Friday, January 31, 2014

IVF and Adoption: Complementary or Competitive?

Infertile couples resort to IVF as their last option. They have exhausted every resource while trying to conceive and do not have many other options left. They put all their hopes on this last resort and can be very stressed out about the outcome of the procedure.

The word ’adoption’ is often taboo for some infertile couples. They feel that if the doctor is talking about adoption, this means he does not have any hopes for IVF success. They become irritated, feeling that that the doctor is insensitive about their feelings. They fail to look at adoption with an open frame of mind. Adoption is looked upon as a forcibly administered bitter medicine. These infertile couples think that exploring adoption means they have failed .

This mindset of downgrading one option as compared to the other is wrong. Adoption is a non-medical option to have a baby in your life while in vitro fertilization does the same thing medically. No option is better than the other. It is essential to judge them in an unbiased manner to choose the method most suitable for you. If you explore the adoption method before you go in for your next IVF cycle, you will be able to undergo the treatment with much more peace of mind because you now have a Plan B to fall back on. The reduction in stress levels may actually help the process of IVF.

Exploring adoption before in vitro fertilization has other benefits as well . You may realize that adoption suits you better than IVF. Most of the patients coming for IVF have been through many investigations and treatment procedures. They have consulted many doctors and are tired of visiting clinics. In such cases adoption can help them realize their dream of having a baby. In other cases , the couple may find that adoption is not very suitable for them. Thus they can put in all their efforts in trying for IVF success.

We need to understand that IVF and adoption are not competitive methods. IVF specialists, adoption counselors and social workers can help to brief you about adoption. If you are fortunate and get pregnant in your IVF treatment, the adoption agency would happily cancel you name from the waiting list and make the option open for other infertile couples.

IVF and adoption are mutually supportive options for infertile couples, so it is important that you explore both of them with an open mind. Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !





Thursday, January 30, 2014

Managing the Two Week Wait ( 2ww)

During your IVF treatment cycle, once your embryos have been transferred back to the uterus, there is a 2 week waiting period before you can find out if you are pregnant or not . This wait can create havoc in your life. There is a a huge amount of advice and tips about what to do or not do during this period. You are anxious not to do anything which could harm your precious embryos in any way. Your stress levels are sky-high because you want to ensure that everything is perfect , so your embryos can implant successfully.  Your major fear is that you will do something bad which will cause them to get dislodged or rejected !

Someone might suggest a particular diet during this period , while others might have a completely opposite opinion. It is said that having foods like papaya can increase the body’s internal temperature,  which in turn may harm the embryo. There are contrasting opinions about many daily habits like taking a hot bath, riding a two wheeler, taking pain killers and lifting weights. You are likely to be overwhelmed by the quantity of conflicting advice that you get every day. This can exacerbate your stress levels or make you even more over cautious or excessively emotional.

This waiting period can harm your emotional balance. It is normal to be protective towards your embryos but it is inappropriate to be obsessed every moment about the IVF treatment outcome. The fact is that nothing you eat, drink or do will harm the embryo. You can lead a normal daily life even after the embryo transfer . No activity can be harmful to the embryo which is safe and snug and secure in your uterus . Leading a normal life may actually help you tackle the stress better.  Your mind would be occupied in regular work rather than obsessing about the result – over which you have no control in any case.

It is important to understand that IVF is not an artificial pregnancy technique. It just provides assistance for patients who are unable to conceive in the natural way. Fertile women who conceive naturally may not even know that they are pregnant until they miss their period, so they never worry about the 2 ww – so why should you ? . In the same manner, after the embryo transfer , the biological processes of your body continue working perfectly . They will work efficiently on their own and are not by external habits or actions.

Need help in coping with the 2 ww ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm,  so that I can guide you better !




Wednesday, January 29, 2014

An Uncommon IVF Success Story for a Couple from Bangalore

" On Dr Malpani's website, you may have seen a lot of Success Stories of many Infertile couples, every story is unique,  having it's own feeling, full of emotions and happiness at the end.

But Our story is entirely different from everyone here. We are thankful from our deep Heart for Dr. Aniruddha & Dr. Anjali Malpani and embryologist Mr. Sai (who plays a key role in the Lab), and their caring staff. Dr.Malpani's are not less than God for us!

I'll try to explain in very Brief:

I was in my engg. final year, it was Jan 2008, a tragic bad day for me when I got infected with HIV virus accidentally. My life became a disaster after that incident. I'll not go into details of that tragedy .

I was in deep love with a beautiful girl, and I told her everything clearly . That it was better for her to leave me in my condition as she has a bright future in front of her, and I am infected with dangerous HIV virus. It was was a disaster news for her, but she told she can not think of her life without me, and we were married in May 2009.

Now our biggest worry was I am HIV+ and she is negative, this is called scerodiscordant couples, though we both were fertile couples. I can not take a risk of infecting her, she is everything for me in my life, so how we will get child, as our life was very empty.

I came to know about Dr. Malpani's through internet, web reviews, in 2012 and found that he seems top be probably only Doctor in India who can help us to have a baby by Sperm Washing Technique + ICSI(using a to remove HIV virus from sperm).

We went to them in 2012 July-August, and that cycle unfortunately failed due to low quality of eggs retrieved, but we were very happy by treatment, care and the way they put all their effort to do their best.
Due to that strong belief we visited again in 2013 Nov end. They studied our case and entirely changed the treatment plan (Injection dosage, type etc.) for her, and finally we got 12 mature eggs, 7 embryos, and Dr. Malpani transferred  4  A grade embryos to her.

When we went for Beta HCG test on 26th Dec 13...Wowww...our eyes were full of tears of Joy, it was a miracle for us, technology has given us our own pregnancy. All thanks to great efforts of Dr. Malpani's, it was a tremendous new year 2014 for us.

Today on 25th Jan 2014 she is almost 8 weeks pregnant, that too we have seen twins in scan...woww....a happiness over happiness. Dr Malpani always answers questions regrding, medicine , scan etc.

I advise couples like us who are looking to have a baby to visit Dr. Malpani,  as we know it is a dream come true to us in our empty, struggleful life.  Hope many peoples like us will find it helpful.

We are looking forward to give good news by September 2014 :)"


Mr and Mrs Mishra





Tuesday, January 28, 2014

IVF overtesting - what IVF patients need to know to protect themselves !



I see lots of infertile couples who had lots of expensive, painful (and unnecessary ! ) tests performed. When they go to an IVF clinic, the doctor gives them a long list of tests which they have to do. This is a checklist – which is followed mindlessly for all patients, because this is the clinic protocol/ policy ! Most of these tests provide very little useful clinic information , and when I ask patients why they did the tests, the standard answer is – Because my doctor ( or more typically, his assistant) told me to do so .

When I tell them that this is not a good answer and that they need to be better informed about their medical tests and treatments, they look at me with a blank, uncomprehending stare. Isn’t the doctor the expert ? Aren’t patients supposed to do whatever the doctor tells them to ? How can I challenge his authority ? Won’t he get angry and upset if I ask questions ? After all, doesn't he know far more than what I do ? Does it make any sense that I cross-examine him ? Won’t he do what’s right for me ? Isn’t he my doctor after all ?

In a perfect world , patients would really not need to ask any questions at all, and they could just blindly do whatever their doctor told them to. However, the bitter truth is that life is complex , and not all doctors have the patient’s best interests at heart. They will often order tests which have not proven their value, because they are additional extraneous commercial considerations which come into play in real life.

While we may bemoan this  sad state of affairs, we need to accept this reality , and patients need to think about what they can do to protect themselves from overtesting and overtreatment . The most important question every patient should ask when the doctor  orders a test is simple - How will test result change my treatment ? Often, doctors just provide a blanket ( and meaningless) justification for their test panels, by saying – This will help us to find out what the problem is. While this maybe a logical answer, on deeper thought, it makes little sense. Unless that additional information translates into a better clinical outcome for you, the doctor is not justified in ordering the test. After all, the purpose of an IVF treatment cycle is to achieve a pregnancy m and not to get more information .

There is a laundry list of tests which IVF clinics routinely order – and in the USA, these tests are usually at least twice as long ( and four times more expensive !) as compared to IVF clinics in other parts of the world – many of which have a much better pregnancy rate as compared to the US clinics. More does not mean better, but patients are often fooled into thinking that a doctor who orders lots of tests is much more thorough , analytical and detail oriented ! A list of tests which are “routinely” done for all patients should actually raise a red flag. Ideally, testing should be tailored to your particular needs .

The other question you need to ask is equally important - is it possible to get this information by doing noninvasive , less-expensive tests ? Thus, it is important to evaluate the uterine cavity prior to doing IVF. This is why a lot of doctors do hysteroscopy routinely for all their IVF patients. While it's true that hysteroscopy provides valuable information about whether the cavity is normal or not, it's also true that the vast majority of pre-IVF routine hysteroscopy surgery reveals a completely normal uterus. This means that the patient has been subjected to an unnecessary surgical procedure . The doctor could have found out the cavity is normal simply by doing a vaginal ultrasound scan – and this is often more useful, because it lets us check if the endometrium grows well and is functioning properly.

While hysteroscopy maybe a “minor” procedure, it’s still not justifiable to subject all IVF patients to this. It should be reserved only for the small minority of patients who have an abnormality on their vaginal ultrasound scan results. Unfortunately, it takes time and trouble to tailor treatment protocols and individualise these, which is why most clinics prefer following a one-size fits all policy, because it improves their efficiency – and their profitability !

Patients should not be afraid to speak up ! Sadly , many doctors feel threatened by well-informed patients. They try to intimidate them and “ put them in their place “ when they ask for more information. Patients may have spent hours scouring the internet doing their research, but some doctors will just throw out their precious printouts without even glancing at them, by calling them rubbish. To add insult to injury, some will even actively discourage the patient from trying to become better informed. They say cruel things like – “ You IT professionals think you are very smart. You will never get pregnant because you waste so many hours doing “ online research”. This just adds to your stress levels. You would be much better off if you just left everything upto experts like me ! IVF success rates are much better for the illiterate villagers who trust us 100% ! ”

If your doctor refuses to answer your questions, this should be a considered to be a red flag. A good doctor will treat his patient as a partner, and will try to empower them with Information Therapy, so they have realistic expectations of their IVF treatment. They know that working together with the patient maximises  the chances of IVF success !


Need to find an IVF doctor who is happy to talk to you ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Monday, January 27, 2014

What I hate most about being infertile


Infertility causes a lot of heartbreak , sorrow and unhappiness.

This is what one of my patients had to say about being infertile.

" I hate the fact that I can't have a baby to cradle in my arms. This loss is like a death – the death of my dreams and hopes.  I grieve over this void , which will always leave a sense of emptiness in my life . But I know I can deal with this heartbreak . I have dealt with disappointments in life before, and I can find the strength and emotional resilience to go through with this.

I hate having to see my mom grieve over the fact that she can't have a grandchild . I feel inadequate that I haven't been able to give her what she so deeply desires. I can deal with this, because I know I have given her lots of joy as well. I know that she loves me, and she just wants to see happy . Her unhappiness is a result of my unhappiness , and it’s very comforting to know she is always ready to be a bedrock of strength and support when I need her. She cares for me , and she is my strength .

I hate seeing my husband sorrow , because he doesn't have a child to play with – someone whom he can toss high in the air – or teach how to play cricket or tennis. This breaks my heart , especially when I see him looking wistfully at other dads playing with their kids – and when I see how much his nephews and nieces love him, because he is  so patient with them.  I can deal with this heartbreak as well, because I know he loves me , and he didn't marry me just for the sake of my uterus. He married me because we love each other. We complement each other, and our marriage is stable. I know this painful infertility journey has exacted a toll, but it has also helped to make our marriage even stronger .
I hate it when my friends and family members say cruel and unkind things like - Why don't you just
adopt ? or Why don’t you do IVF ? They do not realize how difficult , taxing, emotionally draining and expensive infertility treatment can be – and that the results are always uncertain. I can forgive them as well , because I remember Jesus’s last words on the cross – Lord, forgive them for they know not what they do.

The thing I find hardest to bear,– and what I hate the most , is the pity I see in other people’s eyes when they say – Poor thing – She doesn’t have any children. This is the last straw , because I am far more than just a woman who is unable to have a child ! I am a smart, intelligent, productive citizen who has a brain and who looks after her family. I wish people would realize this , and understand that just because I cannot have a child does not make me less of a woman . I do not need their pity , and wish they would keep it to themselves – I have enough strength to fight and win my own battles ! "

Fed up of being infertile ? Need help in creating an IVF success story ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Sunday, January 26, 2014

Why I do not agree with Prof Michael Sandel


I enjoyed listening to Prof Michael Sandel on his recent trip to India. He is very articulate, so it's easy to see why he is a philosophy rockstar ! He made an important point – that society needs to set limits to what markets are allowed to do.

While it’s true that markets can fail us, I did not agree with this conclusions

When talking about kidney donation, he felt that markets were bad because of the coercive element which is implicit in their functioning.  Thus, very poor  people can be easily exploited by the rich, because they are compelled to donate their kidneys for financial reasons. This is why he suggested that markets should be banned for kidney donation and we should continue to depend upon altruism.

While it can be comforting to take the moral high ground, my worry is that as a result of his advise, we will end up causing even more harm to the poor. By making payments for kidney donation illegal, aren’t we coercing people into not donating their kidneys, even though they may want to. If a person decides that money is worth more to him than his kidney, by preventing him from doing so, isn’t the State also being coercive ? Is it fair to encroach on a person’s autonomy just because he is poor ? His  message is that the poor need protection, which is why we need to pass laws , but doesn’t this also imply that they are too stupid to be able to defend themselves . Is it fair to prevent them from making decisions which they feel are in their best interests ?

He also bemoaned the fact that the rich can now buy skyboxes to watch baseball games, and waxed eloquent about the "good old days" when everyone had to sit on uncomfortable seats in the stands, thus levelling the rich and the poor.

However, rather than think of this as worsening the divide between the rich and the poor, the skyboxes could also be seen as providing aspirational goals for the poor, who will then be willing to work hard and persevere in order to get sky boxes of their own ! Surely this is more desirable than forcing everyone to sit in bleachers !


How and why pharma needs to prescribe information therapy




Thursday, January 23, 2014

Why I enjoy teaching IVF patients


When doing an IVF cycle for my patients, I often ask them to point out their follicles during the ultrasound scans; or to tell me which of their embryos is of the best quality when we show them these in the IVF lab. Many  patients are quite taken aback when I ask them these questions. The knee jerk response is – How do I know ? I am not a doctor ! ( And I am sure some of them must be secretly worrying about my medical competence -  this doctor must be very confused if he needs to ask us for our opinion !)

I tell patients that I am not trying to make them IVF experts. I ask them these questions to try to engage them in their treatment. This way, they know exactly what's happening to them . Because they know I am going to question them, they do their homework and this make it much easier for me as well, because it’s much easier to explain medical minutiae to well-informed patients.

Not only do they feel in control of their treatment , a well-informed patient will always get better medical care, because she will make sure no inadvertent errors are made by any of the medical staff who are looking after her. After all, the patient is the most important member of the medical team !

Even better, these patients are much more satisfied with the quality of care they receive, no matter what the outcome , because they can see we are doing our best for them. Patients like this openness and transparency and are happy that we are respecting them as being intelligent adults.

Today, I had to prescribe the HCG trigger for a patient to schedule her egg retrieval. I asked her – Why don’t you write your prescription , and I will sign it. She looked at me as if I was crazy. Actually, this is a very effective tool to make sure patients understand exactly what’s going on. Most patients are quite intimidated by doctors and are very reluctant to ask questions . They will often nod their heads, even when they don’t have a clue what is happening. They will then try to fill in their knowledge gaps, by questioning the nurse .  This technique is called “teach-back” and ensure that patients know exactly what is going to happen. It’s a great quality control tool for me as well, because it allows me to check I am doing a good job with teaching my patients.

This way, I also get to learn a lot from them, because many of them will be able to explain technical details in terms which other patients find much easier to understand. The biggest pride for a teacher is having a bright student who outshines him – and when my patients are capable of  writing their prescriptions for themselves, I am happy that I have done a good job ! This helps to demystify the IVF process , and gives patients a lot more control of what's happening to them . It also makes my life a lot easier , because there's much less scope for errors and misunderstandings when patients are actively engaged in their treatment.

Wednesday, January 22, 2014

Investing in educating IVF patients



Most patients are quite amazed by how much time , money and energy we invest in developing resources for educating IVF patients .  While I love teaching, I also do this for selfish reasons  ! It’s not that educating patients helps me get more patients and grow my practice – this is just one of the fringe benefits ! What’s far more valuable is that thanks to these resources, our patients have a much better understanding of what IVF treatment entails.

The outcome of an IVF cycle is always uncertain, so that no matter how good a doctor I am , and however hard I work, there is no certainty the patient will get pregnant.

While poorly informed patients will often blame the doctor for the failure, and then hunt for a new IVF clinic, patients who have taken the time and trouble to make good use of our resources and become expert patients appreciate the effort and hard work we have put it. Even if the outcome is not good, they can appreciate that we have followed the correct process. It’s only patients who understand the technical niceties who can appreciate the quality of the work we do. They can figure out why we are much better than other IVF clinics. Patients who are ignorant and clueless , because they treat IVF as a black box which is beyond their understanding, will not be able to differentiate between a good IVF doctor and a bad clinic.

They are often unhappy and bitter when their cycle fails, and will often vent that anger on the doctor. A well-informed patient , by contrast, understands that we have done our best , and finds it much easier to deal with the ups and downs of an IVF cycle in a rational fashion .

Unhappy patients can create a lot of stress for the doctor; and this is why we do our best to make sure our patients are well-informed. We are open and transparent, and this means that our patients are happy with the quality of medical care receive, so that they can partner with us effectively , thus maximizing their chances of having a baby . Happy patients make for happy doctors , and this is the reason we invest so much in patient education !

Want to learn more about how you can maximise your chances of IVF success ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Tuesday, January 21, 2014

Interactive workshop at SIES College , Navi Mumbai on Putting Patients First





Why our IVF clinic prefers treating older women


Lots of IVF doctors don't like treating older women because their chances of IVF success are lower and this affects their IVF clinic pregnancy rate. In fact, some will advise donor egg IVF for all women over the age of 40 , no matter what her ovarian reserve is ! It’s quite easy to understand why the dream patient for most IVF clinics is a young woman with good ovarian reserve, because their success rate is so high . This is obviously good for the clinic’s statistics and their league table rankings !

We actually prefer treating older women. The primary reason is that these are challenging patients – and after so many years of experience and expertise, it’s much more fun tackling difficult problems ! Most IVF clinics can easily get a young woman pregnant – but older women are much more difficult to deal with. They need much more personalized attention and careful monitoring , and this is something we take pride in providing! Because we do not have any assistants, all the care we provide is hands-on , and we devote a lot of attention to each individual patient . This is why our success rates even with these older women is much better as compared to the average clinic .

It’s also much more enjoyable treating these women , because they're more mature. They’ve experienced a lot and have a better understanding of life . They’ve often failed IVF cycles elsewhere, which means they are well-informed; and because they've done their homework , they appreciate the efforts we put into treating them. They have much more realistic expectations , and even though they know the outcome of the cycle is not in our hands , they are grateful that we are working hard in order to give them the best chance of having a baby.

Want to maximise your chances of having a baby ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !

Monday, January 20, 2014

Why email is better than a phone call when you need to talk to your doctor


Patients will often have many questions to ask their doctor, and the standard way of getting answers to these was by meeting him face-to-face after taking an appointment at his clinic . While this can be very important during the first consultation , it's often not worthwhile for the patient to travel all the way to the clinic for follow-on questions ( for example, when they want to ask a query about their lab results; or need to know if they should continue their medications). Most of these questions were best handled by phone, because this was much more cost effective for patients. Patients are used to being able to talk to their doctors on the phone , and when patients call, they expect their doctor to take the call – or to return it if he is busy. When doctors don’t do so, patients get upset , and they feel that the doctor is rude or is not accessible ; or doesn't care for them .

When my patients have questions , I request them not to phone me. I prefer that they e-mail me – and I promise that I will reply within 48 hours. Some of them don't like this , because they feel that email is impersonal . They expect their doctor to be available on the phone; and it’s true that it can be quite reassuring to hear the doctors voice on the phone . However, the fact is that the signal-to-noise ratio of a telephone conversation is extremely poor . For example , if I'm busy doing a consultation . and I then have to answer a phone call from another patient , it disrupts my flow of thought . I am likely to be quite curt in my replies, because I don’t have the time to sit and chat and fulfill social niceties. Also, the patient sitting in front of me is likely to think I am rude, because I have interrupted her consultation. The telephone call is actually an intrusion , and as a result of my tone, the patient may get even more upset after talking to me on the phone , because she may conclude that I am curt , unhelpful and uninterested.

Also, the quality of information which is exchanged in a phone call can never be good . For example, the patient may not communicate her concerns very well ; or I may not remember her exact medical details , as a result of which the advice I give may not be of high quality . While SMS ( texting) is not as disruptive, because of the shorthand it uses, the information content in these messages is often limited .

This is why I tell patients that if they do need to talk to me , rather than do this by a telephone call , it’s far better to do this by email. This way, everything is documented ; and I can check her medical records before giving her advise.

The major benefit of e-mail is that I can copy and paste answers to similar questions which patients have previously asked me ( and after so many years as an IVF specialist, I don’t come across questions which haven’t been asked before !). I can also provide links to websites which have more information , so that patients can go through these and get more depth and context.

Of course, when patients have questions , sometimes they don't just want information - they require a bit of handholding or emotional support . In these situations , an email is not as effective as a telephone call. However,  often a phone call is not a good tool either, and if you find that you need to talk to your doctor not because you need information , but because you need a shoulder to cry , then it’s far more sensible to go to the clinic and do this face to face !

Saturday, January 18, 2014

The uterus as an oyster


One of the reasons the 2ww seems dreadfully long is because patients are paranoid about what is happening to their embryos inside their uterus. They are petrified that if they cough or sneeze, their embryos with fall out of their uterus. They are worried about the impact lifting weights or commuting or stress will have on their embryos . They start treating themselves as fragile dolls, and worry that even if they move too much, their embryo will get dislodged. They are scared to do anything which may affect the chances of their precious embryos implanting successfully.

Because we still don't understand too much about what affects embryo implantation , it seems quite logical to conclude that anything which is put inside the uterus can also fall out , especially since we are putting it inside artificially . It makes sense that if the patient strains or does something to increase intra-abdominal pressure , this could cause the intrauterine pressure to rise as well, as a result of which the embryos could get dislodged.

This is why a lot of mothers –in- law insist that their daughters-in-law lie flat in bed for 14 days after the embryos transfer. Many doctors also advise bed rest for their patients , for completely irrational reasons.
They feel they are being kind when dispensing this advise – after all, won’t a break from daily duties reduce stress levels and improve the chances of success ?

In reality, this advise makes the patient's life extremely difficult for those terrible 15 days. An idle mind is the devil’s workshop – and all she does is brood about what may be happening to her precious embryos all day long . She feels trapped and helpless – and each day seems to take a week to pass. Her mind plays games with her – and there is nothing she can do about it.

What’s even worse is that as a result of this advise, when the cycle fails , doctors and family members often blame the patient for the failure . They believe she must have done something wrong, which cause the embryos to get expelled, even though the doctor transferred them so carefully. This victim-blaming further damages her self-esteem, and she starts thinking of herself as a failure, who is doomed to remain childless all her life.

When the cycle fails , women are extremely emotionally , and they keep on playing back all the events during the 2ww. They rewind and remember minor trifles – for example, the time when they lifted a bucket or when on a bus ride. They attribute the failure of the embryo transfer to something which they did. This is also perfectly reasonable, because we always try to find logical explanations who the events in our life. This guilt just makes their burden even more intolerable to bear.

It’s high time we cleared this misconception. Many research studies have shown that bed rest does not improve IVF success rates. In fact, it can actually be harmful, because it increases emotional stress levels; causes back ache and sore muscles ; venous thrombosis; and reduced bone mass.

I always remind patients that the human body has been cleverly designed , so that once the embryo reaches the uterus, it does not matter whether it got there after spending three days in the fallopian tube ( in vivo ) , over if the doctor transfers it there with an embryo transfer catheter, after it spends 3 days in the test tube ( in  vitro)  . Once the embryo is inside the uterus, it is safe and secure. This is why it makes much more sense to think of your embryo as being protected in your uterus. You can visualise your uterus as being an oyster shell, and your precious embryos as being a pearl, which is being nurtured and nourished. No matter what you do , just like you cannot harm the pearl in an oyster shell, there is nothing you can do to dislodge your precious embryos. The uterus is possibly the best incubator which has ever been devised , and will keep your embryos snug and protected.


Friday, January 17, 2014

My IVF angel

Dear Doctor,

Thank you doesn’t come close to describing my gratitude for all you have done for me. Not only are you an outstanding doctor, but you are a wonderful person. There’s no way I can ever thank you for being such an awesome doctor. You’ve always been honest, patient & encouraging. I’m extremely lucky to be taken care of by you. My whole family is. Thanks for making me feel so special. Thanks for putting up with me and my tantrums also.

I remember the first day when I met you at your clinic, all alone, scared, frustrated and depressed because of my inability to become a mother. I had been literally pushed by my boss who is also a doctor to meet you. I had come to you with no hopes, more so since I was tired of visiting various gynaecologists for 17 years and spending lakhs of rupees on my so called treatment.

My first meeting with you kindled a ray of hope yet again and I agreed to undergo an IVF  under your supervision. Unfortunately the first cycle failed leaving me depressed completely. However, with your patient ear towards me and your encouragement I decided to undergo another cycle of IVF. I had made a promise to myself during my second attempt that if I fail this time, I would never ever try again. But as you say “never say never”, your magical hands did the unbelievable…… my implants were successful and voila – I was pregnant. The word sounded Greek and Latin to me. My mother thought I was insane when I broke the news to her.  Allah Almighty had heard my prayers and decided to bless me with my little bundle of joy.  All this after 18 years of my marriage.  HE gave me my world when I became a proud mommy to my son on 16th of October 2013 on the auspicious occasion of EID!! I am still in a daze, two months after my delivery. The feeling of being  a mother has yet to sink in. Every time I look at my son, I thank Lord Almighty for showering his blessings on me and most importantly, for introducing you in my life.

My parents bless you everyday when they see my son and say a special prayer for you every time they bow their heads to the Almighty.

Thank you doctor for being the angel of my life…


… Warm regards, Nishat

Here's a photo of my angel !


Thursday, January 16, 2014

Angel investors - Knight, Knave , Pawn or King ?


Entrepreneurs can be very helpful in stimulating the economy because they create new businesses which add value to society. They cannot do this without capital, which is why they need to raise money , and this is where angel investors in come in. However, the way angels view themselves is very different from the way entrepreneurs perceive them.

Investors think of themselves as being knights - the good guys . They feel they have a lot of maturity and experience,  and are willing to share their wisdom and invest their money in young entrepreneurs . They want to act as mentors , so they can help the company to grow and succeed, while earning a return on their investment at the same time. They think of themselves as being brave , because they are willing to put money on an unproven idea.

However , a lot of entrepreneurs think of investors as being knaves. They are fearful that investors will purchase a huge chunk of their company for a pittance. They are scared that the investors will interfere with their dreams; and will stunt their plans through “back seat driving” through various control mechanisms and “affirmative rights” that investors insist on, . The ordinary man on the street often thinks of investors as being kings with deep pockets . They feel these angels are savvy businessmen , who are happy to pump money into these startups, so that as they become billion-dollar companies, the angels become rich beyond the dreams of avarice !

The reality, however , is that a lot of angels find they are merely pawns. Once the entrepreneur has got their money, he conveniently forgets the verbal and written commitments made – he no longer bothers to keep them in the loop about what is happening in the business, many do not even have the courtesy to share ifinancials, and the angels remain helpless bystanders as the company goes down the tube , because the entrepreneur i is not willing to respect the agreement he has signed to and the court process to address grievance with takes forever. listen to reason. Even worse , when an occasional startup actually does start doing well, and seeks more funds from venture capitalists in order to fuel its growth, the VCs often insist that early stage angels exit the company at the stage they are entering, so they become the sole financial investors.   . Angel investors in India have burnt their fingers so often, that they are very reluctant to participate in what seems to be an uneven playing field, where the odds are stacked against them !

Wednesday, January 15, 2014

My IVF Success Story

This is our story towards success. We are a couple from Bangalore, married in 2011 and reside abroad. We wanted to start our family immediately after marriage. But after a year of no luck, we decided to consult an infertility specialist. In our vacation, we came down to Bangalore and consulted an infertility specialist in a well known Infertility Centre.

During this period we got to know that my husband was suffering from Azoospermia. The doctor suggested us to get a Testis biopsy done.The process in which under local sedation, a small needle is used to extract sperm directly from the testicle. The result was Zero Sperms. Once again the tesa was performed and the report was the same. The only options suggested by the doctors was either getting a MESA done (in which the scrotum is cut opened to see if sperms are present) or IVF with donor's sperm. MESA is a painful procedure and requires rest for few days. By the time our vacation was coming to an end and we had to leave India.

In the meantime, I went through various websites and finally came across Dr. Malpani's. Thanks to internet technology through which I could find the best doctor.The website contains detailed information on each topic related to infertlity in male and female. It gives you knowledge and fills your minds with positivity. Here I realised that, with multiple diagnostic biopsies it is possible to find sperm even in patients who have testicular failure (nonobstructive azoospermia) - even in those men with very small testes without undergoing painful MESA procedure. The reason for this is that in such men, sperm production is patchy and not uniform in the entire testis. In my next vacation, the first thing in my mind was to meet Dr. Malpani personally to share my problem and take his advise.

In my appointment with the doctor, he clearly explained me the procedure to be followed in my case. No high hopes were given to me. But the doctor had told to be calm and keep faith in God.I left the clinic with few hopes. The treatment then carried on as said. My husband went under TESA (multiple diagnostic biopsies) and the doctors could successfully find healthy sperms. After the procedure in the lab, 10 A grade embryos were ready. Out of which 3 were transferred The doctor had suggested to wait for 14 days for the final result. It was the longest wait of our lives. Then came the day of test and the report was positive. Our hearts were filled with joy. My pregnancy is continuing successfully. Loads of thanks to Dr. Aniruddha and Dr. Anjali Malpani. Without them, we don't think this was possible and in such a simple way.

Everything is well organised in their clinic. Its neat and clean the staff is co-operative. Attention is given to individual patients. We could see vast difference between the treatment and attitude of the doctors in Bangalore and at Dr. Malpani. I would really wish my story inspires the readers and if any one is thinking to go for IVF, I would suggest one and only Dr. Malpani.

From a grateful patient

Tuesday, January 14, 2014

The Top Ten Myths about Infertility


Infertility is often diagnosed late , owing to various assumptions made by women. We live in a society where women are comparatively unaware of infertility issues , until they have to undergo treatments like in vitro fertilization. There is an interesting book called ‘A Few Good Eggs: Two Chicks Dish on Overcoming the Insanity of Infertility’ , which talks about infertile women living in the US. It is written by Julie Vargo and Maureen Regan who have put together quite a list of myths ; and have exploded these misconceptions

1. Infertility will not happen to me.

One in ten couples is found to be infertile. There is no way of knowing about this before you try to conceive.
2. I cannot be infertile. I already have got a child!

A previous child only indicates your fertility at that point of time. It does happen sometimes that an unexpected problem crops up later on, which may requiring interventions like IVF.

3. I can easily conceive, therefore I do not have fertility problems. I basically have miscarriages.

An expanded meaning of infertility is the inability to have a child over period of time. It also includes women with repeated miscarriages as it means that they are unable to carry their pregnancy to term.

4. I am just too young to have fertility problems!

Fertility and age are not always related. While older women have a higher risk of being infertile, even younger women may need in vitro fertilization treatment ( for example, because their tubes are blocked) .
.
5. My physician shared with me that I don't need to visit any fertility expert unless I have 3 miscarriages.

Miscarriages are fairly common. Doctors do not undertake detailed investigation of a single event of miscarriage but you can always ask for one.

6. I am fit. I work out on a regular basis. I cannot become infertile.

Fertility or infertility is completely unrelated to physical fitness.

7. I am certainly not infertile. I am just not having enough sex.

It is better not to deny the possibility of infertility, if you are having sex at least once a week and have still failed to conceive.

8. A person can easily wait for a long period to have a child.

Time and age are critical factors for infertility treatments like IVF; so better be smart than sorry.

9. Males cannot be infertile. They produce sperm regularly.

This is true , but factors like poor quality of sperms or less number of sperms may cause infertility. Only a lab test can diagnose this

10. Normal fertility is a miracle.

That definitely is not a myth. Normal conception is truly a nature’s miracle. However, you cannot always wait for miracles to occur – and sometime IVF allows you to create your own miracles !

Summary: It is important that women are aware of the facts about infertility and related treatment options like in vitro fertilization.

Monday, January 13, 2014

Factors Affecting the Success of IVF Treatment Cycle


IVF treatment is not a completely foolproof method of treating infertile couples. There are many instances where the transferred embryos fail to implant, even though they are high quality. No-one can predict which cycle will fail and which will succeed. Some patients blame the doctor for the treatment failure and choose to go to a different one for the next cycle. A few others believe the mother’s uterus is not able to nurture a child.  Others get fed up because there are no answers for the failure and choose to just stop the treatment process. All these speculations do not have a concrete base , and so lead to mistaken decisions.

The success of IVF depends primarily upon:
-    The implantation potential of the embryos prepared in the lab
-    The receptivity of the uterus

These are the two most important factors ( among several others ) that affect the chances of success. If things go perfectly , then a good quality embryo when transferred to a healthy would implant. But this does not happen every time. There are several factors that may or may not come in the way. Sometimes even when the embryo is of good quality and the uterus is receptive, the embryo fails to implant. In these cases all the blame is put on one or the other reason that comes to mind. Let us name that factor as X factor.
X factor may include one or many reasons which caused an IVF treatment cycle to fail. It’s fashionable to blame the immune system for this “rejection”. After all, if the body can reject a kidney, than it seems quite logical that the uterus will be able to “reject” the embryo. In reality, the uterus is an immunologically privileged site, which can accept embryos for anyone. This is why immune therapy using intravenous immunoglobulin is a waste of time of time and money.and immunosuppression therapy.

In other cases, the patient claims that the embryo is cursed , because of which she is not able to conceive. It is not uncommon for IVF specialists to come across such patients who have such orthodox beliefs. There also have been cases where the doctor is asked to exorcise the embryo before the procedure.
Sometimes the blame is put on excessive stress. Many doctors will also blame the patient for being too “stressed out” and will blame the high stress levels for the IVF failure ! This is a way of blaming the victim. It is not the stress which causes infertility, it is the infertility which causes the stress !

Summary: The success of an IVF cycle depends on many factors; some are better known and treatable while others are still poorly defined .

Sunday, January 12, 2014

Principles for Self Management of PCOD and Infertility


Poly cystic Ovarian Disorder is a common cause of infertility. It is a disorder of the ovaries which leads to irregular menstrual cycles. These patients need regular cyclical treatment every month to help get their regular menstrual cycle. Most of these patients are unaware of the details of the disease and how to manage it. The associated fear of infertility worsens their mental stress. Some doctors try to cash in on this ignorance and ask the patient to come in every month for a dose of hormones.

PCOD patients who are infertile often suffer because of their ignorance, more than their hormonal imbalance. We, at Malpani clinic, ensure that every patient is informed about the disease, its implications and self management principles. Here are a few basic principles that may help patients in self management , and reduce their stress of frequent visits to the doctor.

Firstly, the patient needs to understand what PCOD and what its consequences are. Hormonal imbalance and irregular periods go hand in hand with PCOD. It is better that patients schedule their monthly dose of progesterone hormone themselves, so they get regular periods. Otherwise, the missed period every month creates false hopes and prompts them to undergo a pregnancy test, and a failed pregnancy test causes stress and leads to a doctor visit.

In these cases it is better to be proactive than reactive. Our advise is thatyou do a pregnancy test on the first of every month. If it comes back negative, then you should start your regular dose of medication to induce periods. The normal treatment for inducing periods is to take progesterone medication. This is medroxyprogesterone acetate, and is available in the market by various brand names like Regesterone, Provera and Delvry. The patient needs to take 5 mg tablets twice a day for 5 days. You will get a ‘withdrawal bleeding’ for 2-7 days after the last tablet intake.

Many of the patients visiting Malpani Clinic fear this monthly treatment as they feel they might get addicted to it. It is essential that the patients understand that this treatment is essential and is safe. Just as a diabetic patient needs regular antidiabetic medication to keep sugar levels in control, PCOD patients need hormonal support. These medications are completely safe and have no harmful effects , even if you accidentally take them during pregnancy. This hormonal treatment is supplemented by ovulation induction therapy if the patient plans to have kids.

Summary: PCOD is a chronic disorder of the ovarian system and requires continued medical self management using hormonal support therapy.

Saturday, January 11, 2014

Repeated IVF Failure - Should I Stop or Go on with the Treatment?


Many infertile patients face the dilemma of stopping or continuing after multiple IVF cycle failures. It is always tough to give up on a treatment but the decision to go on is difficult too. Patients with repeated IVF failure often consult their doctors to help them decide what to do. They have gone through a lot of physical and emotional stress. They have started many IVF procedures , full of hope, but all these have ended in unfortunate disappointments. All of this can take its toll on the patient’s mental status.

How do you decide what to do? One way of addressing the issue is by getting a second opinion . Patients with repeated IVF treatment failure need to understand the hard facts about the procedure - why it may work and why it won’t. The truth is that if a patient has had 4 previous IVF failures, no doctor can surely say whether the fifth one will work or not. The reason why the four procedures failed sometimes cannot be pin-pointed.

Another way to decide is by knowing the level of your personal emotional stability. We have grown up listening to stories of persistence . We have been taught to face every daunting task in our lives and to keep on trying, even when the odds are against us. All this works when talking about examinations or job interviews, but does it hold true when we are dealing with biological interventions? In the case of medical treatments like IVF, the patient is taxed physically, emotionally and financially. Every failed procedure leaves the patient and her relatives searching for some kind of an alternate solution.

You should decide what is best for you - decide what makes you happy. Such a decision is sure to hold true for you in the long run. The next IVF treatment may or may not work. The best part is you get to decide on what you want to do beforehand. Everyone is not emotionally strong enough to handle this stress over and over again. Some patients may decide to give it another shot and some may just give up. Your doctor can help you take the decision , but in the end the final decision is completely yours.

Summary: Repeated IVF failure is tough to tackle as it affects both the body and mind, but only you can decide whether to continue with the treatment or not.


Need help in coping with multiple failed IVF cycles ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !





Friday, January 10, 2014

Anxiety before an IVF Cycle - Are You Handling it Right?


Infertility and its management is a long and tough journey for a woman. The traditional social concerns of being infertile overpower the modern intellectual mindset of treating it as a plain medical problem. The ongoing array of investigations combined with a complex set of treatment options can confuse and upset even a stable individual. It is very common for most women to grow anxious before a scheduled IVF treatment cycle.

The patient needs to first accept and understand that the anxiety is not abnormal. The challenges of an IVF procedure and the uncertainty of its results will surely cause some degree of nervousness. It is better to accept this and try to find a solution to manage this . Some patients go into a stage of denial and fail to understand their mental status. This would not definitely help and may also lead more trouble later. 

Another point of concern for the patients is the outcome of IVF treatment. It is essential that the patients as well as relatives are completely aware of the procedure in detail , as well as the success rates. This will ensure that they do not have unrealistic expectations from the procedure. An unfortunate failure or the fear of the same may cause panic in an uninformed patient. You need to understand that an IVF cycle is not a guaranteed treatment method for infertility.

Voicing your concerns to qualified personnel also helps in controlling the level of anxiety. It is obvious that you may have some doubts regarding the procedure. You patient should clear them rather than suppressing your queries. The only stupid question is a stupid one ! There are lots of online tools, such as our IVF comic book and our IVF learning course, which will help you empower yourself with information, so you can go through the treatment with a calm mindset .

Unfortunately there is no simple cure for this anxiety. The patient needs to take control of her own emotions and not let them overpower her mind. Most of the patients do agree that their anxiety is uncalled for , but they are unable to hold it down. The patient can also choose to let their IVF specialist worry about the technical minutiae of the IVF treatment . A doctor can work towards helping you find a constructive solution for your particular worry. He is the best person to rely on, to handle all your IVF treatment related anxiety.
Summary: Anxiety before an IVF cycle is common, but it is important is to handle it well using the right human and online resources. 

Need help in coping with your anxiety ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !




Thursday, January 09, 2014

The Top Ten Fertility Misconceptions


Most women live under the mistaken assumption that they are fertile until they are forced to visit a doctor . They seem to ignore the possibility of their being infertile infertility until they have exhausted themselves, and all their home remedies have failed them. . Julie Vargo and Maureen Regan have written a very interesting book based on this. It is called ‘A Few Good Eggs: Two Chicks Dish on Overcoming the Insanity of Infertility’ . It is a humorous take on the topic of infertility. 

Amongst their other top ten lists is a list of the top ten fertility fallacies or misconceptions.

1. You can have a baby easily until you're at least forty-five.

The biological clock for every woman is different and some may continue to get anovulatory cycles until the age of 55. The truth is that as as age advances the number of fertile eggs goes on decreasing.

2. Menopause happens to women in their fifties.

Menopause is not restricted to some age and can happen anytime when the body runs out of eggs. 10 years before menopause, the body goes through oopause , when the fertility goes down.

3. If you are young at heart, so is your body.

This unfortunately is not true. The body will always go through its natural cycle of ageing.

4. If_______________ (fill in the blank with your favorite post forty pregnant celeb) can do it, so can I.
The particular celebrity may have gone in for IVF treatment, or used donor eggs to have a baby . These celebrities do not disclose every detail of conception publicly.

5. Once I stop using birth control and have unprotected sex, I'll get pregnant right away.

Nature has its own way of dealing with this issue. Natural conception is not always possible easily.

6. If I eat right, exercise regularly and don't smoke, my body will be able to carry a baby whenever I am ready.

The physical health of a woman is not directly related to her fertility level. Sometimes even perfectly fit women need to visit a fertility center for conception related problems.

7. Its no big deal if I can't get pregnant. My doctor can always get me there.

It is true that Medical technology has grown by leaps and bounds in the field of infertility treatment. But even today there are some problems like poor quality eggs which are tough to tackle, even by IVF. IVF is not a panacea for all infertility problems !

8. You can never be too thin.

Infertility is one of the dangers of being too thin or anorexic.

9. Nobody I know would ever use donor eggs!

This is private information and mostly stays so.

10. When I want to get pregnant, it will just happen.

It would be great if this happened in reality , but sometimes it doesn’t.

Summary: The list of top ten fallacies of fertility highlights the common misconceptions related to fertility and is a wakeup call for women who may need IVF in future.


Need help in clearing up your own infertility myths? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !





Wednesday, January 08, 2014

Natural Cycle IVF - Procedure, Treatment Plan and Benefits


Natural cycle IVF is a simpler way of doing in vitro fertilization. It is especially of benefit to patients with poor ovarian reserve. These patients have a limited ovarian reserve and do not respond well to conventional superovulation with gonadotropin injections.

Natural cycle IVF or gentle IVF is a procedure done using minimal or no ovarian stimulation. It is a procedure with few side effects; is less expensive; and can be repeated ; and has good success rates over a period of time, in expert hands.  It is important that the patient is treated by IVF specialists who are completely aware of the challenges involved in this type of IVF. The procedure is quite demanding in terms of timing egg retrieval and fertilization of the egg. The procedure will fail if any these factors are not monitored properly .

At Malpani Infertility Clinic, we are expert at ensuring you have the highest chances of success. We have a treatment schedule and protocol that we strictly follow for patients who come in for natural cycle IVF.

1.    We do a vaginal ultrasound scan on day 7. This scan shows the follicular size and thickness of the endometrium which confirms that you have a viable and growing follicle.
2.    When this is confirmed, we start you on a GnRH antagonist medication to avoid untimely LH surge.
3.    We do the next scan and an E2 blood test on Day 10
4.     Once the follicle size is 18 mm and E2 level is 200pg/ml, we give you the HCG trigger shot
5.    The egg collection is done 36 hours later
6.    The egg is fertilized by our expert embryologist and the embryo transfer is done within 48 hours

Another option with better pregnancy rates is mini-IVF.  It involves mild super ovulation to ensure the growth of 2-3 follicles. At Malpani Clinic the treatment plan for mini IVF is similar to natural IVF with some additional medical treatment. The first scan is on day 2 to confirm downregulation and absence of any ovarian cysts. You are then put on Letrozole from day 2 to day 6 and Menogon from day 3 onwards. The next scan is on day 7 and rest of the procedure is similar to the one followed for natural cycle.

Summary: Natural cycle IVF and Mini IVF are safe, repeatable, budget friendly treatment procedures with good success rates in patients with poor ovarian reserve.This is a kinder, holistic approach, which takes advantage of your body's own hormones !



 
What to explore the simpler option of patient-friendly gentle IVF ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !




Tuesday, January 07, 2014

The problem with PGS/CCS - more is not always better

Most doctors have an abiding faith in medical technology and naively believe that science can solve all problems. This is why so many IVF specialists are now actively pushing CCS ( comprehensive chromosomal screening) for all IVF patients.

Admittedly, it's hard to argue with them, because their logic is so seductive. After all, if we can use whole genomic sequencing to exclude genetically abnormal embryos,   then isn't it logical that  the transfer of genetically normal embryos will improve pregnancy rates ?

However, biology doesn't always fall in line with human logic ! There are 3 flaws with this reasoning.

1. These tests cannot pick up all genetic problems ( because our technology is not good enough to do so as yet). Just like the older FISH technology had limitations, CCS has its limits too ( which doctors don't talk about)

2. Embryos are alive and can self-correct their genetic errors . This means that the rationale for testing itself is flawed

3. The tests will provide lots of false positive results, which will cause doctors to discard embryos which could have given rise to completely healthy babies ! There are lots of grey areas , which doctors conveniently gloss over by labelling the test results as being "inconclusive".

Sadly, most IVF specialists understand very little about genetics - and very few are honest enough to accept this. Now , I am not a Luddite, but I think we need to do a lot more research before offering CCS on a routine basis to all IVF patients. Patients are very emotionally vulnerable, and it's very easy to convince them to say yes to anything we tell them to, but this is often not in their best interests. The trouble is that doctors like offering the "latest" services because these are cutting edge !  They need to show they are better than the other doctors . This means that there's a lot of oneupmanshipat play - and huge financial stakes as well !

A very sensible article at Virtual Mentor discussed the ethics of CCS. This is what they concluded.
" One can only surmise, however, that more intense genetic analysis of embryos is likely to show multiple variants of uncertain significance ( VOUS) , and all the counseling needed for prenatal testing will need to be made available, and perhaps even expanded, for patients considering having embryos’ genomes sequenced. Will finding VOUS lead to discarding healthy embryos? "

http://virtualmentor.ama-assn.org/2014/01/stas1-1401.html

The Role of Various Supplements for IVF Preparation




Dietary supplements are defined as products with one or more of the following ingredients , such as vitamins, minerals, herbs, amino acids or botanical preparations. Almost every woman takes one or another other type of dietary supplements to prepare for IVF. These supplements are said to improve egg quality, reduce stress and facilitate implantation. The desperate yearning for a baby leads women to do whatever they can. Any therapy with a success story will lure women into trying it. The manufacturers try to cash in on the emotions of a woman craving for a child. 

The different dietary supplements that infertile women use can be grouped into the following: antioxidants, insulin sensitizers, PCOD mimetic, essential amino acids and some miscellaneous supplements. These dietary supplements claim to enhance the success rate of infertility treatments like IVF 

Pycogenol is n antioxidant derived from the bark of a pine tree. Antioxidants are said to delay the process of ageing and thus are claimed to even delay reproductive ageing. Myo-inositol, another supplement is also known as vitamin B8 , and helps only patients who have PCOD Evidence shows that patients with PCOD have insulin resistance; so insulin sensitizers like myo-inositol improve ovulation by addressing this issue. The tragedy is that many doctors will start treating all their patients with myo-inositol, simply because it is a “natural supplement” ! Melatonin and co-enzyme Q are other antioxidant supplements. The botanical preparations include wheat grass and royal jelly. Each one of them has its own way of working towards a successful conception.

Although all of these products claim to be beneficial for the infertile woman, not all of them have proven results. Some of the dietary supplements are just an elaborate version of old wife’s tales . The intake of dietary supplements does not have any proven benefit in the success of IVF. There is just one essential supplement that any woman trying to conceive must take and that is folic acid. Folic acid is proved to prevent neural tube defects. It is essential that you take the prescribed dose of folic acid for at least 3 months before in vitro fertilization. 

Some doctors prescribe supplements to keep their patients happy . In a nutshell even though the dietary supplements do not have any side –effects, it is important to be prudent and aware when you take any one or more of them. The supplements should only be taken if and when required as supportive to IVF.

Summary: Dietary supplements may be beneficial for infertile women but their utility has not been proven in clinical practice .

Not sure what you need to take to maximise your chances of IVF success ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better

Monday, January 06, 2014

Unexplained Infertility and the Best Way to Handle it


At Malpani Infertility Clinic we often come across patients who have undergone millions of investigations for their infertility problem with no result. All the investigations come back normal with no traceable problem. This leaves the doctor as well as patients in a fix. These unexplained infertility patients become increasingly frustrated as time goes on , with no diagnosis in sight. Their logic is - if the doctor is not able to pin point the problem , then how will he find a solution? So they keep going from doctor to doctor to try to to get to the root of the problem.

The focus of these patients shifts from trying to conceive a baby to getting diagnosed. Their doctor shopping leads them nowhere. Every doctor comes up with an idiosyncratic perspective, and advises a host of unproven investigations . This often becomes a game of one-upmanship, where doctors compete in ordering the most expensive and exotic tests, to prove how much they know . Gullible patients, who don’t know any better, and also suitably impressed when the doctor orders tests no one else did in the past ! Doesn’t this prove this doctor is wiser than the others ? . The laboratory paperwork goes on piling up . The biggest tragedy is that these innumerable tests will invariably lead to detecting some unrelated minor problems . The doctor will the  take the credit for making the right diagnosis – even though the abnormality is just a common variant, which is also found in fertile women ! . Doctors, just like patients, feel at peace if they can put a name to the cause. Because of this nominal fallacy, all efforts are centralized to investigation, examination and diagnosis , rather than treating the basic issue of the inability to conceive.

The fact is that once a woman conceives, the cause of infertility is only of academic interest. The diagnosis of a particular disorder would not help the infertile couple. Naming a problem is only of academic interest ! It is important to focus all efforts on finding a solution, rather than trying to find a label for the problem . For example a woman with blocked fallopian tubes would benefit by in vitro fertilization therapy, rather than by doing a laparoscopy to find out the reason for the blocked tube. The laparoscopy will just waste the patient’s time and money, because it does not change the treatment options the doctor can offer her. . IVF is the modern day solution for couples with unexplained infertility. In simple terms, this is because it helps the doctor to get around any barrier which is preventing the process of fertilization inside the body.

Another common mistake that couples with unexplained infertility do is try to continue conceiving naturally. It is a well known fact that if a couple is unable to conceive after trying for 2 years they need some assistance. When a couple with unexplained infertility obstinately tries to conceive naturally , just because everything is “normal”, they may lose out on precious time. If time runs out, then even IVF may not be able to help them, because their egg quality has become poor. Having a success oriented approach towards the problem would help these patients.

Unexplained infertility is an inability on the part of the doctor to point out the cause of infertility . Fortunately, it is surmountable with treatments like in vitro fertilization !


Need help because your treatment is stuck ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !




Sunday, January 05, 2014

Twice as nice - our IVF success story at Malpani Infertility Clinic

After 6 years of marriage, my husband and I decided to try for children.  Things such as our careers and schooling prevented us from trying earlier.  We felt that starting a family should be easy in our early 30s, since couples much older than us were conceiving naturally and we had no family history of infertility.  To our dismay, we found that having a baby was more difficult than we had anticipated.  Perhaps our plight was not as extreme as it is for some, since we only had 2 unsuccessful years of trying to have a baby.  However, watching friends and family members around our age effortlessly having children made our failure to have one all the more painful.  

    During this time, we tried several things before IVF.  Among these would be 3 rounds of Clomid and also an IUI.  Towards the end of this 2 year period and after discontinuing Clomid, my husband and I actually conceived naturally.  Unfortunately, our excitement was short-lived as we had a miscarriage at 6 weeks.  We realized that we were not getting any younger and indefinitely gambling on natural pregnancy seemed to unnecessarily delay the starting of the family we wanted so much.  The decision to go to Dr. Malpani was an easy one.  This is because my husband's aunt and uncle, in their mid 40s, already had a great success story from his clinic in the form of twins. 

    Right from the start, Dr. Malpani conducted himself in a professional and knowledgeable manor.  Furthermore, he made sure that you are aware of exactly what is happening in any given step of the IVF process.  The nurses and other staff also went out of their way to show that they cared. 

    We were happy to find that after my husband provided the sperm and I provided the eggs, many of the subsequent embryos were of very high quality.  When we implanted our first 2 embryos we were quite hopeful.  Sadly, I soon encountered heavy bleeding and it was concluded through blood test that result was negative.  We were devastated.  We had almost given up hope and began to strongly consider surrogate motherhood and even adoption.  I found myself to be  non-functional due to the shock of the failure.  However, Dr. Malpani was not only a great medical support but an active moral support as he reassured me that one way or another a child will happen for us.  He emphasized that sometimes failures happen before successes in IVF. 

    Prior to our second attempt with 2 more embryos, my medication was doubled.   After the second implantation, I was to remain on the double dosage of medication.  I was told to have blood work done the 12th day after implantation.  The waiting was brutal and frightening.  However, with God's blessing the blood report showed a positive pregnancy.Then at 6 weeks of ultrasound in Mumbai we were able to detect one heartbeat.  Given our past failures, we were still reluctant to get too excited, especially since I was again experiencing some bleeding.  Dr. Malpani tripled my medication dosage and assured me that this type of spotting is possible even in successful IVF procedures. 

    After returning to the US, intermittent bleeding continued and this was quite scary to say the least.  Upon finally visiting my OBGYN, however, we encountered a big surprise.  There were 2 heartbeats found!  We are now several months into the pregnancy and everything is looking normal.  We would highly recommend Dr. Malpani to anyone who is having trouble conceiving.  His method and service are exceptional and we are forever grateful to him for giving us twins. 

T.M., USA

DDR102012@yahoo.com



Saturday, January 04, 2014

Breaking up the pharma-doctor nexus

Drug major GSK may have created a flutter in the pharma industry recently when it announced "revolutionary'' changes to stop aggressive marketing of medicines.

TOI has a great article on how GSK is cleaning up its act in India by refusing to bribe doctors !
This is a very healthy trend - and can help to heal a sick healthcare system. Hopefully , Indian pharma companies will also copy this ( and not just their molecules !)


The article talks about  Indian pharma companies will "benefit" as a result of GSK taking the high moral ground. This is very short-sighted. There are major advantages to taking the high moral ground and this move will pay off in the long run. Not only will it help GSK ( because ethical doctors will prefer prescribing brands produced by ethical companies), it will help patients as well  ( as GSK will be wasting less money on bribing doctors, and can spend this on promoting patient advocacy instead ). If GSK can do this, then why can't all pharma companies ?

Preventing IVF failure


While it is true that not all IVF cycles will succeed, the good news is that a lot of IVF failures are
avoidable !  What can you do as a patient to prevent these failures ?

Let’s start by acknowledging that not all IVF clinics are equal. Some of them are poorly equipped ( and don’t even have a reliable 24-hour electric supply); some of them don't have enough experience and expertise in actually doing IVF, and have to depend on the expertise of traveling embryologists and doctors to do the procedures for them. Many have poor quality control measures , and since the quality of the IVF clinic can make such a big difference to the outcome of the IVF cycle , the most important thing you can do to maximize your chances of success ( and therefore reduce your chance of failure ) is by spending enough time and energy in selecting a good IVF clinic . This is easier said than done , because every patient goes to a clinic which they think is good ! How do you check whether the IVF clinic you have selected is truly good or not ? This is why Information Therapy is so important ! Not only do you need to do your homework before starting the IVF cycle , you need to be actively engaged during the IVF cycle itself , to make sure that things are going according to plan ; that your injections are being given properly; that your follicles are going well on the ultrasound scans; and that the clinic will provide you with photos of your embryos at the time of your embryo transfer , so that your documentation is complete. This will ensure your treatment is high quality; and this openness and transparency will increase your confidence levels that you are in good hands.

One of the reasons for avoidable IVF failure is errors – and while some errors occur because the medical team maybe incompetent, overworked or fatigued , others occur because the patient fails to do what they are told to. Poor patient compliance is a particularly poignant cause of IVF failure, because it is so easy to prevent. Sadly, we still see patients who mess up their IVF treatment, because they do not mix their medications properly  ( for example, they do not realize that they need to dissolve the active HMG powder in the solvent; or they fail to take their HCG trigger shot at the right time, as a result of which the doctor is not able to collect any oocytes during the egg retrieval.  A particularly tragic event IVF clinics see occasionally is when the husband is not able to produce a semen sample on demand, at the time of the egg collection. This often means  that the entire cycle gets wasted, because the clinic does not have the expertise to freeze the eggs or do an emergency electro-ejaculation or TESE. This is why it’s a good idea to freeze the man’s sperm sample prior to starting IVF, so this can be used as a back up, if needed. While some clinics do this routinely, active patients may need to take the initiative and proactively ask the doctor to do this for them.

It is true that IVF treatment can be complex and it’s easy to get confused The good news is that clever technology can help you to remain in control , so you do everything you are supposed to do . For example, the free IVF app for android smartphones at www.myfertilitydiary.com can help to remind you of what medicines you are supposed to take; and when !

Some errors may occur because of the lack of coordination between the nurses and doctors; or because the junior doctor is inexperienced. This is especially likely to occur in clinics which batch patients, and have to depend upon an external expert to do the actual IVF treatment. For example, the doctors may not give you the right dose of HMG injections for  superovulation, as a result of which you may grow few follicles; or the doctor may not have the experience to do the egg collection properly, as a result of which they may not retrieve all the eggs in your ovaries. This is an especially vexing problem with PCOD patients, and most doctors are not able to do a good job with superovulating them. They are so scared that their patient may develop the complication of OHSS, that they often end up mistiming the HCG injection, as a result of which they are able to retrieve few poor quality eggs , which result in IVF failure because the resulting embryos are of poor quality.

The biggest problem is that when the IVF cycle fails because of an error on the part of the medical team, they will usually try to cover this up, as a result of which the patient never finds out the truth !

This is why you should take an intelligent interest in your treatment . You should know exactly what the plan is ; and whether you are growing your follicles as expected. Insist on seeing the ultrasound scans; and ask for embryo photos. Engaged patients are empowered and get better care, because they keep the medical teams honest and on their toes !

Of course, just becoming an expert patient is no guarantee that your cycle will not fail. It’s important to be prepared for failure, so you become emotionally resilient, and can cope better with the IVF roller coaster ride. If you have realistic expectations, including a Plan B in the event of failure, you will be able to bounce back, no matter what !

The good news is that while you cannot control the outcome, you can control the process . Taking treatment at a world-class clinic will maximise your chances of success and give you peace of mind you did your best.


Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !








Friday, January 03, 2014

Year of the Aam Patient !

Now that the new year has started, there’s a lot of optimism in the air . Some of this because of the results of the Delhi elections ,which helped the Aam Aadmi Party to come to power. While no one knows how long they will last or how much they will be able to accomplish, they still present a breath of fresh air. They are young and idealistic and whether they will be able to live up to their promises or not , at least they offer hope because they are a marked contrast from the traditional politician, who is viewed as being corrupt and crooked.


What can the medical profession learn from the Aam Aadmi Party movement ?

http://health.india.com/diseases-conditions/2014-the-year-of-the-aam-patient/

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