Friday, June 28, 2013

Why don't patients ask for their IVF medical records ?

IVF patients understand that their chances of success to a large extent depend on the competence f their doctor. This is why they go to great pains to do their homework, to try to find the best possible doctor for their treatment. This is extremely important, and it's good that patients are demanding and assertive during their search. However, during and after the IVF cycle, I am very disappointed when patients don't insist on copies of their medical records. I still find it hard to understand why this is so. It's important to have documentation - whether you're talking about your bank account or your credit card statement or your medical treatment. Now most patients will routinely expect copies of medical records when they have even a simple appendectomy - but somehow they don't seem to apply the same set of standards to their IVF treatment ! I still am not sure why this is so.

Read more at http://www.drmalpani.com/why-dont-patients-ask-their-ivf-medical-records.htm

What patients want from IVF doctors

IVF can be an emotionally taxing treatment. Not only is it very expensive, there is a lot riding on the outcome. Patients know that the success rate depends on how good the doctor is, which is why they have very high expectations from their doctor. They will spend a lot of time hunting for Dr Right - an IVF expert who is approachable and affordable; who will design their treatment plan and personalize it specifically for them; and who will be available to answer their questions.

Read more at http://www.drmalpani.com/what-patients-want-from-ivf-doctors.htm

Thursday, June 27, 2013

Endometriosis - laparoscopy or IVF

Patients with endometriosis who are infertile are often very confused. They don't know which doctor they should go to ? Gynecologist ? Infertility specialist ? and what treatment they should take. The first point of consultation is usually their gynecologist - and most gynecologists usually advise doing a laparoscopy. This is usually a knee-jerk reflex - for many reasons. The importance of making the right diagnosis has been drilled into doctors right since Day 1 of medical school - and the only way of making a definitive diagnosis of endometriosis is a laparoscopy. They also sell the patient on this procedure, by telling them that will also allow them to "treat" the endometriosis in the same operation ! 

Read more at http://www.drmalpani.com/endometriosis-laparoscopy-or-ivf.htm


Monday, June 24, 2013

If I were the CEO of an Indian pharmaceutical company

The primary job of a CEO is to maximise profits , and as a pharmaceutical company CEO , I know that the best way of doing this is to maximize the number of prescriptions of my drugs.

Since the people who write the prescriptions ( the influencers and the decision-makers ) are doctors , like any sensible CEO, I will spend a lot of my energy in convincing doctors to prescribe my drugs. This is what the Pharma industry has done for many years , using advertising and marketing and an army of medical reps in order to create relationships with doctors , so that doctors will prescribe their brands.

However , this is a broken model . For one, it's very expensive and cost ineffective. This is a very competitive field, because all pharma companies are vying with each other to occupy the same limited "top of the mind" space in the doctor's head. This means that it is no longer cost effective to continue to use this technique - and it's only because of inertia that companies continue to do so.

Second, governments worldwide are exerting regulatory pressure in order to crackdown on the doctor-pharma nexus, as this has been one of the reasons drugs have become so expensive and cause healthcare costs to spiral out of control. Since providing financial gratification to doctors has become illegal in India, this is now being done under the table , as a result of which it becomes that much harder to crack ! Sadly, many companies merrily continue using inducements ( such as funding overseas trips to medical conferences) in order to manipulate doctors . Until the Indian government makes an example of erring doctors, this is unlikely to change in the near future. The tragedy is that it is the senior , influential doctors ( who have  the most
clout ) , who are part of this nexus, and because they benefit the most from these sponsorships, it will have to be an outsider who will need to clean the system.

The good news is that principled doctors are refusing to be manipulated by Pharma companies. They are no longer willing to waste their time seeing medical representatives , so that the old fashioned route of influencing a doctor based on his relationship with the company reps is going to die a natural death.

So what is the alternative ? I still need to influence doctors, and if I refuse to do this unethically, what are my options ? The answer is simple - I would try to make the doctor’s life as productive as possible . If I can solve doctors’ pain points , they will be obliged to me, and the first principle of exerting influence is that of reciprocity. Doctors whom I can help would be much more willing to prescribe my drugs 
( assuming , of course, that their quality is good – and most drugs today have similar bioequivalence, no matter who manufactures them!)

So what are the doctor’s pain points which I can help to solve in a cost effective manner ?

One major issue is practice management . While most doctors enjoy taking care of patients , they are not very good businessman , because they do not realize that running a clinic means that they need to think of themselves as being entrepreneurs. Many do a bad job , because they do not have the requisite skills. This is a relatively easy problem to fix - it's a simple question of teaching doctors practice management strategies ! Not only would I hold workshops , I would actually provide real-life and online training for the Doctor's office staff - the receptionist , the secretaries , and their assistants, to help them become more productive and efficient. The good news is that a lot of these resources are easily available  - it’s just a question of adapting them to the needs of Indian doctors.

The second pain point which doctors have is that it is difficult for them to remain up-to-date . I would provide them with access to online resources from leading medical publishers , so that they have 24/7 access to medical textbooks and journal which they want. This is something which is likely to be heavily utilized, because doctors understand that they need to update their knowledgebase on a regular basis.

The third pain point today is that doctors need to earn many hours of continuing medical education ( or CME) in order to renew their certification and license to practice from their State Medical Council. The trouble is that the only way the Councils provide certification today is for attending medical conferences. Sadly , most conferences are not academically productive at all, because they flout the basic principles of adult pedagogy. Doctors don’t actually end up learning much – as a result of which most serious doctors are quite disillusioned with the conference business, which they rightly treat as a circus ! Even worse, conferences do not allow any way of documenting whether any learning has actually occurred or not. I would provide online CME for doctors, which would be recognized by the appropriate Medical Council . This is easy to do , since this model has been shown to work very well in the USA – the country which invented CME !  Since the Doctor can do this CME online , he will not need to travel , and this would save him a lot of time , and be much more convenient . Doctors like learning  - it’s just a question of designing engaging teaching materials for them. Even better, by ensuring that the doctor answers a quiz at the end of the CME, this would allow documentation that he has mastered the information which was presented.

The fourth pain point for doctors is medical record keeping. Most keep very poor records – and they have a hard time finding the information they need about a particular patient. This means that even though have enormous clinical experience, this is very poorly documented, so that they are not able to systematically review this – or publish it in medical journals either. This is such a waste ! Information Technology has helped to revolutionize how medical records are stored and accessed today in the USA and I would provide doctors with online electronic medical records ( EMRs) . This will help them take better care of their patients , because they would be able to accurately document and access everything they need to know about their patients. It would also help them to keep their patients happy , because I would provide a patient portal , through which patients could access all their information online !

The fifth pain point for doctors is financial. I would help them to improve their profitability, both by helping them to get more patients; and by providing them with tools to delight their patients. The best way to do this would be to provide doctors with their own personal branded websites, so they can establish an online clinic . Affluential Indian patients are all online  today - and doctors understand that they need a digital presence as well. By giving them this, not only will I be able to help them improve their patient flow, I would also allow them to keep their patients happy , by educating them online with suitable educational materials about their illness. This would help patients to have more realistic expectations of their medical treatment – and save the doctor a lot of time, as he would not have to explain the basics all over again.

By implementing these five measures , I would be able to make doctors lives more meaningful and productive . I would fund this by using the money I would save on no longer employing an ineffective army of medical representatives, most of whom have become dinosaurs in this digital age. Even though this is not my core business, I can do this on a large scale by outsourcing it cost effectively. This is likely to enhance my reputation and standing amongst doctors , which will improve the sales of my brands and the profitability of my company ! This is a disruptive innovation, and I am likely to reap a lot of benefits by being the first mover in this exciting space !




Thursday, June 20, 2013

IVF doctors who cheat

While most IVF doctors are competent and ethical , the sad truth is that not all doctors are equally good - and some doctors will actually cheat their patients. What can you do to protect yourself ?

IVF is an extremely competitive field, and in order to lure patients, some clinics with overpromise and under deliver. They do not share information with patients and are not transparent about even basic information, such as how many eggs were retrieved. Only a minority provide photographs of embryos to their patients; and as result of this shroud of secrecy, most IVF patients are completely clueless about their treatment details and they know painfully little about what is happening during their IVF treatment.

Read more at http://www.drmalpani.com/ivf-doctors-who-cheat.htm

Wednesday, June 19, 2013

Shah Rukh Khan and Gauri Khan: All your questions about IVF and surrogacy answered


Shahrukh khan babyBollywood megastar Shah Rukh Khan is all set to become a father for the third time. But before you start looking for pictures of a pregnant Gauri Khan, here is the big news – the power couple are actually having a baby via surrogacy. Ironically, it was his arch-rival Aamir Khan and his wife Kiran Rao who made headlines by declaring they were having a baby through in-vitro fertilisation or IVF which went a long way in making these topics mainstream and getting rid of the taboo attached to it. We spoke to our expert Dr Aniruddha Malpani, renowned IVF specialist, about surrogacy and what it means.

http://health.india.com/diseases-conditions/shah-rukh-khan-and-gauri-khan-all-your-questions-about-ivf-and-surrogacy-answered/

Tuesday, June 18, 2013

IVF Promises a Bundle of Joy

Instead of wasting time with ineffective procedures that score low on success rate, many patients are opting to go for IVF, to maximise their chance of living their dream of healthy baby
“Technological innovations which simplify IVF and make it less expensive are going to be very important”

In the past, In-Vitro Fertilisation (IVF) was often the method of last resort for infertile couples. There were very few clinics which had the equipment and expertise to offer this advanced technology; the success rate was poor; and there were many myths and misconceptions about what was involved in the treatment. After recent spectacular advances in reproductive technology, IVF has now become the treatment of first choice for solving many infertility problems, because of its high success rates. There are now large number of IVF clinics, which means that this treatment is easily available.

http://ehealth.eletsonline.com/2013/06/ivf-promises-a-bundle-of-joy/

Monday, June 17, 2013

Doctor why did I miscarry ?

Miscarriage is always an emotionally painful event. When you are looking forward to having a baby, they losing the pregnancy can break your heart. It's much worse for infertile patients ! After all that waiting, when you finally get a positive pregnancy test, you are over the moon and start looking forward to holding your baby. However, if you then end up miscarrying, this is extremely cruel, because when someone gives you something and then snatches it away, it's much harder to cope with the pain and heartache.

Sometimes patients are confused as to what actually constitutes a miscarriage. A lot of them think that once a pregnancy test is positive ( when the hCG blood level is more than 10, this means that they are pregnant ; and that if this level drops, they have had a miscarriage. This is not true a positive.

Read more at http://www.drmalpani.com/doctor-why-did-i-miscarry.htm

Why do IVF patients feel the doctor cheated them when an IVF cycle fails

When the cycle fails, IVF patients are understandably upset and angry and they need to vent their frustrations on someone. There are only 4 possible targets. They can get angry with themselves and curse their fate; they can curse God, for not giving them a baby; they can blame their spouse, for not supporting them ( for example, by not agreeing to do IVF when she was younger and had a higher chance of success) ; and, finally, they can get upset with their doctor. The doctor is an easy target and there are many reasons why patients will feel angry and cheated when an IVF cycle fails. Some of this has to do with the patient, and some has to do with the doctor .

Thus, when doctors sign patients up for IVF treatment, they are often overoptimistic because they are in "sell" mode. They promise the earth and the moon and talk glibly about their high success rates and how good their facilities are.

Read more at http://www.drmalpani.com/ivf-patients-feel-the-doctor-cheated-them-when-ivf-cycle-fails.htm

What to do if you and your spouse disagree about treatment options!

When tackling infertility, you will be flooded with a variety of treatment options. The field of ART is vast, and depending on the nature of your problem , the treatment choices can vary all the way from simple ovulation induction with clomiphene to IVF and surrogacy.

With the advances in the field of ART, there is a solution for almost any kind of infertility problem you face, but being open to different treatment options is not easy for everybody. Not everyone is comfortable in subjecting themselves or their spouse to treatments which are not agreeable to them physically or mentally. Financial conditions, social, cultural and religious limitations and fear of medical procedures all play a major role in deciding whether to pursue a particular infertility treatment or not.


Infertility is more of an emotional ailment than a physical one ! The unquenchable desire for a baby combined with social and peer pressure are the most important driving forces which compel couples to undergo different infertility treatments. As long as both partners' couples are on the same page regarding pursuing a particular fertility treatment option, everything is well and fine. But what happens when they do not see eye to eye about their options ? What happens when one of the partner wants to put an end to the infertility treatment and move on with life, while the other person could not imagine a life without a baby ?

Read more at http://www.drmalpani.com/you-and-your-spouse-disagree-about-treatment-options.htm

Why don't Indian patients ask their doctors questions ?



During the consultation, I encourage my patients to ask me questions . However , I often find that some of them are quite reluctant to do so , and I think this is for two reasons - one which has to do with patients; and the second which has to do with doctors . 

Because most doctors don’t encourage questions, patients are not used to being told by the doctor to ask them questions ! This is why when I tell them to ask questions , they find this little bit startling and unusual and they are not sure how to respond . In a perfect world, doctors would  routinely encourage patients to ask queries, so they could clarify their doubts . However, because doctors are so busy , this often becomes a counsel of perfection which is relegated to textbooks. In the real world, it’s hard for most doctors to do this, as a result of which patients usually bottle up their doubts and queries. However, when things go wrong, this can cause a lot of long-term dissatisfaction , because of unrealistic expectations. This is what leads to complaints from patients , and this is often why patients feel cheated because they feel that the doctor did he not give them all the information which they needed. 

The second issue has to do with patients themselves . Patients have been brought up in a culture where they put doctors on a pedestal. They feel doctors know everything, and can be trusted to provide them with the right guidance . They are not used to doing their homework or finding out information for themselves ; or attempting to clarify details about the doctor’s explanations, even when this goes over their heads. 

Because patients aren't used to doing this , when they encounter a doctor who asks them to ask questions , they are not sure how to respond. The good news is that on the second visit , patients are far better prepared ! Not only do their homework, they come with a list of questions - most of which they have been able to answer for themselves. But if there are some complicated ones they are not certain about,  I'm quite happy to clear their doubts during the consultation !

Friday, June 14, 2013

Which is the best medicine for increasing a low sperm count.. ?

One of the commonest requests I get is - Doctor , I have a low sperm count . Which is the best medicine to boost this ?

They try to manipulate their diet and their lifestyle , with the hope that something will work. Popular interventions include:
Cold water showers
Boxer shorts
Sexual abstinence
Lots of almonds ... it's a long list !

There are lots of myths and misconceptions about low sperm counts . Let's try to dispel these one by one.

Firstly, lots of men think they have a low sperm count , when in fact they don't ! This is because labs are extremely unreliable - and there are still many labs which report normal sperm counts as being more than 60 million per ml ! This means that a man who has a sperm count of 30,000,000 per ml ( which is completely normal) starts thinking that he's infertile because of a low sperm count ! infantile. However, the WHO has defined a normal sperm count as being more than 15,000,000 per ml - and if your count is more than this, and if your motility is normal, this means your semen analysis report is normal and you do not need any treatment at all ! Not only is this something lots of men don't understand , many gynecologists are also still not aware that normal ranges for sperm counts have changed so dramatically over the last few years, as our understanding about sperm physiology has improved . This means that a lot of men who seem to have a low sperm count actually have a completely normal sperm count and don't need treatment at all !

Read more at http://www.drmalpani.com/best-medicine-for-increasing-low-sperm-count.htm

Thursday, June 13, 2013

I am an embryologist and I love my job !

Dr. Saiprasad Gundeti, Chief Embryologist, MALPANI INFERTILITY CLINIC PVT. LTD.

I am a Clinical Embryologist and I love my job. Every day, I get to help infertile patients and guide them through the challenging process of IVF, so they can hold their deeply cherished babies. I love using my science background and my spatial skills in performing what is a very demanding and technically exacting hands-on job.

What I do is an essential part of providing IVF services to infertile couples. As part of a multi-disciplinary team, I am involved in collecting the eggs, preparing sperm, checking fertilisation ,growing the embryos, transferring them; as well as freezing and storing them. The services I provide are directly linked to the success of IVF procedures - and how well I do them will determine the success rate of the clinic.
I am privileged, because I have the opportunity to see the joy in patient's eyes, when they see their embryos for themselves ! I also have provide patients with a shoulder to cry on ( for example, when their eggs fail to fertilise) - and I have a ringside view to the entire gamut of human emotions - joy, despair, hope and sorrow - and all this in a single day !

Read more at http://www.drmalpani.com/why-i-love-my-job.htm

Surgery for the future - enhancing function !


Typically surgery , has always been about correcting anatomical problems. If you broke a bone , the doctor joined it for you; if you had a tumour, he cut it out; and if you had an abscess , he drained it. In the future , surgery will become much more exciting , because rather than focus on fixing problems, clever surgeons and biomedical scientists will create procedures which will enhance function in normal people.

Thus, for example , functional neurosurgery will allow normal people to improve their memory while phonic surgery on the vocal cords will allow people who have a good voice to make it even better because of surgical intervention. This is a very tempting concept , because people prefer shortcuts and even though everyone understands that it's possible to improve your memory by studying harder; and that you can improve your voice by taking speech classes and practicing , this is not something which most people are willing to do because they don’t want to invest so much effort . If the surgeon can offer a safe and convenient shortcut which works , lots of people will be willing to pay for this.

There’s lots of money in this approach – and in one sense, this is a natural evolution. For example , when pharmaceuticals were first discovered , they were used to treat the sick. If someone had malaria , you treated them with antimalarials . Now, however, we use pharmaceuticals in order to enhance lifestyle quality , so we use drugs to improve people’s sexual performance or to make them happier.

In the past , psychiatrists would only concentrate on people with mental illnesses such as schizophrenia. Today, they're working on what they can do to make people happier ! The focus is moving from treating illness to enhancing health

We can learn a lot from plastic surgeons . Their original focus was on fixing surgically correctable lesions such as cleft lip and burns. Today, most plastic surgery is aesthetic, and is done on people who are normal but want to look better, which is why they are willing to subject themselves to the surgeon’s knife.

This is quite a logical progression. Thus, rather than merely replace worn out joints, orthopedic surgeons will develop procedures to enhance joint function - for example , by inventing procedures which improve the way tendons work , using carbon implants .

This makes a lot of sense for medical devise manufacturers as well because they can now address the need of a much larger population of possible customers !  This is an exciting time to be a surgeon !




Wednesday, June 12, 2013

Are patients stupid ?

Sometimes doctors get very upset by how poorly informed their patients are . They find it very frustrating when patients know so little about their medical problems ; and they feel that the time they have to spend on explaining the basics of human anatomy and physiology to their patients could be better used making the right diagnosis or doing treatment procedures. They believe that every patient should have enough background knowledge about their own body – and cannot understand why patients are not willing to take the time and trouble to learn more about their most precious possession – their own body. The general perception amongst doctors is that patients are stupid and are not capable of understanding the basics; or that they are lazy and are not interested in finding out more. I think both of these are flawed perceptions.

The truth is that patients do want to know more about their illness and its treatment, but some of these topics and concepts can be fairly complicated , and it takes time for them to understand what's happening.

The right approach should be that it's not patients who are stupid or lazy but it's much more likely that it's doctors who are lazy , because they will not take the time and trouble to explain to patients in simple terms which they can understand. After all communication is always a two-way street and if the patient cannot understand what the doctor is saying, this means the doctor is not doing a good job in explaining to the patient.

This doesn’t mean that doctors are  stupid – it just means that they are shortsighted and are not willing to look at things from the patient's perspective . They tend to jump to conclusions which are incorrect , and blame the patient for something which is actually a shortcoming on their part.  Some doctors take perverse pleasure in making simple concepts complicated, because they want to show to their patient how erudite they are. Some doctors deliberately use this as a tool to put patients in their place, to awe their patients with the polysyllabic jargon which they throw at them .

I always tell patients that if you can't understand something which your  doctor tells you, it’s not your fault – it’s your doctors, because this just means he does not know how to simplify and communicate !
Good doctors will take the time and trouble to teach their patients and ensure they understand – and the best doctors will create educational materials which patients will be able to comprehend , no matter how limited their current state of knowledge maybe.

After all, this is education is all about – taking the student from where they are presently, to where you want them to be. The good news is there are now lots of online resources which help patients to make sense of what's happening to them , so they no longer have to depend upon their doctor to teach them. Smart doctors are now “ prescribing “ this information to their patients, to create win-win situations, so that patients have realistic expectations of their treatment.

Decoding Medical Gobbledygook now available for the Kindle

Tuesday, June 11, 2013

Is bed rest after embryo transfer necessary ?

Will moving after an embryo transfer cause my embryos to get dislodged from the uterus ? Does being physically active affect the ability of my embryos to implant ? Every woman undergoing the 2ww is very worried about carrying on with her routine daily activities, because of her fear that these will affect the outcome of her IVF cycle. To add insult to injury, many IVF specialists also ask women to take bed-rest after embryo transfer ! Does restricting normal activities make any sense ? Will bed-rest really help ? There are many scientific publications which address this issue.

These confirm that normal activity after embryo transfer has no adverse effect on embryo implantation. There is no difference in the IVF outcome, if a woman restricts herself to bed; or if she carries on normal activities after embryo transfer. Recent research in fact suggests that strict bed rest after embryo transfer might actually reduce the chances of conception ! Please carry on with your routine activities , but do not do anything which will cause you to blame yourself if your cycle fails.

Read more at http://www.drmalpani.com/is-bed-rest-after-embryo-transfer-necessary.htm

Monday, June 10, 2013

What every patient needs to know about the IVF lab

Saiprasad Gundeti
Senior Embryologist, Malpani Infertility Clinic

The IVF lab is the heart of an IVF clinic because this is where we grow and safeguard your precious embryos. The IVF lab equipment and the skills of embryologist play a very crucial role in IVF treatment, but most IVF patients are clueless about what happens in the lab. Let me take you behind the scenes, so you can get a peek as to what the embryologist does in the IVF lab.

Why should you bother ? Not only is it very important for IVF patients to do their research, so they can understand which of the many modern assisted reproductive technologies available today are best for them - they also need to select the best IVF clinic to maximise their chances of success ! The clinic can be only as good as the lab is - so in order to judge the competence of the lab, you need to do some homework for yourself !

Read more at http://www.drmalpani.com/every-patient-needs-to-know-about-the-ivf-lab.htm

Pregnancy in a man with Globozoospermia

Saiprasad Gundeti, Senior Embryologist

Here's a case study of a very challenging patient we treated recently. This man was diagnosed with globozoospermia with normal sperm count and motility.

Repeated semen analyses showed 100 % sperms with absent acrosome.


ROUND HEAD SPERM (GLOBOZOOSPERMIC SPERM)


He had had an earlier ICSI treatment cycle in another clinic which had failed. Unfortunately, no treatment details were available, as the medical details of the treatment performed had not been well documented.

The principal cause of fertilization failure after human ICSI ( in a good lab) is a deficiency in the oocyte activation mechanism. Oocyte activation typically occurs immediately following sperm-oocyte fusion and the master key to initiate these changes in fertilized oocytes is a calcium influx into the oocyte. The sperm factor phospholipase C zeta (PLCz) ,which is normally found in the acrosome, is considered to be the agent responsible for these calcium oscillations. If this is absent ( as in men with globozoospermia), then assisted oocyte activation needs to achieved by alternative means, such as by using a calcium ionophore ( as described below).

Read more at http://www.drmalpani.com/globozoospermia.htm

What makes an embryologist Grade A

http://1.bp.blogspot.com/-66qRdSGdEkA/UZfCJMfXdkI/AAAAAAAABvU/Q4Two3uw-lw/s320/embryologist+in+lab.png

This is a guest post by Dr. Saiprasad Gundeti, Chief Embryologist, Malpani Infertility Clinic Pvt. Ltd.

Embryos are graded in the IVF lab routinely, according to their appearance ( morphology) under the microscope. Good embryos are called Grade A embryos, and have a higher chance of becoming babies.
The scientists who are responsible for taking care of your embryos in the IVF lab are called clinical embryologists . We are involved in fertility treatment and reproductive research and need a practical and theoretical understanding of human reproductive biology, embryology, infertility and assisted reproductive technology (ART). We also need to keep up to date with current regulations and legislation involving these subjects. Just like you have Grade A embryos and Grade B embryos, you have good embryologists - and bad ones. Unfortunately, patients don't know much about what happens in the IVF lab and what embryologists do, so this article will shed some light on the role we play in your treatment !

Read more at http://www.drmalpani.com/what-makes-an-embryologist-grade-a.htm

HCG levels after IVF

Can the level of HCG in blood tell me whether my pregnancy is a healthy one or not?

Yes - but only to a certain extent. The HCG (human chorionic gonadotropin) hormone is a remarkable molecule which is very unusual because it is produced only by the cells that will become the placenta of the developing embryo (trophoblast cells). Once the embryo implants in the uterine lining, these cells start producing HCG. It takes a few days for the HCG hormone to build up in the body to a level, which is high enough for it be detected in the blood or urine of pregnant women. Normally, you do your first pregnancy test (HCG blood test) 14 days after embryo transfer.

At this point, if the embryo has implanted, you will also get a positive urine pregnancy test. The HCG hormone level in the blood doubles every 48-72 h. If the HCG level doubles well, this indicates that the cells of the embryo are dividing well, suggesting that the pregnancy is progressing normally and is healthy. This is why monitoring the HCG blood levels during the first few weeks helps to make sure that the pregnancy is advancing as expected. A drop in HCG level during this time is a sign that the pregnancy is not healthy. Make sure that you measure your HCG level in the same lab each time to avoid discrepancy in the results.

Read more at http://www.drmalpani.com/hcg-levels-after-ivf.htm

The 2 week wait and IVF

Will my symptoms during the 2ww tell me whether I am pregnant or not ?

During the 2ww ( 2 week wait, from embryo transfer to the pregnancy test) it is very natural to wonder about the fate of the embryos which are transferred to the uterus. Every woman who has had an embryo transfer longs to know the outcome of her IVF cycle. Every minute of the 2ww lasts an hour - and the 2ww is the longest wait for any woman who has undergone IVF.

When going through the 2ww, women become aware of even the slightest change that happens to their body. " I am feeling warmer than usual; I have a tingling feeling in my breast; my nipples are sore; I could sense a muscle being pulled in my pelvic region; I have a strange vaginal discharge; I urinate frequently; I feel nauseous - does this mean I am pregnant ?" This is the question that lingers in the mind of every woman - whether they explicitly acknowledge it or not . This can be made worse by a worried spouse who solicitously asks every day - How are you feeling ? Many women constantly surf the web to read about the 2ww symptoms of women who got pregnant after an embryo transfer. Although this can make the 2ww interesting , and can help some women to cope with it, many women start to panic too when they do not experience any symptoms . Others start imagining that they are pregnant of if they have any of the about symptoms. Are there really any symptoms which could tell you whether you are pregnant or not , before taking a pregnancy test ?

Read more at http://www.drmalpani.com/the-2-ww-and-ivf.htm 

Sunday, June 09, 2013

HELP gets the Health Literacy Hero award !

The Health Literacy Hero for June 2013 is HELP (Health Education Library for People) based in Mumbai, India. Founded as a modest-sized patient education resource center in 1997 by Drs. Aniruddha and Anjali Malpani, HELP is now India’s largest patient education center--housing thousands of books, pamphlets, health care magazines, and audiovisuals on all aspects of health and disease. HELP offers free public seminars in Mumbai nearly every day. HELP also provides an online resource center where users worldwide can ask health questions and search its vast medical knowledge base. Anjoo Chandiramani and her staff of librarians maintain the HELP collection. Here’s the link, http://www.healthlibrary.com

We are very proud that our efforts are being recognised globally !
 

Friday, June 07, 2013

Embryo transfer - mechanics versus biology


http://2.bp.blogspot.com/-8Jx2ZNM0tMs/UZfB9Gtg-xI/AAAAAAAABvM/bB8gQ01QPyk/s320/embryotransferprocedure.JPG

Patients have lots of doubts and misunderstandings about the embryo transfer procedure and I'll try to dispel some of these.

We need to understand there are 2 separate components to embryo transfers. One is the mechanical procedure of physically putting the embryos back inside the uterine cavity through the cervix , using an embryo transfer catheter . The mechanics of an embryo transfer procedure are fairly easy and straightforward . It usually just takes a few minutes to transfer the embryos , and this is something which is performed routinely in IVF clinics all the time . A good IVF doctor is skillful. He transfers the embryos gently , and because he's patient , he ensures that little damage is caused either to the embryos or to the uterus. When doing this procedure , he need to be gentle and deliberate. Interestingly, even though it seems to be very simple straightforward procedure , there is a marked difference in the pregnancy rates amongst doctors who do the transfers . There are some doctors whose success rates are nearly 3 times as high as others , even though they work in the same clinic, and seem to be performing exactly the same procedure . We still do not understand why there is such a marked difference, but this is why it's a good idea to find a highly experienced doctor ! Doctors have tried improving the results of embryo transfer by doing the transfers under ultrasound guidance , so the doctor knows exactly where he is depositing the embryos, but whether this actually helps in experienced hands is still controversial .

Read more at http://www.drmalpani.com/embryo-transfer-mechanics-versus-biology.htm

Thursday, June 06, 2013

Why pharma companies need to engage directly with patients

" As a Customer Engagement Manager covering the Nordic region for Janssen Pharmaceuticals , Petteri Jarkka deals with multiple customers including the patient, payer and physician, in a role which combines marketing and patient engagement elements. As he explains, “this is a fairly new role which reflects a new direction for Janssen. Yet it also has something to do with the situation in the Nordic market, a very mature market with limited access to the physician. We’re averaging less calls than we used to, everyone is, even with Medical Representatives so clearly there is a greater need for customer-facing access and the use of multiple channels. I think we will see the same things happening more and more in other European countries as those markets mature.”

Pharma companies in mature markets like Europe understand the value of "co-creating" with their doctors and patients. Hopefully, mature pharma companies in immature markets like India will see the value in doing this as well !

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