Sunday, October 04, 2015

IVF success story at Malpani Infertility Clinic

After 6 years of blissful married life, the only thorn was the lack of a child. And it takes special efforts to cope with the pressure in India, the social stigma attached to it. It seemed like everyone was waiting for our child to arrive and we just did not have enough answers for everyone.

After couple of years of futile treatment efforts, we came to know about Dr Malpani from a friend. Knowing that he's an IVF specialist, it got us worried even more. It seemed unfathomable that it was happening to us. The mere thought of having to undergo IVF was scary. And to add to it, I hated Dr Aniruddha the first time we consulted him, he asked me to undergo the dreaded HSG :-)

We took our time heeding his advice and finally got it done. Fortunately HSG was positive, but unfortunately that did not result in any success. That was the time we took a call and decided to go for an IVF. The next question was even more concerning. Which is the best place to have an IVF, and thankfully, Dr Malpani had all the correct answers to our queries and worries. Once the treatment started, it never felt like we should worry even a bit.

Both Dr Aniruddha and Dr Anjali were more than friendly and the treatment was absolutely pain free (except the injections). We were made very comfortable by the time the actual procedure was carried out (thanks to the entire staff as well). Though I feared some some pain and discomfort after the retrieval and transfer, there was none at all. And the most encouraging part was I was not made to feel like a patient throughout the entire procedure and afterwards as well. We were encouraged to follow our daily routine which was very comforting.

And of course, the IVF resulted in pregnancy and am now currently in my second trimester. Things are going fine with me and I have all the symptoms and developments as any normal pregnancy would have. We are eagerly awaiting the due date, and know its still a long way to go. But hoping for the best!!!

Lastly, for everyone reading this, I sincerely hope that nobody should have to undergo infertility issues, but if you do, remember that there is treatment available for everything. It takes some courage to face the facts, but once you do, you could get the gift of your lifetime :-)

And certainly Dr Malpani is one of the best you could hope for. Visit him once and you would find yourself calm and relaxed inspite of everything going on in life.

Lastly, it certainly is the best place to have a baby through IVF :-)"


Natural cycle versus standard IVF

Many IVF patients are worried about the side effects of all the hormones which the doctor is pumping into their body . They are worried that these hormones could increase their risk of having health problems in the future - for example, an early menopause , or breast or ovarian cancer. They're looking for a kinder and more gentle alternative, such as natural cycle or minimal stimulation IVF.

While natural cycle IVF is a great option, we need to remember that just like any other treatment, it has advantages as well as disadvantages. Thus, for most young patients with a good ovarian response, the first choice should still be standard IVF . Not only does this have a high success rate, it helps us to get lots of eggs and therefore lots of embryos. As a result of this, we can freeze the extra embryos and then use them in future cycles . This means that even if the first fresh cycle fails, the cumulative pregnancy rate with a single egg collection is actually very high.

By contrast, in a natural IVF cycle, because we only have one egg, we will only get one embryo, as a result of which the chances of conceiving is significantly lower. While it's true that a natural cycle can be less expensive ( because we don't have to spend money on the expensive injections used for superovulation) on a per cycle basis, a standard IVF cycle can actually be far more cost effective, when you calculate the number of embryos generated per rupee spent. This means it's well worth spending the money on hormone injections for patients with good ovarian reserve.

It's also important that patients understand that the hormones which we use are natural hormones, which all get excreted promptly. They don't hang around the body , and don't have long-term risks . Neither will these deplete your ovarian reserve , because these hormones only save the eggs which would otherwise have died in any case .

Lots of patients who have failed a standard IVF cycle protocol are pretty much at their wit's end , and are looking for alternative options. Because the standard IVF treatment cycle has failed, they want to know what they can do differently to achieve success the next time around. One of the worries is that the IVF injections may affect their endometrial receptivity because of the supraphysiological high levels of hormones achieved at the time of a fresh transfer. However, when we transfer these embryos after freezing them in a natural cycle, this problem automatically goes away.

Natural cycle IVF or mini stimulation IVF is a very useful option for a selected group of patients , and shouldn't be used routinely across the board for everyone. Thus, for older patients or for patients who've had a poor ovarian response even to high doses of injections, it makes a lot more sense to use a natural cycle. This may not be very intuitive, but if the patient is growing only one or two follicles even with a high dose of injections, then why not just use the one follicle which she grows in a natural cycle ? This this will give her an equally good chance at getting pregnant, without her having to waste her money on  the injections.

As a patient,  you need to select a versatile, flexible IVF clinic, which has experience and expertise in using different protocols. This way your doctor can tailor your treatment , and select the one which is right for you, rather than use a standard " one size fits all " for everyone who comes to them. It's not that one protocol is always better or worse . The truth is that for an individual patient , one particular protocol will definitely have advantages as compared to another , and both the patient and doctor need to sit together and decide jointly what works best.

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !

Saturday, October 03, 2015

I will be giving a lecture at the International Nursing Conclave

Nursing has been called the oldest of the arts and the youngest of the professions.  Nurses are the ones who provide the care in healthcare, but they are usually underappreciated and underpaid.
While we all remember the name of our doctor, isn't it tragic that we rarely know the names of our nurses ( even though they spend much more time with us when we are in hospital !)

I will be giving at talk at International Nursing Conclave to be held in Mumbai . You can read more about this at

Over-testing after a failed IVF cycle

We find that patients after a failed IVF cycle are subjected to a lot of unnecessary, expensive tests. There are lots of reasons for this over-testing. Patients are desperately seeking answers and they want to know why the cycle failed. They put a lot of pressure on the doctor to provide these answers. The simple truth that we don't know why the embryo failed to implant , because it's not possible for us to track the biological process of implantation after the transfer . How do we figure out what happens to this microscopic living ball of cells once we put it back inside the uterus ? However, the truth is just not good enough for many patients.

This is why doctors are pressurized into ordering a battery of what appear to be very scientific and sophisticated tests , including genetic tests and immune tests , in order to keep the patient happy. Sadly, none of these tests have been clinically validated and most are unproven. However , because patients are so vulnerable and start grasping for straws, they are quite happy when the doctor orders these tests .  This is why we see so many patients who have failed an IVF cycle who do very fancy tests, such as NK Cell testing or ERA ( endometrial receptivity assay ) testing, which checks the endometrial genome. All of these have a plausible scientific basis, but are of unproven clinical value.

Part of the problem of course is that doctors love playing with new tests. They love zebras, and are quite happy to show the patient that they are not leaving any stone un-turned in their search for answers. In fact, the newer the test and the more expensive it is, the happier some doctors are to order it  ! They do this in order to impress their patients about how thorough and careful and up-to-date and modern they are.

Some patients are very impressed with this battery of tests . They believe that the more the money their doctor makes them spend on the tests, the better the doctor ! While it's true that these tests can be very expensive, a lot of patients don't mind spending this money , because they are led to believe that the results will help the doctor to tailor their next treatment cycle, and improve their chances of success.

This line of thinking  is illogical and flawed . If any of these tests were actually helpful, then wouldn't it make sense that these tests should be done for all patients when they start their first IVF cycle , rather than wait for the cycle to fail before ordering these tests?

The reality is that a lot of these tests are of unproven value, but some IVF doctors prey on their patient's emotional vulnerability and desperation for answers . They pander to their patient's emotional demands to keep them happy. After all, it's so much easier for the doctor to just order the test , and then try to " fix an abnormal result " , rather than sit down and explain to the patient why the tests are of limited value , and why there's very little point in ordering them.

After all, the one thing busy IVF specialists have a major shortage of is time. Very few will spend the time and energy to counsel patients that a failed IVF cycle doesn't mean that there's anything wrong with them ; or that the doctor overlooked a potential problem ; or that the doctor has not done a good job. A failed IVF cycle just testifies to the fact that human reproduction is surprisingly inefficient . Just because one cycle fails, doesn't mean we need to do something different in the next cycle. Often, patience and tincture of time are all that a patient needs to achieve success !

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you !


Friday, October 02, 2015

How reduced ovarian reserve reduces your fertility

Today, a larger number of women are delaying childbirth and are focusing on building their careers instead of building their families. All would be well, if they could pause their biological clocks. The sad part is that while these women are pursuing their career dreams, their ovarian reserves keep steadily depleting and when they actually do decide  to have a baby, it may sometimes be too late to get pregnant the natural way.  Since the decline in ovarian reserve is silent, their inability to have a baby when they want to have one comes as a rude shock , and can be very frustrating. Since these are successful women who are used to having their own way, they are very upset when their body doesn’t live up to their expectations – especially because they pride themselves on their health and fitness. The problem is that they get misled by the fact that their menstrual cycles are regular, because they assume that regular cycles in a healthy woman equates with normal fertility, no matter what her calendar age is. This brush with their own biological frailties can cause a lot of heartache, and they resent and regret the fact that no one bothered to educate them about the harm which the inexorable passage of time has on their ovarian reserve.

Let’s take a look at how ovarian reserve testing is done and what impact it has on treating infertility.

Number of Eggs

Every woman is born with all the eggs she will ever have, which is around 1 to 2 million. By the time she has her first menstrual period, this egg count will have diminished to 300,000- 400,000. In each cycle, more than forty follicles will start to grow , but typically, only one of these eggs is released during ovulation; the rest of them will be reabsorbed silently, and aren’t functional.

The Age Factor

In a woman, peak fertility occurs before 20 years of age , and her fertility rate ( called her fecundity) is approximately 20-25%. By age 32, this monthly rate begins to decline but by the time the woman reaches her late 30’s, there will be an even more rapid decline in this rate. By the time she reaches age 40, she will definitely  face difficulties getting pregnant and almost one in 3 women experience infertility by this age; the primary cause being poor egg quality .

As a woman ages, this decrease in her egg quality results in impaired fertilization and reduced implantation . She also has a greater chance of having a miscarriage; and there is also an increased potential of the fetus having chromosomal abnormalities.

Monitoring Ovarian Function- The Tests

When we have to measure ovarian function in our patients, there are a number of different tests that can be used including:

Day 3 blood test for FSH (follicle stimulating hormone) & estradiol levels
Transvaginal ultrasound for checking antral follicle count
The newest test is a blood test to check your AMH Level

The oldest test was checking the Day 3 FSH and estradiol level. As the woman’s egg reserves decrease, there is a rise in the blood levels of FSH. We measure both levels , as higher estradiol levels can bring down the Day-3 FSH level and this can provide false reassurance that all is well.

Checking the AMH level has the advantage that it can be done on any day of the cycle. However, like any other test, this has limitations as well, and it needs to be interpreted intelligently by an experienced infertility expert.

Adding a transvaginal ultrasound AFC has significantly added to our ability to diagnose decreased ovarian reserves.

The Egg Freezing Option

And so, even as women focus on their careers, it’s important that they focus on their fertility too. After all, when they are young, while some women feel that they may never want to have children, many do have a change of heart later in life. Today, it’s possible for women to opt for egg freezing when they are young and then use these eggs at a later stage in life, if necessary.

Need help in getting pregnant ? Please  send me your medical details by filling in the form at so that I can guide you better!

Thursday, October 01, 2015

IVF horror stories

I just received this email from a patient.

" In my  IVF treatment, on the day of embryo transfer, in the last minute, embryologist said that the embryo of your own is of grade II quality. Chances of success is less. So embryologist said that 2 embryo of your own and 2 embryo of some other couple of grade I quality will be transferred in my wife's uterus. We were afraid about this, We didn't decide in right way in last few minutes, and we agreed about this under pressure. We are very afraid. What should I do ? Please suggest if your clinic have any solution.we like that we have our own child or from my semen and donor egg."

This is the kind of treatment which makes my blood boil. This IVF clinic took undue advantage of the poor patient's emotional vulnerability and coerced them into accepting donor embryos without adequate counselling, simply in order to pump up their success rates.

Even worse, they "borrowed" another patient's embryos and "donated" them to someone else. Not only is this unethical, it's very unfair on the poor patient - and the unborn child. There is a very high risk this couple will reject the child after birth, because they were not ready to use donor embryos.

It's these kind of shady practices which give all IVF clinics a bad name !

Is your IVF doctor doing too many expensive tests ?

Diagnostic tests are a vital aspect of medical practice today, and all doctors rely on these to make the right diagnosis for their patients; this helps them embark on the appropriate medical treatment. Regardless of what the medical problem, tests are a very standard component of the workup and most doctors follow a set protocol when they are treating patients.

The Tests

It’s the same when patients come in for infertility treatment, and there are a slew of tests which some IVF doctors will order routinely to evaluate all infertile couples. These can include:

Sperm DNA fragmentation test
Chromosomal study
Antisperm antibodies
Antiovarian antibodies
TORCH tests
NK cell testing

A Matter of Unnecessary Testing

The problem occurs because different infertility clinics follow different testing protocols. There are some doctors who will by default order a battery of tests for every patient at the time of their first consultation and these tests are often steeply priced. There are a number of esoteric, exotic and expensive tests such as genetic tests , as well as some for immune function.

Most large clinics will follow this typical “one-size-fits-all” approach. This is because they have to ensure that the junior doctors at the clinic follow protocols unquestioningly. This is largely a part of their standardization technique, but isn’t really fair to the patients, because these tests are unnecessary for most and they end up wasting a lot of money.

How we go About Testing

However, certain doctors are very selective in their approach. They do order some basic tests for most of the couples who come to them; however if a certain patient has failed an IVF cycle, they will order many more. We do things a little differently at our clinic and order just 4 tests. These are to test the 4 key components required to make a baby - sperm, eggs, fallopian tubes and a uterus. The tests we order are:

Vaginal ultrasound scan
Semen analysis
Blood tests for FSH,LH,PRL,TSH and AMH
HSG ( hysterosalpingogram)

Are Fewer Tests Better?

There is a dual benefit in taking this route- The tests can be  completed within 10 days and can determine what the cause of the couple’s infertility is, at  cost of only Rs 10,000/- . Some patients who have heard that IVF clinics order reams of tests, sometimes wonder whether we are being thorough in our approach to their treatment. If they voice this, I tell them that their fears are unfounded and that a number of clinics will over-order  tests only because it translates into more money in their kitty.

The Patient’s Preference

The patient’s preferences also have to be taken into account when tests are being ordered. Some patients feel more comfortable with a thicker sheaf of test reports in their hands and feel that they are leaving no stone unturned in their treatment; in contrast , intelligent patients get upset if their doctor orders too many tests or if he insists that they repeat the tests from a lab he recommends. They recognize that the doctor is wasting their time and money. More is not always better !

Time for Patients to Wizen-Up

If you find that your doctor is ordering tests in a very random manner, it’s important that you speak up and ask why he is ordering those tests. Some tests can have side-effects and it’s crucial you know which ones are  really necessary and which ones aren’t. Excessive tests can distract the doctor and he will end up treating so called “abnormalities” instead of focusing on the infertility treatment itself.  In our clinic, we adopt a success based approach; we shine the spotlight on creating solutions that bypass problems, rather than on digging for them.

Worried that your IVF doctor is doing too many expensive and unnecessary tests? Please send me your medical details by filling in the form at so that I can guide you properly !

Wednesday, September 30, 2015

Why we are so good at treating unexplained infertility

Couples who come to us for infertility treatment want answers; in some instances this could be their first visit to an IVF clinic, while at others they may have gone to various other clinics, been unsuccessful in getting pregnant, and will have come to us. Regardless of which category they fall in, they all want answers !  The first question is the most basic one - What is causing our infertility?

I tell them very candidly that we can’t always provide them with an answer to what seems to be a simple question, even though we do have the skills and technology to treat it in the best possible way.

What makes the unexplained infertility reason so puzzling for patients is that they expect IVF specialists to have all the answers because we are the medical experts. However, now we are saying that we can’t pinpoint the problem!  Patients are understandably frustrated with this “non-diagnosis” because from their point of view, it’s a dead end. The good news is that this is not true, because even though we are not good at identifying problems , we are good at bypassing them !

The Facts

The first question to ask here is- when exactly do we say that a couple is infertile?  They are said to be infertile only if they are unable to achieve pregnancy for 1 year despite having had frequent, unprotected sex. In the case of younger couples (below 35 years), this timeframe is 6 months.
So, if you hear the term unexplained infertility, it simply means your IVF doctor has tested your fertility and your results are normal. This is actually reassuring, and you should count your blessings that your tubes are open and that the sperm test is normal. Would you be happier of your tubes had been blocked ?
Of course there is some limitation to the number of tests that current day technology allows doctors to perform. Typically, infertility is said to be unexplained if:
  • The woman is ovulating regularly
  • Her fallopian tubes are healthy & open
  • Her partner has a good sperm count and the sperm motility is good

This is the standard on which we decide whether a couple has unexplained infertility . One in ten infertile couples will be labeled with this diagnosis.

Infertility Treatments

Even though our diagnostic technology has limitations, patients are happy when they realize that our therapeutic technology is far more advanced . Even though we cannot identify the problem, we can solve it by bypassing it.

I remind patients that the question should NOT be "Why am I not getting pregnant ? " Rather, it should be - What can I do in order to get pregnant ?" After all, no one cares about problems - we only care about results - about having a baby !

The diagnosis of unexplained infertility means that the eggs and sperm are not meeting in your fallopian tubes when you are trying naturally, even though all your test results are normal.
You can read more about this at

The logical treatment option is HMG/IUI, to increase the chances of the eggs and sperm
meeting. You can read about this at

If 3 cycles of this fail, then we advise IVF ( This allows to do in the lab what is not  happening in the bedroom !

For young patients with unexplained infertility, we have such high success rates that we can offer a money back treatment option. You can read more about this at

Need help in getting pregnant ? Please send me your medical details by filling in the form at so that I can guide you!

Tuesday, September 29, 2015

When we don't have all the answers to the infertile couple's questions

Patients who come to us for IVF treatment have a lot of questions ! They want to know why their sperm is of a low quality or why the fertilization rate was so low. If their embryos were A-grade, they want to know why they didn’t implant ; or why there is no improvement in their uterine lining even after treatment.

There are a slew of questions that come our way and in most instances, we have no answers to give them and so, the only truthful answer is – “I really don’t know”.  Maybe the more appropriate answer would be- “ Medical science doesn’t know”; this is because when I tell the patient that I don’t have an answer for them, some of them doubt whether I’m competent enough and whether I am sufficiently well-informed.

Harboring Unrealistic Expectations

The truth is that patients tend to have extremely unrealistic expectations from their doctors. They want them to be the “fixers” and want the doctors to take the concern of infertility off their shoulders. Irrationally, they want a doctor who will be able to give them a 100% guarantee that he will be able to help them conceive and one who will confidently tell them that this is exactly what he will be able to do.

I would like to say here, that if a doctor categorically tells his patient this, it would be no less than a sham.  Biological systems are complex and messy and there is no concept of having all the answers. Many doctors will get their patients to run numerous tests- this is how they make a “diagnosis” and also keep their patients happy that they are actually doing something. Sure, these tests do give us some answers; but most of the results are totally pointless and irrelevant to the IVF issue.

Doctors Should Come Clean

Since these doctors don’t really have any answers, they go onto a complete tangent and treat these abnormalities, losing track of the issue on hand.  If you ask me, it’s much better to come clean with the patient and tell them that we don’t know. In the same breath, I’d like to say, that patients don’t need to go berserk when they hear their doctor say this.

After all, we aren’t researchers and don’t run a research institute; we are an IVF clinic that tries to help infertile couples have a baby. The point to keep in view here is that though we may not always know what the problem is, we have the knowledge, technical expertise and experience to craft solutions that allow us to bypass the problem, and this is really for the best.

I always tell my patients that the quality of my answers will be directly dependent on the quality of the questions they shoot at me, and if they ask pointless questions- the truthful answer from me will be- “I really don’t know”.

The Best Way to Battle Uncertainties

It’s important that patients recognize that their doctor isn’t fobbing them off with “pseudo answers”. The undeniable fact that we all have to deal with is that life is riddled with uncertainties and IVF is no different from any other fields, in this respect. The minute we learn to accept this fact, it will become significantly easier for patients as well as doctors to deal with this in a level-headed manner.

When a patient asks me a question, I sometimes deliberately say, “I don’t know the answer, let’s look it up.”  I’ll deliberately do a search for them, and go to a curated and reliable website, and we’ll read the answer together.

Doing Things Differently

This is antithetical to what I was taught at medical college and it was hammered into us that just as treating a patient is important, so is instilling confidence in them. And some doctors follow this dictate in a blindfolded manner and pretend to know everything there is to know. But as Abraham Lincoln said- “You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time”.

Some patients aren't too happy with my answer, because they don't like being treated by a doctor who doesn’t have all the answers; however more mature patients appreciate the fact that I am being honest with them.

Need more information? Please send me your medical details by filling in the form at so that I can guide you better!

Monday, September 28, 2015

Most Infertile Couples Don’t Factor In Male Factor as the Problem

One of the first things that I tell couples when they come in for a consultation is that infertility is something that either the woman or man can suffer from. Unfortunately in our country, with the male-dominated society we live in, when a couple is unable to get pregnant, hardly anyone including the woman herself think that the problem may lie with the man.

The Test

The fact is that the problem can lie as much with the man, as it can with his wife or partner. Here is the standard testing and treatment procedure we follow when we are testing a man for infertility.

We start with a semen analysis
The patient has to provide semen for testing- this may be collected in the lab or he can collect it at home, but will have to ensure that it is brought to the lab within an hour after it has been produced
This sample with then be analyzed to check whether there is sperm present in it
A sperm count will also be performed ; if this is found to be less than 15Million sperm per milliliter or semen/ if the total sperm count is less than 30-million/entire ejaculate, its considered to be a low sperm count
The technician also analyzes what the motility (movement) of the sperm is like and whether  they are of normal shape

You can see what a sperm test report should look like at

The Problems

There are different problems that can be present in isolation or it may be a combination of problems that is causing infertility, such as:

The sperm may not be  moving well - low motility
The sperm count may be low, but all of them may have good movement- low sperm count
There may be no sperm present at all – azoospermia
There may be sufficient sperm with good motility but a large percentage of the sperm may be abnormally-shaped- abnormal morphology

The semen analysis results help us ascertain which treatment options will be most suitable to the patient.

For men with a low sperm count or poor motility, IVF/ICSI is usually the best option.
For men with azoospermia ( zero sperm count), we need to use additional procedures, such as TESE.

If we don’t find any sperm after the TESA/TESE procedure, we recommend that our patients opt for donor sperm or consider adoption. Regardless of which option the patient decides to opt for, we provide complete guidance and support to the couple.

Want to confirm you do not have male factor infertility ? What's your sperm count ( million per ml) ? sperm motility ( percentage) ? grade of motility ? morphology ? Please send me your medical details by filling in the form at so that I can guide you better!


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