17 Weeks: The Long and Winding Road

Baby is now the size of an onion, or a turnip, roughly 5 inches, and is developing a hard skeleton and starting to put on weight (so is Mama! eek!). Heard the heartbeat again this week, and even heard a little bit of movement…SOMEbody didn’t like being poked by the Doppler, I think. Grow little frog, grow! See you on the big screen in two weeks!

It’s well on time to tell it, but I don’t even know where to begin the story of how we got to be 17 weeks pregnant. I think maybe it starts when I was in high school, in early 2001, when my mom had brain surgery to clip off an aneurysm. It was the kind of aneurysm that might or might not have been inheritable, so I knew that there’d come a day when I needed a brain scan to rule out an aneurysm too. I mentally set the date for when I wanted to try getting pregnant. Best to make sure my brain’s all there beforehand, right?

Skip ahead to two summers ago — happily the MRI turned up no aneurysms, but almost as an afterthought the technician reading the scan noted that I had a partially empty sella in my brain. Empty sella syndrome (ESS) is a disorder of the bony structure surrounding the pituitary gland, the sella turcica (Latin for Turkish saddle). It isn’t actually empty, but injury to the pituitary gland can cause that gland to shrink or flatten, making the sella where it sits appear empty — bright white — in scans.

There are two kinds of ESS, Primary and Secondary. Primary ESS is the result of an anatomical defect that increases pressure within the sella turcica, flattening the pituitary. Secondary ESS occurs when the pituitary gland regresses in the sella as a result of injury, surgery, or radiation therapy. Individuals with Secondary ESS due to glandular damage experience symptoms “that reflect the loss of pituitary functions, such as the ceasing of menstrual periods, infertility, fatigue, and intolerance to stress and infection.” (Wikipedia) I’ve never had surgery or radiation therapy, and infertility issues do not result from Primary ESS, so somewhere along the way, there must have been an injury. Conditions associated with ESS and pituitary damage are early puberty and growth hormone deficiency…

So let’s go back a bit — In my early 20s, I was diagnosed with Polycystic Ovary Syndrome — a catch-all name for a group of issues affecting the reproductive system in women. The doctors couldn’t feel any cysts, but tests on my endocrine system all came back borderline questionable. The diagnosis was mostly based on anecdotal evidence and the borderline tests, but most PCOS diagnoses are. So for the middle part of my 20s, we treated the symptoms of PCOS with medication, and I was told that when I wanted to have kids, my doctor & I could address any issues then.

Fast forward again to two years ago, about the same time as the MRI, when I wanted to start clearing the PCOS meds out of my system. I weaned off the meds under my physician’s guidance and my body just. shut. down. My stress and anxiety went through the roof, and my menstrual cycle jammed to a stop. For months, nothing happened. Inquiries with my primary care physician forwarded me to an ultrasound technician who visually confirmed no cysts and then an OB who misinterpreted my blood test results (slightly elevated prolactin, a hallmark of the PCOS sufferer) and congratulated me on my new pregnancy, hastily backpedaled when I turned pale as a ghost and nearly passed out, and reordered blood tests and then sent me to a reproductive endocrinologist who, I swear, is the first doctor in my life to ever actually listen to me. I had had a bad reaction to the first OB’s medication, and the RE prescribed something different. It convinced my system to work for a month, which cleared lingering hormones out of the way and gave us a blank canvas. We made the mutual decision to start slow and eliminate potential solutions starting with the least invasive and working our way up as necessary. She did another battery of blood tests and determined that somewhere along the way, my brain was not instructing my ovaries to DO anything. And that’s why my cycle had simply stopped: my pituitary gland was not, for whatever reason, working right. It was basically stuck as though it were perpetually the second week of a menstrual cycle. So of course, the first thing I think is “Aha! That damned empty sella!”

Well, I think that’s enough for this week, and I don’t want to tire you all out before the end of the story. 🙂 See you again with the rest of the story next week!

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