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Saturday, August 30, 2014

My follicles were growing but my eyes were wet!

On the day of my first ultrasound, I entered the clinic. I am no more a stranger there (but it is not so amusing to visit an infertility clinic often); people were greeting me with a smile. I sat there waiting for my turn to be scanned. I could hear Dr’s voice in his consulting room. I was looking at the baby pictures on the walls as usual. I started to think of my children. I dreamed of bringing them both to the clinic, to meet everyone who took part in creating them. I always imagined how happy those moments would be, but, now, I am sitting in that same place with empty arms and an aching soul! Suddenly all my happiness vanished, I felt gloomy; an unknown fear gripped me strongly. I felt miserable. I wondered what I am doing there! Like in snake and ladder game, I was back to square one when I was thinking that my destination is at arm’s reach. I realized the cruel joke life played on me much more intensely at that moment! I had tried 6 long years to achieve my dream and suddenly it was taken away from me in the most unfair manner. What is the guarantee that such a thing will not happen again? How long will I be able to play this IVF roulette? Why I am not provided with the ease and security of normal conception? What is the guarantee that I will produce enough eggs and embryos, what is the guarantee that I will become pregnant again?  Even if pregnancy happens, will I have a healthy child in hand? What gave me the courage to try this stupid stuff all over again? My eyes started to tear. I tried hard to concentrate on my smart phone. Dr came out of his room, and I tried even hard not to look at him. I was sure that, if I do so, I will cry. I expected that he will greet me, say hi and ask how I am. But he just carried on with his work. That was even more hurting. He didn’t even say hi! It brought more tears.

Dr. Anjali came. She was as cheerful as always. She gave me a warm smile as she entered her room. Sister Mary called me in. The moment I entered in, I broke down. I started to cry. I felt embarrassed but I had no control over my crying spell. Dr. Anjali did the scan; she said that everything looks fine and showed me the growing follicles. There were many. There was one follicle which was well ahead of the others. I was a bit worried whether this lead follicle will suppress the other small ones. But, there is nothing more I can do than to just wait and watch. Dr. Anjali called Rajender inside and explained him the scan picture. I was asked to continue the same dose of menogon (300 IU) Dr. Anjali said, ‘we are sorry, it was really an unlucky happening. We were shocked when we heard about your loss’. She asked me, ‘is it still painful?’ I replied, ‘this place is painful for me, I have gotten over it (really!) and sometimes the pain is unavoidable’. She said, ‘try to forget it and move on’. I smiled and came out of the room. We went to the reception to buy some medicines. 

Rajender was looking at me. He understood that I cried. He asked me what happened. That was enough to trigger my crying episode again. He was so used to this. I just went on shedding tears. He said, ‘Manju, there are people around you, stop crying’. I told, 'Dr didn’t even talk to me’. He said , ‘didn’t you see, he is busy’. I replied, ‘but how much of his time will be wasted if he asks me how I am!’ Rajender said, 'when you went out of the room, Dr came outside, he did greet me'. My sobbing got even more uncontrollable, ‘see, he did talk to you but he didn’t talk to me’. He looked at me as if I was mad and he realized too it was a waste of time talking to me, consoling me. Sister Lizzy gave me that day’s injection. I haven’t stopped crying yet. She was curious to know what is going on. She asked me, ‘aren’t you responding well to medicines, aren’t your follicles growing?’ She said, ‘don’t worry; you have taken medicines just for four days’. I told her that my follicles were growing nicely. She looked at Rajender. He was forced to respond and he said, 'she is crying because Dr didn’t talk to her'. For the first time I came to my senses, felt ashamed. I stopped him in between and said, 'nothing sister, I am a bit depressed'. She told that it is very normal to feel so because of all the medicines I was taking, might be she was right! She consoled me by saying, do not worry, all will be well. I said to myself, 'yes, all will be well!'

We came out of the clinic. I wanted to go to marine drive, so we went and sat there. I was getting back to normal. My fears eased a lot. The vast, roaring sea always brings calmness within me. I was watching the huge crowd in that area. There were so many different people and everyone must be having their own world filled with struggles and happiness. I was thinking, what for should I worry. I am following my dream and that makes my life interesting. Life is more beautiful when there is a challenge to face. I must be proud of myself; I am strong even after going through so much. Living in the present moment is the best thing I can do. I don’t know what tomorrow holds for me. I do have problems in life like everyone else and I have learned a great deal out of it. Those lessons have helped me to enjoy life even better. Hard times in life have taught me many things than any of my good times. Struggles are what that gives definition to my life.

During the days which followed, I had two more scans. My follicles grew luxuriously and there were many too. My only concern was that of the fast growing follicle. Dr. Anjali said that, it might be just a cyst and we might not get an egg out of it. I was thankful that it didn’t hinder the growth of other follicles. The second time when I went for scan, Dr was not there in the clinic. So there were less patients around. I and Rajender had time to have a hearty chat with Dr. Anjali. I told Dr. Anjali how difficult it was for me when Rajender tries to control what I eat too during IVF times. He doesn’t even want me to eat papaya when stimming, and I love that fruit. Even worse, for breakfast, in the hotel we stayed, they always have that colorful fruit. Whenever I pick a bowl of it, Rajender gets restless. He believes that it enhances body heat and it might interfere with the cycle. I have tried to make him see the truth, I told him how nutritious it was, I even fought with him but I could never get back the joy of eating my bowl of papaya. Dr. Anjali was kind enough to explain him why he must allow me to do what I like. She said, ‘the more stress you put on her, it is not good for her during this time. I believe that stress do play an important role in hindering IVF success, but, Dr. Malpani might not agree with this’. This is enough to put my dear hubby at ease. The next day I took an extra large bowl of papaya and sat in front of him. I ate to my heart’s content and he was not bothered too, atleast he tried hard to act as if he was not bothered :) Not only that, he allowed me to eat whatever I wanted thereafter. He was also extra nice to me the entire cycle and I must thank Dr. Anjali for that :)

The day of egg retrieval approached very fast. I took menogon only for nine days. For the last two days I took 450 IU of menogon. This cycle was somehow much easier. I never obsessed about the number and size of follicles. I never asked Dr.Anjali how many eggs I might get. I just took each day as it was; neither did I expect anything miraculous, nor was I fearful. I had copious amount of EWCM and my estrogen rose very nicely. This put my mind at ease.If I remember correctly my estrogen was 2000 plus (pg/ml) before I took the trigger shot (hCG). On the day of egg retrieval I was eagerly waiting to go under anesthesia and I just love it!


  1. Hi Manju,
    Glad to know the follicles are growing nicely. Lots of baby dust to you!!

  2. Remembered you Manju: when i came across the following: "Indian women are forbidden to eat papaya during pregnancy for fear of losing the baby. As stated in the "Handbook of Fruits and Fruit Processing," normal consumption of ripe papaya during pregnancy might not pose any significant risk, but unripe or semi-ripe papaya might be unsafe in pregnancy"

    1. Even during pregnancy, ripe papaya is OK to eat. It is such a nutritious fruit. But my overprotective hubby doesn't allow me to eat during stimulation period of IVF too :) Most of the fights we get during this time is about what I should and what I should not eat :D Joys of infertility !

  3. Very glad to read this post Manju! Just have faith in God. Not sure if you understand and/or speak hindi but I just came across these lines this morning and really felt like sharing with you!

    I am in my 2ww after FET last Wed and getting scared for next Wed when I test - not sure how do I prepare myself for this! I am feeling as if everything will get over if its a negative. But then I think of you and your relentless spirit of achieving your dream and that gives me courage!

    मुश्किलें केवल बहतरीन लोगों
    के हिस्से में ही आती हैं .!!!!
    क्यूंकि वो लोग ही उसे बेहतरीन
    तरीके से अंजाम देने की ताकत
    रखते हैं !!
    रख हौंसला वो मंज़र भी आयेगा;
    प्यासे के पास चलकर समंदर भी
    आयेगा; !!
    थक कर ना बैठ अए मंजिल के
    मुसाफ़िर;मंजिल भी मिलेगी और
    जीने का मजा भी आयेगा !!!

    Lots of good wishes and caring thoughts coming your way!

    1. Translation :

      Difficulties comes only to outstanding people because only they have the strength to handle them

      Keep your strength - and you will reach your goal

      Even the ocean will come to slake the thirst of the truly determined person who is thirsty

      Don’t give up and sit down

      You will reach your goal and will enjoy life as well
      ---------------- ---------------- ---------------
      Hope it helps others too :)
      I should thank Dr. Malpani for this kind help.

  4. Lots of good luck and prayer coming your way too ! I wish you get the much needed BFP. Even if it is otherwise, nothing is going to end. Every end is an opportunity to begin new. Don't get scared, all will be well. I don't know Hindi. But I think I can ask my friend's help. Or, you can give me the crux of this passage :)

  5. Thanks Manju! Please share with us where are you now in your cycle :) I really hope its going well.

    the crux is that "God give difficulties to only those people who have the stamina to take them head on! keep faith..don't bog down..the day will come when you achieve your dreams and life will be a lot of fun" . As best as I could try to translate :)

    1. I understand your eagerness but can you please wait for a few weeks ? I am really sorry and hope I am not being rude.
      That's a lovely poem and thanks for sharing it with me !

  6. Ofcourse! I can imagine why would you want to wait! No question of being rude..take care :)

  7. So happy you had a good stim! As for the episode in the doctor's office, I've always found it so frustrating that fertility clinics have pictures of babies all over the place... It hurt my wife and I so much. It's as if the clinic is some anthropomorphized entity that is shouting: "Look how fertile I am! Look at all my babies! Where is your baby?? Oh, wait..." Gr... anyway, I'm hoping all the best for you!

  8. It is really courageous of you to go to try this again, despite all the uncertainty and painful memories. Sorry that your doctor was so insensitive and didn't talk to you. Some doctors, like mine, are just so businesslike. I like papaya too, it's good for digestion and i've never heard about it interfering with the cycle :) Things are looking good and I understand why you are taking it one step a day. Looking forward to your updates.

    1. :)

      My Dr can never be insensitive, he is just busy.

  9. You are really testing our patience by not updating the blog with your latest position regarding this cycle.
    But we have no other option rather than waiting.
    Fingers crossed for your successful cycle.

  10. Hi, wishing you the best on your new journey! I have been reading your blog recently. Liked the way you explain scientific funda. Anyway I wanted to highlight the side effect of metformin - increased homocysteine (which PCOSers have too) decreased B12 and decreased vitamin D. May be the prolonged Metformin use caused a decrease in your vitamin D. Have you ever had your homocysteine levels checked? Sorry to repeat myself if you have already addressed this in your blog previously. I was just connecting the dots on metformin - low vit B12 and D - high homocysteine - thick blood leading to early miscarriages. I have had PCOS myself since menarche just turned 37. Starting my TTC journey. Though I was prescribed metformin 10 years ago in India, I did not take them as my doctor in the UK did not agree with them. Now I want plan to take them anyway but I researching on side affects and came across the B12-homocysteine-metformin feedback loop. Just thought it might be of interest to you. Would really like to hear your views on it. - MM

    1. Thank you for the kind wishes !

      Thanks a lot for that info too ! Yes, I am aware of the connection between metformin usage and vitamin b12 deficiency. I always took Vitamin B12 supplement and folic acid 5 mg when I am on metformin. Metformin helped a lot to ovulate regularly. I checked my homocysteine levels and they were pretty normal.

      Problem with PCOD is, there are many types. Some women have high insulin levels and typical swollen ovaries which indicates PCOD. I do fall under this category. Metformin is an insulin sensitizer, it helps our body to utilize insulin efficiently and perhaps thereby helps in regular ovulation. PCOD women with high insulin levels are prone to first trimester miscarriages . Metformin brings down miscarriage rates in PCOD women.

      Are you overweight ? Have you checked your insulin levels ? Do you ovulate regularly ? Recently myoinositol supplements are also found to help women with PCOD. Myoinositol doesn't have the unpleasant side-effects of metformin. You must try to look for it. Are you trying for natural conception ?

      I am not aware of metformin, vitamin D connection. But I have read PCOD women are Vitamin D deficient. Can't comment on its significance though!

    2. Hi Manju, thanks for your prompt feedback. The metformin does not cause vit D deficiency, it is the B12 which leads to lack of adsorption of others such as vit C, Mg, Se and Ca. I do not have the exact order in which they affect each other. Will post it when I dig out the reference. I am not anti metformin as it has worked wonders for my friends. I am just looking to make a more informed choice for myself.
      Thanks for suggesting myoinositol. I am taking APCOD (myinositol powder) since the start of this cycle. Too early to say if there is any significant change. I am also planning on N-acetyl cysteine soon. Regarding B12 - I came across an article that stated methylcobalamin is better than cyanocobalamin and L-methylfolate being better than folic acid - it's to do with bioavailablility. All this was tied in the article regarding MTHFR gene. I don’t think there is a normal range for homocysteine that has been decided, it seems variant, but generally lower the better.
      As for my history - TTCing since May 2014, hence so far it’s natural. I was referred to the fertility clinic recently. My fasting insulin level was 18 mIU/ml which is high. Blood sugar, LH, FSH, testerone, progesterone (decent enough) and thyroid normal. Lipids are a bit dodgy. I am overweight at 65 kg for 157.5 cm. My PCOS diagnosis was always based on scans with classic pearls around both ovaries, ovarian volume right now 17 ml for both. I also have the acanthosis nigricanis as I am dark skinned. Had them even when I was skinny. Oral contraceptives always made my periods disappear and made me feel horrible. So I think the doctor back in Chennai was right to prescribe Metformin. But after reading your article on AMH and Metformin, I decided to wait before I get my AMH test. I got them today. It is 23.93 (pmol/l) or 3.35 ng/ml. It states satisfactory fertility in my report (whatever that means). Honestly I was hoping for a higher count that way I would have better chances with IVF. My periods range from 35-70 days. According to the biphasic BBT chart and opks I do ovulate but never did a follicle tracking study to confirm it. The last thing I need, is be diagnosed with LUFS.
      Just wanted to say that even when you have an emotional breakdown in your articles you exude strength so continue to be strong but also allow yourself moments of weakness if you have to survive. Sending the best of thoughts your way.
      I am torn between starting metformin in case my AMH count goes down even further, will discuss it with my GP tomorrow, I doubt she will have anything valuable to add. As much as she is lovely I don’t think my concerns are not down her alley to address. Anyway my POA is to go to Chennai (where I am from) and get investigated soon, all tests including laproscopy, if possible IUI or IVF. Did you ever have laproscopy done? I am worried of surgical complications.

      Sending my love and prayers

      PS - Sorry about the long post, didn't want to email it in case somebody benefits from your feedback so leaving it in the comments section

    3. I would strongly reccomend you to take metformin. Start with a dosage of 500 mg and build up to 2 grams. Metformin is not effective below 1500 mg dosage. I think your problem is insulin resistance and metformin is the best known drug to tackle it. Do you have diabetes running in your family ? Once you take metformin and start to avoid taking much simple carbs and saturated fats found in red meats, and if you include exercise too, you will start to ovulate on your own. Even few kilograms of weight reduction will bring on drastic changes. Please avoid white sugar, soft drinks, fruit juices, limit the intake of white rice, avoid red meat, if possible avoid NV altogether. Do you know banana stem and flowers ? If possible include them in your diet 3 or 4 times a week. Drink lots of water.

      Metformin doesn't immediately bring on Vitamin B12 deficiency. I think several years of metformin intake, especially in elderly population leads to Vitamin B12 depletion. If I were you I will not fancy supplements. It is wise to take b-complex, folic acid (5 mg) and omega 3. Please do not overdo anything ! Myoinositol, I am not sure whether it helps insulin resistance but you can give it a try.

      I would try on your own for 6 months. If there is no success then you must seek help because of your age. It is not wise to waste time. I am very happy with your AMH value. It is good. If your AMH is too high it can create lots of problems during IVF, if you need one. Too high AMH also prevents normal ovulation.

      My guess is, with metformin and diet changes, your ovulation will resume. Yes, it is wise to do basic infertility work up.

      Thanks, I think I am not pushing myself too much. I have my weaker moments too. But such moments makes me unpleasant and I try hard to fight it. And moreover my weaker moments are known only to people who are closer to me :) Whatever I write here is after winning those weaker moments so that it helps someone too.

      Thanks a lot ! That's very thoughtful of you to post the query here. Hope this helps in someway.

  11. i wish you all the best on this cycle. ill pray for you.lets cross fingers
    by the way , are there any forbidden foods during the cycle?
    all the best

    1. Thanks Maria ! Make sure to eat healthy, no need to avoid anything.

  12. Hi Manju!
    Can natural remedies like castor oil massage and serrapeptase reverse infertility due to adhesions?
    I have thin, flimsy adhesions due to some surgery and fimbrie of both tubes have become agglutinated. I do not have Hydrosalpinx.
    I have already failed few ivf transfers. My cycles are normal and husband's sperms are healthy too.
    Can natural remedies work in my case? And are there any other options available other than ivf?

    1. I am sorry for not being able to give you any hope. No, such treatments can never help you in anyway. Have you consulted doctors, did you ask them whether a surgery to repair the damage is a possibility ? This is the only way out. Even if a surgery is performed, the chance of success is very low. Having said this, who knows miracles happen but definitely even if it happens it will not be of castor oil or some other stupid things !

      Can you give me the details of IVF cycle ? How old are you ?

      Please do not waste your time in treatments which will not work. IVF is the only best option in front of you.


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