A quick update ! When going gets tough ...

I will be having a FET on June 29th, exactly one year after my previous FET. Until previous December, we didn't have holidays; and my attempts to grow my endometrial lining to decent thickness from the beginning of this year failed miserably. My lining would halt at 6.5 mm everytime ! I didn't try anythingelse other than progynova (different doses !). Went in for a hysteroscopy, a month ago, during a dummy FET cycle. Uterus is fine - no problems were detected ! My endometrial lining expressed estrogen and progesterone receptors as it should. There was no infection or malignancy ! During the dummy cycle, exactly one week after my hysteroscopy, my lining was only 4mm. I started progesterone and within 4 days it grew to 8mm. I didn't know lining grows after progesterone support ! Might be I am very unusual in all ways :) ! The speculation is, it is not the actual proliferation of endometrium but just an increase in thickenss of individual cells (change from proliferative to secretory endometrium) after progesterone support. But can it thicken 4 mm ! The happenings are very confusing, and there are no reasonable answers. This cycle I decided not to take more than 4 tabs of progynova (estrogen tablets), whatever may come ! My lining seems to be around 7mm ! Not the best. But we have decided to go for ET. This is the story from my side. I don't know when I will update my blog again. I have promised my DH that I will not sit in front of computer (he feels that I am stressed out because of writing !). I will definitely miss my blog, but I should respect my DH's view too, afterall he goes through a lot of struggle because of me. I will miss writing - it gives me so much solace ! When I start writing again, I would like to make a post about endometrium ! I learned a lot ofcourse ! Please do wish me good luck ! Thank you for all your love and support !

A love story !

I have a friend. I met him during a summer evening when I used to go for walks. He is so smart and cute. I started to like him the moment I saw him. I think it is the same with him too. I wanted to go near him, feel the warmth of his closeness. I used to long for his proximity. But I am afraid of my DH. Whenever I went alone, without DH, I got the courage to go near him. The beauty is, he used to come too when no one is near me. As our relationship grew, we became closer. It felt so good to touch him; to pour my love through my hands. He too loved the warmth in my hands and in my voice. When I run my hands through his hair, it is a moment of bliss for both of us. I used to talk in my mother tongue but he is a German ! Language was never a problem for us. Do we need a language to express love ? Isn't eye contact and a warm touch more than enough ? Even when his family members are around, he comes to me when he sees me. They used to watch it with surprise. They heard me talk to him in my mother tongue. An elderly person from his family came out and talked to me. He said, I am very happy that he likes you so much. Just your voice is enough to make him come running for you, this is really strange, what are you talking to him ? :) I just gave a smile in return - can love be explained ?

This summer came. I went for walks avoiding DH intentionally. My eyes searched for him all the time but no sign of him. I wanted to ask his family members but I am a bit shy and a bit afraid. Today, I was riding a bicycle. Naturally, when I crossed his home my eyes searched for him. My heart longed to see him. I wanted to tell him that I am going to India for FET. I thought, if I see him today everything will be fine with my FET. Yes, irrational but isn't everything rational when in love ? Suddenly, I spotted him in his garden. I can't explain my joy in words. I just stopped the bicycle; some lady was sitting in the garden with him. I didn't mind, I called him. He looked at me and came running. I just hugged him, caressed his hair, but as I ran my hand through his body, I was shocked. He was not the same person I knew, the softness of his body was gone. Why is he like this - reduced to bones ! I could feel something is wrong. He had cough too. I looked at that lady, she said, he is not well for some time now. He had an infection, and his kidneys are no more working. I could feel my heart sink. My eyes showed my heart's pain. He just lay down allowing me to feel him. He really enjoyed it closing his eyes. I donno what kind of pain he is going through. His love for me didn't reduce a bit even when he is in extreme suffering. I really wished I could take away his pain.

My husband came and looked at me angrily, 'do you want to complicate our situation even more,' - that was the question in his eyes. I understood it. I do not want to hurt my DH too. But my heart longed to be near my friend who is in pain. I just said bye to my friend with tears in my eyes. On the way home my hubby said, wash your hands properly. I couldn't say a word, I just nodded my head affirmatively. My heart was heavy thinking about my friend's situation !

My husband loves me a lot. But the relationship I had with my friend is very special. We loved each other without any strings attached - just for the joy of love ! It gave us both so much happiness. The moment we spent together will always be there in my mind. Who said 'puppy love' is not a true one, and it will vanish. No love will go away forever, every pleasant feeling will stay for life. The only difference is - what I had is not 'puppy love' but 'cat love', yes my friend is a CAT ! Yet the love we shared is special and brought me so much happiness, I hope it's the same for him too !

What to do if you and your spouse disagree about treatment options !

When tackling infertility, you will be flooded with a variety of treatment options. The field of ART is vast, and depending on the nature of your problem , the treatment choices can vary all the way from from simple ovulation induction with clomiphene to IVF and surrogacy. 

With the advances in the field of ART, there is a solution for almost any kind of infertility problem you face, but being open to different treatment options is not easy for everybody.  Not everyone is comfortable in subjecting themselves or their spouse to treatments which are not agreeable to them physically or mentally. Financial conditions, social, cultural and religious limitations and fear of medical procedures all play a major role in deciding whether to pursue a particular infertility treatment or not.

Infertility is more of an emotional ailment than a physical one ! The unquenchable desire for a baby combined with social and peer pressure are the most important driving forces which compel couples to undergo different infertility treatments.  As long as both partners are on the same page regarding pursuing a particular fertility treatment option, everything is well and fine. But what happens when they do not see eye to eye about their options ? What happens when one of the partner wants to put an end to the infertility treatment and move on with life, while the other person could not imagine a life without a baby ?

Infertility becomes easier to handle when there is understanding between the partners. When one of the partners is ready to move heaven and earth in order to realize their dream of having a baby, and the other cannot understand this overwhelming craving to procreate, then the relationship gets strained. The stress of infertility combined with a strained relationship can play havoc !  There are couples who decide to end their marital relationship because unable to bear the brunt of the assisted baby-making journey !

When you and your spouse do not agree about treatment options what can be done ? How can you find a balance so that your relationship goes on smoothly ? Should one person sacrifice their desire for the sake of the other ?

But before going into what can be done, let us see where the problem arises. Below are the some of the common reasons why a spouse might not be ready to undergo fertility treatment or might be uncomfortable pursuing a particular treatment option :

Denial 

This happens during the initial stage of infertility diagnosis. The natural reaction from many would be “ I am healthy and normal, I will not undergo any treatment – we will have our baby without any treatment !” Many will want to bury their head in sand and try to pretend that everything is well and good.  A man normally equates his fertility to virility. He panics that because of the diagnosis of infertility, his manliness is being questioned ! Likewise, a woman also thinks that her feminity is in suspect if she cannot conceive ! This mental make-up makes the diagnosis of infertility impossible to accept , and as a result some people might vehemently refuse to go through any kind of infertility treatment.

Fear of invasive procedures and injections

Infertility treatments demand a lot of blood tests, use of injectable medicines and sometimes invasive procedures for diagnosis and treatment. As a result people who are phobic about injections and surgeries become jittery to carry on with infertility treatment.

Concern about the effect of infertility treatment on prospective children

There are lots of misconception surrounding infertility treatment and its effect on children born out of such treatments. This might create fear in the mind of your partner and he or she might consider such fear as a valid reason for avoiding infertility treatments.

Worry about the enormous cost associated with infertility treatment

In most parts of the world , infertility treatments are very costly , and can be a very big economic burden for the family. It can lead to emptying of your bank balance and can leave you financially insecure. This can create enormous mental pressure for the bread-winner of the family who would naturally want refuse to undergo costly treatments where the outcome is always uncertain.

Social, cultural and religious limitations

Third party reproductive assistance such as using donor sperms, donor eggs, donor embryos and surrogacy is banned in certain religious groups. Social and cultural restrictions will also play a major role in deciding whether a couple is willing to undergo a particular fertility treatment or not.

Fed up of infertility treatments

Fertility treatments consume lots of time as well as physical and emotional energy.  There is also a lot of uncertainty inherent in such treatments – there is no guarantee that you will end up pregnant after spending so much of your time, money and energy. The stress of infertility treatment can make life lacklustre. This can create an aversion towards infertility treatments !

So when a situation arises where you and your spouse do not agree about infertility treatment options, how can you deal with it ? How to constructively resolve your disagreement ?

When disagreement arises in a marital relationship there are four possible ways to solve it :

1. End the disagreement by agreeing with the other person’s choice
2. Coming to a mutually acceptable solution
3. Living with the difference
4. Separating and ending the relationship

When one of the partners does not want to pursue IVF and the other wants to leave no stone unturned in order to have a baby, but decides to end the conflict by agreeing to the option of not undergoing IVF (either out of love or out of coercion !) , it appears that the disagreement is solved and all is well. But, this kind of conflict solving usually causes lots of bitterness and may ultimately lead to the loss of intimacy ! Even if a partner sacrifices his/her wish out of love, it will never be a creative experience because “baby lust” is much stronger than anyone could imagine. The urge to have a baby is very hard to sacrifice and the partner who decided to “sacrifice” will always regret his/her decision , whenever they see a “cute little family”! These kind of “solutions” can lead to your marital relationship breaking at some point or the other !

So, how can you come to a mutually acceptable solution ?

 

Have an open mind

Most problems in life become difficult to tackle if we close our mind to new information and ideas. Having a closed mind also makes it impossible for you to understand and appreciate the goodness in your partner’s point of view. It also becomes tiresome and frustrating for your partner to have a rational argument with you , because you are incapable of seeing things from their perspective .  When you adamantly hold on to your views , there will be no possibility of a fair argument which involves give and take. For example, if you believe that taking infertility treatment increases your risk of having children with mental and physical disabilities, this is a very valid concern. But, having an open mind will help you to judge the validity of your belief with the help of scientific information , and by talking to people who are better informed than you are ! Closed-mindedness when facing infertility may curtail your treatment options and hence your opportunity to have a baby.  It might also leave your partner wounded forever !

“Your assumptions are your windows on the world. Scrub them off every once in a while, or the light won't come in.”  - Issac Asimov

Have a heart to heart talk!

Try to be expressive and talk openly about what is in your mind. It is very difficult for your partner to read your mind if you are not ready for healthy communication. The worst enemy to a good communication is emotional outbursts (crying, name-calling, slamming doors, threatening) ! Disagreement regarding infertility treatment is a highly emotional topic, so make sure you find a good time to talk about it. Do not raise the issue when your partner is tired, upset or irritated. Explain clearly - why you are not ready to agree about a particular treatment option ;  what your fears and concerns are ; how avoiding or pursuing a particular treatment option will be beneficial for you both (not only for you !). Try to analyse the pros and cons of your decision rationally. Remember, communication is a two way street. It is very important to allow your partner to talk and try to be heedful ! Listen to  your partner’s concern and respect their fears and insecurity. Do not interfere when your partner is talking ; do not discourage them when they express their point of view and never be sarcastic ! Never think that the problem is with the other person and you are always right !  I would like my partner to sit close to me, hold my hand, give me a few hugs so that I feel the warmth and kindness. Such intimate, non-sexual contact can make the communication much easier by adding lubrication and hence can make it very honest too ! Mutually acceptable solutions can never be reached without proper communication and deep understanding of the conflict.  Once you understand where the conflict lies , it is easier to reach a solution.

“Seek first to understand, then to be understood.”   -        Stephen R. Covey

Respect each other’s differences !

If you allow yourself to see other person’s point of view, you will naturally respect their fears and concerns.  Their concern may appear very silly and insignificant for you, but you have to understand that it really bothers your partner ! For example, the fear of injection or surgery can be a powerful deterring force for undergoing particular treatments. Instead of laughing at it and ignoring it, try to ease their fears by showing them how little the injection needles are ! You can also show them educational videos, where your partner could watch how the injections are administered or how a particular surgery is performed. This will help in reducing their fears and concerns about the treatment ! When your partner is worried about the financial aspect of a particular treatment, please respect this -remember, that your financial security is as important as having a baby ! Do not get emotional and blame that your partner for being money-minded ! Respecting each other’s concern and giving proper importance to their thought process plays a very important role in amicably solving the disagreement.

To be one, to be united is a great thing. But to respect the right to be different is maybe even greater. - Author Unknown

Be well informed !

It is very important to be well-informed about your treatment options. Learn all you can ! This will help in thinking clearly and agree or disagree with your partner in a rational manner. Knowing the pros and cons of different treatment options will also aid in solving the disagreement that arise between you and your partner in a wise manner, so that you can reach a consensus which benefits both !

Find a good counsellor

If all your attempts in arriving at a mutually acceptable solution fail, it is wise to turn to a counsellor who is knowledgeable about infertility and the treatment options that are available.  A counsellor can give a rational and impartial view of the situation which can help both of you to see the truth and resolve the conflict amicably.

Going through infertility is an excellent time to understand your partner and build a strong, everlasting relationship. Relationships actually get stronger during a time of crisis provided you have the maturity to make use of your difficult marital times constructively ! Disagreements between couples are very common when grappling with infertility, but make sure you disagree in an agreeable way. It is important to “fight fairly” and find a way which will lead to your most important goal – a baby ! Please do not  “sacrifice” your desires for each other’s sake – not all sacrifices create a happy ending. Make sure that the decision you take about the treatment options will not leave your partner hurt and wounded for life ! In your pursuit for having a baby do not lose the essential ingredients in your relationship  - Mutual LOVE, RESPECT AND ADMIRATION !

" The Joy of Medicine - finding meaning in medicine" - by Dr. Aniruddha Malpani

Dr. Aniruddha Malpani, MD

This  post  is written by Dr. Malpani and I like it so much ! The words flow direct from his heart and it says so much about who he is - as a doctor, as a human ! I know him for more than a year now, and I have learned so much from him. His writings are a source of great inspiration for me, and I derive the strength and courage to carry on with my IVF struggle from them. He patiently corrects the articles I write (every article), and provides great ideas for the posts too ! This blog wouldn't have been possible without him. I wish every patient gets a Dr like him. I respect and admire him a lot ! Thank you very much Dr !

Even though medicine has traditionally been regarded as a profession which provides tremendous job satisfaction, many doctors are finding themselves increasingly dissatisfied with the practice of medicine. In the past , when doctors met, they used to talk about the interesting patients they helped to treat. These days they usually talk about financial stresses, job pressures, bureaucratic hassles and red tape. Doctors are increasingly toying with the idea of changing careers , while others are burning out in their mid-forties. Where has the joy of practicing medicine gone ?

In order to find joy in medicine, we need to find meaning in our profession. Work is an essential part of being alive and physicians are fortunate to work in a job which can provide so much satisfaction . They are presented with new challenges daily ; they can apply their mental abilities and their physical dexterity to successfully solve many of these problems; they are accorded respect and status; and they have control and autonomy . Unfortunately, many doctors no longer work for the sake of working - they’re working for a car, a new house, or a vacation. It’s no longer the work itself that’s important to them, and this is a shame, because there is such joy in doing work well.

We are privileged to help take care of patients, and we need to respect our role, so we can learn to respect ourselves. If you do what you love and love what you do , you will find a higher purpose in life - and if you are passionate about your work , your life will be full of meaning. Getting paid for this should be seen to be the ultimate bonus !
We are fortunate to be doctors, because we can learn so much from our patients. They bare their heart to us, and make us privy to their innermost confidences, so that daily we get a ringside view of human drama, suffering, courage, life and death – the stuff of which life is made ! Doctors have a chance to plumb the depths of the human soul, as they accompany their patients through their suffering. Our work lends itself to contemplation and introspection – allowing us insights which few other people are privileged to have. Our patients can teach us how to live and how to die – and we need to keep our hearts open to their lessons. While it is true that daily exposure to misery and suffering can drain some doctors, causing compassion fatigue; and leave others hardened and unfeeling, these same experiences can also invigorate and rejuvenate you.

Watching patients die should remind you of your own mortality , so that you remember to learn to live each day well . Seeing very ill patients recover should renew your sense of amazement at the marvels of the human body , so that you appreciate the perfection of your own body every day. Observing friends and loved ones provide comfort and courage to the ill should awaken your own feelings of compassion, so that you remember to touch all your near and dear ones with love every day. To live life to the fullest, we need to recapture our sense of wonder at life daily – and being a doctor allows you the privilege of doing that at close quarters !

It is true that physician morale is declining today, and doctors are hard pressed to find job satisfaction. However, instead of focusing our efforts on trying to identify what is wrong with medicine today, we should identify happy doctors and delve into their secrets. I am sure we all know doctors who still look forward to each day as an opportunity to do good, and to become more skilled physicians. We should try to learn from their successes. Many of these happy physicians may never become the president of the medical association, or grab media headlines , or be written about in House Calls, but they are the true stars of our profession, because they have found meaning in their lives. My personal role model is my father, who is one of the most satisfied people I know. His primary source of happiness is his patients , and they have provided him a major source of personal sustenance. He enjoys talking to them, they enjoy talking to him, and his links with them are deep and personal. Even more importantly, I have learned that professional satisfaction does not come from acquiring money, but instead from gaining “social capital” through community ties. He has numerous extracurricular activities , and is very well connected with his family, friends and neighbors, and these social bonds contribute enormously to his satisfaction.

The first rule for being a happy doctor is very simple – it simply means caring for your patients. Treat all your patients like VIPs – whether they come from Dharavi or from London . Remember that the relationship with our patients is at the heart of our professional role – and a healthy doctor-patient relationship can nurture both patient and doctor ! Medicine is really about service, not science - and the true meaning of medicine is found in the relationships we have with our patients. Savor your patients. When a patient thanks you for your work or says that you've become like a family member, stop and relish that moment. Those moments are the real reward for being a doctor, if you can slow down to let them in. When it comes to getting positive feedback, no profession in the world comes close to medicine ! The joy of medicine is in doing good , which is why patients still confer a special status on us – we need to prove ourselves worthy of it..

Find an area of special interest in your field which you enjoy, and acquire a depth of knowledge in this focused area. Once you've mastered an area, then master its intricacies. Not only is it personally rewarding, it'll be professionally rewarding, as well. Your colleagues will refer problem patients in this area to you ( allowing you to become even more expert in the topic), and you will also acquire a reputation amongst patients as being very good in this area.

If you find your practice has become boring, tedious and monotonous, you need to recharge your batteries. Be willing to do something new, even if it involves a risk – after all, if you continue doing the things which bore you, the situation will get even worse ! You can consider hiring an assistant, to take care of the parts of medicine you find boring, so you can concentrate on what interests you. Other doctors have rediscovered joy not by narrowing their scope but broadening it to encompass a new area of expertise – for example, by exploring alternative medicine, such as acupuncture, homeopathy and chiropractic.

Try to publish and present your clinical experiences. This will force you to read the medical literature and provide intellectual discipline as well , as you have to carefully document your experiences and answer your colleague’s queries. Advances in medicine depend upon clinical acumen, and if we apply scientific rigor to our clinical experience , we can all contribute to improving medical practice. Treasure your rare patients and your difficult cases – they can teach you the most !

Develop humility. Often you will find that the reason you are unhappy in your professional life is that you have let your ego get out of control. Practicing medicine can make us feel that we are indispensable, and self-importance is a serious malady that stands in the way of professional satisfaction.

Learn to develop interests and friends outside medicine. While it is true that medicine can be a demanding mistress, don’t let her take over your life. Good doctors are well-rounded individuals , who have an open mind and are curious about everything. Having outside interests will not only make you a better person , it will also help make you a better doctor, as you apply what you learn from other fields to your medical practice. For example, I enjoy playing tennis, and have found that learning how to serve has helped improve my surgical skills by honing my hand-eye coordination.

Do some charitable work – for example, offer a free clinic once a week. One of the best ways of feeling good about yourself is by doing good for others , with no strings attached. The gratitude of the patients you see free of charge is worth much more than any amount of money . As a doctor you have many opportunities for being altruistic – make the most of them !

Don't make the mistake of equating wealth with happiness - the pursuit of wealth only complicates our search for happiness. . As physicians, we should be grateful that we get the opportunity to make a positive difference in the lives of others every day – a goal most humans aspire to. Be thankful daily that you can help others - expressing gratitude is a powerful tool in the search for contentment and self-worth.


Most of us become doctors in order to help others, and all of us get this opportunity to do so on a daily basis, whether we work in Mayo Clinic, or in the heart of rural India. We should remember how lucky we are to belong to such a privileged profession. Even in ancient India, vaidyas were considered to be very fortunate, because their lives offered them the opportunity of fulfilling all the three aims of a good life – dharma ( religious gain, by relieving the suffering of patients); artha ( material gain, by building up a rich practice); and kama ( personal satisfaction, by curing those whom he loves and respects, and by acquiring fame for his expertise). This is as true today as it has been through the centuries ! Medicine is a wonderful way to make a living – be glad you are a doctor and make the most of your profession – for your sake, and for the sake of your patients !

Is there anything I can do to increase my ovarian reserve ?

When a girl is born , she already has the entire stock of eggs she is ever going to produce in her life. Unfortunately there is no new egg production in the ovaries after birth , and we cannot coax the ovaries to produce new egg cells. During an IVF cycle, we just grow some of the eggs which are already present in your ovaries.  Please do not believe the stem cell scam for increasing ovarian reserve – it is not sound science !

What is a good embryo ?

A good embryo is one which becomes a healthy baby. Unfortunately with the embryo selection methods available now, it is hard to predict which embryo will become a baby. Grading embryos according to their appearance under the microscope is not fool-proof. Sadly, most embryos fail to develop into a baby because of the genetic defects they carry. Recently, a technique to screen the embryos for chromosomal defects , which allows the doctor to transfer only those embryos which do not have chromosomal defects , has been claimed to provide better pregnancy rates after embryo transfer. It is called comprehensive chromosome screening (CCS). IVF success rates are likely to increase in the future, as these technologies mature and improve.

What are antral follicles ?

Good ovarian reserve in a recombinant gonadotropinstimulated ovary studied with 3D. The use of orthogonal planes and 3D rendering allows a much better visualization of the antral follicles. This image shows the typical asynchrony. courtesy : jaypeejournals.com

 

Antral follicles are small follicles ( ranging in size from 2-7 mm) which are present in your ovaries , and can be counted using a vaginal ultrasound scan during the earlier part of your menstrual cycle (day 2 –day 5). These are the follicles which develop in response to the FSH injections given during an IVF cycle. The number of antral follicles in your ovary gives a rough estimate of the number of eggs that will be retrieved from your ovaries  in the IVF cycle. The actual egg yield will also depend on the dosage of FSH used to stimulate your ovaries – and how well your doctor monitors your superovulation ! The greater the number of antral follicles , the greater will be the egg yield. A woman with a normal antral follicle count usually has good ovarian reserve and is more likely to produce a decent amount of eggs which are of good quality . This is why her chances of success with IVF are high too. Women with poor ovarian reserve tend to respond poorly to ovarian stimulation drugs , and their egg yield can be low. They have a poorer chance of success with IVF.