Post "BFN" Consultation with Dr Prashant

I was very nervous while waiting for 1+ hour to see Dr. Longest I've waited to see Dr. But Dr also prefered to speak to us last, since its gonna be a long discussion. Which I totally agreed. I was hoping that I don't melt down and create a drama in front of him. Luckily I didn't.....


After my ET Dr mentioned that he'd be surprised if I don't get pregnant. Apparently it's due to 2 reasons.


1. My uterus lining was perfect on the day of transfer (I think it was 8mm)
2. My 8 cell embie was compacting which means edges between the cells are getting blurred, so it's becoming harder to count the number of cells. Compacting embryo has more chances of implanting compared to my 2nd embie which was 6 cell.


Ok, in that case 'Why didn't I get pregnant?' No answer for that. This stage is beyond anyone's control. So we have to leave it to fate.


Could it be due to my dry cough? No you cannot clearly define the cause for BFN.


Dr believes that we should continue to try. He firmly believes that I can get pregnant due to these reasons.


1. Age Factor I'm going to be 34 
2. We got good quality embryos.


But my problem is getting matured eggs, since my eggs were not matured enough it had been difficult to retrieve them.


So challenge now is to get matured eggs. For which Dr recommended I should continue with my medication. 


I want to take a break, I really don't like dumping whole loads of tablets into me. So both of us can start medicine 3 months before our next cycle. And of course loosing weight could help to improve egg quality and uterus lining.


Also it is believed that fish oil, royal jelly, green tea, acupuncture and Co-Q 10 could improve egg quality. But I'm not sure if its ok to take all these together.


Dr recommended a change in approach for our next cycle. Which could be freezing the embryos and transferring them after a natural cycle. Sometimes patients uterus can be sensitive to stimulation hormones. Scan cannot determine this sensitivity. (Japanese usually practice this method)


Also getting the embryos to blastocyst stage and doing D5 embryo transfer is another option. But in my case I'm not sure if I'd get embryos till blastocycst stage, because during past 2 cycles I only got 2 embryos.


Other important factor facilitating implantation is stress levels. More positive, stable and cheerful you are greater the chances of implantation. This is proven in an Israeli research where clowns performed to patients for 15 minutes after the procedure. “Medical Clowning” improved pregnancy rates compared to a group not exposed to a clown on the day of implantation." In conclusion patients who are less stressed and are positive in attitude had better outcomes.  (See source article)


Since having this kind of entertainment is not available everywhere, we can take our own entertainment devise with us to keep us relaxed after ET. Also figure out our own means of being cool and calm during the whole treatment process. It could be meditation, exercise, yoga, acupuncture.....


Ok now my focus is on weight loss and on improving my egg quality.


One major relief is Dr's strong belief that I can get pregnant. sigh....our journey continues...

The Results

After the embryo transfer I came across this wonderful info about "What happens to the embryo after transfer?" from http://www.nyufertilitycenter.org/ivf/embryo_transfer.


3-Day Transfer

Days Past Transfer (DPT)	Embryo Development
One	The embryo continues to grow and develop, turning from a 6-8 cell embryo into a morula
Two	The cells of the morula continue to divide, developing into a blastocyst
Three	The blastocyst begins to hatch out of its shell
Four	The blastocyst continues to hatch out of its shell and begins to attach itself to the uterus
Five	The blastocyst attaches deeper into the uterine lining, beginning implantation
Six	Implantation continues
Seven	Implantation is complete, cells that will eventually become the placenta and fetus have begun to develop
Eight	Human chorionic gonadotropin (hCG) starts to enter the blood stream
Nine	Fetal development continues and hCG continues to be secreted
Ten	Fetal development continues and hCG continues to be secreted
Eleven	Levels of hCG are now high enough to detect a pregnancy

So I kind of knew everyday what would be happening to embies inside my body. So by Day 6 post transfer, I was absolutely certain that I'm not pregnant. My friend challenged me, telling that I could be wrong. My answer was I'm 100% certain. My hubby believed what I said. How can I be so sure of my results, when my test is due only on Day12 post transfer?

When implantation occurs, there is increased blood flow to the uterus, and increase in hormone production i.e. estrogen and progesterone. This results in increased creamy cervical mucus(CM). In my case till D6 post transfer since ET day it had been very dry.  Usually it is the case after ovulation for me i.e. from mid cycle it's always dry till I get my menses  Since CM  was completely dry I was absolutely certain that I did not succeed.


Besides I did not have any other pregnancy symptoms, although these can be mimicked by lutel phase hormone support medicine. For example these medicine causes abdomen cramps, breast tenderness and bloatedness.


I cried, cried and cried; I could not take it, why does it always have to be like this? I've never experienced, the feeling of being pregnant. Will I ever experience? How many times do I have to go through IVF before I succeed? We both hugged and cried not knowing what to do?


I'm determined to do one thing before my next attempt i.e. "loose weight". My BMI is 26.6 I want to bring it down to 24. My thought behind it is, at least I'll do whatever is manageable i.e. within my control. Coz obviously pregnancy is something beyond my control.


Only time can answer if loosing weight could bring me success......

On Beta Test Day - Today

Went to the clinic by 9.30 am, did the blood test. And was hanging around in nearby mall. Decided to do a hair treatment while waiting. I was very nervous, even-though I knew my results. By the way yesterday morning I did a HPT which was 'negative'. Dreaded call never came till 12.30pm even-though they said that they'd get the results in 2 hours.


I called them at 1pm, and nurse said they have just got the results and will call me back. I spoke to my hubby and we almost guessed it. Because if it was positive they would have immediately congratulated me right?

Hubby told no point in hanging around, he told me to just go home. It's confirmed now. So I finished small errands in the mall and was just getting into the car, when I finally received the call confirming that my cycle didn't work out.


So now what? I really want to loose weight and improve my egg quality before I do my next cycle. So please share with me any tips you have


1. To improve my egg quality
2. Improve DH's sperm count
3. How to succeed in IVF ?


I hope and pray I too can be pregnant and become a mom for healthy babies one day.......

2 Week wait

As soon as I came home after ET, I lied in bed for few hours, later had my lunch watching TV, and again lied down after inserting progesterone pills.


1. I spent a lot of time on internet, reading ivf blogs and early pregnancy symptoms. Infact I created this blog during this time.


2. Watched TV, but for me internet is more interesting than TV. These are some of my favorite TV shows. Kardashians, MasterChef, America's next Top Model, Guliana & Bill, some tamil soaps etc., 


3 Watched a comedy flick with my husband and laughed out loud.


Oh I have this worrying dry cough, even on ET day I had this cough, its very strong I fear when I cough, I squeeze my stomach and cough out, I worry I might de-stabilise my embies. I took Prosphan a herbal dry cough syrup and drank lot of hot water.


4. I drank around 10 cups of hot/warm water flavored with lemon juice, ate healthy, took only plenty of fruits and milk with 'ensure' for dinner.


5. Sorted out digital photos which had piled up in my camera and computer.


6. Updated our expenses including amount we spent on our Baby endeavor till now.


7. Did simple work at home like sweeping the floor, ironing, cooking (hubby did all chopping, and washing)


8. I had some choclates lying in my fridge, on and off had them. (I was avoiding caffeine so chocolates only on and off)
Even in mornings I did not take coffee, instead switched to milk flavored with milo and 'ensure'.


9. Hubby gave some sit, search & update assignments which I had to do lah...


Note : during my 2 ww I hardly had any pregnancy symptoms, not even the one's mimicked by progesterone and estrogen pills :(, so with each passing day I'm becoming more and more certain that I'm not pregnant. One of the very early symptoms of pregnancy is increased creamy discharge. This should happen after implantation. Formation of mucus plug in cervical canal, and increased blood flow, and increased production of progesterone and estrongen resulting from pregnancy are the causes for increase in cervical mucus. In my case it's very dry down there. It's usually the case for me, before I get my periods. 


So readers, this is the reason I'm becoming more and more certain of my results again a BFN. Sigh..................Oh God will ever become pregnant? I'm not going to give up! "Winners never Quit, Quitters never Win" 


(heard this quote from Bill Rancic, Gulliana's hubby)

IVF Attempt No 2

Sep 2011


D2 scan revealed around 20 follicles on both side (because of PCOS). Dr said he will be starting my treatment with Menopur 300iu. But before I was ordered to do a blood test to check my progesterone and estradiol levels.  Only if hormones are within the range I can start the treatment. I went to bangsar village and was window shopping till I get the results. 


After around 2 hours nurse called me to  inform that I could pick my medicine. I did my first injection in the clinic and continued with same dose from D2-D4. On D5 & 6 my dose was Menopur 225iu. During this time I felt very bloated, I drank a lot of water, consumed one or two eggs daily, and continues with my exercise routine. (1 1/2 hours cardio and 1/2 hour weights every other day) From D6, I also started my second daily injection, Cetrotide 0.25mg to prevent me from ovulating.


I was very nervous for my D6 scan, thinking of my previous experience of not responding to stimulating medicine very well. Scan revealed 3 follicles on L and 6 on R ovary.


From D7-9, I continued with same dose i.e. Menopur 225iu. Again I was nervous for D9 scan, because last scan Dr told big ones are on left, so I was thinking what if, like my first attempt if others did not grow. And considering the fact that Dr has reduced my dose.


Scan revealed 3 on L and 5 on R, which Dr said is exactly what he's looking for and was happy with my scan results. I went with my bladder full that day as Dr also did an abdomen scan to check my uterus lining. It was 6.8mm and Dr said above 6 is ok.


D10 my dose was 150iu & D11 no menopur only cetrotide. D11 scan revealed 8-9 follicles and again abdomen scan reveled my uterus lining was ok. 


On D11 night I also had to take Ovidrol shot to release my eggs, for egg pick up scheduled after 36 hours from injection time.


I was very nervous before egg pick up, considering my previous experiences. I kept thinking repeatedly 'what if, if they are empty sacks like last time'. My blood pressure spiked before my egg pick up.


I was little relieved to see confident Dr, cheerfully wishing me before my egg pick up.


While I was slowly getting back to reality after egg pick anesthesia, I heard someone calling my name. It was Dr, he came to inform me that I had 7 eggs. My next question was 'how are their quality?' (I didn't know that time Dr would not know about the quality till next day) Dr's answer was 'ok'. (May be he said that to relieve me)


After I was fully recovered from sedation and had a cup of milo, I was ready to go. (Nurse in the ward commended that I was very quick) I went upstairs to Dr's clinic and met with the nurse. Dr also made a quick visit to ask if I'm feeling ok. Dr was very confident he was telling that I might have some embryos to freeze this time. Well my answer was 'Well Dr, that depends on egg quality and sperm', Dr was 'Let's hope for the best'.


After I came back home I had severe cramps, it was almost as if I could not stand straight, and it was painful when I was coughing or laughing. After a days rest, next day I was feeling absolutely normal.


Due to my past experience, I asked nurse to inform me about the progress next day. From morning I nervously waited for the call from clinic. I was so nervous, I really can't recall me being so nervous in recent pass. Except 16 years back I was nervous like this when I was waiting for my GCE O/L results.


Finally around 9.30 am embryologist called me, (that was quick) ' you have 4 matured eggs, 3 fertilized'. I was quickly doing my math and comparing my results to other patients whom I know.


Patient 1 got 15 eggs, 12 fertilized, 6 good quality on D3
Patient 2 got 15 eggs, 11 fertilized, 2 transferred on D2, balance frozen


OMG my results is nothing compared to them, norm is 80% fertilization, in my case only 42%. From that point onward I was very stressed thinking if my embies would survive till D3.


I had two days before scheduled embryo transfer, first day I went shopping and did hair color  second day whole day I was busy cooking as we were hosting dinner for some friends at our place. It was a good distraction for me.


On embryo transfer day I arrive at the clinic, I emptied bladder one hour before scheduled transfer, and started drinking water. I took 2 glasses of water, when I changed cloths went in to the procedure room for abdomen scan, embryologist told my bladder was full. Thank God, this limit is bearable for me. 


My hubby was allowed to sit with me during transfer, but he too has to wear special cloths. He looked very funny with it, I was laughing at him. Good, some distraction for me.


After few minutes Dr came, he informed that 3 eggs had some chromosomal issue hence they could not inject sperm into it, and out of 4, 3 fertilized and 2 survived till Day 3, 3rd one did not divide into cells.


Dr said those two are good quality embryos and he'd be surprised if I don't get pregnant. I asked 'how many cells' & 'how about fragmentation'. One was 8 cell and other was 6 cell, fragmentation nil. Ok I'm satisfied with the results. I was hoping if all 3 survived till D3, it'll be good to transfer all 3, which means more chances of pregnancy. But 2 is ok.


Inserting speculum inside me is very very painful, even though some women don't feel any pain or only minor discomfort. May be it took around 10 minutes to do the transfer and it was done.


I brought my ipod and eye mask with me. so while I was resting I asked them to turn off the lights and was listening to music. Didn't even realize 10 minutes passing by. Afterwards I was allowed to pass urine, and rest another 30 minutes in recovery room.


We changed cloths, went to the clinic to get Lutel phase support medicine.(Duphaston (Oral Progesterone), Utrogestan (Vaginal insert Progesterone), and Progynova (Estrogen to start from 5th day post transfer)  Friendly nurse wished me luck and I am required to go back for my blood test 12th day post transfer.




Word of Caution - Maximum 2-3 glasses are adequate to have your bladder full, start drinking from an hour before the procedure. Don't over do because you will not be able to relax after embryo transfer if your bladder is very full.


For egg retrieval we are supposed to go fasting, you may feel uncomfortable if you have not emptied bowel in the morning. My tip is eat plenty of fruit and drink 8-10 glasses of water on previous night and  so that you can pass motion without any trouble. I ate one big guava which works well for me.

Appointment with Dr Prashant Nadkarni

April 2011 - Sep2011

We both went to see Dr P. One good thing is, this clinic is closer to my hubby's office, which means he'll accompany me for all the appointments. During last two attempts I always go alone and my hubby comes only during procedures.

Dr listens to our history and shared that PCOS patients respond differently to IVF medicine. Not in a predictable manner, hence my past results. Dr asked me to do fasting blood test to check my insulin and vitamin D levels.

Hubby has to take Vitamin E, multi vitamin, Co-Q 10, Vitamin C & D. These medications will prevent DNA damage in sperms. For both of us its recommended to take Omega 3. We opted for flaxseed oil capsules.

I also did accupuncture, may be for a month and after a while I could not take needles any more, so I stopped.

Dr also told that having normal BMI i.e. below 25 is essential, because higher the weight is higher the rate of miscarriage.

My insulin levels were high, it has to be below 11. Insulin plays an important role in egg quality. Hence Dr prescribed glucophage xr500mg twice a day, along with metformin 500mg twice a day.

I took metformin after lunch  and dinner, and glucophage xr (extended release of metformin) after dinner and managed to bring down my insulin levels within the range.

Next is Vitamin D, my vitamin D levels were way below required levels. Vitamin D levels are important for uterus lining. So Dr prescribed GNC vitamin D 400 iu capsules 3 in the morning 3 in night, totally 2400iu daily to bring my vitamin D level under normal range. He also recommended I do swimming and be outdoors to get enough sunlight, which I'm not so fond of considering hot, humid, sweaty weather in kl.

By June 2011, my test revealed my Vitamin D levels are within the range. Dr said now I'm ready for my IVF.

We were hoping to do our IVF in July, but got interrupted by unforeseen travel opportunity. So we thought of doing it in end of August.

But after I returned from my holidays, due to my binging, my insulin levels had spiked up again. So I waited till Sep so that I can regulate my insulin levels.

Yes I managed bring my insulin under control and I'm ready for my next IVF.