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20 comments:

  1. What a lovely blog ! I wish I had seen this when I was going through my IVF cycle! This is seriously good- please do promote it so people who suffer the idiotic comments of the less informed or go through emotional upheaval during IVF can find some solace and some logic ! Kudos lady :)

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    1. Archana, thanks for the kind words ! It will definitely help me in keep going.

      Manju

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  2. Hi Manju!
    Any thoughts on empirical use of prednisolone or other steroids preimplantation to prevent the immune system from attacking the embryos? I have tubal factor IF and had failed IVF a year ago with nearly empty follicles that resulted in poor quality embryos. Im on a different drug this time around, with better response. A larger number of ova were retrieved. I want to give this second cycle my best shot. Will empirical steroids and aspirin help? When are they introduced for how long and at what dose? Testing for NK cell or antibodies is not available in my country.
    Thanks, Leona.

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  3. Dear Leona,

    How old are you ? This is the most important information when talking about infertility and IVF. What is your AMH value ? If you are young, you have a very good chance of success. Most women (60%) conceive within 3 IVF cycles. Nothing you mentioned above including aspirin, steroids etc are proven to be of any help; but using steroids or aspirin will not do any harm. So, if you think using them will give you peace of mind that you have done your best, just go for it. Aspirin dosage is 75mg and regarding steroid I have no idea. These medicines are used in the field of ART for a decade now. No, NK cell testing is absolutely not necessary.

    Leona, instead of worrying about all this, just have faith in your body. Select a good clinic, have a balanced diet, be calm (it's difficult I know!), be persistent in your attempts - you will find success !

    Let me know your age !

    Manju

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  4. Hi,
    Maju
    My age is 41.5 years. I have been trying for children form the past 5 years no luck. One 6 week miscarriage. 2 failed ivf. My doctor told that my uterine NK cells are 70mm2 which should be below 20mm2, and referred to NK cells specialist and that doctor done target cell test and confirmed that no such effect to me. i am alright regarding NK cells activity. In my first ivf i got 3 eggs all fertilised and 1 morula tranferred other 2 stop growing. 2 ivf only one egg and perfect grade 1 embryo on day 3 and afterwards stop growing. After my 2nd ivf i started reading all the blogs regarding failure to conceive.Can you give your advice regarding why my ivf failure. Does my age is suitable for having kids or not. I have been on DHEA for 3 months after using DHEA my FSH went to 31,5 after stopping it came back to 12.5.my AMH levels are 0.7 pmol. (this is Indian based readings). AFC is 4. Now stopped DHEA.

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  5. Hi Manju,

    I have been reading your blog for months and I appreciate a lot your courage to share our experiences so others can also know more and take somehow better decisions in this infertility journey.

    I wanted to share with you one thing I've just included on my last 3rd IVF treatment perhaps you know about it and have some more information. This new addition to my treatment was "Seminalplasmaspülung" (more or less translated to "application of semnal plasma) on the day of the punction. I have only found very few web pages in german like following: http://www.kinderwunsch.at/wissenswertes/seminalplasmaspuelung.html
    From that one for example, it seems very important to have the seminal plasma applied inside the vagina around the punction time (my Dr. also told me I could just have sex with my husband the night before), in order to trigger certain reaction in the uterus which could benefit the implantation rate.

    By the way, I live in Germany (I understood that you too?) and doing IVF treatments here.

    It would be great if you could comment this.

    In all cases, I wish you all the luck and the strength for this next IVF trial you are going to do, even if the AMH is already low (but you know, nothing is impossible!)

    Rf

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    1. There is a very old school of thought which says that seminal plasma could make the lining receptive for the embryo. There is no proof that it works and like most empirical therapies which exist in the field of IVF, this kind of treatment also doesn't have any scientific proof for its efficacy. The only way to prepare the uterine lining Inorder to make it receptive is to use estrogen and progesterone. The only important factor that determines embryo implantation is embryo quality. If treating uterus using seminal plasma is safe and cheaper, it is ok to try it if it gives some peace of mind that you have done your best. If you are from India, I strongly advise you to do your IVF cycles in India incase if you don't find success in your recent attempt.

      Lots of good luck to you and thank you very much !

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    2. Hi Manju,

      Thanks a lot for sharing your comments... you are right, as seminal plasma application is safe and cheap, will do it for the sake of it.

      I am not from India, I am a Latin-American and currently checking possible action plans for the next IVF attempt after the 3rd failure. Let me please share my case with you and what I am thinking to do for my next attempt in order to get your valuable opinion:

      . 1st IVF: 2 eggs extracted, both got successfully fertilized. I had to get a hysteroscopy therefore transfer got cancelled that cycle. We tried to grow the 2 embryos up to blasto but they only reached 8 cells and 4 cells.

      . 2nd IVF: Done on the next cycle after the 1st IVF. Again only 2 eggs extracted and both fertilized. This time we did transfer on 3rd day (1 embryo "B" with 8 cells and the 2nd one with 7 cells more "C" type). Finally, 11 days after transfer, I got HCG = 0.7 and 3 days later, HCG=0. From those HCG values, could we say that the embryo got implanted but did not progress further? which could give a possibility that the embryo had chromosomal issues?

      Then we changed the doctor as we thought the previous one was not offering detailed explanations and in general we were not feeling comfortable.

      . 3rd IVF: we included lot of different things on this one:
      - Supplements: I took 45mg DHEA for 3 months and then increased to 50mg for 1 more month before starting this 3rd attempt. Also took Royal Jelly and Maca (both seem to do miracles for the egg quality) but only for ~3 weeks before this 3rd attempt started. And in addition took "orthomol natal" which should contain all the needed vitamins + Omega3
      - I took holidays since stimulation started until I got the "negative" so we could discard "work stress"
      - Seminal plasma application the night before the punction
      - This time, we got 5 eggs but unfortunately only 1 fertilized successfully, another one just did not fertilized, other 2 did not "survive" to the ICSI process, 1 was not mature and somehow did not progress further. I will ask details on the failures on my next visit to the Dr. in couple of days.
      - The only one fertilized egg was transferred after assisted hatching. I had 30mins acupuncture session before and after transfer.
      - Then I had all following during the 2 weeks of "waiting time": Daily injections of Heparin, 1 daily "mini-aspirin" tablet, 1 daily Prednisolone tablet, 3 times a day Progesterone, 3 injections of Brevactid 1500 (HCG) (on the transfer day, 3 days after transfer and 6 days after transfer), 1 injection of Decapeptyl 0.1mg 3 days after transfer.
      And finally negative with HCG=1.2 after 14 days of transfer.

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    3. My thinking is that there might be an issue with the embryo quality (no evidence of my embryos been able to reach blastocyst) or somehow implantation itself (not a single positive). Therefore we are thinking to try the following:

      . To grow the embryos up to blastocyst
      . To have the transfer on a cycle with NO stimulation (frozen embryo or natural cycle)
      . To try natural cycle for 3-5 months while I take DHEA and Royal Jelly hoping to improve egg quality and quantity on the next IVF with stimulation
      . To try DGP once we get ~5 eggs at least to discard genetic issues

      Also:
      . my husband and I are 38 with no kids (yet)
      . we started IVF because the reversal vasectomy on my husband failed. we will try once more soon
      . our gen tests are showing no issues
      . my AMH has been 1.82 ug/l (8th May 2014 with my current Dr.), 2.2 ug/l (31st Jan 2014 with my gynecologist), 3.2 ng/ml (31st Jan 2014 with my previous IVF Dr.), 1.3 ng/ml (8th May 2013 with my previous IVF Dr.)
      . Rest of values in range
      . I have hypothyroidism but it is under control with daily 100 thyroxin and we have been keep my TSH ~1 on all the 3 IVFs

      Well, after such a long message (sorry for taking your time), what do you think on our possible plan for the next attempt?
      Your comments would be really appreciated Manju, thanks in advance!

      Rf

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    4. Rf, I think age is the reason why you have such poor response to stimulation. Do you know your day 3 FSH and e2 value ? Do you know your antral follicle count (AFC) ? Interpreting your ovarian reserve with only AMH value doesn't make any sense, because, your AMH fluctuates a lot.

      I would suspect that your ovarian reserve is declining and hence the poor response to ovarian stimulation. Or, in Germany they use only minimal stimulation protocol ( less FSH to stimulate egg production ) and it doesn't work good for all. How much FSH they used for stimulating your ovaries ?

      Since you are 38 and if you really have declining ovarian reserve, then the possibility that your eggs are genetically abnormal is high too.

      It is good to try to grow the embryo to blastocyst. But since you get only 1 or 2 embryos each time, it is a remote possibility. Genetic testing of eggs is a possibility too but I am not sure whether such manipulation on the few eggs you get could damage them.

      Only an hcg above 10 is considered positive to indicate some implantation has happened. Most embryos do not implant because they are not genetically competent, I do not think you have implantation issues, just defective eggs ( no problem with uterus)

      So, now, there are two possibilities, one is, your doctors are not doing a good job of stimulating your ovaries efficiently ( like they always do in Germany because embryo selection has to be done on day 1 as per German law and hence they avoid getting more embryos ). If this is the case, doing IVF in other European countries or India helps a lot, where they follow rigorous ovarian stimulation protocols, try to get more eggs and embryos, so that they can grow for longer period and select the best embryo to transfer.

      On the other hand, if your ovarian reserve is really poor, if your AFC is less, then, doing further IVFs with your own eggs is just like waiting to win a lucky draw. You might win or might not. If you are willing to, consider using donor eggs. That will give you the best chance for success if you are really running out of eggs.

      Hope this helps !

      I wish you lots of good luck in your endeavor !

      Work stress will not harm your ability to get pregnant and unfortunately supplements will be of no help. You could try DHEA. The dosage is 75mg per day.

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    5. My E2 was 237 pg/mL and my FSH 24 UI/L, on my day 3

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    6. I am really, really sorry to say this but your FSH and e2 clearly shows your ovarian reserve is very poor. Didn't your doctor advice to use donor eggs ? RF, miracles do happen and I really wish it happens for you. If I were you, I would consider using donor eggs.

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    7. To be very honest, I'm not ready for donor eggs :(
      The Dr. in Spain suggested so but the one in Germany didn't as he knew we wanted to try on our own and donor eggs are not possible in Germany

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    8. I agree, not able to propagate one's own genes is a great loss. You might not able to get over it. But, I tell you again, don't make your situation like that of a person waiting to become rich all his life by believing that he will win a lucky draw. By using donor eggs you are giving your hubby a chance to propagate his genes. Moreover, it will help you to enjoy a pregnancy. Afterall, 100 years from now, no one who lives now will be there. We have only one life. I am sure you will love the baby you carry wholeheartedly. Just some thoughts. I sincerely wish that you find success in whatever you decide.

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    9. Thank you very much for your comments and advises Manju, I appreciate your sincere opinion and at the same time the kind words how you tell them. We are at the moment trying to check all possibilities and we would try to keep ourselves open to all the options. Months ago I completely refused the idea of donor eggs but I knew that if this last IVF failed then I should considere it as the potential solution. I wish you all the best in your own journey and will keep in touch :)

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    10. RF, can I give you some suggestions ? For the next IVF , please do not take supplements. You will never know what they actually do to you. I will continue taking orthomol and eat well ( not even healthy, just well ). May I know your BMI ?

      Then, I will transfer all the embryos you get on day 1 itself to your uterus, when they are in the 2PN stage. Since you get only few embryos, why to grow them in an artificial environment ( in a lab). Perhaps your uterus is the best place for them. In this way, you avoid introducing lab errors. You will not have the stress of finding out how they grow in the lab ! I will never grow them to blastocysts. I don't think you need FET. Since you produce only few eggs, your e2 will never get high enough to damage the lining. FET helps women whose e2 gets too high during stimulation. If I were in your situation, I will do this.

      Good luck !

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    11. My BMI is 29.1.
      Yes, our other idea was to get the egg just fertilized and then to make the transfer, we were also considering to use ZIFT (zygote intra-fallopian transfer) for this case to allow more synchronisation between the uterus and the embryo -> what do you think about ZIFT?

      Our plan so far is start this month or next one for natural cycles to avoid the stress of "what if there is only 1 egg..." and continue like that for ~4 months while I take the DHEA. Then we could have the possibility to try different things each time: first we wanted to see if the embryo was strong enough to grow up to blastocyst, if not working then to make a transfer on day 1 and if not working then to collect them until I get the ~4 months with DHEA and go for a full IVF.

      Rf

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    12. I thought this will give us the possibility to perhaps even have more attempts based on our IVF trial periodicity: so far we've got in total ~5 successfully fertilized eggs in 3 IVF the last 11 months. I think it would be also beneficial for me in terms on having peace of mind as I will not put all my hopes and stress in a specific IVF but instead I would know that we plan to do an attempt every month so even if we have to pass for the horrible 2 weeks waiting time after the transfer, still I will not drain my brain during those days thinking what to do if it is not successful because we would have already a plan for the next 4-6 months

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    13. And one question, what would it be a "high E2" that could harm the implantation in the uterus?

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  6. Hi, my iui failed last month although DH's sperm motility was good. Today I tested and found to my surprise that my TSH is 7.9. all other parameters are normal... do u think this TSH can cause IUI to fail ?
    - Childless

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