How to make love to a plastic cup

Every once in a while you come across a book title which makes you laugh out loud. This is so rare, that when I saw this book featured online, I just had to buy it from Amazon.com . I have just received my copy and would like to review this great book, which is called– How to make Love to a Plastic Cup - The guys guide to the world of infertility by Greg Wolfe.

In general , it's true that women are the neglected sex and are often treated as second-class citizens. However in the world of infertility, it’s exactly the other way round. It's the men who are neglected because most of the attention is centered on the woman. While this is not always an unmixed blessing, it's true that men feel left out during the entire infertility process

In most IVF clinics, men ( also know an DH) are usually considered to just be appendages to their wives. Their only role seems to be that of being a sperm donor ( and a banker !) Of course, if they have no sperm , then they do become the focus of attention, because we need to extract their sperm from their testes – but really that's just about it.

There's not much discussion about what the poor man feels - or what goes on in his head and his heart when he sees his wife crying because she can't have a baby. Most of the books on infertility are written for women - there is very little written for the man. Also, most infertility bulletin boards online are populated by women ; and while there lots of shoulders for infertile women to cry on, there’s very little support available for the man.

The great thing about this book is that it fills this need extremely efficiently . It’s written by a man – and is a short, quick read which means that most men will be quite happy to at least pick it up and browse through it, even if they don't read it from cover to cover . Its written in a very breezy style – and while it’s full of accurate medical information, this is presented in an entertaining format, so it never gets overwhelming or boring.

With chapter headings such as " Begin by Putting Tab A into slot B “ and “ What a prick” ( no, this does not refer to what you think it does !) , this book is tailor-made for men with short attention spans , who just want to know enough so that they can fix the problem. With such a great title, how can you not give it at least one shot ?

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When doctors make their patients cry

I was just talking to a patient who was in tears. She had had diabetes for many years and was having a hard time controlling it , but was very sure that she did want to have a baby desperately. Since she was already 38 , we did an IVF cycle for her and she conceived in her very first attempt . We referred her to an obstetrician , who could provide her with the antenatal care she required , since she was a high risk pregnancy . She promptly went to a senior obstetrician, but came back to me in tears. She was extremely agitated, angry and upset and when I asked her what happened, this was her story.

Doctor I'm a grown-up woman and run my own company. I have lived with my diabetes for many years , and I know that I haven't done a very good job controlling it , but that's the reality because I am so busy working . I have spent many years trying to lose weight; control my diet; and get my blood sugar to normal. If you remember , I had come to you 5 years earlier, because I wanted to get pregnant, and you had advised me to control my diabetes, and then get back to you. I did not manage to do so, and finally requested you to do IVF for me, because I am already 38, and my biological clock is ticking away.

I'm pregnant after so many years and I'm extremely excited. I'm looking forward to the fact that I will finally become a mother. I went to the senior doctor you referred me to, so that he would help me manage my diabetes , so that I could have a healthy baby. However, instead of explaining to me what he would do and how we could work together to make sure everything would go well, he started berating me for doing such a bad job at controlling my diabetes - and even went so far as to say that it was irresponsible on my part to do IVF in order to try to get pregnant when I had such uncontrolled diabetes. Not only was he rude, a lot of what he had to say was extremely hurtful and I was very shaken up and upset.

My mother had come with me to the consultation ; and now I'm sure the next eight months of my pregnancy are going to be living hell. Rather than looking forward to an enjoyable pregnancy and a healthy baby in my hands at the end of it , I will be worrying about the possibility of this baby having birth defects. I had much higher hopes from such a senior doctor. I know that he told me off for my own good , but there are better ways of criticizing a patient.

I had to spend about 15 minutes consoling her , explaining to her that the doctor didn't really intend any harm, and perhaps he was saying things in order to motivate her to be more careful about managing her diabetes. I also told her that sometimes patients tend to over interpret the doctor’s expressions or his statements , when he really doesn't mean to be critical.

She refused to be consoled, and insisted on going to a second doctor . I did refer her to a second one , with whom she was happy, but I think this story has important lessons for all of us.
Doctors sometimes forget the power of their words and expressions when talking to patients. Patients are extremely vulnerable , and hang onto every facial expression or word. I know doctors can’t be on their guard all the time , but they need to understand that how they frame a particular sentence makes a world of difference to the patient. They need to learn to be positive and to understand the patient's anxieties. After all , managing the patient doesn't just consist of controlling her blood sugars. It also consists of managing the patient's peace of mind and building confidence in the patient - both in her own abilities to manage her problem , as well as the doctor’s ability to be able to care for. Unfortunately, this doctor , even though he was very senior , failed on all counts.

I think part of the problem is that when patients are upset with doctors , they just walk away and go to another doctor. Because they never provide any feedback to doctors about these negative encounters , doctors don't even understand that they're making mistakes ; and they merrily continue making them all the time. I'm sure I'm guilty of the same error, even though I do try my best to be as responsive and alert to my patient’s signals.

Should doctors tell patients what to do ?

There are many doctors who don't like patients who ask questions and argue with them. They basically want their patients to agree with their advice and to just do what they are told by the medical expert. The get irritated when patients want to discuss alternative option they have found on the internet. These the doctors have a paternalistic approach and sincerely believe that patients do best when they follow the doctor's orders, rather than try to apply their own mind and make decisions for themselves. There doctors don't like patients who have made up their own mind. This is often the case of an irresistible force meeting an immovable object ; and because the chemistry between the doctor and patient is never right, they never managed to hit it off ; and may end up hitting each other ( figuratively !)

There are also doctors who want patients to provide inputs and to make their own decisions for themselves. These are the doctors who will make a list of options , and ask patients to select the option which they prefer. They get irritated when patients refuse to do their homework; and they dislike patients who want to just passively follow the doctor’s advise, because they feel that their doctor is God !

One would think that this is a very enlightened approach , because it treats the patient as an empowered adult; and that patients would appreciate doctors who treated them as intelligent partners. However, there are some patients who don't like this kind of doctor, because they believe that these doctors are wishy-washy and confused and can't make up their own mind ! These are the kind of patients who want authoritative doctors who will just tell them just what to do. They’d rather not than discuss the pros and cons with their doctor, because they feel that all this discussion just leads to paralysis by analysis and creates more confusion, rather than solving problems.

These patients want a doctor who will guide them and make the decisions for them - someone who's a father figure , who will tell them what the best treatment option is for them. These are patients who can't be bothered to apply their own mind , because they don't think it's worth the effort. Why not leave everything to the expert ? They believe that half knowledge is dangerous ; and that it's better to leave such critical decisions up to the professionals , who are trained to make them , and presumably will make better decisions as compared to an untrained layperson.
I don't think one type of doctor is any better than the other type . In fact , a really good doctor will be able to tailor his approach to what the patient needs. However, if there is a mismatch between the worldviews and personalities of the doctor and the patient, both are likely to be unhappy . On the other hand, when the patient who is seeking an authoritative doctor finds a doctor who has a paternalistic mindset, both are likely to be happy. Similarly, if a patient who believes in making decisions for themselves finds a doctor who believes in offering patients choices , so that they can choose their path for themselves, they are both likely to do well with each other.

As the patient, sometimes you may not have much of a choice ; and you may be forced to live with a doctor who has a philosophy which is diametrically opposite to yours. You should be aware of this , and realize this is likely to create a lot of angst and unhappiness for both of you. However , if you do have a choice , it's well worth spending some time searching for a doctor who shares your worldview - you’ll both be a lot happier !

Teaching patients how to ask good questions

I encourage patients to ask questions. This is important, because it allows them to understand exactly what their problem is ; and what their treatment options are , so they have realistic expectations as to what I can do for them.

However, sometimes patients ask such poor quality questions that it's very hard to provide intelligent answers. This is why doctors sometimes get so frustrated by patients who carry lists of over 100 questions , and expect the doctor to answer all of them. The truth is that the quality of the doctor’s answers depend on the quality of the patient's questions. The problem is that patients are not sophisticated enough to be able to differentiate between good-quality questions and bad quality questions.

How can doctors help patients to ask good quality questions ?

This needs to be a two-step process. Firstly , patients should compile a list of generic questions and then try to answer these questions by doing their homework online. If they do this properly about 80 percent of their questions will already be answered before they go and see their doctor . This way, the doctor can focus on the really important stuff , which applies to their individual problem . Doctors can encourage this by providing information to patients on their own website , so that most of the generic questions have been answered before the actual consultation starts. This will save the doctor a lot of time and also ensure that the answers to the generic questions are retained by the patient, because they've been clearly documented. Many studies have shown that patients forget about 50 percent of what their doctor tells them during the consultation , so that this kind of blended approach helps to ensure retention of information by the patient.

Patients need to learn what questions to ask ; and how to ask them. This is an important skill, which is worth acquiring , and doctors can play an important role in teaching patients the difference between good quality questions and poor quality questions. Broadly, if the question can be answered by doing a google search, it’s not a good idea to ask this question to your Doctor . Good-quality questions are those which relate to your specific problem ; and which require the doctor to tailor the information specifically to your condition .

This approach will create a win-win situation , where patients get satisfactory answers to all their questions ; and doctors are happy because they've been asked intelligent questions , and their time has not been wasted on generic stuff.

Yes, I agree we also need to teach doctors how to provide good quality answers to good quality questions – and this will be the subject of another post!

Using Felopio and herbs to unblock your fallopian tubes naturally

Every once in a while I come across a website which make my blood boil, because it takes advantage of an infertile women's ignorance; and exploits her hopes and desires to make a quick buck.

A good example is www.felopio.com, which promises a " natural herbal remedy " which will allow women to open their blocked tubes.

This is a very tall claim to make - but they can make it and get away with it, because it's a herbal remedy, so it does not need to be tested or approved ! Also, this is the internet, so people can make any claim they want !

Felopio is a tampon which contains herbs , which are supposed to work their magic on the fallopian tubes, after being placed in the vagina. This is a very clever marketing ploy, and even though it's all hocus-pocus, it's not hard to understand why it's so successful.

Women would rather try natural stuff at home rather than go to a doctor - and if they can order a simple remedy sitting at home, they are very tempted to do so ! Using felopio is easy to do - and because they can do it for themselves, they feel they are taking control of their problem and tackling it proactively.

Husbands also like the idea that this is a DIY remedy , which is safe and non-invasive. After all, what's the harm of trying it out ? It's local - and putting the herbs so close to the tubes makes a lot of intuitive sense ! So what if doctors don't recommend this ? Doctors don't know everything, do they ? Aren't there lots of other herbal remedies which have been shown to be effective
( which doctors don't learn anything about ?) Even if doesn't work, at least it won't do any harm ?

It's true that it's tempting to buy this product. The site is very attractively laid out - and is full of glowing testimonials and (unauthenticated) success stories.

Yes, it's true that some women may get pregnant after using Felopio - but this does not mean that the Felopio opened their tubes ! Often, the diagnosis of "blocked tubes" itself was wrong in the first place. It's common for doctors to report the tube is blocked, when actually it's just a cornual spasm which prevents the dye from entering the ( open) tubes.

The tragedy is that it is still very easy to fool infertile patients, who are deperately seeking a quick fix solution. It's easy to prey on their ignorance - and this results in their wasting valuable time and money .

Don't get taken for a ride - your best protection is Information Therapy !

i am 9 days late and and 3 pregnancy tests have come out negative. What could be wrong ?

As we all know, the commonest reason for missing a period is pregnancy. This is why, when you miss your period, your first thought is - Am I pregnant ? If you are infertile and have been trying to conceive for some time, there's a lot of hope and suspense when your period does not come on time.

So you check by doing a urine pregnancy test - and keep your fingers crossed - hopefully, this is the time when you've finally hit the jackpot ! Maybe it's the weekend trip you took which finally did the trick ?

However, when you find the test is negative, your hope go crashing to pieces ! Maybe I did the test too early ? Or perhaps I didn't do it right ? Aren't there lots of stories of women who were pregnant but whose pregnancy tests were negative for many weeks ? Maybe the test is not very reliable ?

The reality is that urine pregnancy tests are quite reliable - and if these are negative, this most probably means that you are not pregnant.

Your next step is to do a blood test for HCG to find out if you are pregnant. This is much more reliable. If this is negative, this establishes the fact that you are not pregnant.

This means the reason you missed your periods is because you did not ovulate. This is called anovulation. You may need to induce a period with medicines.