Wednesday, January 16, 2019

What is your IVF commission rate?



Gynecologists refer infertile patients for IVF treatment to specialist IVF clinics ,because they can not offer this treatment themselves.
One would logically expect them to send their patients to the IVF clinic with the best pregnancy rate because they want all their patients to get pregnant.
This is why you would expect that when gynecologists meet IVF specialists, the question they would ask is, "What's your success rate?" or "How do you tackle with patients with a particular complex problem?"
But interestingly, the commonest question gynecologists ask IVF doctors these days is, "What is your commission rate?" which means, "How much money will you give me for referring a patient to you?"
The tragedy is that because kickbacks have corrupted the medical profession, IVF patients are no longer being sent to the best IVF clinics by their gynecologists, but they are being referred to the clinics which provide the highest kickback to referring doctors, even if their success rate is poor.
The new corporate chains of IVF clinics have made a bad situation worse, and this is now becoming a race to the bottom, so that IVF clinics are no longer competing on the basis of their success rates, but on the commission rate they offer !
What a tragedy !
You can learn more about IVF by reading the IVF comic book free at https://www.drmalpani.com/pdf/IVF_COMIC_BOOK.pdf
I am also happy to provide a free second opinion at www.drmalpani.com/free-second-opinionhttp://www.drmalpani.com/free-second-opinion !






Tuesday, January 15, 2019

When Freezing Embryos is a Bad Idea.



In the past, the pregnancy rate with frozen embryos was poor, because a lot of these embryos would die as a result of the freezing and thawing process. The standard method was called slow freezing, and when the embryos were thawed, the ice crystals in the cytoplasm would kill the embryos. However, today, with flash freezing or vitrification, the survival rate is 100% in good clinics.
However, the reality is that not all clinics are good clinics , and lots of them don't have the experience or the expertise to be able to vitrify embryos well. As a result of this, a lot of these frozen embryos get damaged during the thaw process.
The trouble is that these labs don't share the truth with patients. They don't give them photos, so patients have no idea that the doctor is transferring damaged or dead embryos into them - embryos which have a 0% chance of implanting. Some labs do provide photos, but they doctor them , and patients aren't sophisticated enough to realize that the cells are dead or damaged.
This is why so many of IVF patients start believing that freezing embryos just doesn't work .
However, it does not work because the labs are bad - there's nothing wrong with the freezing technique !
That's why it's so important that you demand the clinic give you photos of your embryos, and that you do enough homework so you can make sense of them. No , you do not need to become an embryologist, but being a well-informed patient will help you get the best medical care from your IVF clinic, and maximise your chances of getting pregnant !
What to find an IVF clinic which respects your time and intelligence ?

Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Monday, January 14, 2019

Why sophisticated IVF patients love technology - and how this can hurt them



We treat IVF patients who come from different backgrounds , and it's interesting to see that the ones who are engineers and MBAs want to use the latest advanced technology in order to solve their problems . These are the patients who want us to do all kinds of tests, such as  ERA ( endometrial receptivity assay) , PGT ( preimplantation genetic testing) and sperm DNA fragmentation, because they've read about these newest tests on Dr Google. 
They believe that the more the technology we use, the better their chances of getting pregnant with IVF. They know that IVF success rates are not 100%, and their belief is that the deeper we investigate problems using sophisticated technology ( for example, genetics and immunology), the higher their chances of success with IVF will be.
This is a very tempting conclusion to come to. After all, if more technology helps to improve smartphone performance, it's it logical that more technology will also help in the IVF lab ?
Unfortunately , the overuse of technology in medicine often backfires , and ends up causing over-treatment, which actually reduces pregnancy rates . Biology is messy because it's  a complex adaptive system . You may do an intervention in good faith , based on sound logic that this will increase chances, but this often end up having second order unintended consequences which end up reducing pregnancy rates !
A great example is PGT, which is being oversold as "precision IVF", so please be careful before being lured down this path !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Sunday, January 13, 2019

What IVF patients need to do when they are not sure what to do !



We treat many challenging patients, and because their treatment is complex , they are often unsure what to do next. For example, they have failed 2 IVF cycles elsewhere, and have grown only 3 follicles in the current cycle, even though we have superovulated them aggressively.
They are not sure whether they should cancel the cycle , or whether they should continue because they know that we may or may not get an egg; the egg may or may not be mature; it may or may not fertilize; and it may or may not form a good quality blastocyst.
If they go ahead, they will end up spending a lot of money , and if they don't get to the stage of embryo transfer, this can cause major heart burn.
They want the doctor to decide, and because we are IVF specialists , they expect us to tell them what to do.
The problem is that we can't predict what the outcome is going to be ! We can tell them what the right process is , and offer high quality care technically, but we're not fortune tellers. If we tell them in good faith to go ahead and we don't get any eggs , the patient may feel cheated - she may feel that we did the procedure just in order to earn money, whereas the reason we did it was to give her the best possible shot at getting pregnant  - after all, there is no certainty that she will grow even 1 follicle if we try again.
This is the process we use to counsel our patients. We tell them - As professionals , we will not allow you to make a decision which is medically wrong, but when there are choices , we will help you to make the decision which is right for you. However,  you do need to listen to your heart to find out what this is !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Saturday, January 12, 2019

The three things you need to bring to an IVF cycle.


When patients come to us for an IVF treatment , we request them to bring three things with them - and no, money is not one of them !
First is lots of follicles, because obviously the more the follicles you have, the more the eggs, and the better your chances of getting pregnant. Now I understand that patients can't control how many follicles they will grow,  because this is a biological variable, but it's a good idea to visualise that lots of them are growing !
Second is  lots of smiles, because being optimistic and hopeful helps ! IVF treatment is thought of as being stressful, but it should actually be a stress buster. You should look forward to doing your IVF treatment because it maximizes your chance of getting pregnant - after all, not having a baby is very stressful, and IVF should help to reduce this ! If you're optimistic, we think it just makes going the cycle that much easier , because IVF should be a positive process.
Third, bring realistic expectations. Please do your homework , so you understand what's in your hands; what's in the doctor's control;  and finally what's in God's hands, so you have peace of mind you did your best.
What to find an IVF clinic which respects your time and intelligence ?

Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




Friday, January 11, 2019

Are you fed up of being treated as a number in your IVF clinic



Does your IVF clinic seem to be an assembly line , where they're more interested in extracting your money rather than treating you as a human being?
Do you feel that there's no overall treatment plan or continuity, and that every time you go to the clinic, you meet a different doctor ( usually an assistant or a junior ) who has no idea what's happening to you ?
Do you find that you have to wait for hours on end , with no clarity at all?
Do you find that no one is willing to share your medical records with you , or give you any details as to how your treatment is progressing?
Do you find that there always seem to be last-minute changes in your treatment protocol , based on some arbitrary reason , and no one gives you an answer as to what's happening?
Do you find that the senior doctor is always inaccessible ?
Do you find that there's a huge rush, so the doctor doesn't have enough time to spend answering your questions ?
Do you feel that after you've paid your money , they only treat you as a wallet , rather than as an infertile woman who wants to have a baby?
If so, then please come to us for your treatment.
We're a boutique IVF clinic , where only Dr. Anjali and I take care of all our patients personally. We're very hands-on, and have lots of experience and expertise to treat you with tender loving care, which is why we have such a high success rate !
What to find an IVF clinic which respects your time and intelligence ?
Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Thursday, January 10, 2019

Making difficult decisions - a guide for IVF couples



While most IVF cycles are straight-forward, sometimes we come to a cross-roads when it's not always clear what the next step should be .
For example, if have poor ovarian reserve, and have grown only 2 follicles after aggressive superovulation, should you cancel the cycle? Or should you continue?
These decisions can be difficult to make, and it's especially when patients find they have to make a difficult decision that they expect their doctors to tell them what to do. After all, doctors are professional experts, and they have the experience and the skills to decide. How can a patient decide for herself ? She has never done this before, and is confused, and wants her doctor to decide on her behalf.
                                It's very easy for a doctor to be paternalistic and tell you what to do, but I don't think this is a good idea . After all, even if the doctor's intention might be honest, if he tells you to go ahead and then fails to retrieve eggs, the patient is likely to feel cheated. She may feel that the doctor did it only to earn more money - and may resent the doctor for subjecting her to a futile procedure. After all, patients need to live with the consequences of the decision. We don't want them to feel afterwards - "I wish I'd done this," or, "I wish  hadn't done that."
A respectful doctor will explain the facts to the patient , and try to respect the patient's personal  preferences. We will  empower the patient to make a decision which is right for them.
The secret is to follow the path of least regret. Thus , if you choose to cancel the cycle, will you kick yourself afterwards that you didn't give yourself the best chance of getting pregnant with your own eggs? Then please go ahead and do the cycle  - and even if the doctor doesn't collect any eggs, you will have peace of mind that you have followed the best process - and this is all anyone can do !
What to find an IVF clinic which respects your time and intelligence ?

Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






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