Happy Birthday , Dr !

Dear Dr ,

Many more happy returns of the day ! May you live a very long , happy and healthy life , and let no harm come near you. May all your dreams and ambitions come to fruition. Keep smiling , and have a very beautiful life ahead !

Thanks a lot for making Anisha happen ! She has made our life happier and purposeful. We learn a lot from her , everyday. Not even a day goes by without wondering how dull and colourless our life would have been without Anisha ! Thanks to you and your team for all the technical help and support !

For me , your presence has been a great support. When I was shattered beyond words by the loss of our twins , the thought that you are there gave me enormous strength. I wouldn't have fought this battle gracefully without your blog , my blog and you. Thank you , you are a wonderful doctor , and moreover , a beautiful human being.

Have a great day , Dr ! Stay blessed , always.

Manju

The Easy Breezy 2WW

A view of Mumbai from the hotel we stayed (Photo courtesy: Virender)

We entered the most exciting yet dreaded part of an IVF cycle - the 2ww! Surprisingly it felt good, I was happy that I got one more chance to enjoy the thrill of a two week wait. Rajender was adamant that we must stay in Mumbai for five more days. I told him that it would be very expensive to stay back but he said, "we are together on our own after long, long time, we have spent a lot until now, what will happen if we spend a bit more?" True, after coming to India we were either in his home or in my home. Even worse, the last couple of weeks I was in Madurai and he was with his parents. We did miss our togetherness without any interference. So, we stayed back. Five days just flew by. We used get up late, have breakfast, troddle around the hotel area, do window shopping, drink tender coconuts, go back to our room, sleep. I also got to eat lots of Jamuns, one of my favourite berries! It is a seasonal fruit and I was lucky to have them everyday. In the evening he would take me to a nearby small restaurant, I would taste different chaat items (an assorted savoury snack) each day, while he would sit and watch me devour it with a cup of tea. He is such a picky eater. He wouldn't touch any food he is not familiar with (even if it is presented to him in the most tempting manner). New food and new tastes never pleases him. I, on the other hand, will never say no to new food varieties; I could taste and even enjoy them all. The agreement between us is, I can eat whatever I would like to, but I must not force him to have it :) He is not greedy for food or for anything else in his life. This attitude of him has made my life much peaceful, pleasant and enjoyable. 

In the hotel, where we stayed, everyone knows us; they even know the reason for our visit. We stay in the same hotel during each of our visit. Everyone there is very friendly. They try their level best to keep our spirits high. This time everyone were saying, "The room you stay now is a very lucky one, for sure you will come with your little one next time". The most beautiful place in that hotel is the terrace restaurant. They have aptly named it as serenity restaurant and the view of Mumbai from there, during night, will be so beautiful. You do feel serene when you sit there for some time.

After five days of stay in Mumbai, we were gettig ready to leave to the airport. It was early morning and I was brushing my teeth. When I touched the inner corners of the mouth with my brush, I gagged violently. Rajender came and peeked inside. What happened was the question in his eyes. This gagging sound, when I brush, was very familiar to him. I gagged when brushing teeth all the five months of my pregnancy with our twins. He got to hear it every day, every morning. We both looked at each other but we dared not to talk about it. I knew what he was thinking and he knew my thoughts too. Then, I was trying to wear a new top which I brought there a week before and it didn't fit me quite nicely as it fitted the day when I brought it. I was quite frustrated. We got ready, went to the airport, and boarded the flight to Madurai. I sat and tried to fasten the seat belt. I looked at my tummy and was shocked! It looked as if I was three months pregnant. Slowly I touched it, it was hard. I remembered that I decided not to take cabergoline, a prolactin suppressing pill, which was prescribed in the clinic to prevent ovarian hyperstimulation syndrome. Rajender told me several times to have it. Dr. Anjali asked me too whether I was taking it after egg collection. But, my stand was that, it makes me depressed and even more I have gone through 6 IVFs and I never suffered OHSS once. So, I decided not to take it!  I regretted my decision. Am I developing OHSS ? I was scared.

We reached Madurai. I was so happy to meet my mom again. On that day night, I had a dream, an erotic dream. I woke up being close to an orgasm. I touched my lower abdomen - is my uterus contracting was the immediate question in my mind. This has happened to me now a few times. It happens during 2ww (when you are on hormones after IVF) or during pregnancy and never on other times. In short, it happens when you are afraid to have sex or orgasm. Is it due to all the hormones we take, or due to long abstinence from sex? Is it our body's way of saying that we are in need of increased blood supply to uterus and hence it coaxes our brain to produce images which ultimately leads to an orgasm? Then, does it mean orgasms are actually beneficial and are we avoiding them? I would be happy if someone could share their experience - does an orgasm in 2ww lead to your BFP? 

Seven days after my transfer I couldn't bear the suspense anymore. I just want to do a pregnancy test and move on. It was becoming unbearable. During all my previous 2ww I got the nerves not to test early. I never tested until 12 days after transfer. But, this 2ww was killing me. I just want the suspense to end so that I could plan further. The thought that I have 6 frozen blastocysts, and the possibility of transferring them to Rita did give me some peace of mind; after all, I have a plan B! So I decided to test on 7dp5dt. Dr told me to buy two different brands of home pregnancy tests to be sure. In the morning I collected urine, added few drops of it to the test kit. I and Rajender held our hands and waited anxiously. And ...

We met Rita for the first time

One day, in the clinic, we met Rita. I was excited to meet her. Rajender was a bit reluctant; I could see it in his eyes. When Shonali came and told us that Rita was waiting for us in a particular room, I became a bit nervous too. What should I talk to her; I haven't prepared anything in my mind. I was wondering how she will look in person! Will she look undernourished, sad, and mature-looking for her age? Somehow that is the image I had about her in my mind. I was even afraid to find a woman whom my heart will reject on the very first look. I am a very intuitive person and I normally develop an impression about someone on the very first look.  As I went closer to that room, I could hear my heartbeat in my ears very clearly, I was excited and nervous too. I eagerly opened the door to have a first look of the woman who will carry our child and I must say I felt very relieved.

The moment I looked at her all my anxiety vanished. There stood a younger-looking, healthy, humble, friendly woman with a warm smile. She looked just like my sister.  There is of course a tinge of anxiety in her eyes too. I held her hand to make her feel comfortable and to make myself less anxious too. I asked Shonali to stay in that room so that she could help us in communicating with Rita, I was not so confident about Rajender's Hindi language skills :) I asked Rita how she was, her family etc.., the normal conversation which could bring some ease between us.  I could understand Hindi, (thanks to Doordharshan, our only entertainment when I was young) so I was following what she was saying. After the initial introduction, she told us that she was sorry about what happened to our pregnancy. She said, 'I was careful enough but somehow it happened'. Before she finished those words her eyes were tearing up. I told Rajender, 'please tell her that it was not her fault. Such things happen to many early pregnancies and she was not responsible for what happened'. When saying this I saw Rajender's face for the first time after we entered that room. I could see that his face has softened. He told Rita what I told him. This conversation brought much more closeness between us. Rita's body language became much friendlier, her face appeared relaxed. She started to open up much more. She was talking about her children. She said that she was married at a younger age and her son was now 12 years old. Her daughter was around 8 years of age. She showed her family pictures which she had in her cell phone. They all looked so healthy and happy. Her eyes were beaming with pride and happiness. She said that her children go to English medium school. I asked her about her husband, whether he takes care of her well. I was trying to read her face. Definitely there was a genuine happiness and content when she said that her husband loves her so much. She paused for a moment. Her face showed some pain.  She lowered her head and said, my husband was doing business; we faced lots of loss in it. We need money now. That is why I decided to work as a surrogate. Even my mom doesn't know this (I was not happy with this statement!). She also said, 'I do not stay idle at home, I do work. I run a small canteen at home'. I could understand that she was feeling humiliated, wondering what I was thinking about her! I told her that she must be proud of herself for coming forward to support her family and help us too. I explained her how priceless is the help she will be doing for us. I told her why we needed surrogacy. I showed my children's picture to her, my 5 months old twins ( our children whom we lost at 20 weeks of pregnancy ), the ones whom I will love and cherish forever. I couldn't stop my tears. Those pictures are very personal ones but I thought I must share it with her, after all, it will tell her clearly about my inability, our situation. I could see her eyes getting wet too and her grip tightening around my hand. 

I gave her a saree which I brought for her and chocolates for her children. Rajender gave her some money and he was thanking her again and again. I could understand him. He was totally overwhelmed by that meeting. He said, ‘we are sorry that you have to go through this trouble because of us, sorry that you have to go through that miscarriage’. I was happy that he was empathetic enough to think about Rita's pain.  I was so proud of my husband as usual.

It was time for my scan. I had to leave. Rita gave me a very warm hug. She said, ' I like you both a lot, I will be very happy to carry your child. When I become pregnant again I promise that I will be extra careful. Do not worry '. She said, 'I wanted to meet you both. I was always asking Dr. Malpani when I could meet you and I am so happy now'.

When I and Rajender came out of that room we felt a lot more happy and confident. Dr was after all very correct in saying ' Manju, you must meet Rita and you will feel a lot better’ 

The day of embryo transfer came. On that day I was present in the clinic too and ...

The much awaited fertilization report

Blastocysts which were frozen on day 6

Growth arrested embryos

This post is going to be easy for me. I will just copy and paste Dr. Sai’s emails.

On day 1, I had 15 embryos. I guess one egg matured in the lab, so there were totally 15 mature eggs out of 19 retrieved, and all were in the 2 PN stage on day 1. This means all ICSIed eggs fertilized, a 100% fertilization rate! This is just awesome and clearly shows the technical expertise of Dr. Sai.

The Day 2 gradings of your embryos are as follows:

2x 5-cell grade A

4x 3-Cell Grade A

6x 2-Cell Grade A

3 Embryos got arrested at 2pn Stage.

There are total 8 Top Quality Embryos on day 3.

Day 3 Grading is as follows:

5 x 8-cell grade A

3x 7-Cell Grade A

1x 6-Cell Grade A

1x 5-cell Grade A

3x 4-Cell Grade A

Day 4 Grading of your Embryos as follows:

3x MORULA

6X 8-CELL Grade A (COMPACTION OF CELLS SEEN)
.

2X 6-CELL Grade A

1X 4-CELL Grade C

Day 5 Grading of your embryos as follows:

1x blastocyst grade 1AA

1X EARLY BLASTOCYST

6X MORULA

2X 8-CELL Grade A 

1X 6-CELL Grade A

1X 4-CELL Grade C

Day 6 (One must keep in mind that, on day 1, fertilization of eggs were done during late evening!)

We are Freezing Total 6 Blastocysts today on day 6.

All morulae Stage Embryos have Become Blastocysts.

Although Exp Blastocyst in image Cap1020 doesn't have great Trophectoderm (the last blastocyst in the above collage) we are freezing it becauze it has got a good Inner Cell Mass.

Altogether I got 7 blastocysts out of 12 cleaving embryos, this means 50% blastocyst formation rate. This is  a great result ! Normally women below 35 years old can expect a blastocyst formation rate of 40%

I am already getting queries regarding how it was possible to get so many eggs. I have no clue too. My AMH was infact low but my AFC count was high. Honestly, I didn’t expect such a good outcome. But, I had lots of faith in Dr. Malpani’s team. Dr. Malpani designed the protocol, Dr. Anjali monitored me very closely and decided when to give the trigger shot, ofcourse, as always, she did a great job during egg retrieval, Dr. Sai was excellent in doing his part of the job and my ovaries cooperated too well! I didn’t take any supplements. Two and a half years ago, when I had my first IVF cycle with Dr. Malpani’s clinic I took DHEA 75mg for 6-7 months and I thought might be DHEA helped me to get many eggs. But this time I took nothing and I do understand now that DHEA might  not have contributed to the improved outcome previous cycle. My first five cycles which I had in Germany were terrible (http://myselfishgenes.blogspot.in/2012/05/my-ivf-journey-timeline.html). I was much younger at that time, had great AMH value, yet, I had only very few eggs to work with.In short, I am very thankful to God and to everyone who helped me to get 7 blastocysts. In the beginning, prognosis of this cycle looked very bleak, but it ended up much pleasant and successful than expected.

There were 6 blasts frozen on day 6. What happened to the remaining one? :) Was it transferred to Rita and what happened thereafter? Keep reading ! :)

Dr. Sai was kind enough to provide the pictures of embryos which got arrested during its development. I have given the pictures of blastocysts frozen on day 6 and the ones which stopped growing in the above collage.

Egg retrieval and Rajender’s sperms

I am sure Rajender will not be so happy to read the title :) Anyhow, let me keep this one, it sounds interesting. On the day of egg retrieval I was so happy for no reason. I was not even a bit worried, might be all the good hormones were at play! I went to the clinic, the nurses started to prepare me for the retrieval. In Malpani clinic they have a gown; you need to wear it when you go for egg retrieval and during embryo transfer. I have gone there four times and not even a single time I tied the gown correctly. Rajender couldn’t succeed too in helping me! If someone of you who go to Malpani clinic, wear that gown and tie it properly, I would easily agree that you are one of the intelligent person in this universe, a genius :) This time I and Rajender wanted to do our best to tie it correctly. We tied it; Rajender did it actually and gave me a very proud smile. I looked at him with great admiration until sister Lizzy came, looked at me, removed the knots and retied it properly :) When sister Lizzy entered the room she told Rajender that Dr. Sai was looking for him. So he left the room. I was wondering what for Dr. Sai called! Usually the sperm collection cup is brought to the room where we are. During our first IVF, in Malpani Infertility Clinic, a nurse came with a big cardboard box into the room where I and Rajender were. I was wondering what it was! She looked at us both, smiled coyly and kept that box in the table, left quickly with a much shyer body language. I was amused by her behavior and when we opened the box there was a sperm collection cup. I still remember that smile and I guess she was new there at that time. Her shy, naughty smile did make that room very romantic ;) 

After Rajender left, Sister Lizzy gave me enema (how much I hate that!) and I was lying down. Few minutes later Rajender entered the room and looked at me as if he would burn me to ashes. I asked him what happened. He burst out – ‘what do you think of yourself? Is it very important to see the sperms?’ I was totally clueless for a moment and then I understood what happened. Actually, I was the one who mailed Dr that I would love to watch the sperms live under the microscope. He must have told Dr.Sai. Sister Lizzy instead of sending me, sent Rajender. I was excited. I asked Rajender whether he saw the sperms. He said with a very rough look, ‘no, I didn’t’. I asked, ‘why?’ He said, Dr. Sai asked me whether I wanted to have a look but I said no. That appeared very ridiculous to me. They were kind enough to let him into the embryology lab inspite of their busy schedule; they were ready to show him the sperms and why should someone be angry for that! Rajender continued to talk, actually he spitted out. He said, I went to Dr. Sai and he asked me whether I want to see the sperms. I said no and came out. Shonali came and she asked the same question to me. Everyone sitting there was watching me (the patients probably!). When I was about to come out, another Sister came and she asked me the same question. I felt very embarrassed, and it is all because of you. This blaming got me too irritated. Instead of seeing the sperms, what for he is coming and shouting at me! I couldn’t really understand at that moment about how he felt, and the reason for his anger, but now I could. He was already too tensed about the sperm giving part. He prepared himself for that five minute job for days (abstinence, healthy food). When Dr. Sai called, he must have gone thinking that he must give sperms and all the little drama that happened there made him very irritated; especially, he couldn’t tolerate the fact that everyone was watching him when he was being asked whether he wanted to see the sperms. Whenever I think of this incident I smile, a happy memory! I dare not talk to him about that incident after that.

When this fight was going on between us, Dr entered the room. I had no clue that he would come. He smiled and asked ‘are you ready to give lots of eggs’. I said, ‘I hope so’. Before I could start the next conversation, he wished us good luck and he was gone. Dr. Malpani talks so fast, and if there is a Guiness record challenge about who speaks the maximum words per minute, I am sure he will easily win! :)  I needed some time to talk to him, I had some questions in mind and more importantly I had something with me to show to him. He just came like a lightening and left. All I could think thereafter was, 'I need to talk to him!'

After sometime, they called me for egg retrieval. I went, and there stood the anesthesiologist. He asked me whether I was afraid and I replied very happily that I love anesthesia and I am not a bit afraid. He again asked whether I am nervous about injections. I said, ‘I have gone through 7 IVFs (as if it was the most proud happening in my life!), I am not afraid of needles’. I saw Dr. Anjali sitting there. As soon as the needle entered my vein I lost consciousness. Someone woke me up, don't know after how long! I felt I am being disturbed from the most happy, peaceful sleep. I said, ‘I had beautiful dreams’. The next question I heard was, 'do you remember them’. I said, ‘no’. Then I asked them, 'please give me more anesthesia, I want to sleep' :) I wish death is similar to going under anesthesia - a long, deep, peaceful sleep. If it is so, I am sure death will be an amazing experience! Then I remember someone asking, most probably Dr. Anjali - 'do you know how many eggs you got?' I kept quiet. Dr. Anjali said 19 eggs. I couldn’t open my eyes but I thanked her and said, ‘ma’m you have the luckiest  pair of hands’. Then I said, ‘I want to talk to Dr’. Someone asked me which Dr. I was angry, I thought very hard (it was very difficult to use my brain!) and said ‘big Dr’:)  I could feel that I was back to my bed, heard Rajender’s voice, said to him that they retrieved 19 eggs and again repeated ‘I want to talk to Dr’, I dozed off. I heard Dr. Anjali’s voice, Rajender’s voice and then after one or two hours I woke up. I could see my husband’s face eagerly looking at me. Obviously it must have been boring and he was waiting for me to get up so that we can go to our hotel room. Happiness is waking up from anesthesia to see the love of your life waiting anxiously for you! I smiled at him and said, ‘I am very hungry’. 

After getting dressed up, I said to Rajender, ‘just wait for a moment; I will be back in few minutes’. I told Sister Mary that I want to see Dr. Sai. I was still in half-sleeping mode. I held my forehead with my hands and sat in the waiting room until Dr. Sai came out. I asked him, ‘can I see the sperms?’ He said, ‘wait a moment’, he went inside the lab and called me after some time. He asked, ‘do you want to see your husband’s sperm?’ I said any sperm sample would be fine. He took a sample from Rajender’s sperm, mounted them on a slide and showed those little swimmers. I was so happy to see them live. They are like tadpoles and were moving constantly, at least most of them were. I thought, if Rajender could see this too it would be wonderful, but, I had no guts to start the sperm topic again to him :) I looked around the embryology lab; Dr. Sai must have been busy working there. In the music system, which he had in that room, devotional songs about Sai Baba was oozing out making that place much more peaceful and desirable. I did feel comfortable that Dr. Sai will be handling our eggs and sperms and creating our embryos. He actually does the most important job, the job of Lord Brahma – the creator!

Yes, I got 19 eggs. I learned soon after that, 14 out of 19 eggs were mature. I and Rajender were happy. We have crossed one hurdle successfully! Will I get enough embryos on day 5 so that we could do ateast 2-3 transfers to Rita; this was the nagging question in my mind! I thought, I will be very happy to transfer my embies to Rita. We met her during one of our follicle growth scan and we liked her instantly. More on that soon!