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.

What can I do differently after a failed IVF cycle to increase my chances of success ?

This post is for you Anu (thanks for the kind suggestion!) and for all my blog readers! I will be very happy if you could ask me more questions. Remember, every of your questions and doubts will help others who are in a similar situation too !

"Manju, what did you do differently this cycle ? You have undergone 7 embryo transfers without success, so what helped you to succeed this time ?" This is the question I am asked most frequently now-a-days.  I wonder how people came to the conclusion that doing something different helps in achieving success ! Here are my answers.

1. Can you tell us something about your medical history ?

My reason for doing IVF is tubal factor infertility. At the age of 29 I was diagnosed with a hydrosalpinx in the left tube and I had to remove it. My right tube is present but non-functional due to adhesions. I started my IVF journey at the age of 29. I learned that women with tubal factor infertility have very good chance of IVF success and now I am 35 years old and pregnant with embryos that were created from eggs extracted from my ovaries when I was 33 years old ! I expected my IVF journey to be short but I it took almost 6 years to get pregnant and carry it past the first trimester !

2. Is there any problem with you other than non-functional fallopian tube ?

I was diagnosed with PCOD and I am insulin resistant (this tendency run’s in my dad’s family!). I have been on metformin 1500mg from the age of 25. While on metformin , I had regular periods. Many different tests were done on me during my IVF attempts and after my miscarriage. The following “abnormalities” were found :

• Compound heterozygous MTFHR mutation – I started taking 5 mg folic acid because of this diagnosis.

• I was tested for HLA compatibility with my DH. They found 2 or more HLA loci compatible with my husband. This test was done immediately after my m/c. I didn’t have much knowledge then. I thought let them do whatever is needed so that I will have my baby. My RE in Germany asked me to undergo paternal lymphocyte immunotherapy to help my embryos implant and prevent further m/c. I didn’t even understand the principle behind the therapy then. I asked my RE but he had no clue either ! The therapy was performed like this : they isolated lymphocytes from my husband’s blood, injected them under my skin and monitored my blood after 1 month to see whether I had developed antibodies against his HLA ! They said “you have to get pregnant within a year, otherwise the antibody titer falls and you have to repeat this therapy again”. This therapy was done in 2009. I never conceived in my further attempts. I really started to panic whether this therapy did any irreversible harm to me and then I started to explore what this therapy really means. Then Dr. Malpani asked me whether I could write about it. During that time I learned a lot about HLA matching and about the “mindless” therapy I underwent for no good reason. My current pregnancy shows that HLA matching between husband and wife has nothing to do with successful embryo implantation or early pregnancy loss ! Please read : http://myselfishgenes.blogspot.de/search?q=HLA

•  I have PAI 4g/4g mutation. The literature says PAI 4g/4g mutation predisposes me to insulin resistance. Another information I now know about this is, this mutation carriers may have increased risk for HELLP syndrome.

3. What kind of therapies were suggested by your REs ?

As mentioned already , I underwent paternal lymphocyte immunotherapy in Germany 4 years ago without it helping at all! My RE in Germany firmly believed that giving me heparin will help. I asked Dr. Malpani about it once and he said it was unproven and not necessary. I was so comfortable with Dr. Malpani’s conservative approach. He never wanted to experiment on me with any therapy which had no evidence to back it. His confidence made me very confident too. He believes firmly that embryo quality matters the most and that is what is my current pregnancy shows. I never again thought about using heparin – after all , I don’t have any problems with blood clotting. I did not even use baby aspirin this successful cycle.

4. How many IVF cycles have you done and where ?

I have done 6 IVFs and 3 FETs (9 embryo transfers altogether). The last FET was a success and I am currently 11 weeks pregnant with twins. I have done 5 IVFs and one FET in Germany without success (although I conceived in my 2nd IVF , that pregnancy was short lived !). I did my 6th IVF with Dr. Malpani of Malpani infertility clinic. You can see all my IVF cycle details (dosage of medicines, how many eggs retrieved, how many embryos were obtained and how many were transferred to the uterus ) in this post : http://myselfishgenes.blogspot.in/2012/05/my-ivf-journey-timeline.html. You can also read about a more detailed description of how I ended up with more eggs in my 6th IVF in this post : http://myselfishgenes.blogspot.in/2012/08/from-3-eggs-at-age-of-29-to-24-eggs-at.html

In my 6th IVF cycle with Dr. Malpani, I got more eggs than all my other 5 IVF cycles combined. Dr. Malpani allowed me to tweak the protocol in the beginning a bit , but I do not think that could be the sole reason for a high egg yield. I took 75 mg DHEA for 8 months (as per Dr. Malpani’s recommendation) before my 6th IVF and I also stopped metformin which I was taking for years. I also didn’t use Gonal F (a recombinant form of FSH which is a highly purified form) during my 6th IVF. I used a much cheaper version of FSH called Menopur ( a crude form of FSH preparation which is isolated from the urine of menopausal women). Might be a combination of everything or just the increased dosage of FSH which Dr. Malpani started me on from day 1 of cycle worked its magic and I got 24 eggs in that cycle. I am sure Dr. Anjali’s egg retrieval skills played a major role too.

5. What kind of transfer was your successful cycle – was it a fresh embryo transfer or frozen embryo transfer ?

I got 24 eggs in my 6th IVF. 3 good embryos were transferred during that cycle (fresh transfer) and 7 embryos which were of good quality were frozen. Out of 7, 2 were blastocysts and 5 were 8-celled day 3 embryos.

My fresh transfer was not successful. I had a great endometrial lining during that cycle. It was around 10mm, trilaminar. The next was a FET where we transferred 2 frozen blastocyst stage embryos. Again no pregnancy was established- the embryos failed to implant. We thought my poor endometrial lining (only 6.5 mm) was to be blamed for this failure (I used G-CSF for this cycle as uterine infusion to help my endometrium grow but it was of no use, my endometrium didn't respond well to G-CSF as expected).

I got a BFP with my recent FET during which my endometrial linig was only 6.7 mm. We transferred 3 8-celled embryos which were graded excellent. The remaining two 8-cell embryos ( out of the 5 frozen ) were grown to blastocyst and were refrozen again. Out of the three transferred two implanted and I have completed 11 weeks as of 28.8.2013 - and so far so good !

Remember, FETs are much more successful than fresh transfers now-a-days ! So find a clinic which uses vitrification for embryo freezing ! Please read this post for more info : http://myselfishgenes.blogspot.de/2012/12/in-past-standard-was-transfer-best.html

6. So what did you do differently this time ?

To be very honest, I didn’t do anything differently.

Many things went wrong this cycle. I had a poor endometrial lining again. It was only 6.7mm at the time of transfer ! I took 4 progynova (estrogen, 2 mg each) from day 1 of my menstrual cycle until day 21. Usually I ovulate at around day 21 so I thought why not give my lining a bit more time to grow. Since my endometrium was thin I just continued taking 4 progynovas until day 21. But the lining didn’t increase its thickness beyond 6.7 mm. I didn’t use lupron this cycle to suppress my pituitary. We actually thought lupron use might have caused poor endometrial growth but later we found that lupron was not the culprit (omitting lupron didn’t make any difference in my endometrial response to progynova). Since I didn’t use lupron this successful FET, at around day 7 of taking progynova I had an early LH surge (which indicates ovulation !), my LH at that point was 22 IU/l. But my progesterone was within pre-ovulatory range at that point and I didn’t have any follicles in my ovaries ripe enough for ovulation. Hence there was no chance for ovulation. So we continued with the cycle. Just 5 days before transfer I ended up with severe pain in my stomach (perhaps amoebiasis due to eating in restaurants in Mumbai !), so I ended up taking metrogyl 400 mg twice a day and I stopped it just the day before embryo transfer !

So with a lining of 6.7 mm, a premature LH surge and taking massive doses of metrogyl (actually this wouldn’t have had any ill effects anyway !) we carried on with embryo transfer. Dr. Malpani was not so happy that I decided to transfer my precious embryos to my poor lining but he was happy to let me decide. I always told him “Dr, I have the best lining in the whole world”.

7. What went right this cycle ?

Lot of things :)

• I believed in what I did. My poor endometrium (as per so many scientific publications !) did not deter my spirit. I didn’t waste my time thinking that something is wrong with my endometrial lining and I didn’t do anything to improve it. I didn’t take massive amounts of estrogen nor did I take baby aspirin or any other blood thinners. No Viagra too :) After thinking a lot, I came to the following conclusion - My endometrium grew very well during all my fresh IVF cycles (10-12mm). This clearly showed that I had no underlying problem (fibroids, adhesion, infection etc) with my uterus. I confirmed it with a hysteroscopy which took just 5 minutes. The doctor who did hysteroscopy concluded that I had a small uterus but there was nothing to worry about – after all there will be lots of biological variations in the size and shape of uterus ! Since my endometrium grew well in fresh cycles (where enormous estrogen is present in the body) any end-organ damage is ruled out. During FET my estrogen levels (on progynova) rose to about 200pg/ml and this is in the normal range for an ovulatory cycle (200-300 pg/ml). With that amount of estrogen in my body, my endometrium could only grow upto 6.7 mm. I thought well and good, that might be my body’s natural response. I see so many women in infertility forums worrying about their lining thickness and trying so many different therapies to increase the thickness. From my experience I would say, If you do not have any underlying problem in your uterus , then do not worry about the lining thickness. The receptivity of the lining is what matters the most, and a thin lining can be receptive. What matters most is your embryo quality. If endometrial lining is that important for embryo implantation how come ectopic and extra-uterine pregnancies occur ?

• I had wonderful people around me who made me so comfortable during embryo transfer. Dr. Sai’s gift to me did magic to my confidence level ! I suggest every IVF clinic give their patients some cute gifts before ET to boost their morale (how much does a gift cost when compared to the huge amount they charge :)

•  I was so relaxed and was ready to face whatever comes my way. I always have plan B, C, D etc

•  I believed in the competency of embryologist and my Dr - I trusted them !

• My embryos looked so beautiful-thanks to the embryo creating skills of Dr. Sai !

• My loved one’s prayed for me. My mom sent me to the ET room like a warrior, she applied some holy ash on my forehead ( and my DHs’ as well for extra god luck) . I did feel like going to a war front :) The love I felt in her gesture and HER prayers, the sacrifices she made (removed her hair, gave up eating sweets and pickles – the things which she likes most !) did play a major role in achieving this BFP.

8. Manju, did you take any supplement ?

I personally don’t believe in taking supplements to improve endometrial lining or its receptivity. So I didn’t take anything at all. All I took was 5 mg folic acid, 500 mg metformin (I am insulin resistant !), 4 progynovas and uterogestan ( progesterone) as instructed by my Dr and that is it. Please read : http://myselfishgenes.blogspot.de/2013/01/does-taking-supplements-help-ivf.html

9. How about bed rest ? Did you restrict your activities ?

I was on my feet 5 minutes after ET . I went back to hotel room, had my dinner and slept. From the next day onwards I took it easy, meaning, I didn’t engage in any strenuous activity. I went out for shopping, walked to a nearby restaurant to have my lunch, roamed with my mom and husband in the evenings. No bed rest at all ! Please do not torture yourself by lying down in bed for 3 or 4 days-it doesn’t help. It can harm your physical and mental well-being. Please read : http://myselfishgenes.blogspot.de/2013/02/will-embryos-fall-out-after-embryo.html

10. Can I fly immediately after ET ?

Yes, you can. But I stayed in Mumbai for 5 days after ET. The sole reason was to spend time with my mom. I get a chance to see her only when I come to India . She lives with my old granddad , and takes care of him, so it is not possible for her to visit me in Germany. I was not able to take holidays because I needed holidays for my treatment. I was so happy to be with her and my DH those 5 days. They both treated me like a queen :) (few joys of being infertile !)

11. What was your thyroid level pre-pregnancy ?

I was diagnosed with sub-clinical hypothyroidism (TSH 5.5) few years back. So I am on thyroxine. I do not have TPO antibodies. I tried hard in the beginning to keep my TSH around 1, as it was said that a TSH of close to 1 is ideal for achieving a pregnancy. I took 75 mcg of eltroxin and my TSH was around 1.3 or so but I felt like crap. I felt too hot, got frequent cramps in my leg and lost weight. After sometime I gave up worrying about the numbers on the papers and tried to concentrate on my body. I took 50 mcg and my TSH was around 3.5. I felt good. I had no symptoms of hypo or hyperthyroidism. So I maintained my dosage of 50 mcg. Last week during my visit to gynecologist (at around 10 weeks of pregnancy) they checked my TSH again and it was 0.88 to my surprise. As hCG hormone increases TSH levels tend to fall. Such increase in thyroid function is normal during pregnancy I learned. If you have thyroid autoantibodies it is wise to regulate your levels before getting pregnant but please listen to your body rather than obsess about the values on the lab report. Maintain a dosage which is comfortable for you and do not try to bring your TSH too low if you are not comfortable with this . A large scale study didn’t show any association between sub-clinical hypothyroidism, chance of conception or miscarriage. Women with TPO antibodies are prone to increase in their TSH (due to declining thyroid function) during pregnancy. So please check your TSH during pregnancy and adjust your dosage accordingly. Remember, severe hypothyroidism has to be treated as it can lead to abortions and premature deliveries.

12. Is there any advice you can offer me to increase our chance of IVF success ?

Yes, for sure !

• Select a competent clinic. Go to the best IVF clinic available nearby. It does make a lot of difference.

• Learn a lot about the IVF procedure. Opt for information therapy before IVF therapy.

• Ask your clinic to show you your embryos. Educate yourself about how your embryos should look according to their age. Do not say I trust my doctor so I do not have to look at my embryos. There is a old saying “ Believe in God but lock your car”. Be wise and protect yourself from fraudulent activities which exist in the field of IVF. If someone cheats us once, they are fools . If they cheat us twice, we are. Please read : http://myselfishgenes.blogspot.de/2012/10/what-can-i-do-if-my-ivf-doctor-does-not.html

• Demand a copy of your medical records.

• Do not think IVF is a single attempt process. The younger you are and the more the eggs you produce , the more likely you are to succeed. So have patience and be persistent in your attempts. Be flexible and open to different treatment options (like donor eggs, donor sperms etc)

• Do not doubt your uterus, in most cases the culprit is the egg quality ! Please read : http://myselfishgenes.blogspot.de/2012/12/why-did-my-ivf-cycle-fail.html

• Trust the doctor you selected, appreciate them for the work they do for you, be friendly with the hospital staff. If you treat them only as workers you will fail to get their warmth and compassion when you need it the most !

• Please do not undergo any unproven therapies like IVIG, LYMPHOCYTE IMMUNOTHERAPY, USE OF STEROIDS, BLOOD THINNERS (if you are not diagnosed with clotting problems) which are not scientific established when undergoing IVF. IVF is a game of probability. If you are young and lucky enough you will find success soon. Otherwise it might take a few more attempts. I recently received a mail from an infertility specialist who conceived in her 17th attempt. An IVF failure doesn’t mean something is wrong with your body and you need to “correct” something. Human reproduction is a remarkably inefficient process. A normal, fertile couple needs on an average 12 months to conceive. If they don’t conceive in their bedroom in 4 months, they do not go to the doctor and ask him to “correct” something in their body- you don’t have to either!

Please read : http://myselfishgenes.blogspot.de/2012/07/my-advise-for-someone-starting-their.html

13. Can you provide me with an IVF checklist – what kind of tests are a must before an IVF cycle ?

• Check your anti-muellerian harmone (AMH) and antral follicle count (AFC) to test your ovarian reserve.

• Check your Thyroid stimulating hormone (TSH). If it is not within the normal range please see an endocrinologist to further asses the reason for thyroid dysfunction.

• If you are diagnosed with PCOD and have high BMI, check your fasting insulin. If the fasting insulin is high, life-style changes along with metformin use will give you a better chance for IVF success. Metformin use during the first 12 weeks of pregnancy was shown to reduce miscarriage rate in PCOD women.

• Check your blood sugar to make sure you don’t have diabetes. This test becomes very important if diabetes runs in your family.

•  Hysteroscopy to check your uterus if any abnormality was detected using ultrasound images.

14. What did your infertility experience teach you ?

I will never consider my infertility experience as ill-fate. Infertility taught me many good things, introduced many wonderful people in my life, and made me knowledgeable. I have an infertility blog (thanks to Dr. Malpani !) now which helps many people and all the writing I did and the knowledge I gained because of that made me very confident. The confidence thus obtained and emotional protection it gave me is also one of the reasons for my success.

The lessons I learned :

• Never believe in unproven therapies that exist in the field of IVF and waste your time, energy and money.

• IVF is a game of probability, you may need few attempts before finding success. If you do not find success soon, It doesn’t mean your body is defective.

• There are only three main components important for IVF success : good embryo, efficient embryo transfer and a uterus without any defects. Your embryo quality is decided by two factors : your age and your clinic’s competency in producing good embryos and to some extent the quality of sperm (perhaps a 10%). Embryo transfer (please read : http://myselfishgenes.blogspot.de/2013/02/embryo-transfer.html) depends on two factors again : the ease with which your uterus can be accessed and your doctor’s skill. Your uterine cavity must be free from adhesions, scar tissues and certain type of fibroids which might interfere with embryo implantation.

• The competency of your IVF clinic matters a lot ! Always asses your clinic’s competency by how your embryo looks. Please, please do see your embryos before transfer and demand pictures of your embryos.

• Patience and persistence during times of infertility provides rich dividends. 

• Helping others is the best way of helping yourself.

• Find good emotional support.

• Have healthy hopes and weed out unhealthy expectations.

• Infertility struggle doesn’t end when you get a positive BFP. The real struggle starts then and doesn’t end until you have your baby. Even if you get a positive BFP be cautiously optimistic. I was totally heart-broken with my m/c after my 2nd IVF attempt – I wish someone could have warned be about the possibility of m/c. 1 in 4 pregnancies end too early and the risk of m/c increases as your age increases.

• Enjoy the journey !

15. I do not have enough money to do IVF, IVF is too costly for me – what should I do ?

This is a tough question and a question which breaks my heart all the time. I will try to suggest some possibilities :

• If you are ready to donate half of your eggs to women who are in need of egg donation , then you are entitled for free IVF in some clinic. Please do find out if this is feasible. But for egg donation you must be within 30 years of age.

• Some clinics offer a money-back guarantee programme. You have to pay for 3-4 cycles and if your IVF is not successful, they then repay 100% of your treatment costs . This gives you some financial security . You can check out an example of such a program at http://www.drmalpani.com/guaranteedpregnancy.htm. Not everyone qualifies for this programme, and age matters , so enquire about this option in your clinic.

•  Bargain – there is nothing wrong in bargaining with your IVF doctor. Doctors are humans too and if you could give a valid reason and show proof that your income is low , many doctors might help you. I know in Dr. Malpani’s clinic they do free cycles for people who couldn’t afford IVF. But again if you are healthy and young the chances are more that your doctor is willing to help you.

• The most important solution is to fight for the rights of infertile couples. We need to pressure the government to pass rules which ensure that IVF treatment is covered by medical insurance. It will take a lot of effort and lots of people to achieve this.

What is the upper age limit for ART treatment using your own eggs?

The graph shows the decreasing success rates (live births) with increasing age for in vitro fertilization using embryos derived from a woman's own eggs compared with using eggs from a young donor.Nature 428, 133-134(11 March 2004)

Scientific studies show that after the age of 46, the chance of live birth using a woman’s own eggs is almost zero. Most IVF clinics will not set an upper age limit for treatment. If your ovaries develop follicles in response to ovarian stimulation, they will be happy to treat you. If you are an older woman going in for IVF treatment using your own eggs, you should clearly understand the scientific facts. This will help you to analyze the pros and cons and make a good decision. If you are above 40 and would like to try with your own eggs , you have every right to do so provided you are well-informed. The drawbacks of using old eggs are :

• The chance of retrieving a decent amount of good quality eggs from an older ovary is low , as a result of which there is a higher chance of IVF cycle cancellation.
• There is a higher risk for complete fertilization failure – your partner’s sperm might fail to fertilize your eggs because of the changes in your eggs due to old age.
• Even if fertilization occurs and embryos are formed , more of your embryos have a chance of being genetically abnormal. There is a higher risk of miscarriage because of this
• The risk of having a genetically abnormal child ( such as a baby with Down syndrome) is much higher as compared to a younger woman

As you age , your response to ovarian stimulation and likelihood of a live birth decreases. You should understand the above mentioned facts clearly  before going in for treatment with your own eggs !

How to prepare yourself emotionally for an IVFcycle ?

Emotional preparation for an IVF cycle is as important as preparing yourself physically. Our mental and physical health is intertwined and any adverse change in one can affect the other too. Actually an IVF cycle is much more emotionally draining when compared to the physical discomfort it can cause. There are so many fears and concerns before starting an IVF cycle – and you are likely to feel excited and terrified at the same time. For most people the first IVF cycle (and for some every cycle) will be a scary emotional roller-coaster ride , filled with lots of uncertainty and heart-breaks. Of course there are a fortunate few who go through their IVF cycle smoothly and achieve success in their first attempt. But remember , this is not true for everyone. While we all want our first IVF cycle to be our last as well, if you are not hardy enough , an IVF cycle can play havoc with your mental health, sometimes irreversibly. So how should you prepare yourself mentally to deal with such an emotionally challenging journey ? How can you through an IVF cycle and come out successfully with minimal heart-breaks and few emotional scars ?

Acquire knowledge about the process

 

This is the first and foremost requirement which will safe guard your emotional health when going through IVF. Being literate about the IVF process gives you lots of confidence and a sense of control over the entire treatment. If you are knowledgeable , you will able to deal with the uncertainty inherent in the process more effectively.  Many first time IVFers find it hard to go through an IVF cycle because most of them are naïve about the process. The only thought they have in their mind is a baby , and they believe that every IVF cycle ends in a baby. They believe that all the medical nitty gritty of their IVF cycle will be taken care of by their doctor , and that everything will be fine if they are optimistic and have faith, so why should they worry about the technical minutiae of the process ? When their cycle doesn’t progress as expected , or if it fails , they are very vulnerable and may suffer from an emotional breakdown. Their belief in the entire process disappears into thin air and they find it very hard to cope. The best way to prevent this is to learn as much as you can about the IVF process. This will help in preparing yourself emotionally , because you will know : what to believe; what to expect; what can go wrong; how far your doctor can help you; how to deal with the cycle if something goes wrong; and why your cycle is different than that of your friends. The knowledge you acquire will act as a shield in protecting your emotional well-being. It will also aid you in designing a plan B if plan A doesn’t work. 

  

Prepare your mind for the failure

Some readers may find this advise absurd. Others may even get angry and think that I am a very pessimistic person. After all , who wants to hear about failure before starting their IVF cycle ? Everyone loves to talk to a person who encourages them and fills them with tons of positive thought. Everyone loves to hear that their cycle will have a positive outcome and they will take home a baby. Many refuse to even consider the idea of failure , because they dread the very possibility. They are worried that negative thoughts reduce the chances of success – or that they will create an unlucky jinx if they think about failure. Remember, you do not need any emotional preparation to face success but you need lots of emotional groundwork to face failure. The scientific truth is that only about 40 % of perfect IVF cycles end in pregnancy ! This means that only 4 out of 10 women who undergo one IVF cycle find success. Everyone , including me , wants to be one of those 4 ! But what if you are one of the 6 who fails to conceive after an IVF cycle? If you always obsess about success and a baby, how will you be able to face failure ? Many women who go through IVF are constantly advised by their friends, kith and kin ( and even their IVF doctors ) to remain optimistic. As a result of this, many women will train their brain to visualize only a positive outcome. They believe that if they do so they will end up becoming pregnant. I don’t know whether it will help you in getting pregnant , but it will definitely shatter you totally if the cycle fails. The pain a failed IVF cycle creates is enormous , and if you are a weak-hearted person it can paralyze you completely. So take care to prepare yourself for the worst. Write down how you will cope in case your IVF cycle fails. This will help your mind to be prepared for failure and hence the pain becomes a lot easier to deal with. Preparing yourself for failure will speed up your emotional recovery and will help you to plan for the next IVF cycle. 

Build a good emotional support system

It’s easier to handle difficult situations if you have a good emotional support system and family and friends can play a pivotal role in decreasing the stress of an IVF cycle. However, it is not wise to tell everyone that you are going through IVF and you need to decide who should know about your IVF journey. You might have lots of friends and family members but you might feel close and comfortable only with a few of them. Select people who really understand what you are going through, who are empathetic and who can whole-heartedly take part in your happiness and sadness. Surrounding yourself with friends and relatives who understand you will make a positive difference in your emotional well-being. This in turn will make your IVF journey a lot easier. My friends took away the stress of my IVF cycle by chatting with me (I forget to obsess when I am with them), by their compassion and by their kind words and deeds. During my recent failed IVF , my friends and their comforting words helped me a lot in regaining my routine. They patiently allowed me to grieve; and when I started to feel better , they came home and spent some quality time with me. One of my friends brought me a plant which is full of blooms and gave me a hug and that is all I needed to feel better instantly. I understand that many of you may be reluctant to share your IVF journey with anyone. I was also like that when I did my first IVF cycle, but it’s only later on that I realized that it is impossible to bear the brunt of an IVF cycle alone.  Happiness shared is multiplied , while shared pain is divided – share your IVF journey with your loved ones so that you get more emotional protection.If you have busybodies and nosy-parkers  in your life, please stay away from them. They just add to your stress levels and make coping with the IVF cycle much harder.

 

Turn to online infertility support groups

The best way to feel good is to talk to women who are going through the same infertility struggle as you are. There are so many online support groups where you can meet women who are knowledgeable about the IVF process . Most importantly , they are ready to help you both intellectually and emotionally. Another advantage with such support groups is that you do not have to reveal your identity and so you feel more comfortable sharing your journey with them. When you express your fears and concerns , you feel better emotionally. You don’t have to worry whether you will be ridiculed for your silly doubts because the other women have gone through the same situation you are in . You can also help other women with the knowledge you have gained. This will make you feel appreciated ; and this increased self-esteem will improve your emotional competence and strengthen your ability to face the next IVF cycle.

 

Prepare yourself physically

It is a well-known fact that a healthy body harbors a healthy mind, so take time to prepare yourself physically.  Please see my post on ‘How to prepare yourself physically for an IVF cycle?’

Relax

An IVF cycle is emotionally very stressful.  The most difficult challenge is to relax amidst that emotional stress. But when you relax , you will feel definitely better. You need to use relaxation techniques, and the good news is that there are many available, such as like breathing exercises ( pranayama); meditation; yoga and so on. But will they help ? How can a woman undergoing IVF relax her mind and get relief from the worries and doubts which constantly assail you. While yoga and pranayama will help you to relax physically , how far will they help you deal with your emotional stress ? I have found that the best way to relax is to address what is bothering you directly, instead of trying to suppress your fears and concentrating on something else. The major worry for a woman who is going through IVF is - ‘What will happen if my cycle fails?’ This question is the starting point of all stress, so try answering this along with your partner. Design a plan B ! It can be anything depending on individual circumstances – it can be another IVF cycle, it can be adoption or it can be child-free living. Once you decide what you will do if the IVF cycle fails , then it will be several times easier to relax mentally – and having a healthy conversation with your partner about what is bothering you will help you to relax as well !

Can an EmbryoScope help me in achieving IVF success?

Why is embryo selection important in the field of ART ?

Not all embryos which are transferred to the uterus implant and develop into a healthy baby. This shows that not all embryos are equal in their developmental competency. Fewer than 2 out of 10 embryos actually implant. This scenario underlines the importance of embryo selection before transferring them to the uterus. An ideal IVF cycle would produce a live birth when a single embryo is transferred to a receptive uterus. But even after 3 decades of IVF invention we are still far away from an ideal IVF cycle. Most clinics around the world have a success rate of 40-50% per cycle and this means the chance of failure when undergoing an IVF cycle is higher than the chance of success. During an IVF cycle several embryos are produced. The embryologist normally selects the best looking embryo(s) to be transferred to the uterus. The remaining embryos which are viable are frozen and are transferred to the uterus during the subsequent IVF attempts. How does an embryologist decide which embryo(s) should be transferred to the uterus?  There are a set of well-defined rules for selecting the best embryos (the embryos which are viable and most likely to implant) based on their morphological appearance under the microscope. Depending on those criteria, embryos are graded, the best ones are selected and are transferred to the uterus. But this technique is not fool-proof ! Fifty to sixty percent of the time , even the best looking embryo (called a top quality embryo, selected based on the embryo grading rules) fails to achieve a pregnancy. On the other hand, sometimes less than optimal looking embryos implant and give rise to a healthy baby.  If we are able to correctly pin-point which embryo will implant ( by being able to assess the developmental competency of an embryo accurately !) and become a baby then the success rate of an IVF cycle will greatly improve. A good embryo selection technique will be able to reduce the time taken to achieve a viable pregnancy when undergoing ART, even if it doesn’t lead to a 100% success rate.

What criteria should a good embryo selection tool have?

A good embryo selection technique must provide meaningful (it should be possible to make use of this information in routine clinical practice), quantitative information and should be non-invasive. It must be able to differentiate between ‘viable’ and ‘non-viable’ embryos as well as ‘normal’ and ‘abnormal’ embryos. For example an embryo which is viable need not always be genetically normal. Many viable embryos implant but fail to produce an ongoing pregnancy  because they are genetically abnormal . On the other hand , if the embryo is not viable , then it fails to implant and achieve a pregnancy.

Why don’t all the embryos produced via IVF implant and develop into a baby?

This is a million-dollar question ! Scientists are trying hard to decipher this puzzle. As per the present state of our knowledge, there are two major reasons for the failure of an embryo to implant:

1)      Lack of genetic competency in embryos

It has been found that 50 – 60 % of embryos created via IVF are genetically defective. Women of Advanced Maternal Age (AMA) produce an even higher percentage of genetically abnormal embryos. Such embryos are called aneuploid. Aneuploid embryos carry an abnormal number of chromosomes in them. Chromosomes are the structures which carry the genetic information necessary for creating a healthy baby. Abnormal chromosome number leads to abnormal genetic content which in turn prevents the ability of an embryo to implant and develop into a healthy baby.

2)      Lack of  receptive endometrium

The endometrial layer ( the uterine lining) plays an important role in embryo implantation. For the embryo to implant, a successful cross-talk between the endometrium and the embryo has to take place. If the endometrium fails to express proteins which are crucial in assisting embryo implantation, then even if the embryo is genetically competent , it will fail to implant in the uterus.

So, for an embryo to implant and develop into a baby, it has to carry accurate genetic information and the endometrium should be receptive enough to allow it to implant and grow.

What are the methods which are employed in the field of ART to select the embryo which is more likely to develop into a baby?

The most widely used method or ‘traditional’ method for embryo selection is based on assessing the morphological appearance of an embryo under the microscope (embryos are graded according to their cell number, amount of fragmentation and cell size). You can learn here how the embryos are graded according to their morphological appearance. The bitter truth is that not all ‘perfect’ looking embryos survive in utero and become a baby. On the other hand, sometimes even the worst looking embryo can give rise to a beautiful baby. Since looks can be deceiving, as always, there is a need to develop techniques which could accurately say whether an embryo is viable and competent enough to develop into a baby or not. At present there are two new developments which promises to increase the success rate of IVF. The first one is called comprehensive chromosome screening. This technique screens all the 23 chromosomes of the embryo for genetic abnormalities and thus helps in selecting embryos which are genetically normal. Since genetic incompetency of the embryo is said to be the main reason for IVF failure, this technique theoretically should improve IVF success rate. But this technique is invasive by nature and still in its infancy. Further clinical trials are necessary to determine whether CCS is a panacea or a pipe dream. You can read my blog post about CCS here.

There is one more recent invention which promises to increase IVF success rate by improving embryo selection criteria and this technique is based on time lapse embryo imaging. The instrument which is used for this purpose is called an EmbryoScope.

What is an EmbryoScope ?

A new technological advance which promises to improve IVF success rate is an EmbryoScope. It is an incubator (an instrument which maintains ideal temperature, humidity and proper oxygenation in order to support the optimal growth of embryos) with a built-in camera which can be used to monitor the growth of the embryo continuously without the need to remove them from their cosy culture conditions. The EmbryoScope thus provides a time-lapse , slow-motion picture of your embryo’s growth, minute by minute.

What information does an EmbryoScope provide ?

EmbryoScope provides information about an embryo’s morphokinetics (changes in morphology with time). It can be used to monitor the embryo’s development , minute by minute , and is capable of generating several images of embryos growth over a period of time. As a result an EmbryoScope can give details like - the time taken from fertilization to the first cell division; time taken to complete first cell division; time period between the subsequent cell  divisions; how many cells the embryo had at a particular time point; details about the cell nuclei and so on.

How useful is the information generated using an EmbryoScope  ?

The company which developed the EmbryoScope and many IVF specialists who own it claim that an EmbryoScope can improve IVF success rate. It is true that an EmbryoScope generates hundreds of beautiful pictures of an embryo’s growth. But how useful are these pictures / data in real life ?  For example, if an EmbryoScope is programmed to take pictures of an embryo every five minutes and if the embryo is monitored continuously for 3 days, then the instrument generates 864 pictures of an embryo, during its different stages of development. How will these pictures help in determining an embryo’s developmental competency? The company which sells the EmbryoScope provides software into which these pictures are fed . The software then says whether the particular embryo complied with the ‘optimal cell division rules’ during its development.  The key question is – how many randomised clinical trials ( not sponsored by the manufacturers) have been done to study the utility of the Embryoscope ? What is the proof that it is better than the ‘traditional’ method of embryo grading which relies on five or six single conveniently scheduled observations during its in vitro development ?  There are lots of unanswered questions and a lot more has to be done before someone can claim that EmbryoScope can improve IVF success.

Will the EmbryoScope help me in achieving IVF success?

As patients, we should welcome any new technological advance with utmost caution. Already the field of IVF is plagued with flawed technologies, flawed analysis and erroneous conclusions which affect us – the patients. We should not forget that the main aim of the company which sells this instrument ( and of the IVF clinics which buy this costly instrument ) is to sell this technology and reap a profit. As patients, our main aim should to get a baby with minimal expenditure. So if you are lured into selecting an IVF clinic based on their promise to use an EmbryoScope for improving the IVF outcome , you need to be careful. This is true especially if you have poor ovarian reserve or if you are a poor responder to IVF drugs and yet the IVF specialist promises that ‘come to us because we have an EmbryoScope, and can use it to help you in attaining success’ . The best thing you can do is to avoid that clinic because this clearly shows that even the IVF specialist is himself not aware of the limitations of an embryoscope or he just wants to earn more money. Remember, an EmbryoScope cannot give you more embryos or better quality embryos. It is just an instrument to select better quality embryos. The truth is that the selection criteria for embryos using an EmbryoScope are not well-defined at the present moment. A poor responder normally produces few embryos and what is the point of subjecting those embryos to monitoring using an EmbryoScope ? With few embryos , selection often becomes unnecessary because beggars cannot be choosers, and the doctor has very limited choices in the first place, because of the paucity of embryos !

At present, the EmbryoScope is a novel technological advance which might or might not prove to be helpful in improving IVF success. It is definitely not a magical solution for conceiving a baby via IVF. Until then , an EmbryoScope is just an instrument which provides beautiful pictures of your embryos - and if you have to do it for an added cost , it is definitely not worthwhile to use it!