Wednesday, February 21, 2018

Review from a patient about Malpani Infertility Clinic

After getting cheated by doctors at local IUI and IVF clinics, we had lost trust in doctors.

But we took one chance and visited Malpani clinic for their opinion. When we met Dr Anirudha he was very patient and understanding. He spoke to us in a very friendly manner and asked us not to blame ourselves.He clearly explained the procedure at Malpani clinic and all the costs involved. 

He also explained that IVF takes time and we should not lose hope. He also explained the number of times we have to visit the clinic. This was very less as compared to other clinics and doctors which allowed us to go on with our usual lives. We were impressed with all the facilities and staff at the clinic and wanted to take another chance. 

When we started the cycle Dr Anjali would personally attend to us and do the scans. There were no assistant doctors involved. She did the egg retrieval process which went very smoothly and we did not face any difficulties. The nurses are very co-operative and patiently explained the medicines and injections to be taken.We were even refunded the unused injection charges.

Embryologist Dr.Sai kept us updated on the eggs retrieved and fertilised. He sent us photos of the blastocysts and explained quality of each of them. Due to this we were at ease that we have good quality blactocyst and our chances of getting pregnant are good.We froze the embryos and transferred one of them. Dr Anjali does the transfer and she is very experienced at it. We were given photos of the embryo which was transferred and before the transfer Dr. Sai also showed us the embryo to be transferred under the microscope. But unfortunately the cycle did not work.We were disappointed but Dr Anirudha called us personally and empathised with us. He gave us hope to keep trying. 

We did another embryo transfer and this time we were lucky and got pregnant.However after 5 months we suffered a miscarriage because of placenta previa bleeding and infection. We were heartbroken and completely shattered. We spoke to Dr Anjali when we were hospitalised and she gave us hope. 

After waiting for 4-5 months we again went for embryo transfer and luckily again we got pregnant. We still have some months to go to have a baby but the doctors and staff at Malpani clinic have given us plenty of confidence and hope that we will become parents one day. Dr Anjali and Anirudha have God gift to help childless couples like us Finally our advice to other couples is Don't give up hope..your day will come it just a matter of time. And if possible please visit the Malpani clinic for your problems.

Tuesday, February 20, 2018

Why it's a pleasure treating well informed patients !

A patient sent me this email

We are considering embarking upon IVF to have our 4th living child . We have a history of successful pregnancies (births 2008, 2010, 2012) mixed with miscarriages (3 in 2007, one in 2017). We want to expedite conception rather than trying for years more on our own. My AMH appears reasonable (21.6 pmol/l) and my CD3 FSH was 8.3; LH and estradiol, prolactin etc. were in normal range). We have approached two fertility clinics (one in Greece, one in the Czech republic, both well known) who have both recommended a hysteroscopy before proceeding. I do not feel that this is evidence-based practice. I have received recent serial ultrasounds, which showed normal uterus and ovaries - on CD14 endometrium was 10.6mm, trilaminar and had good blood flow; 22mm follicle to RHS (LH surge was later that day and CD21 progesterone confirmed ovulation). To my mind, the value of hysteroscopy is negligible in my specific case, despite having had 2 D&Cs for miscarriage in my past. I feel that any major issues are likely to have shown up in the ultrasounds - but I am interested to see if you agree! I also wish I could ask you my chances of having a baby - but I suspect that is far too complex a question. Moreover, with 3 previous successful pregnancies and just over a year trying for this one (with one miscarriage), decent AMH etc. I am going to remain very quietly optimistic on that front. Very best wishes, 

This is a patient who has done her homework and is clearly aware of all her options. She has used Information Therapy, so she can Say No to unnecessary procedures, such as hysteroscopy. She is not a doctor, but is very well read, and wants answers to her questions.

Many IVF doctors would not want her patient like her, because they would think she is too "demanding" - but she is the best kind of patient to treat, because she has realistic expectations of what an IVF doctor can do for her, and will not put up with an BS !

I am 28 and my girl friend is 33.We want to get married. Will we able to have a baby ?

I am 28 and my girl friend is 33.We want to get married, but my mother is worried about her fertility, because she is older than I am 

Can you help ?

While I can do some simple tests to check her fertility, I am very reluctant to do tests without  any good reason.

If you are both healthy and active, then the odds are stacked in your favour that you will have  no problems at all - the human race has proved to be quite efficient at reproducing itself !

If your girl friend is worried about her fertility because of her age, please share this with her.
Please test your AMH level (  read more at http://www.drmalpani.com/knowledge-center/infertility-testing/amh) and 
your antral follicle count by doing a vaginal ultrasound scan ? Read more at http://www.drmalpani.com/knowledge-center/articles/afc
If these are normal, then we can reassure you that your fertility is fine.
It's not your calendar age which matters - it's your ovarian age !

Sunday, February 18, 2018

Can you suggest medications to enhance chances of conceiving ?

A patient sent me this email

Can you please check my semen analysis report  and confirm that this is normal

I checked it,and since it was normal, I replied,

Good, this is a normal report ! Read more at http://www.drmalpani.com/knowledge-center/resources/book/chapter4b

He then emailed back, saying 

Can you suggest medications to enhance chances of conceiving ?

I am confused !
Instead of being pleased that everything is normal,  why do patients still want doctors to prescribe medicines for them ?
Why can't they be patient and let Nature take its own course ?
Too much meddling can cause problems - and medicines do have side effects as well !

How do I calculate the age of my IVF pregnancy ?

A patient sent me this email


I had a query. I have conceived through IVF and ET was on Jan 6 th and my LMP was on Dec 20th.
I got my ultrasound done on 16th Feb and in scan it showed the pregnancy is 5 weeks 6 days.
If I calculate the growth of the baby from the date of the transfer, this seems fine, but if I calculate from the date of the LMP , it seems to be lagging behind.
I am completely confused - can you please help ?
This is a common problem, because IVF patients use their common sense and assume that doctors would calculate pregnancy dates based on the age of the embryo. Since they know the date of the embryo transfer, should the pregnancy be dated using this as the baseline.

However, doctors don't use embryonic age when dating a pregnancy in practise, because the clinical convention is always to use menstrual age !




Saturday, February 17, 2018

Is your IVF doctor ordering too many tests ?



Most patients are understandably wary about signing up for any surgical treatment options which a doctor offers,  because they understand that these treatments can be expensive and can have side effects. This is why they take a long time before providing consent for any invasive treatment. Unfortunately, they don't utilize the same skepticism when the doctor advises a panel of tests.
It is this unwillingness to question the need for tests which causes so many problems today. The fact of the matter is that too many doctors these days order too many tests. A lot of these tests are unnecessary, because they don't provide any useful information - they don't really change your treatment options, which is why they are pointless.
However, there is a lot of pressure on the doctor to do lots of tests, and this comes from many sources.
Ironically, patients will put often put pressure on the doctor, because they crave a diagnosis - they want to know what is wrong ! They are worried that if the doctor cannot put a label on their disease, they will not be able to treat it. This is why they're not happy when the doctor says, " All the test results are fine," , because they think this means the doctor is incompetent - after all, if he has not even been able to make the correct diagnosis, how can he be trusted to provide the right treatment ?
Doctors are also quite happy to play with the newest diagnostic toys, and when they attend a conference where a speaker waxes eloquent about the latest tests, they want to try it on their patients as well . After all, they want to remain on the cutting edge of medicine. The problem is that this results in their patients bleeding, because the conference talking about a new test is often out to promote it - either because he's the inventor, or because he has been " sponsored" to say good things about the test by the medical company which sells it. He talks at length about  how cool it is , and how it's helped him to find out the reasons for infertility in many couples, which other doctors have missed.
Doctors are still quite happy to use their patients as guinea pigs, because they want to try out new stuff ! They also believe - "What's the big deal about doing a test? Why don't I just go ahead and order it. It'll hopefully provide us with more information , and we may be able to use this in order to treat the patient's problem."  This is just wishful thinking - after all, the eye only sees what the mind knows.
And yes, doctors will often get cuts and kickbacks from the lab, and this incentivises them to order lots of tests, which is why so many of them subject their patients to "diagnostic panels" routinely - whether they actually need them or not. However, not all this over-testing is necessarily done with a bad intention.
The big problem is not the financial harm which this causes to the patient. The much bigger danger is that a lot of these brand new tests haven't been proven to be useful in clinical practice. Because they are new , we don't understand what their limitations are. They've not been subjected to controlled clinical trials to document they are beneficial in real life. However, the problem is that the moment you do tests , you're bound to find patients who have abnormal results. After all, that's what the purpose of doing a test is - to pick up abnormalities, so that's the easy bit. However, managing patients who have abnormal test results is exceedingly hard, because we don't have enough clinical data to do so intelligently !
Not only do these abnormal results cause a lot of anxiety in the patient, the doctor's knee-jerk reflex kicks in, and he wants to treat the so-called abnormality. This means his focus is now on treating the abnormal test result, rather than the patient. The moment he does this, he goes down the slippery slope of over-treatment. These tests are plagued with the problems of false positives - abnormal test results , which are completely unimportant and irrelevant. However , once a doctor gets an abnormal result, he triumphantly pronounces, "Ah, this is your problem. We found it!" The patient is also very impressed that he has such a clever doctor who's helped her to pinpoint what the problem is, and she's quite happy to take the treatment suggested, without realizing that this doesn't really increase the chance of her getting pregnant at all, because the test shouldn't have been done in the first place.
Unless patients learn to ask their doctor this simple question - How will the results of this test change my treatment options? - this problem is going to get even worse over time , especially with all the new DNA based genetic tests which are being introduced left, right and center - expensive tests which are looking for a patient to experiment on !
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, February 16, 2018

Genetic testing and the confused IVF specialist


Genetics plays an important part in reproductive medicine , and it's well known that the commonest reason for failed implantation is a genetic defect in the embryo . This is why it's very tempting to tell patients who have failed an IVF cycle to undergo genetic tests , and this issomething which IVF doctors do all the time . Sadly, most of them are pretty clueless about reproductive genetics , and they order all kinds of unnecessary tests , which they don't know how to interpret . Not only are these tests very expensive , they are completely unhelpful, because they don't really change the patient's treatment options. And because the doctor is confused , he ends up confusing the poor patient even more  !

The diagnostic equipment is expensive, and the genetic laboratories are happy to market these tests to IVF specialists, so they can generate revenue for themselves ( which they share with the referring doctor). This is why so many IVF specialists are quite happy to order the "latest" genetic tests for their patients - after all, isn't this the age of "personalised precision medicine" ? This also helps them to demonstrate to the patient that they are doing everything possible !

This is why IVF specialists end up ordering a wide range of useless tests , all the way from chromosomal testing ; to sperm DNA fragmentation ; to routine prepregnancy genetic carrier testing  for a host of rare disease.

This is why it's so important for patients to read the fine print before signing up for these expensive tests ! Thus, it is common to find many gene variants , but their clinical significance is not clear. Not only do abnormal results cause a lot of unnecessary mental stress, the truth is that it is not possible to exclude every disease risk utilizing these expensive genetic panels, no matter how "comprehensive" they are !

This kind of "spray and pray" routine machine-gun genetic testing  is much worse than looking for a needle in a haystack ! Because there are so many needles , there are tons of false positives, as a result of which patients end up wasting time and money while their doctor goes around chasing red herrings !

Do you suspect that your doctor is groping in the dark, and is covering up his ignorance by ordering too many tests ?

 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, February 14, 2018

Why IVF treatment does not increase your risk of getting cancer

Selecting a good IVF clinic

Making sense of your IVF blood results

A patient sent me this email

I am doing an IVF cycle, and my Day 6 results are as follows: E2- 1776 (great result) PO- 0.6 nmol/l LH 1.6 mIU/mL I am wondering if LH or Progesterone can be too low and should the cycle be cancelled. I am on Puregon- 300iu Menopur- 1 vial Orgalutran- 1 syringe Thanks

I am very pleased when patients are well-informed, and take an active and intelligent interest in their treatment !

Yes, the medical jargon can be quite confusing, and doctors don't make it easier, because they rarely bother to explain what's happening.

This is why the internet can be such a valuable resource for infertile women, who want to learn as much as possible about their IVF treatment

I reassured her.

 A high E2 ( estradiol) level means your ovaries are responding well, and this is a good sign. The LH and progesterone are meant to be low during superovulation , because you are being downregulated with Orgalutron ( a GnRH antagonist). You have had a text book response, and there's no need to cancel the cycle !

Why Hospitals need to prescribe Information Therapy to their patients?

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