Breaking the Silence: Navigating the PCOS-Miscarriage Connection

Note: I will be covering the symptoms and effects of polycystic ovary syndrome. If you are uncomfortable discussing topics of menstruation, reproductive organs, miscarriage, and medical symptoms, please exercise your discretion.

Did you know that although Polycystic Ovary Syndrome (PCOS) is known as a common cause of infertility, it can also increase the risk of miscarriage?

Women with PCOS are more likely to have a miscarriage. The average woman’s risk of miscarriage during the first trimester is 10-15% while women with PCOS are more likely to miscarry with a 30-50% risk. This means that women with PCOS are three times more likely to miscarry than women without PCOS.

When you are diagnosed with PCOS no one prepares you for this reality. If you are lucky enough to get pregnant there is at least a 30% chance that you’ll miscarry before the first trimester. Personally, that doesn’t sound like great odds especially considering that you are already battling fertility odds.

What are those odds you ask? Well, let me tell you. While a completely healthy young couple has a 25% chance of getting pregnant during a single cycle, takes on average 2.5 years longer to get pregnant with PCOS.

I feel this statistic deeply in my soul. As someone who has been married a little over the two-year mark, we have only had one successful pregnancy, and that pregnancy resulted in a miscarriage.

Why Does it Happen?

There are several different factors related to PCOS which can increase your miscarriage rate. These include:

• High levels of androgens or male hormones (Hyperandrogenism)
• Elevated LH levels
• Insulin resistance with elevated Insulin levels
• Endometrial Dysfunction with failure to implant
• High plasminogen activator inhibitor-1(PAI-1) activity
• Infertility treatments
• Genetic abnormalities

Why does this happen to begin with? Women with PCOS may experience difficulties getting or maintaining a pregnancy due to their menstruation cycle (monthly period). Many symptoms if PCOS include:

• too few menstrual periods
• having your period for longer than usual
• not getting your period
• very heavy periods
• higher levels of male hormones like testosterone
• acne breakouts
• getting facial hair and extra hair in other places
• small cysts or bundles of fluid in the ovaries
• fewer eggs released from the ovaries

While PCOS isn’t life-threatening, there is no cure for it.

No One Prepares You

While I knew about the fertility struggles, I was not prepared to miscarry our baby in March of 2022.

Not only was the process of discovering the pregnancy to miscarriage whiplash quick, but it was an extremely painful process. I had been experiencing excruciating pelvic pain continually for about three weeks. I had lower back pain similar to when I had kidney stones, accompanied by exhaustion and some nausea. Regular pain pills didn’t alleviate the pain, and it woke me up at night. Also, no one talks about the blood loss.

The emotional and physical pain is terrible and certainly not something you are prepared for in your early twenties. The experience makes you scared. Will I conceive again? Will I miscarry again? Was my first baby a boy or a girl? Did I do something wrong?

It sounds stupid, but I think about that baby often. He or she would have been two now and I wonder what they would have been like. I have other family and friends who have had similar experiences to commiserate with. While their mutual loss takes away some of the guilt, the loss still remains.

Resources and Help

If you have PCOS your body might make more of both the male hormone testosterone and the female hormone estrogen. Your doctor might recommend prescription medications to help balance your hormones which may include:

• metformin to balance insulin levels
• clomiphene citrate (or Clomid) to help balance estrogen levels
• birth control pills to balance estrogen and testosterone levels (before beginning fertility treatment)
• fertility medications to jump-start the ovaries to send out more eggs

While the process of determining your fertility is a struggle, it is possible to have a baby with PCOS. There may be some struggle, heartache, and a lot of frustration, but that doesn’t mean it isn’t possible.

You can find support and answers to your questions through many credible sources:

• National PCOS Challenge
• Cysters
• PCOS Awareness Association
• My PCOS Team
• PCOS Support Group
• Pregnancy Loss Support Group

Another Homeland

Growing up, my grandmother and grandfather painted vibrant portraits of the “old country” before they emigrated to the United States. We watched documentaries with them that showcased the extensive history of Germany and poured hours over old pictures. We received cards from the family that remained in Germany. I always felt a tug of longing for the homeland of my grandparents and great-grandparents and a sense of belonging to this family across the sea.

However, I had my mementos and tastes of the ‘homeland.’ My grandparents spoke German to one another and passed down their proud cultural heritage to their children and grandchildren. Events like Germanfest and Oktoberfest weren’t excuses to drink or party but the opportunity to lecture us on our heritage.

My sister has lived through that longing and displacement for the past decade.

When my sister Josie was seventeen, we adopted her and her youngest brother from an orphanage in the Philippines. Josie’s father had just died, and her mother could no longer support all nine of her children. Some of my sister’s siblings went to uncles and aunts, but Josie and her youngest brother were placed in an orphanage. While our brother has hazy memories of the country he left behind, there is always a part of my sister that calls the Philippines home.

While I am grateful every day we adopted them, I have always felt a knowledge gap.

Josie has been a pivotal part of my life and my family tree but I barely know anything about where she is from. Sure, I have attended seminars, watched documentaries, and eaten food she has prepared, but I have always held the Philippines at arm’s distance. The Philippines is a place that I know about, but I have no real attachment or understanding of what the culture is. I only get snapshots from my sister’s bittersweet past without fully experiencing it.

I would love to travel to the Philippines with my sister. I would love the culture shock of a lifetime. 

I know we would brave the insane roadways by Jeepney to Bulacan. Her biological family and much of her extended family still live in the region. I would love to embrace my sister’s mother, all her brothers and sisters, and get to know the family that gave me my sister. Even though it was the hardest decision of their lives to give her up, they knew that it was best for her. I can’t wait for them to see the resilience that shines through Josie.

We’ve talked about the eventuality of not seeing her family. Even if we can’t find her family, we can still visit the graves of her father and grandparents. She can show me the house she grew up in and the school she walked to daily with her siblings. If she feels up to it, she may even show me the orphanage where she lived alone with her brother.

I know there are places she’s never been before simply because her family could not afford it or it was simply too far away.

The Philippines is known for its voluptuous hills, numerous volcanoes, sandy beaches, underground rivers, and rich biodiversity. The whole country is a panorama of natural beauty. Although we’ve talked about visiting some of the more touristy destinations, Josie would have full reign over our travel plans. You can see the excitement in her eyes as she recalls stories from the past or memories of places she once dreamed of seeing. When I look at the places she considers visiting, I know that I can hardly go wrong with her as a travel guide.

For the first time in a decade, my sister can eat real Filipino food and not the mock meals that I, family, or friends have attempted to make through the years. There are dishes I know my sister is dying to eat again. If she is reunited with her family, she’ll finally have a real meal with her family again.

Even though the Philippines is not my cultural homeland, it is for my sister. If I can’t fully appreciate and understand the country that she called home for the first 17 years of her life, then I don’t truly know my family history. That is the beauty of it all, is that this is not someplace that my sister holds for herself. Her homeland is vibrant, alive, and ready to be shared.

Author Michael Crichton once wrote, “If you don’t know history, you don’t know anything. You are a leaf that doesn’t know it is part of a tree.” 

Review: The Memory, Sorrow, and Thorn Series

The Memory, Sorrow, and Thorn series by Tad Williams holds significant influence in the realm of fantasy literature. First published in the late 1980s, this epic fantasy saga remains a cornerstone for lovers of intricate world-building, compelling characters, and rich storytelling.

I’ve been in a little bit of a reading slump and was craving something reminiscent of the Song of Ice and Fire. You know the desire: strong word-building, life-like characterizations, complex political intrigue, and twists that leave your head spinning. A Google search for, “series like Game of Thrones” pulled up The Memory, Sorrow, and Thorn series which I admit, I had never heard of before and I am not sure why.

George R. R. Martin was a fan of Memory, Sorrow, and Thorn and cited Williams’ work as a key influence for his own epic novel series, A Song of Ice and Fire. Another famous author, Christopher Paolini, writer of The Inheritance Cycle, also cited Memory, Sorrow, and Thorn as an influence, calling it, “one of the great fantasy epics of all time.”

Lore Prologue

Tad Williams was once a disenchanted fantasy reader. At 11, his mind was blown by The Lord of the Rings trilogy and he spent years devouring all the fantasy books he could find. “I was looking for originality and what I was getting was warmed-over rehashes of Tolkien. Eventually, it occurred to me: I can do better than this,” he said.

“Better than this” would be the Memory, Sorrow, and Thorn series, a captivating epic that unfolds across a richly detailed and immersive fantasy world known as Osten Ard. The series consists of three main books: The Dragonbone Chair, Stone of Farewell, and To Green Angel Tower.

The Plot

The story begins with a seemingly ordinary kitchen boy named Simon, whose life takes an unexpected turn when he stumbles upon a dark conspiracy that threatens the entire kingdom of Osten Ard. It is such a slow beginning for the first half of The Dragonbone Chair, but as political tensions escalate, ancient prophecies come to light, the story begins to build an ominous tension. The careful slow building of the first 500 pages culminates in the foretelling of a great conflict between the forces of light and darkness.

Central to the narrative is the struggle for power over the legendary Dragonbone Chair, a seat of immense magical significance. Simon finds himself thrust into a world of court intrigue, mythical beings, and ancient secrets as he becomes entangled in the fate of Osten Ard.

Along the way, Simon encounters a diverse cast of characters, each with their own motivations and roles in the unfolding drama. You have elf-like creatures, trolls, giants, wizards, and men who all must put aside their differences to unite under one banner. All must choose to unite under King Elias or his brother, Prince Josua and the choice could literally mean life or death.

The series weaves together themes of heroism, sacrifice, and the consequences of wielding great power. As Simon navigates this perilous journey, he undergoes profound personal growth, transforming from a humble kitchen boy into a key player in the battle against a malevolent force threatening the very fabric of the world.

When I say that each book gets more and more intense I mean it. Take J. R. R. Tolkien, add George R. R. Martin, subtract the profanity and lewdness of Game of Thrones and you have The Memory, Sorrow, and Thorn series. It literally is the perfect fantasy baby.

Epic Scale Narrative

Tad Williams’ meticulous attention to world-building in Osten Ard set a standard for the genre. Williams incorporates intricate details of cultures, histories, and magical systems, investing deeply in crafting immersive and expansive fictional worlds.

If the sheer scale of the world-building is not already impressive Tad Williams demonstrated the feasibility and success of a long-form, multi-book story, embracing the opportunity to explore complex plots and diverse character arcs over several volumes. With an epic scale and carefully paced storytelling, the series offers a satisfying blend of grand-scale conflicts, political intrigue, and intimate character moments. The narrative unfolds across multiple volumes, allowing for a deep exploration of the plot and characters.

The Memory, Sorrow, and Thorn series is renowned for its well-rounded and evolving characters. The depth of character development, especially the protagonist Simon’s transformative journey is the real gold standard. Williams created multidimensional characters with relatable flaws and growth arcs while focusing on strong character-driven storytelling.

Subversion of Tropes:

Tad Williams challenges traditional fantasy tropes, offering a narrative that subverts expectations and introduces moral ambiguity. This adds depth and complexity to the storytelling, making it a refreshing and thought-provoking read. The series delves into profound themes, including the impact of power, the responsibilities of leadership, and the consequences of choices made in the pursuit of both good and evil.

Williams also somehow manages to walk a thin tightrope by simultaneously focusing on Simon’s coming-of-age story.

In essence, The Memory, Sorrow, and Thorn series provides a compelling and immersive fantasy experience that combines rich world-building, complex characters, and a thought-provoking narrative. For those seeking an epic journey filled with magic, intrigue, and timeless themes, this series is a must-read that continues to captivate readers across generations.