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Friday, May 31, 2013

What is a chemical pregnancy ?

Sometimes, the joy of being pregnant can be very short lived. You might get a positive urine pregnancy test, or a positive blood pregnancy test, two weeks after (or even earlier !) your embryo transfer. But, to your agony, the subsequent pregnancy tests you take  might reveal a dropping HCG value ; or your urine pregnancy test may become negative. This is a very hard situation to face because you feel disheartened and cheated. Such a pregnancy, which dissolves quickly, is termed a chemical pregnancy. This means your embryo implanted in your uterine lining , but failed to develop further. This is quite common and occurs because the embryo is not competent enough to grow further. Please do not blame your life-style or other activities for this ! A chemical pregnancy cannot be prevented by any means what so ever - taking extra progesterone,  avoiding certain foods,  avoiding intercourse or taking strict bed rest cannot prevent a chemical pregnancy, so please do not beat up on yourself !

Thursday, May 30, 2013

Can the level of HCG in blood tell me whether my pregnancy is a healthy one or not ?

Yes – but only to a certain extent.  The HCG ( human chorionic gonadotropin) hormone is a remarkable molecule which is very unusual because it is produced only by the cells that will become the placenta of the developing embryo (trophoblast cells). Once the embryo implants in the uterine lining, these cells start producing HCG . It takes a few days for the HCG hormone to build up in the body to a level, which is high enough for it be detected in the blood or urine of pregnant women. Normally, you do your first pregnancy test (HCG blood test) 14 days after embryo transfer.  At this point, if the embryo has implanted, you will also get a positive urine pregnancy test. The HCG hormone level in the blood doubles every 48-72 h. If the HCG level doubles well, this indicates that the cells of the embryo are dividing well , suggesting that the pregnancy is progressing normally and is healthy.  This is why monitoring the HCG blood levels during the first few weeks  helps to make sure that the pregnancy is advancing as expected. A drop in HCG level during this time is a sign that the pregnancy is not healthy.  Make sure that you measure your HCG level in the same lab each time to avoid discrepancy in the results.

However, do remember that because the HCG is produced by the trophoblastic cells of the embryo, just because the level is rising well does not always mean that the pregnancy is healthy. Thus, while a drop in HCG confirms the pregnancy is doomed, a rising HCG level provides limited information. 

Also, once the HCG level crosses 1000 mIU/ml, a vaginal ultrasound scan provides much more useful information than just the HCG levels,  because it allows us to actually visualize the development of the growing embryo. 

Wednesday, May 29, 2013

Will my symptoms during the 2ww tell me whether I am pregnant or not ?

During the 2ww it is very natural to wonder about the fate of the embryos which are transferred to the uterus. Every woman who has had an embryo transfer longs to know the outcome of her IVF cycle.  Every minute of the 2ww lasts an hour – and the 2ww is the longest wait for any woman who has undergone IVF.

When going through the 2ww, women become aware of even the slightest change that happens to their body. “ I am feeling warmer than usual; I have a tingling feeling in my breast; my nipples are sore; I could sense a muscle being pulled in my pelvic region; I have a strange vaginal discharge; I urinate frequently; I feel nauseous – does this mean I am pregnant ?” This is the question that lingers in the mind of every woman – whether they explicitly acknowledge it or not . This can be made worse by a worried spouse who solicitously asks every day – How are you feeling ? Many women constantly surf the web to read about the 2ww symptoms of women who got pregnant after an embryo transfer. Although this can make the 2ww interesting , and can help some women to cope with it, many women start to panic too when they do not experience any symptoms . Others start imagining that they are pregnant of if they have any of the about symptoms. Are there really any symptoms which could tell you whether you are pregnant or not , before taking a pregnancy test ?

Sadly , the answer is no. While every woman is different, the reality is that your body cannot provide you with any clue during the 2ww which could tell you whether you are pregnant or not . Women who do not have any symptoms at all find they are pregnant – while women who experience all the symptoms can end up getting a negative pregnancy test. During the 2ww, your body is under the influence of the two most important sex hormones – estrogen and progesterone.  These sex hormones have an influence on many of your body functions. Because of excess progesterone, your body becomes warmer than usual; your digestive system become sluggish and you can suffer from constipation; water accumulates in your tissues leading to sore breasts and nipples; you might have low-back pain, cramps and so on. High estrogen can make you nauseous; can cause breast pain; and might make you sensitive to smells. So the symptoms you experience during 2ww are only due to the high levels of these hormones, which is why they are so similar to the symptoms of PMS ( premenstrual syndrome) . The only proof whether you are pregnant or not is a positive blood pregnancy test.

Tuesday, May 28, 2013

How long should you wait after a miscarriage before undergoing another IVF cycle ?

When you get your menstrual cycle after a miscarriage,  you are ready to start another IVF treatment . It takes some time after a miscarriage for your menstrual cycle to return.  This is because the pregnancy hormone human chorionic gonodotropin (HCG) needs time to drop to your pre-pregnancy level (below 5 iU). This decision also depends on your physical and emotional comfort. Taking enough time to heal physically and mentally will prevent you from feeling exhausted ! Starting an IVF cycle soon after a miscarriage , or waiting for  3 or 4 cycles will not make any difference to your next IVF outcome.

Monday, May 27, 2013

How long to wait between IVF cycles ?

It depends on your physical, financial and emotional comfort. Some women find it difficult to do back-to-back IVF cycles while some women do not want to wait in between IVF cycles. Sometimes, due to ovarian hyperstimulation you might end up with cysts in your ovaries. In such cases your doctor will want you to wait until the cysts regress before starting another IVF cycle. If you have frozen embryos, you can do the cycle back to back, if you so desire. Whether you do your IVF cycles back-to-back or whether you wait , is a very personal decision. It will not affect the outcome of the IVF cycle. Your age also plays an important role in determining how long to wait between IVF cycles. As a woman ages,  her fertility declines, and hence it is wise not to wait too long before proceeding with another IVF cycle.

Friday, May 24, 2013

Why are my embryos of such poor quality ?

Grading human preimplantation embryos. Courtesy :

Your embryos are graded according to their microscopic appearance and are given a rank (like grade A, grade B, grade C and so on).  A day 3 embryo which gets the topmost grade will have 8 cells which are equal in size, with all cells having single nucleus , without any fragments. If you have 10 embryos, not all of them will be of top grade on day 3. Some will have a fewer number of cells, some might have uneven cells, while others may have lots of fragments. The doctor will select the best embryos from amongst these (the top grade embryos) , and transfer these to the uterus . The remaining embryos can be frozen, if they are of good quality. But what happens if all your embryos are of poor quality? Why does this happen ? There are 2 possibilities :

  • The embryology lab had some technical problems,  and failed to create good embryos
  • The quality of your egg is not good , which is why the cells did not divide properly, and hence the embryos appear poor morphologically

To rule out the first possibility , insist that your embryologist show you photos of the embryos of other patients who were treated on the same day . If these are good quality, this means the chances of their being a lab problem are small.

If this has been ruled out, then remember that the commonest reason for poor quality embryos is poor quality eggs. It’s the mitochondria in the cytoplasm of the egg which provide the energy for cell division. If the eggs are of poor quality , their mitochondria cannot provide enough power to drive normal  cell cleavage, which is why the embryo may arrest; or the cells may have lots of fragments. Unfortunately, there is no method to test egg mitochondrial quality as yet.

However, do remember that grading is a very crude tool and that the appearance of your embryo cannot predict its ability to give rise to a baby accurately. Poor grade embryos do give rise to a healthy baby , while many good looking embryos fail to do so !

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