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Wednesday, August 6, 2014

Beginning of our 7th fresh IVF cycle

Every IVF cycle is like a roller-coaster ride – they are scary as well as exciting! As you get used to it, you will learn to enjoy the fun and suspense. Beware, it can be addictive too! I wonder whether women (including me) who go through IVF get addicted to the thrill of it.  I find no other sane explanation for going through it again and again. Of course, the urge to reproduce, to propagate one’s own genes, does play a major role in going through this insane IVF journey. Few months ago, I was so sure that, I will never go through a fresh cycle again. I was in so much pain and everything appeared scary. But, spending some time in India, in the warmth of loved ones was enough to get back the Manju I lost. Thinking of crossing the bridge was fearful, but when I came near it, I got the courage to do my best.

I wondered and wondered why I wanted to use donor eggs in the first place. There were several reasons. This IVF journey is eating up our normal life. All we are doing for several years is to wage war against infertility. I think, we forgot, how a normal life would be! On the other hand, I would rate our life as very interesting when compared to most other people. It is painful at times, but extremely challenging too. We learn a lot about life because of our infertility struggle. I thought, we have learned too much already (which is not too good too :), and I just want this struggle to end as quickly as possible in a pleasant manner, so that we can move on to the next stage of life. I am already 36, and one of my biggest fears is, the possibility of high risk of miscarriage and begetting a child with genetic defect when using my own eggs (although still the possibility of such happening is not extremely high!) I thought, if using donor eggs could reduce miscarriage rate and give us a higher change of having a healthy baby, why not go for it? Afterall, I and Rajender want a baby to make our life more interesting, we badly want to nurture our parenting instinct before it vanishes with age. You might ask why not adopt then, we tried. We did go to an adoption agency in Madurai (Grace Kennet foundation) to collect details. When we asked about international adoption, the response was, it will take many years. For domestic adoption, we have to live in India for a year and then we are eligible to apply for adoption. If we apply, it might take another couple of years to actually finalize the entire process! Rajender went with so much expectation and when we came out of the adoption agency I could see his forlorn expression. After we lost our twins, the longing to have a little one in our life as early as possible is very high for Rajender too.  He was able to quench his paternal instinct by the company of little ones in our family and immediate neighborhood.  

I started preparing for another ovarian stimulation. Dr. Malpani asked me to measure my AMH and AFC. Two and a half years before my AMH was 1.8 ng/ml. I was wondering what will it be now! When I started my IVF journey it was in between 4.5-3.5 ng/ml. One fine morning, I went with my mom to a nearby lab (Thyrocare) to give my blood for measuring AMH. I also asked them to measure my Vit D and TSH. I waited for the results anxiously.

I called Rajender and told him not to expect much out of this IVF cycle. I said, I am much older now and I have no idea how I will respond to stimulation. Perhaps, I might produce only a few eggs. Might be, we will not have enough embryos to grow to blastocyst stage. Who knows, I might not respond at all! I told him, be prepared for everything. He knows about me and how negative I could get. He thinks I am pessimistic, but I think I am cautiously optimistic and it helps me a lot to accept whatever comes my way.

Two days later my AMH results came. As I expected it was such a poor value. When I sent the results to Dr.Malpani, he sent me a sad smiley in return! My Vit D was 12 ng/ml and the normal range was 20 ng/ml (and this is after my skin enjoying lots of Indian sun!)

MY AMH WAS A MERE 0.6ng /ml :(


  1. I completely understand what does it feels like going through IVF again and again. I have read all your posts and your writing is very impressive.
    This is a very exhausting process and at the same time exiting too. Each day of the cycle feels like a new exam.
    I have undergone total 2 cycles and 4 transfers. All of them have failed.
    No implantation at all. Not even a chemical.
    What do you suggest to people like me?
    Should I accept my fate and stop trying? Should I look for surrogacy? I don't know what to do ahead. I am 30 and do plan to go through another cycle but I do fear failure.
    My uterus doesn't have any problem apart from endometrium thickness not too good, somewhere between 6-7.5 mm. I am pursuing ivf due to tubal blockage.
    We have tried everything, like heparin, steroids, high dose progesterone etc yet it has not worked yet. Embryo quality was fine too according to doctors. If it has not worked yet despite of trying everything, what can I do differently now for success.
    I am not yet ready for adoption or donor eggs now. I know it is a very hard truth to accept for me.
    What would you suggest me, Manju?

    1. I understand your frustration. Can I ask you some more questions ?

      Are your tubes filled with some fluid ? Did they say you have hydrosalpinx ?

      Is the reason for tubal blockage understood ? Do you have endometriosis ?

      Do you ovulate regularly ? How many days apart are your menstrual cycles ? Were you diagnosed with diabetes anytime ? Is your BMI normal ? Do you know your AMH value ?

      Is your uterus lining during your fresh cycles in the range of 6-7.5 too ?

      May I know how many eggs were retrieved from you and how many embryos you had every time ? How many embryos were transferred to you each time ? Was it a day 3 transfer or day 5 transfer ?

      Is your TSH normal ?

      Could you please answer these questions so that I could help you better.

      60-70% women conceive within 3 IVF cycles and others need more attempt. Your clinics proficiency in creating good embryos and their experience in embryo transfer also plays a major role in IVF success. So make sure you are with a good clinic who is experienced in the field of IVF for several years.

      I don't think you need surrogacy.

      I am sure you can get pregnant. Embryo quality is the ultimate determinant of IVF success. Using therapies like heparin and steroids is not going to help.

      Lots of good luck !


  2. Thanks Manju for your prompt reply.

    Tubal blockage is due to an infection.
    I have had hystro-laparoscopy and HSG. nothing about hydrosalpinx was mentioned in it.
    I don't have endometriosis.

    In first cycle I got 7 eggs and 2 embryos. Both of them were transferred in an fet of 3 days embryo. Embryo quality wasn't great.
    In 2nd one, I got 9 eggs and 5 good quality embryos. We did 3 transfers this time. One fresh with 2 embryos of 8 cell and 6 cell, one fet with a early blastocyst and last one with 2 embryos, 10 cell and 8 cells.
    Endometrium thickness for fresh xfer was more than 9. But for fet's it is always between 6-7.why is that difference?
    I do have hashimotos for which I regularly keep my thyroxine dose and TSH is under 2.

    My clinic is in this field for more than 15 years so I do think they are good.

  3. And yes, my AMH was 1.2, six months back. Have given my blood sample for retest yesterday.

  4. My cycles have always been regular at 28 days. I do get them early sometimes, specially when I am doing an IVF cycle.
    My BMI is normal too at 20.

    My embryo transfers have always been easy, as mentioned in my records.

  5. It is wise to make sure you do not have hydrosalpinx ( fluid in tubes, as it can interfere with implantation ). But I do not think this might be the cause of lack of implantation.

    I am concerned about your AMH value of 1. 2 at 30 years. Your first IVF cycle seems to be poor. You had very less egg yield, very less fertilization rate. Do you know the dosage of gonal f used for your IVF cycles ? Did you ask your clinic the reason for poor fertilization rate ? Did they do IVF or ICSI with your embryos ?

    Do you have photos of embryos from your second IVF cycle ? Can I have a look at them ? If you would wish to, please send me the photos to : manjupadmasekar@yahoo. com.

    Easy embryo transfers doesn't mean efficient transfer. Are embryo transfers done by a doctor who is doing it for years ? Make sure they are done by a doctor who is doing it routinely and not by an assistant. This can help.

    I do not think you have some problem with your uterus lining. I too develop good endometrial layer with fresh cycles. During my FET, lining thickness is always less than optimal. But, my FET worked. So I wouldn't worry about it. My guess is, since the estrogen is supplied from outside and not our body's own, it is not as efficient in stimulating the growth of endometrial lining.

    You have gone through only 2 IVF cycles. The first cycle is more like a mock cycle, which gives your doctor an idea about how you respond to stimulation. I think you shouldn't panic or get disheartened or think about surrogacy.

    I hope your next cycle gets better still and you conceive. I would ask your clinic to grow your embryos to blastocyst stage and see how they fare. If more of your embryos reach blastocyst stage then your chance of pregnancy is really brighter. I would also aim for more eggs. I agree more is not always better but many a time, having more embryos helps !

    After 3 IVF cycles, if you haven't got success with your clinic, I would consider changing clinic! Please read the below article, it can give you some insight :

    Hope this helps !

  6. They did ICSI on all eggs for 2nd cycle. For first, I don't have any idea. But they say that they do ICSI on all eggs. Its their clinic's norm, one sperm for one egg.

  7. If these are ICSI cycles then I would expect a fertilization rate of 70-80%. I am not sure why such such a poor fertilization rate was achieved during your 1st cycle.

    Make sure you see your embryos and get a photo of them. Do not believe just their words.

    I wish you lots of good luck for your future endeavors !


  8. Thank you Manju.
    And that link you shared was really helpful.

  9. Manju, i wanted to wish you luck as you start your 7th IVF process. thank you for blogging and your unique perspective. You are very courageous and i wish you much success and happiness.

  10. Hi Manju.

    Is it possible that AMH increases with time?
    Well , I got my reports today and my AMH is 2.75. It was 1.2 in January this year. I hope it is not a lab error.
    I did take some supplements, specially Vit D. My vit D was very low in feb, at 8 .

    1. That's nice to know that there is a huge jump in your AMH value.

      Ofcourse taking Vitamin D could increase AMH levels in your body. The reason is, the AMH gene's promoter contains Vit D-response element. Hence Vit D could increase the production of AMH.

      If this is so, you might love to believe that more AMH secretion from antral follicles when using Vit D means more number of antral follicles itself and you will produce more eggs. Unfortunately, this is not true. Vit D increase AMH production from already existing follicles and it doesn't increase the number of antral follicles hence no increased egg production.

      Hence, it is always wise to interpret AMH values with your antral follicle count. A woman with less AMH could have high AFC too and vice versa. This can be due to Vit D deficiency or excess or due to some other reason too.

      In short, taking Vit D cannot increase your ovarian reserve, evenough there is an increase in blood AMH level. In fact, women with poor ovarian reserve must avoid supplementing with high doses of Vit D as it can bring down their number of follicles which responds to FSH.

      But I wish your is just a lab error previous time and your reserve is good. The value you got now is really good and I hope your doctor does a good job in getting more eggs from your ovaries to work with. Good luck !

      Perhaps I will write a post on Vit D and AMH and I will try to simply it as much as possible.

  11. Thanks Manju.
    This was informative.
    Would be waiting for your post regarding AMH and Vit D.

  12. I felt pretty emotional and was in tears when I read your AMH value. I feel your pain Manju. Your strength and courage is really motivating. I wish you all the best in your next ivf cycle!! Stay strong, you are blessed to have a wonderful supportive husband.

    As for me, I will be starting my first ivf workup later this month. I am keeping my fingers crossed and pretty scared thinking of all the stimming shots but trying to stay positive!

    Good Luck to both of us!

    1. Nio, do not worry about injections. They are the easiest part of IVF. If they hurt, it will be just like an ant bite. But mostly they don't hurt. Also remember that they are not evil. Think of them as costly anti-aging drugs. When the estrogen starts rising in your body as the result of those injections, you will feel great, just like a teenager :) Enjoy the ride, don't be afraid.

    2. Thank you Manju for your response. It is deeply encouraging as well as comforting with a tinge of humor. I smiled when I read it. Let's keep in touch.


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