Last attempt to find a cure for my DH's Azoospermia and Bilateral Varicocele Grade III

After hearing the same advice from Dr. Rupin Shah in Mumbai, we visited a few famous tourist spots, namely Siddhivinayak Temple, Mahalaxmi Temple, Haji Ali, Juhu Chowpati, Colaba Causeway, Gateway of India, Elephanta Caves etc in the rest two and a half days.

Upon our return to Bangalore, DH and I decided to visit one last specialist. We re-visited Dr. A Nagaraj Rao (Professor & Head of Urology Department, St. John Medical College and Hospital, Koramangala, Bangalore) in May'14. He briefly remembered our case history (told to him in Sep'12) and we also updated him about our latest Doctor-Hopping and their conclusions.

His advice was to get a Bilateral Testicular Fine Needle Aspiration Cytology (FNAC) done at Anand Diagnostics, Shivaji Nagar. I do not remember the cost of this test, shall update if I recall. Here's what FNAC procedure is :-

The result of this test would determine whether a Varicocelectomy could be of any help or not. We went ahead with the procedure in May'14 itself. The report was ready after 3 days and here's how it looked :-

 The report came with the studied slide too, for further reference or investigation. 

We went for the review of this report to Dr. Rao. He concluded that although Sertoli cells and Spermatids are seen but occasional; performing another procedure wouldn't change anything or undo the past. At that moment, it seemed to be a dead-lock situation for us; anger, depression, disappointment, fear, frustration, regret were just a few emotions to name which were portraying our state.                                                          

Meeting Dr. Rupin Shah in Lilavati Hospital - Mumbai

Our Delhi and Kolkata trips were informative but not pleasing. Our next destination was Mumbai and target specialist to meet was Dr. Rupin Shah. He was a visiting faculty/consultant in some clinic/hospital in Bangalore in 2014 but he wasn't visiting Bangalore in May or June that year; that forced us to make some travel plans. My DH likes to call such trips as "Medical Tourism", although it is within our country itself.

Anyway, we called and took next feasible appointment with Dr. Rupin Shah (Consultant Andrologist and Microsurgeon, Centre for Male Reproductive and Sexual Medicine, Lilavati Hospital and Research Centre, Bandra West, Mumbai). We flew to Mumbai 16 hours prior to our appointment and also emailed him our reports (we had briefly discussed our case with him over the phone, as they think out-station patients deserve to clarify few things before travelling to Mumbai).

Reaching the hospital an hour in advance is always a good idea. There's a One-time Registration done for Rs.100 and I fail to recall Dr. Shah's consultation fee. Everything is quite organized there; however the only tricky part was dropping one's prescription paper (which later gets attached to your file) in a letter-box type enclosure attached to the doctor's cabin door. That way, your turn may not come as per your sequence in queue, but randomly, by chance/luck/probability. Since there weren't many patients waiting at around 9:30AM on a weekday, we met up with him well within the "waiting time at a clinic" norm.

His advices were :-
1. Attempting a microsurgery (Varicocelectomy and Biopsy) to fix Bilateral Varicocele Grade - III
2. Using Artificial Donor Insemination (ADI)

We were so convinced with his confidence on fixing the Bilateral Varicocele that I almost got my DH admitted in the hospital on the spot, with no family or friends around to bank on for any help. Then we both took individual 10-minute time-off to virtually walk-through the whole thing. Fortunately, we agreed to "not taking hasty decisions" again and immediately went back to meet Dr. Shah to ask the Percentage of Success in such cases.

By his vast experience, he concluded that the TESE could have destroyed any plausible chances of natural sperm generation; his final advice was to take a chance with Varicocelectomy. We had already collected all possible details required for the microsurgery in those 10 minutes. After hearing the dreaded phrase “take a chance", we told Dr. Shah that we need to re-think and take advice of our parents too, and pushed off from there. Dr. Shah had patience; he quietly listened to all our concerns and fears and gave unbiased advice. He was quite affable too.

We faced disappointment in Mumbai as well. Since we had planned a 3-day trip, we continued with our plan after spending nearly 3 hours in Lilavati Hospital. In those two and half days, we explored Mumbai as much as possible and had good fun. It isn't just the disappointments which get hard-wired on your memory, good things too are a part of it; the key is to strike the balance to stay happy and positive. That's why we never miss an opportunity to enjoy life in spite of the tough situation we were facing.

My DH's Computer Assisted Sperm Assessment (CASA) and Semen Analysis Test Reports

Here's a copy of my DH's CASA and Semen Analysis Test Reports for reference.

The first report is of a Computer Assisted Sperm Assessment (CASA) done in Manipal Hospital Bangalore (MHB's) Advanced Andrology Laboratory in the month of Dec'12, which was 2 months prior to my DH's TESE procedure.

The next report is of a simple Semen Analysis test done in a reputed Pathological Clinic in Bangalore. It is evident that the sperm count became NIL after TESE.

Our visit to Institute of Reproductive Medicine - Kolkata

After meeting 3 specialists in Delhi and getting disheartened, my DH joined me in Delhi and we took off to Kolkata to visit another specialist and also to take some time off from stress for a few days by exploring Kolkata.

First things first, a month prior to heading to Delhi, I had called Dr. Baidyanath Chakraborty (Institute of Reproductive Medicine, Salt Lake City, Kolkata)  for an appointment. Since he has a busy schedule, one has to wait for a month (plus/minus few days) to get an appointment. Well, it isn't just a simple Doctor's Appointment; they issue you a specific date and time for visiting the institute. You need to carry a print-out of your Appointment Confirmation E-mail sent by the institute, else the guard won't let you in. Reaching the venue 30-60 minutes prior to your appointment is recommended, as their waiting area (in 2013) on ground floor was not very big, with limited number of chairs provided. Since our time of visit was in Apr'13, 9:30AM appointment suited us well to beat the heat outside and also to find a good seat with a fan above; we reached the institute at 9AM and had to wait for almost 2 hours just to get our name called (FYI, we were 5th in queue for that day).

Next step was to check the female partner's height and weight, then a brief wait again, and then head to the first floor to meet a Data Operator to feed all possible details of medical history of both partners into their system. After some more wait, we were finally sent to a hall on ground floor to meet Dr. Chakraborty.

Then a disgusting and embarrassing thing took place. Turn by turn, all females were asked to go to a hallway and then a vaginal test was conducted by a junior lady doctor by inserting her finger(s), not a probe; without even enquiring the diagnosis/prognosis.

Anyway, after the physical examination, me and my DH were sent to finally meet Dr. Chakraborty. After explaining our case (in spite of narrating it to the Data Operator), DH's physical examination was done. His conclusion was to meet another Uro-Andrologist as he didn't have the expertise on male infertility. He recommended meeting Dr. Rupin Shah in Mumbai. 

Since we were already in Kolkata, we made our trip fruitful by visiting Belur Math, Dakhineswar Kalibadi, Kalighat Temple and a few local markets. Unfortunately, because of the strict Airline Rules, we couldn't carry the famous Kolkata Roshogullas back home for our folks, but no one could stop us from carrying different shapes and flavours of Sondesh :)

                                                                    

My meeting with 3 specialists in Delhi

I am back to broadcast the description of our Doctor-Hopping sessions in Delhi, Kolkata and Mumbai. Here it goes...

In Feb'14, we completed two years of Trying To Conceive (TTC). In these two years, my DH and I discussed our infertility with 12 doctors (Allopathic and Ayurvedic) in Bangalore. Guess that wasn't enough to find a solution to our problem. So we shifted our concentration from Within Bangalore to Within India.

We travelled alone to Delhi in Feb'14 and first met with Dr. Sanjay Mittal (Uro Andrologist, Sir Ganga Ram Hospital, Rajinder Nagar, New Delhi). His Consultation Fee was Rs. 700 then. It took him just 5 minutes to glance through my DH's reports, give his verdict and support it with logic and science. He appeared to me as a very knowledgeable and experienced Uro Andrologist. Unfortunately, his conclusion was just the opposite of what I wanted to hear from him. He advised only 2 things; Artificial Donor Insemination (ADI) or Adoption :( His confidence made me lose hope, whatever little was left.

Hearing this for the first time was too much to handle alone. These 2 years had taught us that Patience and Perseverance are of great importance in pursuit of a happy life. With this zeal, I took a week to roam around in Delhi and then meet Dr. Kapil Kumar Juneja (Urosurgeon and Andrologist, Moolchand Medcity, Lajpat Nagar III, New Delhi). Since my DH wasn't there to meet him personally and Dr. Juneja was going out of country for few days, he advised to get an Epididymal/Testicular Biopsy at Moolchand after a week or any good hospital in Bangalore. 

Exactly 1 year prior to that date, my DH had got TESE/ incision-suture process done on him; neither of us wanted him to go through the same state of affairs, again. I informed Dr. Juneja about TESE and that no sperms were found in the extraction, so should there be any chance of finding them now. Dr. Juneja politely suggested me to pay a visit to Ayurveda Dept. at Moolchand.

Were we back to square one? 

Well, I met Dr. S V Tripathi (Chief Physician - Ayurveda, Moolchand Medcity, Lajpat Nagar III, New Delhi) the next day, as I reached Ayurveda Dept. after its closing time. I was pretty clear about not repeating the steps, but fortunately, he didn't say so. He saw all the reports and prescriptions (Allopathic and Ayurvedic medicines) and told me very frankly, not to waste more time, money and efforts on trying to treat something which isn't possible anymore. He had good knowledge about science and his field, but we couldn't make use of it in our case.

My Doctor-Hopping session in Delhi wasn't fruitful. Guess that was enough for me to call my DH to Delhi and plan a weekend getaway trip. After all, vacations make you feel good and help in relaxing your nerves, and that was exactly what the need of the hour was.

Bon Voyage!

9 months of Ayurvedic Treament for DH, yet no positive results

On Dr. Sowmya's recommendation, we visited Dr. L. Sucharitha (Pandit Clinic, 5th Main, Chamarajpet, Bangalore) in Dec' 13. Her Consultation Fee was Rs.200. She wrote 4 really expensive medicines for a month's consumption and none of the medicine names were available on Google (neither then, nor now). Those specific medicines were available only in Pandit Clinic; I guess they used code words for all their medicines, not sure if that's ethical. A layman like me couldn't decipher anything from this attached copy of the bill.

Anyway, my DH did consume those Ayurvedic medicines for a month. At month end, the report remained the same. So in Jan'14, Dr. Sucharitha told that she'll tweak the combination of medicines. Here's what she prescribed next :-

With 9 months of Ayurvedic Treatment, DH's sperm production remained nil. We then decided to look for options outside Bangalore.

My next post will tell you about our experience/ conclusion told to us by famous doctors in Delhi, Kolkata and Mumbai.

Beginning of a new treatment... Ayurveda!

After being on Ayurvedic medicines for almost 2 months, DH got his SA test done and there were still no sperms to be seen. That called for another visit to Dr. Sowmya. For your information, in Patanjali Chikitsalaya, there is a concept of No Consultation Fee. There is a box kept on the doctor's table, if you wish, you could put any amount of money in that box; nobody will question you if you don't. As a goodwill gesture, we always did.

In Sep' 13, she asked my DH to conduct the Panchkarma process at home, with all detailed instructions provided by Dr. Sowmya, printed on a piece of paper. Once that got over, DH resumed all his medicines and an extra medicine added, called Ajamodadi Churna for 7 days. Upon completion of Panchkarma and 7-day course of new medicine, DH was asked to repeat SA test. Unfortunately, repeat test had the same result.

In Oct' 13, she made little more advancement in her line of treatment. She added a mix of few medicines to be consumed once daily, along with the previous medicines. This was a complicated one. We had to mix Heerak Bhasma, Vang Bhasma, Abraka Bhasma, Praval Pishti, Moti Pishti and Pushpadhanva Ras (quantities were decided as per her calculations) and then divided it into 60 parts, each to be consumed twice daily. This process was followed for two months.

In Dec'13, SA test result didn't show any improvement. This time, Dr. Sowmya had no new medicine to prescribe but suggested us to visit another doctor, one of her Gurus, Dr.Sucharitha.

Details will be in my next post.

"Ayurvedic" medication for DH was our next step

By the end of Mar'13, we both were physically and mentally tired so we decided to take Dr. Vasan's prescribed medicines and expect a miracle to happen; and also buy time to find a good, knowledgeable and experienced ayurvedic doctor.

For that, we then visited Patanjali Chikitsalaya. Patanjali Chikitsalaya (Clinic) is of Baba Ramdev fame. We had heard a lot about the success of Ayurvedic Treatments done in his Patanjali Yogpeeth, Haridwar Campus (Bhagirathi Nagar, Bhupatwala, Haridwar, Uttarakhand).  

We met Dr. Sowmya (Brigade MM Complex, K R Road, Yediyur, Jayanagar 7th Block, Bangalore) in July' 13. She read all reports and understood the harm done.  She explained the scope of treatment and asked us to be patient as Ayurvedic Treatment is a time consuming thing.
Here’s a copy of her prescription :-

Part I of medicines were tablets and Part II were powdered medicines to be mixed together and consumed with hot milk. All the medicines were available in their own Divya Pharmacy, just next door. She asked my DH to consume the medicines for at least one month, then repeat the SA Test and come back for review along with the report.