Using DS, 1 failed ICSI, 2 failed IUIs... what next?

We decided to do ICSI first with Donor Sperm (DS) sample procured by a bank suggested by MHB in Jayanagar, Bangalore. Out of 6 oocytes frozen in one straw, 5 oocytes survived after thawing process and only 3 fertilized well with DS of my DH’s blood group. All 3 were transferred and none got implanted :-(

Since we had 6 more frozen oocytes, the plan of action was to fertilize 3 oocytes with 1 DS sample of DH’s blood group and last 3 with 1 DS of my blood group and use IUI instead of ICSI.

Unfortunately, none of the 2 IUI cycles succeeded. By then, my body had taken a lot of injections and medicines and the brain was really dissatisfied, hence a break or change was required.

We decided to say Good-Bye to Manipal Hospital Bangalore (MHB) and decide another place to continue our quest. Deciding on whom to consult next in Bangalore seemed next to impossible as MHB was the ONLY last option in Bangalore.

As I had a few relatives in Delhi whom I could trust blindfolded, I chose to stay with them and take my chances in Delhi.

More about it, later.

Cost factor of our treatment until now

In this post, I will reveal some financial implications of our treatment until now (Jun'12 to Mar'13, which included Problem diagnosis, Hysteroscopy, TESE and Egg Retrieval).

Consultation Fees of Dr. Joshitha Naik & Dr. Mahendra Jain in Lady Hospital (LH) were Rs.250 each, way back in mid 2012, (and Rs.100 as one time Registration Fees).

--->   4 visits to Dr.Naik and 1 visit to Dr.Jain cost about Rs.1350 (including Reg Fee)

Ultrasound Scan Pelvis in LH was Rs.800. This was done just once.


SA in LH was Rs.300; in SRL Diagnostics was Rs.220;

-->   2 SA tests in LH & 6 SA tests in SRL cost about Rs.1920

Consultation Fees of Dr. Uma Maheshwari was Rs.325 in Sure Fertility (and Rs.100 as one time Registration Fees); Dr. Ravish I.R. was Rs.500 in Lucid Diagnostics (and Rs.100 as one time Registration Fees).

--->   1 visit to Dr.Maheswari and 2 visits to Dr.Ravish cost about Rs.1525 (including Reg Fee)

Consultation Fees of Dr. Madhuri Patil was Rs.1000 in Dr. Patil's Fertility & Endoscopy Clinic (which included Ultrasound Scan Pelvis. We visited her just once.

Each strip of I-Sure Ovulation Kit costed Rs.100 then.
--->   10 such kits cost about Rs.1000

FSH and LH Tests costed Rs.325 each in St. John's Medical College and Hospital. It was done just once.

Consultation Fees of Dr. Bina Vasan & Dr. Vasan S.S. in Manipal Hospital Bangalore (MHB) were Rs.400 each, way back in 2012 end, (and Rs.100 as one time Registration Fees).

---> 20 visits in MHB cost about Rs.8000 (including both docs)

Ultrasound Scan Pelvis in MHB was Rs.550 in Sep'12.

--->   This was done 10 times, costing about Rs.5500

SA, Sperm Function Test (SFT) and DNA Fragmentation Index (DFI) in MHB was charged at Rs.340, Rs.470 and Rs.1850 resp.

--->   This was done 3 times, costing about Rs.7980

Tablet Penegra 50mg (5 tablets) and Paternia (20 tablets) costed Rs.118 and Rs.800 in MHB. However, Paternia (20 tablets) in Apollo Pharmacy was sold at Rs.362.89 only (no fake or expired tablets).

--->   Medicines taken for 6 months cost about Rs.14400

Free T4, TSH, T3 in Clumax Diagnostics costed Rs.450, Rs.250 and Rs.200 resp.

---> Above tests done just once costing about Rs.900

Hysteroscopy procedure (Half-day care) costed us Rs.29170 in Feb'13 (Rs.25000 fixed for OT & procedure and balance amount for bed charges & misc. stuff).

TESE performed on DH in Feb'13 cost us about Rs.20840.

In Mar'13, Injection Gonal-F 300 IU/0.5ml was sold at Rs.8020, Injection Persinal HP-75 IU was Rs.1100, Injection Persinal HP-150 IU was Rs.1760, Injection Ovurelix 0.25mg for Rs.1020 and Injection Ovitrelle 250 mcg/0.5ml for Rs.1500 in MHB.

--->   3 Gonal-F injections costing about Rs.24060
          3 Persinal injections costing about Rs.4300 (depending on follicular growth)
          4 Ovurelix injection costing about Rs.4080
          1 Ovitrelle injection costing Rs.1500
         

ECG and ECHO in MHB was for Rs.220 and Rs.1560 resp, in Feb'13. Done just once.

Doppler and Ultrasound Scrotum in MHB was Rs.1000 in Mar'13.Done just once.

Cryopreservation of Sperms costed Rs.6600 for each vial and Embryo Freezing Single Straw for Rs.19800, both valid for one year.

IVF/ICSI- Deluxe costed us Rs.111500 in MHB (excluding injections and progesterone test) and there was nothing DELUXE about it. It too was a half-day care thing.

My Egg Retrieval process at Manipal Hospital Bangalore

Preparation for Egg Retrieval (ER) consisted of a one-time antibiotic dose with a few shots of Injection Gonal F 300IU (Gonadotropins) and Injection Menopur (Follicle Stimulating Hormone), both daily for at least 5 days to start with. Follicular Monitoring (FM) was done by timely scans after the initial 5 days of stimulation and the next dosage was prescribed based on my body's reaction to the medication. A few more shots were administered before a single shot of Injection Pregnyl (human chorionic gonadotropin or hCG) was administered in MHB at an exact specified time, 36 hours prior to my ER schedule. I might be missing few details here, if so, I will update later. For your information, IVF Specialists in India prefer under-stimulating the patient's body, rather than inviting Ovarian HyperStimulation Syndrome (OHSS).

On the day of my ER, my DH was asked to be prepared to give a fresh sample of semen (the 4-day abstinence rule to be followed). The objective was to fertilize two of the extracted eggs and keep the embryos ready for a Day-3 transfer in the same ICSI cycle. Since a good number of sperm ejaculation was in question, IntraCytoplasmic Sperm Injection (ICSI) was considered for our case.

 

ER process was done under General Anaesthesia (GA) and they retrieved 13 eggs. Meanwhile, they cryopreserved all 13 eggs and my DH gave his sample to work on the fertilization part for ICSI.

Similar to Hysteroscopy, ER was also painless. After I woke up from a 30-minute anaesthesia sleep, I could feel slight pull/ cramps in my lower abdomen, which continued for a day or two. Doctors/ Nurses told that it was pretty normal, as the body is trying to do the built-up of any damages done to the cells/ membranes.

TESA or TESE: It is the doctor's call

Since the medication prescribed for my DH was doing no good, his andrologist Dr. Vasan S S decided to introduce us to the term Testicular Sperm Aspiration (TESA). TESA involves anaesthetizing the scrotum, then a very tiny needle is passed into the testicle, and sperm along with a small amount of testicular tissue is aspirated out. As per his gut feel, this process will enable him to retrieve a few good quality sperms; TESA had been proven successful in cases where no sperm was found in the Semen Analysis but sperms would be available in the testicles or the epididymis. As that was our case, we went ahead with the "needle aspiration" procedure in Feb' 13.

Although information on the internet said TESA is done under local anaesthesia, we were asked to get my DH's Pre-Anaesthesia Check (PAC) to be completed two days prior to the TESA procedure. The procedure took time and after the minor surgery got over, Dr. Vasan informed me that he had to perform a Testicular Sperm Extraction (TESE) instead. TESE involves few small incisions and taking out some tissue from inside the testicle. As you are made to sign all sorts of consent forms before the hospital performs any procedure, it is then the doctor's decision to take necessary steps to try all possible ways to achieve the objective.

They informed us of cryopreserving two vials of sperms extracted during TESE. Since the incisions and sutures were at a very delicate part of my DH's body, he was advised to take a break from work for a week with restricted movements. It was a tough and painful phase of our lives.

Now, things were supposed to unravel the next month, after my Egg Retreival (ER) process.

                                                              

My Hysteroscopy Report

After taking medication for a month, my DH got CASA done in Dec' 12. Reports showed 2% Slow Progressive Sperms in Nov as well as in Dec; Total Motility increased from 3% to 4% in Dec; Volume was 0.5ml and Sperm Concentration was 1 million/ml for both the months, but the Percentage of Live Sperms reduced from 14% to 2% after taking medication. Off those 2% Live Sperms, Percentage of Normal Sperms was Zero.

My Hysteroscopy was planned for Dec' 12 itself, and Egg Retrieval (ER) was planned for Feb' 13, so we were asked to continue with his medication and see if it has more effect by then.

I got my Pre-Anaesthesia Check (PAC) done by anaesthetist two days prior to my procedure. Since I was diagnosed of Hypertension in June' 12, they thought of getting an ECG done. MHB is very professional and they check your body thoroughly before performing any procedure. As everything seemed normal, my procedure was given a go-ahead.

Hysteroscopy took place in Dec' 12 and everything was normal and healthy. I was asked to take rest for two months and let the body recover from the internal scratches; ER was re-planned for Mar' 13.

But before my ER, Dr. Vasan S.S. wanted to get good sperms from my DH to perform ICSI in March itself. For that, he repeated CASA test and instructed his lab to freeze the sample obtained from ejaculation instead of performing test, in case good sperms were observed. Our bad, no sperms were retrieved :-(

Making a decision: ART or Ayurveda?

It was a difficult decision to make. We wanted to explore and exhaust all possible options before choosing "What's next?". So we decided to consult a few ART specialists discussing our case and see if a mid-way could be found.

We started with Dr. Kamini Rao (Dr. Kamini Rao Hospital, Jayanagar 5th Block, Bangalore - now Permanently Closed) in Oct' 12. She straightaway suggested IVF, not even considering IUI. It didn't give us a good feeling so we chose to walk away with no acknowledgement to her advice (no, it wasn't rude at all).

Google Search provided us with a list of Doctors and Clinics in Bangalore who conduct IVF/ ART. Then we met Dr. Uma Maheswari (Sure Fertility, J.P.Nagar 5th Phase, Bangalore) in Nov' 12. Since we had all possible tests reports for me and my DH, she concluded to either go with a Varicocectomy or ART. Probably, not what we wanted to hear, AGAIN. As their success rate in 2012 wasn't that great, we decided to keep it as last priority and discover more clinics/ specialists.

Few days later, we read about Dr. Madhuri Patil (Dr. Patil's Fertility and Endoscopy Clinic, Bannerghatta Road, Bangalore). So we headed to her clinic. She did a default Pelvis Scan (all patients were made to pay even before being informed about it) not considering which day of your menstrual cycle you visited. I got highly pissed off with her for pinching my areolas without notice. She didn't even give it a mention why she did that. She concluded to do an ICSI because as per her, I had PCOS which the previous two scans conducted at two different clinics were not seen. I definitely didn't want to get pinched again, plus the PCOS was not very convincing so we never went back to her.

After all these experiences, we decided to visit an ayurveda centre. This lead us to Dr. V R Padmanabha Rao (Amruth Ayurvedic Centre, Basavangudi, Bangalore). His treatment stated a 23-day Panchakarma process. I am attaching details for your reference.

The process seemed very cumbersome, as it required my DH to visit the said ayurvedic centre daily for an hour in the morning, coming back home, taking bath and then head to work, and a lot of driving during peak office hours. This treatment that time costed INR 35000.00. Although this cleansing process looked promising, the dynamics of it didn't work out well for us, hence we gave it a pass.

"What's next?"

Current day... Struggle is still on

After yet another failed IVF cycle (ICSI process), I am on a month long break to let my hormones settle down and get geared up for the next attempt. This statement might create an impression of me in your mind as a very strong woman; I am. But feelings change every second, each day. My state of mind keeps fluctuating whenever I recall all the struggles of our "trying to conceive a new life" as a couple.

In this blog, I wish to unfold the sequence of events and share the experience that my husband and I have been through since Dec' 2011. Trust me, it isn't just a struggle to make a baby of your own, but a lot more to deal with.

I know, there are many blogs/ posts/ discussions on infertility (mostly USA, Germany and UK based couples) which has all the latest updates of their cycles and quick references from their past, but that doesn't help much. Even I have read such posts a hundred times myself, but I am going to make this blog different from the others by revealing maximum details (names of places/ clinics/ doctors, tests, costs, etc) for the benefit of my countrymen and foreigners too (many foreigners visit my country to find solution to their infertility problems). My aim is to help other struggling "trying to conceive" couples understand the nitty-gritty of infertility and find their bundle of joy.

My next post will talk about my journey from the very beginning. I plan to do it fast, keeping in mind that my next cycle is just a month away and I have to capture details of past 50 months.

P.S.:  I am an Indian and all my references will be from India.