Thursday, 30 August 2012

Thus starts my second IVF cycle

After unsuccessfully trying naturally for past 2 months, we decided that we should get onto our second IVF cycle at the earliest possible. After much deliberation, my husband and I decided to go to a different fertility clinic for our 2nd IVF try. We have been visiting this clinic and met the doctor multiple times for her to understand our history on this journey. 
Finally the time arrived for me to visit my doctor and let her evaluate on how my ovaries were doing and what is the protocol to follow which will give me best possible chance.

If you remember I had mentioned that I have low ovarian reserve and during 1st IVF cycle we did not see good results. My fertility expert decided not to give me high dosages of hormones as they would not make much of a difference on my low reserves. The best chance that I have is to stimulate whatever few follicles we see and hope to get eggs from them. And ofcourse with low dosage, I hope the side effects also are less.

She suggested that we should try soft protocol (in medical terms: KATO protocol / mild IVF / mini IVF). What happens in this protocol is that doctors use milder stimulation; which studies have shown can result in higher quality eggs.

We started the protocol which required me to take 150 iu of FSH hormone and clomid. 

On day 2 the baseline scan showed 5 average size & 2 small follicles on my left ovary And only 1 average size and 2 small follicles on right ovary.

A repeat scan after 5 days of stimulation showed that out of the 6 decent sized follicles atleast 4 were growing as desired. Doctor prescribed another 5 days of stimulation. Under normal cases I have heard that doctors stimulate only for 9 days starting from day 2 and on day13 do the egg retrieval. However in my case the doctor added one more day of stimulation because the follicles were showing slow growth.

In my previous IVF cycle, I had been taking the hormone shots in the morning. However, this time I took them at night. The doctor suggested taking them at night, maybe that way they are more effective! One point to keep in mind is that they should be given at almost the same time each day.

In my previous IVF cycle, I was told I have 3 follicles on each ovary; however by the end of stimulation the follicles on the right ovary were not growing as expected So the doctor could get viable follicles only on left ovary. So during egg retrieval, the possibility was from 3 follicles only.

This time was much better. Even though the right ovary had only 1 good looking follicle, this one was growing well And the 5 good sized follicles on left ovary were also growing well. So it seemed like 100% improvement this time :-)

After 10 days of stimulation, the scan showed that the follicles were reaching their optimum size. So I was prescribed Ovitrelle to be taken that night.

Eventually the day of egg retrieval approached. This is Day 14 of my cycle days. 
Pre-OT preparation went smoothly. The nurse was a gentle one and did not hurt me much with the pricks :-)
In all my time in OT was just about 45 mins, during which I was sedated and the doctor picked eggs from my follicles.
After recovering for an hour or two, I went to see the doctor and she told me that they got 6 oocyte out of which she is expecting that atleast 4 will be mature.

Can't explain how happy I feel. Compared to my 1st IVF cycle, this was such an improvement. I kept my fingers crossed for the best to happen this time.

While returning back, I was so happy that I told my husband that we should go out somewhere to eat. I also knew that next few weeks, I will be confined to home so make use of the opportunity while there is time :-)

I am expecting a call tomorrow from the embryologist on how my eggs have done.

Apprehensive / tensed / worried, all these words come to my mind about my state at this point in time.

Tuesday, 28 August 2012

Choosing the right fertility clinic !

One of the most crucial decision while taking fertility journey is choosing the fertility clinic. This will be the place where you will end up making frequent visits, so it better be a good and conducive place ;-) And hence its but prudent to do a thorough research before picking the place where you will be heading for advice on your fertility treatment. 

I spent almost 2 months before I narrowed down to the place I wanted to go for my IVF cycle. Below are some of the criteria that I used in deciding my IVF clinic:

  1. How good is the Doctor at listening? Listening is an art (specially active listening). A very important characteristic of a good doctor (specially a fertility expert). Most of the people who go to a fertility expert are in low morale and low self-confidence. It is very important that the doctor gives you enough time to listen to all your fears, apprehensions, and is able to give you hope. One of the fertility experts that I met was very upfront in telling me that since I am more than 35years of age, I should also look at the option of donor egg. Now I must tell you that I do not have any so-called hormonal  imbalance / tubes / ovary malfunction and I have seen ladies in their 40s having a healthy pregnancy. So such statements about donor eggs even before the doctor gave me a chance to use my own eggs, put me off completely from her. What hope could I get from such a person! Some of the fertility experts that I met were so positive in their discussions that even though they were saying that my chances were low as compared to others but it still gave me lot of hope. I do not want to give up before giving myself a fair chance on trying to get pregnant.
  2. How busy is the doctor? If you are at a place which a choc-a-block full of people and the doctor is there only for an hour or two, she might not give you the due attention. While speaking to her, see if there is an urgency from her side to close the conversation and see you out of her room. I prefer a doctor who will have time for me (and I don't mean to say that she should sit with me the whole day but someone who makes you feel that at that moment you are the only person whom she is to treat)
  3. What are the IVF protocols that the doctor follows and on what basis does she decide which one is best for you. Is she ready to be a little experimental or does she follow everything by the book. I met one fertility expert who told me on day one what kind of medicines will she use on me (this was without even studying my investigation reports); that made me realize that I am a mere statistics for her! Whereas some of the experts that I met said that they can tell what protocol they plan to use after they see some of my reports. Also they mentioned that they keep changing the dosage of the hormones based on what how my body responds to it. This gave me lot of comfort cause as per the fertility experts admitting that science has still not understood female fertility completely so if the doctor is willing to study my response and then keep giving me whatever is the optimum level of hormones I might stand a better chance. I am not just another patient for her, I am someone whom she is paying due attention and time.
  4. Is the doctor reachable in case of any emergency and or for ad-hoc advice. Check on the options of being able to reach the doctor via phone. Some of the doctors are happy to share their mobile numbers also. 
  5. Distance from your place of stay - During the IVF cycle, you will be needed to visit the clinic frequently (atleast 6-7 time during the entire IVF procedure). There are some clinics which need you to be at their place everyday during the 12-14 day procedure duration. So make sure you are prepared for the travel to and fro.
  6. How is the Support Staff? See how the nurses are at the place. I always prefer a place where I see positivity around; it automatically puts you in a relaxed frame of mind which is very important when you are undergoing fertility treatment.
  7. Does the clinic specialize only in fertility OR are they also in general gynecology. I visited couple of places where I found that they had both gynecology & fertility departments with common waiting area. In the first glance, when I saw many pregnant ladies sitting there it gave me the feeling that this place has huge success rate. But when I learned that most of these ladies were the ones who did not have any fertility issues and conceived naturally, it kind of put me off. I realized if I keep coming to this place, I might get more depressed thinking of all the people who very soon will be mothers BUT I will still be struggling with the hope of assisted conception. I dropped these places from my radar as I also doubted on their fertility expertise.
  8. Check on the cost of IVF at the clinic. Some quote different price for IVF & ICSI and some have a common package even if you go for IVF rather than ICSI (which is a much advanced form of IVF). Make sure you understand what will be the additional costs as you go along the IVF path. Some places include the cost of all the scans and blood test Whereas some charge extra for it. Ask the clinics if they do any refund of the IVF package you paid, should there be a situation that the procedure has to be aborted mid-way. 
  9. Check on the success rate of the clinic. However I kept that as last of my evaluation parameter since IVF success is a very individualistic thing. Two people with same fertility problem, undergoing exactly same IVF protocol can have very different results. So for me knowing the success rate is a feel good factor for me but not the deciding criteria.
  10. Lastly, see how comfortable you feel sitting in that place. How comfortable you felt while talking to the doctor.
I visited many IVF centers and checked on all the above factors and in the end decided that place where I wanted to go. I do not know whether the decision is right or not But all the visits that I made to this clinic have re-emphasized that until now my decision has been good.

Thursday, 23 August 2012

Fertility Drugs and more

Going through IVF treatment is hectic as well as emotionally very stressful.

To add to the stress is the daily overdose of hormones which start to play havoc with your mood. I think during my IVF cycle I would have snapped at my husband much more than he actually deserved ;-) And I used to realize that I am being irrational in my out bursts but during those 10-15 days I would explode at just about anything and everything.

My doctor had prescribed me DHEA, to be taken for about 3 months before we even started the IVF cycle. When the IVF cycle started, there were many more medicines that were going into my body everyday (first ivf attempt). I am susceptible to migraine when I get stressed. After I started to take my hormone shots, the first 2-3 days were going all good, however for some reason on 4th or 5th day of my IVF treatment cycle I started to have headache. I had headache for 3 days continuously, and I refused to take any medicine lest it interfere with my IVF medication. Thankfully the headache disappeared on the fourth day morning when I woke up.  I knew I am being super cautious about not taking any other medicine but I didn't want to take any chances.

All through the rest of the days of the procedure, I kept praying that I should not get hit by any other migraine attack.

I read somewhere that headache is one of the most common side effect of fertility drugs. I was lucky I did not experience any other serious side effects, though who knows what is happening inside our bodies all the time!

The other part which caused lot of stress was the trip to the clinic to get my daily hormone shots. It is a barely 5 mins job but the clinic is almost 45 mins drive one-way. So after few days of going to a nurse who can give me my hormone shots, I decided that I will try to administer them myself! I checked with the doctor if she was fine with me administering the injections to myself; and she said she was OK till the time I knew what I was doing. These are subcutaneous shots and don't need the expertise of finding a vein or anything. Easier said than done ;-)

I asked the pharmacist to give me an extra set of syringe so that I will be able to experiment first with a mock trial. The mock went fine, I tried to poke my thigh with the needle and was able to. But when I tried the actual shot, it didn't happen as desired :-( I filled up the syringe as instructed, sanitized the part of my abdomen where I planned to give the shot, pinched a small part of it, then I tried to insert the needle BUT it just wont go in. Maybe I was tensed and scared and was not applying the right amount of pressure. So I tried one more time, a little away from earlier spot as it was hurting and this second time it thankfully went in. Next day I noticed that I had a bad dark blue bruise where I had tried the first time. I thought thats it; I would rather make the travel than get my stomach full of bruises because of my stupidity. So after that incident I made up my mind that no more experiments, I should rather go to an expert rather than trying it myself.

I had watched this video "Subcutaneous Injection" to get the technique, but I guess it needs little more practice and patience.

I wish rather than injections, these come in the form of tablets which I can swallow and get done with it ;-)

Friday, 17 August 2012

You are not the only one

Everytime my thoughts wander to my fertility issues, I end up feeling so lonely and disheartened. Past few months have taken me to doctors much more often than I would have ever imagined. And everytime I have visited one of these fertility clinics, I have been amazed by the sheer number of people I find waiting there.

On one occasion, I couldnt help mention to the doctor how surprised I get everytime I see so many couples and some as young as 25-26 and this is just in the places that I personally visited, there are so many more clinics. I was reading in some newspaper report that in India almost 10 - 15% population gets affected due to fertility issues. On days when I get disheartened, I remind myself that I am not the only one, there are others who have gone through the same pain and have come out smiling and rejoicing the birth of their child !

Fertility problem is such a personal issue that couples find it difficult to even discuss with others in family. On multiple occasions when I have chatted up with others like me at one of the fertility clinics, I found many of them mentioning that they have not even told their mothers about it. Coming to think of it more, majority of this population is well educated, I wonder how do the people living in much smaller cities / towns deal with this issue. There are so many lower middle class people who have to face this problem and for them getting access to a good fertility expert in itself is a challenge. Add to it the exorbitant cost of fertility treatment! One of the fertility experts whom I met recently was telling me that people come to her from far-off places and when they are told that in order to take the treatment they might have to stay in the city for almost about a month; many say they just have barely enough money to stay for another couple of days or only enough to buy a return ticket to their hometown. It breaks my heart to think of all those couples who wish to have a child but do not have means to get good fertility treatment. Most of such people end up going to quacks and burning their money with no result at all (who knows it could increase their problems also).

I feel blessed to be living in a city where I have access to good medical facility. 
I am also thankful of having been born in an age and time where science has advanced so much that it can give people like me lot of hope. Availability of such advanced techniques and more importantly awareness was not even imaginable 25-30 years ago. 
I feel blessed to be capable of taking fertility treatment, it means I can still hope for my wish getting fulfilled.

Tuesday, 14 August 2012

How good are Ovulation Predictor Kits (OPK)

Since the time we decided to give ourselves a break from going to doctors; I thought I just cannot give up on my natural cycle. So we decided to go the old fashioned way without thinking of what doctors have said about our slimmest chances of conceiving naturally and keep the thought that we did get lucky once with spontaneous conception so maybe we can get lucky again.

Now as I have mentioned I have been trying to conceive since past many months, so I thought this time let me try to time it with the help of Ovulation predictor kits. Until now I was using the broad range of days most of the websites help you determine. But the range is so big that there comes a time in between those days that even though you know you have to do it but you are just not in the mood of it or have had a bad day at office and are just not upto it. So many time I might end up missing on that critical 24hrs when my eggs are live and kicking.

So this time I thought of using the ovulation predictor kits. In western countries these are used very frequently however in India I had not heard of them as such even from the doctors. I asked one of the gynecologist about the OPKs and she said the results are not very assured (meaning you could be ovulating but the kit might give you a negative result). And I thought to myself that something is better than nothing. If the pharmaceutical companies making these kits advertise almost 90% accuracy, there is a likelihood that the kit can help me know when my eggs are ready to mingle ;-)

I got 2 brands of kits to test myself with. Unlike the pregnancy test kits where you need to use you morning urine sample; here it has to be sometime during the day. And I literally put a reminder on my phone to sneak away from my desk to go to the restroom for peeing on that stick and test my hormone levels. (I am sure the colleagues sitting next to me must be thinking weird about me, that this female uses a phone reminder to go to the loo :-D)
I started to test from day 13 and continued to test myself for next 6 days But on non of the days did the stick show a positive result. Possibility could be that I started late (the kit said to start from day 11 as per length of my cycles) OR I did not ovulate this time OR the hormone level was so low that it could not be detected by the kit OR the kit is not as good as the manufacturer claimed it to be.

All in all, we did what we have mostly been doing without quite knowing whether today gives me the best possible chance in getting pregnant.

Am also trying to search on what means a "healthy diet" which will enhance my chances of getting pregnant. During all these past weeks / months, I became so aware of the fact that no matter what you do, there are certain things which cannot be governed by your wishes. No matter how hard you wish for it, no matter how hard you pray; it will happen only when God thinks you are ready for it (and there is a possibility that God thinks you are not even meant for it, though this possibility breaks my heart and I don't even know if I will be able to deal with such a possibility)

I guess my best bet is to go IVF way, the natural conception that I had was probably God's way of telling me not to loose hope and just keep trying !

Monday, 6 August 2012

Spending sometime in the kitchen

Now I must tell you that I am not at all a kitchen's person (if the only way to a man's heart was through his stomach; I would have failed miserably and would still have been single)

But off-late, I realized that I was getting more keen on wanting to experiment in the kitchen. This could be due to the fact that I have lots of time with me these days, having quit my job last month!

I have been avoiding talking to my friends / relatives for fear of the question "so do you have something new to share with us" 
Specially coming from "well-meaning" aunts / aged relatives; along with the advice that I should not delay it any further. I wish there was someone telling them that certain things happen only when (and if) they are meant to be. I have to control the strong urge of telling them to mind their business. 

So basically with nothing much to do with my time, I turned my attention to kitchen :-)
Have been experimenting with my microwave; so I am sure needs no guesses, have been doing some baking past few weeks. Tried cookies and puffs which surprisingly came pretty decent; and I couldn't help pat my back for it :-D. 
Tried baking honey & raisin cookies, masala cookies (these were yumm), orange cup cake, cheese knots.

On Saturday; tried chocolate brownie and it did not turn out to be as I expected it. Had little too much chocolate, which meant it didn't set as it should. Incidentally had a friend of ours visiting that same day and he is a person who has a sweet tooth; I was glad that he scooped up 2 large slices of the brownie (which was close to looking like double chocolate cake rather than a brownie)

Today baked 2 batches of butter cookies to give to my friends kids; I hope they like it.

Next on my radar is to try date&walnut cake and pineapple cake (eggless).

Someone once said cooking is a good stress buster. Had not quite believed it since it was not often that I entered kitchen until now. But now I too can vouch for this statement :-)