CHAPTER 1 START ME UP: What to Do Before You Get Preggers Time to get knocked up! It's kind of ironic, isn't it? As younger women, we spend a considerable amount of effort trying not to get pregnant. Then, when the time comes to completely reverse that mind-set, it can be a little disorienting. Please don't let me be pregnant somehow turns into Please let me be pregnant! The average woman in the United States spends 3 decades of her life (not necessarily all in a row) trying to avoid pregnancy and about 5 years trying to get pregnant, being pregnant, and going through the postpartum period, to get the two children most women say they want.1 However, during those 5 precious years (for you it may be only 1 or it could be a decade), how you live your life can help in big ways to determine how easily you will become a future mom. Although not everyone does it, planning and prepping your body appropriately for fertility and a healthy pregnancy are essential--both for you and for your baby. If you are already pregnant, you could skip straight to Chapter 2, but I hope you will read this chapter anyway. You might learn some good stuff that will still be relevant to you. If not, let's start the preparation process for the pregnancy to come. And it is a process--an important one. Maybe you didn't expect that. And maybe you are trying to guess what I am getting at: "I am at a healthy weight." "I have no fertility issues that I am aware of." "What is she talking about?" Not to worry. I'm gonna tell you. OUR INADVERTENT PATH TO PREGNANCY PLANNING I don't want to jump ahead too much, but in an attempt to stress the significance of this chapter let me say the following: Thankfully, Heidi is gay. No, it isn't because we like rainbows and pride parades. It's because we were doing IUI (intrauterine insemination), aka the turkey baster method, which forced us to the doctor before Heidi was pregnant and not after, like most heterosexual couples I know. And these doctors asked a million questions, sent her to several other doctors, and ran a battery of tests, which I initially thought unnecessary and inconvenient. "We're gay," I thought, "not infertile, for God's sake! Get the baster and shoot her up. This is such a waste of time!" I was incredibly impatient and annoyed, until those tests revealed some surprising and extremely significant results. It turns out Heidi had uterine polyps, a definite roadblock to conceiving naturally. Had we been a typical heterosexual couple, we likely would have tried to get pregnant for 2 years before discovering something was wrong. And had Heidi actually managed to get pregnant in spite of those polyps, she had thyroid issues she was unaware of, which could have caused major complications during her pregnancy, or even caused infertility, had they not been addressed beforehand. As grateful as I finally was to have had this utterly inadvertent intervention, I was also a bit stunned. I remember thinking, "Why doesn't everybody go through this process?" If a perfectly healthy young woman found these unexpected conditions, wouldn't all couples want to know what their health status is before they start trying? Think of the time and heartache it would save those with fertility issues left in the dark month after month, wondering why the at-home pregnancy tests kept coming up negative. Even more importantly, wouldn't everyone want to find out if they have any issues that could cause problems during and even after the pregnancy and resolve them ahead of time? Why don't all doctors recommend this to all their patients before they try to conceive--not just the gay ones sent to the fertility clinic as a "formality"? I was also left wondering why a young, healthy woman would be hyperthyroid. And why was her uterus covered in polyps? Heidi saw her ob-gyn for regular checkups. Why didn't somebody catch this ages ago? Why hadn't her ob-gyn asked her if she planned on getting pregnant at any point, so all these issues could have been identified and rectified much sooner? This is really when my gears began turning. How could this whole process be backward for the majority of our population? But there is much to tell, so let's start at the beginning. Don't worry, we aren't going back to the big bang--I mean the beginning of how Heidi and I came to learn about the importance and necessity of a prepregnancy plan and how we implemented it. THE BEGINNING This process started for Heidi and me in early 2010. At this time, I was working on a TV show called Losing It. On this show, I would move in with overweight families and coach them back to health. Of course, the families had kids, and for one of the episodes, I moved in with a family in Detroit who had two little girls. One of the little girls was named Lily, and she was 9 years old. I adored her. I would wake up with them, pack their lunches, help them make healthier dinners, and talk about why we were switching out certain foods for other foods, like whole grain bread for white bread . . . and I loved it. Truly. I enjoyed my conversations with that kid more than any other conversations I was having in my life at the time. Well, this rocked my world. Until this point I truly never thought I was going to have kids. I was very focused on my career and I had some fertility issues (which I will delve into momentarily), and the combo of the two had me relatively oblivious. After Lily, however, the genie was out of the bottle . . . and she wasn't going back in. Cliché as it may sound, I finally realized that family is the true meaning of life. I love my work, don't get me wrong, but having children transcends it all (in my opinion). They are the point. The whole point. I recognized pretty immediately that I was not going to get to the end of my life and think, "Wow, I wish I'd spent more time at the office!" The epiphany swept over me completely, and it altered my perspective forever. So now what . . . ? At this stage, Heidi and I had been together for roughly 18 months. She was only 28 and her clock was ticking, but not very loudly. Prior conversations about kids were fleeting and brief. They went a lot like this: "Yeah, maybe we'll do that down the road," or "Sure, maybe one day." I didn't want to pressure Heidi, and I didn't know where life was going to take us as a couple, but I knew I needed to start getting my ducks in a row. Now before I tell you what came next, I need to share with you what came first. YOUR HORMONAL HISTORY . . . AND MINE I was a "fat kid." You might already know this, as I have written about it in previous books and my "before pic" has been splashed on nearly every talk show I have ever done. But just in case you didn't, I was chubby. To give you an idea of how chubby, at my heaviest I was about 170 £ds at just 5 feet tall. Now, I am 5'3" and roughly 115 £ds. So, as I said, I was a fat kid. If you're wondering why I am bringing up being overweight in a book about maternity, the answer is simple: My weight and what caused me to become overweight had a significant impact on my hormone balance and my fertility potential later in life. I of course didn't know this at the time, and neither did anyone else, really. It was the '80s, and no one was even talking about whole foods or organic foods, let alone xenoestrogens (chemical com£ds that mimic estrogens in your system) or thyrotoxic foods (foods toxic to the thyroid gland) or obesogens (chemicals foreign to the body that disrupt hormone function and lipid metabolism, increasing the tendency toward obesity). Everything I ate or drank was completely processed and loaded with chemicals. Plus, I was relatively sedentary until I got into martial arts at about 13 years old. So not only had I been eating horribly, I also wasn't a very active kid. Insult to injury, I know. My mom got me into martial arts, not necessarily because she thought I was fat, but because she thought I needed something to be passionate about. And she was right--I loved it. I started going several times a week, and the activity helped me gradually gain self-esteem and slim down. It didn't change my eating habits, though, so the stage was set for what came next. When I was around 15 years old, I had an ovarian cyst burst. This is not a fun experience, by the way. In fact, it is incredibly painful, and I honestly thought at the time, not knowing what was happening, that I was going to die. But I didn't die. They told me I had PCOS, or polycystic ovary syndrome, a hormonal disorder of the endocrine system, and probably endometriosis, a condition causing troublesome and painful periods, in which the uterine lining (called the endometrium) tissue spreads and grows outside the uterus, causing the Fallopian tubes to scar and not function properly, if at all. Lovely. As if the teen years aren't difficult enough! At the time, I was told that PCOS causes ovarian cysts, and that's what happened to me--cysts were growing on my ovaries, then bursting, causing me agony. (Our dream team ob-gyn expert, Dr. Suzanne Gilberg-Lenz, tells me that this is an "old-school" point of view and that actually, my pain was likely due to endometriosis. But at the time this was my diagnosis to explain the cyst formation.) I had always had troublesome menstrual periods, as well as acne and weight gain from insulin resistance--in other words, my hormones were definitely not functioning normally. I didn't know all this yet. All I knew was that my ovaries were "cystic." Dr. V Says . . . Our brilliant internal medicine doctor and endocrinologist, Katja Van Herle, MD (I call her Dr. V), has this to say about PCOS. As an endocrinologist, this is her area. PCOS is likely named incorrectly. It isn't really a problem with ovarian cysts, though when the cysts are present, this often becomes problematic. In fact, many PCOS patients do not have ovarian cysts, but they do tend toward abnormal ovulatory cycles; anovulation (meaning a "period" happens but no egg is kicked out); irregular periods; often androgen dominance (which means higher levels of DHEA and testosterone); acne; hair growth in unplanned places (like the face, belly, and areola); and male-pattern hair thinning. Importantly, PCOS often includes insulin resistance (high insulin levels, prediabetes, or diabetes). This is key when it comes to getting pregnant but also while being pregnant, because it increases the risk of gestational diabetes. Dr. Suzanne Says . . . Here is what our awesome and vastly knowledgeable Yeah Baby! consulting ob- gyn, Dr. Suzanne Gilberg-Lenz, has to say about PCOS. Approximately 20 percent of women today have PCOS. It has become rampant, and this has had an important impact on fertility. Early intervention is crucial to preserve fertility, so be sure to get checked for this problem before attempting to get pregnant. Now the 40-year-old me would have thought, "WTF?! What is PCOS really? And what is endometriosis? What causes these? Do they typically occur together?" (Dr. V says no--they are mostly different processes, but when they happen together, they present a real challenge to fertility.) And what most disturbs me now is this question: Why would an otherwise healthy, active teenage girl have this? How did my body get so out of whack? What is the origin of this issue, and what holistic changes can I make to put my body back in sync? The 16-year-old me, however, was thinking more along the lines of, "Is this birth control pill they want me to take going to make me gain weight?" I was 16; what can I tell you? To make a long story short, as I grew older, my knowledge of fitness, nutrition, and endocrinology grew. By the time I was in my thirties, I had a strong understanding of the endocrine system and was incredibly well versed on how to manage my weight, immunity, and overall health via clean and active living. I hadn't had a cyst burst since I was in my midtwenties, and my periods were far less painful. I was able to manage my weight without starving myself and training my body into the ground. Fantastic. At that point, I never even thought for more than about 5 minutes about ever getting pregnant. I was extremely focused on my career and didn't even know if I would want kids. But because of the PCOS and endometriosis, I figured from a very young age it probably wouldn't be an option for me anyway, at least not without substantial medical intervention. I knew my tubes were blocked from the endometriosis, and I would either need surgery or, most likely, in vitro fertilization. Knowing that I already had cystic ovaries and that I was an "estrogen-dominant" female (having particularly high levels of estrogen in my body), I was concerned that fertility drugs could increase my risk of ovarian cancer and pose other significant long- term health risks. So I wasn't about to go there. I was nervous about messing with my hormones, and I knew that while drugs and surgeries have allowed many women to overcome these issues to bear their own kids, I didn't feel like I could put my body through any more hormonal trauma than it had already endured. I had personally accepted the fact that maybe God had other plans for me. For all those reasons, I began to explore adoption. Heidi supported me in all aspects of Operation Adoption. We certainly hoped to be together long term, but at that point in our relationship, we hadn't officially made that kind of commitment. As time passed, though, and I worked tirelessly to adopt a child, Heidi ended up very involved in the process. By 2011 it became obvious that this adopted child was going to be "ours." We were starting a family--together. But the adoption process can take years, and by mid-2011, there we were, still with no hope or sign of a referral for our child. We were feeling frustrated and hopeless. Before I Go On . . . Excerpted from Yeah Baby!: The Modern Mama's Breakthrough Guide to Mastering Pregnancy, Having a Healthy Baby, and Bouncing Back Better Than Ever by Peter Walsh, Jillian Michaels All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.
