Saturday, January 31, 2015

The 10-Minute Million at the IIT-B Entrepreneurship Summit


I am on the Investor Panel at The 10-minute million at the Entrepreneurship Summit at IIT-B and am looking forward to hearing startup founders pitch to us on 1 Feb 2015.  

Will be carrying my cheque book with me !

“Having an angel to watch over you is cool! But do you know what’s really cool? An angel with money!”

http://ecell.in/esummit/the10minutemillion/

Friday, January 30, 2015

Seven Bad Things Bad IVF Doctors Do


A good IVF doctor can add tons of value to your quest for a baby. However , “good” can be a subjective term,  and the bitter truth is that not all doctors are good.

Here is a list of seven things IVF doctors do that might mean that they're not the right  doctor for you.

They Ignore Your Spouse

This is especially common with female doctors, who usually  all but ignore the poor husband, whose only job seems to be donating his sperm; and paying the bills. Every good doctor will talk to the couple since infertility is always a couple's problem !

They Talk Down to You


Not all patients are sophisticated, and many don't even take an interest in their medical treatment. Still, it's the duty of the doctor to explain to you why he suggests a certain course of action . If this isn’t the case be assertive , or switch doctors. Never let any doctor talk down to you or make you feel stupid.

They Put Their Interests Before Yours

Most patients feel that doctors have become very commercial, and are more interested in making money, than in helping you to have a baby. You need to ask the right questions and explore all your options, to make sure your doctor is giving you the right advice.

They Won’t Return Your Calls or Emails

A good IVF doctor, but if you are not important enough to them to rate a response in a reasonable amount of time , this isn’t right.  IVF patients need a lot of hand holding, and this is part of the doctor's job description. If the doctor you are paying won't bother to return your calls, then why keep paying them?

They Suggest That You Don’t Need a Second Opinion

Every good doctor understands that an independent second opinion can help to improve the patient's confidence levels in the treatment they are proposing, and will encourage patients to seek a second opinion. If his self-esteem is so low that he feels threatened when you want a second opinion, you should be concerned !

They Don’t Speak Their Mind

An important aspect of a healthy doctor-patient relationship is honest and open communication. This goes both ways. Patients might express a desire to pursue an experimental and expensive treatment which they have read about online, but a good doctor will not pander to the patient's demands, simply in order to keep them happy. A good doctor will tell the patient if he disagrees with the treatment, and provide reasons why. Yes, it is your money, but a good doctor will not let you throw it away !

They Recommend Expensive , Unproven Treatment

Patients are desperate and are happy to cling at straws, which is why they will often blindly obey what the doctor tells them to do . However, no good doctor will charge the patient for experimental treatments ( for example, immune therapy using IV immunogolubulins)  which have not been proven to be safe and effective using controlled clinical trials.

The Bottom Line

If your doctor displays any of these traits on a consistent basis , this might be a sign that it's time to find a new IVF doctor.

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





Thursday, January 29, 2015

The interminable IVF 2ww


Most IVF patients dread the two-week wait (2ww), which is often the most nerve-racking part of their treatment. The 2ww is a quiet two-week period of waiting and hoping , that follows a huge flurry of activity involving injections; scans; and visits to the IVF clinic for monitoring during superovulation, egg collection, and the embryo transfer. However, during the two-week waiting period, patients feel abandoned and alone.

Family doctor or IVF doctor? Help me please!

Doctors at IVF clinics tend to disconnect from their patients during this period and have less support to offer except the generic advice that they need to continue taking their luteal phase medication. During this phase , time seems to pass at an agonizingly slow pace. Moreover, they are often clueless as to what they should and should not do during this period.They are confused about the smallest of health problems , such as whether they should take antibiotics if they have a cough . Is it acceptable if their family doctor prescribes them a medicine , or do they need to go running to their IVF doctor ? Patients are scared that the medications may reduce their chances of success.

Family doctors are reluctant to treat even minor coughs and colds during the 2ww, as they know little about the IVF procedure, and are afraid of prescribing medicines that may unknowingly affect the patient's chances of success. They usually advise the patient to consult their IVF doctor. IVF doctors, on the other hand, are not interested in prescribing cold and cough medications - after all, they are IVF specialists !  This is why the poor patient is forced to shuttle between the family doctor and the IVF clinic. Patients feel abandoned, confused, and lost during this phase. They often are forced to suffer through many minor discomforts needlessly, because they are scared that taking any medication during their 2ww period will damage their embryos and cause the treatment to fail.

Not sure how to handle your 2ww? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm and allow me to guide you!


Wednesday, January 28, 2015

What IVF patients should not do



One of the commonest questions patients ask is - What should I look for when selecting an IVF doctor ? What should I be monitoring when I’m doing my IVF cycle to confirm everything is on track ? How can I be sure that my IVF doctor’s doing all the right stuff? These are difficult
questions , and patients don’t want to become IVF specialist or get involved in the technical minutiae and scientific nitty-gritty of an IVF cycle . The good news is that there's no need to do so !

Rather than create a list of what they need to do , it's sometimes far more important to create a list of what not to do . This is based on the "inversion principle" , made famous by Charlie Munger, Warren Buffett's partner and the world-renowned investor. If you make sure you don’t make these common mistakes, you will improve your chances of IVF success considerably !

These errors are surprisingly common, and  if you learn to avoid these , your chances of finding the best IVF doctor and getting pregnant in your IVF cycle will increase dramatically. Most of these are common sense, but we sometimes forget them, because as we all know , common sense really isn’t that common at all.

What are the stupid things which IVF patients do which will pretty much ensure failure?  These are the things you need to avoid , and once you stop doing them , you will increase your chances of success.

Not doing any research about IVF.

Many patients don't bother to do any homework at all, either before going to the doctor, or even while the cycle is going on. They only wake up after the cycle fails, by which time it's too late. Unless you spend some time trying to figure out exactly what’s involved in a IVF cycle, it’s going to be hard for you to make intelligent decisions. The good news is that it’s not very difficult to do this , and there are so online resources available at various different levels of sophistication . Any patient who starts an IVF cycle without doing their homework is actually being very irresponsible.

Blindly following recommendations about which IVF doctor to go to.

Just because you've been referred to a particular doctor by your GP ; or by your sister in law ; or by your friend who got pregnant at the clinic doesn't mean this is the best doctor for you. You still need to apply your own mind . The kind of doctor who she likes may not be your type, which means her choice will not work well for you. All infertile couples are different , and you need to find the doctor who is right for you - not someone who’s been right for someone else.

Leaving everything up to the doctor.

I think this is the commonest mistake. A good doctor will do whatever needs to be done, but doctors aren’t superhuman , and sometimes things do fall between the cracks. Being pro active and taking an active interest in your treatment is good for you , because you can make sure that the "i"s are being dotted, and all the "t"s are being crossed. This is good for your doctor as well , because he’s much more likely to respect you if you take an intelligent interest in your treatment.  This means that your chances of getting VIP care because you’re a well informed patient increase dramatically !


Want to make sure you don't make these common mistakes ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !




Tuesday, January 27, 2015

Is IVF the best path for infertile couples?

   
The two perspectives

Patients and doctors perceive illness and treatment from completely different perspectives. Let's look at infertility, for example. Most doctors look at the world through a biomedical perspective. They want to diagnose the problem, and then come up with solutions to help the couple to conceive. This is the traditional approach in medicine, where the first step is to make a diagnosis, and then devise a treatment plan. Text books will talk in terms of treatments based on correcting an underlying problem, and will usually offer a chain of treatments which progress from simple to complex, and less expensive to more expensive. This is the step-by-step care approach, which makes a lot of sense from a societal perspective.

However, the patients’ perspective is completely different. They don't really care as to whether the reason for not having a baby is low sperm count or blocked tubes. All they want is a baby, so they can move on with their lives.

This often creates a lot of tension between patients and doctors. From a patient's perspective, instead of wasting time, money, and energy on ineffective treatments which have a low success rate, it makes sense for them to move on directly to the treatment which gives them the best chances of success. Yes, I am referring to IVF – the final common pathway which allows infertility specialists to bypass all medical problems!

However, most doctors do not share this point of view. Many are not very empathetic and do not understand the emotional pain infertile couples suffer from. They would prefer taking a text book approach to the problem. Many are tied down by treatment guidelines published by gynecology societies or the government, which limits the options they can offer to patients. Furthermore, doctors often tend to be quite arrogant. Their approach seems to reflect that they know what's best for the patient, because they are the experts, and often end up not taking the patient's viewpoint into consideration at all.

IVF – The ray of hope

Let's look at a 35-year old couple who wants a baby. The couple is financially quite well settled, and now needs a baby to complete their life . Traditionally, doctors would do an infertility workup to find out what the problem is, and then start treatment to rectify the problem. Unfortunately, this sort of approach can be very time consuming, and not very efficient. Patients will often get fed up, as they simply do not have the time or energy to keep going back to the doctor for repeated follow-ups, all of which can exact an emotional toll. Not only does this aggravate the pain of failure but also leads to opportunity cost , and a waste of time. From a doctor's view point, this is par for the course. Yet, I feel doctors need to be more flexible, and tailor treatments to suit the patient's perspective.

For this particular husband and wife, the bottleneck is not likely to be the money but rather the time and energy they can devote to their dream project of having a baby. It would make much more sense for them to opt for IVF to maximize their chances of having a baby soon. I understand most doctors will consider this as being too aggressive and maybe overkill. In fact, I too shared the same view in the past. However, now I feel we should let the patients decide rather than make decisions for them. If the trade-off is between time and money, many will decide to go for the most efficient route. Even if it is more expensive, it may be the most cost-effective for them!

Not only are we saving the couple a lot of time by giving them a baby through IVF but we are also helping to improve the quality of their parenting, so that they can spend precious time with their baby while they are young and energetic, rather than waiting till they turn 40 and are then told to do IVF!
In a fee-for-service setting, I believe decisions about which of the available treatment options to select are best left to patients rather than to doctors. A good doctor will explain all the options to the patients, including the trade-offs involved, and then allow the patients to decide for themselves!

Unfortunately, especially in the UK, most general practitioners are not quite empathetic toward infertile couples. They end up wasting valuable years of the couple's life in ineffective treatments before referring them to a specialist. This culminates in years of wasted opportunity and heartburn for thousands of infertile couples, leading to enormous misery.

Do you think IVF is your best option ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !




Monday, January 26, 2015

Why you Should Stop Complaining About your IVF Hormone Medications


 The In Vitro Fertilization (IVF) procedure is a definite boon for couples who have been unsuccessful in having children the normal way. However, it’s also a source of constant stress for women, on account of the daily needles they need to endure; and the anxiety and suspense about whether the procedure will work for them or not.

Since insurance companies do not provide cover for IVF, it can prove to be a very expensive proposition. Patients who are undergoing IVF treatment do a certain amount of research on the internet. Based on what they read, they tend to harbour doubts about the side effects of the medications themselves , even though the they are natural hormones.

Debunking Some Myths

Most women will blame these hormones for their emotional swings during their IVF cycle. However, a study done in Human Reproduction showed that women who are undergoing IVF treatment and who displayed neurotic tendencies prior to their treatment, will continue to be that way while the cycle is in progress. Similarly, those who had no such symptoms , did not develop them during the course of the cycle. In simple words- the hormones are not to blame !

Let's take a look at some myths which are well- nothing but myths:

Myth- All “infertility” medications have similar effects
Fact: There is a significant difference between oral medications used for intrauterine insemination (IUI) treatments and the injectible medications used in an IVF procedure.

Myth: Hormones always make women “crazy.”
Fact: It's convenient for men to  label women as being "emotionally labile" because of the IVF medications, because they contain mysterious hormones, which act in strange ways. While some of the medications may cause PMS, it's unfair to generalise and blame the medications for the mood swings.  In any case, the hormones get excreted promptly and do not have any long term side effects. They can have good effects as well and a lot of women find that their libido increases during the IVF cycle .

Myth: IVF drugs are to blame for all emotional symptoms during the treatment
Fact: It’s very difficult to ascertain what the IVF medications are doing, compared to the emotional burden that a patient carries. A number of patients complain  of emotional difficulties while the treatment is in progress. However, in most cases this emotional stress is related to their worry about the cycle not working. Some patients are also affected by needle phobia. I have found that proper counselling at the outset helps in  calming these unfound fears that patients have.

Myth: It’s difficult for others to understand what you are going through and this stress will be endless
Fact: This process can be likened to running a marathon. You train hard and walk miles every day till you finally run the marathon; but when you win, all the hard work pays off.  It’s true that all those daily shots and monitoring can get overwhelming at times, but remember that millions of IVF patients have done this before , and have become pregnant . The payoff is well worth the effort ! As doctors, we understand what a patient goes through and are always here to counsel and support you.

Myth: There is nothing that can be done about the emotional stress during your cycle - you just have to grin and bear it.
Fact- In most cases, emotional stresses during your cycle are a result of interpersonal as well as external factors. Counselling is one way of getting relief. You can also talk to someone who has been through IVF, or with a close friend.

Positivity Helps

It’s important to keep in mind that IVF is a proven treatment , and that millions of  babies have been born as a result of IVF. A positive frame of mind will help you cope better. When taking the shot, if you remind yourself that each injection brings you closer to the baby you dream of, you'll be able to handle the ups and downs of the cycle with much more equanimity.

Still worried about the side effects of the IVF hormones ? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you better !





Sunday, January 25, 2015

Empiric Therapy in IVF - Science vs Emotions


A number of patients who have failed an IVF cycle (either in our clinic or elsewhere) want us to try something new and different for their next cycle. The common requests are whether we can prescribe steroids, IV immunoglobulins or Intralipids for them.

IVF failure can come as a rude shock, and patients are desperate to do something differently in the next cycle in order to make it succeed. Patients who have failed an IVF cycle can become quite frantic and are happy to clutch at straws. When they read about “new and latest” treatment advances, they want us to try those out for them too. The stumbling block is that a number of these treatments are empirical. Empirical therapy is that which is based on experience , and has not been proven to be effective in controlled clinical trials.

Doting on Anecdotes

However, these are supported by umpteen anecdotal case reports of success, where some patients have benefited from trying that particular treatment intervention. At this point, it’s important to understand that the lack of clinical trial proof doesn’t really reflect that the treatments don't work - it's just that no clinical trials have been conducted about them. 

Remember that just because there was a pregnancy after the treatment does not mean that the pregnancy was a result of that treatment. This is a natural bias and this logical fallacy is called the “post hoc, ergo propter hoc” fallacy. Sadly, it’s very easy for people to fall prey to this, which is why there are so many accounts online of patients who swear by unproven treatments such as IVIg (IV immunoglobulins) therapy , and swear that it helped them get pregnant.

The Emotion Quotient

These are very emotive stories; it’s easy to conclude that when a patient who has failed her first IVF cycle gets pregnant in her second cycle , after taking IV immunoglobulin, this means that the IV IgG "worked" and helped her to have a baby. However, this is flawed logic.

If IV immunoglobulins were really effective, what’s stopping IVF doctors from using them routinely for all their patients?  Why would they wait for the cycle to fail before using a therapeutic intervention which has been proven to improve pregnancy rates? While I have nothing against empiric interventions, I think patients also need acknowledge that these have many limitations. Not only can they be prohibitively expensive, but have hazardous side effects as well. For example, the overuse of steroids can cause hip necrosis, and actually harm the patient.

Inadequate Documentation


Unfortunately, patients as well as doctors are under a lot of pressure. Doctors are sceptical about using methods that have no clinical basis while patients are very easily influenced by the success stories they read online (even if these accounts have no scientific basis). Therefore, patients who get pregnant after taking IV immunoglobulin will wax eloquent about how effective the treatment is – while the ones who don’t get pregnant will keep mum, or will go on and try something different. This is exactly why documentation about the failures of empiric therapy is so inadequate.

A Matter of Science

The major risk is the false hope these treatments create in patient’s minds and hearts. I'm perfectly alright with using simple empirical therapy, such as acupuncture, DHEA, vitamin D and other supplements , which maybe unproven, but inexpensive and safe. However, when it comes to giving the nod for treatments that involve use of IV immunoglobulins that are expensive, risky and unproven, I wouldn’t approve unless the patient arm-twists me. 

As a scientist, I am compelled to depend upon reliable scientific evidence, but patients are not shackled by these considerations and have the freedom to do as they please. For me, a patient’s health and wellness is of paramount importance and I am happy to honour patient preferences, as long as there are no chances of harm.

Failed an IVF cycle and not sure what to do next? 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!

Saturday, January 24, 2015

Making sense of early pregnancy scans



For most women, pregnancy is a very exciting time ! However it can also be extremely nerve-wracking. For instance when you go for your scheduled ultrasound scans, there is a lot of trepidation in your mind because the results could be either positive or negative and in most cases, you are not too sure about what they exactly mean.

Is my baby fine? How many babies are there? Is the baby in the right position? Is the growth of my baby good? Is the heart beat strong? Is the pregnancy progressing well? These and a myriad other questions flood your mind especially when you have certain symptoms- and even when you don’t! Most women have morning sickness in their first trimester and if you don’t, the first thing you are going to be concerned about is whether anything is amiss.

Routine Tests

Since approximately 10% of all pregnancies fail, your doctor routinely conducts ultrasound scans for you. It’s the one way of reassuring you that all is well. If you have conceived after IVF, this becomes all the more necessary. Though an ultrasound has now become a routine test during early pregnancy, interpreting these scans is not a straightforward task.

The pregnancy grows and develops rapidly which means there can be dramatic changes in the scan findings over a few days. What was “normal” at 6 weeks may not be so at 8 weeks. In most cases, a sonographer or technician only does the scan and they do not discuss the scan results with the patient. When the technician directs you to speak with the doctor about the scan, you start scanning the situation with your “worry radar”.

Too Many Doubts

The suspense can be killing- you are able to see a sac on the scan but can’t really see a baby. This can be very aggravating and you wonder whether it means the baby has perished or whether it’s just too small to be clearly visible on the scan at this stage. The suspense becomes even more unbearable when the doctor can see the baby but not the heartbeat. At this point if your IVF doctor says – “We will have to do another scan next week to be able to figure out if all is well”, this pushes you deeper into the vortex of doubt.

Once again you are not sure about exactly what the condition of the baby is. At times the fault lies with the ultrasound machine which is unable to pick up the baby’s heartbeat. In some cases it could be just too early for your baby to have a heartbeat. There are just too many variables and the snowball of doubt and worry just gets bigger and bigger.

The Biological Variability Factor

In this frenzy of worry, you begin Googling extensively. You exchange notes with other women in online pregnancy forums to compare notes, and this sometimes fuels the already raging fire further. It’s important to understand that during pregnancy, the spectrum of biological variability can be very broad. While some babies will have a distinct heartbeat at 6-weeks, in other babies, it will be imperceptible till they are 7-weeks old.

But before you go overboard with all the worry and give yourself a few greys, simply visit www.hcgexpert.in and enter your scan findings. We will be able to tell you if your pregnancy is progressing normally or not. This is a free service, and we hope it will help reassure many women that their pregnancy is fine, so that they can enjoy it wholeheartedly, rather than worry needlessly!

Friday, January 23, 2015

Embryoscope - the high cost IVF marketing gimmick

The medical field is evolving at an almost hypersonic pace and new technology is being researched and launched rapidly  . The fact is that patients who are eager to get pregnant, are easily impressed by all the technical jazz that some IVF clinics throw at them. And who could blame them? When strong marketing words like “latest” and “state-of-the-art” are thrown randomly at them, they are bound to be dazzled.

Embryoscopy is the latest gizmo on the IVF medical technology block that has caught the attention of those who are looking to expand their families. Many doctors tout the  fact that they are now using the embryoscope at their IVF clinics. The claim they make is that using this latest piece of equipment will dramatically improve pregnancy success rates. It's a competitive market, and every doctor tries to play the oneupmanship game. The trouble is that it's the patients who pay the price !

Scoping the Embryoscope

So, what exactly is the embryoscope? It’s a type of incubator with an in-built camera. This piece of equipment has the capability to take multiple pictures of a patient’s embryo, every hour. These pictures are strung together to create a time-lapse video that shows the development of the embryo at every stage. This helps the embryologist assess how well each embryo is developing and then select the best ones for transfer.

Like any new medical equipment, an embryosope doesn’t come cheap. IVF clinics buy this to " prove " they are in-sync with the times , but they also have to recover costs. This latest acquisition therefore becomes the latest “window dressing” and will feature very prominently on their website and all their advertising materials. This is used to lure customers to their clinic and away from the competition.

This marketing tactic works very well on patients who are eager to get pregnant and will go the whole nine yards to have that baby- and if it means that the embryoscope is going to increase the chances  of a successful IVF procedure, then so be it- they will opt for it. The additional Rs 30,000 that they are asked to pay for use of the embryosope in their treatment seems of little consequence if it brings them a step closer to their dream of cuddling a baby in their arms - which is what the embryoscope marketing materials promise.

Revelation Time

Now, let’s take a look at what goes on behind the closed doors of the IVF clinics. Many clinics cheat patients in that they claim they are using an embryosope, while they really aren’t. Let me explain- 

Each EmbryoScope has the capacity to culture only up to 72 eggs or embryos from a maximum of 6 patients at a time. They have to be observed over a period of 5 days ( for a blastocyst transfer). This means that one embryoscope can typically be used for only 1 patient every 5 days. Thus, if there are 3 egg collections daily, the embryoscope will be fully blocked in a 2 -day period for a total of 5 days.

This means that the embryoscope cannot be used for another patient who is cycling at the same time.  Embryoscopes are expensive, and most clinics cannot invest in more than one piece. And so, if a busy clinic is telling all the patients who are cycling at the same time that they are using an embryoscope for each of them, they are clearly pulling the wool over their eyes!

Just Verify

So how can you shield yourself from being conned? Remember that the purpose of an embryoscope is to take a series of images of your embryos as they develop in vitro. If the IVF clinic tells you that it is using an embryoscope for you (and charging you extra for this), then you need to insist that they give you a images of your embryos, so you can verify this.  You can see what these should look like by checking out the image above.

The embryoscope automatically provides a video output, and you should ask for a copy of this; so you at least have documentation that an embryoscope was actually used for your care (even though using this does not improve your pregnancy rates). This is the simple way in which you can ensure your doctor is using the procedure you are being charged for. After all, the proof is in the pudding, isn’t it?

Free Second Opinion on IVF

Not sure if you are getting the right IVF care ?

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






Thursday, January 22, 2015

IVF 101 - what every infertile couples need to know


 In Vitro Fertilization (IVF) took birth around 35-years ago, and since that time, it has traversed a long way and evolved into an extremely sophisticated and accessible procedure.  IVF helps couples overcome a range of fertility issues. For people who are unable to have children in the conventional way, IVF becomes the knight in shining armour.

It's important that patients understand the basics of IVF, so they can select the right IVF doctor. The IVF procedure is complex and needs a high level of experience. The 5-step procedure spans a few days. It includes preparation of the ovaries and the uterus, to the ultimate insertion of the prepared embryos.

Step-By-Step

Regardless of whether you have undergone any fertility treatments or not, understanding more about the IVF procedure can be really helpful. If you are planning on having In Vitro Fertilization, here’s what to expect:

•    Step 1- The couple will be tested and the ovaries will be prepared for stimulation.  A number of women undergo a test in which the doctors will test the uterus and a mock transfer will be actioned. This helps the doctor “map” the uterine cavity to ensure that the embryo transfer is smooth & atraumatic. This mock transfer is akin to a pap smear. After this pre-test, the IVF cycle commences. Many women are given birth control pills to synchronize the growth of the eggs in the  follicles

•    Step 2- In this step, the ovaries are stimulated & monitored. In any IVF cycle, it is helpful to have as many mature eggs as possible. The greater the number of eggs, better the chances of success.  For about 8-10 days, the woman is injected with HMG drugs that spur the ovaries onto producing multiple eggs. In this phase, the woman is required to visit the IVF clinic 2-3 times for ultrasound scans which are used to monitor egg development

•    Step 3: After the stimulation stage, the woman is given a trigger HCG shot. This shot provides the final maturation of the eggs, which would now be ready for harvesting. This is the most crucial step in the IVF procedure since the doctors harvest the eggs in this stage. Timing is of essence and the eggs cannot be harvested either too early or too late. Generally, egg retrieval is performed around 36 hours after the final trigger shot.

•    Step 4: This is the stage in which the embryo development takes place. The eggs are fertilized with the partner/donor sperm, in a laboratory. After about 16-18 hours, they are checked to ascertain if fertilization has occurred. If the eggs are fertilized, after 3-5 days the best 2 or 3 embryos are chosen for transfer

•    Step 5: This is the final stage in which the actual embryo transfer occurs. The number of embryos transferred into the uterus depends on the age and health of the woman, after considering the risk associated with multiple births

Before going in for IVF, you need to be well prepared. You can watch  a film about IVF  at www.ivfindia.com


You can download a free IVF app at www.myfertilitydiary.com

When Expertise Counts

After approximately 14 days of the egg retrieval, the woman is asked to take a pregnancy test to see if implantation has taken place. If the embryo has successfully implanted, the pregnancy test would show up as positive. This is typically how an successful IVF procedure runs and “baby dreams” reach fruition.

The experienced doctors at clinics such as the Malpani Infertility Clinic have the knowledge and expertise to help you with a successful IVF procedure. Need more information? Get a free second opinion from Dr Malpani by filling in the Free Second Opinion form.


Wednesday, January 21, 2015

When the man is shooting blanks - The Ins & Outs of Male infertility

Recent surveys have revealed some alarming facts- 15% of Indian couples in the 31-40 years age group need medical intervention to successfully conceive , as either one or both the partners suffer from fertility issues.

Generally, if a couple has unprotected intercourse for a year and are still unable to conceive, they are said to suffer from infertility. The sad truth is that there are number of misconceptions about infertility floating around. The most popular one of course is that it’s always a problem with the woman. This is one myth that has to be debunked.

The truth is that in almost 40 percent of all infertility cases, the problem lies with the male partner while 40% of infertility issues are attributed to the female. In 10% , we cannot find out the cause; and in another 10%, both have a medical problem.

Semen analysis is the basic test used to determine male fertility. In case any abnormalities show up, your doctor will get you to repeat the test at a later date.  Please make sure you do the test in a reliable lab !

Understanding the Causes

It’s only when there is a persistent abnormality in the  semen analysis that doctors will tag it as male infertility. There are a number of causes for it such as childhood infections, genetic factors, physical abnormalities and hormonal disorders:
•    Men who drink alcohol and smoke tend to have a 13%-17% lesser sperm count compared to teetotalers
•    In some cases, STD’s such as Chlamydia and gonorrhea are the reasons for infertility. These block the sperm-carrying tubes
•    Testicular damage & failure can result from mumps in childhood. At times this can also lead to absence of sperm
•    A boy might also be born without a vas deferens (this is the tube via which the sperm travels from the body to outside it); this is a congenital disorder
•    Undescended testes can be another cause of male infertility. This can result in damage to the testes which is why no sperm will be produced


Treating it Right

•    ICSI: If the man has a very low sperm count Intracytoplasmic Sperm Injection or ICSI is the preferred procedure that doctors use. The woman’s eggs will first be collected during an IVF cycle. Each sperm will then be picked up and injected into the egg utilizing a micromanipulator. Once the eggs have fertilized and divided after 2-3 days, the embryo is then placed inside the womb

•    PESA: In those cases where the semen does not have any sperm, PESA is an option for men with obstructive azoospermia. ICSI is done to inject the sperm into the egg

•    TESA:. For men with non-obstructive azoospermia, TESA can be explored. A tiny needle will be used to remove the sperm directly from the testes. This is a minor procedure and no major surgery or cut is required. The ICSI procedure will then be used to inject the sperm into the egg

IUI is NOT a good treatment option for the infertile man. If the sperm are functionally incompetent, then using these sperm and injecting them into the uterus will not help. It just wastes time and money and creates frustration.

In cases of no sperms, and complete testicular failure, using donor sperm is the only option. These have to be taken from a sperm bank. The success rate of this procedure is quite high, since the woman if fertile. The procedure itself is simple and inexpensive, but can be very hard to come to terms with.

Even a Male can Fail

As you can see, male infertility is not as much a rarity as our male-centric society makes it out to be. So before making any assumptions or embarking upon a blame-game, it’s important that you consult an infertility doctor and confirm the diagnosis.  You will then be able to take a decision about what the further plan of action should be.

The experienced doctors at clinics such as the Malpani Infertility Clinic have the knowledge and expertise to help you with a successful IVF/ ICSI  procedure. Need more information? Get a free second opinion from Dr Malpani by filling in the Free Second Opinion form.



Tuesday, January 20, 2015

IVF Treatment Failure is not the End of The Road !


IVF treatment cycles can swing either way- sometimes they work and sometimes they don’t. When they fail you need some time to recover- physically and mentally, or else you might find yourself averse to pursuing  further treatment. But giving up can prove to be an expensive decision which you may regret later on in life.

The Options

Give yourself breathing space to recover - If a particular IVF cycle has failed, it is recommended that you take a break and then try again. This “interval” is your time to break free from the stress of the IVF treatment and give your body the time to recover. In this period of time, you may want to reassess your options, focus on healing and come to terms with all your feelings


Change the IVF clinic - This can be helpful, as you can get a fresh perspective. At any rate, getting a second opinion never hurts, and helps to confirm you are on the right track
Consider third party reproduction - This could include using donor eggs or donor embryos. This can be a challenging dilemma, and you need to listen to your heart - there are no right or wrong answers !
Surrogacy- If you've failed a number of cycles, you may want to contemplate the surrogacy option. Consult your IVF doctor about whether it is advisable to try IVF again and whether using a different method will be more beneficial.  Check with him whether there is something you can do to step-up your chances of conception the next time around. If surrogacy is something you are open to, speak with your doctor about that option too
Counselling- This is one aspect you must strongly consider. Though consulting a psychologist is not something everyone is open to, counselling helps you voice your feelings and you get a sounding board and an independent objective viewpoint from an impartial advisor, which will help you put things in the right perspective.

Learning from the failure -

It is crucial that you discuss with your IVF doctor about what you can learn from the failed IVF cycle. The most common reason for failure is failed implantation. The commonest cause is that the development of the embryos which were transferred into the womb arrests.  Often embryos which look perfect may have faulty chromosomes which prevent them from growing further.

Time to Stop?

Regardless of the number of times you have attempted IVF treatment, there may come a time when you have to take a decision about discontinuing it. This could be because:

•    You do not feel emotionally strong enough to go through with it again, and are frustrated

•    You are unable to financially afford the treatment

•    Your IVF doctor may inform you that you have no chance of conceiving, and that the treatment is futile

•    He may suggest third party options such as using donor eggs which you may not be comfortable with

The Alternatives

Discontinuing treatment can lead you to other choices:

•    It might just help to consult a counsellor or speak with other women who have been in a situation like this. This will help you think more clearly and decide how best you can move on

•    You may want to explore options such as adoption or fostering

•    You may just want to delve into what life without children can be like

The important thing is to maintain positivity at all times. A negative outlook can only do harm- to your health as well as your psyche. At times, it’s this positivity that will get you through the toughest of situations in life and you may find that even though you've reached the end of your fertility journey, you have peace of mind that you tried your best, and can then move on with your life.

Want to explore your options after a failed IVF cycle ? Please contact me via this online form, so that I can guide you!

Monday, January 19, 2015

HIPA for Indian health insurers

The global healthcare landscape is changing, and health insurers need to adapt and evolve if they don't want to remain dinosaurs who are doomed for extinction. US health insurers have learned to comply with HiPAA - the Health Information Portability and Accountability Act, which focuses on healthcare documentation and data security . Indian health insurers seem to be stuck in the past, but they need to reinvent themselves as HIPAs if they want to remain relevant and competitive !

Not sure what HIPA means ? Read more at 

http://health.economictimes.indiatimes.com/news/industry/hipa-for-indian-health-insurersdr-aniruddha-malpanimdmalpani-infertility-clinic/45933882

Sunday, January 18, 2015

Do we really have a doctor shortage in India ?

Once we stop equating “more care” with “more doctors”, we are one step closer to building a more sustainable healthcare system.

http://thehealthcareblog.com/blog/2014/07/21/the-answer-to-the-doctor-shortage-isnt-more-doctors/

In fact, churning out more doctors can create more problems than it solves !

For one, many of these doctors choose to specialise in highly lucrative branches in order to maximise their income . Because these specialists need lots of technology to support them, they are forced to practise in large corporate for-profit hospitals, all of which are located in big cities. Because there are too many of these specialists in the metropolises, they compete with each other, leading to overtesting, overtreatment, price wars and medical corruption.

The standard solutions of forcing doctors to practise in the villages is also doomed to fail. If you force a doctor to go to a primary health center, and then don't provide him with the supplies and resources he needs, how can he perform his duties ?

The problem is really a healthcare delivery problem , rather than a doctor-shortage problem.
We have enough doctors. We just need to tap into their expertise more cleverly, using digital technology, so they can reach out to where the patients are.  Unfortunately, there is too much money to be made in starting private medical capitation fees colleges, so we will continue addressing the wrong problem.

Saturday, January 17, 2015

Infertility and the joint family


For god’s sake, infertility is not a sin!

For infertile couples living in a joint family, coping with the stress of infertility could be nothing less than a nightmare. Many such couples are derided because of their infertility, and are often excluded from family functions because they are considered to be “inauspicious”. And if that was not enough, they are treated as second-class citizens simply because they don’t have a baby, while preferential treatment is provided for the daughter-in-law who does have a child.

The Hum Aapke Hain Kaun family


On the other hand, there are many joint families who are extremely supportive. Some family members are thankfully mature and provide a lot of affection and motivation to the infertile woman. They empathize with her and understand the pain she’s going through. Rather than painting all mother-in-laws as villains (blame our TV serials for that!), we need to understand the value a joint family can provide. People who live in a joint family often have a much more mature perspective, because they’ve seen a lot more of life's ups and downs. Because they live together, they share their sorrows and joys. And it’s a universal truth that sharing halves sorrows and multiplies joys, isn’t it?
In a supportive household, the daughter-in-law who is infertile is treated as part of the family, and is often pampered. The family members understand that she’s hurting on the inside and they do their best to try to integrate her with the rest of the family. Surprisingly, even some mother-in-laws are extremely supportive, especially when they’ve suffered miscarriages themselves and they know what it’s like to go through the loss of a pregnancy.


It all balances out
 

As one of my patients told me, “I get so much pampering from my family members that I’m touched. Honestly, though I do grieve about the fact that I don’t have a baby, I’m blessed that I have family members who love me so much. My nephews and nieces shower me with so much love that I don’t feel the absence of my own biological child at all.”

The major advantage of having a large joint family is that the chances of finding at least one empathetic family member who will provide care and comfort is much higher.  The love and support this one person provides can outweigh all the barbs and taunts the others thoughtlessly fire.

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




How to Pinpoint When you Will Get Pregnant



Baby-making is all about timing and in order to target it right, you will have to zero-in on the fertility zones in your cycle. Of course, there are no guarantees that you will get it right the first time around. But look at it this way- if you have a flight to catch, don’t you need to know what the reporting time is?  

The Phases

There are a number of things you can do right through the month, to magnify the odds of conceiving. Let’s take a look at what these are:

·         During your Period- By the 3rd day of your period, your estrogen levels will be on the rise because your ovaries are getting ready to prepare the eggs that will be released when you ovulate. On an average, ovulation is 14-days before your period starts.

Tools to track your fertile time

You can use an ovulation predictor kit to track your ovulation. You can also use our free fertility app which you can download at www.myfertilitydiary.com !

Unless you are an extremely early ovulator, the chances are dim that your partner’s sperm will have any eggs to actually work with in this particular phase of your cycle.  The odds of you conceiving are almost zilch.

 ·         Pre-ovulation- I always recommend to couples who are trying to have a baby, that they should have sex at least 2-3 times a week, after the period gets over in order to cover the ovulation window.

     Here’s a little tip. Around Day-7 of your cycle, you will notice that your vaginal discharge is slightly sticky to the touch.

In a couple of days, you will notice that it has turned creamy & white in color- this is an indication that your fertile time is starting . This way you know that ovulation is right round the corner.

It’s a good time to get some of your partner’s swimmers in place (sperm can live upto 5 days if it is trapped within fertile cervical mucus. ) Your odds of conception are good in this phase. Though the egg has not really been released at this point, it’s a good time to add a boost to your sexual routine, in case you ovulate before time.

·         Ovulation- This is the zenith of conception. Regardless of the duration of your periods or your cycle length, ovulation will typically start around 14 days just before your next period. After this this occurs, your body temperature will rise by around half a degree.

However, the rise in BBT happens only after you ovulate, by which time it is too late to time baby making sex.

Ovulation kits can come in handy for pinpointing baby making sex. Once the result is positive, you should have sex and continue doing so for a window of 36 hours. At this point the odds of you conceiving are very high.

·         Post-ovulation- This is the fag end of your cycle . This is called the luteal phase and lasts for 14 days. The progesterone levels will start rising;  and your cervical mucus dries up and acts like a plug that prevents any more sperm from swimming into the uterus.

It takes around 6 days for the fertilized egg to then travel to the uterus. If one implants itself in your endometrium, the hCG (human chorionic gonadotropin) will rise. This is the hormone that is measured via home pregnancy tests.

During the luteal phase, your odds of conceiving are very low , and there isn’t much that can happen till next month.

The Best Try

As you can see, for couples who are trying to have a baby, all this calculation, checking and re-checking can be quite a task. But there are many tools you can use to get it right. As I mentioned earlier, there really are no guarantees that you will get pregnant at first try, but it’s definitely worth all the trouble if you do, don’t you think?

For more information and guidance about how you can plan your pregnancy, you can contact me via this online form, so that I can guide you in a better way!

Friday, January 16, 2015

Making medical decisions can be an emotionally charged issue



One of the most important roles doctors play is helping patients in choosing the right treatment. With an array of choices before them, patients are often confused. What adds to the confusion is their lack of knowledge about the options available. Distressed by this dilemma, patients look up to their doctor as a medical professional who will show them the right path. They expect their doctor to behave as a trusted advisor.
 
http://health.economictimes.indiatimes.com/news/industry/making-medical-decisions-can-be-an-emotionally-charged-issue-dr-aniruddha-malpani-md-malpani-infertility-clinic/45887224

Avoid These Speed Breakers on the Path to Fertility


When infertile couples walk into a fertility clinic, they are full of hope and dreams of having a baby, and in most cases (with some luck sprinkled for good measure), those dreams will be fulfilled. But most of these couples are also just too eager to get on with the process which ends-up doing more harm than good.

Over the years, I have counselled and treated scores of infertile couples and many feel that they know what they are doing. They check “fertile” dates, surf the internet for fertility foods, and make lifestyle changes . Many will flaunt their knowledge and will leave no stone unturned in their attempt to make that much-wanted conception take place.

 The Road Blocks

 Unfortunately, there are a number of misconceptions around fertility which eventually leads to no conceptions. Let’s take a look at what these rumble strips are:

 Ignoring the “Frisky” Factor- If you have a bosom buddy who also faced infertility, shone through it and had a baby, you must definitely be exchanging notes. You are sure to have heard how she eventually managed to have a baby only when she “stopped worrying about it”. As a matter of fact, there is an element of truth to this aspect. When you are stressed out about getting pregnant, your cortisol (stress hormone) levels rise and this affects ovulation and fertility. I consistently find myself telling my patients that they need to stop trying so hard and let their bodies take their course and get a little frisky while having intercourse ·

 Not Doing it Right-

Once you have set your mind to it, do it right. When you know what your most fertile period is, have intercourse every other day. Don’t worry that "overdoing" it will end up depleting your partner’s sperm count - he cannot run out of sperm, so relax ! If you “underachieve”, you may just miss the crucial fertility window

Reaching for Fancy Products-

Many women feel that douching is a good thing, but when you are on a baby-making run, it’s a terrible idea to use douches as they alter the pH-level of your vagina and impair fertility. It’s the same with personal lubricants. Studies have proved that they lower sperm count and impact sperm motility too

The Blame Game

Whenever there is talk about infertility; the first thought that crops up in a couple’s mind is that the issue is with the woman’s condition; while the fact is that 40% of fertility cases are male-related. The point I’m trying to make here is that when it comes to diagnoses, it’s an even playing-field. Its best to scrap the blame game and focus how to make that baby ·

 Math Confusion

Well, you don’t have to be an Albert Einstein to get the fertility dates right, but you will have to hone your math skills. You will find couples circling dates on calendars, pulling out calculators and counting on their fingers. And so, if you are confusing yourself silly with all the math, please use our free MyFertilityDiary app to make your life easier !

Is it all in the Planning? 

 The one thing that I would like to state here is that no matter how much you try and how well you time everything, you cannot really plan a pregnancy. All you can do is avoid the rumble strips on the path to fertility. Take your time, follow your doctor’s instructions, relax a bit after you have had intercourse, avoid alcohol and smoking and definitely stay away from drugs.

Every person’s body is different and will react differently and so, when you are following all the “fertility mantras” that your doctor has advised you about, enjoy sex, time it right and wait for lady luck to do the rest! For more information and guidance about how you can improve your fertility, contact me via this online form, so that I can guide you in a better way!

Thursday, January 15, 2015

Doctor, please listen to me !

The careful history Dr. Martin took revealed that Betsy was taking an over-the-counter weight loss product that contained ephedrine. (I have changed their names for privacy’s sake.) When she stopped taking the remedy, her symptoms also stopped. Asked why she hadn’t mentioned this information before, she said she’d “never been asked.” Until then, her providers would sooner order tests than take the time to talk with her about the problem.

Communication failure (rather than a provider’s lack of technical skill) was at the root of over 70 percent of serious adverse health outcomes in hospitals.


http://www.nytimes.com/2015/01/05/opinion/doctor-shut-up-and-listen.html?action=click&contentCollection=Opinion&module=MostEmailed&version=Full®ion=Marginalia&src=me&pgtype=article&_r=1

The problem is much worse in India, because:

- doctors are overworked and rushed
- patients are in awe of doctors and don't have the courage to speak up; and
- there are so many different regional languages !

We need to develop technology which will improve the ability of the doctor to communicate information to the patient, without eating into the limited face to face time he has to spend with the patient.

For example, intelligent algorithms which can take an automated history while the patient is at home, can help considerably in overcoming the doctor-patient communication gap.

Are Doctors Pros or Cons ?


One of most important roles doctors play is helping patients in choosing the right treatment. With an array of choices before them, patients are often confused. What adds to the confusion is their lack of knowledge about the options available. Distressed by this dilemma, patients look up to their doctor as a pro ( or a medical professional ) who will show them the right path. In other words, they treat their doctor as a trusted advisor.

Unfortunately, the doctor’s advice is often biased. Doctors, by virtue of being doctors, are predisposed to treat. It’s much like “Don’t just stand there – do something!” They are understandably partial toward performing medical procedures, because this is what they have been trained to do – and they are paid well to do these! So, if you have chest pain and go to a cardiologist, it’s quite likely he will advise you to go for an angiography, because this is what he has been taught as the right thing to do.  However, it might not always be the best advice for the patient, and this is one of the reasons there is such a huge trust deficit between doctors and patients today. Many patients rightly conclude that doctors tend to over-test and over-treat. This is why some of them believe that doctors are professional cons !

In the best of all possible worlds, the doctor will hold the patient's hand (well, not literally!) and help him decide for himself so that he makes the right decision. Good doctors do this all the time. They use the McKinsey system of making a mutually exclusive and exhaustive list of all the possible options – both medical and nonmedical – so that patients can work through these, sort out their priorities, and choose what works best for them.

However, making medical decisions can be an emotionally charged issue. For instance, when I suggest the alternative of adoption to infertile patients , they get upset and agitated. They feel I am being extremely negative, or may be because I doubt their chances with IVF. However, this is not true. I am just trying to be as unbiased and neutral as possible, and am consciously making sure that I don't censor the information I provide.

Sometimes, this can be a difficult task because patients simply misinterpret my intentions. This is where a second opinion can be very useful – especially if this is offered by a retired specialist. He can provide objective, trustworthy, reliable advice with no commercial interest whatsoever, because he is not going to provide the actual treatment himself.

Tools for helping you decide

Here’s where web-based Information Therapy can come in handy. The digital information provided is objective, neutral, and evidence-based. Patients can work through their options all by themselves, keeping in mind that the advice they are getting is tested and trustworthy.

However, just providing a list of options is not enough. Making a decision always involves an opportunity cost, because when you choose one option, you have to forego the other available choices – after all, you cannot have your cake and eat it too! Doctors need to provide patients with a process for decision making as well, so that that they can make the right decision for themselves.

A tool called 10-10-10 has been developed by Suzy Welch. The simple tool helps you think logically about the consequences of your decision. Ask yourself – If I select this option, how will I feel about it 10 minutes from now? 10 months from now? 10 years from now? Knowing your priorities will help you with the 10-10-10 process – in fact, this process can even help you discover them. It allows you to see matters from the right perspective, so that you are at peace with yourself.

Avoiding the bias and being adaptable

It’s important that the doctor makes it a point to be neutral and impartial. Most doctors, like all human beings, are full of biases that influence their decision, without even being aware of their personal prejudices. Being tagged as medical experts, many doctors try to act as founts of wisdom, so that they can help the patient decide because he is not clever enough to do so on his own. After all, don’t they know much more that the patient does? And shouldn’t they allow the patient to benefit from their wisdom, experience, and expertise? Isn’t this what the patient expects? And isn’t this what he is paying them to do?

This can be a very tricky issue, especially when the preferences of the patient differ from those of the doctor. This is why it’s important that the doctor behaves like a coach, and allows the patient to decide for himself.  Part of the doctor’s skill is to help the patient tap into his own heart and brain, so he can listen to what his body and gut is telling him. While it’s the doctor’s responsibility to ensure that the patient does not make a decision which can harm him, he also cannot hijack this key role and start making all the decisions for the patient. Just like a coach helps the athlete to tap into his inner resources, a good doctor gives the patient the courage and support he needs to look into himself and make the right choice.

Following this path will help patients to live with the consequences of whatever decision they make, no matter what the final outcome is. This is always uncertain in medicine, but if the doctor helps the patient to follow the right process, it will make the patient's, and the doctor’s, life a lot easier.
Some patients want the doctor to make the final decision because they believe that he is the expert, and they trust him to make the right choice. This is fine as well, because the doctor is then simply honoring the patient's preference.

Nonetheless, because all patients are different, doctors need to learn to adapt their styles to suit the patient’s needs. They need to be flexible, and behave like foxes, so they can do what’s right for the patient sitting in front of them, rather than behave as hedgehogs who are rigid in their approach. Doctors also need to be versatile, so they can tailor their behavior to meet the patient’s needs.


Wednesday, January 14, 2015

How Stress Leads to the Male Infertility Mess



A significant amount of research has been conducted on how stress negatively impacts health and leads to heart conditions, asthma, depression and obesity. But now studies are also linking stress to reduced sperm-count and sperm quality, which impacts male fertility.

In almost 40% of all infertile couples in India, the male partner contributes to infertility. Sperm abnormalities are the primary reason for male infertility and includes immobile/misshapen sperm or low sperm production.

Focus Awhile on Your Lifestyle

When infertile couples come to our clinic , I try to ascertain the kind of lifestyle my patients lead. Modern-day life can be very stressful, jobs are demanding, and people face personal and career stresses as well as financial ones. What makes things worse is the kind of lifestyle that people lead- they work late hours, don’t eat right, and don’t sleep long enough . All these factors tend to weigh down on the person and create stresses that result in a range of medical afflictions including infertility.

The Study

Researchers from The Mailman School of Public Health from NY’s Columbia University and Rutgers School of Public Health in Piscataway (NJ) published a study in the Fertility and Sterility journal. The topic of investigation was about how stress might affect sperm quality.

The study spanned 4 years, and 193 men in the age range of 38-49 years were assessed. Tests were conducted and stress levels were measured- this included workplace stresses, life events as well as overall perceived-stress. The researchers analyzed aspects such as sperm concentration, sperm shape and motility.

The Findings

It was found that men who had experienced 2 or more stressful life events over the course of a year had lower sperm quality compared to men who hadn’t experienced any kind of stressful life events.

The men who experienced job-related strains had low levels of testosterone (sex hormone) and this could have a negative impact on reproductive health. Interestingly, men who were unemployed also had lower semen quality compared to men who were employed.

So What Exactly Goes Wrong?

Researchers are not able to pinpoint how stress impacts the quality of semen, but there are some strong theories:

·         Release of Glucocorticoids- Stresses may activate glucocorticoids (steroid hormones). These affect  metabolism of fats, proteins and carbohydrates which may in turn reduce sperm production and testosterone levels

·         Oxidative Stress- Stress can act as a trigger for physiological (oxidative) stress, which is caused  by the damage from un-neutralized  free radicals- this has been linked with semen quality.

The Stress Mess

Stress and infertility are a chicken and egg problem.  While stress can cause infertility, infertility causes stress as well !

The problem is that we tend to blame everything on "stress". Real life is much more complex than this ; and sometimes just telling the poor man that his low sperm count is because he is too stressed out just adds to his stress levels and makes a bad situation even worse .

Hacking that Stress

We need to focus on constructive solutions. One way to hack stress is to mindfully attempt to rid your body of all mental & muscular tension. Redirect your energies, work efficiently, improve mental clarity and freeze long hours at work, eliminate back pain and improve posture.  Learning yoga and meditation will not only help to improve your ability to manage your stress, it will also help you cope better with your infertility !

These tools will help you think lucidly in high-pressure/tense situations and find equilibrium in your life. Infertility can be a major disruptor of marital harmony, and you need to be able to provide a helping hand to your spouse.

For more information and guidance about how you can improve your fertility, contact me via this online form, so that I can guide you in a better way!

Tuesday, January 13, 2015

Angel investing at IIT - The 10 Minute Million


 Am looking forward to participating in the Shark Tank event at IIT on 1 Feb 2015.
http://ecell.in/esummit/the10minutemillion/#portfolio


Misinformation about IVF


In fact marketing, paired with despair, can work well enough to convince people to demand treatments for which there is no scientific evidence and in spite of their own better judgment. Misinformation is the worst thing for patients trying to navigate the baby business. With so much information out there, it is difficult for people to separate fact from fiction.
http://www.bionews.org.uk/page.asp?obj_id=484018&PPID=484125&sid=708

This situation is much worse in India, where most patients are not sophisticated enough to do their own homework. They naively trust everything their doctor tells them - and this blind faith can be disastrous in many cases.

The only solution to this problem is Information Therapy !

The major advantage of providing information online is that it encourages openness and transparency. While doctors may take advantage of a poor patient's gullibility within the four walls of the clinic, they know they will get into serious trouble if they lie on their website. This helps to keep them honest.

It would be ideal if the Health Ministry ( for example, the ICMR) took ownership of this problem, and create educational materials about IVF  in the major Indian regional languages. Because this information was neutral and was being published by the Government, patients could trust this.

Are you confused because you are finding it hard to make sense of what's true and what's false in
IVF ? Check out our website at www.ivfindia.com which has comic books, e-learning courses and animated films to help you make sense of what IVF can do - and what it can't !

The Lowdown on Why Some IVF Doctors Lie


With IVF technology burgeoning and advancing at a rapid pace, most IVF cycles run as they are meant to.  The patient grows eggs that are retrieved and the good quality embryos are then transferred to the uterus. Even if the procedure does not result in a pregnancy, the doctors show the patient photos of the good-quality embryos that were transferred.

The doctor and patient share a certain bonhomie, in the thought that the treatment was carried out the way it should have been. But this is not always the case. There are times when certain doctors will very fluidly lie when they are faced with an adverse situation - for example, when he is not able to collect any eggs.
The Reason Behind the Lie

Bad things do happen, and sometimes the doctor is unable to collect any eggs at the time of retrieval. In other cases, the eggs fail to fertilize or the embryos arrest in the lab. A conscientious doctor would be forthright with the patient and tell them the truth. Unfortunately, the unscrupulous ones will try to eclipse the truth with a veil of lies.

This may occur because the patients have not been counselled properly and they harbour unrealistic expectations of the IVF treatment. Many doctors resort to the tactic of quoting strikingly high (and bloated) success rates. This is bait and they hope that the hopeful prospective parents will bite , instead of testing other IVF Clinic waters.

The Glitches

But this kind of action doesn’t come without its repercussions; For instance, if there are any technical problems during the cycle, this tactic will boomerang on them. Different occurrences can impact the IVF cycle negatively- For example, a trainee embryologist might accidently kill all the eggs while conducting an ICSI. A power failure in the lab may result in the death of the embryos.

At times, an infection in the culture medium may affect division of the embryos. Some patients have cervical stenosis which makes the transfer technically difficult. The catheter does not negotiate the cervix and the embryos fail to be deposited in the uterine cavity. If any of these unfortunate incidents occur, it is ethically, morally and humanitarianly abiding for a doctor to be upfront & honest; avoid speaking in tones of grey and give the patients the truth.

Though some patients may take this kind of a situation in their stride- many will not, and upset, anger and resentment are bound to surface and boil over, and very rightfully so. Regardless of what misgivings the doctor has, it is crucial for him to be truthful; and this truth serves as a learning point for the patient and the doctor and drives the latter to do a better job with the next IVF cycle.

When Excuses Abound

But the reality is that many doctors will use the excuse of “abnormal sperm” or “weak eggs” as a smoke screen to placate their patients. But current-day patients are smart; they try to source more information about what could have actually occurred. They do this by speaking with other patients, asking the nurse & the embryologist and resourcing information online.

If they are smart enough and are able to figure out that the IVF doctor has lied to them, they are bound to be livid and many will also take to social media to make public the doctor’s wrongdoings. This can be a major blow to his reputation and will tarnish his professional and personal image.

The Power of  the Truth

Therefore, is important for an IVF doctor to maintain transparency while dealing with his patients, but it’s equally important for patients to be proactive with asking their doctor to provide them with accurate information for every stage of their IVF cycle. Being well-informed is about having peace of mind that they have received the appropriate and high-quality care.

Need help in learning more about what your IVF medical records mean? Please send me the relevant medical details by filling in this form, so that I can guide you better!

Monday, January 12, 2015

First time lucky ! An IVF success story at Malpani Infertility Clinic

We are married since 15th January 2005, then for two years we tried to have Baby by just having normal relation with each other like all other couples do which is normal.

In 2007 we started our treatment for having baby with the local Gynaecologist who use to some tablets and Injections for some days and advise us to have relation on this date and that date etc, still my wife did get pregnant and we kept on trying until 2010 during which sometimes we were together and sometimes I was away for my duties/ jobs.

In 2010 through some of my wife’s friend we came to know about one clinic in Madgaon ( Goa) name not mentioned due to security reason where IVF is done for the infertile couples, but when we reached there  and told the Doctor that we want to do IVF, he did not told us that IVF is not done there instead he advised us to IUI saying that it is very cheap and also told us that we need to come there for treatment for at least for six months  which clearly indicates money making business and it was very difficult for us to travel because our house was about 80 kms away from the clinic, but still we went there for treatment and we had done about three cycles of IUI and results were ZERO and the Doctor did not even give us a document of what he has done. So like this we wasted 05 years of our married life in full tension and stress.

On 25th September 2011 I had searched and found on Internet about Dr Malpani’s IVF clinic in Colaba, Mumbai and was satisfied with the information provided in it, So I had put and enquiry for the test to be done, total cost of IVF procedure etc and on 26th September 2011 Dr Anirudha Malpani replied it, but unfortunately I did not had sufficient vacation for undergoing treatment at the Malpani Clinic.

On 26th September 2014 again I had emailed Dr Malpani about the test to be done, cost of IVF procedure etc and he promptly answered My email on 27th September 2014 and advised me to carry out some blood test on the third day of cycle and a Vaginal ultra sound on 10th or 11th day of the cycle for his reference and assessment and nothing more. Then I took an appointment for 18th Oct 2014 for 1500 hrs.

On 18th Oct 2014 we both went to the Malpani clinic and we had a good interaction with Dr Anirudha Malpani wherein he asked us all the methods we had tried to have the Baby which I have already mentioned above. He then asked me if the Doctors had given any documents for what they have done and my answer was no, then he said he will provide all the documents on completion of the treatment. My wife was very happy by seeing the clinic the way it was maintained very neat and clean and the Doctor spoke, who gave us the clear picture saying that everything is fine with us and we just need assistance for pregnancy.

He asked us to come on the first day of the cycle, but my wife’s last cycle was on 27th sep 2014, since it keeps going up and down every month by 05 days before or after the previous date and sometimes on the same day, I did not wanted to take risk and went to Mumbai 10 days before, which was 17th Oct 2014   and met the Doctor on 18th Oct 2014 and he advised us to do the shopping and enjoy our time and live normal life.

The cycle due date passed which was 27th Oct 2014 and we were upset now due to wastage of time and at last there came joy on 31st Oct 2014 when my wife finally had bleeding and the new cycle started. So we immediately rushed to the clinic and our treatment commenced and Doctor used to scanning and he used to show us how the EGGS are developing.

Pre- Operative instructions leaflet was given to us well in advance.  Finally on 15th November 2014 my wife was admitted for EGG retrievals under General Anaesthesia. She was brought out of the theatre and kept in the post operative care room and everyone who came out of the operation theatre told me that they have retrieved 21 EGGS  which itself was a good sign of partial success to me and my wife. As Soon as my wife recovered from anaesthesia, I took her back to the Hotel. Post operative instruction was also given to us and we were told to call the Clinic by telephone after two days to confirm the date of Embryo Transfer which was initially told to us will be on 20th November 2014.

On 20th evening the developed embryo’s were shown to us on the microscope connected to the computer monitor and we were briefed about the developed embryo’s by the Embryologist , Dr Sai. By seeing these images we were very happy and we were very sure that we would get excellent results and that’s the reason we denied to freeze the spare embryos. Finally I was also called inside the operation theatre and the Doctor Anirudha Malpani carried out the embryo transfer procedure without anaesthesia and it was easy for my wife without having any pain and there after she was brought to post operative room for about two hours bed rest. We went to the Hotel and my wife took rest for 3 days in the Hotel, only bathroom and dining in the hotel. We then came back to Karnataka and the days past by very slowly. I helped my wife as much as possible and gave her maximum rest which is not required, but it is up to you.

On 2nd Dec 2014 we did the first blood test, Beta –HCG test for pregnancy and it was positive, the clinic showed the responsibility by calling us at 1400 hrs for the results but it was not ready, the reason for the delay in result was because of the laboratory which was 70 kms away where the sample was sent by the collecting Laboratory. As soon I received the result I called the Clinic and Dr Anirudha Congratulated us saying that, my wife is pregnant, Subsequently the same test were repeated on 5th Dec 2014 and 8th Dec 2014 and the results were good.

Finally we did the vaginal ultra sound as advised by Doctor on 11th Dec 2014 and it was confirmed that one Embryo was implanted and we informed this to the Malpani clinic. Since the Radiologist in Canacona (Goa) could not hear the hearts beat and see the tail of embryo, he suggested a repeat ultra sound after two weeks. We informed this to Dr Anirudha Malpani and he advised us to do it after 10 days. In between one day when I was out from the house my wife had bleeding and she almost lost her hope thinking that its all over now and she immediately called me on mobile. I rushed to the house and called the Malpani Clinic and they advised her to take some rest saying that it is just spotting and normal, No need to worry.

We did the repeat vaginal ultra sound on 23rd Dec 2014 and this there was heart beat and the tail of the embryo as well and one more extra thing the peri gestational haematoma which the Dr Malpani said it will resolve itself and he also advised us to do a repeat Vaginal ultra sound to ensure us that everything was ok and he also said that it is not compulsory, so ignore it . Now there was no end to the joy and happiness to both of us that finally we are going to be parents.

MANY THANKS TO MALPANI CLINIC AND LET THEM KEEP HELPING ALL THE COUPLE WITHOUT CHILDREN.

CONCLUSION AND ADSVISE TO ALL COUPLES WITHOUT CHILDREN PLEASE GO AND SEE MALPANI CLINIC IF YOU ARE NOT ABLE TO CONCEIVE A CHILD WITHIN TWO YEARS OF YOUR MARRIAGE, DO NOT WASTE TIME BY DOING SOME OTHER TREATMENT THINKING THAT YOU WOULD SAVE MONEY.

ITS NOT MATTER OF MONEY ITS MATTER OF PRESTIGE AND RESPECT IN SOCIETY WHICH YOU WILL GET ONLY AFTER YOU HAVE A CHILD WHICH YOU WILL GET AT MALPANI CLINIC

I WAS VERY LUCKY THAT MY WIFE GOT PREGNANT ATHE FIRST CYCLE ITSELF AND NOW SHE IS OF 8 WEEKS OF PREGNANCY AS ON 31 DEC 2014.           

   







   

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