not by the standard guidelines. And definitely not by me. I wanted it to be better. When I got the result, my heart sank. I’d really thought the number would be better. I couldn’t look at Ian, sitting next to me, because I knew that I’d cry. We were ready for a baby. But my diabetes wasn’t. I hated that this was what was stopping us. Especially when I’d just begun to hope that my crazy hormones just might be about to co-operate.

I was still afraid that we might not be able to conceive, but even more afraid that I might not be able to achieve the level of control that I needed just to try.

I really doubted my ability to do any more. I felt like I’d been working so hard, and it wasn’t paying off. I was frustrated that years before I’d achieved much lower numbers with much less effort. Fortunately I was supported by a wonderful husband and also a fantastic medical team. They helped me to see that didn’t need to work harder. That actually I needed to loosen up the stress, and that I needed to be more efficient. We made the decision to invest in a new Continuous Glucose Monitoring System to replace the existing system I’d been using for a number of years, but which was proving problematic, and I changed my insulin pump – back to a previous model that I’d preferred. New gadgets can be a great motivating force for me!

We got there in the end. I achieved a result of 5.9% and we were given the go ahead to try.

We discontinued the contraception. Pretty soon it was evident that I had needed it all along. Getting to the point where I was able to try to conceive was downright tough. But after that, the actual conception part turned out to be pretty straightforward.

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