Thursday, September 21, 2017

Is it worth transferring poor quality Day 3 embryos into the uterus?



Some patients will end up with all their embryos being of poor quality on Day 3, and then they're not certain what to do. Traditionally , most doctors will want to put all of their embryos back into the uterus as quickly as possible , no matter what their quality.

After all, once they've done an embryo transfer, they can tell the patient, "Look , I completed your IVF treatment, and have done everything humanly possible " , so the patient is happy that the doctor did a good job. Of course, it's highly likely that the cycle will fail, but then they can say - Yes, your embryo didn't implant, but that's your bad luck/ kismet/ karma. We now need to study the reason for the failed implantation, so we will run additional tests, so we can improve the chances of embryo implantation for the next cycle."

Unfortunately, this just creates false hope for the patient , and causes a lot of harm.  After all, we know that the chances of poor quality embryos implanting are very poor, and that the reason for the failure was the poor quality of the embryos. However, after the failure, they convince the patient to go through a battery of very expensive, exotic tests , to check her uterus and her immune system, to make sure that her body is not "rejecting" her embryos. These don't provide any useful information at all, but it's not hard to take IVF patients for a ride, because they are so emotionally vulnerable .

So why do doctors do this ? This is because they're not confident about the skills of their own IVF laboratory. However, it's easy to justify transferring on Day 3 ( and even Day 2) by telling the patient - Rather than throw the embryo away, isn't it better to at least put it back inside your uterus ? This way you have a chance, even if it's low?

Ideally, these embryos should be grown to day five blastocysts, and if they arrest in the laboratory before this point, then there is really no point in doing an embryo transfer at all. After all, once the transfer has been done, we create false hope  in the patient, because she's optimistic that she may get lucky and the cycle may work for her. When it doesn't , she is heartbroken , and her willingness to start another cycle drops dramatically , because she has lost confidence , either in the doctor and in her own body.

Much more importantly, the ability to learn from the IVF cycle has been wasted. After all, once you put an embryo back in the uterus , you have no idea what's going to happen to it. On the other hand, if it's in the incubator,  we can monitor it. If it arrests, we can at least tell the patient, "Look , this is the reason why you are not getting pregnant". We can analyse this intelligently, so we can focus on what's important , which is usually the quality of the egg , rather than worry about uterine receptivity.  The truth is that the uterus is usually a passive recipient, and it's very rare that the uterus is the reason for failed implantation, especially when poor quality embryos have been transferred.

So why send patient on a wild goose chase? Why not be upfront and honest with her? This is because most gynecologists don't understand much about embryology , and they don't have full time qualified embryologists who are able to grow embryos to day 5 routinely in the lab. This is because many of them depend on traveling embryologists, who don't have the time or energy to culture embryos all the way to day five. Taking all these shortcuts ends up harming the patient.  Yes, of course patients do get pregnant after Day 3 transfers, but these are good prognosis patients, and it's not right to confuse the two.

Yes, if the embryo arrests in the lab , this does cause a lot of short term heartache, but it gives us valuable information , so we can make changes and maximize the chance of achieving a pregnancy in the next cycle. Patients may have to suffer some short term pain to achieve long term gains.

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 !





Sunday, September 17, 2017

The stem cell therapy racket in India


The stem cell therapy racket in India from Dr Aniruddha Malpani

This is the presentation I gave at the Academy of Clinical Embryologists of India Conference held recently in Hyderabad, India

Wednesday, August 30, 2017

Indians in the Gulf and infertility


One major problem which confronts Indian labourers in the Middle East is that of involuntary childlessness. Because they are forced to leave their wife behind in India, many of them get to spend only 1-2 months every year with their spouse. This obviously means that their chances of getting pregnant are very slim, as a result of which they are often labelled as being infertile. Now while they may not have any medical problems, this childlessness causes major social issues.

The wife feels inadequate, lonely and incomplete; and has to suffer all the taunts of her neighbours, because she doesn't have any children. The poor husband feels guilty, because he cannot do anything about this. This marital distress causes a lot of disharmony, and makes a bad situation worse.

Also, as the woman gets older, her fertility starts declining, and her chances of needing medical  assistance to have a baby go up as she ages, and her egg quality starts dropping.

Often these couples will seek medical assistance when the husband comes to India on his annual holiday, However, the care they receive is often poor and inadequate. They need to understand that time is at a premium for them, because if she does not get pregnant in this visit, she will have to wait for another year to try again.

For these couples, it's important to go to an infertility specialist, so he can expedite the process , without wasting valuable time. Ideally, the tests should be completed even before he comes to India, so no further time is wasted. The good news is that the tests for fertility are simple and inexpensive, and can be completed quickly.

For these patients, rather than wait for nature to take its own course, it's important to assist nature, so that they can complete their family as soon as possible. This is where IVF comes in, and the good news is that IVF treatment is easily available in India now, and the treatment can be completed in 15 days. We suggest that the husband freeze and store his sperm, so that the treatment can proceed in his absence as well.
Because the number of IVF clinics has risen steeply in India, this makes ‘choosing the best’ all the trickier. While most IVF doctors attract patients based on their marketing or word of mouth publicity, it is highly advisable that you undertake research before opting for any IVF doctor.

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 !










Tuesday, August 29, 2017

Infertility is not your fault!


Lots of infertile  women are depressed  because they think life is being very unkind to them. The fact that beggars can have children at the drop of a hat, but they can't even perform such a basic biological function ( which millions of others can perform effortlessly ) hurts their self-esteem. This spills over into other parts of their life, and affects their personal relationships and their professional productivity as well.
Their unspoken plea is – ‘Why me?  After all , I haven't hurt anyone, and am likely to be a good mother, so why is God punishing me ? ' They start blaming themselves, and believe it must have been something they may have done in the past ( or in an earlier lifetime !) which is causing them to become infertile.

  You need to stop beating up on yourself - infertility is a medical problem, and it was not caused by something you did or did not do ! God does not punish anyone, and you need to learn to look at your problem more objectively, so you can deal with it constructively.

1)            Take control
While this can be a distressing diagnosis, at least being able to put a name on the problem can help you take a step in the right direction to solving it. The good news is that there are many options available for family building - both medical and non-medical - so you can start exploring this. You don't need to remain a passive bystander or leave everything upto fate !

2)            Learn to be kind to  yourself
Stop blaming yourself , and don't mull over the past or wallow in self-pity. Playing the "woulda, coulda, shame" game just makes a bad situation worse, and doesn't change matters. You need to move forwards, and remind yourself that  this is a medical problem which needs a medical solution - and the good news is that this is now easily available.

3)            Talk to your friends and family
Sharing your feelings with your loved ones is great way to help you get through the grief.  Let your family and close friends be the support you need through this tough time and instill positivity around you. Keeping a personal diary and journal can also help, as it allows you to vent safely. You can also find lots of other infertile women online, who will support you without being judgmental.

4)            Be Proactive
Stop thinking about your past and start working on your future.  While the final outcome is not in your hands, if you do your homework properly, you will have peace of mind you did your best.
Staying positive is a big step towards leaving behind the self-blame game. Infertility is difficult to handle,  but with internal positivity and external support, you can find a solution !


Tuesday, August 22, 2017

Dr Anjali Malpani interviewed in Mid-Day on problem of rising infertility in Mumbai

In this city of dreams, conceiving a child seems to have become a nightmare for more and more couples, data procured through the RTI Act has revealed.
Statistics show that in the last five years, since 2012, more than 32,000 people have opted for in vitro fertilization, pushing worried doctors to sound the alarm - changes in lifestyle is to be blamed for the rise in infertility among Mumbaikars.

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