So, after the IUI failed, looking at our low AMH, we decided to go with IVF. There was some prep work for IVF. One was measuring our hormone levels again. The other thing is to look at the uterine cavity carefully. Since we had done a hysteroscopy and laparoscopy at Gunasheela, Dr. Jyothi did not want to repeat it. She was unhappy with the uterine lining which has always been a bit on the thicker side and not of a satisfactory appearance in ultrasound (hyper echoic) according to her. So she wanted to do a DNC (dilation and curretage) to scrape out the endometrium and see if it will grow better fresh. Since Sure does not do surgical procedures (those are done at Cloud Nine which is the parent organization), we had DNC done by Dr. Jyothi at Agadi hospital in Wilson Garden. A small and nice hospital and the procedure was smooth. Not fancy, but nice. The other standard tests are for HIV and such.
Then our IVF started. It started with a day 2 scan and recording the AFC (Antral Follicle Count) in each embryo. Then the stimulation started. Given the low AMH, the ovaries were not expected to be great responders. (Somehow are AFCs were always reasonable). So we were given high doses of Gonal-F and a growth hormone. This consisted of injections every day followed by scans every few days to see how the follicles were developing. When the follicles grew higher in size the scan frequency became more frequent and after a point another injection was added to prevent accidental ovulation. The doctor would do E2 (Estradiol) tests which are an indicator of quality of the follicles. If I understood correctly, after a full cycle of stimulation, E2 should measure about 200 per follicle. So if you have 10 follicles , it should be 2000 (not sure of the units). The other check is the level of progesterone just before the HCG injection before harvesting the eggs. There is data that if the progesterone is relatively high (which sometimes happens under the influence of all the meds), the chances of a successful implantation of the embryo reduce quite a bit. I will cover all this in another post.
Short Protocol
To digress a little bit, I want to point out that this protocol is called a short protocol. The other procedure is a long protocol where injection start around the 21st day of the previous cycle to suppress the pitutary gland and then the pitutary is woken up during stimulation. It really causes the ovaries to superovulate, apparently. Please note that I am no doctor! Just spitting out what I understand. Please do verify what I write here, if you are among the few that read it.
Back to the IVF cycle
Eventually, the doctor decided to collect the eggs. They gave us a shot of HCG to trigger maturation of the follicles and in the 36th hour post injection, under general anaesthesia, they went through the vaginal wall with a needle under ultrasound guidance and collected 9 oocytes (eggs). The whole procedure took very little time, but there was some waiting for the effect of the anesthesia to wear off and for the docs to be sure that there are no side effects like nausea. In the meantime, I went and gave my stuff in a cup... so easy. The lab used the sperm to fertilize the eggs. 6 of the 9 eggs were determined to be adequate (average quality, whatever that means). 4 fertilized of which two stopped growing. We were scheduled for what is called a day 3 transfer. But on the second day, we got an urgent call to come in and the doctor transferred 2 embryos. Turns out that the embryos were not that great and they wanted to transfer them instead of risking all of them stopping growing outside. The human body is a much better incubator than any petri dish. Then began a 15 day wait full of progesterone injections every few days and micronized vaginal tablets of progesterone along with estrogen and a steroid course. Some people are given aspirin to increase uterine wall blood flow, but since my wife is sensitive to aspirin, that was avoided. The steroid is used to suppress the immune system which makes implantation of the embryo on the uterus wall easier.
15 days later, there was a test for Beta HCG which is produced by the embryo implanted on the uterus wall. Our result came back as 5.2 which meant that something is happening, but not high enough to declare a pregnancy. On the instructions of the doc, we continued progesterone for 48 hours and retested. If there was hope, the HCG should have increased, but it stayed at 5 and the doctor declared that this attempt was a failure.
Nothing really prepares you for the disappointment of a negative result. It is like you were trying to push a big heavy stone to the top of a hill and after a lot of effort, the damned stone just rolled back down and ran over your body. A slight negative was that the doctor fell ill nearly coinciding with the end of our cycle... so we really did not have a good debriefing with her. We called her and she informed us that she was exhausted from running across town to the various clinics she practiced at and that she had decided to restrict IVF consultations to only Manipal hospital. We finally went and met her there to review this cycle after couple months.
Costs
The cost of this whole business came to about 1.8 lakhs. There was the package fees, admission fees and tests which came to about 80,000. The cost of the medicines which in our case was fairly high doses was about another 80,000. Then there were other things which I do not remember today, but the total was about 1.8.
Then our IVF started. It started with a day 2 scan and recording the AFC (Antral Follicle Count) in each embryo. Then the stimulation started. Given the low AMH, the ovaries were not expected to be great responders. (Somehow are AFCs were always reasonable). So we were given high doses of Gonal-F and a growth hormone. This consisted of injections every day followed by scans every few days to see how the follicles were developing. When the follicles grew higher in size the scan frequency became more frequent and after a point another injection was added to prevent accidental ovulation. The doctor would do E2 (Estradiol) tests which are an indicator of quality of the follicles. If I understood correctly, after a full cycle of stimulation, E2 should measure about 200 per follicle. So if you have 10 follicles , it should be 2000 (not sure of the units). The other check is the level of progesterone just before the HCG injection before harvesting the eggs. There is data that if the progesterone is relatively high (which sometimes happens under the influence of all the meds), the chances of a successful implantation of the embryo reduce quite a bit. I will cover all this in another post.
Short Protocol
To digress a little bit, I want to point out that this protocol is called a short protocol. The other procedure is a long protocol where injection start around the 21st day of the previous cycle to suppress the pitutary gland and then the pitutary is woken up during stimulation. It really causes the ovaries to superovulate, apparently. Please note that I am no doctor! Just spitting out what I understand. Please do verify what I write here, if you are among the few that read it.
Back to the IVF cycle
Eventually, the doctor decided to collect the eggs. They gave us a shot of HCG to trigger maturation of the follicles and in the 36th hour post injection, under general anaesthesia, they went through the vaginal wall with a needle under ultrasound guidance and collected 9 oocytes (eggs). The whole procedure took very little time, but there was some waiting for the effect of the anesthesia to wear off and for the docs to be sure that there are no side effects like nausea. In the meantime, I went and gave my stuff in a cup... so easy. The lab used the sperm to fertilize the eggs. 6 of the 9 eggs were determined to be adequate (average quality, whatever that means). 4 fertilized of which two stopped growing. We were scheduled for what is called a day 3 transfer. But on the second day, we got an urgent call to come in and the doctor transferred 2 embryos. Turns out that the embryos were not that great and they wanted to transfer them instead of risking all of them stopping growing outside. The human body is a much better incubator than any petri dish. Then began a 15 day wait full of progesterone injections every few days and micronized vaginal tablets of progesterone along with estrogen and a steroid course. Some people are given aspirin to increase uterine wall blood flow, but since my wife is sensitive to aspirin, that was avoided. The steroid is used to suppress the immune system which makes implantation of the embryo on the uterus wall easier.
15 days later, there was a test for Beta HCG which is produced by the embryo implanted on the uterus wall. Our result came back as 5.2 which meant that something is happening, but not high enough to declare a pregnancy. On the instructions of the doc, we continued progesterone for 48 hours and retested. If there was hope, the HCG should have increased, but it stayed at 5 and the doctor declared that this attempt was a failure.
Nothing really prepares you for the disappointment of a negative result. It is like you were trying to push a big heavy stone to the top of a hill and after a lot of effort, the damned stone just rolled back down and ran over your body. A slight negative was that the doctor fell ill nearly coinciding with the end of our cycle... so we really did not have a good debriefing with her. We called her and she informed us that she was exhausted from running across town to the various clinics she practiced at and that she had decided to restrict IVF consultations to only Manipal hospital. We finally went and met her there to review this cycle after couple months.
Costs
The cost of this whole business came to about 1.8 lakhs. There was the package fees, admission fees and tests which came to about 80,000. The cost of the medicines which in our case was fairly high doses was about another 80,000. Then there were other things which I do not remember today, but the total was about 1.8.
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