Friday, November 28, 2014

The importance of documentation in an IVF cycle


IVF cycles don't always go as planned, and this can be frustrating for both doctor and patient. However, even if the cycle fails, all is not lost. The question we need to ask is – what went right? what went wrong ? what did we learn from this cycle ? and what can we do differently in the next cycle, to maximize the chances of success.

In order to answer these questions , we need reliable documentation. We need to know how technically proficient the clinic was and whether the quality of the treatment provided was upto the mark. Please remember that just because the treatment was done at a “good and reputed ” clinic doesn’t mean it was done properly. After all, all patients believe that the clinic they go to is good – otherwise they would never go there for treatment in the first place !

The technical minutiae of the cycle need to be analysed carefully.  Was the superovulation regimen appropriate ? Were the follicles monitored properly ? Was the HCG given at the right time ? Were the lab conditions good ? Were the embryos of good quality ? Was the transfer easy ?

In order to answer these questions intelligently, we need detailed medical information about the IVF cycle, which is why documentation is so important. Good clinics provide this routinely and proactively, but often you as a patient may need to insist on getting copies of your medical records. Remember that your records are your property and that you have paid for these !

You need images of your ultrasound scans, so you can see how many follicles you grew. You don’t need to insist on images of every scan, but it’s useful to have pictures of the mature follicles before the hCG trigger was given . You should also ask for an image of the scan after the collection is over, as this will prove that all the follicles present were aspirated properly. While egg collection is usually an easy procedure, sometimes it can be technically difficult ( because of obesity or pelvic adhesions), as a result of which the doctor may not be able to reach the ovary and is therefore not able to collect any eggs at all. When all goes well, the images don’t matter, but if your doctor is able to collect only a very few eggs even though you had a large number of follicles on the scan, this means that you need to find a more experienced doctor , who is an expert at doing egg collections ( for your next cycle)

If the doctor tells you all your eggs are immature or poor quality ( a reason many doctors will trot out to justify IVF failure), then you should insist on photos of your eggs, so you can get a second opinion from a specialist.

Similarly, if the doctor is not able to find any sperm when doing a TESE , he should give you photos of the dissected tissue as seen through the microscope. If this shows that he was able to recover adequate testicular tubules and there is lots of tubular content, then you can be reassured that the procedure was carried out properly and that the failure was not because of poorly performed surgery.

The most important documentation every IVF patient should routinely demand is photos of your embryos. After all, if you have good-quality embryos , a lot of the other stuff doesn't matter at all.

It is true that if your cycle is successful, then all the documentation is of academic interest ( though you can use it later on to show your child how hard you had to work in order to become a parent !)  However, if your cycle fails, then high quality documentation  can make a world of a difference in helping you to decide what to do next. Since you cannot predict in advance whether your cycle will fail or not, you need to collect your medical records proactively, while the cycle is going on.

Remember that these records are invaluable if you need to change your doctor. These images will allow the doctor to learn from your earlier cycle, so he can make intelligent decisions as to what changes he needs to make in order to improve your chances of getting pregnant.

Why should patients bother about all these technical details ? Isn’t this the doctor’s job ? The sad reality is that lots of IVF doctors don’t bother to share information with their patients. This is why patients need to take a proactive approach  ! You need to take an intelligent interest in your treatment to make sure that you know exactly what's going on .

Sadly, when things don’t go well, a lot of doctors become very defensive . They try to hide stuff , and refuse to be honest and transparent. They provide specious excuses, by saying that it’s “not clinic policy” to give the patient their medical records: or that they don’t take embryo photos as this may damage the embryos ! This is ridiculous and unacceptable . Embryo photos are basic medical documentation , and IVF medical records need to be provided to all patients.




Need help in making sense of your IVF 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, November 27, 2014

TESE which is the best technique ?



Patients with non-obstructive azoospermia ( NOA) can be very challenging to treat if they are not willing to accept the use of donor sperm. Since there is no test to differentiate between partial testicular failure and complete testicular failure, we need to explore their testes surgically, to see if they have pockets of sperm production. If they do have even a few patchy areas of normal spermatogenesis, we can recover testicular sperm from these tubules, and use them for ICSI.

For patients with obstructive azoospermia, we can pretty much stick a needle anywhere in the testes and recover lots of sperm. However , this is not true in patients with NOA,  because even though there is no sperm production in the majority of the tubules, we may still be able to find some sperm ,if we are willing to be patient and to look long and hard.

There are many ways of recovering sperm from the testes, ranging from the simple, noninvasive needle biopsy (testicular sperm aspiration ) , to an open microsurgical testicular sperm extraction, where the surgeon cuts the scrotum, delivers the testes, and then examines the surface of the testes using high magnification with the help of an operating microscope, in a procedure called testicular mapping , in order to look for areas of normal sperm production.

You can read more about TESA at
http://www.drmalpani.com/articles/tesa-testicular-sperm-aspiration


The truth is that if there is complete testicular failure, we will never be able to find testicular sperm, no matter what method we choose. Since we don’t know in advance whether the testicular failure is partial or complete, doctors basically take two diametrically opposite approaches .

There are some andrologists who are extremely aggressive , and will do an open surgical biopsy under the operating microscope for every man . They claim that this allows them to find sperm more reliably, and that this technique can work even in men where multiple needle biopsies may fail. I find this hard to believe .

The fact of the matter is that a closed needle biopsy allows us to sample testicular tubules from multiple sites just as effectively as an open biopsy can. Cutting open the skin doesn't help us to extract more testicular tubules; and examining the surface of the testes through an operating microscope does not allow us to identify where the normal seminiferous tubules are ( since these may be deep within the testes).

I can understand why andrologists prefer doing open testicular mapping . They can charge much more for using an operating microscope – and some doctors will charge over US $ 5000 for this procedure ! A closed needle biopsy is much quicker and simpler ( and kinder for the patient) , but some andrologists claim that it’s not as good as an open biopsy , because it’s hard for them to charge US $ 5000 for a simple needle biopsy, even though the truth is that it’s as effective in recovering sperm, if these are present !

I think we should remember the first rule in medicine – first, do no harm. It makes sense to prefer minimally invasive procedures, rather than doing extremely aggressive surgery. The doctor should start by first doing closed multiple needle biopsies when doing TESE. If he can recover enough testicular tissue from each of these sites, then there’s really no justification to cutting the scrotal skin and doing an open biopsy, because the chances of finding any sperm by doing an open biopsy in these patients is virtually zero. If the needle biopsy is technically easy ( which is usually the case if the doctor is experienced and the testes is firm), and the embryologist is happy with the amount of testicular tubules the doctors has retrieved, then there’s no point in being more aggressive.

More is not always better , and in fact going ahead and unnecessarily cutting open the scrotum and then the testis can actually cause harm, because this can disrupt the testicular blood flow and cause testicular atrophy. Especially in men with small testis , this kind of aggressive surgery can precipitate testicular failure because of the testicular damage the procedure itself causes .

A closed needle biopsy ( which is not the same as a fine needle aspiration !) is much kinder than an open biopsy ; does much less harm, and is much less expensive . However, in the very small minority of men who have small soft testes, where the tissue is jelly-like, we may not be able to extract enough testicular tissue using a needle. In these men, an open biopsy may allow us to retrieve testicular tubules more efficiently than a needle biopsy. However, this is such a small proportion , that it's hard to justify doing an open TESE for every man with NOA.

Confused as to which is the best option for you ? Need help ? 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 !





Wednesday, November 26, 2014

Monitoring an IVF pregnancy



IVF  patients are understandably very excited when their pregnancy test comes back as positive . They   are on top of the world that their IVF cycle has succeeded and that all their hard work and effort has paid off . They now start dreaming about the baby they can look forward to holding in their arms in a few months .

However, the reality is that even though the terrible 2ww has ended, you are now beginning another grueling two-week wait. You still can’t afford to be complacent, because not all pregnancies have a happy ending.

While a positive pregnancy test confirms you are pregnant, you still don’t know if the pregnancy is healthy; or if it is in the uterus. While most pregnancies will result in a baby, we do know that about 10- 20% of pregnancies will fail. This is true for all pregnancies, not just IVF pregnancies. Some IVF pregnancies are at a higher risk for a poor outcome , and this is especially true for older women, who have a much higher risk of miscarriage, as compared to younger women.

This is why IVF pregnancies need to be monitored carefully , to make sure that everything is progressing well.  Initially, serial blood tests are done every 3 days, to check that the HCG levels are doubling; and once the HCG level is more than 1000 mIU/ml, then vaginal ultrasound scans are done to confirm that the pregnancy is in the uterus and is growing well.

IVF patients understandably have many worries when they are pregnant, because this is such a precious pregnancy. They are petrified when they have cramping, or spotting and bleeding, because they are scared they may lose the pregnancy. Ironically, many of them worry even if they don’t have any symptoms, because they believe that all pregnant women are meant to have morning sickness, and that the absence of symptoms means that there’s something wrong with their pregnancy.

When your HCG blood test is positive, this means you are pregnant. However, the initial diagnosis is PUL, or pregnancy of unknown location, which means we don’t know if the pregnancy is healthy or not. The pregnancy needs to be monitored so that you can be reassured it is progressing well. Otherwise, the games your mind will play with you can drive you around the bend !

Some pregnancies are destined to fail. They may end up as a miscarriage, or as an ectopic pregnancy. IVF patients find it hard to understand how they can have an ectopic, especially if their tubes are blocked. Remember that even though we transfer your embryos into your uterus, we cannot stop them from travelling out of the uterus into your fallopian tubes.

Even if you are unlucky and your pregnancy fails, please be kind to yourself. Nothing you can do can affect the outcome, because the commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature’s defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetic abnormalities, because they have “aged” and have genetic defects, which cannot be screened for.

The silver lining in the cloud is the fact that you have conceived ( even though you did miscarry) means that your chances of having a healthy baby in the future are excellent.

Want to make sure your pregnancy is progressing well ? 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, November 24, 2014

Impact of Social media on pharma and doctors in India

Social media for pharma and doctors

Infertility, Artificial Insemination & Surrogate Mother in Hindu Mythology By Dr Devdutt Pattanaik


Dr Devdutt Pattanaik is one of India's leading mythologist. He is also a doctor, and a friend.


He was kind enough to contribute a guest post , which reminds us that infertility treatment in India has a long and hoary past . There is nothing new under the sun !


Having children has always been important since time immemorial, and the continuity of the family unit has been of major significance in Hindu culture. Infertility is a social stigma even today, and Indian mythology is full of stories about what couples have done in the past to overcome their problem of infertility.

Ancient tales hold the key to the unconscious desires of a people. They help us appreciate the fears and insecurities of people who visit state-of-the-art infertility clinics. In this article, sacred narratives from ancient scriptures are explored to understand the importance of fertility in the Hindu worldview.

Debt to Ancestors

The following story of sage Agastya from the great Hindu epic Mahabharata (written 2000 years ago) tells us why Hindus, in particular, and Indians, in general, are so obsessed with children. Besides social factors like ‘someone to take care of me in my old age’, it directs our attention to a profound religious demand for a child, especially a male one.

The sage Agastya wanted moksha¬, liberation from the endless cycle of rebirths. So he broke all social bonds, went to the forest, meditated and performed austerities. He believed that by refusing to succumb to any desire, by refusing to yield to the illusory pleasures of the material world, his soul would break free from the prison that was his body. He spent years mortifying himself. Liberation eluded him. Then, one night, he had a vision: he saw his ancestors hanging head down over a gaping hole. They were crying, “We are trapped in the land of the dead. And there is no hope of escape.” “What can I do to help?” asked Agastya. They replied, “Father children, so that we can be reborn. Help us return to the land of the living so that we too can work towards our moksha. Or else, you will land up in the hell known as Put and suffer there for all eternity. Repay the debt you owe your ancestors.” Thus admonished, Agastya returned to his village, got married, fathered children, and only after they had become independent did he return to the forest.

Hindus believe that all men come into this world burdened by a debt – the pitr-runa (pitr = ancestor; runa = debt). The only way to repay this debt is to father a male offspring. During funerary rites, known as shraadha, Hindu males are reminded of this debt. In the Dharmashastras, Hindu law books written between 500-1000 A.D., it is said that those who fail to repay this debt end up in the Hell known as Put where they suffer for all eternity. Since the birth of a child, preferably male child, liberates a man from his debt, the Sanskrit word for son is putra (deliverer from Put). The daughter or putri is also a deliverer from Put, but to a lesser extent.

Dharma and Karma

Two words that play a crucial role in the understanding the Hindu (as well as Buddhist and Jain) attitude towards life are dharma and karma.


Dharma is essentially duty that must be performed for the sake of social as well as cosmic stability. Failure to do so leads to social anarchy and cosmic chaos. Duty is traditionally defined by one’s inherited caste (teacher, protector, provider, servant) and by one’s stage in life (student, householder, senior citizen, hermit). Producing a child is one’s biological duty applicable all human beings. Those who wanted to renounce the world were only allowed to do so after they had fulfilled all worldly duties.

Men who could not fulfil their biological obligations because of a physical problem (impotence) or a mental quirk (homosexuality) were termed rather derogatorily kliba or napunsaka, sexually dysfunctional non-man. In the Manu Smriti, an ancient Hindu law book, such men were debarred from sacred rituals and from inheritance. Only by producing children, were a man and woman considered biologically fulfilled. It must be remembered, that only after marriage was a man in Hindu society given the right to enjoy worldly pleasures and possess worldly wealth. A king could not be king unless he was married. And an impotent man or a man who could not father a child was not allowed to be king. Hence, in the Mahabharata, when the king Pandu learns that he will die the moment he has sex with his wife, he renounces his crown – his inability to father a child debars him from kingship.

Karma means both action and fate. Hindus (as well as Buddhists and Jains) believe that every action leads to a series of reactions. All creatures are obliged to experience the repercussions of their (conscious and unconscious) actions, either in this life or the next. Thus, every event is the result of past actions. If one is barren, it is because of events that occurred in the past, either in this life or in the one before. A folk story based on the Mahabharata illustrates this point. At the end of a great war, queen Gandhari is informed that all her hundred children are dead. She weeps and seeks a reason for this unfair situation, to which a sage replies, “In your last life, you sat on a stone under which there were a hundred turtle eggs. The eggs were crushed. So the mother-turtle cursed you that you too would experience the loss of hundred children.”

A situation in governed by karma, but one’s reaction to is governed by free will. Astrology helps understand what karma has in store for us. The result of karma can be either endured or it can be modified by certain occult rituals, by the power of holy men or by the grace of god. This is the reason why childless men in India visit temples, go on pilgrimages, seek the intervention of holy men or perform elaborate rituals.

White seed and Red Seed

Why a male offspring is more important to a Hindu (besides social factors) can be traced to certain beliefs. In the Mahabharata, it is said that the soul of a man lies locked in the semen. Semen is the medium through which ancestors slip into the land of the living. The soul in semen is embodied in the womb.

According to ancient Hindu seers known as rishis, within the womb is the red seed known as rajas (the counterpart of the white male seed known as shukra). The rajas wraps the soul in flesh and blood. The shukra, besides being a medium for the soul, is also the source of bones. Thus all living creatures come into being because of the father’s white seed and the mother’s red seed. The former generates consciousness and transforms into the skeleton while the latter creates the flesh.

There is an interesting story in this regard from the Padma Purana. A king had two wives but no children. He asked some sages to make a potion that would make his wives pregnant. He died before the potion was ready. The two widowed queens did not want to waste the magic potion. So the elder queen drank it while the younger queen made love to her ‘like a man’. In due course, the elder queen gave birth to a child, but it was only a lump of flesh. The sages said, “Since no white seed was part of the conception, the child had no bones and no consciousness.” They appeased the gods and the child was ‘repaired’.

Power of the white seed

Indian men are known for their obsession with virility. Virility here refers to many things, physical strength, mental agility, sexual energy as well ability to father a male child. So when an Indian says, “I have less strength (takat kum hai),” he could refer to malaise or lethargy or impotence or inability to father a male child. Here again is an ancient belief that physical strength is reflected in semen strength.

The ancient seers believed that food consumed is transformed in the body into sap (plasma), then flesh, then blood, then bone, then marrow and finally seed (Hence the traditional Indian belief that out of a thousand drops of blood comes one drop of semen). The seed can produce a new life or if retained can transform into a magical substance called ojas that gives a man superhuman strength and occult powers. It also helps man escape from the cycle of rebirths.

In women, the red seed is shed every month. Hence, women are considered to be the weaker sex – they cannot attain ‘spiritual’ status because they have no access to ojas.

Men on the other hand can retain their white seed and become ‘holy’. This is the reason given to explain the presence of greater number of holy men than holy women in India. This is also the reason why powerful warrior gods like Hanuman and Ayyappa are associated with both virility and celibacy.
In the Mahabharata, it is said that a male child is born when the white seed is stronger than the red seed. Thus a virile man (one whose semen is strong) fathers only male children. When the red seed is strong, the child is female. When both white and red seed are equal the child is neither this nor that (this was the traditional explanation for transexuality and homosexuality). This belief perhaps explains why, despite modern genetic data on X and Y chromosomes, it is the woman in India who is ‘blamed’ for the feminization of the fetus and why she is given special diets to make the fetus male. This also explains why men feel angry and ashamed when they father daughters. The sex of the child is linked to their virility, or lack of it.

The fertile period

According to the Dharmashastras, though sex for pleasure was permitted, greater importance was given to sex for procreation. Men who had to father male offsprings were advised not to waste semen. They were advised to have intercourse only when the woman was in ‘season’. This period was known as ritu and it roughly corresponds to the fertile period, the days in the menstrual cycle when a woman is most likely to conceive. Women were advised to make themselves beautiful and present themselves to their husbands after their periods.

If a woman who was in her fertile period approached a man for sex, he was obliged to have sex with her, the reason being – a fertile period should not be wasted. Every time a fertile period was lost, an ancestor lost his opportunity to be reborn. When a woman menstruated, she was held responsible for the opportunity last. She was equated with ‘death’ and hence considered polluted. She was asked to isolate herself during her periods, just as men who cremate the dead are isolated from the rest of the community.

A man who turned down a woman who approached him during her fertile period was described as a eunuch and held in disdain. In the Mahabharata, there are tales of women who approached men who were not their husbands during their fertile period because their husbands were unavailable. This was legally sanctioned. The sage Aruni was horrified when his guru’s wife approached him for sex. She explained, “Your guru has gone on a pilgrimage. Asking you do fulfill his biological obligations is a lesser sin than wasting this fertile period.”

The time when men and women had sex affected the nature of the child conceived. In the Bhagavata Purana is the story of Diti who approached her husband, the sage Kashyapa, for sex in the evening, a time reserved for prayers to ward of malevolent spirits. As a result, she conceived children who were demons.

When a man approached a woman, before intercourse, he was expected to invoke the gods, especially Vishnu, the god who sustains natural order, and Tvastr or Vishvakarma, the god who makes things. Only through their blessings, was it believed that a child could be conceived. This was known as the garbhadhana sanskara, or the rite of conception.

The sterile man

When a man could not produce a child on his wife, he was given the benefit of the doubt and allowed to marry again, and again. If despite this, he failed to father a child, it was concluded (but never explicitly stated) that he was sterile. In such circumstances, the Dharmashastras suggested that another man be invited to cohabit with the wives. This practice was known as niyoga or levirate.
In the Mahabharata, when king Vichitravirya (vichitra = odd; virya = virility) dies, his mother invited the sage Vyasa to produced children on his widowed daughters-in-law. Children thus produced were called children of Vichitravirya (the legal father), not the children of Vyasa (the biological or surrogate father).

It is alleged that this practice of niyoga is followed (rather clandestinely) even today, whereby sterile men make their wives cohabit with relatives or with holy men. Though religiously sanctioned, this practice is socially frowned upon and hence no one talks about it openly.

In the Kathasaritsagar, a collection of stories written in the 11th century A.D., there is the story of a king who makes an offering of rice balls to his ancestors. As he about to throw the offering in the river, three hands reach up – one of a farmer, one of a priest and one of a warrior. The oracles revealed, “The farmer is the man who married your mother, the priest is the man who made your mother pregnant and the warrior is the man who took care of you.” The king is advised to give the rice ball to the farmer because scriptures describe him as the true father. Thus was the practice of surrogate fatherhood established.

Artificial insemination

There are tales that suggest that the ancients were familiar with the ‘idea’ of artificial insemination. For example, we learn of ‘magic potions’ being created by sages for queens of childless kings that makes the women pregnant. What were these magic substances? Could they be ‘fertility drugs’ or could they be metaphors for ‘donated semen’?

One story states that the god Shiva once spurted semen when he saw Vishnu in the form of the celestial enchantress Mohini. Sages collected this semen and gave it to the wind-god Vayu who poured it into the ‘ear’ (a common mythical metaphor for the womb) of Anjani, a monkey, who gave birth to Hanuman, the monkey-god. Devoid of the mythical aura, one might say that the tale refers to the practice of artificial insemination: semen is transferred to the womb without sexual intercourse).

The surrogate mother

In the Bhagvata Purana, there is a story that suggests the practice of surrogate motherhood. Kans, the wicked king of Mathura, had imprisoned his sister Devaki and her husband Vasudeva because oracles had informed him that her child would be his killer. Every time she delivered a child, he smashed its head on the floor. He killed six children. When the seventh child was conceived, the gods intervened. They summoned the goddess Yogamaya and had her transfer the fetus from the womb of Devaki to the womb of Rohini (Vasudeva’s other wife who lived with her sister Yashoda across the river Yamuna, in the village of cowherds at Gokul). Thus the child conceived in one womb was incubated in and delivered through another womb.

Serpent power

In India today, when a couple does not have children, they often visit shrines and pray. Some visit holy men. Others offer cradles and dolls at shrines of mother-goddesses. Still others visit serpent shrines.

Serpents in many ancient cultures have been associated with fertility ( don’t forget that the serpent continues to be the symbol of medicine). There are many reasons for this. Probably because the serpent could slough its skin, it was believed to possess the power of rejuvenation. Probably because the serpent lived under the earth, it was believed to be the keeper of the secret that transforms seeds into plants. Farmers in India worship serpents in the hope they have a good harvest. Women worship serpents so that they are fertile and their husbands, virile.

In modern times, these practices may seem silly and superstitious. But for centuries they have offered hope to a people who believed that producing children was their biological duty. They offer the psychological support that today counselors provide. While these support structures can turn into crutches, their place in culture demands the be understood rather than be summarily dismissed.


Friday, November 21, 2014

Free patient education app for iPads



Docexplain is a free medical app which helps doctors to teach patients.

Patients often forget what their doctor tells them. This gap leads to a lot of angst and unhappiness.

Docexplain help doctors to ensure patients understand their illness. Everybody know that a picture is worth a thousand words – and our medical app has a library of over 500 ready to use images which cover all body systems and specialties.

This app helps doctors to build trust with their patients

You can Edit and customize these images, and even add your own images (for example, images of operations and X-rays), share them with patients and colleagues.

All you need is an iPad and you are ready to start teaching your patients during the consultation!

You can download it free at https://itunes.apple.com/us/app/docexplain/id900563096?mt=8

Wednesday, November 19, 2014

Medical corruption - Why is the media not doing anything about the pharma company who paid the bribe to the doctors ?


Indian newspapers are full of the recent action taken by the Medical Council of India against doctors who have been accused of taking a bribe from a pharma company.

" Seven senior doctors from Maharashtra, including three physicians from Mumbai, are among the 300 doctors summoned by the Medical Council of India (MCI) on charges of accepting bribes from a pharmaceutical firm. From huge amounts of cash to cars, flats and exotic foreign tours, an anonymous complaint received by the MCI has accused these doctors to have taken several benefits for promoting an Ahmedabadbased pharma firm by prescribing its medicines. "

http://www.mumbaimirror.com/mumbai/crime/Three-physicians-among-300-docs-summoned-by-MCI-on-graft-charges/articleshow/45198135.cms

We need to clean up the medical corruption which has infected the Indian healthcare system, and this is a step in the right direction.

While the media has waxed eloquent about how medical professionals have debased themselves by taking bribes ( ranging from front page articles in the Times of India; a British Medical Journal campaign; stings on NDTV ; and Aamir Khan's diatribe against doctors on Satyamev Jayate ), I am amazed by the deafening silence in the media regarding the bribe giver.

Why is no one turning a spotlight on the company which paid out the bribes ? They are the ones who have been corrupting doctors on a large scale. Yes, it's illegal to take a bribe, but it's equally illegal to give it !

It's interesting that the original complaint was filed with the Ministry of Chemicals & Fertilizers , who them forwarded it to the Ministry of Health , who they in turn asked the MCI to carry out investigations.
However, why did the Ministry of Chemicals and Fertilisers not take action against the CEO of the pharma company which paid the bribes ? 

This would have send out a very strong message to other pharma companies, and would have been a much more effective deterrent. Rather than picking on a few doctors, why not tackle the problem at its source ?

Or is it that pharma companies have such deep pockets and so much influence and clout that no one dares to do so ?

How pharma companies can delight doctors by creating white-labelled apps for them

Doctors are very valuable customers for pharma companies because they decide which brands they are going to prescribe to their patients. Because most brands are "me-too", pharma companies are forced to spend huge amounts of money on marketing, to try to persuade doctors to prescribe their brands ( in preference to the competition).

This means that most doctors start treating brands as commodities, because they are all so similar. This sets up a negative vicious cycle, where pharma companies compete with each other in trying to influence the most important doctors , who are called KOLs, or Key Opinion Leaders.

Rather than playing this game ( which can become dirty very quickly, because of the underhanded practises some companies indulge in), here's a clever solution which pharma companies can use to influence doctors positively and ethically, by helping them to help their patients !

Since I am an IVF specialist, I am going to talk about what pharma companies can do for gynecologists who treat infertility; but this value-added service would apply to all fields and all specialties.

Here's the solution - Pharma companies need to create intelligent apps , and white -label them for their key doctors.

How can an app help a pharma company to delight gynecologists and improve their management of infertility?

Infertility treatment can be complicated and it's important for the patient to follow the doctor’s advise precisely to ensure a successful outcome. Thus, if the patient forgets to take her HCG trigger  shot at the right time, the doctor will not be able to collect any eggs at the time of retrieval, and her chances of getting pregnant will go down to zero. This is every IVF patient's nightmare, and can be a huge price to pay for an oversight on her part !

This is why fertility clinics give their patients printouts of their treatment protocols, so they know what they need to do on each day. However, these are complex, and can easily overwhelm the poor patient.

This is why we have created a free intelligent android app for infertile patients called MyFertilityDiary ! All infertile patients have a smartphone, and this app has proven to be very popular with our patients.

Pharma companies can license this from us, and we can white label this for their key infertility doctors.

Their doctors can then prescribe their personally branded app to their infertile patients, and by helping them to manage their fertility treatment, they can delight their patients !

The unique heart of the app is the  Treatment Calendar. This has calendars for all the IUI and IVF treatment protocols, including the following:

Monitored cycle
Clomid for IUI
Clomid/HMG for IUI
Long downregulation with Lupron
Short downregulation
Antagonist cycle
Natural cycle
Frozen thaw
Minimal stimulation IVF

Patients  have the freedom to edit and modify this calendar , so that they can follow the exact treatment protocol as prescribed by their doctor . They can set alarms and reminders, so they remember their appointments and their medications.

Pharma companies can lock the brand names of their medications in this app, so that patients will use only the medications manufactured by their your company. This is why it makes business sense for them to invest in the app and give it away free to their key doctors. These doctors will appreciate the fact that they are seen as using the latest technology to help their patients to have a baby !

Using the app will help infertile couples to  become well-informed and better- organised , and this will  improve their chances of getting pregnant !

You can download the app free at
https://play.google.com/store/apps/details?id=com.olicious.fertilityfriend&hl=en


Tuesday, November 18, 2014

Why IVF doctors need to prescribe an app to their patients



How can an app help IVF doctors to improve their IVF pregnancy rates ?

The truth is that IVF treatment can be complicated and it's important for the patient to follow your advise precisely to ensure a successful outcome. Thus, if the patient forgets to take her HCG trigger  shot at the right time, you will not be able to collect any eggs at the time of retrieval, and her chances of getting pregnant will go down to zero. This is every IVF patient's nightmare, and can be a huge price to pay for an oversight on her part !

This is why you give your patients printouts of their treatment protocols, so they know what they need to do on each day. However, these are complex, and can easily overwhelm the poor patient.

This is why we have created a free intelligent android app for IVF patients called
MyFertilityDiary ! All IVF patients have a smartphone, and you can now use this to help your patients to  manage their IVF cycle.

The unique heart of the app is the  IVF Treatment Calendar. This has calendars for all the IVF treatment protocols, including the following:

Long downregulation with Lupron
Short downregulation
Antagonist cycle
Natural cycle
Frozen thaw
Minimal stimulation IVF

Your patients  can edit and modify this calendar , so that they can follow the exact treatment protocol as prescribed by you.

They can set alarms and reminders, so they remember their appointments and their medications.

Using the app will help your patients to  become well-informed and better- organised , and this will  improve their chances of getting pregnant ! They will also appreciate the fact that you are using the latest technology to help them to have a baby !

They can download the app free at
https://play.google.com/store/apps/details?id=com.olicious.fertilityfriend&hl=en

Monday, November 17, 2014

ZIFT has a higher pregnancy rate than IVF


For most infertile patients , embryo transfer is an easy procedure. However, there are some patients where the embryo transfer is technically difficult. These are patients who have cervical stenosis ( as a result of a cervical infection, or cervical scarring after conisation)  ; or a very tortuous and angulated cervix, as a result of which it is difficult for the doctor to negotiate the catheter through the cervix . He finds it hard to deposit your precious embryos into the uterine cavity because the catheter is soft and flexible and does not pass easily through the cervical canal.

When the embryo transfer is difficult , there may be bleeding as a result of the trauma caused to the cervix; and this trauma and bleeding can damage the embryos, resulting in a reduced pregnancy rate.

Doctors have developed clever ways of overcoming this challenging problem. For example , there are catheter sets with stylets, which help doctors to negotiate the canal; and a Towako set even allows the doctor to deposit the embryos directly into the cavity by puncturing the uterine wall.

However, the pregnancy rates with these techniques is often poor because they can harm the embryos, which need to be handled with love and care !

A far better option, if your fallopian tubes are open, is to do a ZIFT - a zygote intrafallopian transfer ( also known as a  TET or tubal embryo transfer).

In this technique, the doctor transfers your embryos directly into your fallopian tubes. This allows him to bypass the cervix, so that he can put the embryos back where they belong - into your fallopian tubes. They will now be guided by the cilia lining the tune into the uterine cavity, where they can implant safely.

The pregnancy rate with ZIFT has always been higher than with IVF. This is quite logical , because we are transferring Day 1, Day 2 or Day 3 embryos back into the fallopian tube, which is where they belong, rather than into the uterus  .

So why don't all IVF clinics offer ZIFT routinely ?  For one, it is more expensive. Also, the technique has fallen into disfavour because the doctor needs to do a laparoscopy in order to do a ZIFT, and most IVF clinics do not have access to a fully equipped Operating Room.

However, ZIFT can be a very useful option for patients who have multiple IVF attempts because of a technically difficult transfer.

You can read more about the ZIFT technique at www.drmalpani.com/zift.htm

Have your embryos transfers been painful and time consuming ? Did the doctor find it difficult to deposit your embryos into your cavity ? If so, then you should consider finding a clinic which offers ZIFT.

Please send me your medical details by filling in the form at
http://www.drmalpani.com/free-second-opinion so I can guide you sensibly!







Sunday, November 16, 2014

How an intelligent IVF app can help IVF husbands


It's the woman who is at the heart of an IVF treatment cycle. She is at the receiving end of all the probing and prodding, the shots and the scans, while all the husband needs to do is to provide a sperm sample when needed.

Wives expect support from their husbands during their IVF treatment , but because men are often so clueless about what is going on during the IVF cycle, that they offer precious little help. This aggravates the wife even more, because she feels her husband is not contributing at all, and concludes that he doesn't care .

On the other hand, many husbands feel sad that they can't play an active role, and that they are being relegated to the role of helpless bystanders.

However, a key role every husband can play is in helping his wife organise the logistics which IVF treatment entails. IVF involves a lot of juggling, because there are so many things to do - most of which seem to happen on the same day !

IVF treatment can be complicated and it's important for the wife to follow the doctor's advise precisely to ensure a successful outcome. Thus, if she forgets to take her HCG trigger  shot at the right time, her doctor will not be able to collect any eggs at the time of retrieval, and her chances of getting pregnant will go down to zero. This is every patient's nightmare, and can be a huge price to pay for an oversight on her part !

This is why IVF clinics give their patients detailed treatment calendars and protocols, so they know what they need to do on each day. However, these are complex, and can easily overwhelm the poor patient. She is often mentally fatigued  and emotionally upset, and her mood swings ( which are a result of her hormonal shots ) make it easy for her to forget key medical information. ( Did I take the shot I was supposed to at the right time ? Did I forget to insert the pessary yesterday ?)

Because the husband has no clue what's going on, all he does is ask - Are you sure you know what to do ( a question which irritates his wife even more !)

This is why we have created a free android app for IVF patients called
MyFertilityDiary ! All IVF patients have a smartphone, and you can now download this app ( for yourself and your wife) to help you help her to manage her IVF cycle.

The unique heart of the app is the  IVF Treatment Calendar. This has calendars for all the IVF treatment protocols, including the following:

Long downregulation with Lupron  

Short downregulation
Antagonist cycle
Natural cycle
Frozen thaw
Minimal stimulation IVF                  

You can edit and modify this calendar , so that you can follow the exact treatment protocol as prescribed by your doctor. You can set alarms and reminders, so you remember your wife's appointments and her medications. Your wife will be very impressed that you know exactly what's going on during her IVF treatment  - and she will be very grateful when you remind her about what she needs to do on a daily basis. This proves that you care because you are being an active and engaged loving spouse.

This app will help you to become a well-informed and loving IVF husband , and will  also improve your wife's chances of getting pregnant !

You can download the app at
https://play.google.com/store/apps/details?id=com.olicious.fertilityfriend&hl=en
 

Saturday, November 15, 2014

Free IVF app to improve IVF success rates !


How can an app possibly improve IVF pregnancy rates ?

The truth is that IVF treatment can be complicated and it's important for the patient to follow the doctor's advise precisely to ensure a successful outcome. Thus, if you forget to take your HCG trigger  shot at the right time, your doctor will not be able to collect any eggs at the time of retrieval, and your chances of getting pregnant will go down to zero. This is every patient's nightmare, and can be a huge price to pay for an oversight on your part !

This is why IVF clinics give their patients detailed treatment calendars and protocols, so they know what they need to do on each day. However, these are complex, and can easily overwhelm the poor patient.

This is why we have created a free android app for IVF patients called
MyFertilityDiary ! All IVF patients have a smartphone, and you can now use this intelligently to help you manage your IVF cycle.

The unique heart of the app is the  IVF Treatment Calendar. This has calendars for all the IVF treatment protocols, including the following:

Long downregulation with Lupron
Short downregulation
Antagonist cycle
Natural cycle
Frozen thaw
Minimal stimulation IVF


You can edit and modify this calendar , so that you can follow the exact treatment protocol as prescribed by your doctor.

You can set alarms and reminders, so you remember your appointments and your medications. You can even email your calendar to your husband, so he knows exactly what's going on - and when he's needed !

Using the app will help you become a well-informed and organised IVF patient , and this will  improve your chances of getting pregnant !


https://play.google.com/store/apps/details?id=com.olicious.fertilityfriend&hl=en

Friday, November 14, 2014

Free app for IVF patients !



MyFertilityDiary is a free android app which will help you manage your IVF treatment.

IVF treatment can be complex and confusing , since it involves taking medications daily; doing scans and blood tests; and going to the doctor regularly to check on your progress. It needs a lot of coordination and monitoring , and you cannot afford to mess up.  The complexity can be overwhelming, because there are so many things happening at the same time. You need to know in advance what is going to happen when, so you can plan your schedule. If you forget your medicines or miss your appointments , you may end up causing your cycle to fail , which can be a major disaster !

Most fertility apps available today are just basic menstrual cycle calendars and ovulation trackers for normal women who have no fertility issues. All they do is help you track your fertile time and plan baby making sex time.

MyFertilityDiary is much more !

The unique heart of the app is the  IVF Treatment Calendar. This has schedules for the commonest IVF treatment protocols, including the following:

Long downregulation with Lupron
Short downregulation
Antagonist cycle
Natural cycle
Frozen thaw
Minimal stimulation IVF


You can edit and modify this schedule , so that you can follow the exact treatment protocol as prescribed by your doctor. Your IVF doctor will be very impressed when he sees how well organised you are, thanks to this app !

The app is designed around a Calendar , which allows you to organize your life. You can set alarms and reminders, so you remember your appointments and your medications.

Becoming a well-informed and organised IVF patient will  improve your chances of getting
pregnant !


https://play.google.com/store/apps/details?id=com.olicious.fertilityfriend&hl=en

Thursday, November 13, 2014

Quid pro quo healthcare in India

This article appeared in Express Healthcare
 
In India can there be transparency around the financial relationships of manufacturers (pharma products and devices), physicians, and hospitals? Are the Indian physicians willing to disclose payments they receive from pharma and device manufacturers? Industry answers these tough questions By M Neelam Kachhap
 
This was my answer.

Yes, of course there can and there should be transparency around the financial relationships of manufacturers (pharma & device), physicians, and hospitals. After all, this was the norm until a generation ago. This secrecy was introduced in order to hide underhand dealings and has gone completely out of hand. It has spread like a cancer. Sadly, it has become the norm, and distorts the care patients get today. The healthcare system has become sick because of these distorted incentives, and we need to heal the system.

Manufacturers use medical representatives to try to influence doctors to prescribe their products. Sadly, because so many of the products are “me-too” products, they are forced to resort to bribes in order to persuade the doctor to prescribe their brand. Rather than spending money on innovation, the companies find it much easier and more lucrative to bribe doctors for prescriptions. Targets are set for medical representatives, who believe that the only way they can succeed is by giving the doctor whatever he demands.

Companies are extremely smart and they are very clever at disguising these bribes as “educational grants” or “payment for travelling abroad to attend medical conferences.” They manipulate doctors and these payments lead to unethical behaviour on the part of medical professionals.

The ones who are ashamed of the money they receive will refuse to disclose these payments. They know that they are guilty and their conscience pinches them, but they are smart and are able to rationalise their behaviour. A common justification is – “After all, if the senior doctors do it, why shouldn’t I ? I’d be a fool to refuse this easy money.”

Yes, there is scope for a law like the US Physician Payment Sunshine Act (PPSA) in India and because medical corruption is so much more prevalent in India, we should implement a similar measure to encourage honesty. Good doctors will appreciate a law like this.

If a database of payments were created in India what would show that often it’s the most respected doctors – the “KOLs or knowledge opinion leaders” – who are the ones who take the most money from pharma. After all, they have the most clout, which is why pharma wants to pander to them. This list would literally be a “ Who’s Who” of Indian doctors – and would feature many who are extremely influential, and are considered to be the leading lights of the medical profession.

The Indian healthcare system has become sick and openness and transparency can be powerful healing measures. Indian patients deserve a better deal!

Dr Aniruddha Malpani, Medical Director, HELP – Health Education Library for People

http://www.financialexpress.com/article/healthcare/strategy/quid-pro-quo-healthcare/

Just relax and you will get pregnant !



A lot of gynecologists advise young patients with unexplained infertility that the reason they are not getting pregnant is because they are too “ stressed-out “. This is especially true when the patient is a young career woman ( for example, an IT professional); and the doctor is more than 45 years old.

Their standard advise is – Just relax, take a holiday, and you’ll get pregnant !

Please remember that these are well-meaning doctors , and the purpose of their advice is actually to reassure the patient that everything is fine , and they have a good chance of getting pregnant in their bedroom without any medical help.

However, sometimes this advice backfires , because the hidden message the patient reads into the advise the doctor is giving is that it’s her fault that she’s not getting pregnant, because she is too tense. Husbands are quick to agree with this “medical assessment”, as are moms and mother-in-laws.

Not only disease and the woman is not getting pregnant is because she's to tens she stressed-out and or that she needs to do is to relax and things will fall into place automatically

This advise is extremely unkind, and is a form of “victim-blaming”. Remember that it’s never the stress which causes the infertility , it's the infertility which causes the stress ! However , when a doctor  says something like this , they assume it must be the truth , and this just ends up making a bad situation worse because they blame themselves even more , just adding further to their stress levels !

Why do doctors continue perpetuating such harmful myths ? For one thing, this is an easy reason to give when the medical tests all come back as normal. Rather than admit to the patient that the diagnosis of unexplained infertility just means that medical science has a lot of shortcomings and does not have all the answers , doctors would rather offer a “waste-paper basket” label of stress, because it is convenient for them to do so.

Sadly, they don’t realise the inadvertent harm they are doing by labeling the infertility as stress-related.  Also, the patients who don’t get pregnant after “relaxing and trying for another 6 months” just get fed up and move on to another doctor who can offer them a more concrete and useful suggestion. They are thus “lost to followup” as far as the original doctor goes.

However, the ones who do conceive ( not because of the doctor’s advice , but in spite of it ) happily go back with a box of chocolates ! This reinforces the doctor’s misconception that getting patients to relax helps them to get pregnant.

Rather than unkindly and thoughtlessly attribute the infertility to stress, good doctors explain to patients that if all the test results are normal, then sometimes continuing to try in the bedroom ( especially when the wife is young and they have not been trying to have a baby for too long) can result in a pregnancy, if they are willing to be patient. “ Relaxing” does not affect the outcome !

Fed up of listening to doctors whose only advise is - Relax ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly !






Tuesday, November 11, 2014

Miscarriage after IVF treatment

Anembryonic gestation.jpg



Transvaginal ultrasonography showing a gestational sac with a diameter of 28 mm, corresponding to a gestational age of approximately 7 weeks and 5 days. It contains a yolk sac (protruding from its lower part) but no embryo, even after scanning across all planes of the gestational sac, thus being diagnostic of an anembryonic gestation.


Patients are very excited when their HCG test is positive  ! They are on top of the world that their IVF treatment has succeeded, and they look forward to cradling their baby in their arms in a few months.

However, like any other pregnancy, 10% of all IVF pregnancies are also destined to have medical problems. The commonest problem is a miscarriage; and in some of these, the reason is because the embryo/fetus does not develop properly. This means that even though the woman is pregnant, and the pregnancy tests are all positive, there is no baby. This is a non-viable pregnancy, and many women get very confused - How can I be pregnant when there is no baby, doctor ?

A pregnancy consists of two tissues - the embryonic tissue, which gives rise to the baby; and the extraembryonic tissue, which gives rise to the placenta. In these pregnancies, only the tissue from which the placenta arises is formed properly. The tissue which gives rise to the embryo does not develop at all. This appears as an empty gestational sac on ultrasound scanning. This is called a "missed abortion" - presumably because the embryo is missing. The technical term is an anembryonic ( without an embryo) pregnancy.

In other women, the fetus continues to develop, and establishes a heart beat which can be seen on the scan at 7 weeks. However, on the next scan, this heart beat stops. This is called an IUFD, or intrauterine fetal death.

The commonest reason for a miscarriage is a genetic problem in the embryo, which prevents it from developing properly. This is a random event, and the risk of recurrence is low, which means patients can be reassured that their chances of having a healthy pregnancy for the future are actually quite good! However , older women, and those with poor ovarian reserve, have an increased risk of having a repeat miscarriage, because their eggs  have more genetically abnormalities, which we still cannot test for.

The medical term for a miscarriage is an abortion. Most miscarriages start with vaginal bleeding which is initially slight and painless. This is called a threatened abortion, because the pregnancy is threatened by the bleeding. This bleeding is from the mother, and is not fetal blood. About half the time this stops spontaneously and results in no harm to the pregnancy. At this stage, the most useful test is an ultrasound scan (usually done with a vaginal probe). If a fetal heartbeat can be seen, this means that there is a 95 % chance that the pregnancy will proceed normally. On the other hand, if the ultrasound scan shows that the fetus has not developed properly ("blighted ovum " or anembryonic pregnancy when no fetus can be seen; or a missed abortion or intrauterine fetal death when the fetus is seen but the heart is not beating, then nothing can be done to save the pregnancy.

In such cases, the bleeding progresses, and the uterus starts contracting. This is felt as painful cramps, and the mouth of the uterus ( the cervix) opens. This is called an inevitable abortion (because it cannot be stopped). If some of the pregnancy has already been pushed out by the contractions, this is called an incomplete abortion.

In patients with a blighted ovum, missed abortion, inevitable or incomplete abortion, the treatment in the past was a uterine curettage (D&C) - a short surgical procedure which is performed to empty the uterus and remove the pregnant tissue. However, in women with a missed abortion, a D&C can cause Asherman syndrome ( intrauterine adhesions) if the doctor scrapes the uterine lining too vigorously. Read more at www.drmalpani.com/asherman.htm . This is why these problems are now better treated with medical therapy.  These pregnancies can be terminated medically with mifegest
( anti-progestational agent) and misoprostol ( a prostaglandin). Your doctor will prescribe these for you.

The standard prescription is the following.

Tab Mifegest ( RU-486, Mifepristone), 200 mg, 1 - 3 tablets at one time. This is an anti-progestin.
After 48 hours, take Tab Misoprostol, 200 ug, 4 tablets at one time. This can be taken orally or vaginally.  This is a prostaglandin
You will start bleeding and cramping about 6-48 hours after the Misoprostol tablet.
You can take pain-killers for symptomatic relief

You need to do a check scan one week after the bleeding stops, to confirm the products of conception are completely evacuated.

It can be very hard to bounce back if you miscarry after IVF treatment after a miscarriage !  Lots of patients get disheartened and give up.  They lose faith in God because they feel he has been exceptionally unkind to them. Others blame themselves for the miscarriage and their self-esteem takes a further battering. They believe that they miscarried because they did not rest enough, or because they lifted a heavy weight ; or ate something which was “ too hot”. Many ill-informed relatives and friends also add to their misery by telling them that it was their lack of taking appropriate precautions ; or their excessive levels of “stress”, which caused them to lose their pregnancy.

All these myths and misconceptions just makes a bad situation even worse ! Please remember that nothing you can do can cause a miscarriage. Your fetus and safe and is well protected in your uterus and nothing you can do can harm in.

The commonest reason for a miscarriage is a genetic abnormality in the fetus, and this is Nature’s defense mechanism, to prevent the birth of an abnormal baby. While these defects are often random, they are commoner in older women. This is because the eggs of older women have more genetically abnormalities, because they have “aged” and have genetic defects, which cannot be screened for.
Interestingly, many patients get even more determined to have a baby after a miscarriage . They feel that if they can carry a pregnancy to 8 weeks, they can carry one to 8 months as well – and the fact that their embryo did implant gives them a confidence boost ! The truth is that the fact you have conceived ( even though you did miscarry) means your chances of having a healthy baby are excellent, so please don’t get disheartened !


Thursday, November 06, 2014

Total fertilization failure after ICSI



My last post discussed the distressing problem of total failed fertilization after IVF.  As I explained, failed fertilization after IVF is usually because of a sperm problem. By contrast, total fertilization failure after ICSI ( which is much less common) is usually very rarely because of a sperm problem.

This is not very intuitive – after all, since 50% of the DNA comes from the sperm, it’s logical to expect that 50% of fertilization failure after ICSI should be because of sperm problems ! Lots of patients believe this, and so do many IVF specialists. Another reason for this misconception is because ICSI is usually done for infertile men , who have a low sperm count, or poor sperm motility. Many of these men have abnormal sperm DNA, so it makes logical sense for both doctor and patient to conclude that failed fertilization is because of the abnormal sperm DNA in these men, which prevents the sperm from fertilising the eggs.  This is why a lot of doctors advise these men to consider using donor sperm.

However, this is bad advise. The truth is that once we’ve injected the sperm inside the egg, the embryologist has done most of the sperm’s work for it. The rest of the fertilization process is driven by energy which is provided by the powerhouses of the cells – the mitochondria, which are present in the cytoplasm of the egg. The sperm has very little role to play after the ICSI has been performed.

This has been proven by doing ICSI for these men using donor eggs. The fertilization rate is completely normal when this is done !
.
Another reason why patients find it hard to understand this concept is because their eggs look completely normal. The truth is that most eggs look exactly the same ! They are basically simple spheres, and there is no way an embryologist can distinguish a normal egg from an abnormal one in the IVF lab.

The problem is that even though an egg maybe functionally incompetent, it looks anatomically perfect – and we have still not developed have any egg function tests to check the fertilising ability of the egg as yet. ( Note that ovarian function tests, which check for ovarian reserve, such as AFC and AMH levels are very crude, and don’t provide any information about the functional competence of the individual egg, which is a microscopic structure).

Failed fertilization comes as a shock – for both patient and doctor. Sadly, it’s one of those things which we just can't predict . It’s only when the embryologist does the fertilization check 16 hours after ICSI that he finds out ( to his dismay) that the eggs have not fertilized, and do not have any pronuclei.

Sometimes the problem could be because of the lab. Thus, incubator malfunction can damage the eggs; as can an infection in the culture medium. A clumsy embryologist can also damage and kill all the eggs when doing ICSI. However , these problems are very rare in a good IVF clinic.

Remember that failed fertilization after ICSI is usually because of an egg problem. This is why it is seen more often in older women; those with poor ovarian reserve; and those with a poor ovarian response. The best solution for this is to use donor eggs.

The major exception is the very rare man with globozoospermia. In these men, the absent acrosome means that their sperm cannot fertilise the eggs even after ICSI , unless they are treated with a calcium ionophore. This is an easy diagnosis to miss, but also one which is very easy to make if the sperm are stained and their morphology checked carefully in a good lab.

Tuesday, November 04, 2014

IVF ( TESE-ICSI) success story for couple from Bangalore


We, VANI & MATHUR ( Both names changed)from Bangalore  were married 14 years and were running pillar to post to have a child of our own.  We did not have any idea of adoption and hence were trying to have our own child and went on with all sorts of treatments for 14 long years . At the end we came to know that my husband was suffering from AZOOSPERMIA and we were told
there was no hope of cure for this problem. We also tried for homeopathy treatment for nearly 1.5 years but this did not yield any results .

One day we came across Dr Malpani’s website and we really liked reading his success stories and all things looked very transparent & we thought there was some hope on the other side of the coin as age was also a concern for us and this was not in our side.

We immediately wrote a detailed mail to him with all our reports and he was quick enough to suggest some more tests for both of us . For me ( husband) he suggested to go for testicular biopsy to check whether sperms were getting produced in the testicles ( testis) and also to check whether this was case of Obstructive azoospermia or a non obstructive one.

We immediately contacted our doctor friend in Chennai for the above tests and he  organized these in Chennai & semen samples were sent to two different labs to check the results. To our joy sperms were getting produced in the testis and the Chennai doctor immediately asked us to rush to Dr Malpani with these results.

We went to Dr Malpani in the April  2013 and TESE-ICSI  was suggested by Dr Malpani & we spent nearly 10 days in Mumbai for the treatment . We were asked to go for HCG test after 14 days of the transfer of the embryos and the BETA HCG result showed  positive and confirmed pregnancy. We were overjoyed but this was short lived, since the second test after  2 days proved decline in the HCG levels , which showed termination of the pregnancy. We spoke to Dr Malpani and he advised us to be strong & face the reality of life  & suggested to come again for the next attempt.  We had frozen  6 A grade embryos and there was still some hope in the second attempt for us .

After some lull , we again decided to visit Dr Malpani in the month of Jan 2014 and we underwent the transfer of the frozen embryos , which was performed by Dr Malpani . We stayed for about 2 days after the transfer and landed back in Bangalore with some hopes of conceiving. We again had the BETA HCG test done after 14 days and wow the results were positive. We repeated the tests again the second and the third time and we found the HCG results doubling, that confirmed the pregnancy and we conveyed this news to Dr Malpani , who continued guiding us and addressing our mails very promptly.

Dr Malpani asked us to enjoy the pregnancy and this was the beginning for the next 9 months battle. We found all the scans were normal and we had a little angel born in Sep 2014 to us . At last, we are proud parents now and can happily celebrate father’s and mother’s day all due to the excellent work done by both Dr Anirudhha Malpani and Dr Anjali Malpani , who were with us throughout this journey . They guided us well and we are grateful to both of them in this life .

We are very pleased that we went to Dr Malpani’s clinic , because they have a high success rate as there they are equipped with all the latest technology and are real experts in this field.


VANI AND MATHUR ( NAMES CHANGED)


nesuka14@rediffmail.com

Want to craft your own IVF success story ? Please send me your medical details by filling in the form at http://www.drmalpani.com/free-second-opinion so I can guide you sensibly ?









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