My IVF Journey Timeline !

1. IVF ( October 2008)
Antagonist protocol
AMH-3.5
One month of BCP
Started stimulation on day 2 with 112.5 iu of Gonal F
Increased upto 150 iu until day 12
Before triggering e2 was only at 626
Only 3 eggs retrieved
Only one fertilized (through IVF)
Transfer on day 3- 4 celled embryo ( After transfer 8% crinone once a day, Progynova 4mg/ day and HCG booster dose)
Negative pregnancy test


2. IVF- ICSI (December 2008)
Antagonist protocol 
NO BCP
Metformin 1500 mg
Started stimulation on day 2 with 175 iu of Gonal F
Continued with same stimulation dosage for 11 days
e2 after 4 days after stimulation 140
e2 after 7 days after stimulation 375
e2 after 10 days after stimulation 1120
9 eggs retrieved
7 mature eggs – 3 eggs used for fertilization by IVF and 4 eggs used for fertilization by ICSI
In IVFed eggs none fertilized.
In ICSIed 2 eggs fertilized
Endometrial lining > 8mm
Both fertilized eggs grade A with 4 cells on day 2
Transferred both on day 2 (After transfer 8% crinone once a day, Progynova 4mg/ day and HCG booster dose)
Positive pregnancy test- m/c at 8 weeks- no HB detected. But had scan only on 5w1d and again on 9w1d. On 5w1d scan a sac measuring 6mm with no yolk sac or foetal pole. On 9w1d there is yolk sac and foetal pole but no HB. D&C March.

3. IVF-ICSI (July 2009)
Antagonist protocol 
AMH-4.5
One month of BCP
Metformin 1500mg
Started stimulation on day 2 with 175 iu of Gonal F
First u/s 6 days after stimulation – Only one follicle on right measuring > 24mm ovary and on the left some follicles and two of them are more than 20mm.
Stimulated for 11 days (?)
Only 5 eggs retrieved and only 2 are mature and both fertilzed with ICSI
On day 2 one embryo had 2 cell and the other 6 cell- Both garde C embryos
Transferred on day 2 – Negative pregnancy test (After transfer 8% crinone once a day, Progynova 4mg/ day , no booster HCG)
Endometrial lining 12mm
Negative pregnancy test.


4. IVF-ICSI (September 2009)
Flare protocol
NO BCP
Metformin 1500 mg
Started with synarel on day 2- twice a day
Then from day 3 Pergoveris ( 150 iu Gonal F+75 iu LH)
After 3 days of stimulation e2 at 101
After 6 of stimulation e2 at 212 ( But still spotted because of synarel ???)
Due to slow growing follicles and slow rising e2 dosage of Gonal F increased to 225iu+75 LH
So after further 3 days of stimulation e2 at 828
Stimulation continued for another 3 days with 300iu of Gonal F + 75 LH
So after 12 days of stimulation at retrieval 8 eggs retrieved
7 mature 7 ICSIed and all 7 fertilized
Transferred 3 embryos with AH and with embryo glue. AH done on day 2.
On day 2 - I had one 2 celled, one 3 celled and one 4 celled embryo.
day 3 transfer- 3 embryos- 1 compacting morula, 2 at 6 celled stage. ( No grade for morula since it is much advanced for day 3 and other 2 embryos grade B)
(After transfer 8% crinone once a day, Progynova 4mg/ day , no booster HCG)
Endometrial lining at 10mm. Added Heparin.
Started bleeding after 9dp3dt. Lots of cramping and lower back pain.
Pregnancy test negative.

FET ( October 2009)
There were 4 frozen embryos (slow freezing)
3 embryos transferred
Negative pregnancy test

5. IVF- ICSI ( January 2011)
Antogonist Protocol
NO BCP
Metformin 1500mg
Baseline scan- no cysts
Started on 187,5 iu Gonal F
After 4 days e2 at 213
Gonal F increased to 225 iu
After 6 days of stimulation e2 at 375
Gonal F continued at 225 iu
After 8 days of stimulation e2 at 656
Total 11 days of stimulation
5 eggs retrieved- All 5 mature
3 eggs fertilized with ICSI
Day 4 transfer- 3 embryos ( 2 compacted morula and one 8 cell grade c)
Pregnancy test negative

All the above 5 IVF cycles are performed in Wetzlar, Germany.

6. IVF-ICSI (at Malpani Infertility Clinic, Mumbai) (November 2011)
Long Lupron Protocol ( a modified version of long lupron)

AMH-1.8
DHEA 75mg (For 8 months)
No Metformin
Mdicines used : Lupron, Menogon, Cyclogest, Progynova
300 iu Menogon
24 eggs retrieved
20 fertilized
10 usable embryos 
7 embryos frozen (5 on day 3 and 2 on day 5)
3 Grade A embryos transferred
 Pregnancy test negative.

FET (June 2012) (at Malpani Infertility Clinic, Mumbai)
Problem with the growth of endometrial lining, after several days it grew to 7mm (took almost 3 weeks to grow to this thickness) Used G-CSF to improve lining.
Transferred 2 day 6 blastocysts
Pregnancy test negative

FET (June 2013) (at Malpani Infertility Clinic, Mumbai)
Thin lining, only 6.7mm at the time of embryo transfer.
Transferred 3 grade A day 3 embryos which are frozen in 2011. (at the age of 33)
Pregnancy test positive :)
First ultrasound showed twins :)
Completed 13 weeks successfully as of 11.9.2013, and so far so good !
Please keep me in your prayers !

Lost babies due to incompetent cervix at 20 weeks.

FET (March 2014) (at Malpani Infertility Clinic, Mumbai)
It was a surrogacy cycle.
Transferred two blastocysts to surrogate (these blastocysts were grown from day 3 embryos which are frozen and thawed during previous FET and frozen again on day 5)
Surrogate had a positive pregnancy test.
Week 6 ultrasound showed only a gestational sac measuring only 4 weeks old.
Surrogate miscarried !

7. IVF-ICSI (at Malpani Infertility Clinic, Mumbai) (May 2014)
Long Lupron Protocol ( a modified version of long lupron)

AMH-1.6
Vitamin D 12ng/ml
No Metformin
No DHEA
Mdicines used : Lupron, Menogon, Uterogest, Progynova
300 iu Menogon
21 eggs retrieved
19 fertilized
7 Blastocysts
One transferred to my uterus
6 frozen
Positive pregnancy test !

Our daughter Anisha arrived !

Anisha born on January 13th 2015

How do my embryos look?

 

Source: The Virtual Human Embryo.

Your embryos are very minute; it is impossible to see these tiny balls of cells using your naked eye. You need a microscope to view them. Your embryo divides at regular intervals after fertilization and will have a different appearance under the microscope each passing day. There is a set of rules which tell you how your embryos should look for their age ( for example, a day 4 embryo looks entirely different from a day 2 embryo because of the rapid cell division they are undergoing). Knowledge about how they look during the different development stages will help you to know how competent your clinics IVF lab is. If you want to see how embryos look , check out: http://www.drmalpani.com/embryos2.htm and http://www.drmalpani.com/embryos.htm

A letter to my embryos - with LOVE !

Dear Blasties, (I wish I could call you children!)

How are you both? Hope you are feeling fine inside my uterus! Is it warm and comfortable enough? Does my activity disturb you in anyway?  I know that the bedding I have provided you is not so great. Is it difficult to snuggle in because of that? Have you apposed to the endometrium, had a successful cross-talk and started to invade? Did the endometrium welcome you with appropriate adhesion molecules , cytokines, growth factors, proteinases and neoangiogenesis factors? If it doesn’t, please do not give up. Coax it to produce all that you need for successful attachment. You can do it!  When I saw you both on Friday, after the thaw (after defreezing) you both looked perfect - as if you have woken up from a nice sleep (of course, it is a sleep but cold sleep!). You didn’t even show the slightest strain of the vitrification process. I even felt that you both smiled :) I thought how competent you both are! Even the embryologist commented how good you both look! So never ever give up the struggle!

I know it will be hard inside. The place you both were formed (in the petri dish in the IVF lab) is so different from the environment within my body . For 6 long days you spent your life in an artificial set-up, and then you both were kept metabolically silenced for 7 long months! I do understand it will be scary inside the uterus. You meet so many different molecules and cells you haven’t met before.  But, remember little ones, this is the place you belong to! This is where you can be happy. This is where your real developmental potential is tested.  This is the place which gives you scope for further development. Of course, life in an IVF lab incubator is easy and cozy. There you are fed at appropriate time, supplied with proper nutrients and the embryologist must have pampered you a lot! But, only obstacles and struggle make you stronger , and not the pampering. Without struggle there is no progress in life (both in yours and in fully developed organisms)! That is the norm in this world. This is the first lesson you both have to learn. If you want to come out with flying colours, fight against the obstacles. When you overcome each and every obstacle inside the uterus , you are one step closer to becoming a full-fledged baby. 

Are you aware that you became blastocysts from the supernumerary embryos which they wanted to wait and watch in vitro before they could freeze you ? You passed that difficult test and that is why you are inside my uterus today. The other embryos which were with you failed to develop and were discarded. The difference between you and all the other discarded ones are- they gave up the fight, they gave up the struggle to survive!  So, whatever way I look at you both- YOU ARE SPECIAL! You definitely have the potential to develop into beautiful babies! Please do fight hard to come into this world. I will not promise you that life on earth is as easy as pie, but for sure it is very beautiful! You have very good people to protect you and take care of you.

There are lots of people longing to see you as babies. The most important person is your dad. I am gifted to share my life’s journey with him. He is a very calm and composed person. Normally, he doesn’t show any overt emotions in his face or speech (be it happiness or sadness!). When we both saw you through the IVF lab microscope , I could not understand what kind of emotions were playing in his mind. He never talks about it. He didn’t allow me to enter the kitchen until now. Yesterday, I tried to cajole him so that I could gain back my territory (I cook super duper good food!), but he refused my plea and went on to  cook some beans with tomato. Sadly, the dish was horrible, but I ate it quietly without any reaction. When he tasted it, he also ate quietly and after few minutes he said- sorry Manju! :) I could not control my smile but to tell the truth, because of the love he mixed with the food it was very palatable ! Now-a-days, he gives me a foot massage. It is a soothing gentle touch, and I love his hands rubbing the sole of my foot. This is one of the most relaxing moments for me. He knows that very well but he never did it on his own -  I would have to plead for a foot massage every time. But, now-a-days, even if I say no, he takes my feet , keeps it on his lap and rubs it gently. Do you understand why? It is  for you both! He wants you both to snuggle in, attach and become his children. I carry you both in my uterus but he carries you both  in his heart. Are you listening? Does it feel good to hear about him? Please young ones , please attach to me and grow into healthy babies! There are also so many other people who are praying for you and waiting for you too – if I have to tell you about everyone , I will need several more pages!

When I talked about prayer, I remember on the embryo transfer day, Dr.Malpani asked me,  ‘Manju, which God are you praying to?’ To tell the truth I prayed to nobody and I do not want to pray to anybody. I told him the same. I asked him whether he believes in God. He said yes and I asked him why ? He said ‘I do not have a rational explanation and I also think it is ok for the heart and the head not to agree with each other :) When he transferred you both inside my uterus, he again said ‘pray’! But I didn’t! I was so adamant! I am not angry with God and neither am I blaming God for my situation. I simply do not believe that praying will help. I just enjoyed the moment you both went inside me and relaxed. But, little ones, when I think of it now , I wonder whether I should have said a short prayer to some God? What do you both think? Will it have helped you? Have I spoiled your chances of becoming a baby? But, still I believe, if I pray or not,  nothing is going to change. Prayer can bring about a sense of relaxation but on that day I am surrounded by good people and I am actually very happy and relaxed. Even if you both become my babies I am not going to teach you about the concept of God. Being good and being a theist has no connection. I will teach you to be good human beings and you have to decide whether you need God or not when you grow-up! I think, in this way I can safe-guard you from the unnecessary guilty feelings most humans suffer in the name of God.

Today is the 5^th day of your stay within me. I sit here wondering what is going on with you both. I wish you could send me some signals so that I could feel your presence all the time. Carrying you both in my uterus is not difficult (even those 9 months won’t be difficult!) but carrying you both in my mind is driving me crazy! I wish the test date never comes! It feels so good to be pregnant , at least in my heart . I have lots to say. But all that can wait. The main message is NEVER EVER GIVE UP! My love to you both! Fight as much as you can. Life is a beautiful struggle and struggle is what makes you HUMAN and keeps you human!

Waiting with lots of love,

Mom

Embryo Transfer

ET was scheduled to 4 PM today. It’s very hard to explain how I feel. My mom left to my native place yesterday. I feel heartbroken without her presence. DH had a hard time controlling my crying spells. I am in the grip of all sorts of blues now. I am excited and at the same time very scared. The result of all the toil will be out in two weeks. Why can’t someone make me to go into coma for two weeks? When I see my DH I feel very sorry for him. I am solely responsible for all the troubles he endures now. All this uncertainty, tension,travelling…….everything is because of me. I am very lucky to have him in my life. If he is not this understanding what would have happened to me? I feel I have a lot to vent. I am depressed probably because of progesterone. I wish I could go back to work so that I can distract myself. I am also dreading thinking about today and tomorrow. I do not believe in rest after ET but my DH will be very upset if I roam around. I have to lie down or sit all the time without doing anything and that is a big torture!

Inspite of all these thoughts, I feel very happy when I see my blasties. I hope they will wake up from their cold sleep happily without loosing any cells, snuggle within me tight and speak with my not so great endometrium for establishing connections. Let the cross-talk between my blasties and endometrium be successful! If someone reads this post send me some positive vibes. I will be very grateful. I am uploading my blastocyst pictures. Don’t they look beautiful? One day we saw a very cute little girl and I said to my DH ‘our child will look as beautiful as this littleone’. He said, ofcourse yes! Our blastocyts look very beautiful so definitely our child will look beautiful too :) These kind of small, sweet nothing talks, keeps us going!