Monday, March 31, 2014

I am 42, what can I do to grow my follicles !


Question:
Need your advice - IVF . I have been on menopur 75 iu and gonal f multi dose 450 iu from 3/7/14 to date taking 225/0 in the morning and at night. I am 42 years old. Yesterday my scan and blood test showed estrogen level of 69 with 4 follicles. I have one ovary and the size of the follicles are 7.6, 6.4, 6.1 and 6.0 the nurse said they are not growing fast enough and we should cancel on Saturday I.e tomorrow if the estrogen level does not increase and if the follicles don't grow.  I need your advice.. I decided to give it my all and continue to take the meds ...I am also taking royal jelly,  maca powder, flax seed in order to improve my levels by tomorrow.  Any other suggestion.  I want to have a baby. I hope you will reply before my visit tomorrow.  I am off from work,  I am unable to focus had to leave work as I was crying too much. I don't want to loose hope this is my only chance. 
Answer:
I understand your pain. Please calm down ! Getting tensed and crying will not help a bit. I understand it hurts, but you have to have realistic expectations about your situation. You are 42 years old. You want a baby badly and decided to try IVF. When they stimulated your ovaries they found that your ovaries are not growing any follicles even after giving lots of gonal F ( this is the highest dose anyone would use ). Now you are heartbroken that your dream is slipping out of your hand and you are desperate to find out whether you can do something to grow your follicles, isolate few eggs, get some embryos so that you can become pregnant. Your wish is very much justified BUT your body is not cooperating. Your heart yearns for something but the reality is different. You adamantly hoped that everything will go on well but now it is not so. Why not accept the reality A ? Then the pain gets lesser and you can think clearly of your next move.

A woman's ovary runs out of eggs as they age and that is what has happened in your case.Since your ovaries are not growing follicles even after using maximum dosage of gonal F, it is clear that your ovaries have no more eggs in them. A, I am really sorry to say this - there is nothing you can do to grow the follicles or to coax your ovaries to produce eggs; the present scientific development is not intelligent enough to help your ovaries to produce eggs. Just because you can't produce eggs it doesn't mean you can't enjoy a pregnancy or have a baby. You just have to embrace other treatment options that are available. Using eggs of a young woman will give you a very good opportunity to conceive and enjoy a pregnancy. If you ask me whether you would be able to love a baby which doesn't carry your genes - yes you will  ! Actually our genes are not that important as we might think. Just close your eyes and imagine what will happen 100 years from now -  none of us will be alive, NONE. Is it then worth worrying about your genes ? :) Any baby you love will be yours. So please do not lose heart. Do not get afraid and upset tomorrow if the doctor says that your estrogen did not rise as it should. Ask him whatelse you can do to have ababy?

I am sure you will not like my answer but this is the bitter truth. I wish you lots of good luck in your endeavor! May all your wish come true!

Be strong and happy!
Reply:
I appreciate your reply. I will ask about donor eggs.  I am trying to stop crying but it's hard. 
Reply:
Manju: Thank you for setting me straight.  I just left the doctors office... the result was that we cancelled.  But I came to my senses and accepted it all and decided to continue with donor egg. I guess even though I don't know you....your email helped me a lot. Thanks again!!

Saturday, March 29, 2014

How to cope with a failed IVF cycle ?





Question:

 Dear Manju,

I dont know where to begin. 

With great hope and faith I approached Dr. Malpani for donor egg ivf. As per schedule they retrived 12 eggs from the donor and 10 fertilised and out of these 9 were A grade embryos. My endo thickness on 10th day was 12 mm and on Day 14 they did the ET. 

During ET they transferred 3 good embryos- one morulla, one 10 cells and one 8 cells compacting. After two days we returned back home. After ET progynova and suppository continued. On day 7 of post ET I noticed little spotting. I thought it was implantation bleeding. But then next 2 days it continued and turned to pink/redish discharge. I asked the Dr. and he suggested me to double the dosage of progynova and suppository. But still the bleeding continued and on 11 day I started to wear pad ( Sorry for my language). I emailed to Dr and he suggested me to do the Hcg next day i.e., 12th day and it came -ve. (Today)

 I am upset and frustrated now. Dont know which path to take. I am not able to decide what to do now. I dont know what went wrong. Dr Sai, Ali and Dr. Malpani including me and my husband were very happy about the embryos. Dr. Anjali said " your endo thickness is good. why you are not getting pregnant. You should get pregnant this time" 

I dont know what went wrong? 

 Sorry I cannot continue.. 


Answer:

I feel your pain. I have gone through this pain for more than 7 times now and the most recent ordeal I went through is horrible. If I can be strong, you can be too. I agree it pains, just cry your heart out. This pain will subside. Take your time. Tomorrow will not be like today and one month later it will be much better ((((((( hugs)))))), lots and lots of. I wish I could be nearby you to hold your hands during this difficult time.

N, hope and faith can't help much with IVF success. You must have realistic expectations about IVF. Do you think women of younger age conceive in their first attempt (either in bedroom or during IVF)? Science of IVF is not fool proof. There are so many variables which needs to be perfect for implantation to occur and many of which are not in anyone's hand. The embryos must be good enough, your endometrium should be receptive (thickness of an endometrium doesn't say how receptive it is!), the ET has to be perfect and after transfer your embryos should grow and attach. It is just like a probability game. Since you are using donor eggs your chance of success was brighter and still is. When doing IVF, please give 3 tries – with the same clinic, provided you are confident about their competency and most importantly their ability to create good embryos. 60 % women conceive within 3 IVF cycles. The remaining 40 percent need more attempts and some never conceive - no one can pinpoint the reason! 

N, I am sorry that everyone's positive words have raised your hopes too high. Just because the embryologist says you have good embryos and just because your doctor says you have good endometrium, it doesn't mean you have 100 percent chance of success. Every IVF cycle gives you only 40 - 50 percent success even if everything looks perfect. I am sorry, really sorry I didn't know that you didn't expect a failure. Otherwise I would have warned you before.

I agree that the amount of money spent and the efforts made and the dreams you had will make coping difficult. All I can say is - do not give up! It is our ill fate that we have to undergo so much financial, emotional and physical pain to get a baby. All that we have in our hands is to make this journey as pleasant as possible. There is something to learn, there is something to expect for, there is something to be happy about, there is something to be proud of (who will be able to tolerate such a suffering!) even during this difficult journey. Use it to grow spiritually, enjoy your time with your husband, use this time to make your relationship stronger, develop more love for your life, and see everything with curiosity and amazement - this suffering then becomes somewhat pleasant. Never think a baby is the ultimate happiness. There are many ways to have a little one still, do not give up until you have exhausted all your options. Never fall into depression, take care of your life, never let your happiness slip out of your hands in your quest to have a baby. All will be well! 

I hope my words will help you, lessen your pain a bit.


Reply:

Dear Manju,

Thank you so much for your response and advice...I truly appreciate it. I especially like what you had to say about there being no mistakes in life, only lessons.

" All that we have in our hands is to make this journey as pleasant as possible. There is something to learn, there is something to expect for, there is something to be happy about, there is something to be proud of ( who will be able to tolerate such a suffering! ) even during this difficult journey."

I have never heard that before and I just love it. I am feeling much better now. I will stay in touch and let you know what we decide to do....probably going to take a break and then we'll see about it in June. It's tough to think about doing it all again....but I just need to remain strong and we will get through this.

Thanks and God bless you.

 

Thursday, March 27, 2014

A query about Malpani Infertility Clinic


This query which I got from one of my blog reader is very honest. Many will hesitate to ask these questions but she was so good in putting her doubts in words.

Question : 
 I am a regular visitor of your blog and found very useful information.  We are facing fertility problem since long. We are living in Delhi and belong to a medium family. Two failed IVF(ICSI) cycles in Delhi.  Reason for IVF failure was poor embryo quality. They were little  fragmented. So doctor suspected my egg quality is poor. I am taking Coq 10 now and planning for next round in November. We are planning for Dr Malpani guaranteed Success program, although it cost too much , which is bothering us. To manage such a large fund is really very difficult for us, but we will try to do. As we became so much frustrated with this issue and want to give our  best and final. Here I need your opinion as an elder sister, i am 32 now. I have read about doctor Malpani and one of my friend told me that he is too commercial, but whenever I  saw your blog I was convinced you would tell me the truth.
Now my decision depends on your reply , so please try to answer my queries- 

1. Does Dr Malpani pay attention to all his patient or only to  some specific VIP patients like you who is a blog writer((Please do not get angry))
2. My husband has motility issue, does it make our case weak ?
3. Does IVF protocol make any difference in embryo quality.
4. Is it safe to fly after embryo Transfer. 
5. Is it ok to do follow up with other doctors after positive pregnancy test.
6. Why did you choose Dr Malpani over others ?
7. Is doctor Malpani commercial ?
8. Do they handle each case on their own or handover to associates ?

How can I contact you by phone.

I am waiting for your reply.
 
Answer :
Nice to hear from you. I appreciate your questions :) and I am not a bit angry ! I am sorry that two of your attempts failed - Is your husband's sperm motility issue the reason for IVF ? Can you please send me the photos of embryos transferred to you ? This will give me a better idea about their quality. You should remember quality of an embryo also depends on the competency of the embryology lab. Can you send me the complete details of your IVF cycle in Delhi ? What is your AMH value ? Dosage of meds used ? How many eggs retrieved, how many fertilized and how many transferred ?

 1.  
Does Dr Malpani pay attention to all his patient or only to  some specific VIP patients like you who is a blog writer
 He treats all his patients the same, including me ! I had a chance to see him and talk with him less than 10 mins this time. I had nothing much to ask and my FET is quite straight forward. He gives the same treatment to all his patients and  treats everyone as a VIP. Dr. Anjali does the egg collection and scan, the embryologist , Dr Sai, does all the fertilization work and loads the embryo into the catheter and Dr. Malpani does the consultation and ET.
 
2. My husband has motility issue, does it make our case week.
No, definitely not ! ICSI will give you the best chance for success.
3. Does protocol make any difference in embryo quality?
I think so, because better eggs will give rise to better embryos.
4. Is it safe to fly after embryo transfer?
I did fly after my ET :)
5. Is it ok to do follow up with other doctors after positive preg test.
Sure, you have to !
6. Why did you choose Dr Malpani over others.
1.    I am comfortable with his conservative approach (He doesn't order unnecessary tests and therapies)
2.     He is very knowledgeable (He knows what he does!)
3.    It is very easy to contact him (available 24/7 via e-mail)
4.    He is not over optimistic nor does he promise the moon; he doesn't think he is God or the final authority on IVF. He clearly understands that only certain things are in his hand and does that part of the work well good. They are very transparent in what they do, from embryo photos to medical bills everything is open and documented !
5.    The clinic is so compact there is no need to run around. I felt very comfortable.
6.    I believed in him - this is my intuition! When you select a doctor you can't know 100% about their honesty or competency. Our intuitions play a major role. I like his honest writings and I believed him whole-heartedly. The vibes we create around us (the way think about a person) play a very important role about how the opposite person reacts with us :) I went with good vibes. I didn't look at Dr Malpani with suspicion. Once I selected them I believed them :)
    
7. Is doctor Malpani commercial ?
Every doctor needs money to survive-aren't they humans? What do you mean by commercial? His clinic is in a costly area and he has staff to feed. They charge a bit more than others but it is all worth at the end because of the service they provide. They don't charge anything extra.
8. Do they handle each case on their own or handover to associates ?
    No, Dr. Malpani and Dr. Anjali handle everything themselves. They do not have any assistants.

I hope this helped ! :)
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