Cycle 1 Recap

Cycle 1 finished a week ago... I'm just now getting around to writing up the recap.

Cycle 1 went okay-ish at best; the first two weeks were on protocol but things really fell apart in week three. Finding the time for multiple vaginal insertions daily during the progesterone phase really made adherence to my planned dosing schedule difficult. The VagiBiom and vaginal estradiol cream portions also had similar protocol adherence issues.

For the progesterone insertions during the cycle, I managed to insert 7 of 20 (35%) of the planned doses which equated to ~2,200 mg of ~7,200 mg (31%) of the planned progesterone dosage.

For the VagiBiom doses, I had similar results of inserting 7 of the 20 (35%) planned doses, although I inserted Day 9's suppository during the early AM hours of Day 10 so this could be considered 8 of 20 by exposure. I skipped the entire first week of VagiBiom while waiting for the final Evvy results. Establishing a biome only to nuke it if the baseline came back full of problematic bacteria seemed counterproductive.

Finally, for the vaginal estradiol cream, I applied it 3 of the 8 (37.5%) planned applications.

The protocol fatigue was truly real here as everything fell off around day 20; this included me having to push the planned Day 22 EV injection to Day 23.

Even with my body only being exposed to around 30% of the planned progesterone, I saw an FSH spike on Day 19 to 7.7 mIU/ml against a baseline that mostly ran below 0.5 mIU/ml. This is most likely related to the initial progesterone exposure that began on Day 15 (insertions successfully occurred on days 16-18); this E2-primed + acute P4 exposure onset leading to increased FSH connection was previously described by McCartney et al in 2007 [0].

One other interesting bit of data that wasn't originally included in the protocol but is now available due to an update to the cycle tracking app that I use was access to the skin temperature tracking data collected by my Apple Watch. Over the cycle it had me at 35.7 to 35.8°C through ovulation, mid-36s in late luteal, and 36.63°C on Day 27, which was the highest of the cycle. Even with my subpar progesterone regimen during the cycle the skin temperature trends are interesting as increased progesterone levels are known to increase basal body temperature in cycling people (Baker et al, 2020) [1].

A short withdrawal bleed occurred again on Days 25-27 of the cycle.

For cycle 2, I do plan to continue with the protocol as written, in the hopes that many of the adherence challenges are simply teething pains from integrating the protocol into my everyday life. Even with the less than optimal compliance with the protocol plan, many suspected bodily "processes" still were observed which does further validate what I'm doing here.

[0] - McCartney CR, Blank SK, Marshall JC. Progesterone acutely increases LH pulse amplitude but does not acutely influence nocturnal LH pulse frequency slowing during the late follicular phase in women. Am J Physiol Endocrinol Metab. 2007;292(3):E900-6. https://doi.org/10.1152/ajpendo.00371.2006
[1] - Baker FC, Siboza F, Fuller A. Temperature regulation in women: Effects of the menstrual cycle. Temperature (Austin). 2020;7(3):226-262. https://doi.org/10.1080/23328940.2020.1735927