Tuesday, September 9, 2014

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:
2X 6-CELL Grade A
1X 4-CELL Grade C

Day 5 Grading of your embryos as follows:
1x blastocyst grade 1AA
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.

Tuesday, September 2, 2014

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 (absistence, 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!

Saturday, August 30, 2014

My follicles were growing but my eyes were wet!

On the day of my first ultrasound, I entered the clinic. I am no more a stranger there (but it is not so amusing to visit an infertility clinic often); people were greeting me with a smile. I sat there waiting for my turn to be scanned. I could hear Dr’s voice in his consulting room. I was looking at the baby pictures on the walls as usual. I started to think of my children. I dreamed of bringing them both to the clinic, to meet everyone who took part in creating them. I always imagined how happy those moments would be, but, now, I am sitting in that same place with empty arms and an aching soul! Suddenly all my happiness vanished, I felt gloomy; an unknown fear gripped me strongly. I felt miserable. I wondered what I am doing there! Like in snake and ladder game, I was back to square one when I was thinking that my destination is at arm’s reach. I realized the cruel joke life played on me much more intensely at that moment! I had tried 6 long years to achieve my dream and suddenly it was taken away from me in the most unfair manner. What is the guarantee that such a thing will not happen again? How long will I be able to play this IVF roulette? Why I am not provided with the ease and security of normal conception? What is the guarantee that I will produce enough eggs and embryos, what is the guarantee that I will become pregnant again?  Even if pregnancy happens, will I have a healthy child in hand? What gave me the courage to try this stupid stuff all over again? My eyes started to tear. I tried hard to concentrate on my smart phone. Dr came out of his room, and I tried even hard not to look at him. I was sure that, if I do so, I will cry. I expected that he will greet me, say hi and ask how I am. But he just carried on with his work. That was even more hurting. He didn’t even say hi! It brought more tears.

Dr. Anjali came. She was as cheerful as always. She gave me a warm smile as she entered her room. Sister Mary called me in. The moment I entered in, I broke down. I started to cry. I felt embarrassed but I had no control over my crying spell. Dr. Anjali did the scan; she said that everything looks fine and showed me the growing follicles. There were many. There was one follicle which was well ahead of the others. I was a bit worried whether this lead follicle will suppress the other small ones. But, there is nothing more I can do than to just wait and watch. Dr. Anjali called Rajender inside and explained him the scan picture. I was asked to continue the same dose of menogon (300 IU) Dr. Anjali said, ‘we are sorry, it was really an unlucky happening. We were shocked when we heard about your loss’. She asked me, ‘is it still painful?’ I replied, ‘this place is painful for me, I have gotten over it (really!) and sometimes the pain is unavoidable’. She said, ‘try to forget it and move on’. I smiled and came out of the room. We went to the reception to buy some medicines. 

Rajender was looking at me. He understood that I cried. He asked me what happened. That was enough to trigger my crying episode again. He was so used to this. I just went on shedding tears. He said, ‘Manju, there are people around you, stop crying’. I told, 'Dr didn’t even talk to me’. He said , ‘didn’t you see, he is busy’. I replied, ‘but how much of his time will be wasted if he asks me how I am!’ Rajender said, 'when you went out of the room, Dr came outside, he did greet me'. My sobbing got even more uncontrollable, ‘see, he did talk to you but he didn’t talk to me’. He looked at me as if I was mad and he realized too it was a waste of time talking to me, consoling me. Sister Lizzy gave me that day’s injection. I haven’t stopped crying yet. She was curious to know what is going on. She asked me, ‘aren’t you responding well to medicines, aren’t your follicles growing?’ She said, ‘don’t worry; you have taken medicines just for four days’. I told her that my follicles were growing nicely. She looked at Rajender. He was forced to respond and he said, 'she is crying because Dr didn’t talk to her'. For the first time I came to my senses, felt ashamed. I stopped him in between and said, 'nothing sister, I am a bit depressed'. She told that it is very normal to feel so because of all the medicines I was taking, might be she was right! She consoled me by saying, do not worry, all will be well. I said to myself, 'yes, all will be well!'

We came out of the clinic. I wanted to go to marine drive, so we went and sat there. I was getting back to normal. My fears eased a lot. The vast, roaring sea always brings calmness within me. I was watching the huge crowd in that area. There were so many different people and everyone must be having their own world filled with struggles and happiness. I was thinking, what for should I worry. I am following my dream and that makes my life interesting. Life is more beautiful when there is a challenge to face. I must be proud of myself; I am strong even after going through so much. Living in the present moment is the best thing I can do. I don’t know what tomorrow holds for me. I do have problems in life like everyone else and I have learned a great deal out of it. Those lessons have helped me to enjoy life even better. Hard times in life have taught me many things than any of my good times. Struggles are what that gives definition to my life.

During the days which followed, I had two more scans. My follicles grew luxuriously and there were many too. My only concern was that of the fast growing follicle. Dr. Anjali said that, it might be just a cyst and we might not get an egg out of it. I was thankful that it didn’t hinder the growth of other follicles. The second time when I went for scan, Dr was not there in the clinic. So there were less patients around. I and Rajender had time to have a hearty chat with Dr. Anjali. I told Dr. Anjali how difficult it was for me when Rajender tries to control what I eat too during IVF times. He doesn’t even want me to eat papaya when stimming, and I love that fruit. Even worse, for breakfast, in the hotel we stayed, they always have that colorful fruit. Whenever I pick a bowl of it, Rajender gets restless. He believes that it enhances body heat and it might interfere with the cycle. I have tried to make him see the truth, I told him how nutritious it was, I even fought with him but I could never get back the joy of eating my bowl of papaya. Dr. Anjali was kind enough to explain him why he must allow me to do what I like. She said, ‘the more stress you put on her, it is not good for her during this time. I believe that stress do play an important role in hindering IVF success, but, Dr. Malpani might not agree with this’. This is enough to put my dear hubby at ease. The next day I took an extra large bowl of papaya and sat in front of him. I ate to my heart’s content and he was not bothered too, atleast he tried hard to act as if he was not bothered :) Not only that, he allowed me to eat whatever I wanted thereafter. He was also extra nice to me the entire cycle and I must thank Dr. Anjali for that :)

The day of egg retrieval approached very fast. I took menogon only for nine days. For the last two days I took 450 IU of menogon. This cycle was somehow much easier. I never obsessed about the number and size of follicles. I never asked Dr.Anjali how many eggs I might get. I just took each day as it was; neither did I expect anything miraculous, nor was I fearful. I had copious amount of EWCM and my estrogen rose very nicely. This put my mind at ease.If I remember correctly my estrogen was 2000 plus (pg/ml) before I took the trigger shot (hCG). On the day of egg retrieval I was eagerly waiting to go under anesthesia and I just love it!

Friday, August 29, 2014

I started injections for ovarian hyperstimulatimon

I started to take birth control pill 12 days before my expected menstrual period. I do it to make sure that I get my periods on time. There were times when I wait and wait for my periods to start and it never happened. The reason was, either I failed to ovulate that cycle or I ended up with a cyst which prevented my periods. So, to be on the safer side, I took birth control pills. After 7 days on birth control pills, I started taking lupron too (overlapping BCP and lupron). I stopped BCP after 10 days and continued only lupron. When my period arrived, I started FSH injections on day 3 of my menstrual cycle (lupron continued until egg retrieval). Don’t ask me the name of this protocol. This is what has helped me previous time to get more eggs and so we followed the same. 

I ordered medicines in Madurai. In the beginning, I was scared. Medicines necessary for IVF will not be available in nearby medical shop (definitely not in our village). In a small city like Madurai, I was wondering, where will I go in search for it? But to my surprise, I found that, I could order all the medicines from home. I just have to call the pharmacy and order the medicines and they delivered the medicines to my home safely in a cool pack. I never expected this in Madurai and I was relieved. If any of you staying in Madurai was wondering how to order the necessary medicines, please contact Vasan medicals. They are very sincere, and prompt. They do their best to get the medicines you ask for in time.

I called Vasan medicals and the first question I asked them was which FSH preparation is the cheapest in the market. FSH is available in 3 different forms – Gonal F, Menopur and Menogon. Gonal F is the purest form of FSH. It is a recombinant preparation (genetically engineered) and hence very costly too. Menopur and menogon are prepared from the urine of post-menopausal nuns and hence called as hMG (human menopausal gonodotrophins). They are of course purified (not as pure as Gonal F) and contain equal amounts of LH and FSH. Menopur is a much purer version than Menogon. Menogon is the cheapest. I ordered Menogon. I used Gonal F for my first five IVFs in Germany. My ovarian response to Gonal F is very, very poor. But when I came to Dr. Malpani for my 6th IVF, I was given menogon and I responded so well to stimulation and produced many, many eggs. Might be I needed LH too for getting my follicles to grow. So, when you are given an option to select between gonal F and menogon, chose the cheaper one. Scientific studies have failed to show that one form of FSH preparation is superior to the other.

When I got all the medicines and when my mom saw it, her eyes became so wide for a moment and then watery too. She asked with fear, do you have to inject them. I said, amma I am so used to it. I don’t even feel any pain. If at all I feel something, it is just like an ant bite. From that day onwards I made sure my mom doesn’t see me injecting the medicines. Many women who are about to start IVF ask me with fear, "I am so sacred of injections, will they hurt?” Believe me, they don’t. I think, when compared to all the emotional turmoil we undergo during IVF, pain caused by these injections are nothing, absolutely nothing. If you are afraid of these injections, how will you face the pain of child birth? They say childbirth is the worst pain you could ever feel. I actually like those injections (FSH) for another reason. They are like costly anti-aging drugs (who wouldn’t love to look younger!). This is what my RE in Germany says. I truly, truly believe so. When you take those injections and when your estrogen level starts rising, it is a wonderful feeling, at least for me (I know women who suffer from nausea and other side-effects because of it). I feel like a teen ager. My thoughts change. I become so optimistic, I sleep too well and my skin becomes beautiful. Do you remember the first time you fell in love as a teenager (your first crush), it feels exactly like that! As a scientist, I am amazed to see and feel by myself how hormones could control our brain, our thoughts, perhaps our actions too. Is there anyone out there who could relate to what I say (very curious to know)? So, please do not panic about your injections. They are not as evil as you might think. One another fear most women have about IVF drugs is, “will I put on much weight when I take them?" I have heard women complain – “only after I started using them I became fat”. Please be assured that it is not true! What makes you gain weight is the depression that you go through during your infertility treatment. Because of the stress and depression, you unknowingly increase your food intake. Eating food, especially which are rich in carbohydrates, creates a feel good sensation due to the release of a hormone called serotonin. In order to beat depression, many women get addicted to the effect of serotonin and overeat unknowingly. The best way to prevent weight gain during fertility treatment is to develop creative strategies for beating depression. In my case, infertility actually helped me to maintain a healthy BMI. I understand the impact of body weight on fertility and I don’t want to put myself through another problem, I think I already have enough problems to tackle!

Rajender came to Madurai. I was eagerly waiting for him. How happy I was to see him! The first question I asked him was, “did you miss me?” He replied with a naughty smile, “no, never!” But his happy face said otherwise. I took my medicines for the first four days in Madurai, and on the fifth day we were in Mumbai for my first ultrasound. I asked Dr whether I could come to Mumbai much later, after 8 days of taking stimulation drugs (I thought I will reduce the hotel expenditure there, Mumbai is of course costly!). He was not happy. He said, “If you want to do so, I need a very good digital picture of your ovaries after 4 days of starting stimulation”. I was so sure I wouldn’t be able to get a digital picture (I remembered the not so cooperative doctor in that scan center).  He said, “Manju, don’t be penny wise and pound foolish. It is better we monitor you closely so that we can adjust your stimulation drugs as and when needed, this will provide you with a high chance for having an optimal outcome”. So, we were in Mumbai a lot earlier this time and I love Mumbai.

Mumbai is very beautiful and lively. People are friendly. Shopping areas are amazing. But the most important attraction for me in Mumbai is the Marine Drive area. I just love to sit and watch the sea. I feel so happy and relaxed when I do so. One thing that makes me sad about Mumabi is the wide-gap I see between the rich and poor people. There are overwhelmingly rich people who drive BMW and dine in Taj, and on the other hand I could see poor people, especially poor children who are just left on streets. I really, really feel guilty at such times for pursuing a costly way to have a baby, after all a baby, which are present in abundance in India, even on roadsides (babies, babies everywhere but not even one for me !) Once I was walking near the Taj hotel. The beauty and richness of it always amazes me! There were so many Benz, BMW and Jaguars parked there. Rajender was telling how much those cars would cost. I was hearing it open-mouthed. I thought what a life it is! I wanted to be that rich too. I want to drive a costly car, enjoy my evenings in a five star hotel like Taj and want to live like a queen (who wouldn’t want to!) Caught up so much in those thoughts I forgot to see the foot path. I was about to stamp on something and Rajender pulled me aside and looked at me angrily (It happens many a time when we go out, most of the time I will be too attracted by what I see or will go into dream mode). I looked down and realized that I was about to place my leg on the hands of a 12 year old girl. All my excitement drained in a second. There lay a poor girl, near that richest hotel, clothed in rags and with a small torn bag under her head (I hope it is her only possession). She was fast asleep in that busy roadside (serenity amidst chaos!). I was ashamed of my inability to do anything for such unfortunate children, yet, desiring after things which could make my life even more comfortable. I felt guilty. I was angry and bitter, I cried. People like me, easily blame Karma for such inequality and unfairness, and move on with their life. I realized that there are so many things in my life I must be grateful for. I had a safe childhood, I couldn’t imagine the life that little girl was leading. How unsafe it is for a girl to live on streets! I have a shelter above my head, I have good clothes to wear, I have food not only to satisfy my hunger but I could have food for my enjoyment too. If I start writing the things I must be grateful for I need several, several pages. If that is so, do I have any right to complain about infertility, not being able to have a child?

I went to the clinic for my first scan after four days of taking 300 IU Menogon. I was very happy when I went in. I was eager to meet everyone, especially my Dr. I was very eager to know how I am responding to stimulation. But when I came out of the clinic I was too tired, tired of crying my eyes out!
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