Saturday, September 05, 2015

Should you tell your obstetrician that you did IVF ?



IVF patients are very excited when they get pregnant , and once they've crossed eight weeks , they register with an obstetrician to get regular antenatal care . An IVF pregnancy is exactly like a natural pregnancy  - the only difference is that instead of it starting in the bedroom, we jump start it by providing a little bit of assistance in the IVF lab.

Once an embryo has implanted , it's just like any other pregnancy.  After all, it really doesn't matter whether the embryo spends five days in the fallopian tube , or five days in the test tube . Logically, this means IVF pregnancies should receive exactly the same routine antenatal care which every other pregnancy does. This is why it’s perfectly natural and normal to tell your OB that you had IVF treatment. After all, it’s not a good idea to hide anything from your doctor , is it ? He should know exactly what's happening , particularly given the fact that since you are pregnant after so many years of trying , and this is such a precious pregnancy .

However , in real life we find that just because it's an IVF pregnancy a lot of obstetricians automatically treat this as being a high risk pregnancy , and most of these patients end up with a cesarean section for absolutely no valid medical reason .

The poor patient is pushed into doing unnecessary interventions, in order to protect her “precious pregnancy”. Because of the VIP syndrome, a much higher proportion of IVF patients is subjected to a cervical stitch ; repeated ultrasound scans ; and hospitalization for “bed rest”.

Part of the problem is that many obstetricians do not have enough experience in dealing with IVF pregnancies , and they are very worried that if something goes wrong , the patient will never forgive them. Part of this is because of financial reasons , because it's much more profitable to do an intervention as compared to doing nothing. However, all this overtesting and overtreatment is bad advice , and a good obstetrician will treat an IVF pregnancy exactly the same way he treats any other pregnancy . This is why you may need to think carefully about whether to tell your obstetrician it's an IVF pregnancy or not. Ideally, he should be able to reassure you that you will be treated just like he treats every other pregnancy , because you're a healthy woman , who is very happy to be pregnant , and he will take the best possible care of you to make sure that you have a healthy baby.

Friday, September 04, 2015

Having problems having your second baby ?




A lot of couples put off having a baby as they have career and financial concerns in mind.  To a great degree this has pushed the “having a baby” phase a little further down the list of priorities that many couples make. And then there are some couples who have their first baby at the right time and defer having the second one. Either that or they feel that they want only one child and then have a change of heart later and start trying again.

But in many instances, they find there is a surprise in store for them. No matter how well they time baby making sex, they just can’t seem to get pregnant. While some just give up hope, there are some who approach infertility specialists to find out what the problem could be. When the tests show that they have fertility issues, it completely throws them off-balance.

And it’s easy to understand why. They already have one child , and they wonder where and how this infertility issue surfaced out of nowhere ! They even wonder if it’s possible for a proven fertile couple to suddenly become infertile, and they may even doubt their doctor. However, this is a common problem, and is referred to as secondary infertility .

With age, there is a decline in the number as well as quality of eggs that a woman has. In addition to this, there is an increase in the miscarriage rate (which is also attributed to egg quality). Apart from this, just because you have had one baby doesn’t make you immune to diseases which cause infertility, such as STDs, which can cause fallopian tubes to get damaged; or endometriosis.

Tests and Treatment

When a couple with secondary infertility comes to our clinic, the workup includes:

An HSG (hysterosalpingogram)- this is an evaluation of the uterine cavity & fallopian tubes
Semen analysis
Hormone testing- this includes an ovarian reserve evaluation

Once a thorough assessment and evaluation has been conducted, we create an individualized treatment plan which addresses the patient’s underlying diagnosis.
In many cases, we will also combine these particular treatment cycles with an IUI (intrauterine insemination). This is a simple and quick procedure performed at our clinic. In the case of women whose only condition is the lack of ovulation, we may recommend timed intercourse in place of IUI.

About IVF

If this process too doesn’t bear results, we will then suggest IVF to the patient. Typically an IVF cycle involves:

Daily injectable medications
Ultrasound monitoring & blood hormone levels
Egg retrieval
The eggs are fertilized with sperm, and allowed to grow in our IVF lab
After 5 days, we will choose the best embryos and transfer them into the uterine cavity

Today, IVF is proving to be an excellent option to have a baby, in case other infertility treatments have been unsuccessful. This treatment has one of the highest success rates; it’s also fast emerging as the smart first-line treatment for infertile women above 35 years. It’s the most efficient treatment and also results in the shortest time to a pregnancy.

Need more information? 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, September 03, 2015

Don’t let IVF treatment stress you out !




Growing scientific research has revealed the physiology behind mind-body connections as well as the impact stress has on fertility and overall wellness. Regardless of how much of research you conduct about IVF and get counseled for it before actually starting on the treatment, you may find it difficult to handle the levels of stress you go through at different phases of the IVF cycle.

We see a lot of patients who are frazzled and completely out of sorts while they are going through their IVF treatment; this despite the fact that they have been extensively counseled about the process and have complete information about the treatment and its limitations.

The good news is that it’s possible for you to actively alter the way your body responds to stress. It’s possible to learn how to handle stress better and you can learn to calm your system , so you can cope better with the stress of IVF treatment.

Mind Body Coping- How it Helps

Using mind body techniques can very effectively help address the effects that stress has on you. Whether this stress that you feel is the anxiety related to your scheduled IVF treatment, the 2WW or even emotions such as  hopelessness, sadness or jealousy, these techniques will help you re-balance your system on an emotional as well as physiological level.

Consistency Matters

When you regularly practice yoga and meditation, your body is able to rapidly move into a state of deep relaxation; and once this particular pathway to calm and relaxation has been cultivated, automatically, your brain is also able to improve its ability to calm-down in times of stress. You will find that you are able to draw upon your own calming systems when you need to feel comforted and soothed.

A Range of Mind-Body Techniques

There are a range of mind-body techniques you can use; you just have to find one which resonates with you. For people who have type A personalities, meditation can be a somewhat difficult task; and yoga or mindful walking may be a much better option.  Deep breathing, relaxation response, vipassana, visualization and guided imagery are just some of the other mind-body techniques you can use to calm down your stress cycle & rebalance your system.

Find a good practitioner whom you trust, and learn a few mind body techniques; these will help you through the stresses and worries of IVF treatment.

And don't forget that there are lots of useful simple practical hacks you can use to cope with managing the nitty-gritty of the IVF cycle. Scheduling clinic appointments, waiting for the scans, doing the blood tests and organising the rest of your life can seem overwhelming, and this can add to your stress levels. The free MyFertilityDiary app can help you regain control of your life, so you can organise yourself more efficiently.

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


Wednesday, September 02, 2015

What Infertile Patients can do when they find they are stuck




I get very frustrated when infertile patients come to us after many years of marriage, and find that they’ve taken no medical treatment during this time. I wonder what has paralysed them into this level of inactivity where they choose to do nothing at all. Doesn’t it ever cross their minds that they are doing irrevocable harm to their chances of having a baby by waiting and doing nothing- that time never comes back again ?

The wait and watch approach is harmful because the woman’s ovarian reserve begins to decline after the age of 35 and reduces her chances of conceiving – and this age-related deterioration is irreversible.

As an IVF specialist, I am acutely aware of the impact age has on a woman’s fertility; but it isn’t something that most women are aware of. There really are no symptoms or indicators of declining egg quality and the ticking of the biological clock is silent.

Why People do Nothing

There are a number of reasons why most couples prefer to do nothing:

Some lull themselves into a false sense of security. They sit pretty with the thought that since fertility is a natural process, they just need to have patience and keep trying to have a baby. This approach is underscored by the advice from elders in the family who tell them that patience is all they need and that sometimes, it just takes time to have a baby – after all, don’t all good things come to those who wait

Some couples simply prefer to live in a fool’s paradise; they just don’t want to consider the fact that they may have problems conceiving. The minute they entertain the possibility that they may not be able to make a baby in the bedroom, their self-esteem takes a hit and they shut down into a state of denial.

Many bank on the hope that things will iron themselves out. Haven’t we all heard of uncles and aunts who got pregnant in their bedrooms after a decade of marriage? And it worked perfectly for them, so why shouldn’t it for us?

Others will adopt home remedies and “bedroom” techniques in an attempt to improve their chances. They alter their sexual position, their diets as well as their sexual frequency. They may even get some tips and advice from their
“super-fertile” friends (most of which will be misleading) since these tips are based on misconceptions and myths.

What makes the situation worse is that once they try any of these half-baked, home-grown solutions, they will have to give it a minimum of 6 months to test its efficacy- AND they end up losing even more time. The more of these they try, the more time they lose.

Some people have heard just too many horror stories about IVF treatment and its side-effects, that they cold shoulder this possibility completely. Some people fear that it’s a risky and artificial treatment and that children born via IVF treatment are defective or abnormal- and they refuse to go to an IVF specialist. Many of these people will try some “natural” treatments including ayurveda, herbal medicines and acupuncture in a bid to boost their fertility.

Religious-minded patients go temple-hopping in search of divine intercession. After all, aren’t babies a gift from God? He will give us one when the time is right – who are we to challenge his plans for us? Every month they miss their period , they get hopeful. Sometimes, if they trip and fall, they tell themselves that they had got pregnant, but the fall resulted in a miscarriage and they feel that additional rest will help them get pregnant again.

Some patients are put off by a bad experience at an IVF clinic , or maybe they found the treatment too expensive and backed off after their first cycle. It’s true that IVF is an expensive treatment, but going to a good fertility specialist will only help you understand where you stand , it will give you peace of mind that you have explored all your options.

Not Considered an Urgent Matter

Finally, the major issue is that while infertility is always an important problem, it’s never urgent, so it's always very easy to push it off. Many people plan their life and say - I’ll think about have a baby after I get my promotion / after I have settled down in my new job/ after I can afford it/ after I have bought a new car/ after I have finished my MBA.

Unfortunately, you can't always have your cake and eat it too, and you sometimes need to make a trade-off. It is perfectly fine to put your job before your baby; provided that this is being is done with realistic expectations.

Women need to be well informed about the impact of the passage of time on their fertility. It’s easy to do nothing, but there is a price they pay for this – the opportunity cost, which they forget to factor in, because it is concealed. Many couples rue the fact that they did not do IVF earlier – but by then it’s too late!

Need more information? 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, September 01, 2015

What makes Malpani Infertility Clinic special - a first person account from a prospective parent


I am Yogesh Joshi, Recently  wife Sneha and I had treatment at your clinic. Our treatment is now over & we are in the phase of 2 weeks waiting period.In the mean time we just wanted to share some of our thoughts with you.

I could remember that difficult day (On my wife's 3rd day of cycle) when we had our first ultrasound scan at your clinic and found the antral follicle count was just 4 with one cyst. It was very difficult for both of us to digest this fact considering my wife's young age (She is just 28 yrs old). Today I don't have proper words to describe our satisfaction we got with the treatment received in your clinic. On 28th August, we transferred 3 Grade A embryos to my wife and frozen  (!!!!!) 3 Grade A embryos. As explained by you many times, IVF treatment contains many steps/ hurdles and we need to clear all to get success. The journey from 4 follicle count to 6 Grade A embryos was very difficult. But I must say that this awesome result could not be achieved unless we had the perfect protocol designed by you, skillful egg retrieval / embryo transfer done by Dr. Anjali and Embryo work performed by Dr. Sai.

We understand that final outcome of IVF treatment is always in God's hand. But today we are having complete satisfaction that we got best possible treatment in your clinic.

Moreover, in this difficult journey from 4 follicle count to 6 Grade A embryos, we always remembered your sentence. " The final proof of the pudding is in the eating - and your response to superovulation is the best way of assessing your ovarian reserve. If you grow eggs well, then you should not worry about your "numbers" !

We must say that in addition to an awesome doctor, you are also a great writer. Your articles are not only informative but also supports many patients like us emotionally.

Today there are many doctors in India who are offering IVF treatment, unfortunately, we feel that many of them have just set up a business. Just to share with you, one of my friend's wife got so serious after egg retrieval procedure that they had to postpone their embryo transfer. One another friend's IVF treatment got postponed because doctor found some bacterial infection in his sperms (Actually it can be avoided by sperm wash).

Lastly, by looking at this scenario, we just want to say, that you are the best doctor / writer & in addition to this a very nice human being. You have created the complete setup of clinic very nicely including the staff. We will always wish for your good health & long life.
Thank you very much for everything.

With warm regards,
Sneha and Yogesh Joshi

findyogeshjoshi@gmail.com


Living through the 2WW of Fear, Trepidation, Optimism and Hope




Typically, the 2 Week Wait (2WW ) after an IVF cycle is a time filled with fear, trepidation, optimism and hope for patients. It’s a very stress-filled period, not just for our patients, but for us too. At times, week 1 is a little easier, but by the time the patient nears day 13, she finds it’s very difficult to resist doing that pregnancy test. Many of our patients tell us that they try to fight the feeling of hope during the two week wait; and I know exactly what they mean.

IVF isn’t easy, it’s no less than an emotional roller-coaster and the 2WW is a time for second-guessing and uncertainty. When patients come to our clinic for the first time, they are all hoping for a miracle. Many of them will have conducted a certain amount of research about IVF and know that it is their last option for having a baby. The patients who are not so well-informed about the treatment are still full of hope when they come to us and we try not to let any of them down.

Realistic Expectations

But while consulting our patients, we always stress that while it is important to be optimistic, it doesn’t help to go overboard with unrealistic expectations of the outcome of the treatment. The fact is that IVF is a very complex process; and this is not just with reference to the technology and procedure used, but the fact that there are just too many variables in play.

After all, conception is a biological process and once the embryo has been transferred in the patient’s uterus, we have no control over what takes place there and we too (just like our patients) have to wait through the two weeks to know whether the implantation has been successful.

The Fears

Women who have gone through multiple failed cycles are afraid of being hopeful and positive in case their hopes get dashed again, and as an IVF doctor, I address this issue over and over again with a number of my patients. The fact is that there is no cut and dried answer as to how to cope. A patient’s inherent physiology, past experience and ego will always have a role to play in the manner in which they experience the 2WW.

The best way to approach the dreaded 2WW is to create a balanced perspective and try to overcome the tug-of-war between fear, agony and hope. You might feel that you’re being very realistic by tempering your excitement about the possibility of a successful conception; and you may feel that it’s a useful self-preservation technique you are adopting- but under all that fear, you will also find that you go through some moments of pure joy when you start day-dreaming about how your life will change if all goes as planned.


I tell my patients that the best way to deal with this brew of feelings is to retain your poise. Hope is the one important factor that allows couples to cope with all the ups & downs that infertility and IVF treatment puts them through.

Maintaining this kind of perspective helps lessen the fear and anxiety that you have about the future. Though all this advice may seem idealistic, and every patient who is doing IVF feels that no one else can understand what she is going through, we as your doctors will do our best to support and counsel you every step of the way.  We are here for you !

Need more information? 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, August 31, 2015

Can Donor Eggs give you the Baby you Want ?




Over the years of our practice, we have seen scores of couples struggling with infertility. In some , all the pieces of the IVF jigsaw puzzle fall in place and they get the baby they crave to have, while in others a missing piece or two do not allow them to complete that picture, and their family in the way they had planned. This is a dejection point, not just for our patients, but for us too. After all, it’s our aim to get all our patients pregnant.

When a patient fails multiple IVF cycles with her own eggs, she always wonders whether it’s the end of the road and whether she will have to cope and live with the idea that she will never be able to have babies of her own.

A Difficult Decision

The fact is that we do consult our patients about all the possibilities and limitations of IVF treatment. As part of the initial consultation, they are also informed about other options available to them, such as donor eggs in case their IVF cycles fail (based on what the reason for the failure is).

But if and when they actually come face-to-face with this situation, most patients struggle with the decision of using donor eggs. Some couples embrace the idea willingly and move through the process quickly, while there are some who aren’t really ready to entertain the thought at all. As their IVF doctor, I do counsel these couples and help them recognize as well as focus in a more concerted manner, on their overall ultimate goal- to have the baby they want.

A Change of Heart

In most instances, it becomes a journey of transitioning through various unsuccessful treatments which eventually leads to the donor egg option. This also means that along with the dejection of failure, in some cases, there is also an increased sense of desperation. However, it’s imperative to understand the implications that are associated with choosing this option. In addition to getting consulted for it, it’s also important to communicate with other couples that have gone through the same situation.

Through this process, some of our patients eventually move ahead and accept this option- in many ways the desire to have a baby supercedes any of the biological issues; over time many couples do begin to welcome the idea.  For many of these couples, they are finally able to see the light at the end of the tunnel.

And so, with the first major hurdle being navigated; it may seem like the rest of it would be easy, from an emotional perspective. The truth is that there are some other inhibitions and concerns that patients have when it comes to using donor eggs to have a baby.

The Concerns

Most couples that I consult worry about whether they will actually feel connected to their baby if it doesn’t resemble them. I hear a lot of patients talking about the lack of any genetic connection and the manner in which it will affect their child’s life; the questions that crop up in their minds are:

Will this baby really be mine ? Will she/he have anything at all from me? Exactly how am I going to feel towards this child?  Will I be able to love her ? What will she look like ? Whose personality will she have ? Will she talk and smile like me ? Or will she resemble  the egg donor -  someone who I have never seen or met.  As you can guess, this can be a scary proposition, and lots of patients will have nightmares and fantasies about their donor.

Will anyone guess that I have used donor eggs ?

I always suggest that my patients go in for professional counseling before they make a decision.  In fact, it's always the ones who worry a lot about making this decision who end up making the best decision.

Nature, Nurture and Epigenetics?

After birth, the child picks up her parent's traits and mannerisms - after all, if you speak Hindi at home, so will your child. And your child will mimic your smile and your laugh. Even as regards the genes, while it's true that the genes come from the egg donor and not from you, please remember the key role of epigenetics. This is the mechanism via which various non-genetic factors influence gene expression . This means that even if the baby does not have your DNA, you do play an important role in how the genes of your child will be expressed in utero. In many ways, this can be a big comfort to couples who are considering the use of donor eggs. What eventually pulls the trigger so to speak is a person’s attitude, lifestyle and environment; this despite the fact that genetics loads the gun.

The Thing that Finally Matters

One of my patients who had eventually opted for donor eggs after several years of vacillating between her emotions of wanting to have a baby and not wanting to have one using another woman’s eggs, recently came to meet me. She told me that her moment of awakening was when she realized that there was nothing so special about her genetics. Many people feel that genes are immutable; the truth is that the notion of selfless and unconditional love is the only thing that’s truly unalterable.

And this is the love that parents have for their children- whether biological, born using donor eggs, adopted or otherwise.  At the end of the day, the path you take to become a parent becomes inconsequential and the only thing that matters is your baby.

Want more details ? 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, August 29, 2015

The patient's guide to making sense of your semen analysis report

The semen analysis report is the basic test for testing a man's fertility. It's a surprisingly complex test to interpret correctly ! If you need help in making sense of your sperm test report, check out our interactive test report at http://www.slideshare.net/malpani/sperm-test-semen-analysis-report

There’s Nothing Artificial about the ART of IVF




IVF treatment has been around for over three decades and today it has phenomenal success rates too. Despite this, a number of patients have their qualms about doing IVF. This is because they think it is an “artificial” process. Their concern is that any baby that is made by artificial processes in a lab will be abnormal and weak. The slightly more sophisticated patients are concerned that since the embryos are inserted artificially into the uterus, they will have to take bed rest post the transfer as the embryo will “fall out” if they don’t do so.

The fact is that when it comes to IVF treatment, myths and misconceptions abound. This is even more evident with reference to the care that patients have to take once they get pregnant. Most of this misinformation is propagated thanks to the influx of online forums and bulletin boards.

Why Myths are Aplenty

It’s not difficult to figure out why these myths are so prevalent- they just make a lot of intuitive sense. Just think of it- if the doctor is putting the embryos via the cervix into the uterus, isn’t  it logical  to believe that if the woman sneezes, coughs or strains, the embryos will fall out? This is exactly why women are advised to take so many precautions post the embryo transfer. While some of these warnings come from doctors, other advice comes from friends and relatives, or even women who have undergone IVF treatment in the past.

Regardless of whether the patients think this is logical and true, they follow it- they only want to maximize their chances of success and make sure that their embryos come to no harm. And so, we find ourselves telling our patients over and over again that they don’t really need  to take any special precautions after IVF and that there isn’t really any need to create an extensive list of do’s and don’ts.

Mimicking the Natural Process

Nothing they do will either lower or up their chances of success. We keep telling our patients that ART is an acronym for Assisted Reproductive Technology and not Artificial Reproductive Technology. IVF allows us to perform in the IVF lab what is not happening naturally in the bedroom for infertile couples. Of course, we are fertilizing the eggs and sperm In vitro, in the lab; but we are only mimicking the natural In vivo process. In the case of fertile couples, this is something which occurs in the fallopian tubes, while in this case is taking place in an IVF lab, that’s all.

Navigating Hurdles

Another important fact to keep in view is that once the embryo has been transferred to the woman’s uterus, whether it spent 3 days in the fallopian tubes or 3 days in the lab, is totally inconsequential. Once the embryos implant, the pregnancy is just like any other normal pregnancy.

In the uterus, the embryos follow the completely natural biological process of in utero implantation- it means that the final common pathway remain the same. Just think of IVF as a technique that allows us to navigate the obstacles that eggs and sperm of infertile couples encounter in the bedroom.

Need more information? 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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