Advice. Thanks but no thanks.

From have you tried this IVF specialist? You know you must. He/ She hasn’t disappointed anyone, you know. Concerned family and friends gave many suggestions. Some suggested homeopathy and some suggested Ayurveda (yes, we even went to Old Delhi hakim). Some overly concerned ones even suggested a 90+ year old STD doctor who attributed my infertility to a sexual disease which either Sumit or I might have acquired before marriage. We had to literally escape the old doctor before she could make us do weird things.

I know family and friends around are concerned if a couple doesn’t procreate after 3 years of marriage. After 5, they think it is their birthright to give unsolicited advice. No matter how concerned, I feel people around an infertile couple must realize that it is a highly sensitive issue. If they need your advice, the couple will probably ask for it. Till then, keep your precious views to yourself.

The other thing about advice is that no one really understands till the person goes through the experience. There are only a handful of people who learn from others’ experience. For example, I never realized how critical it is to have kids early in life while you still have the energy and earning capacity, and so do your folks. Children need a lot of your energy and given the current jobs, traveling, and unhealthy lifestyles, the earlier, the better. As we reach the disturbing end of 30s, it become a herculean task to manage the little things, and especially in today’s day and age where you want to do everything right.

That apart, whenever someone asks me for the best IVF specialist around. I always tell them the one who worked for me is the best for me but may not be true for you. 

The curious case of Ms Cyst

There’s always been a lot of mystery around ovarian cysts. Personally, after meeting so many infertility specialists and gynecologists, I haven’t been able to figure out whether cysts are deterrent to fertility and if I ever had PCOD. Most women are known to have cysts and it’s pretty normal but it suddenly transforms into a villain during ultrasounds. If the infertility specialist finds repeated cysts in your repeated ultrasounds, there you go, your villainous cysts are blamed for those repeated heartaches. You start on a journey of killing those cysts.

As if the mystery around cysts wasn’t enough, there are many types of cysts. Like the follicle cyst, chocolate cyst (happens if you have a condition called endometriosis), Corpus luteum cysts (whatever that means), and the rest.

If you have PCOD, which I was told I had, you tend to gain weight (I had something to blame after guzzling cheese oozing pizzas and bowls of creamy hummus bathing in pita bread). You tend to have a lot of hair (I had something to blame for that one hair always sticking out of my chin…aargh). You tend to have a deeper voice (I had something to blame for people mistaking me for a male on phones). You tend to have hair loss (I had something to blame for my hair loss, of course it wasn’t the three times rebonding attempt). You tend to be depressed (I had something to blame every time I was depressed to see a Vicky donor sort of movie).

Jokes apart, I don’t think I had PCOD. I had nothing actually and due to my panicking and a hasty decision to get laparoscopy done (along with ovarian drilling at only 30), I suffered from a loss of both egg quantity and quality.

So a big shout to all those women trying to conceive, do not panic and ask your doc a lot of questions no matter how busy the doc is. 

What is the right age for an IVF treatment?

Is it 30 or 35? The right age to think of an IVF treatment.

I hear people often say that infertility is on the rise. Is it because women are getting married late? Or is it coz we are consuming chemical infused fruits and vegetables? Perhaps its coz of the high pollution levels. Well, I think it’s primarily due to our impatience.

If you go to an infertility specialist, you will never be told that you perhaps are too young for any infertility treatment or you need to consult a gynecologist first. The assumption is that you already are infertile. When I received my first IVF treatment at Fortis La Femme IVF Clinic, I was shocked to see a 25-year old who was married for 3 years and undergoing the treatment. Not sure about the reason for her decision at such a young age but I used to wonder – why wouldn’t the doctors suggest her to try naturally? Why couldn’t she consider IUI? Why couldn’t she wait for a few years as she had age on her side?

As I kept wondering, the day of the Embryo Transfer (ET) arrived. There she was howling and seething in pain, on a wheelchair, with her mom on one side and mom-in-law on the other, consoling her. She had a condition of hyper stimulated ovaries and the doctors decided not to go ahead with the transfer. Did she have hyper stimulated ovaries coz of her young age? What had mistriggered, I wondered?

Shouldn’t there be a cutoff age to consider IVF? In fact, there should be an upper age limit too. Heard about the 72-year old in Punjab having a son? As per the Indian Society for Assisted Reproduction (ISAR) president-elect Dr. Narendra Malhotra, the upper age-limit for a woman to undergo IVF treatment is 45 years and no more. Why not have a lower age limit too? Unfortunately, one of the past presidents of ISAR, Dr. Hrishikesh D Pai, was the one to treat the 25-year old mentioned above.

Since IVF is not a disease, a lot of infertility specialists treat it like a cosmetic surgery. In the absence of laws to govern it, the doctors do what they please and also what some unreasonable couples seek.  

How much does an IVF cost?

It's one of the biggest concerns when couples are considering an IVF treatment. Whatever the cost of the treatment, let me tell you (which no one else really thinks about) the cost of a failed IVF. The cost of a failed IVF is intense heartache that may take days and sometimes months to heal. There's a piece of your heart that dies forever. Every time you see the bruises on your thighs or tummy from the 30+ shots, the painful memories keep coming back to remind you of your incapability. I always say that IVF takes a huge toll financially, physically and mentally but that's just an understatement. Unless you have a really patient and caring family, and especially husband, it's hard to recover. 

Since I've had the tendency, IVF treatments have made me gain weight too. The doctors, without informing you, will administer steroids that obviously lead to weight gain. Imagine the double trauma of having to lose despair and weight. 
  
Infertility clinics, typically, have IVF packages. Usually, the cost of a package does not include the cost of the medicines, laboratory tests and any precondition that might have to be treated to get you IVF ready. For example, I required a laparoscopy before the first IVF, biopsy before the second and another laparoscopy before the third. For reasons beyond comprehension, IVF or infertility are not covered under medical insurance in India (which makes you feel all the more worse for spending so much money from your own pocket). Insurance companies feel that IVF is not a disease for which you go to the doctor but a condition, and therefore most commonly not covered. Now the debate if it should be or not, is a topic for another blog. 

One should be prepared to spend around Rs. 2 lakhs (under a package at Fortis or Max) and another Rs. 50,000 for the medicines and tests. If you have to be treatment to prepare for an IVF, then consider another Rs. 50, 000 - 1 lakh depending on the severity of the condition. 

After a failed IVF, the doctors suddenly might lose patience with you (you're a bad case study for them) but don't forget to follow up for possible reasons of the IVF failure. In the 3 attempts I've had, the doctors never educated on what to do if IVF fails or succeeds. So in case of failure, stop the medicines and wait for your periods (which normally should happen in a week or so). If the cycle is successful, continue the medicines after confirming with the doctor and wait for your 6-weeks scan.
  

The strange condition called Endometriosis

Endometriosis is probably the most confusing term (and frustrating conditions) I’ve heard till date (I still can’t get the spelling right). I was told (multiple times) that I have it and I apparently had a chocolate cyst (ok I had too many chocolates) that was removed with the help of laparoscopy but it recurred after a year or so. Now what is not clear and most ironic of all things is the fact that endometriosis is deterrent to pregnancy and the only cure to the condition or disease is pregnancy. I have not heard, from any of the docs or should I say infertility specialists, a clear answer as to why it happens and how it can impact pregnancy. When it won’t let you get pregnant, then how can you cure it?

As far as I understood, it is a condition where the menstrual blood flows back in (and lands wherever it likes). The strange thing (in my case) is that it flowed to the same ovary again after being removed once where it formed the chocolate cyst (really? Does endometriosis have favorite spots?). It also impacts the egg quality and quantity, I heard.

Again the other strange thing was that I experienced none of the symptoms of this condition, which includes extremely painful periods (lower abdomen cramps or fullness, abnormal or irregular mensuration or the likes). I had only one symptom and that was infertility. But that could also be cause of PCOD (which I was told by some docs that I had and by some others that I don’t).

I suffered from an information overload for years. I have undergone probably 100 transvaginal ultrasounds (if not more) and doctors have given different verdicts trying to attribute my infertility to some of the most common causes available. I used to research terms from my ultrasound report and then after the doctor visit and the diagnosis, research again. And when researching, you will also read about Padma Lakshmi, who in spite of having endometriosis got pregnant.

When I look back now, I feel the doctors are as clueless.

On Women’s Day as I write this, I wish you have access to complete, accurate and right information about the condition that you may have. Power, knowledge and emancipation. It will be all good (endometriosis or no endometriosis) in the end, trust me.