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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.
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 :

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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

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

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

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 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 !

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

If you need to talk to me , you can write to

Sunday, May 22, 2016

Is there a vitamin alternative to laser hatching of Zona pellucida ?

Question # 2
i'm doing an IUI in two days & wanted to know if there is an oral supplement or vitamin or food that will help in naturally thinning (or making less rigid) the outer zona pellucida.  i'm 48 yrs old & want to combat the more rigid ZP that older women have...
i had one IVF last year with assisted hatching (5 eggs retrieved... 4 were viable.... 3 were fertilized & those 3 embryos were implanted) ...but it failed

because i only have two mature follicles this time, my doctor wants to do an IUI, so i was hoping that i could take an oral supplement or vitamin or food that would thin or soften the outer layer of the zona pellucida (because it's probably more rigid since i'm 48 years old) since laser-hatching is not an option.
i don't have children because i'm the youngest of 9 children so my parents were both elderly when i was born & i had to take care of them after they had strokes (they both had high blood pressure) & so i delayed having children.  my boyfriend & i have tried to conceive over the past two years but without success.  hopefully this upcoming IUI will be successful.
Answer : 
Unfortunately , nothing can be done to reverse the aging of your eggs - you cannot thin it's outer covering with any vitamins.
I wish you lots of good luck. That's so nice of you to put your parents' needs first and supporting them. I love your optimism , and may your wish get fulfilled soon.
Although , I answered carefully in a way which doesn't hurt her hope and optimism , I felt guilty for not telling her the truth.
The chance of her getting pregnant and having a healthy baby with her own eggs is almost close to zero. I am sure she is aware of the scientific statistics , yet , she is trying her level best to fight the odds. Women like her amaze me. I wonder what I would have done if I were in her shoes !  What's the right move for a woman in her situation ? Should they move on to donor eggs , or try conceiving with their own eggs - until they produce eggs and embryos ?
According to scientific data , women after the age of 42 , have only 5 % chance ( perhaps , even less ! ) of taking home a healthy baby. After 45 , the chance of having a healthy baby with their own eggs is almost nil. Even though they produce eggs ,  the chance that all their eggs are genetically abnormal is extremely high.
Reference :
But , what if ,  a woman after 45 years old luckily finds that one good embryo which will become her much desired baby ? Such happenings are not unheard of . Please read this article :
This is exactly why  you must trust your gut feeling when deciding whether to continue IVF with your own eggs or to call it quits. Apart from considering financial , physical and emotional discomforts , please listen to your gut feeling too and decide for yourself.
But , if someone asks my opinion , as a biologist , as a person who values scientific evidence , I would say it is insane to continue with your own eggs if you are above 45 years. But , always remember , that there are a lucky few who have beat all the odds ! If your gut feeling says you could be one too , give IVF with your own eggs a few tries.

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

If you need to talk to me , write to me to

Friday, May 20, 2016

Can a high white blood cell count prevent embryo implantation ?

Question # 1
Would a high white blood count of 13500 stop implantation.  No symptoms of being sick however my wbc has been high for months.  I have ulcerative colitis but take humira and have no current symptoms.  I have three failed ivf attempts and one failed donor egg cycle all bfn
Answer :
My very confident answer is 'No'. 
Uterus lining , where the embryo implants ( decidua ) , is an immunologically privileged site. It means , the immune system doesn't do the actual function what it is intended for , in those sites. Even though ,  the trophoblast cells and the placenta carry antigens ( foreign molecules ) which are disparate to mother's immune system they are not attacked by the mother's immune cells. Since decidua is an immunologically privileged site , the immune system's usual reaction ( to attack foreign antigens ) is turned off ( by the secretions of the embryo ) and hence the immune cells doesn't hurt the embryo. Even in healthy pregnancies , the WBC count increases in your circulatory system. In other words , pregnancy can lead to an increased WBC in blood without any negative consequences to the developing fetus.

The success rate of an IVF cycle is not 100% , even with donor embryos. Sixty percent of women who are within 35 years of age , and who have good ovarian reserve  get pregnant within 3 IVF cycles ( not within 3 IVF transfers ! ) It is very natural to think that something is wrong with your body ( especially , the uterus ) when an IVF cycle fails. But the truth is , in 99% of the cases nothing is wrong . Not every embryo have the potential to implant and give rise to a healthy baby ( because of genetic defects in the embryo ) . We are still faraway from having a foolproof ART technology which could pin point which embryo will become a healthy baby. 
You just have to repeat your IVF cycle with donor embryos until you find success. Make sure that you are with a good IVF clinic which has high success rate.
Good luck !
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