Poor ovarian response

When ovarian stimulation is commenced the aim is to get 10-12 follicles. As worrying as overstimulation, is the scenario when too few follicles grow in response to stimulation. The cut off that most doctors adhere to is 6 follicles. So when less than 6 follicles are present the response is said to be low.

When I counsel my patients facing this problem, the commonest questions asked are "Why?", "What are the implications?" and "Does this mean I cannot get pregnant?". Let me answer these one at a time. Please do feel free to write to me if you have any further queries.

Why?

The reasons of low response can be :

• Insufficient dose of FSH/hMG
• Ineffective Drug (Good quality injections need to be maintained at the right temperatures in order to work well)
• Unresponsive ovary/Low reserve of eggs in ovary

What are the implications?

The implication of low number of follicles is the retrieval of lower number of eggs and this in turn means a lower number of embryos. On an average, eggs may be retrieved from 70% of follicles. In other words if there are 3 follicles the number of eggs may be only 2. Of these not all eggs may be mature (or usable for making embryos). The outcome would then be a low number of embryos or even no embryo. If there are no embryos there can be no pregnancy! 

Your doctor may advise you to either cancel the cycle in case of a poor response or try Intrauterine Insemination. This may prove to be more cost-effective than an IVF cycle as the success rates are bound to be low. 

Does that mean I cannot get pregnant?

The further course of action after the cycle with poor response depends on the cause. Treatment may be repeated using a higher dose of gonadotrophins or changing the drug. In case of low ovarian reserve being the reason for poor ovarian response, the situation becomes a little tricky. Treatment using drugs like DHEA and Arginine may be tried with variable success. The other option may be Minimal Stimulation IVF using Clomiphene to augment stimulation. The last resort would be Donor egg IVF.

The answer to this question is not easy but is certainly not a "No"!

Good Things Happen To Other People

On this Feast of the Assumption, Catholics recognize the miraculous moment when Mary was ascended into Heaven, bodily. It's hard to imagine a human body ascending into Heaven, isn't it? I find myself wondering whether we have any real sense of Mary's journey through life - or the details surrounding her Assumption - from our vantage point in the year 2015. Are we so far removed that we can't relate anymore? 

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Around every corner, there is another birth announcement. It seems birth is "in season" lately. I guess it makes sense though... as Christmas was 9 months ago. Almost all of the people who I began this walk through infertility with now have children in their arms - or they eagerly await impending births (biologically or through the gift of adoption) of children still in utero. And really, there seems hardly any greater joy than to be able to congratulate someone on the birth of a child after they have suffered the pains of infertility. We all jump at the chance to do it - myself included. What could be better? I mean, I have one idea... ;)

Good things happen to other people, so you can hardly begrudge someone at realizing their life's dream, just because your own dreams were the same and remain unfulfilled. It's one of the more complicated sets of emotions that get navigated when a couple experiences infertility: joy at the blessing you crave for yourself, bestowed on someone you care about.

For some, birth announcements (regardless of whose) become painful - stinging at the mere mention of children. And yet for others, the announcement of a birth itself isn't painful... but it is a reminder of their own infertility. And it's a reminder of the dull ache and sadness at childlessness that is still lived in their own life. Neither feeling is wrong. And feeling either way, in my opinion, is more a product of instinct than anything else. You don't aim to be upset and overjoyed at something simultaneously. It just happens that way.

Marian feast days have a way of stinging when you have experienced infertility though, don't they? Here we are, celebrating something beautiful and unbelievable that happened to a mother. Let's be honest - at it's core, that's what a Marian feast day is: celebrating a mother. Albeit an amazing mother... but there is no point in rationalizing the details and qualifying specialties with those who are in the throes of infertility. For some reading here - this is what the meme would look like, if they were honest about their feelings on a day like today:

You might be saying "yeah, but it's different". OK, great. It's different. But it's still a celebration of a mother. And for those who get lost in the pain of that - I write this post. My goal in writing here isn't always to have the neat or poetic answers. It isn't to tell beautiful stories that always end exactly the way we want. And it isn't even my goal to spin all the details into some neat, tidy, little package that in hindsight makes it all seem worth it. God isn't our magician. 

Sometimes life is hard. Infertility is always hard. And Marian feast days are tough when you navigate infertility. I'm validating that here. You aren't a bad person for feeling sad when good things happen to other people. You're human.

But today is a reminder that sometimes unbelievable things happen to humans. Sometimes the impossible happens - like getting carted up to Heaven with your skin on, and your soul still jiggling around on the inside. It's not a concession to your current pain. But it is a reminder that there is purpose in celebrating things that are painful. And that God does have a plan - and sometimes it involves the unimaginable. 

Infertility isn't something you were ever in control of to begin with, regardless of your 27-pills-a-day-regimen and your carefully plotted out diet. But if you are suffering on Marian feast days, struggling to find a relationship with the Blessed Mother, hurting from your own experiences with your own mother, confused at how to reconcile your faith with your pain, or otherwise feeling like you are flailing with this whole infertile-and-Christian thing... I have words of encouragement for you:

I am praying for you: The person who is reading this and crying. The person who is reading this while lurking silently online, never leaving a comment. The person who reads this and feels guilty, sad, alone, and forgotten. And I'm asking God to make His Plan a little clearer in your life so that you can see how hope is conceived in all things... even the things that seem difficult.

If you would like for me to pray for a specific intention, I am in the middle of a 54 day novena - praying only for others' intentions. I would love to add what's weighing on your heart to my prayer list. Just send me a message on the contact form above or comment below.

Good things are going to continue to happen to other people. And I hope you realize that to someone else, you are the other person. And they'd have given anything for the blessing they've watched you receive. Meanwhile, you'll continue to look at others' blessings the same way. This is human nature in our fallen world, isn't it? We aren't in a competition with each other, nor are our pains in vain. Nor am I ever going to say "get over it" to you.

If I'm even remotely right that it's instinct that creates these reactions though - then that means we have a reliable source of ignition to let us put our suffering to work, doesn't it? It's the only way out of the self-centered-prison that infertility wants to build around us and reduce our lives into and I'm convinced prayer is the most powerful weapon. Let's burn the pain of our infertility and use the strength of the inferno to power good things to happen to other people. It doesn't diminish the deepest longing in our heart for children. It won't relieve our childlessness. But I'm pretty sure if there is anything that could impress Jesus and answer His call in our life and fulfill His plan for us - it would start a little something like humbly putting your most painful pains to work selflessly for others. And that you could pull yourself out of the emotional and spiritual (and sometimes physical!) paralysis of infertility would be a testament to how we may be broken, but that it will not dictate what we are capable of as Christians...

God be with everyone reading here on this Feast of the Assumption, and the good things can you make happen for other people. Think about it.