Tuesday, February 23, 2016

A first-person account of IVF treatment

Seventeen years of experimentation has come to an end. It all started since about three years of marriage when we decided to have a child. Both of us were keen not to take any measures in the first three years which could harm conception in future, hence she never took any pills for control. 

A few months passed by, and we started doubting that something was not normal.

A couple of more months and we decided to consult doctors. At that time we were near Bangalore, in a small industrial town in the Southern Indian state of Tamil Nadu. We consulted a clinic there. We started hearing about hormone tests, semen analysis, sperm count, motility and several other terms which were new to us. Sperm count and motility of the sperms were the issues identified. Her scan was perfect and she had clock like precision periods. To improve motility Vitamin tablets, hormone injections etc. started being part of our routine. A couple of months went by with no specific effects, except for the fact that occasionally the dosages of injections were increased or a costlier injection was prescribed. Both of us were young amongst the ones who will think about a treatment for infertility, as we got married at the earliest possible legal age in India, hence the stress of not having a baby was not really into us during those days.

Nearly a year passed by and all these became serious, and we started worrying about not having a baby. We were advised to consult a centre in Salem another Tamil Nadu city nearby and there I had an ultra sound scan and they detected me having bilateral varicoceles. This finding gave a relief to us because now we have a reason to blame and possibly a cure out there is waiting for us. In a couple of months I underwent surgery for bilateral varicoceles. The urologist who did the surgery had told us that there could be an improvement in sperm count and motility but such an improvement is not guaranteed; also the effect of the surgery could take some time to show up.

Post the surgery, we waited three-four months hoping that the quality of sperm will improve, but nothing happened. Things were becoming serious, as our relatives who are of our age are getting married, and few of them have conceived. We were advised to consult an infertility clinic. This was a decade ago, and during that time such clinics were rear in South India, especially in my state Kerala. People were sceptical too on such treatments.

After several rounds of discussions with parents we finally decided to consult an Infertility clinic in Trivandrum. The lady doctor who was a well-known gynaecologist was now offering infertility treatment also. Her appearance in several television chat shows on pregnancy and infertility gave us the confidence on her. It was almost like a start-up clinic that time. We still remember the first day when the doctor’s husband, (he was coordinating and managing the logistics of setting up the start-up clinic) took us to different rooms having scanner / microscopes and cryogenic-cylinders. We were explained about the Intra-Uterine-Insemination (IUI) and how it could be of help to us. And we started our experimentations with IUI. Each visit was such a painful experience that we had to be in queue with long periods of  waiting, with no certainty on when we will be able to go home. A treatment day was a day when you cannot plan anything else. Believe it or not we did almost half a dozen IUIs, with no success. Each time after the IUI my wife will get a new batch of friends who had IUI along with her. After few weeks you will hear some of them got positive results from the IUI, this kept us trying again and again. When we started being desperate they introduced us IVF. The cost was a deterrent to us to get into this treatment. And we had to take a couple of months break to take this up.

Once we had enough funds to invest on the experiment of IVF, we approached the clinic again. This time the procedure was horrible and tiresome for her. The clinic did not have a resident embryologist. They were getting him from Hyderabad and because of the cost involved for his flight; they always did the egg collection in batches. The fee for the embryologist should be given as cash and no bank transaction will be accepted and bill also won’t be given. Clearly this was going as black money for the specialist. To optimize the embryologist’s expenses the clinic modified the periods and ovulation cycles of patients to get critical number of patients in each batch to cross the breakeven. This put a lot of mental and physical pressure to my wife.We were told that the eggs fertilized and we were all hopeful. The embryo transfer happened as planned followed by waiting for the result. With all those struggle and mental tension fuelled by the massive investment on IVF the results were negative. This shattered our morale and the cost involved in the treatment made a deeperimpact. Now we were introduced to the term “unexplained infertility”.

A couple of months in despair went by, and we decided that we first take steps to improve the quality of sperm before we invest further on IVF. We turned to alternate medicines in the hope of improving the sperm quality. Ayurveda, Unani and Siddha were the ones we tried. And each of them we would have tried for four months to six months, followed by waiting for a couple of months to see if the effect is reflected in the sperm quality. In this process we realized one thing; alternate medicines are not really cheap especially when it comes to treatment of infertility, as some of them even have gold in powdered form in it!! Taking those will improve the glow in your face, reduce the weight of your pocket and increase your weight!! But certainly you will find several cases where people claim to have got success with these treatments, and my personal opinion is that such cases would be when either the problem is of general wellbeing, hormonal deficiencies, vitality or sperm quantity.

Our desperation started to grow; we did one more round of IVF at the same clinic and this time also with no success. By this time they had built a multi storey hospital for infertility!!

We changed the hospital to another one in Trivandrum itself. The doctor here asked only about the number of IUIs and IVFs undergone and if the embryos were good. He did not ask for any other previous records. Here too we had half a dozen IUIs and a couple of IVFs. None of them succeeded. The doctor suggested trying ICSI even though costlier. After a couple of months of waiting for funds we did an ICSI and that too failed.

After about a year someone advised to consult an endocrinologist. After a few tests I was advised to take some medication and hormone injections. This was a horrific period for me. I was not able to sleep and was feeling very stressed, and when I manage to sleep somehow it used to be a very restless sleep. All these added to the fact that we did not find any significant and sustainable improvement in the quality of sperm forced me to stop this treatment.

By now it was more than twelve years after marriage. We badly wanted a break, as this was getting into our minds too much.We started accepting the fact that we have tried our possible level best, and this is all out there what medical science can provide us at that point of time. What if we just forget about a baby and start enjoying the life? This was not easy but we did manage it, except for occasional incidents of mental agony.

We were getting older and our parents were hinting at options of adoption. We were not mentally prepared for that. Whether we were confident of having a baby of our own… not really… but somewhere deep in our thoughts we believed that whatever is meant for us will happen.

Then one day one of my mother’s friends pointed us to a facility in Mumbai which offers infertility treatment and gave the link to the clinics website.  This website I had visited some six years back. What was interesting to us was the money back offer if the treatment fails. But in this package we have to pay charges for four IVF/ICSI cycles in advance. Cost of logistics and stay at Mumbai added to the advance cost of four IVF/ICSI’s was not affordable for us during that period. But now, this was probably the last treatment we will be able to attempt before the age factor would deny any more attempts. Moreover with the financial support from parents for the advance amount and the savings we had during our “hibernation from treatment” made this an affordable or rather manageable option. And even if the attempt fails the money back offer will cushion out some of the mental trauma.

The website was very clear with plenty of information. Even the medicines that will be administered were clearly mentioned. Finally we decided to do our final attempts at Malpani Infertility Clinic, Mumbai. Our first encounter with the doctor was an eye opener. With respect to all our earlier treatments what was provided by the doctors to us as records of treatment were very minimal. Blood test reports/ bills etc. No photographs of embryos were provided; we were not even shown the embryos. Apart from the treatment options the consultation with DrAniruddha Malpani went on to Patient’s Rights. The discussion with the doctor gave confidence to us. And most importantly there was no long queues and the waiting period was less than fifteen minutes from the scheduled appointment time!!! The doctor still had all the time to listen to us and patiently heard our concerns. While assuring that he will do his best, he also told us that treatment that he is going to provide is no different from any other IVF/ICSI clinics. The difference is that both of them have been in this field for quitea long period and the experience that they gained over this period of time. A good doctor needs to know a bit of human psychology too..!! It was a one day affair and we paid the advance amount and got some blood tests done.

With the learning on Patient’s rights we attempted to get our old medical records from the clinics but without any success. Being employed in a private firm getting the leaves for the treatment was something which I had to manage. The fact that we could take the medicines and the scans from anywhere in the world and need to be there only from the tenth day of periods was a great relief for us. We could send the reports and photographs over email and doctor will reply to it by night. This saved me leaves and could manage every treatment cycle with seven to ten days of leave. I mentioned about my treatment plan and requirements of leave to my manager and he was very supportive. This relieved me of some work pressure, and I am thankful to him for that.

For the next cycle we went to Mumbai for our first attempt of ICSI at Malpani. The medicines were as mentioned in the website. We spend a few days roaming around sightseeing. It was a rainy season. By the time of the egg pick up the effect of the medications were seen, she had complained about high temperature on palms and feet. Was it because of the rains or the effect of medicine? The egg pick up was under general anaesthesia. We got good eggs and also got good quality embryos for freezing too. The fertilization was normal and the embryo transfer was also smooth. The embryos were shown to us on the day of embryo transfer and the quality and classification of embryos explained to us. The embryo transfer was done in my presence, which was a first time experience for me. Dr Malpani would ask us what we were praying, while he was about to perform the procedure, and would suggest to pray “whatever happens let it be for good”. In all the previous clinics the entire procedure was carried out as though it was some sort of which craft with no transparency what so ever. In the case of Malpani clinic embryo that was going to be placed was shown to us by Dr Saiprasad the fulltime embryologist.The report contained information on the number of eggs collected, embryos fertilized, embryos transferred, the grade of the embryo transferred and the grade of the remaining embryos and the photographs of all embryos. We choose to freeze the remaining embryos. For each and every financial transaction we were provided with the bill. There was also no restriction on the manner in which payment has to be done. The entire dealing was so transparent and assuring, after all ethics cannot exist in bits and pieces.

But unfortunately the results were negative. And it was disheartening, the doctor assured that the embryos were good and the fertilization was also good, and this means that the chances of getting pregnant are good. We did the next cycle with frozen embryos. This time the beta HCG showed a slight positive but it proved to be a chemical pregnancy. We did ICSI cycles several times with frozen and fresh embryos. In couple of cycles the medicine dosages were varied.In every single visit we had at Malpani Clinic we used to return satisfied that we got the best we could get. The entire team at Malpani was very cooperative and helpful and considerate, and this cannot be just for us because we were no special patient for them.

In one of the cycles we learned a simple method to reduce body heat and discomfort because of medication—increase the water intake. The 8 glasses of water a day rule won’t help since we are taking medicines which change our metabolism. Instead we ordered one litre mineral water bottles. This helped to keep trac kof the water intake. She started taking one full litre bottle every two to three hours and ensured that she finishes minimum four to fivebottles of water in a day. This allowed the body heat to be maintained normal and she was feeling comfortable even with the higher doses of medicines that were administered. The fact that eight glasses of water was not sufficient was hinted to us by Dr Anjali Malpani. Usually when my wife complained about body heat advice was to drink “more water”. This usually will prompt an increase in intake by say another two-three glasses of water in a day. But from our experience the water intake should be so frequent and in good volumes such that the burning sensation on feet and palm is not felt by the patient. So she used to take as much water as possible at a time, and after some time she will have to pass urine, and immediately after that she will again have water as much as possible. I would hence advice the same to others who is undergoing treatment.

In the last couple of attempts with the fresh embryo and frozen embryo, the embryo was allowed to grow until the blastocyst stage and a day five transfer was done. And why I am writing my story now because one of those attempts gave positive results. And now we do have a baby of our own.

If we had gone to Malpani fourteen years back would we have got the baby earlier? I can’t say, may be we were destined to get one when we almost lost hope so that we will value it most. May be, had we got a baby earlier we would not have been as thankful as we are now. Or God just thought we were not grown enough to raise a baby.

The last seventeen years has thought us how valuable is the support of parents and siblings for an infertile couple to pass through the mental rollercoasters. They were there with us to share the mental and psychological strains we were through, and were extremely conscious that none of their deeds hurt us. To all those out there trying for a baby, if you are destined to get your baby you will get one day, don’t lose hope. 

And if you want to get medical assistance for getting one, Malpani Infertility Clinic will be the one which can give you a comforting and stress free experience through your treatment cycles. Best of luck, May God bless you all.

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