Contact me !

If you need to contact me , please write to me to this email ID : manjupadmasekar@yahoo.com. I will be happy to help.

Wednesday, August 31, 2016

How life style changes helped me to overcome premature ovarian failure ( POF ) - a real life infertility success story !

I got this very thoughtful email from my blog reader. Although , I do not support her view that eating organic food or doing yoga could help you conceive , I was really impressed by her detailed account. If it helps someone , inspires someone to make lifestyle changes , I would be very happy.

A word of caution - she is young and that could have made all the difference even if she is suffering from POF. Hope everyone gets lucky as she did.

Hi Manju,

I am an engineer by profession and work in the IT industry.  I am a long time follower of your blog. However,  haven’t gotten in touch with you before..The recent publication of  Sarah Marie’s post makes me write this to you. I have a tangential story to tell..

Me too a sufferer of infertility.  We have been searching for our baby luck for 9 long years and finally found our bundle of joy!. I had severe female factor infertility.  Premature ovarian failure was the diagnosis. I have had 8 failed IUI’s and 4 failed IVFs. At 28, I was told my menopause is  approaching. My AMH was very low.  I responded very poorly even to aggressive stimulation. Very few follicles . Even those follicles did not result in mature eggs. We  know very well, the pain of infertility is beyond anything that words can capture and the emotional trauma of giving up is bigger than continuing to try . Through my  struggles and fears, your blog had been a great moral support. Thank you so much!  I cried when you lost your twins, excited when you chose to have the embryo transfer yourself instead of the surrogate, delighted when you got pregnant and thanked God when beautiful Anisha was born. Indeed, I am so happy for you Manju!

 Coming back to my story, I had produced just 2 viable embryos in all those 4 IVFs combined! They too did not implant. For me, more than getting pregnant, producing a decent number of follicles itself was a huge challenge. I had one tube blocked and the other was clear. I was seriously advised to clip the other one too to prevent embryo implanting in the tubes.  

I came to know of Dr.Malpani through your blog.  I wrote to him, asking for a opinion before starting my 5th IVF. Even Doctors thought I was mad to go for one more IVF after the results I have had till then. But, I had come too far to go back. Dr.Malpani’s reply came back promptly with the treatment options ranging from aggressive stimulation to donor egg. Along with that he had prescribed some supplements and suggested to read the book “Inconceivable” by Julia Indichova. I least expected a book recommendation from an IVF specialist. I purchased the book and started reading it. It was the story of a woman who conceived naturally at the age of 42 after having been turned down by all IVF clinics. She had attributed her success to mind-body work, yoga practice, supplements,  some traditional medicines and a diet that included raw fruits and vegetables. The same list that was bashed and called as quackery in Sarah’s post. I too never took such unproven ways seriously because doctors have told me repeatedly there is nothing I can do to improve my egg quality.  Anyways, I liked the holistic approach. I  decided to try this keeping my next IVF attempt in suspension for a while. I had nothing to loose. I had already hit rock bottom 😃

I realized that I had totally started believing that my body is incapable of conceiving naturally because that’s what every Doctor  told me. I had to recover myself from that mindset first. The book helped me do that. I cannot exactly describe the process. It is about renewing one’s own connect with the body. IVF treatments had basically made me treat my body like a lifeless entity. I looked at it like an object - a place where  I let needles to be  punched in and then step aside to see if a  baby pops out. For five months I followed the suggestions in the book religiously. Grabbed every bit of information on diet that helped improve egg quality. Practiced yoga poses that  specifically help the pituitary glad.  Stopped all medications including DHEA. I saw my period length getting corrected. Getting closer to a 28 day cycle from 24 or 25 days and period blood looking healthier (It is only then, that I learnt how a healthy period blood should look like). On the sixth month I took acupuncture sessions for 20 days.I conceived my baby girl naturally the same month.  She was  born 2 months back. It was a normal delivery.  I  started approaching infertility specialists at the age of 28. I am 35 now :)

BTW, I did not pay for any other programs the author offered. It is easy to brush aside these alternative approaches  as unproven or not scientific. But, tell me  which pharma company is going to fund a research on yoga’s effect on harmonal balance. Who is going to make money  proving life style change can help in conception.  All the research happens only on the IVF drugs. It’s a race run by one man and no wonder he is the winner.  I am speaking from my experience.  My case may not stand scientific probing. I don’t have a  degree in biology. I am just an engineer. I am sharing my experience for  it might help someone out  there with a condition like mine. I just want to say there is hope even after multiple IVF failures.

What changes she did ?

1. Practiced yoga for 45 mins morning and evening (mainly the poses that help with pituitary functionality  Headstands and Shoulder stands).  I had a teacher come home and teach me.

2.Took a green juice every day (wheat grass power or goose berries)

3.Changed from cooked lunch to Raw vegetable salad. Eliminated Rice and Sugar. Switched to millet based diet and organic produce.

4.Took supplements Royal Jelly, Coq10, Shatavari, Wheatgerm oil.

5.Took acupuncture sessions for 20 days straight to correct ying-yang energy balance  (Dr.’s observation was that I had immunity disorder due to stress and male energy was dominant compared to female energy).

I leave it to you if you want to publish Julia’s name or even the letter itself. You built the blog . You are free to not publish content that you don’t agree with :)  I am totally fine with whatever you choose..

If anyone wants her email ID , I will be happy to provide.

Warm Regards,

Deepa





 

Warm Regards,

Deepa

Tuesday, August 30, 2016

How to regulate commercial surrogacy in India ?

There are now so many articles in favour of , and against , Indian government's move to ban commercial surrogacy. I do not want to get into that debate. I have gone through infertility and I know how hard it can be when you are denied the right to have your biological child because of a medical problem. On the other hand , surrogacy in India , in its present form , is definitely not ethical enough. The most exploited person in a surrogacy arrangement is the surrogate. When Indian doctors claim that this surrogacy arrangement is OK , and it's a win - win situation for all , I wonder whether they have ditched their conscience. In terms of benefit , in a surrogacy arrangement , the surrogate occupies the bottom rug of the ladder - but she does the most important and tedious job. The IVF patient and doctor are happy partners who are keen on getting their much needed baby and money , respectively. Although , intellectually speaking , this arrangement looks perfect - everyone gets what they want and no one is harmed - but the truth is , surrogate , who in majority of cases is uneducated and desperate for money ,  is exploited.
So , what can the Indian government do to regulate surrogacy rather than banning it ?
Step # 1
Does a patient really needs surrogacy ?
Government must set up a panel of doctors to decide whether a patient must be allowed to take up surrogacy or not.
If it is decided that a particular patient needs surrogacy to conceive , they must be first encouraged to find a relative who is willing to be their surrogate. If it fails , then they must be encouraged to pursue commercial surrogacy.
Step # 2
Examining the candidate who wants to be a surrogate.

Why shouldn't a surrogate's basic qualification be fixed ? A woman with a functional womb - is this qualification enough to be a surrogate ? Isn't it a profession which needs a bit of intelligence and understanding too - in order to safe guard their rights , their body ? Apart from medical tests , the woman who wants to be a surrogate must be tested for their basic knowledge regarding IVF procedure , pregnancy , the risk involved in surrogacy , surrogacy laws etc. They must be able to read and understand the surrogacy document - the documents must be available in local language. 
Step # 3
Surrogate banks must be set up by the government.
Women who wants to pursue as surrogate must register their details in the bank. Whenever a patient needs a surrogate , the bank must supply the surrogate in the order they are registered. Surrogate bank must fix a minimum fee for surrogacy - it must be the same nationwide. A surrogate must also be allowed to fix her rate - it can be anywhere above the minimal rate which is fixed by the surrogate bank. When doctors can fix their rate - why can't surrogates do the same ? If the intended parents agree to the rate , they can continue the surrogacy procedure with that particular surrogate , otherwise , they can try bargaining with the next surrogate in line. This kind of arrangement gives an upper - hand for the surrogates - and I believe it's extremely important to give power to the surrogates.
Step # 4
The IVF doctor will carry out the IVF procedure on the surrogate whom his / her patient has chosen. This kind of regulation , takes away the burden from the IVF doctors. They do not have to run behind agents for recruiting surrogates , they do not have to act as a middle - man between the patient and surrogate - this will give them lots of time to concentrate on their profession.
Step # 5
Once the surrogate gets pregnant she must be taken care of the intended parents. This will encourage patients to select an IVF clinic and surrogate bank which is situated in the proximity where they live. In this way , the stigma surrounding IVF procedure , including  surrogacy , can be removed. After all , the surrogate is carrying their baby - who else will take care of surrogate's need better than the intended parents ?
Banning surrogacy altogether , and telling patients who need surrogacy to adopt , is definitely against the citizens' right to freedom. Banning commercial surrogacy altogether can lead to many underground activities. The patients will definitely go to other countries where surrogacy is legal to fulfil their rightful wish. Why should the government loose the income ?
If foreign nationals are allowed to do surrogacy in India , the surrogates must be paid equal to what they would pay for a surrogate in their place ? Why should Indian wombs be a lot cheaper ? The care of foreign nationals' surrogate must be again taken care by a government agency.
I don't know whether I am intelligent enough to propose something like this. Might be there are many loop holes in this proposal which needs to be mended. My idea is to give a lot of power to surrogates so that they do not get exploited. This kind of arrangement also protects patients from unscrupulous IVF doctors.

I must mention about my surrogate here. If you are reading my blog for a long time now , you will know that I have attempted surrogacy once. Even though it didn't work out and I abandoned the option , I still have contact with my surrogate , Rita. Such a lovely soul she is. She keeps in touch with me via WhatsApp. She calls me didi ( sister ) and showers me with so much love and affection. On seeing the news about shootings in Germany , she was the first to enquire about our well being. She was so excited to see Anisha and loves her very much. She was so happy for me when I had Anisha. Her son talks to me too , especially when I and Rita couldn't communicate deeper because of the language barrier. Once I offered Rita to pay her children's education fees as long as they study. Do you know what her reply was - " thanks didi , I have enough ". What a rich woman she is ! I know her well. She was ready to carry my child for a mere 3500 dollars. Imagine how important is money for her. She gently refused to take money from me when I offered her. I am so gifted to come across her and she carried our embryo for six weeks :) 

Indian surrogates need to be paid better and they shouldn't be treated as cattles by hoarding them all in a small place when they become pregnant. Why should others earn more , and benefit more , at their expense ?
I would be very happy to hear reader's views and suggestions , please leave your comments below !



Wednesday, July 27, 2016

Infertility hurts - and you are not alone !



This post ,  I found in a IVF support group ,  written by Sarah Marie ( Sarah Wu ). She is an herbalist and permaculture teacher , living in Costa Rica .

This is how people who go through infertility feel. She has poured her heart out. This post will help others who are in a similar situation as her's to realize that they are not alone. May her infertility journey have a happy ending , and so be all yours !

" I am asking only for an open heart and an open mind...
I need to get this off my chest, it weighs so heavy...
My life is wonderful and I am beyond blessed.
And I have done everything I can think of... And now I want to share, with my friends, family, community, allies, acquaintances, connections and the world...
I have cast spells, prayed to the Mother, prayed to the Father, called to my ancestors, I have lit candles night after night, I have had akashic karmic healing, past life regressions and energy work. I work with crystal, plant and animal medicines. I read tarot, medicine cards, runes and pendulums. I have done mikvahs.  I have burned, buried, drowned and blown away that which doesn't serve me. I gaze at the moon, sun and stars. I have died and been reborn with Ayahuasca. I have used blood magik. I have chanted and prayed to the Virgin Mary, Durga, Kwan Yin, Juno, Inanna and Diana. I never stop reading and researching. I use western and Chinese herbs. I follow diets and eat what I want. I have had and regularly receive Acupuncture, massage, reiki, kinesiology, cranial sacral, abdominal massage and guided meditation. I have been hypnotized and I lucid dream. Have had my Vedic and Western astrological charts read. I have a therapist, Drs., friends and family.  I read my Basal Body Temperature daily, weekly, monthly.  I have taken handfuls of supplements. I try to keep my weight up. I manage stress and work hard. Have had endocrine tests, blood tests, and sperm tests. Have had my tubes checked, multiple ultrasounds and endometrial biopsies. I have given myself so many shots in the stomach, ass and thighs that it doesn't scare me anymore. I have felt my ovaries swell and lost my mind to hormone overload. I have had three rounds of IVF, two IUIs, intravenous immunoglobulin treatments and paternal lymphocyte therapies. I had a hysteroscopy and a polyp removed from my uterus. My ovaries sometimes have cysts.
I know my body, mind and heart better than most people will ever know and I still don't understand.
I have felt my heart break more times than I thought humanly possible. I have felt incompetent, insufficient, depleted, hopeless, scared, ashamed, useless, pitied and like I wanted to die. I have felt bad for myself, jealous of others, angry, sad, depressed, alone and numb. I have felt empowered, brave, healthy, loved, supported, nourished, held and faithful. I feel alive, I feel strong, well, confident, I love myself and I love all life.
I ask why almost every day. Why me? What did I do? Who did this to me? Why is this my karma? What is the lesson? Will this help me to be a better person? A better woman? A better mother? A better friend, lover and wife? A better teacher and better healer? Will this help me to help others? Will it happen? When?
This is my struggle and pain... These are my lessons, my inspirations and reflections.
With every month, comes the bleeding of disappointment and sadness, comes the blood of empowerment and gratitude.
Will I give up one day? Will it happen? Will my biological child be the ultimate gift from the Goddess? Will she help me? Will we adopt? Will we?
I still don't know...
I will stay my course...  listen to my heart and keep trying... I feel my baby near...
In gratitude... "
Sarah Marie

Monday, July 18, 2016

Dr.Malpani's Blog: Book Release - Patient Safety - Protect yourself f...

Dr.Malpani's Blog: Book Release - Patient Safety - Protect yourself f...: Please do come to our book release - Patient Safety - Protect yourself from Medical Errors on July 19 at KEM Hospital at 2 pm. This will...

Monday, July 11, 2016

Detox your way to IVF conception



I went through a website which is very popular among infertile women. They offer nutrition and exercise advice ; sell imagery CDs - which they claim , " they are as powerful as fertility drugs " ; and moreover , they offer emotional support. So , it's a complete package - and , it's completely natural ! They call it as natural fertility treatment. How I wish I could start something like that - who doesn't want to earn money !
Their website is full of word play - you get nothing useful from there until you pay money. And even if you pay , I wonder , what you will get out of it ! But nevertheless , they are very famous and have many glorious testimonies to their credit !
Let me come to the point - how to detox your body ? Before that , let me ask you some questions :
1. Do you have a very stressful life ?
2. Don't you eat organic food ?
3. Do you eat genetically modified food ?
4. Do you use lots of chemicals at home - shampoos , cleaning and washing lotions , soaps , etc., ?
If your answer is 'yes' for the above questions , it clearly shows you have poisoned your holy body ! This is the reason why so many diseases exist in modern world - from cancer to infertility ! It's a punishment imposed on humans for going against nature. Your body has accumulated so much of toxins - as a result , your ovaries have stopped functioning properly ; your embryos haven't implanted because your uterus is not embryo friendly as a result of all the toxins it has accumulated over the years ! If you could get rid of these toxins , you get your fertility back !
On reading the above , how many of you feel scared ? How many of you feel guilty ? How many of you are wondering what I can I do to get rid of the toxins ? This fear and guilt you feel is the raw material for many peoples' business - and unfortunately , many fall as prey for such scams , yes , scams !
Why do people believe such scams ? The foremost reason is , they lack knowledge about how human body works. Next comes the glorious advertisements and testimonials they see , read and hear - and ,  when it comes from a friend or doctor they trust , they easily fall for it.  The third is , when they meet a person who claims that treatments like detoxification works , and sells it too , they get carried away by their bedside manners - their promises , concern , care , consideration , reassurance and sympathy can feel like an oasis in their desperate attempt to hold on to hope and faith. As a result , many turn out to be loyal customers even if the treatment doesn't lead to what they wanted - they will find ways to suppress their rational part of the brain , because , all they remember is how emotionally pampered they are when going through such treatments. They stay loyal forever irrespective of the outcome !
Our body has amazing ability to remove any harmful substances that enters in. Organs like liver , kidney , skin , lungs , etc ., work to remove all the waste products that form in our body as a result of digestion and metabolism. The detoxification programmes claim that they help your body to eliminate wastes ( toxins ) better by making your liver and kidneys function better. They sell several herbs  and supplements for the same - and , what attracts people most is the word ' NATURAL .' Unfortunately people fail to understand that natural doesn't mean it is without unpleasant side - effects ; natural doesn't mean it's free of harmful chemicals ; natural doesn't mean it's safe. Actually , the herbs , herbal cocktails , vitamins and other supplements sold by them doesn't have FDA approval. This means ,  they are not checked for the ingredients they claim that it contains ; they are not checked for appropriate dosages - and hence there is no guarantee for their safety or efficacy. As a result , they can actually prove to be much harmful than you might imagine ! You are in danger of not only loosing your hard- earned money but also your precious health. You can't enhance your liver or kidney's ability to clear wastes. If your kidney and liver function tests are normal , they are working just fine. Just because your liver and kidney cleans your body's metabolic wastes , doesn't mean they accumulate toxins and slowdown in function  ! You do not have to detoxify  them regularly in order for them to work properly.
Organic food doesn't means it's pesticide free. Produce that are not organic is perfectly OK to consume after washing them ( of course you have to wash the organic produce , too ) . By consuming them you are not accumulating toxins in your body ! Organic food is definitely not more nutritious - it is just more costly ! Genetically modified food is not poison. No one will get cancer by consuming them , nor do they carry toxins ! Genetically modified foods don't deserve the negative propaganda they are receiving by the people who really don't care to understand how genetic engineering works ! I have learnt from some infertility forums that some patients' IVF doctors have insisted that they go organic and remove all chemicals from their lives ! How unreasonable such suggestions are ! How easily doctors too fall for cognitive biases ! Or , is it a strategy they ploy to blame their patients' life style for the IVF failure ?
Just like , you can't detox your way to IVF conception , you can't use your visualization power to bring on a powerful ovulation ; you can't use imagery CDs to make your egg quality better ; you can't make your embryo stick by imagining that they are doing so ! If it works so , majority of us don't need an infertility doctor.
So , why so many patients swear by the efficacy of such unscientific practices ? The answer is simple , those websites provide enormous emotional support. They give you so much personal attention and reassurance , provided , you pay them ! When we are going through a difficult journey , we all need someone to hold our hands and say that all will be well and we can get through it ; we need real life examples , real life success stories ;. and moreover ,  we need someone with whom we can can confide our fears , insecurities , hopes and dreams. They offer all this ,  and much more. I feel they work like a cult with their own unscientific doctrines and principles. They know how exactly to brainwash their customers. Since , infertility is an emotionally  stressful and tiring journey , we easily fall for their promises. Infertility makes us emotionally vulnerable. Many of us lack proper support system when infertility strikes - it is still a taboo in many parts of the world. All these factor earns a lot of customers for such quacks.
When you find yourself getting lost in the stress of infertility , please try to do the following :
Educate yourself about your problem scientifically - this will help you to build realistic expectations , it will also strengthen your hope and make you confident.
Have an open mind and have alternate plans  - don't get desperate for success !
Build proper support system - your family ,  online infertility forums and your doctor can play a major role in keeping you sane and hopeful , amidst the enormous stress.
Please do not waste your emotional and financial energy by believing in quackery ! You can ask me , " If , what they offer makes me feel better , if I find solace there , why not follow it ? "  The problem here is ,  people who sell such ' alternative therapies ' claim that it can make you conceive or make you fit for conception , which is totally false. They are promoting something which is not scientific and trying to make a business out of it by playing with your emotions.  I understand that we need to find a middle path - but , middle path doesn't mean you need to mix delusion and reality and end up with heart ache when the treatment doesn't work ! Mixing placebo sugar solution and real medicine isn't going to enhance the medicine's effect , it can even make the medicine ineffective - that's not the real middle -path ! Many a time , alternative therapies distracts you from your real goal.  The real middle path is , understanding your problem , working on what you can really improve scientifically and let go of things what is not in your hands ( for example , if your ovarian reserve is exhausted and your ovaries are no more responding to drugs ! ) - instead of repeatedly hitting the dead end and wasting your physical , financial and emotional energy. When you hold on to false promises and hopes for support , when you fall , you fall really hard - the pain will be enormous. When you hold on to reality , even if it is bitter to accept , when you fall , you do so gracefully - the pain will be lot lesser and you will spring back to action very soon.

Thursday, July 7, 2016

Elective Single embryo transfer ( eSET ) - is it for me ?



The answer to this question depends on a number of factors :
1. Your age
If you are of young maternal age , the chance that more than one of your transferred embryos being genetically normal increases. Hence , it is wise to opt for single embryo transfer ( SET ). If you are less than 35 years of age , with good ovarian reserve and good quality embryos , you must consider transferring only one embryo.
2. Your ovarian reserve ( the number of embryos obtained in a particular IVF cycle )
If you get many eggs and embryos in your IVF cycle , it is better to grow them to blastocysts and do a SET.
3. Having good looking embryos
If the embryos that were created are of high grade , then doing eSET can be beneficial, provided , you are of young maternal age with good ovarian reserve.
4. Blastocyst transfer
If 40 % of your embryos develop into blastocysts , it shows that they are following a normal growth pattern. In such cases , elective SET can be beneficial.
5. Your clinic's success rate
If your clinic has high success rate for women of your age , then it is important to listen to your doctor's suggestion regarding how many embryos to transfer. You have high chance of having multiples if you transfer more than one embryo in a clinic which has high success rate.
6. When using donor eggs and embryos
Women who donate eggs are usually of young maternal age , so , the chance that many of the obtained embryos are genetically normal increases. Donor embryos are mostly got from couples who have completed their families using the same cohort of embryos. This is a sign that the remaining embryos may be good enough , too. And moreover , majority of the time , only couples who are of young maternal age will have ample embryos to donate  . So , when using donor eggs and embryos , it is good to go with single embryo transfer.
7. When using embryos which are tested for genetic competency
When using embryos which are tested using advanced genetic testing techniques ( for example , embryos tested using NGS ( next generation sequencing,  where all 23 pairs of chromosomes are screened )  , SET must be preferred.
In short , if you are of young maternal age ( ideally , below 35 years ), with good ovarian reserve ; if 40% of your obtained embryos grow to blastocysts and are of good grades allowing you to select the best ; if you use embryos which are tested for chromosomal normalcy ,  and if you are with a clinic which has high success rate , or , if you are using donor eggs and embryos , you must opt for SET - this will greatly reduce your chance of having multiples. 
Remember , a successful IVF cycle is not about getting a positive pregnancy test. Only when you take home a healthy baby ( healthy babies )  healthily , your goal has been achieved. Multiple pregnancies can be  disastrous , many a time.  Having premies in hand is heart - wrenching and losing healthy babies can break your heart. The chance of something going wrong in multiple pregnancies is several times higher when compared to singleton pregnancy. So , aim for eSET whenever possible - aim for a healthy IVF pregnancy.

Tuesday, June 28, 2016

Happy Birthday , Dr !





Dear Dr ,

Many more happy returns of the day ! May you live a very long , happy and healthy life , and let no harm come near you. May all your dreams and ambitions come to fruition. Keep smiling , and have a very beautiful life ahead !

Thanks a lot for making Anisha happen ! She has made our life happier and purposeful. We learn a lot from her , everyday. Not even a day goes by without wondering how dull and colourless our life would have been without Anisha ! Thanks to you and your team for all the technical help and support !

For me , your presence has been a great support. When I was shattered beyond words by the loss of our twins , the thought that you are there gave me enormous strength. I wouldn't have fought this battle gracefully without your blog , my blog and you. Thank you , you are a wonderful doctor , and moreover , a beautiful human being.

Have a great day , Dr ! Stay blessed , always.

Manju

Saturday, June 25, 2016

Wednesday, June 22, 2016

Can stress cause infertility , can the stress of infertility treatments prevent my conception ?




This is the most disturbing question in the minds of men and women fighting infertility. The most important piece of advice you will receive from well - meaning people , when you are struggling to conceive is , " Relax , it will happen ". Even if you are reacting to your situation normally , like every human will do , the ' relax ' advice makes you to worry that you are worrying too much about getting pregnant ,  and hence that stress has come as a stumbling block to conception. Once you start to believe so , you will be stressing all the time not to stress ( instead of working on your stress to make the situation better ) ; you will be worried about how not to worry - as a result , you will slowly be caught in a stress cycle which is not productive. Worrying how not to worry , instead of reacting to the situation appropriately , can never lead to any constructive action , unfortunately !
We are all made to believe that stress is bad for us. The truth is ,  stress is an inevitable part of human life , it helps us to become courageous , it makes us caring and empathetic , and most importantly it makes us resilient ( that's what the new research says ! )  What else do you need to fight infertility ?
The idea that stress is toxic to our body is an old school of thought. As scientists developed proper models and tools to explore further into stress and it's effect on our body , it became clear that stress is not bad , after all. It is our body's defense mechanism to cope with difficult situations. Stress actually makes us healthy - it boosts our immune system , makes us physically and mentally resilient and has a positive impact on our brain health.
Further more , research has also pointed out that , people who believe stress is bad for them tend to experience the negative side - effecets of it ,  and people who think stress helps them to perform better , reap the best out of it. How can it be ? For example , if a person going through infertility treatment starts to believe that the stress of the treatment is causing him / her  not to conceive , they naturally quit their treatment. This happens many a time. People start to believe that the stress of infertility treatments is stopping them from conceiving. Once such a thought enter their mind , they quit treatment and try to take a route which is least stressful - for example , natural cures ( homeopathy etc ).  If the cause of their infertility needs allopathic treatment , they will never conceive in spite of their decreased stress ( for example , if the problem is blocked tubes or low sperm count ). In such cases , their belief that stress is harmful hindered their ability to endure difficulty and fight back. The end result is ,  they end up wasting their precious fertile years and unintentionally decrease their chance of conception. On the other hand , people who accept their stress caused by infertility and use it in the best possible manner will tend to achieve their baby dream much more easily. This is because , they are least likely to give up , they remain energetic , stay focussed and motivated. They rise to their challenge and give their best. They can also use their stress to become best care givers for people who are in a similar situation as they are.
There are three beneficial stress responses ,  ' challenge response ' is one among them. This stress response reduces inflammation and helps you to rise to your challenge. So consider your infertility as an interesting challenge and make the most out of your beneficial stress. To give a simple analogy , imagine a mad dog running towards you. You have two options : you can try not to stress yourself too much and wait patiently for the dog to approach and bite you , or , feel the stress and respond accordingly by running as fast as you can to escape the ferocious dog ( the challenge here is to run faster than the dog ) ( although ' a dog chasing ' is a type of threat response , I have used it as an analogy for ' challenge response ' )
If someone tells you that stress is bad for you , please do not believe them. Stress is not bad. It is not evolved to harm you and your body , but to help you. Nature wouldn't want the human race to end , nature wants that we thrive and flourish. If stress is so bad for us , our body would have developed mechanisms to evade stres all together.
When infertility strikes you , it is a very normal reaction to worry. Worry leads to further actions - you find a doctor , you read a lot about it , you ask for multiple opinions , and you spring into action. If someone says that this is wrong and you must relax , something is wrong with them and not with you ! Except for the threat response , aka , fight and flight response , no other stress response leads to a toxic state. During threat response , it's true that inflammation is increased , our decision - making ability is impaired , hormones which suppress our immune system are released and our brain cell's health is compromised. BUT,  remember , the threat response is only short lived and is helpful too , for that particular situation. Other that that , no other stress impacts us negatively.
Infertility is stressful , there is no doubt about it. If you see it as an interesting challenge and tackle it accordingly , the stress of it will only help you and your body to fare better. Believe in your body , it will not let you down. Don't be afraid of the stress , it is only working hard to make you much stronger , courageous and resilient. Don't you know that the coals which withstands high pressure turns out to be precious diamonds ? If you withstand the stress of infertility and infertility treatments ,  you are more likely to give rise to precious babies :)

Monday, June 20, 2016

IVF failure - when emotional pain is stronger than physical pain !



" Thanx a lot manju...i just love to read your reply.
I am very lucky to have a very loving and understanding husband. Just finiahed my 3rd ivf. Same protocol with 450 iu fsh daily for 10 days fron day 2 and cetrotide. Collected 9 eggs. 4 mature and 3 immature, 1 dead. 4 eggs icsied and got 3, 6 celled and 1,8 celled day 3 embryos and 8 cell embyo was grade a with no fragments. and others with small fragments.they tranfred 4 embyos My dr was very hopeful for this cycle. But just got my bfn on day 14. And this cycle also was not succesful. My progestrone on day of hcg administration was 1.7ng/ml. I was reading that elevated progestrone on day of hcg admnstration have a negative impact on implantation. As endometrium is less receptive. I am not finding any comfort anywhere. I am so hopeless. Just want to have my bundle of joy, but it seems its not going to happen.
I feel good talking to you. Just someone with whome i can share everything.
Thanx a lot for being there. "
Dear S ,
" I understand your pain. I have gone through IVF failures many a time - we feel so hopeless , and future might appear very dark and bleak. All I would say is , cry , cry and cry. It will make you feel better. 
Remember , there are women who go through much horrible times due to infertility. I know women whose husbands took it as an opportunity to leave them. I know women who can't get the baby they want because they do not have the necessary money. And , there are women  who just can't have a baby because their ovaries don't work anymore. Being grateful for what we have helps a lot to feel better at these difficult times. It helps you to feel thankful in spite of the sorrow you feel now. Life is never easy , not for anyone. The battles we fight , the courage and strength we show , will define who we are. 
First , even if you do not succeed in having a baby that's not the end of the world. You are already a wonderful mother and your child will come to you in the appropriate time. Never lose hope.
Yes , progesterone rise at the time of hcg administration can make the lining not in sync with the embryos' developmental stage - this might lead to failed implantation. Why didn't you tell your concern to your doctor at that time ? You could have opted for a FET. Nevertheless , past is past. The good thing is , you produce eggs still. When are you planning to start the next cycle ? Can you write to me before starting it , perhaps a month before you start ?
Now , just take your time to recover - read good books ; grow your spirituality ; do something which makes you feel good about yourself. Life will not stay as such forever - nothing lasts longer. This difficult time will come to an end , too.

Find happiness , please ! You can , it's all within yourself. You just need to know how to experience it , enjoy it , in spite of all the troubles. Finding ways to be happy amidst these difficult IVF times can help you to reach your goal with ease . "

IVF failure is no joke. I have seen couples who became suicidal after an IVF failure. The pain can be excruciating - you feel as if  you are sucked out of energy from every cell of your body ; thoughts about future can be very fearful. You feel as if you can never function properly - doing everyday chores can feel like an Himalayan task ; your professional life can have a set back , for that time being.  But the good thing about an IVF failure is , after you cry your heart out , you feel cleansed inside out. For many , IVF failure can open the door to spirituality - they try to analyze their actions ( life ) spiritually - as a result ,  most couples will definitely become better humans. Your preferences in life will change for the better. Your ego gets tamed , and naturally you start to give importance to the most valuable things in life - you will fill yourself with love and gratitude , rather than hatred and fear. After all ,  that is what life is all about ; that's what a failure does to a mature human being. After a painful experience , you will always be left with two choices - to become bitter or better. The good news is , most humans turn out to be better beating the bitterness within them. The only wise words at such times is , " Stay strong , this too will pass "

Wednesday, June 15, 2016

Why are my ovaries unresponsive to stimulation drugs ?




Every infertile couple , when they start their IVF cycle , are full of hopes. They are excited that they are pursuing an infertility treatment which gives them a very high chance of success - and , for some , it is also a last resort for having a baby !  As they go through each and every step of an IVF cycle , they are tormented with different emotions -  excitement , confusion , despair , happiness , sadness and what not ! But for some women , their excitement comes to a crushing halt during the very first step of IVF - their ovaries simply do not respond to the stimulation drugs which are used to grow multiple follicles. When follicles don't grow there is no chance of harvesting eggs - their journey sadly ends before it even begins ! This situation is more painful than a failed IVF  , because ,  for some ,  this can also mean the end of their baby making journey ! Why do ovaries become unresponsive to stimulation drugs ? Can this situation be overcome ?

There are three possible reasons for having  unresponsive ovaries :
1. Poor or diminished ovarian reserve
2. Use of sub - optimal concentration of stimulation drugs ( gonodotropins )
3. FSH insensitivity

Poor ovarian reserve

Aging is the main reason for having a poor ovarian reserve. All the eggs a women harbors in her ovaries are created when she was in her mother's womb . To start with ( at around 6 months of gestational age ) ,  a woman's ovaries contain approximately 7 million eggs .  But at birth , only 1 - 3 million eggs remain , other eggs are lost even before she is born due to a process called follicular atresia ( a self - destructive process ) . Follicular atresia continues as a woman grows , and hence the number of eggs in her ovaries continue to decreases drastically. By the time she reaches puberty , only 300 , 000 - 400 , 000 eggs are left. When she reaches menopause ( the normal age for menopause is around 50 years for most women )  , her ovaries might contain around 1000 eggs.  Many older women ( > 40 years ) , who undergo IVF , might find that their ovaries are no more responsive to stimulation drugs because their ovarian reserve is extremely poor . As the women approach menopause ( even 10 years before menopause ) the quantity and quality of eggs decreases , drastically.  The follicles ( the structures that contain egg )  present in the ovaries also lose their ability to grow in response to FSH ( because they become refractory to the action of FSH ) . As a result , older women find that their ovaries respond very poorly to stimulation drugs leading to poor egg yield , or they might also experience complete lack of follicle growth . This often comes as a cruel shock ,  because , aging of the ovaries are not as obvious as aging of other visible body parts , and hence no one are really aware about it . For example , we are very much aware of our greying hair and skin wrinkles , but we rarely think about our ovaries , and the changes that happens in them , as we age  . Many women are ignorant about their fertile years  , they think , having a regular menstrual cycle indicates all is well with their reproductive system ! Many even think , if they look young for their age , their ovaries remain young , too ( sadly that's not the case ! ) Older ovaries are most of the time unresponsive to stimulation drugs ,  and there is nothing one can really do to make them sensitive to gonodotropins.

Unfortunately , 10 % of young women can also have ovaries which are much older than their actual chronological age. For example , a women can be 25 years old , and can have ovaries which behave like that of 40 year old women's. This is a very unfortunate happening. There can be many reasons for this , like , chemotherapy , smoking , ovarian surgery leading to the loss of majority of ovarian tissues , autoimmune diseases ,  some genetic defects like fragile X syndrome , etc. These women's ovaries might also become unresponsive to stimulation ( FSH) .
Women who have poor ovarian reserve can be identified using a couple of blood tests , such as , measuring their FSH , e2 and inhibin B levels on day 3 of their menstrual cycle  ,  or measuring a hormone in blood , called AMH. Counting antral follicles present on ovaries using an ultrasound probe , during their earlier phase of menstrual cycle also gives a rough idea of their ability to respond to stimulation drugs. But the ultimate proof of their ovaries' ability to respond to stimulation drugs can only be assessed during an IVF cycle . A woman who fails to grow more than 3 follicles with maximum amount of FSH ( 450 IU ) ,  (  and whose e2 is less than 300 pg / ml for a single follicle or less than 500 pg / ml for 3 follicles  ) , for a minimum stimulation period of 9 days , are classified as poor responders.

Use of sub - optimal dose of gonodotropins

The antral follicles carry receptors for FSH in their granulosa cells.  During IVF , the FSH that is used ,  bind to these receptors and help in the growth of follicles. Since , FSH is used in supranatural amounts during IVF  , it rescues most of the antral follicles which will be otherwise lost due to atresia. The sensitivity of follicles to FSH varies with age. Normally , older women need more FSH to rescue maximum number of antral follicles from degenerating when compared to that of a young age woman. In other words , young women's ovaries are much sensitive to FSH and hence they need less FSH to initiate the growth of  maximum number of antral follicles. The usual starting dose of FSH is 150 miu for women aged 25 - 30 , 225 miu for women upto 35 years of age , and above 300 miu for women above 35 years of age. If lower doses of FSH are used for older women , their ovaries fail to respond to FSH. Hence an optimal concentration of FSH is necessary to make the ovaries respond effectively to stimulation drugs.
For example , I responded very poorly to stimulation drugs during my first few IVF cycles. During my first IVF cycle my AMH was 4.5 ng / ml. Because of my high AMH , and because of the fact that I was diagnosed with PCOD , the doctor wanted to be extremely careful. I was 28 years then and the doctor started me with 150 miu of gonal F . Even though my FSH dose was increased gradually during the stimulation period , at the end of the cycle , I had only 3 follicles that were growing and I got only one embryo  ! That was a disaster and I was heart broken. I thought I would have lots of eggs because of my age and PCOD diagnosis.  Now , when I look back , I could guess what might be the reasons for my ovaries ' poor response to FSH - high AMH and insulin resistance ( insulin acts as a co - gonodotropin ) could be the possible reasons which can lead to poor response if the starting FSH dose is not high enough !
Although , PCOD patients are hyper responders to stimulation drugs , getting most of their FSH - sensitive antral follicles growing depends a lot on the initial dose of gonodotropin that is used.  If the initial FSH dose used was too small , many PCOD patients tend to respond very poorly. A recent publication talks about the effect of high circulating AMH affecting the FSH sensitivity of antral follicles. They found that , higher the AMH level , higher starting doses of FSH are needed to create an optimal ovarian response. High AMH levels make the ovaries resistant to stimulation drugs and hence higher doses of FSH is needed to overcome FSH resistance  ( http://www.ncbi.nlm.nih.gov/pubmed/24341292 )
So , not only old age but also having PCOD can make ovaries resistant to the action of FSH. Hence , determining and administering optimal FSH dose is essential to make the ovaries responsive to stimulation.

FSH insensitivity

There is a genetic condition called hypergonodotropic hypogonodism. It is an endocrine disorder where the ovaries are resistant to the actions of FSH. This happens because of a mutation ( genetic defect ) in the FSH receptor ( to which FSH binds and initiates it's action ). As a result , FSH cannot act on the receptors that are found on the granulosa cells of follicles. Because of the lack of FSH action , no follicles could be grown ! The ovaries will not respond to stimulation drugs and at present there are no cures for it !

Friday, June 10, 2016

A burning question in IVF !



Question # 5
" How are you doing? Hope you are having a good time. Going through second IVF cycle
Kindly help me answer few queries:
1.Could you please guide me if bed rest is recommended (or it has slightest impact) after frozen embryo transfer?
2.Can I go for mild stroll after 2-3 days and resume office?
3. Indian roads are bad and there are lot of bumps/potholes on the road, does travelling in the car negatively affect? "
Answer
I have already written a couple of posts regarding bed rest after embryo transfer. Even after that , I get repeated queries regarding bed rest !
Why are women afraid of carrying out their normal day - to - day activities after embryo transfer ? There are many reasons :
1.  Women turn to internet and online forums for advice - the suggestions they get there are very conflicting. They come across women who swear by bed rest for their IVF success.
2. Irrational fears are normal during IVF - ' what if the embryo falls down , is that light pink tissue on my toilet paper my embryo ! ' Couples who undergo IVF want their cycle to succeed  - their baby love cannot be fathomed. They fear failure , and want to do their best ( anything ! ) to find success. These factors play a major role in preferring bed rest.
3. Lack of knowledge about uterine and embryo morphology can lead to unnatural fears about embryo falling out from uterus .
4. Many clinics still send patients with an instruction to take strict bed rest. Even worse , there are doctors who immobilize their patients and keep them in hospital bed , until pregnancy test. If the pregnancy test comes out positive , and if all goes well ,  the bed rest continues until delivery.  These money - mongering medical professionals make good use of the ignorance and fear of their patients to fill their pockets  - shameful of course !
Why bed rest is not necessary ?
It is very natural to wonder  , " if embryos  can be kept inside the uterus via cervical opening , won't it descend down the same way ? " No , it won't.  Your embryo is microscopic , and is like an invisible dust particle - it can easily fit at the tip of a needle. Your uterus is a pear shaped organ. Assume that the widest part of the pear is the uterus , and the narrow region is the mouth of uterus , aka , cervix. If you cut the pear longitudinally there is no cavity in the upper part , the same applies to your uterus , too. Your uterus walls are like two bread slices touching each other. The endometrium where the embryo implants is akin to the jam applied inbetween the bread slices. Imagine keeping a microscopic dust particle inbetween the bread slices - is there any chance that the dust particle get dislodged or fall down ? The same applies for your embryo too. There is no free space in the uterus for your embryo to roll and fall down. There is no real cavity , the uterus only contains a potential cavity and the cavity develops only when the embryo implants and develops into a fetus. The growing fetus will push the walls of the uterus apart creating a cavity. Hence , gravity cannot act on your microscopic embryo.  The endometrium acts like a sticky jam. Endometrium and the embryo are made for each other ( they communicate with each other , a lot ) , and so they love sticking to each other. Walking , running , jumping , sneezing , coughing , falling down , your dog jumping over your lap , bumpy roads , and not even having sex , will push your embryo out of your uterus.
Won't uterus contractions squeeze the embryo out ?
Although , any increase in the frequency of uterus contractions has the potential to dislodge or expel the embryo , the progesterone which is present in large amounts after embryo transfer , doesn't allow the uterus to contract more than usual. Doctors aim for a very smooth embryo transfer. If the embryo transfer becomes difficult for some reason , it might lead to increased uterine contractions , and these contractions can affect IVF success , most probably due to dislodging of embryo or due to embryo expulsion via cervix. But , your normal day - to - day activities will not cause your uterus to contract , especially when such enormous amounts of progesterone is doing its job in your body.
Is orgasm OK ?
It should be OK. Couples who conceive in their bed room have sex after ovulation. If sex and orgasm could expel the embryo from the uterus , human population would have been a lot less. Once the embryo is inside the uterus , it doesn't remember how it came in. Once inside the uterus , they are as safe as the embryos formed during natural intercourse. There are women who orgasm in dream during their IVF 2WW and worry whether they have caused any harm. You can be very sure you haven't spoiled your chance of success.
What does scientific evidence say about bed rest ?
Studies showed no correlation between bed rest and IVF success. Some studies even pointed out that bed rest could actually decrease your chance of success. Even more , if you apply your common sense -  during and after IVF there are enormous amount of different hormones in our body ( much higher than what will be present during a natural cycle ) . This increased amount of hormones increases the risk of blood clots. If someone keeps on lying down without enough movements , it can actually cause much harm  - especially , in women who are prone to blood clots.
What about the ladies who swear by bed rest ?
Please remember that correlation doesn't mean causation ! I ate bananas today , I met with an accident - but that doesn't mean eating bananas lead to the accident !  Anecdotal stories are not proofs. For every lady who got success after lying down in bed all the time , there are ten more who didn't rest and got pregnant. Instead of searching ' bed rest and success ' , search for ' no bed rest and success ' . Google gives you what you want - always be aware of this ( never believe everything what Dr. Google says )  ! If you want a good advice which can be trusted , talk to someone who is knowledgeable (  most probably that person must be your doctor ! )
Shouldn't I rest at all ?
Take rest - but do not overdo it ! For the first 15 minutes after embryo transfer , lie down. Then for the next two days treat yourself like a queen ( don't do what you do routinely , for example , avoid laundry or anything you find difficult ) . After that ,  get on with your routine. Lying down 24*7 will only make you emotionally sick - it will allow your mind to play games with you. Keeping yourself busy , yet , not doing something which you will regret if the IVF fails , is the key.
I felt wet down after embryo transfer ? Is it the liquid within which my embryo was present ? Does that mean my embryo came along with that liquid ,  I found a red dot in the tissue paper after wiping - is it my embryo ?
No , that's not your embryo. You cannot see your embryo with naked eyes. And definitely , your embryo is not red in colour. So , do not panic. The liquid in which your embryo is present during transfer is just a minute drop of cell culture medium . That cannot flow out of your uterus and wet your inner pants. The liquid that comes out after embryo transfer is the one which is used to wash your vaginal canal. It is just a mixture of water and disinfectant. Any wet sensation you feel down doesn't come from any dripping from your uterus.
I wish , before embryo transfer , doctor or the embryologist shows the patient the embryos ,  embryo transfer catheter , the amount of liquid in which the embryo will be kept etc , so that the patient will have some piece of mind. There are many patients who are afraid to ask questions , and suffer the entire 2WW with unnatural fears about losing their precious embryos !
All I can say is , after embryo transfer , close your eyes , imagine a seed in a fertile soil and visualize it rooting and growing , everyday. Your embryos are within you - they are safe !

Sunday, June 5, 2016

Success with diminished ovarian reserve !






 " I am very happy to see Anisha kutty's photos/videos in FB and in your blog. 
To reintroduce myself:
- I follow your blog very closely
- I have talked to you when i visited Zurich over phone
- I tried to reach you when you were in India
- I have had conversations with you through mail, (i have written it over my old mail so that you get the context)
Good news from my side: We are blessed with a girl baby - Shreya. She is 6 months old today.
I am so happy that we as new mothers are going to travel together bringing up our daughters
My IVFs were a failure. My AMH was so low. In my IVF cycle, there were only 3 follicles, out of that only two eggs were retrieved, out of that only one fertilized, that too was only 3-celled. It did not implant. I did not conceive. Doctors gave me up. I was devastated.
I wanted a baby. I was not ready to go for donor egg option. I was given an option of modified natural IVF cycle and egg-pooling. I was told that it is experimental. I still went ahead, since i had no other choice to have my own baby.
I underwent four cycles of egg-retrieval. Those 4 cycles resulted in 1 or 2 eggs. One of the cycles was a total failure. I came back empty handed. All those eggs retrieved were frozen.
After undergoing egg-retrieval cycles for an year, at the end of it there were 6 eggs for the embryologist to work upon.
With God's grace, out of that 6 eggs, 5 got fertilized, 3(eight celled) were transferred, and our Shreya was conceived from one of them. Two of the embryos(seven celled) are frozen.
It was Dr. X who was of great moral support and technical support during these tough times. She is my friend, doctor, God sent Angel all in one ".

Success stories like these are amazing. These stories teach why you shouldn't give up too soon. Not every women with poor ovarian reserve takes home a baby which is genetically related to them. This emailer is relatively young ( 28 years ! ). She had a doctor who is willing to support her and tailor an individual protocol which suited her need. Many doctors will be reluctant to do so because they don't have the time or interest to invest their energy on a single patient. They treat poor ovarian reserve patients like other patients and send them back with a suggestion of donor eggs when they couldn't retrieve good amount of eggs from their ovaries. 
The message from this story is :
If you are young , poor ovarian reserve will not be a major deterrent for having a baby which is genetically related to you. You can overcome your problem with these ingredients -  lots of patience , perseverance , a good doctor , and of course , money !
But , if you are of advanced maternal age , and produce only a couple of eggs , the chance of having success with IVF is greatly reduced. So , if you are a woman who is above 35 years of age , and who is fighting infertility with diminished ovarian reserve ,  you must have a realistic expectation of your chance of success . This helps to chose your battles wisely !

I haven't published the doctor's name who was mentioned in this email. I do not want that my blog becomes a source of advertisement. But if you are interested , please write to me : manjupadmasekar@yahoo.com. I will redirect your emails to the person who sent the above email  so that she can give you the necessary information.


Sharing your infertility journey can help others !




" Hi Manju, I have also gone through infertility. It took 4 long and heartbreaking years including 4 iuis and 4 ivf cycles. Along with the support of dear friends and hospital staff, your blog kept me.going. I had two miscarriages during these years. You won't believe it ...My second miscarriage coincided with.your loss.of.twins. When I had the second loss I stopped following your blog. You were pregnant with twins and in my state of mind it was impossible to share your joy. Months later out of.curiosity I accessed your blog.thinking you may have already.given birth to them. I was shocked.to hear about your loss. And then on the day you announced your.pregnancy on the blog I was also pregnant ...exactly the same nUMBER Of weeks and days!!! Advaith was born just three days after Anisha. I only believed that I could have a healthy baby when I read about Anisha's arrival and it gave me the confidence to approach labor and delivery. I have been tracking her.progress.since then. We seem to have some karmic connection even though you don't know me. CONGRATULATIONS ON MOTHERHOOD AND THANKS.FOR SHARING YOUR STORY. All my love and blessings for your family ".
This is a comment I received recently in one of my blogs. Sometimes , I do wonder whether I was too open about my struggles. Many of my friends have pointed out that I put myself in enormous stress by penning down my emotions. But , when I receive comments like this , I know I was not wrong , after all.   Every human in this word has a story to share  - a story which can give others enormous strength and wisdom , a story which can inspire . Sharing your story is extremely therapeutic for you and for others , too. By sharing your struggles you are making lemonade out of lemons life has thrown at you. By being vocal about your struggles , you are putting them to constructive use - your struggles are no more a mere painful experience ( a destructive force ) ! Your infertility story can assure others who are in a similar situation that they are not alone.
I am so , so thankful to people who reach out to me. It just shows how good people are. All I can say is " THANK YOU ! "

Friday, June 3, 2016

17 IVFs before success !


" I am an OB/GYN and a mother who conceived after 15 years of sterility and 17 IVFs! I came across your blog and am extremely impressed by it, the one about supplements is so well researched and documented! I wish I could just print each advice and post it in my office (like the part about not going crazy the 2 weeks after ET, my patients tend to literally stop breathing and wait..."

This email , which I received long ago made my day. All such emails and kind words from blog readers helped me a lot to fight infertility. I am forever thankful to my blog  and to my wonderful Dr ( Dr. Malpani ).

IVF patients frequently ask this question - how many IVFs should I do before I take home a baby ? Scientific evidence says , 60% of women find success within 3 full IVF cycles ( not 3 embryo transfers ) , provided , they contain good ovarian reserve. This shows how limited IVF success rates are ( or how overstated IVF success rates are ! ) ! Many women , who start their first IVF cycle , religiously search for success stories of women who got pregnant in their first IVF cycle , in order to strengthen their hope. And unfortunately ,  women who succeed in their first IVF attempt are more likely to boast their success in public ( on online infertility forums , etc ., ) . This creates an unrealistic expectation about IVF success rate in the minds of patients. That's one of the reasons why IVF patients become heart - broken after their first failed attempt and succumb to failure. One of the best advice I can give to fellow IVF patients is , please read failure stories - those stories will teach you enormous wisdom and make you mature enough to handle IVF roller coaster ride !

Monday, May 30, 2016

Globozoospermia and three precious fertile years wasted !


Question # 3
First of all congratulation on your success story. After reading your blog I though I should contact you and see if you have any insight on our history. Below is a brief history. 
2011 - IVF 22 eggs ICSI used on half (36 female, 35 male)
result: all icsi eggs failed fertilization, some non icsi resulted in polyspermic fertilization
2012 - IVF 15 eggs ICSI used on 2 (37 female, 36 male)
result: all icsi eggs failed fertilization,  2 ferts with IVF and rest polyspermic. normal ferts transferred day 3, no pregnancy.
Protocol on the above cycle:
225 follistim and 75 menapour  days 1-6 
225 follistim and 150 menapour  days 7-11 
HCG trigger on day 12
due to failed fertilization my eggs were blamed and we went on to Donor eggs.
2014 - IVF with ICSI with Donor Egg (6 Frozen eggs from Atlanta, donor has proven history) (Donor AGE 29 with proven donation history, 38 male)
result: none fertilized first day but one slow growing embryo detected the second day with 1PN and  made it to blastycyst, transferred no pregnancy.
2015 - IVF with ICSI using AOA (Artificial Oocyte Activation) -  ( age 41) 
12 Eggs 8 mature 4 fertilization. day 3 all 8 cell embryos,  0 made it to day 5.
following was my protocol.
Decapeptyle  .10            days 1-7
Menopur        300          days 3-15
Menopur        225          days 15-17
AMh: 2.6 (ng/ml)
FSH: 8.5 (iu/ml)
The 2015 cycle with AOA was done as we believed that the sperm was lacking in PLCz protein to activate the egg, this explained to us the polyspermic fertilization we have been receiving and lack of fertilization from ICSI. It seems like the AOA helped to overcome these issues. But our embryo failed to survive to blastocyst stage but were good 8 cells at day 3. do you believe this is an Egg problem or could it still involve an issue with sperm. Not sure what direction we can go from here. Thinking of using donor sperm but I am not even sure about me eggs as well. Very frustrating and disappointing that after so many cycles with still have no clear cut answer. Based on your knowledge what problems do you see in our case.
Answer
Nice to hear from you. It is really sad that they took 3 complete years to identify globozoospermia  !  Those three years were precious for your fertility and they were wasted.

I think , before , the problem was the sperms. But now, one more additional factor has come into play - your age and hence egg quality !

But the positive thing is,  you still produce decent number of eggs , and hence stand a good chance of success. Does your IVF clinic perform CCS  -  a technique which is used to identify euploid embryos ? Even though , the efficacy of CCS is still in question for women of advanced maternal age , in your case , it can throw light on the quality of your embryos. But for CCS you need embryos which grows to blastocyst stage !

Your next best option is to go to a clinic which has high success rate for women of your age. 

If you ask whether sperm is the problem, the answer is , yes , it was. But with the help of AOA ( Assisted Oocyte Activation ) , the sperm problem can be overcome. Now , you just have to repeat IVF until you find that one good embryo . It might take several attempts because of your age, or, you might find success in the next attempt, if your are lucky ! A recent study says that the aneuploidy rate can be as high as 90 % in women above 40 years of age.  This means only one out of ten embryos produced using your eggs will be genetically normal !

I wish you lots of good luck in your endeavors !

Need to read more about globozoospermia , please follow this link : http://www.drmalpani.com/knowledge-center/articles/globozoospermia

Please read the disclaimer at the top right column of this blog !

If you need to talk to me , write to me to manjupadmasekar@yahoo.com.

Friday, May 27, 2016

You will never get pregnant - a story with a happy ending !



This email I received in 2012 :
  " I just read your write-up through DR Malpani's website.I Must say you inspired me alot.I am in  the same boat as you and i feel my boat is just sinking but i still await that i might reach the shore one day and get rescued.
  Well my name is A and i went through IVF twice but both times it got cancelled as my ovaries did not stimulate with the drugs.It was a painful scar on me that i still didnt loose hope and the words i heard from the doctors was its all we could do and now leave it on nature,We cant do anything more then what we did.Those words were like a gunshot to my heart.I dont blame them they spoke the truth but i balme my husband as he says it in a worst manner.YOU CAN NEVER GET PREGNANT.That kills me everytime i hear that.
   Our Asian culture is so naive that my mother inlaw is looking for another girl for my husband as they know i wont get pregnant so yeah my scar will never heal with all the negativity around me.But one thing i thank myself that i stook up again to fight the world and i do speak the truth to all that we tried IVF but failed and i leave it on mother nature if its meant to be it shall be.If not i guess its best for me.
    The only thing that hurts me is i just adore kids since i was a kid myself,I always baby sat and loved kids till today.I graduated from med school and wished to be in Peds as my speciality,which i still dream i shall be one day.But yes one thing i can say my life has changed after the IVFs and i still have hope but not sure abt my relationship with hubby nor inlaws but i know one day i shall be a mum and i know deep down i will.I hope the same for you.I love reading your mails.Thanks for the experiences ".
And her email yesterday :
" I gave up on every treatment and was told I won't be able to concieve. I moved on with life. And after three years of stopping treatment. I had gained a lot of weight due to stress and depression. I  started the gym and excercised a lot. Everyday 2hrs and 7 days a week. My menstrual cycles stopped for three months and all tests were negative. My doctor said to cut down the work out. And I did and later on found out I was pregnant. It was a miracle. I had a healthy baby boy and a normal delivery. He is 2years old now. I can only thank God to help me and now my marriage is safe and we are finally happy. The inlaws aren't and will never be bit who cares about them. 
We are trying for a second one now but unfortunately it's not happening and my menstrual cycles have become very irregular. So it's a little stressful. But if it happens well and good, if not I can thank God for giving me the best gift in the world ".
Hopefully , stories like this , provide many of you strength to carry on.
If you need to talk to me , please write to me to msnjupadmasekar@yahoo.com

Thursday, May 26, 2016

What prevents a chromosomally normal embryo from implanting ?



The most common reason for a failed IVF is , the embryo ( s ) that are transferred to the uterus are chromosomally abnormal  ( contain wrong number of chromosomes ) ,  and this genetic defect prevents them from implantating , and/or giving rise to a healthy baby ( since the blue print for forming a baby is defective ) . With modern scientific advancements it is possible to test whether an embryo is genetically normal or not by using techniques like Comprehensive Chromosome Screening ( CCS ). So , when a chromosomally normal embryo ( an embryo which has the correct number of chromosomes )  is transferred to the uterus , patients expect to get pregnant and carry the baby to term. But , the reality is not so. 
Why does a chromosomally normal embryo fail to give rise to a healthy pregnancy ? The reasons are manifold :
1. Not all genetic testings , including CCS , are 100% accurate. They claim that the accuracy of these techniques is close to 99%.
2. Many blastocyst exhibit a phenomenon called embryonic mosaicism. During biopsy of the embryo , 5 - 10 cells from the trophoectoderm of the blastocyst ( the region which becomes future placenta ) are removed and tested for chromosomal abnormalities. Even though , the cells taken from the trophoectoderm of the embryo can have a normal chromosomal number , the inner cell mass which develops into the baby can actually carry wrong number of chromosomes. Hence , because of embryonic mosaicism , a chromosomally abnormal embryo can be labelled as chromosomally normal , and can be transferred to the uterus. Such embryos might fail to implant. Because of embryonic mosaicism there is also the danger of discarding a chromosomally normal embryo as abnormal. 
3. Damage to the embryos during biopsy can lead to failed implantation.
4. Transfer of embryo to the uterus , and depositing them at the optimal location needs a lot of skill and expertise.  When an embryo transfer was not done by a skilled doctor , the embryo might lose its chance to implant. The transferred embryo must also be retained in the optimal location. A stressful embryo transfer due cervical stenosis , or other such problems can trigger uterus contractions which can dislocate the embryo.
5.  The embryo must be transferred to the endometrium when it is optimally receptive. The " window of receptivity " of an endometrium is very short. Although , most embryo transfers are optimally timed , the high amount of hormones present during fresh IVF transfer can tamper with the normal time period when an endometrium is optimally receptive ( it can become receptive too soon ! ) .This can lead to the transfer of embryo to an endometrum which is not synchronized with the embryo's age.  This in turn can lead to failed implantation.
6. An embryo being chromosomslly normal does not guarantee that it is normal at the gene level.  For example , humans carry approximately 20 , 000 plus genes in their chromosomes.  Embryo implantation and growth  involves the complex interplay of many different genes - many of which are still not identified ! Defects in such genes can prevent an embryo from implanting. We simply do not have the technology to identify them.
6. An IVF lab's embryo culture conditions , the medium used , their embryo handling and manipulation techniques can lead to failed implantation. Hence , selecting an IVF lab with good success rate is highly beneficial.
8. Mitochondria are organelles which are present in large numbers in eggs and embryos. They are the power house of cells and perform many other critical functions. They carry their own genetic material. Research shows that defect in their genetic material can prevent implantation. Older women's eggs are more prone to mitochondrial defects. We still do not have the technology to screen them.
9. Many proteins and their metabolites interplay at the site of embryo - endometrial contact to bring on a successful implantation. Defects in those molecules , or in their molecular interaction can lead to failed implantation.

In short , transferring a chromosomally normal embryo doesn't guarantee a pregnancy. An euploid embryo of an younger woman is more likely to implant than that of an older woman ( this indicates that there are many other factors at play other than the presence of normal number of chromosomes ) . 
If you need to talk to me , please write to msnjupadmasekar@yahoo.com



Wednesday, May 25, 2016

What secondary infertility does to you ?



" Well this month also I have not conceived as I got my periods today:-) Not sure how to react. reading your blog has given me strength and I think I should  be thankful to God that he has anyway blessed me. I know there are so many women fighting Infertility bravely.
I am so blessed that when I go home I can hold my daughter close to me and I feel solace when she call me Mamma. At times I tell her call me Mamma again and again and I feel so happy. I know I am sounding absurd but I know the importance now , for which I never valued.
I really feel I am still fortunate, yes I wanted to have 2 kids and when I started I never knew this would come so long and I will  face issues.
Thanks for making so many people feel better and happy. Love to you and Anisha.  Anisha's smile is therapeutic. God bless her truly."

If you need to talk to me , please write to manjupadmasekar@yahoo.com

Monday, May 23, 2016

Endogel to clear endometriosis tissue in uterus !



Questions # 3
Hope you and your baby are fine,I have been reading your postings on IVF so encouraging,I have had three fa
iled cycles,am now preparing for the forth one,my doctor told me I have endometriosis tissues in my uterus,that has been made it impossible for my babies to implant,so I was given Endogel to have them cleared,can this increase the chances of becoming pregnant,am so depressed I surely don't know what to expect next.....               
both my tubes are blocked that's why I opted for IVF am turning 37 years this year, first cycle I had 15 eggs13 fertilized, en two were put back, my lining was 12mm, the second cycle were frozen embryo 2, en the third one was the the fresh one, I only had 4 embryos due to some problems with the last injection that helps the the eggs to mature, it was given very late after the due time, so only one develop en it was a grade A, so I have decided to change the doctor...so I did hysteroscopy with him and he found that I had some tissus in the uterus, so they had to cut them, then the following day I went in for Endogel, in the night I developed serious running stomach just for few minutes, there after I started my periods, they were so heavy for 8 days same flow, after periods I had some creamish discharge for almost  one month,en now everything has become normal and my vaginal discharge is 100% normal, now I have even started ovulating before I never used to........  I actually paid $1000 for the Endogel
Answer :
I have come across this Endo Gel query many a time now ( especially from many African women ! ) I don't understand how Endo Gel can dissolve endometriosis tissue in the uterus ! I feel so sorry for women who are taken for a ride by their IVF doctor. An IVF doctor is a person whom patients trust and handover the responsibility of making their most desired baby dream come true. I feel disgusted when such doctors use their patients' ignorance to make money. It is the utmost responsibility of every IVF patient to read and keep themselves well -informed about infertility treatments , if not , they are in danger of losing their money , health and eventually their baby dream , too.
Let me explain : Endometrium is the tissue that grows in your uterine cavity -  it is the lining of the uterus where your embryo implants. Imagine it as a bedding for your embryo. Endometriosis is a disease where your uterus lining ( endometrium ) grows in places where it is not meant to grow. For example , it can grow in your pelvic cavity , in the organs present in  pelvic cavity , and even in the brain ( very rarely ) . Endometriosis of uterus , that is , when endometrium that lines the uterine cavity grows into the muscular wall of the uterus it is called adenomyosis. Adenomyosis may or may not cause infertility.
Endo Gel is a derivative of hyaluronic acid In surgical medicine , it is used to prevent  adhesion from forming between different tissues or organs.  For example , if you are having a surgery to remove emdometriosis tissue grown in your pelvic region , there is a possibility that the surgery can itself lead to the formation of new adhesions between your pelvic organs during wound healing.  In order to prevent them from adhering to each other ( to stick to each other ) , Endo Gel is applied immediately after surgery.
Endo Gel cannot dissolve endometriosis tissue - it is used to prevent de novo adhesions from forming after abdomino - pelvic surgeries.
As per the above email , the doctor has performed hysteroscopy and done some surgical procedure on her uterus. The next day , he had applied endogel and informed her that the gel will dissolve endometriosis tissue in her uterus. Because of the rhyming between the words endometriosis and endogel , the poor patient believes that endogel will dissolve her endometriosis and all will be well soon ,  so that she can conceive. She had paid a hefty fee for the same - how sad !
This is exactly why  patients must stay well - informed about their treatment. Please stop believing all that your doctor says , blindly !  Seek second opinion ( or multiple opinions ) whenever you are asked to do costly tests , or before undergoing any invasive surgical therapy. Hysteroscopy can actually do much harm when done without any proper indication - it can even damage your uterus , permanently !
If you want to win over infertility , the first thing one had to do is to seek knowledge. Knowledge is power !

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If you need to talk to me , you can write to manjupadmasekar@yahoo.com
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