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.
Showing posts with label Embryo Transfer. Show all posts
Showing posts with label Embryo Transfer. Show all posts

Friday, September 26, 2014

Embryo Transfer (7th IVF cycle)



Transferred embryo (Grade 2AA)
                                   


Embryo transfer to Rita 

Embryo transfer TO MANJU!


Let me explain. When I told Dr. Malpani that I will do one more ovarian stimulation cycle he said, “Manju, I suggest that you transfer one blastocyst to your uterus". He also said, “If that doesn't work, we will transfer the supernumerary embryos, we freeze, to Rita". Until that day nobody was able to convince me for having an embryo transfer again. I was adamant that I cannot go through another pregnancy. But, when my Dr said so, I didn't have any second thoughts. He is my Dr and if he says so, there must be a valid reason behind it. We all have a person in our life whom we admire and respect a lot, whom we look upon as our inspiration. He is one such person for me and I immediately agreed to what he suggested. But, I was not as optimistic as Dr. Malpani was. I thought, first let the stimulation start, let my ovaries respond to the drugs; let me produce eggs and embryos! After seeing my AMH value I became even more pessimistic. I was not even sure whether I will have embryos which will grow to blastocyst stage and whether we will have blastocysts to freeze. If I am left with less than 3 blastocysts, there is no point of transferring them to me. I was very confused. I thought, let me decide whether to transfer the embryo to my uterus or not after the day 5 fertilization report. As you all know now that I had 7 blastocysts at the end, we decided that I will have one (two?) transferred to my uterus. The happiest person about my decision was of course my husband. His positive spirit has always amazed me. His only complaint was that, I didn't budge to his words and when Dr said so I listened to him. But he was like, “atleast you listen to someone’s words in your life!” :)

Dr. Anjali asked me during one of my scans, "What have you decided regarding embryo transfer, how many embryos are you planning to transfer?" I had no answer then, I told her that I was very confused. I said, "Ma'm, sometimes I think I want to transfer two, sometimes one and sometimes nothing at all". This is how my mind was until the very last moment.

The day of embryo transfer came. I went to the clinic. My mind was unable to decide between how many blastocyst to transfer - one or two? I am 36 years old. For my age, chance of having aneuploidy in the resultant blastocyst is more than 50%. If it is so, 3 (minimum) of my 7 blastocysts might have chromosomal abnormality. If that is the case, isn't it wise to transfer two instead of one? On the other hand, I was scared to death of another twin pregnancy. After going through so much, I couldn't understand how my heart was greedy to even think of transferring more than one? Human mind is strange, it forgets pain so quickly! I thought, Dr. Sai will be there, Dr will be there, I will ask them both before coming to a conclusion.

In the clinic, we both entered our allotted room; I wore that wonderful hospital gown and waited eagerly for my turn :). I was also very eager to meet Dr. Malpani. I had met him only for 5 seconds during my entire stay there. I find embryo transfer stress free when he performs it. He keeps on talking something funnily and I forget that I am laying there in the most uncomfortable position, allowing people to poke and prod my private parts. If I am not comfortable during such procedures, I could feel my vaginal muscles tightening, my legs shivering uncontrollably. Sometimes because of getting so tensed, I get cramps in my leg muscles too; if that happens the whole ET episode could become very painful and scary. 

First, we were lead to the embryology lab. Dr. Sai was waiting for us. He showed us our embryos. He also showed the one which will be transferred to me. He said, “this is ahead of other embryos in its growth, so we decided to transfer this to you". I slowly asked him, “Dr. Sai, can I transfer two embryos, will it give me a better chance of success rather than transferring one?" He couldn't give me a conclusive answer. Who will suggest me something after knowing my history of twin loss? I said him, "Ok, I will ask Dr. Malpani, is he in his room? Should I meet him there or can I ask him when he comes for embryo transfer". He said, ask him when he comes to the embryo transfer room. So, I entered the ET room and saw Sister Mary and Vinayak (he works as an assistant). Both are very nice people. On seeing them I felt much comfortable. I just sat there on the ET table and started chatting while they were getting ready with the necessary items for embryo transfer. Vinayak asked, "can I call ma'm" and I looked at him shockingly!

I asked Vinayak, “Isn't Dr around?". He said, I don't know but ma'm said she will come to do the transfer. I was about to cry, my face was becoming grim. I told Vinayak, “will you please look whether Dr is in his room, if he is not going to do the transfer, I will not undergo this embryo transfer at all”. I know it was not very nice on my part. Vinayak looked at me as if his eyes would pop out. I actually ordered him, “go and look whether Dr is in his room", my intention was not to order, but, then, that was how I could react. He left the room. Sister Mary was listening to all this silently and she spoke. “Manju, ma'm will be upset if she hears this. She does embryo transfers very well. Do you know that women come from many different places in order to have embryo transfer done by her? She does embryo transfers equally good" On hearing this I felt guilty. True, how will ma'm feel if she hears what I said. How stupid I was! But I couldn't accept that Dr will not do the embryo transfer. I thought, “he didn't even care for me the least”. I wondered whether he even remembered that I have my embryo transfer on that day! I brought with me my children's foot prints (they gave them to me in the clinic after their birth) to show to him, I wanted him to hold it for some time, he only transferred them to my uterus and above all he is my Dr whom I shared my happiness and pain during my twin pregnancy. He was patient and kind enough to give me a shoulder to cry on during my very difficult times. It was hard to accept that he will not do my embryo transfer this time. It was very hard to accept the fact that my last chance for meeting him was no more viable. He didn't even wish me good luck! I remembered a patient e-mail where she asked whether Dr. Malpani will treat patients like me who writes blog like a VIP, I thought sarcastically, "yea, he does!" Vinayak came back. He said, " Dr is not there, only ma'm is there."

Dr. Anjali came. I always say that she has lucky hands. I think that expression is very unfair, and it somehow underplays her talents. She is the most talented person around. Several years of experience and her dedication has sharpened her skills a lot. Since Dr. Malpani is net savvy people know him better than Dr. Anjali, but, she is the best in the clinic :) The first question I asked her, as soon as she entered the room was "Ma'm, where is Dr?". She said, "He is busy nowadays, he went somewhere out". From that moment onwards till the embryo transfer all I did was to cry. Not just tears I was sobbing!

Dr. Anjali asked me, "Manju, how many embryos do you want to transfer?" I asked her, " how many should I transfer, can I transfer two?" She was not able to suggest me something too. She said, “you must decide". I was baffled. Lying down with legs on the stirrup and trying to think logically was not an easy task. I looked around and said, "I will ask my husband, where is he?" Normally, when Dr. Malpani transfers the embryos, Rajender will be with me. I wondered why he is still not there. Dr. Anjali told me “I don't want husbands inside the embryo transfer room". Even at that moment I actually appreciated her. I always felt that Rajender was more tensed than I was during embryo transfers. Instead of him trying to keep me calm, I have to hold his hand tightly to give him some assurance that all will be fine. Even after coming out of the embryo transfer room, he will be replaying several times in his mind whether all went well. He would say, “I saw some blood in the catheter after transfer, is that OK. Doctor was taking long time, he was moving something here and there, and would he have done it correctly?” His questions and doubts are enough to send me to a panic mode destroying the joy and peace of having a little embryo inside. So, Rajender was not available too to get an answer for the most important question - should I transfer one or two embryos? My mind was racing, I had only few minutes to decide, I was angry with Dr. How to decide, I had no clue! And, then an idea flashed inside me.

Vinayak, was near my eyes reach. Sister Mary and Dr. Anjali were preparing my nether region for transfer. I called Vinayak. He looked at me with little fear, “what is this stupid woman going to order me now was the question in his eyes” :) He was tensed. I showed him two of my fingers and said (ordered!) touch one of the two. He was totally clueless. He blinked for a moment and touched both my fingers. I really went mad for a moment, that's my last effort and he is trying to spoil that too. I said, "Vinayak, touch only one". People in that room were looking at that drama. He reluctantly touched one of my fingers. I calmed down. I looked at Dr. Anjali and said very confidently, "ma'm please ask Dr. Sai to bring only ONE embryo".

Dr. Anjali proceeded to transfer the embryo. She realized that I was crying. She asked me several times why I was crying. She was saying, “See, at one point we were wondering how many embryos you might get; now you have many. I thought you will be so happy and smiling today, why are you crying?" I gave no answer; all I did was to cry dutifully. Dr. Anjali asked me to breathe like the way when we do pranayama. She said, “I must see your stomach moving up and down”. All I did was to sob. She asked, "aren't you happy Manju?" I couldn't answer. She asked this for few times until Sister Mary interfered nervously. She said, “Oh, she is happy, heyna Manju”, she asked. I realized I am behaving stupidly. I said, "yes ma'm, I am happy". Dr. Anjali before transferring the embryo asked me to visualize it. I could see that she was saying a little prayer when she pressed the piston of the embryo transfer catheter. The transfer went on smoothly. I didn't feel any pain or I was not in a mood to feel what was going down there. She did it very carefully and with so much ease. After the transfer I thanked her amidst tears. I could see a very frustrated look in Dr. Anjali's face (due to all my tears!). She said, "I have to leave now, I will meet your husband and then leave"

After Dr. Anjali left, Sister Mary was telling me, “during transfer you were crying, because of all your sobbing I could see the cervix moving up and down". I just gave a blank expression. She said again "do not worry ma'm did the transfer very well". I was still on the crying mode. Vinayak on seeing this was trying to console me. He said, "There was a patient, her name is Manju too. She now has twins after many failures. This time all will go well for you" This further increased my sobbing. He was near my head. He kept his palm on my forehead and said, "Don’t cry Manju". That was such a compassionate gesture. I felt instantly better. I told him with smile on my lips and tears on my eyes, “if I do not get pregnant, for sure I will come and kill you, you are the one who said that I must transfer only one embryo".

Ten minutes I was there in the transfer room. Sister Mary and Vinayak made me feel so comfortable with all their pep talks. Sister Mary never fails to ask me a question whenever we meet, "your husband seems to be a very nice person, isn't he?" :) Previous time she even said, " when I fist looked at you, I thought you were proud but after talking to you I understood that you were not like that" :) Thank God! Mary Sister goes on talking and talking, she talks in Hindi, I reply in English, language doesn’t really matter!

I was allowed to go to my room after 10 minutes. Rajender was eagerly waiting for me. If he sees my tears he will panic, so I wore a smile on my lips. I told him that everything went on well and lay down. I said that ma'm did the transfer and that is why he was not allowed in the embryo transfer room. Before telling him that Dr was not there, tears once again appeared. He said, "please do not start again Manju, atleast not now". He looked at me for some time and said, "who knows I am not there in the transfer room and that might be your lucky charm". I looked at him angrily, didn't want to respond. I just closed my eyes. I thought, "Where will this decision of mine take me to? Why can't I have a crystal ball to predict my future?"

After half-an-hour I was ready to go. Rajender wanted me to rest for some more time but I wanted to leave. I said good bye to everyone. When I was about to leave, Shonali told me, “Manju, you should never come here again". I was very thankful for those words. I knew she meant well. With a heavy heart I came out, I thought, "I will never ever talk to Dr again, and if this embryo doesn't implant then I will see" :(

Where did my decision take me to? Will it lead me to happiness and bliss or to sadness and grief once again? Keep reading!

Tuesday, July 22, 2014

Embryo transfer to Rita and the plight of surrogates in India



The day of embryo transfer came. My two frozen-refrozen embies were thawed.  I was not a bit nervous about the thawing process. I know Dr.Sai is competent enough to do it in a good way. I was just waiting for the photos of the embryos.  Actually, I felt a lot more relaxed than if I have to accept those little embies in my uterus. In other words, nothing appeared real. We were in Tirupathi on the day of ET, praying to Lord Venkateswara ( ridiculous right, you outsource your duty to someone and pray to God ;). I was wondering about Rita! How will she be feeling? Does she really know what it means by embryo transfer? I mailed Dr. Malpani requesting him to  show her the embryos. What will she think seeing those minute blasts? I had no way of talking to her. I don’t know to speak Hindi, Rajender could speak (this is a very big disadvantage!).  Inspite of Dr. Malpani’s insistence that I must meet Rita, I was very reluctant to do so. At those times my thinking was like this: I must never get involved in any way in my surrogate’s pregnancy. I shouldn’t develop a bond with the baby or the surrogate. Once upon a time I even told Dr, I don’t even want to see the ultrasound photos. I thought naively, I will see my surrogate when I have my baby in hand. The pain I have gone through and the pain I saw in Rajender when we lost our babies wanted me so badly to protect myself and my husband against any further pain brought about by any untoward happening. My thinking is - if we are in no way involved in this pregnancy (other than giving our gametes) our pain will be less if something unfortunate happens!  I didn’t realize at that time that my thoughts were too childish and it can never be like that in reality.

Dr. Sai promptly sent me the photos of my embryos after the transfer. They looked perfect; I would say Dr. Sai managed to thaw them perfectly, close to 100%. Dr. Malpani sent me a mail saying that everything went well. I entered into a 2ww which is completely new to me. I was so relieved that I will not have any restriction in my activities from my loved ones (actually in every restriction they put for me I feel their insecurity and pain, it is very difficult to face it); I was relieved that I don’t have to obsess all the time about my uterus area; I was extremely relieved that I don’t have to perform that evil urine pregnancy test at the end of 2ww and nervously wait for a tiny pink line which will decide our future. I was also so relieved that I am in no way involved in the outcome of this FET cycle (although this thought is a kind of delusion) - may it be a positive or negative! What a pleasant 2ww! I was wondering what kind of instructions were given to Rita after embryo transfer. I wanted Rita to go on with her daily life and not lying down even for a day after the transfer.  I hope she didn’t!

During the 2ww, I thought more about Rita than my embies. What it means for her to carry my baby? How will she feel when the pregnancy test comes back positive? Being a first time surrogate, will she be happy or scared if the test comes back positive? I thought, perhaps only when she gets a positive pregnancy test, she will start to realize the real impact of the job that she will be doing for me. I must admit that Rita will get only a meager 2 lakh rupees (less than 4000 dollars!) for the tough and altruistic job she will be doing for us.  But I and Rajender have always thought, when she gives us our baby, her children’s education will be our responsibility (she has two lovely children-a boy and a girl). Rita will be a member of our family, she will be there with us during all the important happenings in our family and we will be there for her through thick and thin (if she wants it that way!) I wanted her to be one among us and my child will grow up knowing that he/she has two mom’s – the one who carried in her womb and the one who unfortunately couldn’t carry him/her in her uterus but who will always carry them in her heart ! After all Rita is doing something for me which my sister wouldn’t or couldn’t do. Treating her the right way is the best compensation I could give her for what she will be doing for us. Loving her and not using her is the way to go!

Surrogay in India is 10 times cheaper than in USA. If an US surrogate receives 40,000 dollars for her altruistic act, Indian surrogate gets only 4000-8000 dollars! This has turned India into a surrogacy hub. This is what attracts lots of foreign couples towards India for reproductive tourism. Such reproductive tourism benefits India as it earns lots of foreign exchange; it benefits doctors as they do see a good amount of profit; it benefits the tourists as they have a chance to get the baby they yearn for in just 1/10th of the price when compared to surrogacy in their own country; but does it benefit the surrogate? I would say yes, that is why they are ready to undergo the whole process. In a poor surrogate’s point of view 2 lakhs is a big money. It helps to alleviate their poverty at least a bit.  Of course those few thousand dollars will not be enough to buy even a piece of land or a flat. It will not be enough to give their children the best education possible. Maximum they can do with that money is to live well for a year or pay their children’s school fees for two years (for a decent education)! Or they could pay the debt they have got from someone at a huge interest which is handicapping their normal life. This is all they could do! On the other hand, a rich person in Mumbai will easily spend more than 2 lakhs in a night for a party! If it is so, then is the compensation an Indian surrogate gets is unfair? Is it financial exploitation of poor women? I would say, yes and no. If surrogates are able to do some other job which could give them this amount of money, many wouldn’t prefer to carry someone’s baby due to the social stigma involved in it, especially in a society like India. Just because they have no source to earn that little money, is it OK to pay just 2 lakhs - 4 lakhs for Indian surrogates? I don’t know what others think about this but for me it does appear unfair and I think instead of discussing what is wrong, who is wrong and getting on with my own life, it is wise to do what is just in my eyes to my surrogate! Will I be able to keep my word?! :)

Other then the meager compensation an Indian surrogate gets, there is one more danger Indian surrogates are always exposed to: lack of freedom of choice! Indian surrogates are not highly educated women. Many are illiterate and even if they know to read and write, it doesn’t mean they could understand the medical terms or medical details that are shared with them.  Many lack basic medical knowledge; like many of us, they suffer from health illiteracy too. Many find it difficult to grasp the medical information provided to them and make use of it aptly. This makes them highly vulnerable to exploitation in many ways.  For example, consider this situation: there comes a couple to an IVF doctor with a demand that they need twins via surrogacy. They promise to offer him more money for that. Remember, doctors work for the commissioning parents as they are the one who is paying him. So naturally many doctor’s aim will be to take into consideration the best interest of the commissioning parents. In order to achieve a twin pregnancy or in order to achieve a pregnancy, the doctor transfers multiple embryos to the surrogate. The decision how many embryos to transfer to surrogate’s uterus is not left to Indian surrogate’s hand. Only the doctor and the commissioning parents decide that, but the risk of multiple pregnancy has to be borne by the surrogate and her body! There is no one for an Indian surrogate who will act on her best interest, someone who could talk on behalf of her and help her to take decisions which benefit her the most. I read in a blog where the prospective parent wants her surrogate to take a particular vitamin. She writes, 'I am not sure whether my surrogate is taking what I give her. So I asked her to take the vitamin in front of my eyes'! This might appear as a trivial issue but this clearly shows how helpless and vulnerable Indian surrogates are! If it is in USA, no surrogate will heed to your orders. If they think that particular vitamin is not going to do any good or if they find it uncomfortable to take it, they can politely refuse your request. They have the freedom to choose! Another example: a surrogate’s early first trimester TSH level is 2.63. The biological parent reads in a scientific journal that the TSH must be within 2.5 during the first trimester and that gives the baby the best possible environment to grow. She gets very nervous and asks the IVF doctor to put her surrogate on thyroxine therapy. A TSH of 2.62 will not harm the baby or hinder its development in any way. As the pregnancy progresses the surrogate’s body will start producing more thyroxine to meet the growing needs.  There is no rationale to give the surrogate thyroxine therapy as it is a hormone which in excess can create lots of problem for the surrogate as well as the baby. But the commissioning parent is adamant that the surrogate’s TSH level must be corrected. Obviously most doctors who work on the best interest of their patient will put the surrogate on thyroxine therapy in order to satisfy his patient. An Indian surrogate will obviously not know what thyroxine is and what effects it will have on her body! If I could give one more example, a surrogate is in her 37th week of pregnancy, the commissioning parent want the baby to be removed from the surrogate via c-section as she was paranoid for many different reasons about vaginal delivey’s effect on her baby. Or, one of the commissioning parents has his/her birthday on a particular date and they want their baby to be born on that particular date. Or, the commissioning parent’s family believes that if the baby comes into the world on a particular day and in a particular time (auspicious day and time fixed by the astrologer!), it will do the family good (yes such people still exist!). The commissioning parent demands a c-section on a particular day. They ask the surrogate whether she would like to have a c-section and the surrogate was too tired to carry the pregnancy for many different reasons (she is eager to get back to her family and children instead of lying in the hospital for 3 more weeks). She says that she will agree to c-section and she desires that too! It is a well-known scientific fact that c-section posses additional risks to the mother. Should the surrogate’s wish be considered and a c-section ordered? Is she wise enough to take her own medical decision by weighing the pros and cons? I hope these examples will make you understand how easily an Indian surrogate could be exploited. I wish every Indian surrogate has a patient advocate with her who works on her best interests! 

There is another view about Indian surrogates too. An Indian surrogate is poor and illiterate. She will do anything for money. Since she works as a surrogate in want of money she doesn’t deserve to be treated well. She has no moral values whatsoever. If you give her more space, she will demand from you more money (yeah, she will build a palace by looting you!). If you get increased vaginal discharge it is overgrowth of your vaginal flora, but if your surrogate gets increased vaginal discharge, it is STD! And even more, there are people who shout at their surrogate instead of thanking her when she was lying in pain after the c-section!  No more a poor woman, who is risking her health and life to carry your baby, for the beggarly compensation you provide could be insulted! Actually, the reality is, Indian surrogates are highly desired because they live in a family setting, don’t use intoxicants, they are humane, friendly and humble than women elsewhere.

Please remember, your relationship with your surrogate is a two way street. Loving your surrogate instead of using her as a baby-making machine will makes a lot of difference in the way she cares for your baby! 

So what happened at the end of 2ww? Did Rita conceive?

Sunday, July 14, 2013

The home pregnancy test showed two lines !


Yes, it is a positive. I saw a positive hpt almost 4 years back, in 2009 January. If that embie had managed to become my baby, my child would have been three and a half years by now. I need to remember that little embie which gave me the strength to hold on to hope and keep trying. I am feeling so calm and serene. No overt emotions are there. After expecting this for a long time, I feel surprisingly numb. I am grateful that I had a positive. I know from now on it is a long journey and I wish I get the strength to face whatever comes my way. Surprisingly, I am not afraid of the future.

I take this opportunity to thank my Dr. I am a very difficult patient to deal with - both scientifically and emotionally. He was always kind and compassionate. He never made me feel that I am stupid or irrational. His team is as wonderful as he is. If you are wondering about the photo above - the colourful Vinayaka is given by Dr. Sai, the embryologist. As soon as I got into the room, to get ready for embryo transfer, he sent this for me. He made me cry but from that time onwards I felt so happy and confident. Thank you Dr. Sai, your good luck charm worked ! The little Vinayaka is my DH's gift. My DH is happy and calm as usual. My mom is excited and I told her that she has to be calm and keep on praying. I believe that her prayers are answered. I want to thank Mr. Ali, Sister Mary and Mr.Vinayak who work in Dr.Malpani's clinic. They said after the transfer - there is a Muslim, Christian and Hindu praying for me (Isn't that sweet ?) . Dr said he will pray for me (Thank you Dr !). I thank Dr. Anjali for being so kind - thank you mam !

I love all my blog readers and I will forever be grateful for all the love, support and prayers I received. Everyone are special in their own way. Ashu, is a medical student who reads my blog and leaves kind comments all the time. I am always very happy that I have a reader like him (he doesn't have anything to do with infertility yet took the pain to read my posts !) I am also thankful to everyone who shared their little one's pictures, conceived via IVF, which gave me so much happiness and hope. Pankaj thank you so much ! Caro, Kavitha, Anjani, Fawzia, Rita, Le, Mamtha, Sherin, Radhika, Ads, San, Nidhi, Mary, Jay, Nushi, Aakanksha.... and lot more of my friends who stood beside me; who shared their happiness and fears; who are kind enough to give me encouraging words when I needed the most eventhough I have never met 99.9 % of them. Many I knew only through my blog....

Another most important person I need to thank  is my boss. He is a very kind human being and made me understand how important is my job during my tough times. He was always pleasant when I asked for holidays for my treatment. I can't thank my friends enough for being so kind, understanding and supportive. Everyone did their best to make us feel good. When I came from India, my friend Priya held my hand and never left it until I wanted to leave. The warmth and compassion in it is so heart-warming. I know that touch helped my embies.This journey has just started, and I know the uncertainty inherent in it. I am holding on to hope and I am accepting today's blessing with utmost humility. My greatest joy is that it will give hope to so many and that is the sole intention for writing this blog.

Once again thank you so much Dr - without you this blog wouldn't have existed and I wouldn't have experienced so much goodness and satisfaction !


Last but not the least - thank you so much my little embies ! Make sure that you don't give up the fight; we have been waiting for you so long now. I need to  have you in my arms (if possible all of you !).


 “Never let go of hope. One day you will see that it all has finally come together. What you have always wished for has finally come to be. You will look back and laugh at what has passed and you will ask yourself... 'How did I get through all of that? ”

- author unknown

Thursday, April 25, 2013

Do’s and don’ts during 2ww



Do’s
  • Take your medicines properly.
  • Continue with your everyday normal activity.
  • Surround yourself with people who will make you feel relaxed and happy.
  • Do not do anything which you are not comfortable with. This will help to avoid self-blame if the IVF cycle did not succeed.
Dont’s
  • Do not use sauna, hot tubs ( you can have showers !) or do any vigorous activity (like strenuous exercise)  which could raise your basal body temperature.
  • Don’t change your diet drastically.
  • Do not restrict your daily activity-do not take bed rest !
  • Do not raise your hopes too much – have realistic expectations !
  • Avoid people who can raise your insecurity and stress levels.
http://blog.drmalpani.com/2012/01/dos-and-donts-during-ivf-2-ww.html

Monday, April 22, 2013

How many embryos should I transfer to optimize my chance of success ?



This decision depends on several factors :
  1. Your age
  2. the quantity of eggs retrieved from you
  3. the quantity and quality of embryos that were formed
  4. The age of your embryo at the time of transfer (day 3 transfer or day 5 transfer)
  5. How many IVF cycles you have failed previously
  6. Your risk taking appetite
  7. The laws that govern Assited Reproductive Technology (ART) in your country
Even though transferring more embryos seems a logical way to achieve success quicker, the risk associated with multiple pregnancy should not be neglected. The goal of any particular IVF cycle should be to produce a healthy baby !

Thursday, February 7, 2013

Will embryo(s) fall out after embryo transfer ?


A fear which is wide-spread among IVF patients is – will my embryo fall out if I stand up or walk around after the embryo transfer ? This is quite a reasonable worry – after all, if the embryos are transferred through the uterus through the cervix, then why can’t they come out through the same route?  However, if you understand the anatomy of the uterus , these doubts will vanish and you will fell much more confident and comfortable during your 2ww.

Women imagine that when the doctor puts the embryos inside the uterus, they are deposited inside a space within the uterus in which the microscopic embryos can roll freely!  They believe that if they rest, the embryos will settle down and stick to the wall of the cavity. After all, when you stick two pages together with glue, don’t you leave them undisturbed for some time to allow the glue to set ? They are worried that if they walk about, the embryos will be disturbed from their resting place , and may fall out of the cavity.

In reality, the uterus is a muscular organ , about the size of your fist. When people hear the word ‘uterine cavity’, they imagine that there is a real cavity within the uterus ( like a cave, perhaps) , but this is not true. The cavity we talk about is not a true cavity , but just a potential cavity . The walls of the uterus are in contact with each other – after all, there cannot be any empty areas inside the
body ! For example, press your palms together. There is no real space between them , since your palms are touching each other. What happens when you insert a small ball in between your palms ? The ball has created a space for itself ! In the same way , a uterus which doesn’t have an embryo inside it carries only a potential space. Only when the embryo grows in size will this space enlarge. Do you know that at 5 weeks of gestation your embryo is just the size of a sesame seed ? Imagine what will happen if you keep a seed between your pressed palms and move your hands in whatever way you might wish to ? There is no way the seed will be dislodged  - it is safe , snug and secure in its resting place. This is exactly what happens to your embryos inside your uterus !  Nothing you do can dislodge an embryo – NOTHING (even jumping or running) ! If the embryo is healthy and if your endometrial layer is receptive , the embryo will stick to the wall and bury itself inside the lining (just like a seed does , when planted in fertile soil). External physical activity cannot influence this natural biological process which occurs in utero.

A lot women refuse to go to the bathroom for a few hours after the embryo transfer, because they are scared that if they pee, their embryo will fall out of the uterus. They just end up making themselves completely miserable – and I worry that an overdistended bladder can actually cause uterine contractions needlessly ! Others are scared that if they cough or sneeze after the transfer, they will ruin their chances of success. Please do not obsess – remember that nature has designed the body with enough intelligence, that you don’t need to worry at all !

After the transfer, the uterus can contract (for example , during an orgasm, which often occurs while sleeping during  the 2ww ), but the progesterone produced during the luteal phase will prevent these uterine contractions from dislodging the embryo. Intercourse and orgasm cannot cause any harm after the transfer – after all, fertile couples do have sexual intercourse during the 2ww, and they get pregnant all the time.

After an embryo transfer , bed rest is absolutely unnecessary. I have heard from women who have been forced to spend 2 weeks in bed after the embryo transfer – and many of them have done so because of their doctor’s orders ! ( I think the reason some doctors continue to give this outdated advise is a clever way of subtly blaming the patient if the cycle fails ! “ You didn’t get pregnant even though I did such a good job with your IVF treatment , because you did not rest properly “ is their subliminal message) . Even a couple of days in bed can do you harm , physically and emotionally. Bed rest may increase body aches and back pain , and makes your physically uncomfortable.  Resting may actually reduce uterine blood flow by reducing pelvic circulation. Bed rest creates havoc  with your mental well-being as well ! When you lie down in bed all the time and have nothing to do, your mind will start to play all sorts of games with you. The end result is an unhealthy obsession with your body’s symptoms and signs – and this often causes panic , which does not help after a stressful IVF cycle.  The bed rest, rather than resting your mind, often causes more stress !

Please do not restrict your normal day-to-day activities after an embryo transfer.  Use your common sense, and do not do any strenuous activity which might cause you to blame yourself if your cycle fails ! And what happens if your mother in law enforces house arrest ? Remember that she has been brainwashed , and is following well-meaning but misguided advise, based on centuries of myths and misconceptions about bed rest and pregnancy. She is not trying to harass you – she is just trying to help you to have a baby , based on her personal ( but flawed) world view ! Please don’t rock the boat by flatly refusing to listen to her – just give her this article to read , so she understands why bed rest does not help!  And if she is still unconvinced, please share this with her - Bed rest has not been scientifically proven to improve pregnancy rate after embryo transfer(PMID: 19590224)
Related Posts Plugin for WordPress, Blogger...