Saturday, May 26, 2018

Is there any connection between Grade C embryos and the risk of birth defects ?


A patient asked me this question.

Can Grade A embryos result in abnormalities in the baby ? Or do only Grade C results in abnormalities ? 

Sadly, there is still a lot of misunderstanding  about embryo grading . Most embryologists are not skilled enough to be able to grade embryos properly, and because many IVF specialists have never set foot in the lab , they don't really understand what embryo grades mean. And if the IVF doctor is so confused, it's hardly surprising that patients are completely in the dark.

Embryo grades are basically lab shorthand for describing the appearance of the embryo - how it looks under the microscope . There is no correlation between birth defects and the grade of the embryo . Top quality embryos have a better chance of implanting and becoming a baby , but even if a poor quality embryo does implant, the risk of that baby having a birth defect is not increased !

This is why IVF patients should insist that the IVF clinic give them photos of their embryos, so they understand on what basis the grading is being done . Sadly, most IVF lab don't bother to provide photos, and their grading is very arbitrary, because they can say what they like, and they know they can get away with this !

Thus, they tell the patient - we have transferred 3 Grade A embryos for you - without even telling the patient how many cells the embryo had ! The poor patient is forced to trust the doctor, because they don't know any better - and it's too late to do much about this now, because you've already paid your fees !

All good IVF clinics provide photos to all their patients routinely and proactively, because it helps to increase the trust their patients have in them.

Being able to see your embryo photos allows you to compare them with an atlas of embryos, so you can check the grading for yourself - and no, you don't need to become an embryologist to do this ! This transparency will your upgrade be without even providing basic information as to how many self the embryo hearts and just missed you a lot of confusion and misunderstanding for the poor patient.

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos



Friday, May 25, 2018

The limits of IVF technology



The IVF lab is the heart of IVF treatment. We keep your eggs and sperms safely in the incubator, and your embryos grow in the IVF culture medium in vitro, until they form good quality blastocysts, which are ready to either be frozen , or to be transferred into your uterus.
The most important thing an IVF lab does is make sure there are no toxic elements within the culture medium or the laboratory , as these could damage the growth of your embryos. We want to keep them happy, so they thrive in vitro, until they are ready to go back into your uterus !
However, sadly there is very little we can do to actually enhance the growth of your embryos. This is because the growth of the embryo depends on the energy provided by the mitochondria in the cytoplasm of the egg, and there is nothing we can do as yet to improve this.
This is one of the limitations an IVF lab has to live with - we have to work with whatever raw materials we get. After all, IVF is an ART - an assisted reproductive technology, where we given nature a helping hand. Yes, it can be frustrating when embryos don't grow well in a good quality laboratory, but if you're sure that the embryologist is an experienced expert, then this is something you have to learn to accept.
This is why it's so important to make sure your IVF lab gives you photos of your embryos - so you can make sure they have been nurtured with tender loving care in the lab !
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 !







World's first infertility Chatbot !


We have created the world's first infertility chatbot, to help infertile patients learn more about their problem.
Naima is an intelligent digital medical assistant, who will help you find what you need to know !

Check her out at www.ivfindia.com

This is a beta release, and your feedback will help us enormously in improving how she answers your   queries ! Please be kind - this is a work in progress

Thursday, May 24, 2018

The difference between IVF outputs and IVF outcomes - what every patient needs to know !


What every patient ( and every doctor) wants from every IVF cycle is a happy ending -  a baby. It's great when we can achieve this happy outcome, but sadly IVF does not have a 100% pregnancy rate, which means many IVF cycles fail.
While this is heartbreaking, the patient then needs to plan what to do next, and this is why it's so important to differentiate between output and outcome.
The output is the end-result of the IVF treatment , and this is something which a doctor can control. This is tangible, in the form of top quality blastocysts.
However, once we transfer the blastocyst back into the uterus, we have no control over whether this will implant or not, which means we cannot predict what the final outcome ( a baby) will be.
Patients need to check the quality of the IVF treatment they receive based on the output - the embryo quality - rather than the outcome.
This is why it's so important to ask for photos of your embryos.
All good clinics provide these routinely and proactively
You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

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 !





Saturday, May 19, 2018

How can we make IVF more affordable in India ?

I often see lots of infertile patients who could get pregnant if they did IVF treatment. Unfortunately, they just cannot afford to do an IVF cycle for financial reasons, and they end up without a baby. It fair to say  that  this causes them a significant amount of  frustration and heartburn when you know that IVF can help you get pregnant; but you can’t, because you just can’t afford the treatment.

Can this be changed?  
But it’s not just the patients who are affected; IVF specialists also go through a lot of anguish when this happens. It’s very difficult to come to terms with the fact that   though there is a medical solution, you are unable to offer it to a patient, simply because she can’t afford it. This isn’t the case only in India, but across the world, there are people who have to forgo IVF because of the cost factor. So what can be done to make the treatment more affordable?

In India, it would make a big difference if the government accepted the fact that family planning and welfare does not just mean limiting family size, but also helping couples to achieve their desired family size. If government hospitals & medical colleges began offering IVF programs, they would easily be able to afford to this in a cost-effective manner.
Our medical colleges are churning out a large number of M.D. gynecologists who haven’t really had any exposure to IVF treatment; it’s a shame that these gynecologists are under qualified. If IVF is offered at these hospitals, both the purposes would be served. Infertile patients would get quality care, and there would be an entire generation of gynecologists who are being trained properly!



Insurance companies say “no” to IVF
Health insurance companies don’t cover IVF treatment. The excuse they give is that infertility isn’t a medical disease and that it’s no more than a lifestyle illness which doesn’t make it eligible to be covered under insurance. Patients don’t have the means to fight back and the companies get away with it.
The simple solution is that infertile patients should form an NGO which would establish that infertility is a medical problem and that it should be covered by insurance just as any other medical treatment would be.  This would make the treatment much more affordable for a number of couples.
So, why is IVF so expensive?
One of the main reasons is because doctors inflate their charges by saying that their years of training, the expensive IVF equipment, the disposables etc, make it very expensive. This is true to a certain extend; however, if they use economies of scale, they will be able to provide more affordable IVF treatment to patients.
 If they start treating a larger number of patients and use innovative technology (like vitrification for freezing), it will improve their success rates and inexpensive IVF treatment can be much more than a pipe dream.


Not happy with the attention you are getting from your IVF clinic? 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!

Friday, May 18, 2018

Why didn't this blastocyst implant ?


The truthful answer is - We don't know !

This doesn't mean we are stupid or ignorant - it just means medical technology has its limitations, and we need to learn to live with them, by having realistic expectations of what IVF treatment can accomplish - and what it can't !

So what do we know ?

We know that human reproduction is not a very efficient process, and that most embryos will not implant because they have genetic abnormalities we still cannot test for. This is the limitation of IVF technology today, and we need to come to terms with it.

The problem is that patients are unhappy when the doctor tells them the truth, because they want the comfort of certainty. Sadly, this is a mirage, but in order to keep patients happy and placate them, doctors will spin all kinds of tales to explain away the failure. Usually this involves "blaming" the patient , and this victim-blaming comes in all kinds of flavours
- you did not rest enough
-  you were too stressed out
- you did not take your medicines on time
your egg quality was poor
- your husband's sperm were bad

Doctors cook up all kinds of fanciful pretexts, but this false pretense just causes more harm. They end up subjecting the poor patient to all kinds of useless tests and treatments, which just waste money, but don't improve success rates !

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, May 17, 2018

What do we need to change for our next IVF cycle



After her IVF cycle failed, a patient sent me this email


In retrospect what do you think could have gone wrong? Is there anything I need to improve or change ? 

It's important to learn from each IVF cycle by analysing what went, and what didn't. The right time to do this is at the time of embryo transfer, because it is only until this point that we have any control. We can only three tangible variables -
embryo quality
endometrial ( receptivity) thickness and texture
the ease of the transfer

Once the embryos have been transferred into the uterus, we have no ability to check what happens inside the uterus. All we know is that human reproduction is not a very efficient process, and that most embryos will not implant because they have genetic abnormalities we still cannot test for. This is the limitation of IVF technology today, and we need to come to terms with it.

This was my answer to her.

No, there's no need to change anything, since it was a perfect cycle ( top quality blastocyst, excellent endometrium, easy transfer)

The problem is that human reproduction is not perfect !

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 !








Wednesday, May 16, 2018

IVF failure - incompetence ? or bad luck ?



IVF failure can be the result of bad luck , or sometimes the result of the IVF doctor's incompetence . The key question the patient wants an answer to is - How do I differentiate between the two ? 

Did my cycle fail in spite of the fact that the doctor did everything right " Or did it fail because the doctor wasn't able to make good embryos in the lab ?

The only way to answer this question is by getting photos of your embryos , and doing enough homework so you are able to interpret the images of your embryos . The good news is that this is easy to do - and if you need help, please feel free to email me !

You can see what embryos should look like at www.drmalpani.com/knowledge-center/ivf/embryos

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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