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If you need to contact me , please write to me to this email ID : manjupadmasekar@yahoo.com. I will be happy to help.

Wednesday, August 8, 2012

From 3 eggs at the age of 29 to 24 eggs at the age of 33!

How many eggs will I lay, sorry : ) how many eggs will they retrieve from me is the most important question in my mind during all my IVF attempts.  I have thought about my eggs more than anything else after my marriage. When we started our journey to conceive; I would tell my DH, ‘I think today my egg will be released, I have all the signs of ovulation’. I will be saying it very seriously and with a determination to catch it and make a baby out of it : ) (poor DH!) He will respond with the most innocent face ‘Manju, why can’t you make an omelet out of that for me’ : ) I will break into laughter. These kinds of “eggie talks” have become a part of our life after starting TTC.


The most important question which lingers in the mind of many women who are undergoing IVF is - why didn’t I get more eggs during my IVF cycle? When I started my IVF journey I was young. I saw so many young women (even some 35+ women!) in infertility boards reporting that they got more than 20 eggs. I am so confident of my ovaries : ) I thought, I am only 29 and my problem is just fallopian tubes; I am a great candidate for IVF and for sure I will produce so many good quality eggs and will be successful very soon. I have read that young women with fallopian tube blockage are the best candidates for IVF and they get success very easily. With so much confidence in mind I started my first IVF cyle. My RE in Germany was too cautious. He started my ovarian stimulation regime with 112.5 iu of Gonal F! Each successive ultrasound for monitoring follicle development shrivelled up my hopes of getting large amount of eggs. After a week or so of stimulation my RE increased the dosage to 150 iu of Gonal F. There were only very few follicles developing and I was really worried. I was not prepared for such an outcome. When I asked my RE why am I responding so poorly to stimulation; he replied very coldly ‘it's your ovaries; how will I know?’(Great answer!).  When I didn’t get a proper reply from him I searched the internet for answers. I will always be grateful to the women in infertility boards who patiently answered all my questions and put my mind at ease.  I ended up with only 3 eggs during that cycle. Out of the three eggs only one fertilized via IVF and that lone embryo was only 4 cells on day 3 of fertilization. I felt so happy to see that single embryo – my first embryo sighting experience!

The next four cycles in Germany lead to the collection of 9, 5, 8 and 5 eggs respectively. I thought that the second IVF cycle was a bust too! Out of the 9 eggs retrieved 7 were mature. Since only one out of three eggs was fertilized during my 1st IVF, my RE suggested that we should try ICSI. We agreed. But I could not accept the fact that my eggs and his sperms cannot even make love in a petridish without help :). I had a notion that IVF is more natural than ICSI. So I came up with an idea. I told the embryologist ‘please keep 3 eggs for normal fertilization (IVF) and do ICSI on the other 4 eggs’. He looked at me strangely and asked ‘do you think that will make a difference?’ I had no real answer but just nodded my head affirmatively. The day after egg retrieval I have to call the embryology lab to get the fertilization report. To call the embryologist and to take the fertilization report is the scariest part! The thought that there were only few eggs and the possibility of complete fertilization failure or any other unfortunate happening haunted me all the time. My heart used to race during those few minute conversations with the embryologist. The day after my egg collection I called the embryology lab for getting my fertilization report. The embryologist said ‘only two of your ICSIed eggs fertilized and there was no fertilization in the eggs which were kept for IVF’. I cried! I could not believe that I have only 2 embryos from 7 eggs. I kept on blaming myself for opting to use 3 eggs for normal fertilization. After the initial crying spell, I was happy that I had at least those two embryos. This is the first lesson my IVF journey taught me – always try to look at the positive side of the story and be happy! When I talked to my doctor he said, ‘come on Friday (which is actually day 2 of fertilization) we will transfer those two embryos’. I told my husband ‘anyhow they cannot select embryos after cleavage (in Germany, embryo selection after cleavage is prohibited by law!) that is why God has selected himself and gave us only two embryos.

I am so happy the day I saw those two perfect four celled embryos! They looked 100% perfect. The embryologist was beaming with pride. He said that my embies looked picture perfect. My hope was high again after the initial tragedy. After transfer I rested for 5 minutes and left the clinic. You know what? One of those 4 celled embryo was actually a fighter – it implanted in my uterus! I always think of that little one. Even though it didn’t become a full-fledged baby (I lost my precious baby at around 7- 8 weeks); that embryo is the one which keeps my hopes high even after undergoing 6 further futile embryo transfer attempts!

I think I have deviated a lot from the original topic. Now back to the topic - why some women get fewer eggs and some more?

As the women age their ovarian reserve gets depleted. Depletion of follicular reserve begins during foetal life and continues throughout a woman’s life.  At around 20 weeks of gestation a female foetus carries 7 million follicles and during menopause (approx. 51 years later) it is reduced to a few hundred. So younger women are expected to produce more eggs and older women tend to produce fewer eggs. PCOD otherwise called as Stein-Leventhal syndrome is a collection of metabolic derangements. Ovaries of women with PCOD produce excess androgen (male hormone) and they might also have more insulin circulating in their body. Women with PCOD have very high antral follicle count (AFC) and hence they produce lots of eggs when stimulated with gonadotrophins. Women, who undergo premature menopause at a younger age, will have very less AFC count, increased FSH and low AMH. They produce less number of eggs too!

Is poor ovarian reserve an indicator of poor egg quality ? The answer is yes as well as a no! When women get older, their ovarian reserve decreases as well as their egg quality. But younger woman with less ovarian reserve can produce good quality eggs. AMH, FSH and AFC are all indicators of ovarian reserve. If a younger woman has higher FSH, low AMH and AFC her chance of producing good quality eggs and embryos is as high as her similar age counterparts. That is why young women with premature menopause are more successful in getting pregnant via IVF when compared to older woman who have low FSH and high AMH. The message here is age of the women is the best indicator of egg quality and not their AMH or FSH.

What helped me to get 24 eggs in my 6th IVF cycle?

I made two important changes during my 6th IVF cycle. I was advised to take DHEA (75 mg) by Dr.Malpani.  I started to take it regularly. I took it for 9 long months. The good thing is, I never had any bad side-effects. On taking DHEA I started to ovulate regularly. I had lots of fertile quality mucus during my ovulation time. I also had ovulation pain which is very prominent. People say DHEA can give them bad hair days. I never had problem with my hair. I should say my hair fall was reduced when taking DHEA.  Please visit CHR (Center for Human Reproduction) website for further details. DHEA was found to increase oocyte production (PMID: 16169414). The mechanism behind it is not so clear. DHEA is used in mice to induce PCOS phenotype in previously normal ovaries (PMID: 16514202). DHEA supplementation was also shown to decrease embryo aneuploidy (genetic defects) (PMID: 21067609)

The next change I made was to stop taking metformin (1500mg). I was on metformin from the age of 26 years. I was diagnosed as having PCOD using ultrasound pictures of my ovaries. My ovaries had a characteristic pearl-like structure. I also have insulin resistance. When I started taking metformin I started to ovulate regularly. I lost weight and felt a lot better. Metformin is found to have anti-cancer and anti-aging properties. It is also touted to prevent or postpone diabetes in PCOD women who are prone to it. So from the age of 26 I was on metformin. I never had a second thought about it. I never thought it can reduce my AFC count and can lead to less egg yield during my IVF cycles. Metformin can reduce your AFC count. A scientific study showed that one week of low-dose metformin therapy can bring down your AFC count (PMID: 17224152).  A recent publication which studied IVF cycles among PCOD patients with and without metformin administration showed that the stimulation length and gonadotropin doses were significantly higher in metformin group than in control group.  The number of dominant follicles on the day of ovarian maturation triggering and peak oestradiol levels was significantly lower in metformin group than in control group (PMID: 21770836).

I believe these two changes (taking 75 mg DHEA and stopping metformin) made a big difference in the egg yield during my 6th IVF cycle. To be exact, I had suppressed my bodies PCOD tendency using metformin. So by stopping metformin and starting DHEA (which is a PCOD mimetic) I was successful to coax my ovaries to produce more follicles and hence more eggs. After 9 months of DHEA intake and stopping metformin my AFC count increased form 7-9 to 18-20!

Moral of this story is .......


If you are a woman who is having diminished ovarian reserve please try DHEA. It worked for many, might be it works for you too. Metformin is a wonderful drug. It really helps woman with PCOD and insulin resistance. If you are young, have excellent FSH and AMH value, have extremely high AFC count, if you are overweight – metformin is for you. It can reduce your insulin levels and thus can help with improving egg quality. It can prevent OHSS by reducing AFC count. If you have extremely high AFC you are prone to develop several follicles in response to gonadotrophin stimulation. More the number of growing follicles, higher will be your estrogen levels. A higher estrogen level is a risk factor for developing OHSS. But if your are a woman who has less AFC count, higher FSH, lower AMH and normal BMI metformin will not help you. I do not think it can improve egg quality in such woman and it can even lead to cycle cancellations by reducing your ovaries response to gonadotrophins! 

74 comments:

  1. Why the process of reproduction is so complex in females ? Males have such a simple process, nothing to store. Your article has increased respect of my wife for the things
    out of her control.

    ReplyDelete
    Replies
    1. Manju after reading this article and your article on supplements i am a bit confused. you sound like supplements dont really make a lot of difference but here dhea seemed to have helped you some.
      So what are you really saying? to supplement or not to?

      Delete
    2. Hi,

      Thanks for this question ! I was never diagnozed with poor ovarian reserve. I had good AMH and FSH values. Since I had PCOD I was always on metformin (insulin sensitizer). My PCOD is under control. When I started DHEA (I took for 9 months) I stopped metformin too. So hard to know which made the difference. Metformin is found to suppress AFC and DHEA was thought to enhance AFC in ovaries.Women with low AMH and high FSH have very few eggs left in their ovaries. Our ovaries cannot form new egg cells. All the eggs we have in our ovaries are formed when we are in our mother's womb. DHEA recruits the follicles (which carries the egg) which are already present in the ovaries in some way. It cannot give rise to new follicles and hence new eggs. So women who already have few follicles in their ovaries will not give rise to more eggs just by DHEA use (very unlikely !). Only when you have money in your account you can withdraw it ! There might be women whose follicle recruitment may be affected in some way. In such case DHEA might help (just a guess !). Only when the promordial follicles in your ovaries (stored follicles) become antral follicles they will grow in response to hormone injection (FSH)given during IVF. That is why some women find DHEA helpful and some not. (My guess!). Hope it answers your question. Try DHEA if you have poor ovarian reserve but do not place all your hope on it !Mail me if you need further info !

      Lots and lots of good luck !

      Manju

      Delete
    3. Hi, i am 27 years old and a week ago I had my AMH level checked on cd. 30 which came back only .08, i was shocked and I requesteda new test, two days later on CD1 they test my FSH 4.7, E2 152, AMH .14. I have been taking metformin for 2.5 months to help me lose weigh, I am not IR. anyways, two months ago my AFC was 14-16ish a week after ovulation she couldn't count the follies since I had ovulated and corpus luthem was blocking. I have been pregnant twice naturenally and both mc. Am i going into menopause? all my other tests have been normal, i have heard high E2 levels can mask the true FSH levels, however the test was done two days before cd3. I am from America and I am not sure if this matches european levels. Please let me know what u think, thanks.

      Delete
    4. Dear anonymous,

      Your AMH is low and your FSH levels are normal because of the elevated e2. Perhaps doctors thought you have PCOD and put you on metformin or you yourself guessed so and started metformin. What is your BMI ? I understand it is difficult to accept this harsh turth but to say in medical terms - you have diminished ovarian reserve (DOR).

      But the good news is, you are young, conceived twice and your AFC count is pretty high. Poor ovarian reserve at an younger age has many reasons but 70% of time the diagnosis has no known cause.

      IVF will give you a good chance of conceiving. Since you are young I would not waste time to seek medical help. Please talk to your doctor regarding more aggressive treatments (like IUI, IVF etc).

      Many scientific papers show that younger women with poor ovarian reserve has good chance of conceiving with IVF and their success rate is comparable to normal women of their age, provided they could retrieve atleast decent amount of eggs from you to work with. Perhaps some women with poor ovarian reserve show very poor response to ovarian stimulation even if they have decent amount of AFC. You should find a doctor who has experience in working with women who has poor ovarian reserve. Starting with a high dose of FSH injection for ovarian stimulation might help !

      How long were you trying to conceive ?

      Many women with poor ovarian reserve fail to conceive on their own or undergo miscarriage too. Is it because of poor egg quality ? The scientific data is conflicting and since there are many reason for poor ovarian reserve, every woman with DOR might be different too.

      Might be you will go through menopause sooner than usual. Please talk to your doctor and clarify your doubts. You are not having menopause now. So do not worry.

      Please write to me if you need more help : manjupadmasekar@yahoo.com

      Delete
  2. Manju, curiously my wife and I have very similar circumstances to your own. Our numbers for the first cycle were dismal and my wife was on metformin, though not for diabetes. During the first cycle, we had to use a murderous amount of medication (3-4 times more than average) and we only ended up with 2 embryos. It was enough for a successful implantation, but we miscarried in the first trimester.

    This time around, she started on DHEA, kicked metformin, and lost a lot of weight. All of our numbers roughly doubled, though we haven't started the next cycle yet. As of now, it's a money saving game. The previous cycle cost us twice what we expected, given the number of meds we had to purchase.

    So out of curiosity, are you and your husband planning to continue more IVF cycles?

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  3. What is your wife's AMH level ? Is her day 3 FSH and e2 normal ? What was her AFC count before and after stopping metformin and starting DHEA?

    Metformin or any other insulin-sensitizer can suppress the AFC drastically. We have five more frozen embies ( day 3 embryos). We are planning for a FET very soon. Will keep you updated. I wish I never should give up until I reach my dream : )

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  4. Manju, shall i under that DHEA will help to convert the premordial follicels to Antral Follicles count but not the quality of eggs , right ?

    ReplyDelete
    Replies
    1. Research says that DHEA improves quantity as well as quality of eggs. But there are no studies with enough power. For some it works, for some not and with such a situation it is hard to say whether DHEA really has an effect. But try it - might be it works for you ! Good Luck !

      Delete
  5. hi manju i have been now prescribed dhea by my doc too as i ovulate just by one ovary that tooo just 3 to 4 follies....but my history is similar to urs 10 yrs pcod and have been on metforin for almost that long but now for some unknown reason the right side is just not fuctioning scans show mild pcod yet thought my AMH is 1.2. for now all i want to know is that can dhea be taken with metforin cause my doc says not to stop metforin and start dhea also...i did one ivf and 3 iuis alll failed done laproscopy prior to that just fed up and everytime there is some new problem amd new reason to wait :-( people who tried at the same time as me are on thier second baby and i am yet trying to get my first its soooo not fair. i feel alone all the time i just hope now this new thing works though i have to wait for 2 to 3 months atleast now...i know its maybe wishful thinking but i am hoping i get pregnant naturally in these 3 months and dont have to go thru all that.
    zara

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    Replies
    1. Dear Zara,

      My suggestion would be to stop metformin and start DHEA (75mg/day). Metformin suppressed my AFC and my ovaries ability to respond to stimulation drugs (FSH). Your AMH level doesn't show that you have PCOD. What is your age ? Are you overweight ? Do you have insulin resistance ? Did you check your day 3 FSH any time ? Is your thyroid normal ? Why are you put on metformin ? Did you have irregular periods ? Please answer these questions Zara !

      Many women with poor ovarian reserve are sometimes misdiagnosed as having PCOD. I understand that it is extremely frustrating. I too wish that DHEA helps you to conceive naturally. I wish you lots of good luck in your endeavor ! Have patience and be persistent and I am sure you will reach your goal.

      Manju

      Delete
  6. i am 33 now and weigh 65 kilos because of treatments gained 5 was around 58 60 always so ya technically i am overweight but if u see me i may not look it my throid is normal and so are my insulin levels ..when i was 23 my periods got delayed almost 15 days and when i went for my scan they concluded pcod the scannin doc was horrible she told me at that age i would not be able to conceieve then my gynac calmed me down almost 8 yrs i was scared of this phase of my life and here i am facing it..anyways i did do a sono recently and do have small cyst on the right buts its a tiny 2 mm thing so they say not to worry..my ivf failure could be due to lots of reason after the egg retrival i had an allergic reaction which was honestly quite bad even the docs were shocked so they pumped me with steroids and avil injections though inspite of telling them not to worry as i keep getting them of and on. my embryos were perfect 6 and 8 cells and graded 1 they said they were perfect my lining was goood after months so i dont know what could go wrong..:-( anyway right now my doses are to tabs of dhea which i 50 mg and 1000 mg metaforin ....as of fsh yes i did 2 nd day of the periods but my files with the doc wil check and let u know next week..i am scared to stop it cause what if i again get cyst on my left back....last two yrs have been very tragic regarding this i dont even know where to begin its so long...naturally my eggs would never rupture they would form into cyst and to top it i have a retroverted uterus so that makes the process a little more complicated ..today my docs great but before this for one yrs iwas withthis famous south bombay doc who did nothing but messsed it up big time for me ...shes good with women who conceive naturally but infertility cases cant handle i yet hold her responsible for lot of things going wrong with me...zara

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  7. sorry my husband asked me to make clear to u the doc i was refering to in my previous msg was not dr malpani it was someone from breach candy and she really made my case worse besides the 5 hr wait to meet for 5 mins did no good ... i wanted to see malpani as i live in colaba but too many family friends he knows and coming in and out of his clinic would just make things worse for us.... can u tell me one thing as most clinics for ivfs dont do 5 day tranfer does he do it 3 day tranfer is common but 5 day doesnt seem that common in mumbai if possible pls donlet me know if he does that thank u ...zara

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  8. Dear Zara,

    I do not think you have PCOD. Might be the issue you are facing now is poor ovarian reserve. I would say - please stop metformin ! Continue DHEA.

    Sorry that you had allergic reaction after egg retrieval - can you let me know what kind of allergic reaction you had ?

    Zara, I understand your fear about your relatives, but being near Dr. Malpani's clinic, you should atleast try to get his second opinion. Dr. Malpani could shed more light on your condition perhaps ! They are really very good and treat their patients well.

    Mail me if you need any info : manjupadmasekar@yahoo.com

    Manju

    ReplyDelete
  9. allergiic to everything med under the asprin family more will know after i meet my allergy specialist next week..wil speak to my gynac and stop metaforin for now made the dose less ...i will consider going to malpani for a second opinion .....all though b4 i go i would want to know if they do 5 day tranfer... btw happy mothers day to u and all u people trying and struggling u get ur baby its probably the toughest phase and all our babies will be really lucky to have us as mums cause the pain and stuggle we go through b4 thier arrival is honestly not easy ...no offence to the ones u have got thier babies in one try but the ones who dont have thier little angels yet never give up and ur dreams wil become reality ..llove and hugs to all going to be soon mums.... zara

    ReplyDelete
    Replies
    1. Zara, for sure in Dr. Malpani's clinic they do blastocyst transfer. I saw my embryos growing into blastocyst after going to them.

      Thanks a lot for the mother's day wish !

      Lots of love,
      Manju

      Delete
  10. thanks for replying..zara

    ReplyDelete
  11. Manju, thank you for this great blog. I've learned so much from yours and Dr. Malpani's websites. I wish you good luck, as I'm going to try DHEA (I'm 38, FSH=7, AMH=1.9, AFC=12). Next cycle will be my first IVF attempt, and I hope it works!

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    Replies
    1. Thank you so much too ! Kind words from people like you, keeps me going ! I wish you lots of good luck dear friend, and please do keep me informed. If you have any doubts regarding IVF cycle, I will be happy to help you.

      My e-mail ID is manjupadmasekar@yahoo.com

      Delete
    2. Hello my name is linn.. my emai is nialinn74@yahoo.com.
      .I am having issues as well...I had 2 failed iuis and trouble getting egg to be eligible for frozen transfer

      Delete
    3. Hello my name is linn.. my emai is nialinn74@yahoo.com.
      .I am having issues as well...I had 2 failed iuis and trouble getting egg to be eligible for frozen transfer

      Delete
  12. Hi Manju I have been married 3yrs and decided its time to have a baby. Im 28 and weigh 78kgs my height is 5.1 so yes im very over weight. my DH is 33. In 2009 I had issues with scanty periods and was gaining weight went to a gynac who diagnosed me with PCOD and put me on yasmin. I continued on yasmin. Went to another gynac two yrs later who asked me to continue yasmin until I decide to have a baby and also put me on metformin but it gave me loose motions so I did not take that until 5months ago. My fasting blood sugar is 115 with metformin but its 130 without it now as I have quit metformin so now since a month. My AMH is .99 my DH sperm count is .03million per ml so we have to go for aggressive treatment. I have started taking multivitamins n royal jelly capsules. I have a couple of months until I opt for the ICSI as thats our only option can u help me with whatI should do about the high fasting sugar matter and to improve my egg quality. Considering the cost of these treatments I want to do all i can from my side to make the first or atleast second one a success rest is ofcourse destiny. I feel lost and dont know what doc to see or how to proceed. Thanks...JP

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    Replies
    1. Dear JP,

      I understand your pain. I am really sorry that you have to go through it. I am sure now you know your problem better. There are two problems : your weight and blood sugar and your AMH shows your ovarian reserve is not so good. I am not sure whether your weight problem has anything to do with ovarian reserve. Does anyone in your family suffer with infertility problem ? Is diabetes prevalent in your family ? At what age did your mom reach menopause ?

      If I were you, I will make diet changes (avoid NV, take in more fibrous veggies , avoid sugary drinks and take in lots of plain water ) and start some form of exercise. Metformin is a miracle drug. If it is taken along with proper diet, it will bring down your insulin levels and make you ovulate. Metformin is effective at a dose of 1500 mg and above. Ofcourse it does create stomach problems but it subsides slowly.

      I don't know what more to say. I am not sure whether bringing down your insulin and sugar levels will improve your AMH.

      Please take metformin and first bring down your fasting insulin and blood glucose before going in for IVF. Women with problem like yours of course conceive easily with IVF , but the risk of miscarriage is higher if your blood sugar is not stabilized. I wish you lots and lots of good luck !

      Mail me, I will be happy to answer your queries.

      Manju

      Delete
  13. Thanks Manju for such a quick reply. Diabetes and high cholestrol run in my family on both sides. My mom reached menopause at the age of 40 I think.
    I got my periods when I was 10 so after my AMH result Im worried its gonna come early for me too.
    The only metformin tab that suite me was bigomet n I took 500sr which I took in the night so what dose and when should I start please let me know. With metformin within a week my fasting sugar goes in normal range.
    I will make the diet changes and start exercising too. Should I also start the DHEA along with the metformin.
    Im in Mumbai so I can visit any doc u recommend. Im sorry for so many questions but I feel lost and helpless.
    Thank u so much.....JP

    ReplyDelete
    Replies
    1. JP, do not panic. Relax and be cool. The only way to remain sane during infertility is to be strong and brave. No infertility treatment is fool proof, all infertility treatments need consistent attempts before reaching your goal. So have realistic expectations. It is normal to be tensed and fearful but learn ways to overcome it. It will help a lot.

      Your family history clearly shows you are prone to diabetes. Your mother's early menopause is also of concern. Do not start DHEA now. First you must be on metformin. Bigomet is OK. Start with 500 mg for a week and slowly increase up to 3 times a day. Do not worry about the stomach problem. It will subside. Bear it. Metformin works well only if you have healthy diet ( avoid sugar, NV and eat more vegetables and fruits, it is wise to avoid sugary fruits too. Do you get plantain stem and flowers in Mumbai ? Include in your diet more often ) and excercise. Even if you lose couple of kgs, you will start to ovulate. I wish you conceive naturally during this period. I am Dr. Malpani's patient. He is a very competent Dr, if possible arrange a consultation with him.

      I wish you lots of good luck !

      Manju

      Delete
    2. Please remember that I am not a medical doctor, take expert opinion before you decide to plan anything.

      Delete
  14. Hi Manju,

    I've just finished my first IVF attempt where with really high stimulation I was able to yield only 2 follicles and both had very low quality eggs - hence had to cancel. I've had 2 laporoscopies to remove endometriosis and was told that that could be one reason for low egg reserve.. I am meeting my doctor tomorrow to understand what next and was wondering if you think DHEA could help in this case? Thanks in advance

    ReplyDelete
    Replies
    1. May I know you age please ! DHEA won't harm but there is no proof to say that it really helps. Sorry that you have to go through this. Do you know your AMH value and AFC count ?

      Delete
  15. Hi manju.

    Been reading your post since yesterday and was wondering and thinking that I might increased my eggs too.

    I had a blocked tubes both of it. Before that my first obgyne gave me clomid for about 6 cycles without checking that I have blocked fallopian tubes. So I change to another Dr and recommend to do hysterogram and semen analysis. That's when we found out. I was only 28 that time. My new Dr said we have to undergo ivf. So we try but sad to say it was canceled. They only seen 1 single egg and it was only fertilizes in 2 cell. They did not transfer it coz they have a high standard of embryo quality. The Dr said we go back after 4 mos. And he gave me dhea. I also went to acupuncture and take vits. Then we go back after 4 mos. Then they only seen 1 single egg again but the quality went to 8ac. Then I have an embryo transfer. Now I have a daughter.

    But we decided to do another ivf this year and my preparation was only 2 and half mos. taking dhea and vits. But again only one egg seen and to our dismay we are canceled.
    My age now is 34.
    Before that my obgyne gave me metformin too to lose weight. But I already stop it before going to ivf again.

    Would like to ask what shall I do to make my eggs more and good quality.

    Thank you.

    ReplyDelete
    Replies
    1. Thanks for sharing your story ! You really have a miracle baby. At 28, eventhough you had poor ovarian reserve, age was on your side. I agree at 34 it becomes a lot more difficult. I have nothing to say. Just repeat until you are able to produce that single egg. Hope another miracle happens too. If you are overweight, reducing even a few kilograms helps a lot. What is your AMH and FSH value ?

      Delete
    2. And please do not have taken metformin atleast a month before IVF cycle.

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    3. Hi manju.

      My amh is 0.52 and my FSH is 11.03.

      Yes indeed I have a miracle baby. Thank you. Wishing that all of us will have their own beautiful babies too.

      Delete
  16. Hi.

    My amh is 0.52 and my FSH is 11.03.

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  17. Hi manju! I really learned a lot from this blog. Thank you so much for writing all these entries.

    Just to share, I am 31 and tried for my very first IVF earlier this month. I have PCOD and overweight. I've always had problems ovulating on my own. Prior to doing this IVF, I've had 2 IUIs that failed on clomid and femara. I would usually just get 1 mature egg and sadly, both IUIs failed. My husband also has poor motility, which is why my OBGYN advises we do ICSI when we have our IVF. I didn't really prepare for my IVF, except for a few sessions of acupuncture.

    Anyway, since I have a lot follicles, (My AMH is 10.9 and TSH is at 2.96) my doctor gave me 1 dose of Pergoveris during my IVF cycle because he didn't want to me to produce too many eggs. I had about 12 follicles in each of my ovaries and my doctor said he just wanted around 8-10 mature eggs. I had this shot everyday until Day 17. Unfortunately, my last E2 test showed that my estradiol had gone down to a measly 55, and my doctor cancelled my IVF as it seemed that I only had 1 mature egg and that the poor E2 means poor egg quality.

    I will have another round of IVF on November and am wondering what I should do differently this time around. I had started taking Metformin again and my doctor advised me to take Vitamin B complex. Do you think this will help? I'm also working hard to reduce my weight to have a lower BMI. What else do you think I should do to improve my chances of producing better quality eggs? By the way, we will use a different protocol on my next IVF and I need to start on Lupron before my period. Thanks in advance!

    -san

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    Replies
    1. San, why did your doctor stimulate for 17 days ? Did they measure your estrogen several times during the cycle ? Can you give me all the values ? Did the follicles grow or did they stop growing at a point ?

      First, I think, you must make sure you are with a clinic who have enough experience in treating PCOD women.

      You have to take metformin. If you couldn't tolerate metformin, try taking myoinositol 2g per day. It was shown to be as effective as metformin. If you take metformin, you need to increase the dosage up to 2000 mg slowly.

      Taking medicine alone will not help. You have to avoid sugar and anything that contains sugar including fruit juices and soft drinks. Avoid meat of possible. If you have to eat, take fish and chicken breast. Increase your vegetable intake, especially fiber rich ones. Say no to junk foods and high calorie foods. Excercise helps too.

      High AMH will prevent your follicles responding to FSH. So you have to bring down the symptoms of PCOD. Diet, exercise and metformin is the way. If you are able to reduce few kgs, you will start to ovulate on your own. May be you will conceive too naturally, provided your husband's sperm count and motility is good too.

      If possible, please wait 3 months to make the necessary life style changes and then start your next IVF. Now, even if you conceive, the risk of miscarriage is little higher for you when compared to women of your age.

      What is your day 3 LH and FSH value ?

      Delete
  18. Hi manju
    your blog seems to offer hope
    I am 36 year old married woman weighing 73 kgs .my menarche started with menorheghia and it was so bad with heavy bleeding and merging of cycles.this continued for years.mranwhile consulted several doctors and they put me on hormone replacement therapy.slowly it started diminishing .in 2003 to 2007 I had scarce periods and eithdrawl bleeding and was on and off taking hormones.
    I was tested for hypothyroidism and insulin resistance and put on metformin and eltroxin which I took for a year or so.elttoxin I have been fairly regulsr.
    in 2013 I again went ti a gynae and she put me on hormones and this time I had no withdrawl bleeding also.
    my amh is .10 and fsh is mormal.
    I am not taking any medicines amd no doctor till now has been able to provide me an answer or direction.i need to conceive but dnt know what to do as doctors do not suggest anything .
    please help

    ReplyDelete
    Replies
    1. Dear Anon,

      I am sorry that you have to go through this. Is your uterus normal ? Have you undergone hysteroscopy to make sure there are no adhesions or scar tissues in uterus ? Did any doctor mention about Asherman's syndrome ?

      Endometriosis ? Do you ovulate ? Any follicle tracking studies done ? When you say FSH is normal, on which day it is measured, did they measure e2 along with it ?
      Is your pituitary normal ? Did doctors do any MRI ?
      Your AMH is extremely low. This indicates you might have reached early menopause. But you say your FSH is normal ! Are any genetic testing done on you ?
      How long were you trying to conceive ? Have you ever tried to seek the help of infertility specialist not just gynecologist ? Have you been pregnant any time ?
      When you say doctors put you on hormones, is it birth control pills ? Do you have your test results with you ? Can you send it to me, manjupadmasekar@yahoo. com.
      Merging of cycles, what do you mean by it ? When you had your periods, how many days apart they were ?
      Do you have hot flashes, symptoms o menopause ? Eltroxin you have to take everyday, lifelong, are you doing so ? What is your recent TSH value ?

      Sorry for so any questions but I need to know so that I could understand and help you better.

      Delete
    2. This is Dr. Malpani's reply:

      Her low AMH level ( www.drmalpani.com/amh.htm)

      Suggests she has very poor ovarian reserve .

       

      She can read more about this at www.drmalpani.com/oopause.htm.

       

      Please ask her to test her antral follicle count by doing a vaginal ultrasound scan ? Read more at www.drmalpani.com/afc.htm

       

      I feel it will be low L

       

      The normal FSH is misleading. A high FSH can be artificially suppressed by a high E2 level and fool doctors and patients

      Delete
    3. Donor eggs will help you to have a baby. You can also email Dr. Malpani, his mail Id is info@drmalpani. com

      Delete
  19. Hi Manju,

    Your blog has been suggested to me. Thank you for sharing it. A quick summary, my partner and I have not been given good odds at all with IVF. We met late in life. I've just turned 43, and have been having tests for fertility for over a year. We left his tests till last not expecting any problems. Turns out he has azoospermia and is booked in for MTESE surgery to see if he has any sperm to surgically extract. It has been a horrible year, and we certainly were not expecting to be faced with the fact that my partner has no sperm and possibly cannot father our child. He does not have good odds because of this, and because of my age neither do I. I did IVF the other month and I had only 3 eggs which they froze, in preparation for his surgery (if they do find sperm it may only be less than 10, and they can't freeze individual sperm so I need as many eggs as possible in readiness in case they find sperm). I had been on DHEA for 3 mths prior to the IVF and still only got 3 eggs. I am told for a woman my age 1 - 3 or 4 eggs is average. A friend who is about 2 years younger got 11 eggs though. I have just swapped Fertility Specialist as the first was dismissive and he didn't want to explain things or answer my questions. The new fertility specialist (a woman this time) is happy to explain things to me and more compassionate. She has now put me on Testogel (testosterone cream), Melatonin, high doses of Co Enzyme Q10 450mg and got me to stop DHEA now and she didn't think it was having much of an effect. My acupuncturist suggested I asked about growth hormones. I have an appt with FS on Wed to ask more about this. But it seems it is very expensive in my country without a rebate. However if it increases egg quality and egg number then I would seriously consider it. Have you had experience with this growth hormone (I don't know what it is called). Bottom line is that apart from needing to find sperm surgically (my partner is on clomid now) I need to have as many fresh eggs as possible as I am told at my age fresh eggs are much better than frozen which may not survive. Thank you...!

    ReplyDelete
    Replies
    1. I am happy that you are well informed about your situation. I am sorry that I couldn't give you any positive words. If they could find some sperms in your partner's testes then it is well and good. The major problem now is your age. Until you produce eggs you do stand a chance of pregnancy. But you must understand that women of your age just have less than 5% chance of having a positive pregnancy test with IVF. The chance of take home, healthy baby is even less. Now with sperm problem the chance of success could be even lesser. You must understand this clearly before going ahead. Unfortunately, there are no proven ways to increase egg yield or egg quality. Even if you get more eggs the quality will that of a 43 year old women's. If I were in your situation, I would try 3 IVFs and if there is no implantation at all, I would think about donor eggs. If there are no sperms available, using donor embryos will give you both a good chance of having a baby.

      Sorry, I have no idea about growth hormones. Let me be very honest, I don't think there are any supplements or hormones which can bring on a drastic change.

      Miracles do happen and I wish let it happen in your life. Good luck!

      Delete
  20. My AMH is 4.15 , i got 4 eggs on the day of scan after gonal f injections doctor advised ovigyn DSR 75 mg, is it safe to take, and i heard that ovigyn is for females who have abnormal AMH value, but mine is pretty good, please advise?

    ReplyDelete
    Replies
    1. Please do not take ovigyn, it is unlikely to change anything ! How much gonal F did you take ?

      Delete
  21. 75 mg 3 vial that is 225 mg, doctor said that i have good follicular study and good prognosis no health issues , my husband has a low count thats why we were going for ICSI but now she said that i have fewer eggs. My age is 28

    ReplyDelete
  22. My husband has1 percent normal sperm morphology and 2.3 million sperm count, will ICSI work for us or we have to go for donor sperm? Earlier i told that my health prognosis is good AMH 4.14 and age 28.

    ReplyDelete
    Replies
    1. ICSI will help you to conceive. There is no need for donor sperms. Yes, you do have good ovarian reserve and age is on your side. You will succeed, do not worry. 60 % of women conceive within 3 IVF attempts. So don't get disheartened if you need to do more than one IVF. Make sure you go to a good IVF clinic. Good luck !

      Delete
  23. Should one go for 1 or 2 embryo in blastocyst transfer, also I was told that in icsi miscarriage happen in 1 month due to yolk sac drying up. Also if anyone can suggest good ivf clinic in Bangalore apart from Cloudnine since my first experience was bad.

    ReplyDelete
    Replies
    1. If you are below 35 and produce lots of embryos, please transfer only one blastocyst.
      I have never heard of what you say about miscarriage. Miscarriages happen due to genetic defect in the embryo and ICSI is not responsible for that.
      Sorry I have no idea about clinics in Bangalore, hope someone answers your question.

      Delete
  24. Hi.
    I am 36 and got two amh tests (0.4 and 0.55ng) with one month difference. My FSH is low but my Estradiol is high. However, I was diagnosed with insulin resistance (not PCOS) 3 years ago and I have been taking Metformin since then. I lost 10kg since is started taking Metformin so now my weight is completely normal. After reading your blog, I wonder if is it possible that my amh and other hormones levels would be balanced if I stopped taking the Metformin. If that's so, how would I control my insulin resistance?
    I am single and not looking to get pregnant right now so I am really worried about my chances to get pregnant in the future. Thank you for any help you can give me.

    ReplyDelete
    Replies
    1. I don't think Metformin could change your AMH value. It is time to accept your diagnosis - poor ovarian reserve ! It is hard, but accepting it will help you see the truth better. Your age and diagnosis says that you don't have much time left before the eggs are gone. Let me be honest, it is going to be difficult to get pregnant in the future - that is what science says ! But, I have seen women conceive against all odds. It is time to find your Mr. Right. Lots of good luck !

      Delete
  25. Thanks for all your replies, but if doctor said I have good prognosis and good amh value then why my response was poor to Gonal F injection, I had only 4 eggs

    ReplyDelete
    Replies
    1. Wait until the end of the cycle. As time goes on, more follicles will develop. Even at the end of the cycle, if you still have only four follicles growing, please do write to me !

      Delete
  26. Dear manju I did not understand what is end of cycle. Doctor scanned on 6 day and found 4 and cancel the ivf. My next period is due on 1 July

    ReplyDelete
  27. Dear manju I did not understand what is end of cycle. Doctor scanned on 6 day and found 4 and cancel the ivf. My next period is due on 1 July

    ReplyDelete
    Replies
    1. I meant after few more days of stimulation. What was the unit near your AMH number ?

      Delete
  28. 4.14 was my amh, however doctor have asked to get my amh check again

    ReplyDelete
    Replies
    1. Whether it is 4.14 pmol or ng/ml ? How many AFC were there ? What ovarian stimulation protocol was used ?

      Delete
  29. It was 4.15 ng/ml, AFC count is not, protocol not told to us only I know is 225 mg gonal F for 5 days. Moreover I am so tensed that I ended my periods on last 7 that is 7 June 2015 and today just after 10 days I got my periods, is it due to stimulation they gave of gonal F or something else. I have a regular cycle of 28 days

    ReplyDelete
  30. Hello Manju,

    Since you said younger women with low AMH have a higher chance of conceiving via IVF (because of good egg quality), What do you suggest to be the minimum amount of eggs to be retrieved for one pregnancy? Also, do you know how long the AMH level stabilizes in a woman? For example, how many years/months can it stay 1.1 before decreasing?

    Thanks!

    ReplyDelete
    Replies
    1. Yes, young women with diminished ovarian reserve do have better chance of conceiving when compared to older women with diminished ovarian reserve.

      Higher the amount of eggs retrieved in an IVF cycle, higher is the chance of conceiving . If a woman produces more than five eggs per IVF cycle, her chance conceiving increases too. On the other hand, you must keep in mind that all you need is one good egg. If you have diminished ovarian reserve and produce only few eggs per stimulation cycle, please try to find an IVF clinic with a good embryology lab and an experienced embryologist. I would also advise you to do consecutive IVF cycles (without break inbetween). Some clinics offer a consecutive cycle package for women with diminished ovarian reserve. For example, you have to pay for four or five IVF cycles, I think they offer it at a reduced price. Please enquire ! Doing consecutive cycles will increase cumulative pregnancy rate.

      After the age of 38 ovarian reserve decreases rapidly. But you can't say how fast they go down by measuring AMH.

      I hope this helps ! Please do write to me in detail, manjupadmasekar@yahoo.com, I can help you better.

      Manju

      Delete
    2. Hi Manju,
      My AMH was high as I have PCOS, so nt a clear egg quality number for me I guess? My FSH is in normal range and I have hashimotos hypothyroid but with meds I'm in a good range too, although high antibodies.
      I have one blocked tube which 12mths ago was clear - no reason as to why as doc says my tubes look healthy no scar tissue and no resin for occlusion? Uterus was ok but removed polyp.
      I'm on metformin for 1.5 yrs stopped recently to get fasting insulin levels and after reading this I don't think I will go back! I'm 32 and thinking of IVF as I'm a walking problem! I have had procedures that checked my tubes uterus and I have had a polyp removed and confirmed a blockage in a tube yet a yr ago both tubes were fine.. I've also had an ectopic on the healthy tube side so bizarre? No reason or diagnosis as to why doc unsure as tubes look healthy no scarring no endo not inflammation everything "looks" normal.
      So discouraged that I think I'm opting for IVF even though doc say do natural.
      I've tried but my cycles are not reg and I don't always ovulate!! Literally a mess of a body.
      I'm wondering when someone should not use DHEA? Is it contraindicated a all? I'm on Vitex just started and selenium for thyroid and a good quality prenatal that's all... Can you recommend anything else in my situation? I know you aren't a doc but often doctors aren't on board with supplements .. Wondering about what else could help me ovulate and sustain a healthy preg esp since I am considering IVF.
      Can someone tell me how IVF is and pain wise.. How did you cope what was the worst part so I am prepared.
      Thank you all in advance
      Wishing all lots of baby dust

      Delete
  31. I retrieved 31 eggs but fertilized 20 with average egg quality, do I have a successful chances of icsi this time

    ReplyDelete
  32. This comment has been removed by a blog administrator.

    ReplyDelete
  33. hi,
    my amh is .99 and high fsh. and i am insulin resistant so i am taking actos, metformin dhea and coq10.four ivf cycles cancelled due to poor response .please help me with an opinion

    ReplyDelete
    Replies
    1. May I know your age , please ?

      How much gonal f is used everytime to stimulate your ovaries ?

      Delete
  34. hi manju,
    This is prema ,your story really helps me to boost my self , after having failed in my first ivf . I am having pcod problem but with good AMH value.During first ivf cycle i got 7 egg and 6 got fertilised, doctor did three embryo transfer but failed and then remaining in frozen cycle even that too failed .Now we are planning to enter to second ivf , but till now doctor didn't suggest me any pills like DHEAor metformin .i was asked to take APOCD-OBIS sachet daily and meprate tablet from day 21 to 25.Please help me with ideas you can

    ReplyDelete
  35. hi manju,
    This is prema ,your story really helps me to boost my self , after having failed in my first ivf . I am having pcod problem but with good AMH value.During first ivf cycle i got 7 egg and 6 got fertilised, doctor did three embryo transfer but failed and then remaining in frozen cycle even that too failed .Now we are planning to enter to second ivf , but till now doctor didn't suggest me any pills like DHEAor metformin .i was asked to take APOCD-OBIS sachet daily and meprate tablet from day 21 to 25.Please help me with ideas you can
    my age is 27 married for 4 years

    ReplyDelete
  36. hi manju,
    This is prema ,your story really helps me to boost my self , after having failed in my first ivf . I am having pcod problem but with good AMH value.During first ivf cycle i got 7 egg and 6 got fertilised, doctor did three embryo transfer but failed and then remaining in frozen cycle even that too failed .Now we are planning to enter to second ivf , but till now doctor didn't suggest me any pills like DHEAor metformin .i was asked to take APOCD-OBIS sachet daily and meprate tablet from day 21 to 25.Please help me with ideas you can

    ReplyDelete
    Replies
    1. Can you please write to me with details - how much drug was used for stimulation , your age , do you have embryo pics , what day transfer was it ? manjupadmasekar@yahoo.com. I will be happy to help.

      Delete
    2. Can you please write to me with details - how much drug was used for stimulation , your age , do you have embryo pics , what day transfer was it ? manjupadmasekar@yahoo.com. I will be happy to help.

      Delete
  37. Hi Manju,

    I am going for some insight from you.. I just cancelled my 1st cycle of if due to a very poor response. I am 33 turnin 34 soon and have pcos and high amh of 91.5 (2015 result), I am hypothyroid hashiomotos sufferer and am super scared that I won't ever be successful or have children because there are constant hurdles that don't have treatments that are working for me I guess..
    I was in gonal f for stim of 125 for 5days maybe then bumped up to 175 then 250... Keep in mind at each time I had one lead follicle that was slowly growing but just not fast enough so we cancelled at day 15 because it only reached 12mm.. Since being off Stims my follicles have continued to grow and we may do a trigger but the biggest is 18-20 the others are around 14

    Hope you can help shed more light
    My doc wants me back on MET as I took myself off says it will help with egg quality but I'm concerned after reading your page in MET

    Thanks Manju

    ReplyDelete
  38. Hi Manju.. just read your blog. Im going through something similar... i realised how much such blogs help us... i have just began writing a blog about my experience... any suggestion with regard to my treatment are welcome... http://whenwillthestorkvisit.blogspot.in/

    ReplyDelete

Please do write to me! It makes me happy :)

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