I really admire some patients. I certainly admire those who bravely endure difficult infertility treatment followed many months later by enduring hours of painful labor in their difficult first delivery. Yet, there is another patient I admire even more who happened to have a super easy forty minutes of labor in her first pregnancy. But she earned it. Here is her story.

Ann is 28 and she and her husband were first referred to me by her OB after a year and a half of infertility. The cause of their problem was pretty obvious. Her husband had great sperm. The HSG said her tubes were clear. However, she had periods about two to three times per year. So the working diagnosis was Ovulatory Dysfunction. In fact, she had already been started on injectable ovulation medications by another doctor and had already been on a high dose of it (Bravelle 225 IU) for three days by the time that I first saw her. I quickly dropped her dose to 75IU, but it was still not enough to slow down her ovaries and she wound up making TOO MANY follicles, so her cycle was cancelled out of fear of triplets. It was disappointing to have to cancel, but it was encouraging to know that she COULD make a lot of eggs with the injectable medications. At this point, I suggested we take a step back and try to figure out better why she had ovulatory problems in the first place. It was tricky determining the reason for her ovulation problem, because she was already known to have thyroid disease, but it was well-regulated on medication, so that wasn’t the problem. Now, all RE’s know that someone who doesn’t ovulate on her own, but then produces a ton of eggs on injectable FSH is a big suspect for having PCOS. Ann had a trim figure and certainly didn’t look like a classic PCOS patient. However upon further questioning, she reported that she exercised an amazing amount!

Ann’s typical exercise regimen consisted of working out 3-4 times weekly, either taking classes at the gym or running 30-50 minutes. Right at the time when she first came to see me, she had just finished six months of training for the California International Marathon in Sacramento, during which time she ran 4-5 times each week for up to an hour with an extra long 2-3 hour run each weekend. By the way, I don’t know how she does it, but Ann also manages to maintain a very rewarding career. Still, she was frustrated, because despite all this, she wasn’t losing weight! Of note, Ann shared that she had a sister who also had the same history of irregular periods. Her sister walks every day, but does not do the same intense exercise that Ann does. (Her sister has kindly given us permission to share that she is not happy with her current weight and would like to lose about 40#.)

Based on this information, what struck me was this might be a case where someone born with an inherited problem of insulin metabolism was able to overcome the effects of it by the sheer will power to exercise like a superstar!

We ran some tests. Ann’s insulin testing showed that three hours after drinking the yucky sweet drink we gave, her blood glucose was 89 mg/dL and her insulin, which was expected to be below 20 by then, was more than double that at 43 uIU/mL. She was promptly started on metformin for a three week trial. She returned to report a tremendous difference. Whereas before she used to have low energy and have to brutally force herself to exercise as much as she did, now she felt great and had a much easier time maintaining her workouts! Her craving for carbs was markedly decreased and she went from 131# to 128# in 3 weeks with a noticeable decrease in her waistline. This was very encouraging. At this point, we had to make a decision whether to just be patient and see if her periods would also respond as well to the metformin as the rest of her body apparently did. Then if so, we could let her try on her own for a few months, at least. She and her husband opted to be more proactive, so we tried another round of injectable FSH and got a much better controlled cycle with just 2 mature follicles developing. However, she did not get pregnant. Then something not all that surprising happened. While we were waiting for her to resolve the cysts from her previous cycle, she reported that she did a pregnancy test and got a BFP! We monitored her for the first trimester and she graduated from our office back to her OB carrying a healthy single baby.

Fast forward to this week when she came visiting with her beautiful three-month old, a beautiful girl with the blondest hair I’ve ever seen in a while. She told me great stories about how she exercised throughout her entire pregnancy, including the funny stares she got from the other gym members while her bulging tummy rocked side to side on the elliptical machine at 37 weeks. I would tell you the story of her labor, but she and husband tell it so much better in their own words:

Saturday morning (@1AM) Ann started having contractions that were somewhat painful but she was still able to sleep around them.  Having never been through this before she wasn’t sure if this was “it” or just false labor so she continued to go back to sleep (priorities in order!).  Contractions came every hour until 4AM at which point Ann woke Matt up and told him she thought she might be in labor (contractions were 10-12 minutes apart).  He was up with a start and asked what we should do so we grabbed our trusty Bradley book and starting reading about the various stages of labor and determined that we were in “early first stage labor” and decided to hang out and try to sleep more.  At 5AM contractions were 8-10 minutes apart and we were thinking we should pack our bags and start our day.  Matt took a shower and went to help a good friend get ready for a garage sale while Ann took a shower and tried to nap again.  Contractions varied everywhere from 3-7 minutes apart and lasted about 45 seconds in duration.

At 8AM contractions were about 5-7 minutes apart but varied in length and intensity so Ann’s friend Laurinda came by to offer distraction.  Ann and Laurinda decided to take a short walk down the horse trails by the house at about 9:30AM…the walk usually takes Ann about 20 minutes but due to the contractions they ended up walking for an hour!  During the walk Ann started getting horrible back labor pains and did the “giant hula hoop” maneuver to move the baby around and off her spine….the Yorba Linda walkers weren’t ready for a pregnant, laboring, hula hooping lady walking down the trails!  Regardless, the hula hooping worked and the contractions were now 4 minutes apart and 45-60 seconds long.  Once they got home Ann was hungry and ate a bowl of Life cereal which evidently is a massive labor starting meal as her contractions were right on top of one another and too difficult to talk through.  (At one point Ann may have told Matt in a stern voice that he needed to focus his attention on her and not the college football games).

The Ollivier’s decided that since Ann’s contractions were causing her to make a “serious face” it was probably time to go the hospital.  They left the house at 11:07 and Matt drove mach-10 down the Toll Roads with Ann’s contractions coming right on top of each other.  Ann attempted to talk herself into relaxation by reciting her mantra “I am relaxed.  I can do this.”  While Matt responded “Yes honey, you are relaxed,” or “No you aren’t.  You need to relax.”  They pulled into the parking lot of Saddleback Memorial Hospital at 11:17 and Matt raced inside to find a wheelchair since Ann was now unable to walk.  He waited, and waited, and waited for what felt to Ann like hours and raced back to the car with….no wheelchair.  Seeing that she had no ability to talk, much less walk, he ran back inside and commandeered (aka stole) a wheelchair from a room and ran back outside to his screaming wife.  Matt pulled Ann into the wheelchair and ran (literally) her inside to the elevators.  Once inside the elevators Ann had a MASSIVE contraction and was screaming all the way to the second floor, down the hall and into the labor and delivery area.

The nurses asked Ann to walk into the area to check her status and she gave them an evil look and stated that she could not walk there under any circumstances (she was barely able to breathe!).  Once on the table Ann was declared 100% effaced, 6-7cm dilated and Baby O was at -2 station.  She was told by a nurse that since it was her first baby she would most likely dilate 1cm per hour and to relax.  Ann continued screaming and trying to relax.  The nurses asked her how much water she had been drinking and told her that 16 oz an hour wasn’t enough and she was dehydrated and started an IV for fluids.  In the middle of having the needle jabbed into her arm her water broke all over the place and she felt the need to push.  The nurses yelled at her not to push and that she was only 6cm dilated.  She yelled back at them to check her again and they decided to draw a vial of blood instead.  Once they had their “essential” vial of blood, they checked her again and she was 100% effaced, 10 cm dilated and +3 station (aka. ready to push).  They raced around to get the room ready for labor and paged the MD on call.  The nurses raced Ann into the labor room and told her to relax (duh) while they got the room completely set up.  Four contractions later and Baby Ollivier entered the world at 12:08PM.  (For those of you “non-math” types that was 11:25AM arrival at the hospital and 12:08PM delivery….43 minutes).  The nurses were amazed (as was Ann) and Baby O let out a solitary cry and they proceeded to look around while her APGAR score was calculated (1 minute score=8, 5 minute score=9).  She flew into the world at 5lbs 9oz and 17 inches long with a full head of blond hair and all her necessary parts.  Her parents think she is beautiful.

Sure, there is plenty of medical evidence that women who exercise regularly have easier labors and less complicated deliveries. And for many people, that is enough to convince them. While I am a believer in properly conducted research studies, I also like stories. Thank you so much, Ann, for sharing this with our readers. We love happy stories like yours.

Ann has generously chosen to share her story in order to enlighten others who might have her same situation. She has given expressed written approval to share the above. Thank you, Ann.