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 weeks) 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 about 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, 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 hindered. We then decided to resume our Doctor-Hopping, but 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 consuming 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 Punchkarma 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 Punchkarma 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.

Lost faith in Dr. Vasan's line of treatment

I mentioned in one of my previous posts that my DH had a lot of pain even after 3 weeks of performing TESE. Well, in spite of Dr. Vasan's claim of having fixed the problem by cutting a realllly tiny piece of suture, that actually didn't fix it and the pain continued. After another week of tolerating unbearable pain and duck-walk, I inspected the area that was cut during TESE. There was a knot of suture thread right in front. With utmost precision, using a very sharp yet small pair of scissors, I dared myself to cut the knot open and pulled out almost three quarter of a centimetre black thread holding the visible knot bulb. DH felt a little relief instantaneously and the rest was gone within a day. In my head, I did question the calibre of such a qualified surgeon, that he couldn't see the knot, and I being a layman saw it with my bare eyes.

DH's SA Report in Mar'13 was disturbing and that made us realize that we had started losing faith in Dr. Vasan's line of treatment. Even today, the decision of going ahead with TESA/TESE seems to be the most stupid and hasty decision that we ever took. We had hopes so we got influenced. We were wondering why Dr. Vasan didn't suggest taking Ayurvedic medicines at the very beginning of our treatment in MHB. I guess, it is OK for a patient to doubt his/her doctor and the doctor should totally accept this. Since no one could undo the disaster, we had to move ahead and look for ways to get the sperm production started.

The biggest question was… HOW???

Cost factor of our treatment until now

In this post, I will reveal some financial implications of our treatment until now.

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) and

--->   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.

Now what... Allopathic or Ayurvedic Treament?

On the day of my Egg Retrieval (ER), DH's semen collection had no sperms. The two vials of semen extracted from his body (via TESE) had no normal sperms either. All the eggs were cryopreserved for the same reason and Embryo Transfer (ET) for that cycle was put on hold.
On the day of my Egg Retrieval (ER), DH's semen collection had no sperms. The two vials of semen extracted from his body (via TESE) had no normal sperms either. All the eggs were cryopreserved for the same reason and Embryo Transfer (ET) for that cycle was put on hold. It wasn't a good sign.

We were then asked by his andrologist, Dr. Vasan S.S. to take a break and wait for the sperm generation to start naturally, with the help of a few medicines. We paid an annual fees for the cryopreservation of my eggs.

We repeated the SA test in May' 13 and the report wasn't good. Here's how it looked :-

We weren't expecting to see this kind of report 3 months post his TESE. We were concerned and scared too. We visited Dr. Vasan at the earliest appointment and he was astonished too. He asked my DH to continue taking those medicines and also try Ayurveda; he claimed that one of his patient with similar case showed some improvement following the Ayurvedic Treatment.

Guess we had no other option, but to do as instructed. The wait was killing...
It wasn't a good sign.

We were then asked by his andrologist, Dr. Vasan S.S. to take a break and wait for the sperm generation to start naturally. We paid an annual fees for the cryopreservation of my eggs.

We repeated the SA test in May' 13 and the report wasn't good. Here's how it looked :-

We weren't expecting to see this kind of report 3 months post his TESE. We were concerned and scared too. We visited Dr. Vasan at the earliest appointment and he was astonished too. He asked my DH to take few medicines and also try Ayurveda, as one of his patient showed some improvement following Ayurvedic Treatment. Guess we had no other option, but to do as instructed. The wait was killing...

My Egg Retrieval process at Manipa 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.

Post-TESE: Excruciating pain for more than a month

Egg Retrieval (ER) process in MHB is done under General Anaesthesia (GA). Similar to Hysteroscopy, I got my Pre-Anaesthesia Check (PAC) done two days prior to the specified procedure date.

Unfortunately, even after a month of rest and recovery, my DH's pain was unbearable. He had troubling driving to work, sitting on his office chair for long hours, basically each and every activity which involved lower body movement.

So after my PAC that day, we requested Dr. Vasan S.S. to have a look at the surgery site. Even before inspecting the source of pain, he concluded it to be an internal clot and said it would heal on its own. Upon requesting him hard enough, he agreed to check. For your information, everyday at least 10 patients came to consult only him.

Turned out that the pain was caused by the sloppy suturing done during TESE a month ago. Dr. Vasan did cut out a small piece of thread but the excruciating pain continued. More about it later.

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 :-(

Decided to go with ART at Manipal Hospital

After running from pillar to post, visiting so many doctors within a month's time, we zeroed in on Manipal Hospital Bangalore (MHB) with high hopes. Actually, we heard about MHB on radio while driving on one of the "doctor hopping" days. They had a dedicated ART/ IVF Dept and talked about good success rates; plus they had Dr.Bina Vasan & Dr. Vasan S.S., Urologist-Andrologist as their Team Lead.

We first met with the Uro-Andrologist in Nov' 12 to discuss my DH's Severe Oligospermia and Bilateral Varicocele Grade III and see if his suggestion was any different. He gave us enough time to understand all the reports and our fears, then prescribed two medicines for one month time period, namely Paternia and Wysolone to boost the sperm production. He asked us to do a Semen Analysis (SA) test before starting the medicines and come back with a fresh SA test after taking a month's dose. He also asked us to discuss the way forward with his wife, Dr. Bina Vasan, ART Specialist.

We met Dr. Bina Vasan, asked about the IVF procedures, their costs, etc. We were given in-depth information about all of it by her Assistant, Dr. Manju Nair. As a norm, MHB asks all their new ART patients to do expensive tests of HIV, HCV, HBsAg, VDRL, ELISA for both the partners before going ahead with any treatment. In the next consultation, they wrote down few more tests like Inhibin B and CASA for the male partner and a procedure called Hysteroscopy for the female partner. 

After meeting the doctor couple, our dimming hopes got new flight. We felt that we are in safe hands, and this might be the positivity that we were looking for. Their enthusiasm and involvement gave us confidence.

DH reports of SA in Nov'12, were just the same as conducted in Sep and Oct' 12 in the previous few "doctor hopping" visits (all of them were reputed clinics, so scope of error wasn't much) although done in different lab. 

They planned my hysteroscopy procedure in Dec' 12. Later, many doctors confirmed that conducting a hysteroscopy even before starting with an ART treatment isn't the best thing to do; makes more sense to be done after a few failed IUI/IVF attempts.

More about hysteroscopy and our journey in my next post.

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).

Then we visited Sure Fertility (J.P.Nagar 5th Phase, Bangalore) in Nov' 12 and met Dr. Uma Maheswari. 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?"

Diagnosed with Severe Oligospermia and Bilateral Varicocele Grade III

Dr. Joshitha Naik suggested that we discuss our case with Dr. Mahendra Jain (Urologist, a consultant in Lady Hospital, Jayanagar, Bangalore). Unfortunately, visiting him was a complete waste of time, effort and money. We, being the only patient for him to consult on a Saturday afternoon, were made to wait for 1.5 hours, that too after making several enquires. Upon his arrival, he did some physical examination and prescribed few medicines to cure Severe Oligospermia. He didn’t suggest any tests or scans. We googled about the drugs and they were nothing but energy pills and some vitamin supplements. We discarded his diagnosis and discussed it with Dr. Naik. She then gave reference of Dr. Ravish I R (Urologist, a consultant in Lucid Diagnostics, Jayanagar, Bangalore), also attached with Vikram Hospital, Millers Road, Bangalore. 


We visited Dr. Ravish in Sep’ 12 itself. He had a fair idea of what it might be leading to. He asked my DH to get a Scrotal Ultrasound done. The report concluded that the Severe Oligospermia could be a result of Bilateral Varicocele Grade III (the worst case). He suggested that a Varicocelectomy “might” fix the problem but post the procedure, my DH would need at least 1 month to recover from the incisions and sutures, and the testis would require another 3 months to produce fresh sperms normally. For your information, Lucid Diagnostics conduct all sorts of tests and scans; their consultant doctors are very professional and they value your time.


We weren't sure if going for this procedure was the first thing to do, so we decided to consult another specialist. This time we googled and discovered that St. John’s Hospital has really good and talented doctors in their panel. St John's might not be the cleanest hospital in town but it is worth going there for their talented faculty. We met up with Dr. A Nagaraj Rao (Professor & Head of Urology Department, St. John Medical College and Hospital, Koramangala, Bangalore). He turned out to be a very knowledgeable and experienced professional. He took a lot of time to go through each and every report we were carrying with us, confirmed that the diagnosis of Dr. Ravish I R was in fact correct, and result of conducting Varicocelectomy might not be successful. He explained the science of testis and how varicoceles impede the production of sperms. Apart from the procedure, he gave us two more options, Artifical Reproductive Technique (ART) and Ayurveda.

Mission "Make a baby" begins

My darling husband (DH) and I planned to make a baby so we initiated the process in Dec' 11. We read and did research about the "fertile days" concept and marked it on a calendar and did the needful on the specified days.

The concept of "fertile days" is 3 days before and after your Ovulation Day (OD) as healthy sperms can survive upto 72 hours inside the uterus. Since one can't be totally sure about your OD, the formula becomes 4-OD, 2-OD, OD, OD+2, OD+4. Yes, your DH has to do a lot of work in that one week. Another way to predict your OD is by using an Ovulation Prediction Kit (OPK) easily available in the market. It is similar to a Home Pregnancy Test (HPT), a drop or few of urine is enough. Basically, OPK measures the level of the leutinising hormone (LH) and Follicle Stimulating Hormone (FSH), LH levels are highest on OD. Third way is to keep a track on your Body Basal Temperature (BBT). Since I could never follow this procedure, I left it. All these methods can't predict your OD in advance, so if you miss the fertile window this month, aim for the next month.

Well, my DH and I tried for a few months using the calendar method but couldn't succeed. So we visited a gynaecologist (Dr. Joshitha Naik, Lady Hospital, Jayanagar, Bangalore) in June’ 12 just to understand if we were heading in the right direction or not. She got my basic tests done (CBC, Lipid Profile as I am hypertensive and on medication, and a pelvis scan). All looked fine so she prescribed a folic acid supplement and baby Aspirin 75mg (for hypertension). She also suggested the use of OPK for better prediction of OD.

Three months went by, and our attempts failed, leaving us a little perplexed. We visited the gynaecologist again in Sep’ 12 and voiced our concern. This time she suggested a Semen Analysis (SA) of my husband. The report wasn’t good, Severe Oligospermia is what she concluded (as the value was 2 million sperm/mL). We were asked to consult an urologist and if not cured, only an artifical way could help us make a baby.

Current day...

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, Canada 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.