Monday, July 16, 2018

Why do IVF success rates vary so much from clinic to clinic?



One reason why IVF success rates vary is because some clinics are much better than others, because of their superior expertise and depth of experience. Remember, the success rates don’t depend upon just the doctor’s clinical skills – they are also affected by how good the embryologist is, and the coordination between the laboratory and the clinical team. Sadly, many IVF clinics depend upon “travelling embryologists”, and they don’t have a full-time embryologist. What’s even worse is that patients are clueless about the fact that such a key professional is missing !
The other reason is because their success rate is a number which a lot of clinics will manipulate, because they understand that the higher the rate they quote to the patient, the better their chance of getting the patient to come to them for treatment.
Because there no regulation of IVF clinics in India today, no one checks whether the doctor's claims have any bearing with reality ! This is why clinics quote completely fabricated, outrageous, and inflated numbers in order to attract patients, and patients have no way of verifying or checking whether what the doctor's saying is true or not.
This is why you will see numbers like 60% per cycle and 80% per cycle being bandied about on their websites - numbers which are being fudged. Sadly, sadly patients aren't sophisticated enough to understand that the doctor is lying to them !
The only way you can protect yourself is to ask better quality questions, to make sure that your doctor is being honest with you. However, there’s still no way of verifying whether what the doctor's saying is the truth or not. This can be a vexing problem, and actually ends up penalizing honest doctors , who want to be as transparent as possible with their patients.
They take the time and trouble to explain to the patient that while their pregnancy rates are much higher for good prognosis patients, the pregnancy rates will drop for older women, and those with poor ovarian reserve. Sadly, patients don’t want to hear the truth, as a result of which many of them get taken for a ride by unscrupulous IVF clinics.
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, July 15, 2018

What are my chances of getting pregnant with IVF ?


The commonest question which a patient asks their IVF doctor is, "What are my chances of getting pregnant?" Now this is a deceptively simple question , but the answer can be surprisingly complicated, which is why most doctors will take one of two approaches to answer this.
Most will provide a highly inflated figure , because their only purpose is to make sure that the patient comes to them for treatment. So they'll say state some outrageous figure like 70% per cycle — an arbitrary number they pull out of their hat—and they have no way of being able to prove that this is the right number. Unfortunately , patients are not sophisticated enough to ask them to verify this figure, and because most Indian patients still have blind trust in their doctor , they will assume that this number is correct. Being na├»ve and gullible doesn't help , but patients are emotionally vulnerable, and doctors take advantage of this.
The better method is to provide a more tailored figure , based on the patient's age, her medical diagnosis and ovarian reserve—all the various biological factors which affect her chances of success. The problem here is that doctors can't be fortune-tellers , and it's impossible to predict for the individual patient what her chances are going to be.
The truth is that we are able to answer this question much more accurately after doing the IVF cycle,  because this gives us a chance to assess the quality and the quality of her embryos. However, patients doesn't want to wait till after the cycle—they want an answer right now ! This is why we sit and explain to patients that the number we provide as regards her chances of getting pregnant is just an estimate , based on : her medical history ; whether she has been pregnant in the past; the outcome of her earlier IVF cycles; her age (as you get older the chances decline , because egg quality declines) ; and her ovarian reserve, as assessed by measuring her AMH level and her antral follicle count. The problem is that are all rough estimates – after all, the final proof of the pudding is in the eating, and for an individual patient in a single IVF cycle, the success rate is either 100% or 0% !.
A better way of answering the question is to say, "In our experience, for patients like you , in your age group , with similar AMH levels and antral follicle counts, the pregnancy rate in our clinic has been  X % in the past. However, we will be able to answer this question more precisely once we've done your cycle for you, as we will be able to assess your biological response more accurately."
Thus, patients need to understand that there's a difference between ovarian reserve and ovarian response. Reserve is just a static number, measured by testing antral follicle counts and AMH levels – and we don’t treat numbers – we treat patients ! We are  much more interested in the ovarian response, which is dynamic – how well does the patient respond to the IVF superovulation, and how good are her embryos ?
The problem with a dynamic result is we cannot predict it in advance, because the body is so complicated , and it is affected by many biological variables, not all which can be measured. The truth is that every patient is different, and when the doctor is being honest, it may appear that he is trying to hedge his bets, or is not being forthright.
However, a good doctor is trying to be as truthful as possible, based on his clinical assessment, so that you have realistic expectations of what IVF treatment can offer you ! Biological systems are complex and unpredictable, and patients need to learn to come to terms with this uncertainty.
This is why it's so important that you find an IVF doctor you can trust , so you have peace of mind you have done your best ! 
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, July 14, 2018

Why do patients have such unrealistic expectations of IVF treatment ?



A huge problem today is that corporate IVF clinics have started claiming highly inflated  success rates,  because they want to attract patients. This harms patients, who have very unreasonable hopes of what at IVF clinic can do for them. This is why when their cycle fails they're extremely unhappy and feel they have been cheated. These clinics want to maximize their profits, which is why they strategy is to overpromise – and they end up under delivering.
                                We prefer being honest and telling our patients exactly what their chances are. Unfortunately, this ends up hurting us , because patients can't understand why our success rates are so much lower than all these other clinics on the web. I guess perhaps that's the price we need to pay for being honest.
However, in the long run, this is the right approach, because we've noticed that these patients who fail IVF treatment in their local IVF clinic then come to us for their treatment. This is when they experience a world of a difference in the quality of the care which they get – and they are able to appreciate the difference between a good clinic and a bad one ! 
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, July 13, 2018

Why do IVF patients feel cheated ?



One of the things which irritates a lot of patients about IVF clinics is that they get inconsistent information from their clinic. Different doctors in the same clinic give them completely different advice. Because there's so much turnover among junior doctors in these clinics, no one says the same thing at different visits, as a result of which patients get completely confused , and don't know whom to believe or trust.
This is one of the reasons why there are so many last-minute changes in their treatment protocol, without any adequate explanation. There’s a complete lack of transparency and the treatment is delivered on an ad hoc basis, depending upon whether the senior doctor is travelling or not. When taking the fees, the clinic promises to do a blastocyst transfer, and then finally ends up doing a Day 2 or Day 3 transfer , without providing any explanation to the patient. This is why patients will often get upset and unhappy, and will feel cheated.
The problem becomes even worse after the IVF cycle fails. Before the cycle, doctors are in sell modem and are happy to tell patients what they want to hear. They want the patient to sign up, so they over-promise and make all kinds of false claim, "Yes, our success rates are brilliant and all the patients we treated last month got pregnant. Don’t worry, of course we will get you pregnant as well – you are young and don’t have any major medical problem." However, when the cycle fails , they end up singing a completely different tune ! They blame the patient for the failure, saying, "Oh, your eggs weren't good ; or your sperm wasn't good because there’s a lot of DNA fragmentation." They then offer all kinds of alternative options , and suggest that patients use donor eggs or donor sperm for the next cycle. As a sweetener, they even offer a discount for the next cycle, so the patient is impressed as to how caring and considerate the doctor is !
Now IVF patients are extremely vulnerable , and many will even say yes because they are desperate. However, it's not surprising that they believe they have been cheated. They many not have the courage to speak up, but they feel, "If there was a problem with my eggs or sperm , why didn't you tell me that when I came to you for the consultation , before I started the IVF cycle? Why are you telling me this now? Are you manufacturing problems to save your own skin ?  Why is what you are you telling me now is so different from what you first told me?"
Unfortunately, it's very difficult to hold doctors accountable. There is very little documentation, and doctors refuse to be transparent or open. Patients feel they're at their mercy , and are forced to do whatever the doctor tells them. This is especially true when doctors in smaller towns take advantage of their patient’s ignorance and exploit their naivete. The tragedy is that all IVF doctors start getting a reputation of being unscrupulous cheats !
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, July 12, 2018

The problem with IVF corporate clinic chains

Practically every newspaper these days has ads for IVF clinics,  and you will also see these ads on large billboards all over the town as well. There's a lot of competition in the field, because lots of financiers believe that there is a lot of money to be made by opening IVF clinics. IVF is thought of being a high-profit business, and they want to make the most of this opportunity. However, their focus is then on how much money they can make by opening as many clinics as quickly as possible, rather than paying attention to making sure that the pregnancy rates are high by providing high quality treatment to their patients.
This creates all kinds of perverse incentives for these clinics , who end up spending a lot of money on advertising (Google Ad words and newspaper articles, whether these are regular ads, or disguised as advertorials)  , because their metric for success is how many IVF cycles they  have done – not what the IVF pregnancy rate is. They don't really care about whether the patient gets pregnant or not because they're not clinicians. They're ultimately just out to get a return on their investment.  And since this is India and there is no regulation, they can claim any success rate they want, because there is no one to verify or check their claims.
 They also incentivize their doctors based on the number of patients they attract for IVF. Ironically, this means that any patient who goes to these clinics is advised IVF . This is very profitable for the clinic, and also improves their pregnancy rates ( because these patients didn’t need IVF, their chances of getting pregnant are very high !), but is a waste of money for the patient. Patients get attracted by these ads, because they're not sophisticated enough to understand that the quality of care in these clinics is poor.
 In theory, one would expect that corporate chains of IVF clinics would be a good idea, as they would offer standardized treatment, at a lower cost, because of their advantage of scale. While they do offer convenience, because patients in small towns no longer need to travel to a metropolis for IVF treatment, the fact remains that their pregnancy rates leave a lot to be desired.
So, why is the quality of treatment poor? This is because these clinics are being run for all the wrong reasons. They're being run to make money, not in order to provide a high quality clinical service, which is why they cut corners all the time. Thus, they typically employ junior doctors , who don't have any experience or expertise . They are taught in a one-week workshop to recite a script at the time of the consultation, and to write a protocol which they perform mechanically and mindlessly. While this may be okay for young patients, they have no idea how to handle complicated patients , as a result of which, the cared for patient continues to suffer.
Most of these new labs don't have highly trained expert embryologists, as a result of which the lab is not able to grow embryos properly. Most of them don't give photographs of the embryos to their patients , because they know they cannot afford to be transparent – patients would start complaining and objecting when they see how poor their embryos are. They fail to follow good global practices, but continue getting away with it , because Indian patients are naive , and don't know any better, and the government has failed to provide any regulatory oversight, though it was tasked to do this over 20 years ago !
This is why these clinics flourish in small towns , where patients are illiterate, and treat the doctors as Gods., They will do everything the doctor tells them to  because they don't know any better. When their cycle fails, they then jump to the erroneous conclusion that all IVF clinics are scams.
The best way to protect yourself from being taken for a ride is to ask a simple question - Do you provide photos of embryos routinely to all patients before transfer ? And if they don't, then this is a red flag !
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 properly!
  

Wednesday, July 11, 2018

The fate of the poorly informed IVF patient


A patient sent me this email

I am married to my husband since 2011 Still now i havent conceived .Nor been pregnant or any abortion happend.I first went to a local hospital near my house.my FSH ,LH,prolactin,and all other hormones are at good level So they said me to try normal.Antral follicle was 5/6 in left and 6/6 in right.We tried for 6 months but it didn't gave result.we went to another hospital.From there I was told that my husbands sperm is with low molitility so when we went for scan found varicocele and husband had varioelectomy for varicocele.after surgery also I failed to conceive. i also had minor fibroid issue but doctors took 3 D scan of utreus and also found it normal.So doctor told me to check AMH when I checked it AMH was 1.3 in 2015.So she insisted me to do ICSI .So we straight forward went for ICSI.First ICSi we got 11 eggs and 9 fertilised out of which 6 survived and they thawed it.they transfered two embroyo at a time but my beta HCG was negative.After this failure they transferred again 2 embroyos but that two failed.My endometrium thickness was 6 mm before medicine.They gave me estrogen patches it failed they gave me Vitamin E that too failed after that they gave me Viagra Then my urteus got thick.They told me to reduce weight My weight was 58 I reduced it to 54 .I had cauterisation for my cervix due to cervical erosion and had  endometrial scratch before ICSI.Also I was adviced to have DHEA for 3 months,Folic acid then vitamin C .Repeatedly went for 2 ICSi after weight loss  with intralip drip 2 day before embroyo transfer and also with embroyo glue and IU HCg.My utreus was 9.1 mm when transferred.this also failed and now they are insisting to do HLT husband leukocyte transfer and also ERGA test then hysteroscopy .Do I need to do this .Will this technique help me to conceive.Doctor I am in depression.I now only have 3 embroyos now .Kindly help me.I Am a very tensed person Do stress effect me badly.


Her quality of care has been remarkably poor ! There is no consistent treatment plan, and she has no idea what's happening, because the doctor has not bothered to share any information with her.

This opacity and secrecy is one of the reasons why patients don't trust IVF doctors any more - and the tragedy is that good doctors also get tarred with the same brush !

This is why patients need to invest in Information Therapy before starting an IVF cycle, to make sure their doctor is credible and reliable, and is not taking them for a ride !

You can download our IVF comic book free at
www.slideshare.net/malpani/ivf-comic-book


Friday, July 06, 2018

Excited to be pregnant after doing IVF at Malpani Infertility Clinic !


We had made the decision to meet Dr.Malpani Sir as we had read on the website that all the queries and procedure is handled by Sir and Ma’am.We  received prompt reply to all our queries and Dr.Malpani sir was very supportive ,for us he is like a father figure.

Our parenthood journey got delayed due to multiple factors but we were open to options to achieve our dreams.Our first cycle was a chemical pregnancy but with the expertise of embryo preservation and a smoot embryo transfer by Dr.Anjali Ma’am and Dr.Sai the embryologist our second cycle is successful and we are enjoying the new joy in our life.

Dr.Malpani Sir is upfront in explaining your queries we got email replies during important moments straight from Sir which was very heartening. 

Not to forget the nursing staff ,billing and front desk who lived to the expectation.

If you are facing infertility don’t get frustrated and avoid the blame game or stigma like we take medicines for so many ailments so nothing wrong with IVF as Sir says "You have peace of mind that you left no stone unturned !"

Dr.Malpanis will always have a special place in our heart not only because the IVF was a success but the way they treated us during our important phase of life.

We pray to the almighty for their good health so they can help many more aspiring parents.

THANKS !

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