Saturday, February 06, 2016

IVF success story at Malpani Infertility Clinic


We have been married for 8 years and tried for kids for last 6 years. We came to know about our issue after going through medical tests. I came across a book(how to have a baby over coming infertility) written by Dr Malpani. We visited his clinic in 2010.we were not sure about ivf treatment in 1st meeting.
We tried everything including Ayurveda treatment,allopathy  etc...nothing worked out except time running out.
After 4years we decided to visit once again Dr.Malpani clinic.
He clearly guided us if we did treatment earlier any where we would have two kids at least.
We surveyed  more clinics but were disappointed coz in all of d clinics procedure was done by junior docs n not d DoC whose clinic it was...he would come only during one major procedure n within no time goes away..
We wanted a doc who give us personalised attention ..n finally v were rewarded in d form of doc Malpani...he has d best in house facilities along with any eye on our every procedure... I had one failed ivf n then v went for a bonus cycle.. V had lots of hope in that cycle but luck didn't favour us ..on that particular day when I got a negative result I got a call from doc n he promised me he ll give me a baby ..n that was a big hope building material...again v gathered all d energy n went for another cycle ..
This time god showered happiness n I got a positive result...this was all due to Dr Malpani...I m grateful to him n his team for d happiness he has given us ..
Thank u sir ,madam n all d staff..v would never forget what u have done for us..
One more thing before I conclude..Dr malpani still is in touch through mails..he still guide us with his valuable advice about every problem v have..he doesn't leave his patients after treatment...happy to share this with u all...best of luck to all d couples who r trying for a baby....

Don't lose hope n get help from Dr Malpani...all d best


shahvirti@yahoo.co.in

Friday, February 05, 2016

An expert patient's medical treatment summary



Doctors sometimes underestimate how well-informed and intelligent patients can be. Here is an unedited description of his medical treatment by one of our patients - in his own words. I don't think a doctor could have done a better job summarising their medical course !

My wife and I visited Dr. Malpani’s clinic for infertility treatment in April, 2014. I am 38 years old and my wife is 36. Due to very low sperm counts accompanied with low sperm motility levels, my wife had not been unable to conceive naturally. Prior to coming to Dr. Malpani, we had a couple of ICSI procedures performed at another clinic over a span of 1.5 years, with unsuccessful outcomes.
My wife underwent superovulation with a medication regimen comprising Lupride along with 4 ampoules of Menogon (300 IU) daily from day 4 of the cycle. 24 eggs were retrieved. However, only one motile sperm was found in a semen sample provided by me two days prior to the day of egg retrieval. On the day of egg retrieval, the semen sample provided showed no sperm. A TESA procedure was conducted to attempt sperm collection from the testes. However, there was no sperm found in testicular tissues either. I was classified as azoospermic, and we were advised to go in for sperm donation. The retrieved eggs were frozen.

It was a wrenching decision to take, and prior to reconciling ourselves to the situation, we wanted to see whether there were any medication options available to restore sperm generation. Dr. Malpani referred us to Dr. Rupin Shah, who put me on Adova 1 mg. The prognosis by Dr. Shah was that there was only about a 10% chance that a regenerative process could kick in, and we needed to give the medicine a trial of about 6 months before we would see positive effects, if any. At this point, we decided to wait till October, and in the meanwhile mentally prepared ourselves for sperm donation.
Two events happened between the first visit to Dr. Malpani, and the next one which was in January, 2015. Around July 2014, my wife was diagnosed with Polycystic Ovarian Syndrome (PCOS). She had very regular periods till then with the cycle duration being 28-32 days. When she overshot her regular period date by over a month, we consulted a doctor, and the diagnosis of PCOS was made. The other critical event was that I developed diabetes (October 2014), and was put on medications to manage the same.

In January, 2015, when we visited Dr. Malpani again, we had mentally readied ourselves for sperm donation. However, a semen analysis revealed a count of 10 million/ ml and a motility level of around 50%. Of course, such a finding was wholly unexpected and an unbelievable positive surprise for us. It seemed an incredible stroke of luck flying in the face of accepted medical wisdom. We expected a smooth course of treatment from hereon, but there were to be more hurdles on our path.
Since we had frozen eggs, the availability of sperm meant that embryos could be generated via ICSI. In spite of having more than 20 eggs, only two viable early-stage blastocysts were obtained. An additional complication was that my wife’s endometrium was not growing to the desired level of thickness. A thickness of at least 7.5 mm is desirable, but the growth was stunted and did not exceed 6 mm. The first planned transfer had to be postponed due to inadequate thickness of the endometrium.

In the subsequent cycles, multiple interventions were undertaken including hysteroscopy to grow the endometrium to a minimum desired level of thickness. The pharmacological aspect of the treatment comprised high (and increasing) doses of Progynova coupled with vaginal pessaries. After a couple of unfruitful cycles where the endometrium failed to grow to a desired level in spite of all treatments, finally we opted for an embryo transfer in May, 2015 when the endometrial thickness had grown to above 7 mm+ - this level of endometrial thickness was achieved only after getting the medication dose up to a whopping 16 tablets of Progynova and 16 tabs of Valest (vaginal pessary) a day. The embryo transfer was unsuccessful.

In July 2015, again we returned to Dr. Malpani. Superovulation was done in the normal way to retrieve eggs and my semen sample yielded a sperm count of ~2 million/ml. This was enough to generate embryos via ICSI. The total number of mature eggs retrieved was 17, and we had two blastocycsts of grade AA4 (6th day), one of grade AA1 (5th day), and  two of grade BB (5th day). The embryos were frozen.

This time around, a rather benign protocol was followed for trying to induce endometrial growth. Letrozole 2.5 mg was started from day 2 for 6 days. At the end of this period, the endometrium had still grown to only a level of under 6.5 mm on day 10. At this point, Gonal-F (1 ampoule) was introduced. In what seemed to be a miraculous transformation, the endometrial thickness shot up to 13 mm in 5 days. We went for an embryo transfer – the best two blastocysts (AA4) were transferred.
A pregnancy did result after all, but the joy was short-lived. The beta-HCG levels on day 12 were 156 mIU/ml, and moved up to 330 at the end of another three days. However, the rise in beta-HCG levels started to slow down after that. On day 18 after the embryo transfer, the levels were around 550 mIU/ml. This represented a rise in levels of less than 60% over the last three days, an ominous sign. This signaled quite strongly at an unviable pregnancy, with either an ectopic implantation or a miscarriage coming down the line. As luck would have it, it was an ectopic pregnancy in the left fallopian tube.

On the 19th day after embryo transfer, my wife complained of unbearable abdominal pain and had to be hospitalized. Tests revealed a lesion in the fallopian tube with bleeding in the tube. She was under observation for two days, as there is always a chance that a disturbed ectopic pregnancy may spontaneously resolve, particularly if the beta-HCG levels show a diminishing trend. This was indeed the case for two days in hospital, and we obtained a discharge. An expectant treatment protocol was to be followed, with regular monitoring of beta-HCG levels.

Unfortunately, the beta-HCG levels started rising again, immediately after hospital discharge, and rose to 900 mIU/ml within two days. We were back to hospital. A laparoscopic intervention was prescribed by the attending gynecologist. The approach was to perform a salpingostomy (using suction to remove the matter in the fallopian tube but not removing the tube). The doctor stated that during the laparoscopic procedure, if there was persistent blood oozing from any area, then she would opt for salpingectomy (excision of the fallopian tube).  In the end, a salpingectomy was required and the left fallopian tube was removed. My wife has recuperated from the procedure, and we are planning for another ICSI. 
 
This is an unusually complex case - one of the most challenging we have treated in our career !   Everything which could possibly go wrong seems to have done so for them - but the fact that she did conceive means there is still hope for them !

Patients can learn a lot  from such couples - about how to be resilient ; well-organised and well-informed !


Need help in getting pregnant ? 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, February 04, 2016

Wht can't the Indian government make up its mind about commercial surrogacy ?



The ICMR ART Bill has been in the pipeline now for over a decade. It was crafted by the Ministry of Health and Family Welfare in order to regulate the practice of IVF and surrogacy. It laid down clear guidelines , to ensure that commercial surrogacy would be practised ethically by IVF clinics in India. It was polished over many years, and inputs were sought from doctors as well as members of society  at large . Public hearings and debates were held, to ensure that infertile couples and surrogates would be protected.

To my surprise and dismay, the Dept of Health is now singing a completely different tune. They have filed an affidavit in the Supreme Court ( which is hearing a PIL seeking a ban on surrogacy) and are now saying that commercial surrogacy should be banned !



Monday, February 01, 2016

How smart doctors use smartphones !



This was the presentation I gave to doctors at HITCON in Ahmedabad

The problem with infertility tests


When infertile couples go to a doctor, they expect that he will do tests to find out what the problem is, make the right diagnosis and then offer the right treatment. I wish life was so simple !

Unfortunately it's not , because though it's very easy to do the tests, what doctors often fail to tell patients is that our tests to assess fertility have major limitations. They're very good at defining anatomy, but not good at checking for function. Thus, we can measure a man's sperm count and motility, but we can't tell him whether his sperms are capable of getting his wife pregnant or not - the only question which he is interested in answering. Remember that a semen analysis cannot tell us if the sperm can fertilize the egg or not. Similarly, we can do a  HSG to find out if the fallopian tubes are open, but we can't check if the tubes are functioning or not. This is a major limitation of all fertility tests , and patients sometimes don't understand this , partly because their doctors don't bother to explain.

This creates a lot of misunderstanding , and this is why patients need to understand why the tests are being done, and what their limitations are. Thus if the sperm count is zero, we can definitely say the man can't get his wife pregnant. However, just because his sperm count is normal doesn't necessarily mean that he can get her pregnant, because the sperms may be functionally incompetent. We would actually have to do an IVF treatment  cycle and document total failure of fertilization to come to this definitive conclusion. Similarly if the HSG shows the tubes are blocked we can tell her confidently, that she is infertile, but just because the tubes are open doesn't necessarily mean that they are working  properly.

In order to overcome this problem, many doctors order even more tests, to get to the "root" of the problem. Thus, they order "sperm function tests" , to try to determine the functional competence of the sperm. However, these tests are expensive , and of very limited use.

A far better option is to explain the limitation of all diagnostic technology to patients. This is one of the reasons why a lot of the focus in our clinic is on bypassing problems rather than diagnosing them. This is why we adopt the success based approach where the question we try to answer is not, "Why I'm I not getting pregnant?" But, "What should I do in order to get pregnant?"

Fortunately , our technology for bypassing problems and solving them in the IVF lab is far better than our technology for being able to diagnose and identify problems !


Need help in getting pregnant ? 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 29, 2016

Success story after TESE-ICSI



Our success journey from lots of infertility stress to the successful story is not too different from other infertile couples. Dr. Malpani and his team proved to be a strong blessing in our life who not only gave meaning to our life but helped us overcome from lots of stress of infertility.

We got married in year 2008. Life was so smooth, we were least bothered about parenthood in the initial years. But also we didn’t do any planning as we were open for parenthood also. My wife never took any contraceptive pills during the period. After a time span of 2.5 years a thought of entering into a new life of responsibility arose. Thus we consulted a doctor in the nearby city from our hometown. Almost all the reports of my wife were normal. Doctor found slight hormonal imbalances in her reports. We were not too much worried with reports. But the pressure started mounting up when there was no sign of conceiving for more years.

Simultaneously, there was a misconception in my mind as I was treated for hypospadias in my age of 12 . I had major surgeries, and also was having urethral dilatations till the age of 20 years. Although the doctor at that age confirmed my parents that I am not going to have any problem in my post married life & having children too. As I mentioned there was a misconception in my mind thus I asked my wife’s gynec to mention entire tests along with my wife’s test. She mentioned a basic semen analysis test to me. That day was the worst day of my life. It was stunning to see that my sperm count was zero i.e. azoospermia,  but my wife’s reports were normal. My mind was not allowing me to accept the reports of semen analysis. Then with doctor’s consultation I had a FNAC test to make sure whether the tract is blocked or if there are sperms in the testicles or not. In my reports there was normal sperm production in the testes which meant that the tract was blocked. The doctor referred me to Medanta for Vaso-epididymal anastomosis surgery to open the tract so that we could have child naturally. After wasting one more year finally we decided to have surgery in Fortis Hospital far from my hometown. Also, we decided to freeze the sperms extracted during surgery but this was again a strong setback to our thoughts. The surgery was unsuccessful & no sperms were frozen. The doctor told my wife that they found very few sperm and these had defective heads and tails, which is why they could not be frozen. She advised us to use donor sperms instead.

Our hope of parenthood was completely shattered. We both were not at all ready to use donor sperm. My wife was completely in depression n tears. The entire treatment procedure for me & my wife was very tough as I belong to a orthodox family with lots of irritating advices. Travelling all the time to different places for doctor’s examination was very stressful. We had to keep on lying to everyone with new reasons for why we did not have a baby.

Meantime I had lots of homeopathic &  ayurvedic treatments with the hope that the quality of sperm would improve. Then one of my family doctor suggested us to visit Dr. Malpani once. After making up our mind we went to Dr. Malpani clinic in August 2014. It was a great feeling at the first meeting with Dr. Aniruddha Malpani. We have never been so comfortable with any of the doctors throughout our treatment. Dr. Malpani impressed us in the very first meeting with his expertise and encouraged us to be calm and face the situation as it comes. He explained the procedure in a convincing manner and cleared all our doubts. He was very sure that we would not require to use donor sperms. His confidence with TESA treatment touched our hearts.

Finally, with lots of courage we planned to move for treatment in February 2015. When i was admitted for sperm extraction, still that Fortis report polluted my brain as to whether the doctor will get healthy sperm or not. When the doctor came & told us that they have extracted lot of sperms from my testes and 11 eggs from my wife, we had a relaxed sleep that night.

Now we have been blessed with a sweet little baby girl on 28th October 2015 and all that has happened because of motivation and courage provided by Dr Malpani and his team. Both of us heartily want to thank him for making our dream come true.

Thank you ……..

Anurag 


anurag.81@gmail.com












Thursday, January 28, 2016

The side effects of googling for information !


Most infertile patients are understandably anxious before starting an IVF cycle. They have lots of worries and concerns ! Will the shots hurt ? Will the hormones cause them to put on weight ? lose hair ? result in moodswings ? How will they manage their job responsibilities while doing IVF ? Will there be side-effects ? Will the treatment be painful ? Will the cycle succeed ? How will they cope if it fails ? And will they be able to afford to pay for it ?

There have lot  of questions, and have read lots of horror stories online, and don't know what to believe.

This is why I prescribe information therapy to my patients. I tell them - Do your homework. Be well read and well informed . This will reduce your anxiety levels . It will help to ensure there are no unexpected surprises , and by clearing your doubts, you will remain in control of your life, because you know exactly what's going to happen next.

However, some patients  believe that searching for information ends up increasing their anxiety levels. Their approach is much simple - ignorance is bliss ! You're the doctor, and I trust you, so you do whatever is required.  Why should I worry about this stuff ? If I start reading about these things, I get more worried and anxious, especially when I read first person accounts which describe how painful the IVF injections are; or describe how they nearly died because of OHSS.

This is a valid criticism, and this is why you need to become a sophisticated patient - someone who understands how to find information which is reliable online. This is why we prescribe Information Therapy - and not just generic non-specific information from a random website which google throws up !

Need help in getting pregnant ? 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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