So imagine my excitement when she came about 20 hours early! Which puts me back at a 30 day cycle. Last month it was 31 which is a little long for my taste. And before the m/c it was 30. So I don't have high hopes that it will get any shorter. But it's ok. I am THRILLED that I have now had two complete cycles. My body absolutely astonishes me. It feels nothing short of miraculous that this is happening. Maybe I've totally lost it. I mean seriously, I wait with baited breath each month around this day now, I get kind of stressed about it. That can't be good. I am recording my temps and cm again. So by day 30 I typically have some idea of whether my cycle is progressing normally, but still - I've spent so many months enmeshed in so many false signals, both from my body and my OBG. It's like the idea of AF actually arriving - at all, let alone on time - seems too good to be true.
I don't know how many months I can go on like this. I am considering TTC in early October. If my cycles continue like this my "O" day will be around the first. That would mean just one more AF to wait for. And then back to business. The alternative is to start early Nov. which is where my ticker is set currently.
One month shouldn't be that big of a deal but, in true form, I'm obsessing and researching and having internal debates and need to throw it out here in hopes that you learned ladies might have some advice.
Here's a summary of the stats. My oncologist says he's not worried if I start now. He says there's no reason to believe the GTD will come back but there's nothing proving three or four months is a "long enough" wait either. He says the six month wait typically prescribed is totally arbitrary and only for differential diagnostic purposes.
My OBG says I should wait 'til January. But she said that protocol came from the oncologist. Which it obviously didn't. So she is a liar. Why am I even discussing her position?
I had four methotrexate injections ending on May 8. I've read a lot of anecdotal recommendations to wait 3-6 months after MTX treatment before TTC. The wait is typically longer the more injections you have. But I have also read advice saying that MTX is cleared from your body within days and will not affect a subsequent pregnancy. My oncologist is, say it with me now, "NOT WORRIED," regardless of when I start. He was surprised when I mentioned this article about the effects of MTX on pregnancy, recommending a 6 month wait. He didn't have much more of a reaction to it. I don't think he buys anything he hasn't read. And he's probably read a lot. Enough to know whether or not to be worried. In any case, for those of you not interested in slogging through the article (can't say that I blame you) the gist, in relevant part, is this:
[MTX's] presence in
the liver has been reported up to 116 days after exposure, although the amount
of drug retained does not appear to be related to the dose received.7,49
There is thus a theoretical risk of fetal exposure in babies of mothers who have
taken the drug up to 4 months prior to conception.
[A]uthors [of a study of
women who conceived after being treated with single and multi-agent chemo
including MTX], from
an oncology unit, advise delaying conception for a year after the cessation of
chemotherapy. This advice differs from manufacturer's recommended `washout
period' before MTX
cessation and conception, which varies between 3 and 6 months.52 In
order to allow for the persistence of MTX in tissues and to avoid potential chromosomal
damage to the dividing follicle, a minimum delay of 6 months would seem logical.
It's strange and a little arbitrary that the authors of this article would issue that final 6 month recommendation. After all, just a few paragraphs before they note that the latest MTX has been detected in tissue is 116 days after treatment. 116 days is (measuring conservatively) 3.87 months. Not six months. So ok, they're leaving a gap, just to be safe. But knowing what I know about how fast MTX is processed suggests to me that any wait time longer than one week is pretty "safe." Just because the substance lingers in your system doesn't mean it's still active and able to retard the growth of cells.
I'm shooting for starting somewhere between 3.87 months and 6 months. If I start TTC in my early October cycle, that would put me at 4.75 months past my last MTX dose. Interestingly, the study notes two women who took MTX for months to treat rheumatoid arthritis and then stopped for 28 days or less before conception. Both had healthy full term babies. There are also studies involving women who waited a year and had complications. Here is the chart on this group of women.
I need to move on with my life. Me and DH. We need to stop feeling like we're walking on eggshells. But I don't want to jeopardize my life or a potential baby's life by being reckless about this. I think ultimately it's going to come down to what I feel comfortable with. I have the green light from my oncologist. But on some level I feel like maybe he is not being cautious enough. But does it make me sufficiently cautious if I follow the article's advice? The part where it says to wait 4 months, rather than 6, which seems unsupported? Probably. And, as we all know, there is every likelihood that we won't conceive our first time trying. But I guess I have to assume that we will. Will it make me more nervous during the pregnancy to know that I only waited (almost) five months and not six? Am I pushing the envelope too much?
