Cycle 3 of ICSI at Manipal followed by FET

So the cycle 3 of ICSI of Manipal went the same way.  Starts with a briefing by Dr. Bina.  Then the efficient Dr. Manju Nair takes over (there is another junior doctor who came in the place of Shyamala who scared the heck out of us.  She just does not come across well).

One thing to note this time was that the oocytes became ready pretty fast this time (no of days of stimulation).  Same number of eggs were retrieved and for the first time, doctors said that the oocytes were good and not "average".  One incident happened which bothered me.  Egg retrieval and embryo transfer are typically the stages where Dr. Bina does the procedure.  We pay the big bucks for her, after all.  In our case, Dr. Bina was not in the hospital in time (there is a very strict time period between ovulation induction and oocyte retrieval - 35-36 hours).  So Dr. Manju did the retrieval.  Everything went smooth, and I am sure Dr. Manju is skilled, but I was disappointed in not receiving even a mention of this from Dr. Bina.

Three good embryos resulted.The uterine layer was not thick enough, so once more, the option was FET.

The FET cycle has been described, except for us, in the first attempt a uterine polyp was discovered.  Then a hysteroscopic polypectomy had to be scheduled.  My take is that all the hormones being used had a role to play in the polyp developing.  They also made some changes where the pitutary suppression was not done this time.  it was natural cycle FET. Anyway, eventually, we were able to do a FET, all embryos survived the freezing, and in due course discover ourselves to be pregnant!

For us however, the joy of pregnancy was diluted by a strange problem that occurred almost simultaneously.  Without going into the details, let me just say that it was a disaster for us.  We do not know why whatever happened did happen.  I am also not too happy with the way Dr. Bina handled the situation, in terms of some of her inputs to us. I do not want to go into details, but only share an opinion.

Anyway, we were pregnant and initially everything appeared okay.  However, in an ultrasound scan, a possibility of a genetic anomaly was discovered along with other problems.  After further testing, very serious, life altering, incurable problems were discovered. We were forced to make the hardest ever decision on saying good bye to our child considering the sheer magnitude of issues.

The second IVF/ICSI at Manipal (MARS)

Eventually, after couple of months, we decided to and registered for another ICSI cycle.  This time, Dr. Jyothi opted for a different approach. The first time, she had given growth hormones in addition to stimulation to increase the number of oocytes retrieved.  This time, the philosophy was different: the objective was quality over quantity, so no growth hormones were given.  We went through the cycle and when it was appropriate, the oocytes were retrieved.  There were three oocytes (eggs) retrieved) which fertilized and started growing in the incubator.

However, there was a hitch. Our progesterone levels came a bit high when measured before inducing ovulation.  My understanding here is as follows.  After ovulation, normally the progesterone levels climb causing a change in the endometrium (lining of the uterus).  If this happens too early, the endometrium can start changing too soon and not match with the fertilized egg.  Oh bummer.  So a decision was made to freeze the eggs and do the transfer in a fresh cycle via "Frozen Embryo Transfer" or FET to give the embryos their best chance.

It was a tad disappointing, but that was okay.  Only fear was if the freezing would cause issues to the embryos, given our low number. Few of them do not survive the freeze.  However, the windom was that the embryos that survive the freeze are more robut and have a better success rate as well.

Another note was that before this cycle, we had done an AMH test and found a small improvement to a reading of 1.2.  Still below 2, but 1.2 was better than 0.8!

Few other notes about Manipal: This is a more busy clinic, though Dr. Jyothi had a smaller number of patients.  Dr. Bina Vasan was the busy doctor here with a huge line of patients.  Dr. Manju and Dr. Shyamala were the assistant doctors who did most of the hard work and kept track of things, did the scans etc.  However, in true fashion, Dr. Jyoti kept tabs and things and was up to date.  Similarly, after anesthesia following oocyte retrieval, she checked in with us in the evening and so on.

Another bummer that happened was that we had an unrelated health issue come up which meant that we could not go back for embryo transfer for 2-3 months while sorting that out. 

Transition to Manipal Andrology and Reproductive Services, aka MARS - the DFI suprprise

Our first IVF was in Aug 2011. We went in to consult with Dr. Jyothi at MARS late 2011 to discuss our options. She preferred that we take a break of few months to let the drugs wash out of our system.  This is one area we have found a difference in philosophy.  Many doctors are ready to do cycles back to back, if required.  Dr. Jyothi is more conservative when it comes to things like this.

She had me go and do one extra test on my sperm called the DFI (DNA Fragmentation Index). Everybody's sperm has some DNA damage due to oxidizing free radicals and such.  If a large number of sperm have this DNA damage, it reduces your chances of successful conception, though there are people with high DNA fragmentation who went on to have babies without treatment.

This test result for me was a bit shocking.  Firstly, the DFI number was very high. In addition, the sperm motility and morphology numbers came out poorer than earlier.  I was surprised because all the tests on sperm in other places (Gunasheela, Sure) all came back with reasonably normal parameters.  Anyway, after this test I was asked to go and consult Dr. S. S. Vasan who is the andrologist and head of the center.  Dr. Vasan got me to do several hormone blood tests and an ultrasound of my testicles.

He finally told me that the reason for my high DFI is a varicocele which is like a swollen vein in the scrotum.  Since blood flow is impeded, the temperature in the testicular region goes up and causes the DFI increase.  As the reader may know, maintaining testicular temperature is critical in getting sperm production right.

Luckily, there is a simple method to improve DFI which is to take antioxidants.  Dr. Vasan prescribed some injections and some hormone tablets followed by a course of anti oxidants to reduce the DFI.  This worked well and after 45 days or so (sperm takes 60-70 days to mature in the testicle), my DFI was much better.

General reactions

My general reaction to the whole deal was not altogether great.  Dr. Vasan is a man in a hurry.  He will work at jet speed and prescribe medication, but does not do a great job of explaining what does what.  Normally I have found google to be a good tool to understand the prescribed medication and correlate doctor's statements, but here I was not successful at understanding what was going on. The varicocele size from ultrasound test was small.  From what I read online, it was small enough that it did not strictly count as a varicocele

The difference in sperm test results of motility bothers me.  The high value of the DFI bothers me.  Further, some of the medication he prescribed caused some amount of testicular pain.  I stuck with it in the second IVF cycle, but in the next one, I became my own doctor and used a different concoction based on online research. I used vitamin C, E and Cod Liver Oil.  Vitamin C at 1 g a day (500mg x2).  Vitamin E (Evion at 2 x 400 mg a day). Cod Liver Oil 2 tabs x 3 times a day.  That seemed to work pretty well based on subsequent test results. I also started to keep my phone in my shirt pocket instead of the pant pocket.

Disclaimer: I am only sharing my personal opinion and my versions of my experience here.  Clearly, if you go and ask doctors who I may express opinions on, they may agree or disagree to my statements.  The thought process is that this would be helpful and a reference point for some among the many that go through this infertility ordeal.