Friday, February 28, 2014

How accurate Medical Records help in increasing IVF success rates


IVF patients understand that their treatment’s success is the result of the combined effort of the doctor and the patient herself. They know that they can play a vital role in ensuring IVF success. This is why infertile couples gather as much information about IVF treatment before starting a cycle. They weigh their options well and judge what is best suited for them. Based on this research , they take efforts to find the best IVF specialist. Given this background, and the amount of time, energy and effort patients invest in IVF treatment, it is surprising to see how apathetic patients are towards seeking and obtaining the medical records of the IVF procedure. 

Even well educated and aware patients do not have a copy of their medical records, even though they know that good documentation is important for any medical procedure – and especially for one which is as complex as IVF . The benefits of proper documentation accrue over a long period of time , and are equally beneficial to the doctor as well as the patient.

Some IVF clinics put forth the specious argument that they do not share medical records with the patient as IVF maybe a long drawn out treatment and that if the first cycle of IVF fails , then they need to refer to the records to plan further treatment. But this does not justify why the clinic cannot provide a copy of the records to the patient !

Others claim that there's no point in providing these to the patient, as they are full of technical medical details, which the patient will not be able to understand ! This is unfair, as IVF patients are well-informed these days - and it's part of the doctor's job to explain these details to the patient !

Some clinics try to hold on to the patients by holding on to their records. It is obvious that it’s much harder for a patient to go to a different clinic for consultation , without her medical reports. If a patient’s IVF treatment cycle fails and she is not provided with the records, she will find it difficult to get a reliable second opinion without good medical documentation. This cheap trick causes the patient to lose trust in the clinic.

Patients are also at fault for not asking for their own medical records. They need to know that they have a legal right to their IVF medical records , and no one can deny them this right. It is important that they have a written proof of the procedure performed, with all the medical and lab details, including embyo photos. If the clinic does not provide the records proactively, the patient should ask for them. This request should be made in writing, to ensure that it is not conveniently ignored by the clinic ! Sharing medical records helps in building a mutually trustworthy long term relationship between the doctor and patient. The medical records of IVF treatment are important documentation , and it is essential that the patient always has a written copy of every detail of the procedure.

Need help in making sense of your IVF medical records ? Please send me your medical details by filling in the form at http://www.drmalpani.com/second-opinion so that I can guide you better !






Thursday, February 27, 2014

Too much IVF ?


Many doctors believe that IVF specialists are now doing too much IVF. A friend, who is a gynecologist, pointed out that he is seeing patients who went to an IVF specialist who advised them to do IVF, who then promptly got pregnant in their bedroom the next month !

He felt that we are seeing an epidemic of IVF overtreatment , simply because there are too many IVF clinics around , and each one wants to do as many IVF cycles as possible. It is true that IVF is an effective treatment for infertility , but he was very critical of the fact that specialists are advising IVF left, right and center, even for couples who could get pregnant with simpler treatment options . He felt that this was unfair on patients .

The problem is that IVF specialists have a jaundiced view. Because he is a specialist in doing IVF , he is quite likely to recommend IVF treatment – after all, this is what he does for a living ! When patients are confused, and go for a second opinion to another IVF specialist , he provides exactly the same advise – the only difference being that he suggests that the patient do IVF in his clinic, rather than the other doctor’s
clinic !  Patients are completely confused as to whether they really need IVF or not – after all, IVF is expensive .

The paradox is that while poor infertile patients don't get enough IVF treatment because they cannot afford it, rich infertile couples get too much IVF treatment , simply because they can ! However, a lot of this may be unnecessary .

It’s hard to judge in retrospect whether IVF treatment was really needed or not. After all, when infertile patients go to a doctor, they are basically looking for a baby, and if IVF treatment can provide them with one, they are more than happy to do this, even though they understand that there maybe simpler and less expensive treatment options available.

It’s not true that all IVF specialists are just out to make a lot of money by doing IVF for anyone who walks into their clinic ! The reality is that IVF is the most effective infertility treatment we have available today, and lots of infertile couples are focused on results , rather than the treatment path which gets them to their final goal.

While it’s true that IVF treatment is expensive , for lots of patients it's actually much more cost-effective to do IVF , because of its high success rates. It actually saves them time , rather than following the traditional path of doing scans with timed intercourse, followed by IUI treatment cycles.

At the end of the day , it's important that patients make these decisions for themselves , so that they can select the treatment which is right for them . This is the best way of solving the problem of overtreatment. A well-informed patient will be aware of the less expensive treatment options available , and if she decides that IVF will be the most cost effective option for her, than I would not consider IVF to be overtreatment for that patient.

Wednesday, February 26, 2014

Reasons Why Infertile Couples Do Not Opt for IVF Treatment


IVF treatment can be a boon for many infertile couples. It has established itself as an effective treatment option and has a high success rate. Inspite of this, why is it that even today many infertile couples opt out of this option? There are many educated couples who are aware of IVF , but who refuse to do IVF,  thereby reducing their own prospects of having a baby. There are several arguments that these couples put forward against IVF. Sometimes it is their own attitude which is responsible, while at other times it is relatives, family doctors or other IVF patients who turn them away from IVF.

Not all infertile couples are able to afford IVF treatment.  It is definitely expensive. Sadly, most insurance companies fail to cover this procedure , which complicates the situation further. Financial pressure is one of the major reasons why patients avoid IVF.


Many husbands are reluctant to do IVF because they feel they should be able to make a baby in their bedroom if they give it enough time.  They feel that resorting to IVF is an affront to their manhood.

Numerous misconceptions and horror tales told by IVF patients can also give prospective patients a misconstrued impression of IVF. Many couples are still under the impression that IVF is an artificial procedure. They feel that the babies conceived by IVF are weak and are at increased risk for birth defects because we are manipulating eggs, sperm and embryos in the lab. Others believe that the hormonal injections given during the treatment have adverse side effects. Patients who have failed IVF cycles in the past are also happy to share distorted horror stories about IVF.

Unfortunately some doctors also end up depriving patients of IVF treatment. Many infertile couples initially consult a gynecologist for management of their infertility. Some gynecologists advise them against IVF because they are afraid of losing their patients to IVF specialists. Often they lack proper knowledge of the details of IVF themselves. Incompetent IVF specialists contribute to this situation because of their low success rates, which end up giving all IVF doctors a bad reputation. This causes patients to lose trust in IVF doctors.

Patients can easily overcome these hurdles by empowering themselves and arming themselves with knowledge about IVF. This will help them make the right decision about whether or not to do IVF – and where to do it as well.

IVF treatment can prove to be beneficial for many infertile couples so it is essential that they do their homework and make a well0informed decision.

Tuesday, February 25, 2014

Why patients dropout after a failed IVF Cycle

In vitro Fertilization is one of the most complicated treatment options for infertile couples. Infertile couples who choose to undergo IVF know that it is their last chance at having their own baby. All their hopes ride on the procedure’s outcome. Many patients undergoing IVF have unrealistic expectations about the results. When their first cycle of IVF fails, many women then stop further treatment, although they know that they are denying themselves the possibility of success by doing so.

The number of dropouts after the first IVF cycle fails is very high. These women stop any further trials for having a baby. Various factors play a role in this decision. In a practical sense, when a couple decides to undergo a particular treatment , they would normally be expected to continue it until the desired results are achieved. However, instead of persisting with further attempts, many couples back off after the first cycle failure. They do not want to go in for another cycle - and some even start thinking of surrogacy.

It is true that patients get a major financial setback when the first cycle of IVF fails to deliver results. IVF is an expensive treatment. Every cycle involves various costly medications and procedures. Not all the patients can afford to repeat the expenditure in the second cycle. In such cases they are forced to simply abandon their hope of doing IVF and they then try to find out other cheaper options, which may not be as effective.

Sometimes the mental stress of IVF becomes too much for the patient to handle. They are emotionally exhausted by the ups and downs before, during and after the in vitro fertilization cycle. The prospect of facing the same emotional rollercoaster ride does not appeal to them. An unprepared patient cannot cope up with the stress of failure , and gives up.

In a few cases , the media and the doctors are responsible for demoralizing the patient.  The media highlights only the positive aspects of IVF and presents a host of success stories. They do not explain the failure rates and thus paint an incomplete picture in front of the patient. Some doctors make the same mistake. They conduct lengthy discussions about the success rates of IVF and seem to ignore the chances of failure. All this contributes to the patient having false beliefs about the outcome of the outcome. When the cycle fails , they are not able to handle it well , and buckle under the pressure.
These problems can be overcome by empowering the patient with the correct knowledge of IVF, and good counseling can make a world of a difference !

IVF is not a one time hit or miss treatment, and patients need to be prepared for the fact that they may have to undergo more than one cycle to achieve a pregnancy.


Not sure what to do now that your IVF cycle has failed ? Please send me your medical details by filling in the form at www.drmalpani.com/conversations so that I can guide you better !




Monday, February 24, 2014

Reflections of an Indian Cancer Surgeon by Dr Luis De Souza


Reflections of an indian cancer surgeon from Aniruddha Malpani

HELP is very happy to share this great book by a senior Indian surgeon. Though Indian doctors have a wealth of clinical experience and a lifetime of wisdom, sadly we do not take the trouble to share this with others. This is a gem of a book, and we hope more doctors will follow Dr De Souza's footsteps. We are happy to help ! 

Should I freeze my eggs ?


We are increasingly seeing a different kind of woman  in our clinic these days. They are not infertile. These are women who are in their 30s, who want to learn more about testing and preserving their fertility.  They are not interested in getting pregnant right now - and some of them are not even married. However, they just want to ensure that by postponing child bearing in order to pursue their career, they are not risking their future fertility.

This is because these are smart, well-informed women, who have done their homework for themselves. They are finding out that some of their friends are having problems conceiving and they are worried that they may find themselves in the same boat., These women know that they have a biological clock which is ticking away, thanks to the internet.

Interestingly, a lot of them are being sent to us by their parents, who want to become grandparents at some point, before their daughters run our of eggs all together ! They would like them to complete their families when they are young , and have good quality eggs, rather than risk damaging their ovarian reserve  and then having fertility issues later on , because they chose to pursue an MBA or went off on a plum overseas assignment or promotion.

Young woman are aware of the fact that it's hard to have your cake and eat it too , and they often need to make difficult decisions , involving trade-offs between pursuing further education or having a baby . A big problem is that they because they are highly educated, affluential and very smart, they are finding it increasingly difficult to find men who meet their high standards. They are forced to postpone marriage, because their just aren’t enough good guys around !

The good news is that these women are now empowered enough to make well-informed decisions for themselves. In the past, they were forced to depend on their doctor, and  sadly a lot of doctors were quite clueless about the importance of testing for ovarian reserve.  This is true , not just of family physicians, but of many gynecologists as well, most of whom are much more interested in delivering babies and taking care of gynecological problems , rather than preventing fertility problems, Also, because fertility preservation is such a new field, most doctors still don’t know much about what is involved.

Thanks to advances in technology , it's quite easy for young women to test their ovarian reserve themselves. This just needs a vaginal ultrasound scan, to check the antral follicle count ; and a blood test to measure their  AMH level. These tests are easy and inexpensive , and interpreting them is straightforward. However, what to do with the information they provide is a decision women need to make for themselves. Some may decide to defer doing the MBA, because they believe that a baby is worth much more than an MBA.  Others may find the information reassuring, so they are more comfortable about taking the promotion , because they feel they have enough time to postpone childbearing.

The even better news is that we now have technological solutions , so that we can actually stop the biological clock . We can do this by freezing the eggs , so that it’s possible for women to have their cake and eat it as well – biology is no longer destiny, and this technology can empower women to puruse both a  career and a family without making any compromises.

It's important for young women to do their homework for themselves , so that they make well-informed decisions . They should have no regrets later in life, .Egg freezing is now robust technology with excellent results. It does not involve any surgery, and has no risks if done in a good clinic. If you can afford it, I’d suggest it’s a biological insurance policy which is worth exploring !

Want to learn more about egg freezing ? Please send me your medical details by filling in the form at www.drmalpani.com/conversations so that I can guide you better !

Saturday, February 22, 2014

Minimising the risks of IVF


The outcome of IVF , like any other biological procedure , is uncertain. The definition of risk is the possibility of an undesirable outcome , so patients need to evolve strategies which allow them to deal with the risks of IVF . There are basically two sets of risks. First, is the medical complications associated with IVF , which are basically the risk of ovarian hyperstimulation syndrome ( OHSS ) and that of multiple pregnancy . The good news is that both these complications can be prevented, which is why you should choose a good IVF clinic which is experienced in dealing with and managing these problems . These risks are easy to manage , because there are well defined medical strategies to deal with them. A good IVF clinic  will inform you about these risks , so that you can discuss them with your doctor.  Thus, one simple way of preventing multiple pregnancies is to do a single embryo transfer ( SET).

However, there are additional risks associated with IVF , which it's not possible for the doctor to control. This is where the role of the patient becomes extremely important . The major risk is emotional – the risk of having to cope with the fact that the IVF cycle may fail . Now a lot of IVF clinics harp about their success rates and reluctant to talk about their failures. However, remember that for every cycle that succeeds , there are cycles which fail. This is a fact of life which we can't afford to gloss over .

It’s important that patients come to terms with this . If you have realistic expectations, it makes it much easier to manage this risk.  Taking an ostrich in  the sand attitude and pretending that your personal chances of success are going to be 100% can only lead to heartbreak.  This is why information therapy is so important , so that you can prepare yourself for any possible outcome. Being mentally prepared for what you will do in case the cycle fails can only make you emotionally more resilient. A failed IVF cycle is not the end of the world and doesn't mean that you can never have a baby . It just means that this particular attempt has not worked, but hopefully you will learn from this particular cycle , and improve your chances of success for the next attempt. Remember that when we talk about IVF success rates , these are cumulative conception rates, over 3-4 cycles.

The most important thing can do to reduce your risk of failure is to choose a good IVF clinic , because the major difference between good clinics and bad clinic is the difference between their success rates . The problem is that's not really easy to get accurate figures as to what your individual clinic’s  success rates are – and what your personal chances of success are likely to be.  It’s often hard to make sense of these figures , because it's possible to game them. Even in countries like the US and the UK, which are required by low to report and publish their success rates, it’s possible for clinics to dress these up ( for example, by refusing to treat difficult patients; or by cancelling cycles for poor responders). This is why you need to use your common sense and use surrogate markers to judge a clinic’s success rates – especially in India, where clinics do not report their figures.

Since the major variable which influences IVF success rates is the ability of the clinic to produce good-quality embryos , IVF clinics which routinely provide you with photographs of your embryos are far more likely to have good success rates, as compared to those which don’t ( presumably because they have something to hide ?)

While it's true that IVF is be a complex expensive procedure , which is fraught with the risk of failure , it's also true that the upside is enormous because it's the one treatment option which gives you the best chance of having a baby . For lots of infertile couples , IVF is definitely a risk worth taking, but you need to go into this with your eyes wide open , so that you don't burn your fingers.


Need help before doing IVF ? Please send me your medical details by filling in the form at www.drmalpani.com/conversations  so that I can guide you better !

Friday, February 21, 2014

How to prevent embryo mixups in IVF


 
The biggest fear that IVF patients have is that the lab may mix up their embryos with some other patient's.  If the embryos get mixed up , then their embryos may go to someone else ; and they will receive someone else’s. This is a valid concern, and embryo mixups have been well documented, even in  the best of IVF labs.

This is an IVF clinic’s major nightmare as well, and because they are aware of this possibility, good clinics develop lots of safety checks , safeguards and processes , to prevent this from happening.

Since every patient’s embryos look like every other patient’s embryos , it’s very important that each dish is prominently identified with the name of the patient, so that the embryologist knows exactly who's embryos he is looking . This is why UK clinics use the system of witnessing, where two independent embryologist cross check and verify the name on each dish , every time it is handled.

This is also the reason why companies have come up with clever systems to allow for the automatic identification of the labels on the dishes, using RFID, to prevent errors which may occur as a result of mixups because of human error. This is also why most good clinics have a rule that only one procedure can be carried out at one time , so that one embryologist is handling only patient’s eggs or sperm or
embryos at one time.

However , there are certain high-risk settings when the probability of a mixup becomes extremely high. This is especially true when many patients being treated simultaneously.  This is very common in programs which batch their patients and do about 20-30 embryo transfer in 1-2 days. While these clinics take pride in being able to treat so many patients so efficiently . the truth is that when such large numbers and being processed in an assembly line setting, there’s lots of stress , and the pressure of time makes the likelihood of errors much higher.

The scope for errors goes up dramatically , because it’s hard to ensure that safety checks and processes are being properly followed when there are so many patients to treat in such a short span of time. It’s tempting to take shortcuts ! This is especially true, when doctors take more than one patient in the OT, so that there are more than 2 embryo transfer being done at the same time. This is a disaster waiting to happen !

The chances of the wrong embryo going into the wrong patient is extremely high in this setting. I have a suspicion that this may be happening inadvertently many a time, and lots of patients ( and sometimes even their IVF doctors) may be completely unaware that the baby they have given birth  carries someone else’s DNA !  Fortunately , because most Indian babies look alike , most of these problems never ever come to light.

As a patient, to protect yourself from this hazard, you must insist that the clinic you go to follows the recommended safety checks ; and that only one embryo transfer is done at one time. This is important so that you can be sure that when you do get pregnant after IVF , the baby has been created with your embryos , and not with someone else's !





Thursday, February 20, 2014

How do I interpret my ovarian reserve test results ?



Modern IVF technology is very effective, and we are every good at making embryos , no matter how poor the sperm quality . The biggest challenge we encounter today is treating patients with poor ovarian reserve, because poor quality eggs result in poor quality embryos.

However, there’s a lot of confusion about testing ovarian reserve and egg quality. Just because a woman has poor ovarian reserve does not mean she will necessarily be infertile.  After all, all testing has its limitations and flaws. Just like men with low sperm counts can father a pregnancy if their spouse is super-fertile , similarly young women with poor ovarian reserve can conceive on their own, if their husbands have excellent sperm count. Fertility is a complex issue, which is impacted by many biological variables, and it’s hard for anyone to predict future fertility for an individual couple.

So what does poor ovarian reserve mean ?  Does this mean there aren’t enough eggs ? Or that the egg quality is poor ? Or does it mean that both the quantity and quality of the eggs have taken a hit ?

In the past, the only way we had of assessing ovarian reserve was based on the patient’s history. We know that older woman have poorer ovarian reserve as compared to younger women; and that endometriosis and ovarian surgery damaged egg quality.

Today, we have better ways of testing ovarian reserve . These include : blood markers for egg quality; vaginal ultrasound ; and the clinical response to treatment. Let’s look at these one by one.

For many years infertility specialists used Day 3 FSH levels to test for ovarian reserve. The trouble with this test was that FSH levels depended on which day of the cycle they were drawn. They often varied from cycle to cycle, and were not reliable, as they were suppressed by the estradiol in the blood. The clomid challenge test was more reliable, but never became popular.

A recent advance has been the AMH test. This is a simple and inexpensive blood test , for checking AMH levels. The problem is that this is a relatively new test, and we still don’t have enough clinical experience with it. Also, while it’s great for assessing groups of women, like any other test, it has limited predictive ability for the individual patient. Also, many labs do not provide trustworthy results, because of poor quality control, and patients often get confused.

A better test is checking the antral follicle count , using vaginal ultrasound scanning. While this is a very useful when done in a good center, many doctors are still not expert at doing this scan and do not report it properly. The AFC does correlate fairly well with ovarian reserve. However, the problem with this test is that we are not interested in follicles – we are interested in the quality of the eggs , which are inside the follicles and which cannot be seen by ultrasound scanning , because they are microscopic. This means that all our tests provide indirect assessments of egg quality, which is why interpreting them can be so tricky.

While good doctors will combine these results to counsel the patient, please remember that we can only provide a rough probability as to how many eggs you will grow.. Test results don’t allow doctors to become fortune-tellers – and there will always be patients who surprise us !

In the final analysis, the proof of the pudding is in the eating , and the clinical response of the patient to superovulation is the best test for ovarian function. This is why an IVF cycle can provide such valuable diagnostic information about egg quality. It allows us to directly assess the eggs, because we can actually check these in the IVF lab after retrieval; and this is the only method which allows us to check the functional competence of the eggs,  because we can see how many of eggs go on to form good-quality embryos . While this is very helpful in a good IVF lab, sometimes even the results of an IVF cycle are invalidated because of a poor quality IVF lab, where even good quality eggs may fail to form good quality embryos, because of poor lab conditions.


Wednesday, February 19, 2014

How good is your IVF doctor ?


One of the biggest fears for any infertile couple is that they may end up taking treatment in an IVF clinic where the doctor is incompetent; or the embryologist is not skilled; or the equipment is not properly maintained ; or the quality control standards are inadequate; or the doctor is not available because he is travelling all the time, and the care is delegated to inexperienced assistants and juniors, who do not know much.

It’s perfectly normal to  have these worries and concerns, because of the cloak of secrecy which shrouds most IVF clinics. All their websites look exactly the same , but there is a lot of difference between the success rates of the good clinics and the bad ones. This is the reason why infertile patients spend so time, money and energy on trying to find the best doctor. While they understand that the outcome of the IVF cycle is not in their hands , and that there are lots of things which they cannot control , they also know that the one thing which they can control , and which can have a significant impact in influencing their chances of success, is finding the best possible IVF doctor.

Thus, while the patient cannot make herself younger, she knows that her chances of success will go up dramatically if she selects an IVF clinic with a high success rate, as compared to  another IVF clinic which may provide less expensive treatment , but which has a lower success rate . A bad choice can end up wasting precious time and money, and reduce her chances of getting pregnant .

The million dollar question is  - How do you judge how good your IVF clinic is ? Now, since every patient does their best to find the best clinic, every patient feels her IVF doctor is the best – after all, if she didn’t, they would never do an IVF cycle in that clinic.

This is a hard question , simply because doctors come in so many different shapes and sizes, and this is true for patients as well . Patients have different personalities and different needs, and each patient needs to find a doctor  who matches what you are looking for ! Do you need a high tech clinic, which does a lot of cutting edge research ? Do you want one who specializes in treating celebrities ? Do you want one which has a high touch, personalized approach ? Do you want one which is the cheapest ?

However, the one thing which is not negotiable is that you must insist that your IVF clinic routinely and proactively provides you with photographs of your embryos . No matter how great the reputation of your IVF doctor; no matter how charming he is ; no matter how attractive his website is; and no matter how many patients swear by his results, this is the one sine qua non of a good IVF clinic.

The only thing which IVF clinics do is create embryos in the lab, and your chances of success depend directly upon the quality of the embryos which the doctor can create for you. Once the doctor has transferred your embryos back into your uterus, whether they will implant or not is not something which he can control, because this is an in vivo biological process . However, good quality embryos have a much better chance of implanting.

The problem is that the reason for IVF failure can be very hard to determine failure can conceal a multitude of sins, including a poor quality lab. If your IVF doctor routinely provides you with photos of your embryos, not only does this prove that he has confidence in his skills, it also means that you can show this documentation in case your cycle fails and you need a second opinion . You should insist on embryo photos before the transfer. This is the one thing which empowered IVF patients should ask for, if they want to make sure that they have found the best possible IVF doctor for themselves.

Will your doctor get upset if you insist on photos of your embryos ? Good clinics do this routinely anyways, so they will be happy to do so . Bad clinics will get upset – but then why do you want to take treatment at a bad clinic ?


Need help in making sure you are getting the best IVF care possible ? Please send me your medical details by filling in the form at http://www.drmalpani.com/conversations so that I can guide you better !

Tuesday, February 18, 2014

Using Information Therapy to Put Patients First - free book !

Our very special delivery......Mumbai to UK...

I married late in life at the end of 2008,  aged 39. so starting a family straight away was important to me, as I knew my biological clock was ticking.  I fell pregnant at the end of 2009, we were so happy that it ad happened but to our devastation, this pregnancy ended in a miscarriage at 8weeks .
We were totally heartbroken , but knew that due to my age this was a higher probability for me and not neglected. The following few months were hard , Christmas and the new year passed. But I was determined to carry on and prayed I would fall pregnant again....

A year passed by and month after month , disappointment was all we seemed to get. I was having acupuncture, Chinese herbs, reflexology, taking every supplement under the sun! Then late 2009, I discovered I was pregnant again, once again we were overjoyed, maybe all the complimentary therapies had worked? but this again ended in a miscarriage , 7 weeks.

The pain of suffering a miscarriage was so painful, physically and emotionally, we discussed options of  IVF with the Drs to see if we could improve and speed up our chances, after one persuasion, we were referred to the local IVF clinic here in the UK.

We went through all the checks and tests and  all seemed to be normal, the nurse even suggested
( from the scan checks prior to having the IVF that my uterus looked fabulous and couldn't believe I wouldn't get pregnant on my own. To our surprise as I waited for my cycle to begin and hence IVF could start, I discovered once again I was pregnant , so we thought , maybe third time lucky! But no , 8 weeks later I miscarried, the pain and suffering again felt worse.

I was beginning to feel shattered and exhausted going through each miscarriage that I almost gave up , but carried on with acupuncture and decided to try IVF on our next cycle and as i waited I found I was pregnant again....but you guessed it , I miscarried once again, this time I was 9 weeks , so getting further each time but just not enough for that little bean to stick!

After recovering we saw a specialist at the hospital to discuss my recurrent miscarriages, the Dr carried out tests etc but all came back normal for both my husband and I, so the Dr then suggested Donor  Egg as he thought the miscarriages were likely to be due to my egg quality.
This wasn't the news I wanted to hear but knew this was probably my best option if we wanted to have a family of our own.

After a few months I started to google donor clinics etc but being Asian , the UK had a a very long waiting list ,and you could end up waiting years. So I decided to look abroad and came across Dr Malpani's clinic. Something drew me to his clinic, reading his website gave me real hope and positive vibes. So I filled in the forms and his speedy replies really impressed me.

I suddenly felt there was hope now....

I discussed via e mail with Dr Malpani my options for donor egg and very quickly he found us a donor. So within weeks we were booking tickets to fly out to Mumbai .
My husband had never been to India before so we were excited and apprehensive all rolled into one.

The day we arrived we went to the clinic that afternoon and met Dr Malpani, who made us feel very welcome. The staff all were very helpful and kind. Our treatment began a few days later . Between days 4-9 we had decided to go to Goa ( on Dr Malpani's recommendation) as we were just waiting for the next scan before egg transfer would take pace around day 16.

The trip did us the world of good, and helped me relax. After egg transfer, we continued to relax at our hotel and flew home a few days later back to the UK

The next couple of weeks was simply a waiting game, Dr Malpani reassured me that no matter what i did, those embryos were not going to fall out!

He was right , the day I took the pregnancy test, I couldn't believe it, I was pregnant ! I even didn't believe my blood tests that came back positive. Later that month we went for our scan, and there before our eyes , was our little one, heart beating strongly!!

The pregnancy was tough, I remember e mailing Dr Malpani, that I don't feel pregnant, he replied
' Why do you want suffer from morning sickness?'

Then a few days later the sickness began, and never stopped, but deep down although hard to go through, it was a good sign....9 months later our beautiful daughter was born!

Our special delivery had arrived and we haven't stopped smiling since.

All of this could not have been possible , without the help and support of Dr Malpani and his team, they got us through this, and we are eternally grateful.

Monday, February 17, 2014

Why doctors abandon patients after IVF failure


Patients do IVF treatment with lots of hope. Many have unrealistic expectations of success and are 100% sure the cycle will succeed. This is natural. After all, very few patients would start an IVF  cycle if they weren't convinced ( at least in their heart of hearts) that it would work. They spend hours scouring the net, doing their research and hunting for the best doctor. They cover their bets by going to every temple and church.

Many doctors encourage these false hopes by providing limited information before the procedure. They tend to highlight only the positive aspects of IVF , and conveniently forget to discuss the possibility of failure. This is helpful for them as IVF is a financially remunerative treatment. They paint a rosy picture, talk sweetly and overpromise , in order to snare the patient. It's easy to lure patients who are desperate and emotionally vulnerable.

The bitter truth is that many patients will fail to conceive after IVF treatment. These very same doctors then start ignoring these patients . Patients are understandably agitated and upset after the failure and can be difficult to pacify. However, the doctor starts avoiding them and playing “hard to get”. They refuse to provide them with basic documentation ( such as photos of their embryos) or medical details of the treatment protocol followed. Many even refuse to provide a treatment
summary ! They claim that the clinic needs to keep all the records and refuse to even provide copies. Patients feel  abandoned and even more resentful. They feel they have been cheated.

Many get disillusioned with IVF treatment, and feel it is a big scam. Others will visit other test tube baby centers, to look for better options.  The new IVF doctor can then add fuel to the fire by playing a game of one-upmanship . He points out all the flaws and shortcomings in the earlier doctor’s treatment protocol. Patients are now convinced that the earlier doctor was incompetent, and are happy to sign up for a new IVF cyce with the new doctor, because they are sure he is better. However, if the new cycle fails again, then this leads to another round of the blame game.

To avoid all these hassles, it is important that you keep an open mind before going for IVF, and accept the possibility that there is a chance that the procedure might fail. Information Therapy and realistic expectations will help you cope better with the stress of IVF treatment.


Not sure why your IVF cycle failed ? 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, February 16, 2014

When IVF patients have Unrealistic Expectations


An IVF cycle is often last resort for most infertile couples. They have tried every other treatment procedure  ( often multiple times, with many different doctors), and these have all failed. All their hopes ride on this treatment. The couple invests a lot of physical, emotional and financial resources into doing  IVF. They want it to succeed , which makes them extremely anxious about the outcome. This in turn leads to unrealistic expectations.

The patient ( and her relatives ) start day dreaming about the pregnancy and her future baby. They are not ready to accept the possibility of the procedure failing. In this situation , if the cycle fails the patient is unable to handle the stress. The couple is pushed into deep grief , from which they are unable to bounce back as they never thought this would happen. The false hope that IVF is a foolproof treatment is shattered, leaving the couple devastated. They start blaming the doctor or the test tube baby center and will often seek out a newer ( and hopefully, better !) IVF clinic.

The reason for this is that patients have insufficient and incomplete information about the procedure. They do not have a complete understanding of the method involved, and the factors that may affect the outcome and the success rates. Some doctors often encourage this behavior by providing limited information and quoting false success rates . They tend to highlight only the positive aspects of IVF and conveniently ignore the possibility of failure. Because they want to "grab" the patient, they sweet talk her into signing up, and are very encouraging . They present unrealistic success figures to lure patients. This is helpful for them , as IVF is a financially remunerative treatment. However, if the patient fails to conceive after the treatment, they abandon the patient, who then feels cheated.

Some of them may drop the idea of continuing with next cycle while a few others visit other test tube baby centers. These doctors often play a game of oneupmanship and fuel the patient’s doubts about the first doctor. They point out flaws in the earlier doctor’s ways of treatment, medication or investigations. Patients start thinking that the earlier doctor was incompetent and that the quality of their treatment was poor. They are happy to sign up with the new doctor, but another failed IVF cycle leads to another round of the blame game.

To avoid all these problems , it is important that the patient keeps an open mind before going for IVF. They need to accept that there is a chance that the procedure might fail. This will help them deal with the stress of a possible failure in a better way. Test tube baby centers need to counsel patients properly , so they have realistic expectations of IVF outcomes before the patient chooses to go in for treatment. 

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





Saturday, February 15, 2014

Is IVF Treatment the Only Option for Infertile Couples?


It is a flawed belief that IVF is the final and only treatment choice that an infertile couple has. Sadly, not many doctors at test tube baby centers care to explain this to the patient. But we at Malpani Infertility Clinic make sure that that the patient has a clear understanding of all the options available to her. Most IVF specialists are either too busy or too focused on IVF to offer alternatives. So many patients who undergo IVF seem to do it as a compulsion – they feel that they do not have any other alternative , and are forced to accept this treatment choice.

Every infertile couple who has been advised IVF by their infertility specialist has a total of 4 options to choose from. They include IVF with their own egsg and sperm; IVF using third party options such as donor eggs , donor embryos or surrogacy; adoption ; and choosing to live without a child. All these are valid choices and they can opt for any of the four at any juncture. The patient needs to critically evaluate each of these options before she decides on any one of them. It is important to have an unbiased view of the choices. None of these options are any better than the other. They come with their own set of success rates, challenges and risks. ( Incidentally, there are three more unconventional paths which include : continuing to try natural conception; remarriage ; and praying for divine intervention. These are some of the other off the track choices available !)

When we explain these alternative options to patients, they feel that we are being pessimistic and think they have a very low chance of success, which is why we are discussing alternatives right from the start. However, they need to realize that IVF is just one of the may options available to them – and they need to select what feels right to them.

When the expertise of patients is more useful than the expertise of doctors


I have a good friend, who’s trying to do his best to stop smoking , with little success. I suggested he try using e-cigarettes , and I did a lot of research on their efficacy online . We also spoke to his physician, who agreed that e-cigarette should help him, as they have been proven to effective alternative nicotine delivery systems. However, when it came down to the real life nitty gritty practicalities , such as which model to buy, he didn’t have any advise to offer, since he wasn't a smoker himself . He suggested we look for additional resources online , but when I did so, it very hard to find out what the differences between the various models were. The prices ranged from Rs 2000 – Rs 10000 – and it was hard to know whether the more expensive models offered better value for money.

One my patients actually imports e-cigarettes, and he kindly agreed to accompany me to my friend’s house, so he could walk him through his options. After all, just buying the e-cigarette would not help – he would have to use them daily, and changing behavior is the hardest thing in the world to do.

I was very impressed when he started demonstrating the different types of  e- cigarettes and their features to my friend. The key it seems is not so much the e-cigarette itself, but rather the favoured nicotine solution which it uses, to give the user the “nicotine kick”.

My patient used to be a chain smoker himself , and when he found that using e-cigarettes had helped him to kick the habit, he decided to start a company to sell them ! He knew all the ins and outs of the market because he was an actual user himself. Since he had been a smoker himself, he was much more empathetic towards my friend’s plight, and had answers to all his questions about how to manage his cravings and how to make the switch from regular cigarettes to e-cigarettes.

This was extremely valuable information , which we could never have got from any other source. He explained to us that it's not just the hardware of the model which maters – it’s software it uses - the nicotine solution , which is used within the e-cigarettes , and which come in over 1500 flavours and strengths ! There were many different models available , some of which were very classy looking and stylish, so that they were easier to carry, but they had a much smaller capacity and a shorter battery life, which meant that they needed to be refilled and charged more often.

He encouraged my friend to try different models , so that he could see which one suited him the best, because this is the one he was much more likely to actually use in his daily life., My friend had lots of questions – for example, how and why e-cigarettes were better than regular cigarettes ( they do not contain the carcinogenic tar which regular cigarettes do).

Since my patient was using the e-cigarettes daily himself, he could answer all these questions with a lot of confidence . Even better , he was able to empathize with my friend , because he had “ been there , done that “.

What I learned is that while doctors are medical experts, expert patients have much more practical , real-life knowledge and wisdom to share with other patients. We need to tap into their expertise , so we can other patients like them get better medical care . There is no reason why this kind of networking should happen only online through support groups . Doctors themselves can help connect newbies with expert patients, so they can learn from them,.

By listening in on these conversations, not only can doctors learn a lot about the daily difficulties their patients face, they can also learn more about how ingenious some of the solutions which their patients come up with can be. This will help doctors to respect their patients even more !

This kind of networking will save the doctor a lot of time; improve his efficiency ; and help improve patient compliance as well. The good news is that expert patients are very happy to help others – and are quite honoured when their doctor asks them for help ! This can set up a  positive virtuous cycle !

Friday, February 14, 2014

Doctors need Intelligent EMRs


There  is no question that electronic medical records ( EMRs) can be very useful. They allow doctors to take much better care of patients , because they allow him to record all the important medical information he needs– and he can review this whenever he wants - even from his smartphone. Knowledge is power, for everyone - the doctor; the patient; caregivers; and the healthcare system. However , what seems to be a great solution in theory often falls flat in the real world – especially when the amount of noise contained in the EMR drowns out the information it contains. Most doctors hate EMRs, because they are so difficult to use – and the reason for this is that they were originally developed as tools to enhance revenue collection , rather than to improve medical care.

The problem with today’s EMRs is that they are template based. This seems to make sense, because each template is designed for a particular specialty. Now while the template works very well for the particular expert who designs the template, it does not work well for other doctors, each of whom has a different personal style. They now need to relearn how to enter data for their patients into this EMR, and most doctors hate this

Not only does this reduce their productivity because of the learning curve, they also need to change the way they take a history. This is a huge challenge, because it’s hard for doctors to change their clinical habits. It’s also very unfair to expect them to do this, which is why so many are so resentful about the fact that they are being forced to use EMRs.

All doctors would happily use an EMR which they can modify in order to suit their personal style. While all EMR companies promise that it’s possible to customize the template, in real life this is a huge pain. The doctor has to raise tickets and send these the IT dept for any changes, and these tweaks cost time and money. Most just get fed up and give up. Even worse, the mindless templates create a tick box mentality, so that doctors start focusing on completing the EMRs expeditiously, rather than providing high quality clinical care. Documentation starts detracting from the patient and hurting  the quality of care, rather than enhancing it.

The truth is that EMRs are not user-friendly because they don't respect the individual doctor’s work
flow . EMRs are designed by software engineers , who treat doctors as being intelligent . They believe that once they’ve given them an efficient software tool - a  software program which has been proven to work well in one clinic - then doctors should be smart enough to change their habits and start using the program , so that they can achieve the same degree of efficiency and productivity in their own practise. They just cannot understand why doctors refuse to invest the time and energy in learning how to use the program properly and blame them for being uncooperative. However,  doctors are creatures of habit , and they hate being forced to change .

Rather than force doctors to change their habits, it makes far more sense for engineers to spend time and energy in making the EMR more intelligent , so that it can adapt to the doctor’s personal style. The good news is that computer technology has now become increasingly clever , so it can anticipate and adapt to the user’s needs. Amazon and google do this all the time, as they learn more about my personal preferences, so why can’t  EMRs do the same ? As Om Malik says, we seem to be entering the ‘Era of Magical Computing’ — a “growing movement to anticipate the computing we want to do–and do it for us.”

This personalization and anticipation will allow EMRs to become much more usable; and allowing this kind of learning will set up a positive virtuous cycle, because the more the doctor uses the EMR, the more it does what he wants it to ! The doctor will be able to complete the record much sooner, because this has now been tweaked to his personal preferences. Software engineers need to remember that doctors are knowledge workers , just like they are ! They have their personal quirks and idiosyncrasies , and we need to respect and honor these.

A great real life example of this is SwiftKey, which is a keyboard tool that autocorrects and offers bespoke next-word predictions. SwiftKey Flow offers the “ mind-reading capabilities of a personalized prediction engine with the convenience of data entry on touchscreen devices “ . Using this tool, it’s possible for the EMR to know with high probability what the doctor is going to type in next.  The trick is not to force doctors learn new skills and new software programs, but to make the programs more intelligent , so that they can adapt themselves to the way the doctor works.

PraxisEMR has also done a great job of implementing this. Effectively, each doctor creates his knowledge base in the process of practicing medicine, consistently improving the speed of documentation with each additional case. It’s simple – but not easy !

The good news is that now that most EMRs are hosted on the cloud, it’s possible to use anticipatory computing and adaptive learning, so that the EMR gets modified and customized transparently and painlessly on the fly for each user, without having to involve the IT dept at all !

Thursday, February 13, 2014

Why I can be critical of other doctors

Dr Aniruddha Malpani, an IVF specialist and a strong advocate of patient therapy often breaks omerta – the professional code of silence that most doctors have about their peers. He tells us exactly why it bodes well for the entire healthcare system if doctors start being more straightforward and honest, which will include criticism of their peers. 

I can be quite opinionated and having strong feelings about why and how doctors should be open and transparent when treating patients. This is why , when I review the medical records of patients who have done IVF cycles in other clinics , and find that they do not have photographs of their embryos , I get upset and tell them that any IVF clinic which doesn’t routinely and proactively provide embryo photographs is not a good clinic in my book. Poor quality documentation often suggests poor quality medical care. Many patients get very agitated and upset when I say this, and I can understand why. After all, when you take treatment with a doctor, you do establish a relationship with that doctor, and are naturally upset when the doctor is being criticized (by a new doctor, with whom you have no relationship. Patients do quite a lot of homework before deciding which IVF clinic to go to, and they would rather believe that they made a good choice. You want to continue to believe that your choice of doctor was a good one, which is why patients often become defensive when I am frank and forthright. Read more at
http://health.india.com/healthcare/why-i-criticise-doctors-n214/

Why you do not need Bed Rest After Embryo Transfer


Embryo transfer is a simple process during which the doctor transfers your embryo into your uterine cavity using a hollow fine plastic sterile tube called an embryo transfer catheter . The embryo then may or may not get implanted depending upon various factors. The implantation process is a natural biological in vivo process, which requires hormonal and chemical factors from both the embryo and the endometrium to work in harmony. There are no external elements which are proven to influence this process.
Bed rest after the procedure is a myth believed by many IVF patients and also prescribed by some doctors. Patients are afraid that if they walk around, the embryo may fall out. This is completely untrue as embryo implantation is unaffected by gravity. Patients naively believe that because the embryo has been transferred artificially, there is a risk of it falling out through the transfer track.

Our bodily systems are designed well and they work smoothly . They are not affected by walking, running, coughing or sneezing. Embryo transfer in an IVF cycle is just an assisted method. We do not change nature’s way of working. The process of implantation will continue as it is designed to, whether the embryo has been transferred into the cavity through a cather, or whether it reaches the cavity after spending 3-4 days in the fallopian tube ( as it does during natural conception) . In most cases of natural conception, the woman does not even know of her pregnancy for quaite a few days, and so continues her normal routine. This does not harm her embryo in any way. The same is the case after IVF treatment.

Strict bed rest would cause more harm rather than help the patient. Lying down is unnatural for human beings and so has adverse effects on the body. Taking a bed pan for bodily needs would be a reason for considerable embarrassment for the patient. Another problem of bed rest is that when lying down, the patient tends to keep thinking of the outcome. It is normal for the patient to be apprehensive of the result but with nothing to do during bed rest, the IVF patient tends to ponder on negative thoughts far more often. A compulsion to lie down can also be demoralizing for the patient. Bed rest can actually create stress !

Some doctors may advise bed rest after an IVF cycle. But this prescription is just a part of the ‘blame game’. These doctors tend to victimize the patient if the results do not come out favorably by saying that she didn’t rest properly. Patients need to understand that they are allowed to do light work after the embryo transfer. After 48 hours, they can go about their normal duties without any fear.

Enforced bed rest after embryo transfer in an IVF cycle is neither essential nor helpful; and patients should continue their normal routine after the procedure.  If your doctor advises bed rest after your embryo transfer, you need to find a better doctor ! 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, February 12, 2014

Confused by Dr. Google ?



Infertile patients are thirsty for information  and they spend a lot of time online, exploring their treatment options . Ideally , patients would be able to get all the information they wanted from their doctor. However, doctors can be very busy, and many are not very good at simplifying and explaining stuff to their patients. This is why many infertile women will spend hours on the net, scouring the web for the latest research and the best clinic. They want to find reliable information, which will help them to identify the best IVF doctors and the best treatment protocol, so that they can maximize their chances of getting pregnant .

While this is a great idea in theory, sadly sometimes the results of this search leave a lot to be desired. Information on the net is not regulated , which is why it can be of widely varying quality.  This can leave many unsophisticated patients even more confused. When patients use Dr Google for help, they often end up getting perplexed because it can be quite frustrating to find the elusive needle in the haystack !

There are tons of websites – but often the information one provide contradicts what other websites say, and the patient is not sure whom to trust . A lot of the sites which rank high on google are commercial sites, which are trying to sell their herbal supplements or fertility kits. Because these sites are out to make money, they spend lots of money on making sure they appear on the first page of google, which means they are easy to find, but this does not make their information trustworthy !

Even information on IVF clinic websites can be diametrically opposite from each other  - especially when it comes to controversial areas such as immune testing for NK cells, for example.  Also, many websites just copy and paste content from other websites, and thanks to this plagiarism, it’s hard to judge which clinic is better than the other.

While a lot of the information online comes from patients ( on forums and blogs) , you don’t know how much of an expert the patient really is. Is she just going by her personal experience ( which doctors call an anecdotal success story), or has she really done a lot of research and is then distilling her wisdom to share with others ?

Searching for information often becomes an obsession, and many women spend hours on end online. This creates a lot of resentment among their husbands, most of whom believe that a little knowledge can be dangerous, and that medical decisions are best left up to the doctor.

Mother in laws often pooh-pooh the results of these searches, because they feel the patient is trying to play at being a doctor. This search just seems to be adding to her stress levels , rather than reducing it.

Doctors can also get quite irritated by internet positive patients, who bring pages of printouts of information which are obsolete or incorrect.

If you are confused by Dr Google, and your doctor is not willing to help you work through your doubts and confusion, here’s a simple solution !

Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm , and I’ll be happy to provide you with my opinion . This opinion is free , and comes with no strings attached . If I can help infertile couples to have a baby thanks to the fact that I'm willing to share my knowledge with them, I would be more than happy that I am fulfilling my duties as a good doctor !

Why Surrogacy is usually not Helpful in older women with Repetitive Implantation Failure


A successful In Vitro Fertilization cycle requires many factors to work harmoniously. These include a few good sperm, good eggs, and a smooth transfer of good quality embryos into a receptive uterus. After the transfer of the embryo into the uterus, the process of in vivo implantation may or may not occur. Many aspects like hormonal levels, genetic predisposition plays a role in this. Unfortunately, in the case of some couples the embryo fails to implant. It is tough for the couple to accept the failure and move on.
Many women start fantasizing about the baby after the embryo transfer. Some even start referring to their embryos as their babies or embies . When the doctor is happy with the transfer and the uterine lining, and describes the embryos as being Grade A, they start assuming that their cycle is bound to succeed, and start planning for their birth. However, when the embryos do not implant, it is difficult for the couple to come to terms with the failure . 

Some of these patients change clinics in search of a better doctor, because their IVF specialist fails to explain the possible reasons for the IVF failure and the next course of action. Some doctors start ignoring these patients. They are understandably confused about what to do next .

Many couples start believing that surrogacy is their best option. The logic is that if the embryo is of good quality and yet the procedure failed , then this means the uterus is at fault. The woman blames her uterus for rejecting the embryo. They come to a conclusion that using some other woman’s uterus would ensure implantation and continued pregnancy.

This logic is completely wrong. The assumption of a faulty uterus is baseless. The uterus cannot immunologically reject the embryo. If the embryo fails to implant after in vitro fertilization then it is far more likely that it is the embryo which is problematic , rather than the uterus. The uterus is usually just a passive recipient. Many times, it is a genetic defect which stops the embryo from implanting. This defect is mostly undetectable , even with today’s technology. Surrogacy would not help in these cases.  For older women, the problem is far more likely to be a result of poor egg quality; and donor egg IVF would give them a far higher chance of success.

Confused as to whether you should explore surrogacy or donor egg 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, February 11, 2014

When your doctor says - I do not know !

Doctors are medical experts and spends years learning medicine. They are meant to have mastered their profession, which is why many patients consider doctors to be omniscient. Therefore, when the doctor’s answer to their questions is– I do not know, they are often taken aback. Many are not sure what to do, and some of them jump to the conclusion that the doctor can’t be very competent or well-informed, if he cannot even answer a patient’s simple questions. They promptly start looking for another doctor, who can give them the answers they need. Actually, it’s only a very confident doctor, who has high self-esteem and is sure of his expertise, who will give this kind of answer!


Read more at
http://health.india.com/healthcare/what-your-doctor-means-when-he-says-i-dont-know/

Why you should not do routine hysteroscopy before IVF


Many IVF specialists perform hysteroscopy routinely for all patients who are undergoing IVF treatment . I think this is a big mistake .

Now I understand why hysteroscopy is recommended. In order to achieve an IVF  pregnancy , the doctor needs good eggs; a few sperm; and a normal uterine cavity. Hysteroscopy is a very effective way of evaluating whether the cavity is normal or not – and is considered to be the gold standard for this indication. Hysteroscopy is a simple and relatively inexpensive procedure , which does not require hospitalization. From the doctor’s perspective , it’s a “ minor “ procedure , which is why they are happy to do it for everyone who comes to them. After all, they need to be thorough and meticulous in their evaluation !

Sadly, no procedure is ever minor for the patient – and they still do need to spend out of their pocket for this surgery. The fact is that most routine hysteroscopies done prior to IVF turn out to be completely normal – which means the procedure was never needed in the first place, because it did not provide any useful information for that particular patient, and did not change their treatment plan at all. While patients are very happy that the results are normal, the truth is that they wasted time and money in doing unnecessary surgery.

A simple rule in medicine is that if we can get the information we need by doing noninvasive tests , then it’s not justifiable to do a surgical procedure to get that same information . Noninvasive tests are much simpler, kinder, easier and cheaper ! Thus, if a vaginal ultrasound scan shows that the patient has a trilaminar thick uterine lining , we know that the hysteroscopy is going to be normal, and there’s really no point in doing at all ( except to maximize the doctor’s profits).

Ideally, IVF doctors should do hysteroscopy selectively – only for patients whose endometrium is abnormal on the vaginal ultrasound scan . This makes sense, because the chances of finding an abnormality are much higher in this small group. It is not a good idea to mindlessly subject a lot of patients to an unnecessary surgical procedure , simply because it is part of the IVF clinic protocol !

What may be profitable for the doctor is definitely not in the patient's best interests . If the doctor advises you to have a hysteroscopy , you should push back and ask he first perform a vaginal ultrasound scan to check your uterine lining. If this is normal – especially with the new digital high resolution 3D vaginal ultrasound scanners available today, then there’s no point in doing a hysteroscopy at all.


Sunday, February 09, 2014

The Big Lie - Motherhood, Feminism, and the Reality of the Biological Clock


Tanya Selvaratnam has done a great service to young women all over the world by reminding them in this well-written book that while IVF treatment can provide solutions to infertile couples, it is not a panacea - and not all fertility problems are fixable, no matter how good our technology.

I like her emphasis on education, so that women can be empowered to make the right decisions for themselves !

For me, the biggest tragedy is to see older women who were lulled into a false sense of security by their doctors , because they were misled into believing that they had enough time to both pursue a career and have a baby later on as well. There is a price we pay for every decision we make - and women need to use all the tools available, to make the best decision for themselves, so they have no regrets later on. Don't expect your doctor to do your homework for you !

Not sure if it's safe to postpone having a baby ? Want to know more about how you can test your ovarian reserve ? Or stop your biological clock by freezing your eggs ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !





Saturday, February 08, 2014

Will infertility make you bitter or better ?


The great thing about being an IVF specialist is I get to learn from my patients every day. Here's an inspiring example from the blog of my expert patient, Manju !

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This is a beautiful e-mail I received from a reader of my blog (now my friend).  I wanted to share this e-mail with you all for two reasons: her life is so inspirational; she found meaning after her irreplaceable loss, and she used her pain and suffering to shape her destiny for the better.

She asked me a very soul-stirring question - “What is your memorial to your children?” This is a very thought provoking, life-changing question. Thanks a lot ‘H’ for your kind e-mail; for your willingness to reach out to me; for sharing your story and your wisdom with me. I hope many who go through suffering as a result of infertility will get the courage to infuse meaning to their life when they read your mail.

Please read her story at http://myselfishgenes.blogspot.de/2014/02/giving-meaning-to-ones-own-suffering.html




Friday, February 07, 2014

Myoinositol for treating infertile patients - a reality check



The most fashionable infertility medicine in India today seems to be myoinositol . It is being aggressively promoted in infertility conferences – and lots of “ infertility experts” are describing their clinical experiences with this drug.

PCOD patients were found to be deficient in myoinositol , and studies from Italy showed that treating PCO patients with myoinositol helped to improve their egg quality. It improved their insulin resistance , and some started ovulating after taking the myoinositol. It was easy to take, had few side effects, was inexpensive , and appealed to patients, because it was “natural”.  This is why myoinositol supplementation for patients with polycystic ovarian syndrome has become quite popular.  It does make sense to try this for PCOD patients , and I have no argument with this use.

However, the problem is that once pharma companies realize they have a new molecule for treating ovulatory disorders, they start promoting and pushing the drug for patients who do not have PCOD as well ! Lots of them have got on the bandwagon, and are manufacturing this molecule. Because they are so good at marketing, they sell this under a lot of clever brand names, such as Oosure.

This is a very clever name , because the message implicit in the name is that this supplement improves egg quality. Infertility specialists ( KOLs, or knowledge opinion leaders) are sponsored by these companies to present lectures at medical conferences, highlighting the utility of this molecule.

What is worrisome is that gynecologists start prescribing myoinositol for all their infertile patients with ovulatory dysfunction – even the ones who do not have PCOD ! After all, it’s very tempting to try the “newest medicine” available on all your patients ! Many IVF specialists now routinely prescribe it to everyone who is doing IVF, in the hope that this will help them produce better eggs. After all, it’s not really a drug , it is a natural supplement, so what’s the harm in giving it to everyone ? Even if it does not help, it’s not likely to cause any harm. It’s inexpensive, and easily available ( Indian companies are great at making copycat molecules very cheaply) and it’s so easy to write a prescription – especially for something which the patient has never taken before. The brand name is very seductive, and patients are suitably impressed that their doctor is uptodate and well-informed. Sadly, this kind of overuse and dilution of valid indications for prescribing myoinositol is not good medical practice – and the only beneficiary seems to be the pharmaceutical company .

Thursday, February 06, 2014

What Steps can You take to Manage IVF Cycle Failure?



Whenever a patient comes in for an IVF cycle at Malpani Clinic, it is evident that they have exhausted other treatment options. Their hopes ride on the only treatment left to them – IVF . Unfortunately sometimes they face disappointment with IVF as well, because it ends in a negative outcome. Not many of them can handle this situation and they find themselves in a state of despair and frustration. This causes unnecessary delay in planning out the next course of action, and thus further delaying conception.

A practical plan chalked out earlier might help you during a difficult period. Failures are always tough to tackle but it is better to be prepared. A prior plan will not stop you from being sad but at least you would know how to deal with the sorrow and move on. IVF treatment is not guaranteed. There is always the chance that it might fail once - and in some unfortunate patients, many times as well . It is better to have a plan ready to help you in such a situation.

Readiness for treatment

Other than preparing your body for the procedure, you need to take steps for emotional preparation too. Principally, you should try and get as much reliable information as you can, regarding the treatment procedure. Once you know what to expect, you will be better prepared . It is also important to expect the worst and prepare for it. It is not pessimism if you plan for a negative outcome – it’s just being realistic. This will give you more confidence to face any  result.

Find an IVF Buddy

Friends can be a great support during a medical crisis. They will give you the required warmth and comfort of togetherness . But if you have experienced a failed cycle, many friends might not understand what you are going through. They maybe Clueless about the details of the procedure, the stress it can cause, why it can fail, and what you can do next. In times like this, a person who has gone through the same hell as you have can give you the best support. An IVF buddy, often a fellow patient at Malpani clinic, would be the most ideal companion to help you regain physical and emotional strength.

The silver lining

It can be difficult at times, but you need to train yourself to look at the brighter side . It is true that you failed a cycle, but there is still hope ahead. You need to distract yourself from the negative thoughts flooding your mind. Every patient might have her own way of looking at the outcome. You need to find your own positives and focus on these, for example, how doing IVF helped you learn how brave you are, because you were able to overcome your fear of blood tests and injections !

An IVF cycle failure can cause extreme emotional upheaval in your life, but simple steps , taken prior and after the procedure , can help you cope better .

If you have failed an IVF cycle, and are not sure what to do next, 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, February 04, 2014

Why are doctors so rude sometimes ?

Most of us have had the experience of waiting for hours for our doctor,  who then spends only a measly five minutes , listening to our complaints. In some cases the doctor may even be rude or downright insulting in his/her demeanor. Ever wonder why that happens? Well, Dr Aniruddha Malpani, leading infertility specialist tells you about why some doctors tend to disrespect their patients.

http://health.india.com/healthcare/why-do-doctors-disrespect-their-patients-p214/

What's your experience been ? Do share your best stories - and your worst ones as well !

Monday, February 03, 2014

FM promotes financial literacy and investor education

The FM also stressed the need for promoting financial literacy and investor education by the fund houses, leveraging on technology like banks have done, to reach out to investors in smaller towns and cities, and also to improve corporate governance to attract more investors into the MF fold.

http://timesofindia.indiatimes.com/business/india-business/Restore-trust-of-mutual-funds-investors-Chidambaram-says/articleshow/29792603.cms

I wish the Health   Minister  would also promote health literacy and patient education by health insurance companies ! Or maybe the IRDA Chairman  can do this ?

Health 2.0 conference - Primary Care for a Billion People

I am going to be on a panel at the Health 2.0 conference in Bangalore, talking about Primary Care for a Billion People. The panel will be moderated by James Mathews from Health 2.0 India,

'Cutting-edge' means nothing if we can't use it to design a health system to support a billion people. We're going to tap into some of the most creative minds trying to crack the code on delivering quality healthcare to those who need it.

http://www.health2con.com/events/conferences/india-2014/

My mantra is simple - Patients are the largest untapped healthcare resource, and we need to be able to utilise their expertise. The fact that they are illiterate and ignorant just means that the opportunity is even greater.   This is a huge challenge - which is what makes it so exciting !

Medical Research - The Emperor has no clothes

We trust modern medical science simply because it is a science. After all, isn't it backed by billions of dollars of research ? This is why Western medicine doctors have such a superiority complex as compared to homeopaths and ayurvedacharyas - because our practise is based on sound science , rather than just anecdotal evidence and tradition !

This is why doctors attend medical conferences and read medical journals - to keep upto date with the latest medical research and update their medical knowledgebase. And this  is why patients believe that their doctors are experts - because they understand and can interpret the latest research findings.
 
Sadly, the truth is very different ! A lot of the "research" published in medical journals and presented in medical conference is useless. 

The following article, published by the ex-editor of one of the most influential and prestigious medical journals, the BMJ ( British Medical Journal) is an eye-opener !


Twenty years ago this week the statistician Doug Altman published an editorial in the BMJ arguing that much medical research was of poor quality and misleading. In his editorial entitled, “The Scandal of Poor Medical Research,” Altman wrote that much research was “seriously flawed through the use of inappropriate designs, unrepresentative samples, small samples, incorrect methods of analysis, and faulty interpretation.” Twenty years later I fear that things are not better but worse.

http://blogs.bmj.com/bmj/2014/01/31/richard-smith-medical-research-still-a-scandal/?utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+bmj%2Fblogs+%28Latest+BMJ+blogs%29&g=widget_default

Embryo Photographs for IVF Patients


Many patients come to me for a second opinion after a failed cycle at another infertility clinic. The first bit of information I request them to provide me with are the photographs of their embryos. Some are puzzled by this request. Some say that they were unaware of the fact the IVF doctor is supposed to give embryo photographs ; while others defend themselves by saying they didn’t know they need to get photos of their embryos.

IVF documentation is incomplete without the embryo photographs. The photos are tangible evidence of the quality of embryos produced. Every infertility clinic must have the expertise to produce good quality embryos. The final outcome - whether they implant and grow into a baby or not , is a different issue. Once a good quality embryo is transferred , its fate is not something that any doctor can control. The prime job of an infertility clinic is to make sure that they produce good quality embryos in the lab.

Keeping a record of embryo photos is beneficial for the patient as well as doctor. From patient’s point of view, seeing a good embryo works as a morale booster. The patient undergoing IVF has been going through a lot of stress . She starts getting the feeling that her bodily systems are defective. A good quality embryo gives her the confidence that her reproductive system is capable of working well , even though it may need some assistance. Also the photos are evidence of the expert craftsmanship of the doctor. The patient builds trust on the doctor , based on the transparency of treatment.

In Malpani Infertility Clinic, we routinely and proactively provide every patient with their embryo photographs. The photos form a bridge of trust between the IVF doctor and the patient. It clearly shows that the doctor and his staff have nothing to hide and are completely open about all aspects of the IVF procedure. A doctor may also benefit from this record keeping. If the cycle fails, he can always refer to the photos to confirm the quality of the embryos. Sometimes the patient may go to another doctor for a second opinion. When the second doctor sees the record of photos, he is also assured of the high quality of treatment provided at the earlier clinic. For fortunate patients who happen to conceive after IVF, the embryo photos can adorn the baby book.

Embryo photographs serve the interest of both IVF patient and IVF doctor . They help to build a healthy relationship . If your IVF clinic does not provide you with photos of your embryos without your asking, this is a red flag and you should worry !


If you need help in interpreting the quality of your embryos, please send me your embryo photos and medical details by filling in the form at www.drmalpani.com/malpaniform.htm , so that I can guide you !





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