Laparoscopic Myomectomy, HRTs and OPU under Dr. Rashmi Yogish at Nova Bangalore

It was May’15 when I met Dr. Rashmi Yogish (Clinical Director & Consultant, Nova IVI Fertility Clinic, Koramangala, Bangalore). After reading my entire infertility history, she suggested that removing the Subserosal Fibroid might make a difference. It didn’t sound like a hunch as she backed it up with logic and explanation.

At that point in my life, I could have possibly said a “Yes” to “Anything” but Dr. Rashmi sounded like “she knows her stuff really well” and that gave me a lot of confidence. My DH agreed to go ahead with the surgery ONLY after understanding all the pros and cons, logics, scientific facts, etc.

In June’15, I underwent Laparoscopic Myomectomy for the removal of my not-so-big Subserosal Fibroid at Malathi Manipal, Jayanagar (one of the other few hospitals Dr. Rashmi is associated with). The surgery went well with not much of pain but looking at my sutures was a disturbing sight. I was on a month-long rest.

The action started after I got my July periods. I was on HRT-1 (1^st month of Hormone Replacement Treatment) for the month of July’15. Basically, taking Tablet Progynova 2mg and Tablet Meprate 10mg for specified number of days. Accidentally, I skipped a dose and got untimely periods. Anyhow, HRT-1 restarted after the bleeding got over. Then Aug’15, HRT-2 followed. At the end of each HRT, there were specific blood tests to be done on few specific days only.

During HRT-2, on a specific day of the cycle, a Mock Embryo Transfer (Mock ET) was performed. Things were smooth and went as expected. My Oocyte Pick-Up (OPU) was planned in the cycle following HRT-2.

Good "First Impression" : Nova Bangalore

Apologies for not posting anything for a week, I was undergoing my latest IVF cycle. Details about it will follow.

To start with my set of stories about Nova Bangalore, I would like to first mention the single point of contact (SPOC) for patients at Nova Bangalore, the receptionists. All the receptionists were (still are) welcoming, smiling, eager to help and multi-lingual.

My first interaction with them was face-to-face. For a change, I didn’t want to Google about my next doctor, so that I have no presumptions or expectations and go with an open mind. One fine day, I just planned to visit the clinic and told one of the receptionists’ that I have come from Nova Delhi and would like to meet their specialist. She asked me if I was carrying my file/ case history. Since I was, I gave it to her. She informed me that the concerned doctor was out of town and would be back in 2-3 days. Instead of letting me go back empty-handed, the receptionist made a quick call to someone, and upon the caller’s consent, she suggested that, if I wish, I could consult the other doctor. I took that option. The other doctor wasn’t in the clinic when the receptionist called him, but he made himself available in the clinic at the earliest. Within 10 minutes, I met Dr. Mahesh Koregol (Gynecologist, Nova Specialty Hospitals, 5^th Block, Koramangala, Bangalore).

Dr. Mahesh read through all my & DH's infertility history. He seemed quite knowledgeable and well-informed about Infertility. He assured me that I shouldn’t lose hope as there are other scientific advancements which could be used as an option in our case. He suggested that I come back and meet the specialist on the Day-2 of my next cycle. It was a ray of hope, and I grabbed that opportunity with full enthusiasm.

Next, meeting Dr. Rashmi Yogish.

Bidding Goodbye to Nova Delhi after 2 more failed Day-5 Blastocyst Transfer

After the failed Fresh Embryo Transfer (ET), Dr. Nalini Mahajan planned a Day-5 Blastocyst Transfer in the next cycle, under the same conditions as that of ERA.

There was a delay between ERA and next transfer because of two reasons: 1) OHSS and 2) either skipping a single dose of Estrogen substitute tablet on my behalf or a malfunction of some medicine, which caused untimely bleeding.

Also, during the Stimulation Process for Oocyte Pick-Up (OPU), I felt I had OHSS symptoms. Although, nobody at Nova Delhi agreed to me, but the internet said it all. I agree that not all information on internet is 100% correct but feeling like a bloated lower abdominal area made me look pregnant and the fullness inside gave me the idea how carrying a baby inside would be like.

Ovarian HyperStimulation Syndrome (OHSS) occurs only after the eggs are released from the ovary (either after ovulation or by receiving a shot of Human Chorionic Gonadotropin (hCG)).

So, the body needed time to get back to normal before proceeding with the next transfer.

Two Day-5 Blastocysts were transferred in Mar'15, but even that didn't work in our favour. A Blastocyst transfer is supposed to have better Success Rates than Fresh or Frozen Embryo transfers. I was waiting to get lucky with my next cycle then, last cycle at Nova Delhi as I was left with just Two more Day-5 Blastocysts. Trust me, all of them were mostly Grade-A, and few were Grade-B. I guess, what matters is "The Right Time". At that point in time, mine seemed far away. We were losing hope with each failed cycle.

The next cycle (3rd transfer at Nova Delhi, under Dr. Nalini Mahajan) was also a Two Day-5 Blastocysts transfer. This was done in the consecutive month, Apr'15, sadly, my beans didn't stick this time also.

I didn't want to start afresh and try another IVF cycle at Nova Delhi, even though Dr. Mahajan was quite experienced and knowledgeable. Somehow, I felt something was missing. That pushed me to get back to Bangalore and try my luck with Nova Bangalore.

I had read a lot about Nova's Success Rates being exceptionally good, hence the decision to visit Nova Bangalore.

All this might seem pretty casual but trust me, when you are going through all this, your body takes a lot of foreign particles inside and your brain works overtime. All you need to do is keep your cool and stay happy... because if mind isn't healthy, body can never be healthy. My DH gave his best in keeping me away from worries, tensions, tears and fears.

A fresh ET & ERA at Nova Delhi

After we met Dr. Nalini Mahajan (Nova IVI Fertility, New Delhi), my DH also felt the positivity in her approach. We went ahead with our treatment with her.

In Oct’14, I had my OPU (Oocyte Pick-Up) and 17 oocytes were retrieved. I was on Injection Menopur 450UI from CD6 and OPU was done on CD13. But before the OPU, she had me change my hypertension medicines. 

Earlier I was taking a combination of Tablet Newtel 40 and Newtel-H 40. According to her, Telmisartian Hydroclorothazide was not pregnancy-friendly, so she changed my medicines to Methyldopa 500 thrice a day.

Three days after OPU, a fresh ET was done, which didn’t succeed. A failed fresh ET and 2 failed IUIs in the past were enough for her to conduct a test on me called Endometrial Receptivity Array (ERA). It is kind of a biopsy of the endometrium done under specific conditions, HRT (P+5) to be precise and the procedure is carried out just like IUI. HRT (P+5) means Hormone Replacement Therapy and P+5 means intake of Progesterone (Injections and/or Capsules) +5 days. 

The report took 10-15 days to be published and sent back to the clinic. Thankfully, mine was Receptive. The preparation, procedure and publishing of report happened during Dec’14 and Jan’15.

Seeing the ERA Report, Dr. Mahajan made some changes in her plan for the next cycle.

Zeroing in on a clinic in Delhi

Delhi, the capital of India, has a gamut of opportunities for everyone. I, being a patient seeking help of a fertility expert, contacted many fertility clinics telling my case history to a few junior doctors over the phone or emailing it to the head of their department. I got positive response from two, Sir Ganga Ram Hospital (SGRH) and Nova IVI Fertility Clinic (Nova). At SGRH, I had direct contact of the senior doctor; she asked me to call her the moment I reach Delhi. At Nova, I had built a good rapport with the receptionist; she not only made to talk to the Director of the clinic, but also book an appointment for me one month in advance.

I wanted to setup everything before setting off to Delhi, as I had to stay with close relatives and causing them least troubles. I called SGRH doctor but she had quit SGRH and had joined a private practice. That didn’t sound like a good idea to me, as I contacted her because of SGRH’s history of FIRST IVF Baby in North India. Since the brand name attached to her got dropped, I chose Nova over her.

In Oct’14, I decided to try my luck at Nova IVI Fertility (Opp. St. Thomas Church, Africa Avenue, R K Puram Sector-2, Block B-2, Safdarjung Enclave, New Delhi). I registered myself as a New Patient and after physical examination, I then met Dr. Nalini Mahajan, Director of Clinic. After understanding the case, she advised a few tests to be done before I met her next. I called my DH for the next appointment.

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.

Choosing and Transporting the Donor Sperm from Bank to Hospital

To simplify things for us and follow the guidelines for themselves, Manipal Hospital (MHB) gave us contact details of a Donor Sperm Bank in Jayanagar (operated in Bangalore, but had nation-wide samples). After speaking to the Bank, we discovered that things shown in the Bollywood Hindi Movie “Vicky Donor” was not fake, if not 100% true. People have huge demands for Donors for both the gametes.

I visited them alone, assuming that it would be little discomforting for DH to go along and ask for Donor Sperms. They had a list of donors and asked me to pick a donor on the basis of their Blood Group, Height, Weight, Complexion of Skin, Eyes and Hair, Built and Education. I selected two, one of my DH’s Blood Group and another one of mine. They had several huge cans (bigger than milk cans used to collect cow milk in the barns) filled with Liquid Nitrogen and Frozen Donor Gametes. Thankfully, the samples I chose were readily available and all they required was a letter from the Doctor stating the reason for purchase and of course, the money. Since our Transfer Date was after more than a month and to be used for IUI, I told the Bank to block those two samples for me. I made a junior doctor speak to the Bank to authenticate my request.

The day my IUI dates were finalized (3-Day transfer on 1^st Aug’14), 5 days prior to that I collected one of the two samples (handed over to me in a mini flask with vials submerged in Liquid Nitrogen, hanging inside attached to a strong thread,) along with the Authentication Report (Semen Analysis, HIV, HCV, HBSAG and VDRL reports) and gave it to MHB's Lab for fertilization process. Transportation had to be done delicately; the flask had to be kept 90 degrees perpendicular to the ground. Although I had placed the flask on the co-driver's seat (seat-belt tightly fastened), driving alone with the flask was difficult.

IUI-1 Cycle details will follow.

Toughest decision: Adoption vs. Donor Sperm

We had had a rough 2-year journey “trying to conceive”. Last few months were the roughest and taking a decision on our way forward wasn’t any easier. Me and my DH, both sat down with a set of pen and paper each. The task was to jot down all the advantages/disadvantages of “Adopting a Baby” versus that of using a “Donor Sperm sample for ADI”.

It was definitely a nerve-wrecking activity. We both took time and reviewed our points several times before starting the debate. I remember keeping those 2 paper pieces in my safe. After a lot of discussion and argument, I had to agree with DH to go ahead with ADI (I am still open to Adoption). I do not understand why our Indian Society is so NOT open to adoption. I guess, the idea is to show off your baby bump to your neighbours, friends and even strangers.

If I can’t have one, why should that stop me from adopting one? After a lot of thinking, I suggested my DH that we could adopt a child and go to another city and live for a year or two and come back with a baby… “Tadaa!!! I delivered while we were away”. DH didn’t approve such a brilliant idea.

DH said if our child can’t have his chromosomes, at least it should have mine. Well, my point was (still is), if it ain’t Yours’ then let’s make one adopted child as ours (not by chromosomes but by characteristics). It will still be Ours’. Unfortunately, I couldn’t win this argument with my DH and had to give in.

We took this decision in May’14 and visited MHB at the start of my next menstrual cycle for IUI.

Next step, visiting Donor Sperm Bank for IUI-1 planned for July/Aug’14.