17w1d update!

Where should I start ? The babies are fine but...... Today I had an appointment with gynaecologist. I waited long for this, 5 weeks! My gynaecologist is on holidays. Yesterday they called me and said my gynaecologist is ill and whether I would like to meet other doctor. We said yes. Today morning I met a new doctor. She measured my cervix and it was only 2 cm. She immediately sent me to the clinic where a tocodynamometer was used to measure uterus contraction. Fortunately my uterus was not contracting. They took several vials of blood and checked my cervix again and took samples to check for infection. They have kept me in hospital bed rest. My DH was devastated. He was asking how will I stay at home without you. I want to cry, I just want to go back home. I don't want to stay here and I don't see any benefit in it. They want me to stay in the hospital for 3 days, hopefully on Monday I will have all the results. If there is no infection they want to do a cerclage which doesn't seem to help with twin pregnancies. I  donno what future holds for us. I wish we could hold our babies in hand safe and healthy. I want my DH to be happy, I know how much he loves the little ones. Something within me is saying nothing will go wrong. I am trying hard to talk to some doctor and get out of hospital. This clinic is just 5 minutes from my home. No place can give the warmth and protection a home gives and I want to be with my husband. I know people will be praying for us but whoever reads it please pray! All these are very new and I am so afraid, but more than that if something untoward happens my DH, my in-laws and my mom will be broken down. Their pain will be unbearable for me than my own. I am lost within myself and so many fear haunts me .......hope everything goes well. I have one roommate here in the hospital. She doesn't seem to speak English or German. She has a newborn baby. I love watching them both :) I wish I could hold the little one for sometime but afraid to ask her and what language should I use ? But first I should get out of this hospital and be with my DH, I am trying to talk to some doctor and hopefully soon I got to see someone, I am determined to get out of here.If anyone of you have faced the issue I am going through, please do help me!

Basic Infertility Workup Which Every Couple Struggling to Get Pregnant Must Do !

Please do a complete workup before starting treatment haphazardly!

You need to do ALL  the following simple medical tests:

Semen analysis for your husband ( to check his sperm count and motility). Read more at www.drmalpani.com/sperm.htm

Blood tests for you for the following reproductive hormones – FSH ( follicle-stimulating hormone),LH ( luteinizing hormone),PRL ( prolactin) , AMH ( antiMullerian hormone) and TSH ( thyroid stimulating hormone) on Day 3 of your cycle, ( to check the quality of your eggs). Do this from a reliable lab such as SRL ( http://www.srl.in/). Day 1 = Day the period starts.

HSG ( hysterosalpingogram, X-ray of the uterus and tubes, www.drmalpani.com/hsg.htm)  on Day 8 of your cycle ( to confirmYour fallopian tubes are open);

The vaginal ultrasound scan on Day 10-11 should check for the following. A. ovarian volume b. antral follicle count c. uterus morphology d. endometrial thickness and texture

Courtesy : Dr. Aniruddha Malpani, Malpani Infertility Clinic, Mumbai, India

Alternative Medicine Versus Western Medicine for IVF patients – Friend or Foe ?

This article is the brainchild of Dr.Malpani. Thank you Dr for giving me permission to reproduce it in my blog!

Indians were unaware of western medicines up to until three centuries ago. Ayurveda, a form of traditional and alternative medicine was practised in India for centuries. Infertile couples in olden days were treated by Ayurvedic or Unani medical practitioners by using plant-based medicines and, in addition, they provided life-style advices too. Undoubtedly, such medical practices are very effective for some forms of infertility and many infertile couples would have achieved their dream of starting a family via using them. When some couples found no luck with such treatments, they sought the help of the supernatural power to give them a baby; many went from temple to temple in search of God’s grace! Since knowledge about the functioning of the reproductive system and its defects were very much limited during that time, infertile couples at one point of time had to accept their fate and move on with life. Many resorted to adoption as a means of enjoying parenthood and some remarried so that they got a chance to propagate their genes and made sure their generation didn’t end prematurely!  

Times have changed today. Since the practice of Ayurvedic medicine was done by word of mouth during ancient days and is vigilantly guarded among families, the enormous knowledge our ancestors possessed about different curative plant compounds, their mode of preparation and the principle behind such practices are eventually lost! Although there are medical schools which teach Ayurveda, there are very few Ayurvedic practitioners existing in India today. Western medicine being based on strong scientific-evidence and rationality, gained importance eventually and is widely followed in today’s India. With improvement in biomedical research and the knowledge gained thereof, ground-breaking discoveries have emerged in the field of reproductive medicine. As a result, modern age infertile couples have enormous treatment options to deal with any kind of infertility problem. With patience and persistence most infertile couples can hope that their dream of having a baby will become a reality!

But the ironical truth is, even today, many infertile couples feel uncomfortable to use western medical advancements that are available in the field of reproductive medicine. The reasons are twofold: many western medicine based infertility treatments are costly and not everyone could afford to spend so much, as a result, many resort to traditional medical practices like Ayurveda or Unani (which are comparatively much cheaper) even though the chance of success is very low or even nonexistent for many infertility ailments using such traditional approach. The other reason is that, unfortunately, still many Indians believe that western medicine is evil and pose many unpleasant side-effects. Especially if you have a granny at home who never went to a modern hospital and managed all her and her family illnesses using traditional medicine, the first advice you receive will be to seek the help of an Ayurvedic medical practitioner for your infertility problem! Some even depend on “faith healers” like “witch doctors” to cure their infertility problem.

So, if you are faced with infertility problem what will you do? If IVF patients depend on such alternative medicine for improving their chance of success, does it make sense? How do doctors who practice western medicine view it when their patients depend on alternative therapies to cure their infertility problem or to improve their chance of success?  Although alternative medicine is practiced world-wide, a lot of infertility specialists are not always happy when patients depend on such treatments. They feel that the patients are being fooled by these primitive systems of healthcare and they pity them for wasting their precious reproductive period by following treatments, which they think, are fruitless.

Doctors who practice western medicine spend many years in medical school, acquiring their degrees. They then work hard at acquiring practical experience in a hospital, so that they can get a license to practice medicine. IVF doctors study for as long as 10 years before they can hang out their shingle as IVF specialists. Not only are they proud of their expertise and experience, they naturally want to guard their domain jealously. They have a low opinion about alternative medicine and its practitioners because they are poorly trained and they acquire a degree in as little as 6 months. Many IVF doctors feel that such degrees are of no value and are just a “license to kill”. Also, they often have a superiority complex, because only western medicine has modern technology (such as vaginal ultrasound scans and endoscopy) at their disposal, to make an accurate diagnosis, based on which they can recommend the right course of treatment on a scientific basis. They think that alternative medicine practitioners do not have the same depth and breadth of training as they posses and many doctors feel that alternative medicine clinics are encroaching on their territory. They look down on these doctors as being quacks, who have no effective therapeutic interventions to offer because they lack any evidence to prove their efficacy.

On the other hand, many alternative medicine practitioners are equally happy to bad-mouth infertility specialists who practice western medicine. They scare their patients by telling them that IVF is “artificial” and the babies born out of IVF are “weak” or abnormal. While some envy the high income an IVF doctor gets, others genuinely believe that the holistic options which they offer have a higher success rate. They feel that IVF is like band-aid therapy, and does not attempt to fix the underlying problems in the infertile couples.

As a result of this conflict between the doctors who practice western medicine and alternative medicine, patients end up getting confused as to which is the reliable argument. In order to try their luck, they shuttle back and forth between these two medical practitioners and finally get frustrated with the treatment process and many end up sacrificing their dreams of a baby being born to them. If this is the case, how should a responsible doctor react? What advice should they give their patients?

We need to remember that many infertile couples will actively seek out alternative medicine options, even when undergoing treatment for IVF. These options are highly respected by their family elders and deeply rooted in their culture. They are also much less expensive. Hence they believe quite logically that even if they have not been proven to help, they will not cause any harm (although this is not true)! This is why they want to cover all possible bases and try them out, to ensure that they have not left any stone unturned in their baby chase. There are tons of anecdotal success stories of women who have conceived after taking a particular herbal concoction; and this, even as the scientific base of alternative medicine is not always strong.

Doctors who practice western medicine must understand that unless and until they take into account the cultural healing beliefs of the patients and learn to incorporate them within their treatment regimen in a rational way, it is impossible to achieve patient satisfaction. Improved patient satisfaction will lead to better compliance to therapy. Cultural competency of the healthcare provider is very important to help patients get the best medical care and also to be successful in one’s own medical profession.

Alternative medical practitioners should also understand the limitation of the treatment they can offer to an infertile couple and encourage them to seek appropriate infertility treatment from western medical practitioners when needed. After all, a patient with a blocked fallopian tube cannot be cured with Ayurveda and Unani medicines. Giving patients false hope and wasting their precious fertile period is very unethical on their part.

Every infertile couple has to decide wisely about their treatment options. Of course, there are some problems which can be cured by alternative therapies (for example anovulation due to PCOD!). But there are problems like low sperm count, blocked fallopian tubes and much more which cannot be cured using herbal concoctions. A well-educated patient will know for sure which treatment should be opted for, after analyzing their medical problem. It is also wise to find a balance, for example when you are going through IVF and if your alternative medicine practitioner advices you to take a herbal potion which he might think will help create a healthy environment for embryo implantation or which might balance your hormones, then it is nothing wrong in trying it, provided such advice is given by a reputed practitioner who is not a quack. Please do not believe in the claims of mushrooming internet sites which are claiming to provide you with herbal therapy to make your IVF a success. First, you will never know if what they are providing you will be of benefit and the next concern is, it should not harm you or your IVF cycle. Remember, many herbal medicines carry the risk of being contaminated with heavy metals!

Rather than taking a confrontationist approach, patients would find it a lot easier if IVF doctors and alternative medicine practitioners could learn to work together for the wellbeing of the patient.

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.

NT scan at 12w6d

Today, I had my NT (Nuchal Translucency) scan. Everything looked fine. The embryos which are transferred to me during this successful FET were collected from my ovaries when I am 33 years old. The risks for trisomy 21 (Down syndrome) for a 33 year old woman is 1:369 but after NT scan my risk fell down to 1:2686 (for both fetus). The risk for trisomy 18 is 1:905 but after the scan it was 1:2741(for fetus 1 and 2) and the risk for trisomy 13 reduced from 1:2837 to 1:20238 (for fetus 1 and 2).The nuchal fold measurement for fetus 1 is 1.5 and for fetus 2 it is 1.2. Hence the possibility for much prevalent genetic risks (aueuploidies) seems to be extremely low.  I don't need aminocentesis or chorionic villus sampling (CVS). It is such a relief ! The babies measured 6.37 and 6.5 cms.
 

My today's experience with those prenatal diagnostic people was not pleasant. The lady (a doctor!) who came in to take measurement of our babies was not at all compassionate. She didn't explain anything, kept on doing her job, made sounds of impatience when our babies are moving around and for me it appeared as if something was wrong with the babies. The whole scenario is like watching a horror movie. I could see my DH panic and suffer. I really wanted to get up and walk away. I regretted my decision to go to them. She went out of the scanning room every few minutes leaving me lying like that, she attended her cell phone every few minutes and it took almost one and an half hour until all the measurements are complete. I do not understand how doctors could do their job so mechanically. I didn't expect too much from her, I just needed a smile, a kind word, just an assurance that my babies are OK. What would have happened if I have got up, told her that this is not the way to treat patients and walked away? Doesn't it hurt her? Won't her entire day be spoiled? I was thinking why I am not doing that. The only answer is, I don't want to be rude. I am not afraid and there is nothing to be afraid of ! My gynecologist is such a kind woman and I am really thankful to her.
 

I had so many different emotions before this scan. What will I do if one our babies are diagnosed with some genetic defect? "Never give up my little ones, whatever you are I will take care of you", this is the promise I give my babies all the time. If one of them was diagnosed with some unfortunate defect, would I have decided to end its life? Even my imagination hurts. Am I an emotional fool? Do children with genetic defects have poor life quality? By bringing a genetically defective child to this world are parents doing harm to that soul?  Why do we all crave for perfection ? Doesn't this society need all kinds of humans - how will we learn to be grateful, kind and empathetic without the so-called 'less than perfect' humans ? As parents, if we desire only perfect children, then why to talk about the greatness of motherhood or parenthood? Will I be able to accept a child with a defect whole-heartedly? If I say that I will accept any baby, then why the hell I had this scan! I have no answers for many questions that keep haunting me. I would be thankful if some of you could share your views on this.
 

I am thankful to everyone and everything around me. Lying there, I was thinking about God, I wanted to believe Him and I asked Him to keep my babies healthy. More relationships I build, more is the need of God in my life! The only times I go and stand before God is to ask Him to help my loved ones. Now, with these two lives growing within me, whom I will love to pieces until my demise (and even beyond perhaps!), I have no other option than to catch hold of God (Who are you ?) very tightly! :)
 

Thank you so much everyone and good luck to all of you who are in your 2ww!

11 weeks and all is well :)

Today I had another ultrasound. Both the babies are measuring as they should (4.5 and 4.1 cms). They are very active: turning around, moving their hands and feet, covering their ear with hand and ........ everything which I saw today still appears unbelievable ! I was lying down looking at them; tears flowing down my cheeks; and I was overwhelmed with so many different thoughts. I was thinking of my dad; my IVF attempts and the miscarriage I underwent; Mumbai trips; suggestion from my RE in Germany to use heparin (I didn't even take baby aspirin this time around !); the HLA matching tests and the stupid therapy I underwent for that; the fear I had to endure; the determination I had; and now some beautiful ultrasounds ! Everything appears surreal.

 

I already have a small bump. Nausea and vomitting is still there and I feel very tired. Please excuse me for not updating my blog as I used to !

 

What more to say - thank you so much everyone for all the love and prayers !

7w5d ultrasound on 5.8.2013 !

We had an ultrasound today because of brown spotting. Both babies had heart beats and measured according to their gestational age. I am really thankful that everything looked fine. I guess the bleeding occured because of using progesterone pessaries. They irritate my vaginal canal and cervix so much. I really hate them. Doctor looked at my cervix and also showed me how much of crinone has accumulated in my vagina (it is brownish in colour!). I am taking progesterone rectally at present, but I have also asked for progesterone injections. Instead of this emotional torture which I undergo because of bleeding, it is better to bear the physical pain of PIO (progesterone in oil). (But later I was told that PIO is not available in Germany !) So at present I am using crinone twice a day rectally. Studies show that both routes (vaginal or rectal) of administration is equally effective (PMID:22714063). So, if you are in a similar situation as me do not hesitate to take progesterone rectally.

People ask me whether I am on cloud nine. To be very honest, I am totally stressed out. This uncertainity is hard to bear and the bleeding is very scary. I think my inability to enjoy pregnancy stems from my long infertility struggle and a miscarriage. It is a pity how we infertile women couldn't enjoy what we longed for the most, or... is it just me ? I will be happy if people could share how they felt during their pregnancy after overcoming infertility !

I am generally tired, my skin is extremely dry, I get weird dreams, feel nauseous both mornings and evenings, my sense of smell is extremely high (I smell many new things at home and they make me to gag !), I cannot brush my teeth without throwing up. I am happy to be sick ! Sometimes I wonder whether I am really sick or subconciously I am making my brain to feel sick ! If I don't feel sick I panic, sometimes I even cry. I couldn't stand the smell of normal Indian food, especially boiling rice. I haven't had any normal, routine Indian food for a week or so. Idlies are my favourite and they please my palate even now. I have a wonderful friend who spends her precious time to bring idlies for me early morning, and I donno how I will ever repay this kindness. In short, all simple carbs and fruits seem to be OK. Odourless, mild tasting food which is cold seems to be fine.

I seldom get very pale brown discharge and it seem to have stopped now. I am scared and my brain is foggy. I force myself to think positive and be happy. Every loving soul around me fills me with positive thoughts and energy as much as they can. Will be having my first gynaecologist appointment very soon. Sorry for not updating my blog - somehow I don't have the mood to do so. I wish I could write somethingelse too other than my pregnancy updates and I am sure I will do so soon.

As always my only request is - pray for us ! I need to surround myself with lots of positive energy. Any advise on how to deal with this stressful period is very much welcome !