Friday, November 13, 2015

Can you point out all the errors this patient and her IVF doctor made ?


I received this email from a desperate patient .

I am heartbroken, My IVF cycle failed. I had all my hopes on this and now it is all gone.I need your guidance. I will turn 31 next month and I see that with my age I am losing all chances

It has been 5 years since my marriage. After 1st year of my marriage I had visited a doc to understand why I was not getting pregnant. I have never used any birth control pills nor any other protection. My doc started stimulations for 2 months without any success, she then asked for my husband sample and we then came to know that the sperm count was 2 million with low motility. The doc then stopped working on me and suggested we use donor sperm for which I was against. Then I stopped seeing any doc for 2 years and left it to nature. Due to pressure from parents, I had to revisit a doc and each time without any result, I had changed around 5 doctors by this time.

Meanwhile my husband has visited a urologist and checked if it is because of varicocele. The doc suggested my husband to be on BENQ10 and many other meds for 3 months and then tested where the motility improved.. So our IUI journey began. First 2 months no success, then I had undergone Laproscopy for tubal block....but my tubes were normal. then next 2 cycles of IUI no success.... The same doc had her own personal lab for sperm wash etc....and in those reports my husband's sperm count used to be 10 million .Doc insisted for 2 more cycles...but I felt cheated so stopped it with 4 as I was drained out of mental strength. My husband had lost his father after 2 months of our marriage and he is not working since then...he has been depressed.I am the only working professional in my house now

I then took strength and visited a doc suggested by my friend. She said I had wasted all my time, money and energy and she said I was on the wrong track and scolded for taking fertyl for 6 months as it could have lead to ovarian cancer....We trusted the doc hence we never question them ...but I was wrong . So this new doc put me on Lineator, Evion, Folimist D Toyo 60 K , limcee and Ovaries SR and also asked me to visit a dietician in the same clinic to reduce my weight as due to so much of medication since 3 years I had put on weight from 48 to 65 Kgs. They said we need 3 months to get me back on track with diet and excercise .In between doc had also done hysteroscopy and did biopsy for testing if any TB traces in the uterine lining which was supposed to take 8 weeks that was in Aug 2015. So by September end I had reduced my weight to 58 Kgs. In October 2015 my IVF journey started. October 1st they did endometrium scratch. I have a retroverted uterus...not sure if that is the problem,...but doc always said thats not a problem at all. Simultaneously Doc put us on to an Andrologist Dr R for treating my husband. So the CASA report showed sperm count as 2 million \/ml\ and motility as 19 % and DFI as 49%. as on Julu...so Dr R prescribed Maxoza L and Heyforte plus and we also took the dietitian help to improve the DFI by giving antioxidant rich diet...and by end of September his sperm count was same but motility improved to 28% and DFI reduced to 37%. Little hope we thought and prepared ourselves for IVF.

IVF cycle details: Long protocol, husband sperms- 2 samples were freezed for back up. TESA was advised so ICSI procedure

1st October : Endometrium scratch,given Lupride 20 units and asked me to continue till my menstrual cycle Day 1 which was due on 5th. and during the scans they came to know there were 2 small cysts.

5th October: Day 1- only spotting continued lupride and lining was thick

6th and 7th  lining was still 6 mm

by 8th October my lining was less than 5mm and cysts were all gone,so lupride was reduced to 10 units and my stimulation started.

8th October -Day 4 and till 16th October that was my Day 12...the medication are as below. In between even intra lipids was given

Lupride 10 units
Menopur: 300
Recagon- 75
and from 17th October till 19th October recagon was stopped and I was only on lupride and menopur same dosage.

21st October: Egg aspiration and TESA

Egg aspiration Report:

Day2 E2= 26.5
Day2 endometrial thickness: thin
E2 on day of HCG pg\/ml: 2860
endometrial thickness on Day of HCG- 1cm HCG date: 19th Oct no of oocytes retrieved: 10 Oocyte quality - average

Medications after ovum pick up

DOLO 650
EMESet 4mg
clavum 625
Lineator, Limcee, Evion, Folimist D, Tayo 60 K Progynova 2mg Cabgolin .5 mg Duphalac Inj Michelle 25 mg Emprogest 200 mg

TESA report:

Indication: Cryptozoospermia
Operation details: Under aseptic conditions, B\/L Testicular aspiration done
Findings: 1-2 sperms\/3hpf seen, rarely twitching noted
Impression: Normal spermatogenesis

24th October: Embryo Transfer

Report:

No of oocytes: 10
No of mature oocytes: 6- subjected to ICSI oocytes fertisised from ICSI- 5 Endometrial thickness: 1.05 cm ET transfered- 3 on Day 3 description of ET: D3-6-7c-gr-1+ D3-2* 6c-Gr-1
2 embryos discarded as did not develop after Day 3

Medication after ET :

Inj Michelle 25 mg
IVF meds
Progynova
Emprogest
Decapeptyl for 2 days on 27th Oct and 2 Nov TSH and Beta HCG on 8th Nov: Tested negative

Her history is a representative catalog of a long list of common errors which doctors make when treating infertile couples !

1. Their diagnosis is male factor infertility, due to a very low sperm count ( oligoasthenospermia).
You can read more about this at http://www.drmalpani.com/knowledge-center/the-infertile-man/oligospermia. There is no reliable way of improving sperm count or motility with medicines or surgery. The IUIs she did were a complete waste of time and money.

2. She did not need a laparoscopy, as this is not needed before an ICSI cycle

3. All the medications and testing done by the andrologist were a complete waste

4. If there were sperm in the semen, there was no need to do a TESA at all !

5. She should have opted for a Day 5  ( blastocyst) transfer

Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





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