My journey

My husband and I were trying earnestly for one year to conceive. We bought ovulation prediction kits, timed intercourse, and waited with our fingers crossed every month. When we didn't get pregnant right away, we chalked it up to playing the odds. We were still relatively young (early thirties); it would happen soon.

After another 6 months, though, we started searching for an infertility specialist. At a (standing room only) orientation at a local fertility clinic, the doctor quoted chances success from a high of around 30% to a low in the single digits, depending on age. How depressing. A one in three chance (at most) of having a baby?! I felt helpless, and judging from the silence in the room, so did everyone else.

Our doctor, however, was positive: we were both young and healthy. He started me on Clomid, to prepare me for an intrauterine insemination (IUI). Closing in on my ovulation date, my doctor did daily pelvic ultrasounds, so we could time the insemination perfectly. The insemination was uncomfortable for me, but pelvic exams usually are, too - so nothing I didn't expect. Then, we waited. When we went back for the pregnancy test, we were feeling pretty confident. But the result was negative, and we were both devastated.

The next two Clomid cycles ended the same way. Then, we tried IUI again, this time with injections instead of Clomid. Each time the phone rang to deliver with the results of the pregnancy tests, I could not bring myself to answer it. My husband had to tell me the bad news, and then I spent much of the rest of the day in tears.

IVF was the next option. We wanted a break before starting the procedure: we needed to do some more research, and I really needed to take a break from the emotional roller coaster we'd just been through.

At the same time, I decided to start losing weight. I'd been steadily gaining weight for years, and thought this break might be a good time to get some exercise. A daily hour-long walk and a lower carb diet helped me lose about 10 pounds.

One week before our IVF appointment, my husband and I were in the gym together; I had just started jogging, but today, I decided not to work out. It had been 6 weeks since my last period, and while I was sometimes late - especially if I had been exercising - 6 weeks was unusual. I thought it would be safer not to work out until I took a pregnancy test.

That evening, we had guests over. I excused myself when I couldn't wait any longer, and took the pregnancy test. I couldn't believe it! The stick said I was pregnant!

I was trying to mime to my husband that I was pregnant, but I was completely incomprehensible. When my husband finally went into the bathroom and looked for himself, he was underwhelmed.
"I think you took the test wrong," he said.
"What?! You think I messed up the test?," was my indignant response.
"Yes."

Well, suffice it to say that another pregnancy test, and then a doctor's exam proved that I was indeed pregnant.

Could it have been insulin resistance?

It was not until I got gestational diabetes 5 months into my pregnancy that I started researching diabetes, and learned about the pre-diabetic condition, insulin resistance syndrome.
5'2" and 140 lbs for years, I was overweight. I have a family history of diabetes, and my very own apple-shaped midsection.

Back then, only a few articles pointed to insulin resistance, and I began to suspect that my weight loss may have helped reverse some of its effects, allowing me get pregnant.

While it may just be a coincidence, if I am right, I am really lucky that I decided to go to the gym during my two months away from fertility treatments.

I am irritated that, knowing my medical history, my doctor never once mentioned the possibility. If I hadn't just coincidentally decided to drop a few pounds, I may never have conceived.


Insulin resistance and fertility

Although there are no outward symptoms, there are tell-tale risk factors and blood tests that can help confirm insulin resistance. The good news is that, unlike diabetes, insulin resistance is reversible with diet, exercise, and medication.

Below are some risk factors for insulin resistance:

• family history of diabetes
• low HDL cholesterol and high triglycerides
• high blood pressure
• [if you have already been pregnant] history of gestational diabetes (diabetes during pregnancy) or gave birth to a baby weighing more than 9 pounds
• minority group background (African American, American Indian, Hispanic American/Latino, or Asian American/Pacific Islander)

From National Diabetes Information Clearinghouse

And how does insulin resistance affect fertility? Most of the information I found on insulin resistance and infertility relates to polycystic ovarian syndrome (PCOS), a condition known to cause infertility. A significant number of women with polycystic ovaries also have some degree of insulin resistance; some sources go further to state that insulin resistance is one cause of PCOS. Symptoms of PCOS include:

• Abnormal menstrual cycles
• No periods
• Irregular periods
• Heavy or prolonged bleeding
• Painful periods
• Inability to get pregnant
• Acne
• Facial hair (more than is normal for the ethnic group)
• Waist measurement greater than 35 inches, or waist bigger than hips (apple shape)
• Acanthosis nigricans: darker patches of skin in neck folds, armpits, folds in waistline, or groin

From American Diabetes Association

Looking back, I see that I actually had many of the insulin resistance risk factors and the PCOS symptoms listed above.

Obviously, ask a doctor about diagnosis and treatment.

With respect to treatment, the consensus is no surprise: be more active, and eat foods that are not likely to elicit a strong insulin response. Foods to avoid include those that have a high glycemic load, or foods that contain simple and highly processed carbohydrates. Examples of foods to avoid include potatoes, sugar, pasta, breads (just be careful around the "white" foods).

To address the problem beyond diet and exercise, I've read that some physicians prescribe metformin (Glucophage) to aid in conception.

Diet and exercise worked really well for me, though. During the two months before I got pregnant, I exercised (walked) about one hour every day, and stayed away from most processed carbs. It was really tough, but eventually, the cravings started to disappear, and the pounds fell off.

Changing your lifestyle works surprisingly well in helping to drop the pounds. While I wasn't too overweight, most of my fat was centered around my belly, and that was the first area that slimmed down with exercise and diet.

Unexpected pregnancy

I love being a mom. Any parent will tell you that raising kids is the toughest, most rewarding job around.

I'm so busy, though, that I often take for granted how hard it was to get here... month after month of crushing disappointment for over two years. And after many examinations, a laparoscopy and a hysterosalpingogram, doctors diagnosed me with "unexplained infertility."

Then, one week before an IVF round was scheduled (and with no medical assistance), I was pregnant. What happened?

In the two months before my scheduled IVF treatment, I took a break from fertility treatments, and decided to find my way back to the gym. I suspect that the ten pounds I lost may have helped me get pregnant.