Embryo Transfer

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

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

Happy Birthday Dr!

Today is Dr. Aniruddha Malpani’s birthday. Many more happy returns of the day Dr! May all your dreams and wishes come true! 

Dr.Aniruddha Malpani

I wanted to write a blog post about my doctor and I am happy that I could do it on his special day. When I first decided to go to Dr.Malpani for treatment I am at my wits’end. I had 5 failed IVFs to my credit. My experiences with infertility treatment have made me skeptical. I was emotionally torn apart and I never thought some doctor will be empathetic enough to help me and give me some confidence. I came across information about Malpani Infertility Clinic via internet and contacted Dr.Malpani through e-mail. Dr. Malpani was kind enough to provide e-mail consultations, which he does as a free service. He writes in his website ‘this is a free service I provide as a labour of love (I believe in karma, and feel that by helping you, I am helping myself)'. This attitude and the passion he has for his profession made me to realise that he is very different from many other doctors. As a patient, the ability to contact a wise IVF specialist, who has been in the field of IVF for 20 years and get all my doubts cleared is a blessing. If I mail him I get a reply without fail within the next 24 hours. I got not only intellectual support but also immense emotional support from him. He only introduced me to the serenity prayer. It really helped me many a time to regain my sanity.

I just love his blog. He is a very gifted writer who writes without any pretension. The thoughts come flowing direct from his heart. I like his out-of-the-box thinking and I believe that is what has made him successful in his career. When I feel emotionally down I open some of his blog posts and read it. This changed me as a person. I started to see my infertility struggle in a whole different way. I became a regular reader of his blog and started to write feedbacks. All those writings and his kind appreciations kindled my passion in writing.  When I started to express myself through writing I began to think clearly. This made me more confident. I owe a lot to him and his writings. Thank you very much Dr! Here are a couple of blog posts from him which I like very much : 

http://blog.drmalpani.com/2005/06/joy-of-medicine-finding-meaning-in.html

http://blog.drmalpani.com/2006/08/when-bad-things-happen-to-good-people.html

Dr.Malpani is a firm believer in information therapy. He dedicates his time and effort for preparing patient education materials and he also runs the world's largest consumer health library HELP, which contains over 10000 books, 10000 brochures and 600 videos. If you visit his website you can find so much information in the form of articles, books and comics regarding IVF and other infertility treatments-all for free of cost!  

I feel very comfortable in his clinic. The staffs are very kind and friendly. It is of no wonder because; if the leadership is good everything else will be good. I could also see the respect his staffs have for him. They always have nice things to say about their boss. One of his staff told me proudly ‘our doctor treats everyone equal’ :)

My journey hasn’t come to a happy ending yet. But it has definitely become better. For the first time in my IVF journey I got 24 eggs collected. The fertilization rate was high too and I got the maximum number of embryos. I had 7 embryos to freeze and I saw blastocyst formation from my embryos for the first time. All this wouldn’t have happened without Dr.Aniruddha Malpani, Dr.Anjali Malpani and their wonderful team.

Now, I am undergoing FET cycle and I know the uncertainty of the process. I may end up getting pregnant or may not. But, I am happy that I am undergoing this emotionally draining process under a skilled physician who really cares to give his best for his patients. Dr. Malpani never ever gave me any false promises. Not even once he said ‘Manju, if you take treatment under me you will have your baby’. I sometimes really wish that he could say it to me. But he is honest enough not to say things which are not under his control. I know that he does his best as a doctor. He is honest, compassionate, empathetic and skilled. He also provides immense emotional support for his patient which is very important during this infertility struggle. Even if I do not end up getting my baby in hand, I will always have the happiness that I had my IVF treatment under a physician who treats his patients with care and respect. 

Thank you Dr! Be happy always! 

Love

I really feel overwhelmed by the love people show. Yesterday, I was asking the hotel employees whether I could get puttu (a kind of rice cake) for breakfast. It is a delicacy from the state of Kerala and I am very fond of it. They said it is not possible to get it from here but one person (he is a keralite!) in that group said that he will get it for me from his home. I thought he is just saying it for that moment and will forget it. When I went down today, for breakfast, he bought a huge box packed with puttu. I couldn’t even say thanks. I am dumbfounded! I ate it to my hearts content. My husband was telling me, ‘Manju, give him some money’. I am reluctant at first but my educated, corrupt mind thought, ‘might be he brought breakfast for me so that he can get some money?’ I feel really sorry for thinking like that. I asked my mom to give a couple of hundred rupees to him; he refused it and left the place. I felt really stupid and hurt. What made me behave like that? Why am I not able to think loving deeds can be done without any ulterior motive? Did my so called intelligence and education made me think like that? Not only me, I have seen this attitude with many rich and educated people too. Why are we so afraid of love and affection? Why are we not graceful enough to receive it without any fear? Why are we not able to reciprocate love with love? Why do we connect a very delicate, beautiful human emotion with money or some other benefit?

Mumbai people are really kind. I am fond of Jamuns (an Indian berry!). Jamuns are my most favourite among fruits and I haven’t had it for 7 long years. Actually I am very lucky to have them this time .I asked in hotel whether anyone could purchase it for me, as the fruit vendors, when they realise that we are not localites, try to sell it to us at an enormous price. The very next day I got a kilo of excellent Jamnuns from a hotel receptionist (from his home perhaps!) and they refuse to take money for that. We are staying in this hotel for a long time now and the person who operates the elevator is very affectionate to my DH. He knew why we are here in Mumbai. He was behind my DH asking for his birthday and his name :) When we could no longer avoid him we gave him the details and the very next day he came and assured us that everything is good and all our wishes will get fulfilled! He obviously knew astrology or took the details to someone who is able to predict our future! (ofcourse we never had gone to astrologer until now and we are least interested to know our future!). So love and affection is in the air in India, especially with people who struggle hard for their everyday life. That is what makes India special. Smile at people and treat them with compassion you get loads of it back! Many people in India are not rich, some are even very poor when money is concerned but they have a rich heart filled with love and affection.

In Germany, people are totally handicapped in giving or receiving love. They always have a motive behind their kind deed and they think that’s the norm! When you try to be kind without expecting anything in return they really doubt whether such a love and affection is even possible. With modernization, education and money-centered life we Indians are also slowly loosing the ability to perceive love as it is! Actually LOVE is the only medicine which can cure all the problems in this world. Let us teach our younger generation to be loving and compassionate rather to be self-cantered and money-minded.

IF YOU ARE KIND, PEOPLE MAY ACCUSE YOU OF ULTERIOR MOTIVES

BE KIND ANYWAY! - Mother Teresa

Thin Endometrium and FET Outcome - Is there a correlation?

It is boring in hotel room and it is drizzling outside. So I am sitting in the room doing nothing. As usual, I have no mood to watch television programme. I did a short search in pubmed regarding thin endometrium and pregnancy outcome in  FET or IVF cycle. I feel so happy when I learn something new and also to update my blog with some decent information. Am I obsessed? I think I am not. When I watch TV or sit without doing anything a kind of depression sets in. My thoughts waver too much in the negative direction. I feel happy and relaxed when my mind is working, especially regarding my FET stuff and my blog. My DH is not happy about it. His accusation is that I am stressing myself too much. How will I make him understand how I feel? :(

So here we go: As always, there are two different views on whether thin endometrium affects the outcome of FET or IVF cycle. A paper in Clin Exp Obstet Gynecol.states that a 47 year old woman with an endometrial thickness of 4 mm conceived twins using donor embryos (PMID: 22268266). I do understand exceptions cannot become the norm.  But this information does give me lots of hope. My belief that embryo competency is important than endometrium thickness might be true. But my RE who has extensive experience in the field of IVF does not agree with me :) Might be my view is flawed, who knows? There is one more publication which makes me happy. You can view it here (PMID: 1513611). I could just get the abstract which states that, the largest study to date on the association of endometrial thickness and subsequent pregnancy rates following frozen embryo transfer, with the endometrium prepared by estrogen and progesterone found no improved or adverse outcome if the endometrium is too thick or thin :) I am now on progynova for a longer time. I started progynova on May 31^st and I added progesterone only on June 23^rd. So I am on estrogen supplement (increased from 6mgs to 64mgs as of now) for 24 days. I am bit uncomfortable with this long-time stimulation to grow my endometrium to decent thickness. 'Will this have an adverse effect on my endometrial receptivity? Will my endometrium quality be compromised?' These are the questions which haunt me sometimes. But my fear seems to be unnecessary. This (PMID: 16983519) paper states that long-term estrogen administration to bring the lining to a decent thickness is beneficial and does have a positive effect on pregnancy rate (infact the pregnancy rate was higher when compared to the control group!).

Now, I will also cite papers which say endometrial thickness is important and thin endometrium compromises pregnancy outcome. This paper (PMID: 22346080) states that mean endometrial thickness is significantly higher in pregnant women compared to non-pregnant.  But they concluded that ‘the mean difference between two groups was <1 mm which may not be clinically meaningful. Although there may be a relationship between endometrial thickness and pregnancy, implantation potential is probably more complex than a single ultrasound measurement can determine.’ So, they did not find a sure correlation between endometrial thickness and pregnancy rate. Another study states that in donor embryo cycles thin endometrium is one among several factors which  can compromises the cycle outcome (PMID: 15482759). This study (PMID: 17681313) says that in medicated FET an endometrial thickness of 9-14mm on the day of progesterone administration is positively associated with pregnancy outcome than an endometrial thickness of 7-8 mm :( One more interesting publication states that, in ICSI cycles (that is ART cycles performed due to male factor infertility) the endometrial thickness has no effect on pregnancy outcome while in IVF cycle endometrial thickness (where female fertility problems are involved) is a factor which determines pregnancy outcome (PMID: 8671501).

In short, studies fail to show a strong negative correlation between Pregnancy Rate (PR) in IVF/FET cycles and thin endometrium. There are several other factors which play a role in embryo implantation. The most important of it all is the age of the woman or the embryo quality.

Now after reading all this I just wish that my two little blasties have a competent genome. No matter how much I obsess nothing is going to change. Whatever happens will happen and let me face the reality with a strong heart and calm mind :)

My endometrial lining has grown!

My endometrial lining after days of struggle has grown to a decent thickness. Todays ultrasound showed a lining thickness of 7.5 mm :) It has time to grow one more day before I can start progesterone. So, lining looks good - ofcourse not great. I am happy with the present situation. For the past three days I am taking sumptuous food and some supplements ofcourse! Today we spent four hours near marine drive. My mind is too relaxed. I am not going to think anything more. Let me take one day at a time. The embryo transfer will be on Friday. I am transferring two blastocysts. I will post their pictures soon. Take care everyone!

Nature at its best!

Photographing nature is a great stress buster for me. The place I live in Germany turns into a little heaven in summer. I used to roam hours with the camera. Somehow I haven't engaged in this activity for a long time. Today we went to hanging garden and the flowers there are so attractive I spent some time capturing their beautiful smiles! I feel so good in Mumbai. No work stress, friendly people-I am sure I am going to cry the day I have to leave from here! Here are some beautiful snaps for you to enjoy too.

Not a bad news afterall!

Yesterday, I had my ultrasound again, after taking 40 mg of progynova for 3 days. The uterine lining seemed to be good. It is trilaminar and Dr.Anjali said it is not at all bad. She continued saying 'ofcourse it is not super good'. So my endometrium looks average with a thickness of 6.8 and can go upto 7 when measured on a different angle. I am happy. I went expecting the worst (I read somewhere that the thickness can go down also!), so I am actually satisfied. Dr.Anjali spent some of her valuable time giving me some positive stories and some casual girly, girly (Ok, womany, womany! :) talks. I felt so relaxed and happy when I came out. When a doctor vibrates positive energy the patient becomes positive immediately. The power of doctor's words!

Now my progynova dosage has gone up even more. I am taking 64 mg! I am also eating heartily after a long time. I will again have an ultrasound on Friday. I sincerely wish my lining goes up a bit. Of course I am not expecting any dramatic improvement. I will be OK with a trilaminar lining at 7mm. The happiest happening is we are not cancelling the cycle. So, my little ones will come inside me soon. Yet we haven’t decided how many to transfer and whether to do a blast or day 3 ET.  Wish me good luck, I need a lot of it now :)

So, why don’t you just adopt a baby?

I stole this title from my Dr’s blog. My apologies Dr! I selected this title because this is exactly what people ask about adoption (very casually!), without bothering to understand what we are going through. Here is Dr.Aniruddha Malpani’s post about the same topic.

To tell the truth I haven’t faced this question often. But when some people advise me to adopt in the most uncompassionate way possible , I get hurt. On the other hand, I have friends who really care for me. Recently I got a mail from one such person. She wrote to me explaining why I am special and how I have touched her life. She then asked about adoption in the most compassionate way possible. ‘Manju, I know you for a long time. I understand the struggle you are going through. My mind sometime thinks why should Manju not adopt a baby?'  She also said ‘Manju, I understand that you know better; might be you want to have a little one as a symbol for the wonderful love you share with your husband’. How thoughtful my friend is! When I read such a compassionate mail, the respect I had for her increased several times more and I am not hurt a bit. Love you dear for what you are!

Why can’t you adopt? I want to ! After undergoing this struggle, I will be happier to adopt than to carry a baby in my womb (I really mean it !). Now-a-days I feel getting pregnant and carrying a baby is a Herculean task. My journey to get pregnant is like this - take fertility drugs, wonder whether my ovaries will respond properly to them, obsess about the number of follicles and the amount of eggs that will be collected, continue to panic about how many will fertilize and divide; and wonder how many will be competent enough on day 3 or day 5 to be transferred to the uterus. After transferring, obsess each and every second about the symptoms and wonder whether the embies will implant or not. When the pregnancy test turns out to be negative I break down to pieces emotionally and the psychological impact that cycle created  will take months to heal. If the test becomes positive; again I have to keep wondering whether the baby will cross the 8 week, 12 week mark. If there is no vomiting, I have to panic whether everything is OK.  Oh my God! Women who get pregnant without knowing when and how should appreciate how blessed they are!

We are making attempts to adopt a baby. But adoption is not as easy as shown in a movie. In movies they will show a woman who is desperate for a baby. Her in-laws will abuse her. The woman will be crying always. Her loving husband will one day decide to give her the gift of her life. They both will go to an orphanage and find a baby who is very affectionate and attractive. They will talk to the head of the orphanage and take the baby home the following day! How sweet and convenient this process is ! But unfortunately this is not true in real life! Adoption is a very complicated process , which can consume all your time and energy.

It is not the inconvenience of adoption process we panic about. When I tried to register myself in CARA I got a mail saying that the registration process is closed and they asked me to e-mail to German adoption agency (Gemeinsame Zentrale Adoptionsstelle- GZA). When I mailed them , a lady replied by saying that the process will take a long time (she wrote international adoption will take several years!) and we have to know German perfectly to succeed in the process because there will be lots of home study. She also warned me repeatedly about the long waiting list! 

So, adoption is not as easy as everyone thinks. Babies available for adoption in India have gone down. This is thanks to awareness about birth control, easily available home pregnancy tests and abortion facilities ! I am happy that unwanted children are no more generated and thrown away like stray cats or dogs! Infertility rates have also gone up because of late marriages and adoption is no longer a social stigma.  Hence there is heavy competition for babies which are available for adoption. There is a thriving black market for adoption – but you need to be a VIP to tap into this. When I talk about adopting a baby, people come up with another question. Why don’t you adopt an older child? I am not comfortable doing so for many reasons. When you adopt, the initial bonding which develops between an adopted parent and the baby is very important. Older children, naturally would have started to form opinions about everyone and everything and hence the ability to show and receive unadulterated love which forms the basis of parent-child bonding will be greatly affected. I am worried this may give rise to bitter problems in the future.

Last but not the least - just because a couple is fertile and are able to produce children, it doesn’t mean that they have the special privilege to be judgmental about an infertile couple. Before asking an infertile couple why don’t you adopt a baby; ask yourself ‘Why I didn’t adopt a second baby when I already had one of my own?’ If you have an answer, the same answer applies to infertile couples too. Do not forget we are humans like you with all the fears and uncertainties which you have in your mind. Just because we are infertile it doesn’t mean that we have to be more compassionate and charitable than you are! When you ask an infertile couple 'why don't you just adopt?', it is like asking a terminally ill person 'why don't you just die?'. When a person dies his existence in this world  ceases. When a person fails to reproduce his gene transmission ends there. We stop being part of our future generation. Every living organism exists just to reproduce and transmit its genes. If the basic reason for our survival is in question, then naturally any human will try their level best to fight for it. That is why infertile couples are ready to move heaven and earth to get their much desired baby. Our genes are as selfish as we are!  Another argument which has no rationale is ‘if you adopt a baby, you will have your own baby out of that happiness’. Nothing can be as hurting as the above sentence. If I adopt I adopt for the sake of love. I will never adopt thinking that this will help me receive my own genetic child.

Actually, an infertile woman is the best mother in the world. Giving birth doesn’t make anyone a mother. Being a mother is an inborn quality. Woman who are kind, loving, caring, empathizing, understanding and ready to sacrifice their happiness for the people whom they care for are all great mothers. An infertile woman learns all these qualities so quickly because of the troubles she undergoes. Even a mother forgets her child sometime , but an infertile woman’s heart always thinks about her prospective child. She learns to look at every child with love and with lots of adoration. For me, every new life I see-from sprouting buds to dividing embryos is something which I respect and look at with wonder. I understand that creating a life, which is perfect in every little aspect  is not easy. A small copying mistake in our genome from ‘A’ to ‘C’ can cause havoc in the life which is being created , which is why anything which is perfect is a great miracle to me. I love every little child as if they are my own and I am sure every infertile woman does so! So next time when you celebrate Mother’s Day never forget to wish me or any other woman who is struggling to have a baby. We deserve that wish as much as every woman who has a child does!

On a lighter note,  my mother gave me the above picture and it suits this topic perfectly. If someone is ready to give me  Krishna , I don't mind being Yashoda :) I get lots of pampering now-a-days. My mom and my DH buys me whatever I desire. I have so many new things now and Mumbai is great for shopping. I get lost within myself when I walk in Colaba Causeway (great shopping area). One of the few joys of being infertile! :)

Not Looking Good!

My endometrium after 48h of G-CSF infusion remains the same at 6.5 mm. It looks trilaminar. I was very disappointed and I am a bundle of negative emotions yesterday. Now I feel it is OK. I beleive everything happens for a reason and hopefully for the good. I will have the next ultrasound on tuesday. Dr.Anjali increased my estrogen dosage from 16 mg to 40 mg. So hopefully we see some improvement by tuesday. If not, I have to decide whether to cancel the cycle, wait for some more time or to go ahead and transfer. My intuition says do an embryo transfer whatever it is! There are studies which did not find any difference in pregnancy rates between thin and thick endometrium. There are studies which talk about the importance of thick endometrium. It will be a a hard decission to take but my heart will break if I have to return with an empty uterus. I do believe that if my embryos are competent enough they will be ok with a thin bedding too ;) Here is the blog post of Dr.Liccardi regarding thin and thick endometrium http://infertilityblog.blogspot.in/2008/08/endometrium-part-iii.html

Thin Endometrium –a side-effect of calorie restriction and fat loss?

Vaginal ultrasound showing a thin endometrium

I always had great endometrial lining during all my IVF cycles (greater than 8mm, mostly between 10-12 mm). In FET cycle too there was no problem. So, what went wrong this time? Even though I can just speculate, I know deep within me that my speculation is right. I have lost lots of weight during the past 5 months. I was insulin resistant before. I had a HOMA IR (a measure of insulin resistance) of 4.1. There is no standard value for HOMA-IR. The current studies consider that HOMA-IR < 2 is normal, HOMA-IR ≥ 2 is pathological, with HOMA-IR > 4 reflecting the pre-diabetic stage. My fasting insulin was 17uUnits/ml (although a fasting insulin of 5-25uUnits/ml is considered normal, anything above 10uUnits/ml is not so good. People with fasting insulin of less than 5uUnits/ml are found to live longer). I have a family history of diabetes in my dad’s side. I was diagnosed with PCOD at the age of 25 and I am on metformin (1500mg) for a long time. I stopped metformin for the past year because of gastrointestinal problem. After stopping metformin my BMI was 26.2. I was overweight. Lack of implantation in my previous ART cycle made me to ponder what can be done to improve my chance of conceiving. The only sore point I had is my weight and perhaps insulin resistance because of it. My blood glucose was normal. I also became aware of the fact that calorie restriction has a positive impact on egg quality. This made me to think seriously about removing the excess weight. My boss is an endocrinologist. I used to discuss with him about the weight issue and ask him whether carbohydrate rich meals are the culprit. He used to say-eat anything, but eat less. I started a very strict calorie restriction diet and jogging. I limited my calories to 800-1000 for the first 2 weeks. I achieved this by intermittent fasting. To my surprise my fat deposits around my waist started to melt. After two weeks I upped my calories to 1200-1500 calories. I avoided sugar, sweets and carbohydrate rich foods. I avoided rice as much as I can. I took only 300 calories per meal. I started metformin 1000mg. I stopped non-vegetarian all together and I am not planning to eat it anymore during my lifetime :). Within 5 months my weight dropped from 68 kg to 61 kg. The best point is I lost all the excess fat. For the first time I had a flat stomach. My energy levels improved. I can skip a meal easily without any trouble. I attribute it to my lowered insulin levels. In short I felt great. Received mixed comments from friends. Some are worried. They said I have lost the charm. But my DH is happy. He said I looked better now. I am happy too :)

Everything sounds good, right? Then, where lays the problem? Calorie restriction is good. It was found to prevent aging in experimental animals. It also delayed egg cell aging and extended fertility in experimental mice. Metformin is a calorie restriction mimetic too. It can also improve egg quality (both by preventing egg cell aging and by decreasing insulin levels). I do not think short time calorie restriction will have any effect on egg quality in humans. If calorie restriction is started in 20s it might extend fertility into your 40s. The same is true with metformin usage. Long term metformin intake can preserve egg quality via preventing genetic defect accumulation, while short term intake can increase egg quality by decreasing insulin levels. It was found that exercise and weight loss is much effective than metformin in decreasing insulin levels. So bringing down your weight at any point of your lifetime will have positive effect on your overall health by decreasing insulin, glucose and harmful triglyceride levels. This will keep your hormones balanced which is necessary for optimal fertility. As a result egg quality (not genetic but physiological parameters) and  endometrial health improves. Consider calorie restriction if you are suffering with infertility due to overweight and PCOD (high insulin!).  Reduce your weight through calorie restriction and proper exercise. Continue exercise regimen and increase your calorie intake for maintaining the appropriate weight. BUT never do calorie restriction when you are on fertility medicines, if you are underwieght or when you are trying to conceive.  Never be on very restricted calories (less than 1500 calories) when you are trying to conceive. This is the mistake I did this cycle. Even after starting fertility medicines (progynova) I continued with fewer calories. Lesser calories actually signal your body to go into the survival mode (during which only minimal bodily functions are maintained). Reproduction is an extremely energy consuming process. Once your body senses that you do not have enough calorie supply (as in times of food scarcity) it switches on mechanisms which  prevents energy expenditure. It tries to switch off high energy demanding functions like reproduction. In short all the anabolic activities which require high energy are switched off and catabolic processes which produce energy are switched on. Since I took less calories my estrous cycle is severely affected leading to poor endometrial development. My body in short doesn’t want to get ready for performing reproductive function.

I got this information from a website:

Reproduction: Feeding the reproductive cycle

Energy metabolism is known to affect reproductive cycles, acting as an evolutionary oversight to ensure that reproduction occurs only in favorable nutritional conditions. A recent study characterizes a mechanism through which the liver integrates metabolic responses to control ovulation (Cell Metab. 13, 205–214).

Investigating the link between estrogen and food consumption in mice, Sara Della Torre and colleagues found that caloric restriction decreased hepatic estrogen receptor-α (ER-α) activation in the liver and arrested estrous cycle progression. Interestingly, amino acid supplementation was sufficient to rescue mice from this metabolic block of the estrous cycle.

The authors found that ER-α activation led to increased hepatic expression of insulin growth factor–like-1 (IGF-1) and increased the amount of circulating IGF-1. Increased IGF-1 expression was required for E2-induced proliferation of uterine lumen epithelial cells and for estrous cycle progression in vivo.

The findings highlight a crucial role of hepatic ER-α as an integrator of metabolic and reproductive functions. The exact mechanisms by which IGF-1 and E2 promote progression of the estrous cycle remain to be determined, but this study might provide insights into infertility conditions, especially those linked to metabolic dysfunction. 

On the other hand there must be a connection between fat reserve and estrogen function. It is known that estrogen is stored in fat reserves. I have read that people who are obese are prone to estrogen sensitive breast cancers. Overweight people are also more prone to endometrial cancer. You need healthy fat reserves for your estrogen to function properly. Dr.Malpani sent me the Frisch hypothesis paper which talks about the connection between body weight and onset of menarche.

In short I learned a lesson which is invaluable. Do not change your diet or exercise regimen extremely during IVF or FET cycles.  Do not loose weight especially fat reserves when undergoing fertility treatment. Increase your intake of healthy fats. Do not restrict calories. The above said are very important for proper functioning of your reproductive harmones which intrun is important for your treatment success.

Another interesting information to ponder : In certain regions of south India, daughter-in-law who enters husband's home for the first time, after marriage, is given cow's colostrum. Perhaps a nice way of preparing her to carry their generation :) Milk is know to increase IGF-1 levels. When I say this I do not want to make IGF-1 master of all reproductive functions, just a note because I am talking about IGF-1 in this post. Our ancestors do have lots of wisdom :)

Stupid me ! Dr said –don’t beat yourself up! He asked me to read ‘Shoulda, Woulda, Coulda’ :). I will try not to regret. Hopefully G-CSF works and perhaps everything happened for my good :) Otherwise I will not have had a chance to use G-CSF which is supposed to increase pregnancy rates atleast in a couple of studies :)

Mumbai - through my eyes!

One and the Only!

Serene

Look at the young one! Sometimes I can't close my eyes in the most comfortable bedding! Lucky fellow!

Blue sky and calm sea! Serene, isn't it?

Another perfect example of serenity! Totally unaffected by the heavy traffic around :)

Gateway of India

Marine Drive

I am constructing my home! :)

I was watching this crow trying to pick up a big twig. Suddenly another crow came, took away the twig which this crow had in its mouth by force and flew away :) I wish the second crow is its partner who just lent a helping hand and not a thief :) Have a happy home and lots of chicks. No home is perfect without youngones!

Mount Mary Church, Bandra

Candles shaped like babies, hands, feet etc. I did buy and keep a baby boy and a baby girl candle figure (twins are great!) at Mother Mary's feet. I will do anything which can bring a sense of happiness to my mom and DH :) If you ask do I believe such prayers ? - I donno! But when I stood in front of Mother Mary my mind is serene and happy.

Update on endometrial ultrasound and G-CSF

I had a vaginal ultrasound yesterday to check for my uterus lining. Not so good news again! After 2 days of 16 mg estrogen (8 progynova tabs) my lining has grown from 6 mm to 6.7 mm. Dr. Malpani suggested that I should have neukine infused into my uterus. Neukine or Filgrastim is nothing but Recombinant Human Granulocyte Colony Stimulating Factor. It is sold under the brand name Neupogen in USA. It is a drug or a cytokine actually sold to prevent decrease in neutrophil count during chemotherapy which causes myelosupression. Decrease in neutrophil counts is called neutropenia and it is accompanied by fever. It causes the patient more prone to infections. Recombinant G-CSF causes a dose-dependent increase in circulating neutrophil counts thus preventing spurious infections in patients receiving myelosuppressive chemotherapy. What does G-CSF has to do with endometrial growth? Please visit this Center For Human Reproduction link for further information. Here is the blog post of Dr.Malpani regarding thin endometrium and the use of G-CSF to improve it.

So today I received an infusion of Neukine inside my uterus. Keeping my legs in that evil stirrup is uncomfortable. Dr.Malpani eased my tension by chatting with me. Still no signs of high estrogen in my body but I wish my endometrium responds well to Neukine giving me a nice, plump lining where my embies can snuggle in and start establishing contacts with me. Mumbai is great, I am very happy today. I will update about my Mumbai adventures soon.
Somemore interesting reads on G-CSF:
http://badplumbing.kurvy.com/2010/12/g-csf-the-last-frontier.html
http://clinicaltrials.gov/ct2/show/NCT01202656

In Bombay for FET

We came to Mumbai two days back. A heavy downpour welcomed us! Every time I enter India, for a day or two, a kind of depression sets in instead of happiness. I feel as if I am waking up from a pleasant dream. The reality slaps me hard. I live outside India for 7 years. The country where I live now is clean, sparsely populated, rich and comfortable. The first thing that makes me vexatious when I reach India is the dirty environment. Mumbai is the financial capital of India, and no need to say how densely populated it is. The dust, unruly traffic, dirt and poverty made me wonder why there is so much discrepancy between two countries. I saw a family of three; husband with torn clothes, wife with the dirtiest saree you can ever imagine and a newborn lying nearby them - all three are resting inside a shed of tarpaulin, on an elevated mound, which is found in between two parallel roads! I could clearly read the worry on their faces. They must have been living in platform and the heavy rain made them to panic. When I saw it, how much I wished I could just go back to Germany and imagine that life is hunky-dory everywhere! If you accuse me of being selfish – I AM. I am selfish to the core. I need the comfort which Germany gives me. I need the clean environment. I need the calm working atmosphere and I badly need the money for our baby-making journey. I am helpless, truly helpless. Every time I come to India my conscience kills me. I feel guilty for being comfortable, for being self-sufficient moneywise, for living in a clean environment, for attempting to create a costly baby when many road-side children are living in the footpath. Wait; do not judge India by what you read just now. This is just one half of the story. When I see such extreme poverty on one side, I also see supreme richness too. Costly cars, branded clothes, dining in five star hotels and lavish spending-this is also the way of life for many in India. Why is Indian society too unbalanced? Are these the result of evil caste system which we created long back?  

Do not form an opinion about me from what you read in the previous paragraph. I am not trying to project myself as a simple person with great social responsibility. I am a very normal and self-cantered woman. All the above said guilty feelings usually vanish from me in 24 hours. I get used to the way of life in India. I do walk past the hungry, homeless road-side children and enter into a mega shopping area to satisfy my shopping spree. My guilty feeling vanes away day by day until it becomes negligible. I indulge myself in all normal worldly pleasures ignoring the sufferings around me! Sometimes I wish I was non-existent or I wish I had the power to change every misery around me. But at the age of 34 I have learned that life is not fair. If I have to remain sane and serene I should surrender to the fact that life is unfair. As a human, I am trying my best to be compassionate and kind to my fellow beings. I try to lend a helping hand to the needy whenever I can. I also try to keep in mind the serenity prayer which Dr.Malpani taught me:

God, grant me the serenity

To accept the things I cannot change,

Courage to change the things I can,

And wisdom to know the difference.

This serenity prayer was written by the theologian Reinhold Niebuhr.

So coming back to the original story - we are doing a FET. We have 7 embryos left from my last ICSI cycle (5 day 3 embies and 2 blasties). I am happy to see Dr.Malpani and his team. Dr, understood that I am the anonymous person who leaves crazy comments (sometimes good ones too!) in his blog. All his staffs are very friendly as usual. Dr.Anajli Malpani is  cute and pleasant as always.

I took 6 mg progynova for 12 days and had a vaginal ultrasound on 11.6.2012 to check my lining. Dr.Malpani was not so happy about my endometrial thickness. My lining was only 6 mm. He increased my progynova dosage to 16 mg. I am going for an ultrasound today. I wish my lining has grown at least a mm by now. I have no EWCM even after taking such a massive dose of progynova. Does it mean anything? I do not know. I am worried and I started to write this blog post to calm my anxiety. I will update after today's scan what actually is the next course of action, and I would also like to speculate in my next post why I ended up with a thin lining!