Saturday, February 28, 2015

Surrogacy Centers in India – Turning Parental Dreams into a Reality


There are times when some couples can’t have babies via IVF; many of them are now warning up to the idea of surrogacy. Today a number of infertile couples proactively approach us with queries about surrogacy and how the process works in India. There are different types of surrogacy:

•    The egg and the sperm from the infertile couple is combined to make an embryo. This embryo will then be transferred into a surrogate (a woman who lends her womb for the pregnancy)
•    A donated egg is  fertilized with sperm from the father and implanted in the surrogate
•    An embryo is created with donor eggs & donor sperm and then transferred in the surrogate’s womb

In the past, traditional surrogacy was used, when the sperm from the male partner & the surrogate’s eggs were used by performing artificial insemination/intrauterine insemination (IUI) for the surrogate. This is now illegal in India.

The woman who is implanted with the embryo then carries the child till the point of birth, after which it is handed over to the couple.

Who Can Opt For Surrogacy?

Surrogacy is now helping many infertile couples realize their parenting dreams. There are different instances in which surrogacy can be a viable option:

•    Women who have undergone hysterectomy (the womb is removed for contraceptive or medical reasons)
•    Women without a womb/ malformed womb
•    Repeated IVF failures , even though the embryos are Grade A blastocysts. However, do remember that “implantation failure” after 1-2 IVF cycles is NOT a reason for doing surrogacy

The Benefits

When you opt for surrogacy via a registered clinic like ours, we help you connect with a surrogate and handle all the legal formalities involved in the process. This ensures you take your baby with you after it is born.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Alternative Medicine- The Best Complement to Boost IVF Success


Science has not been able to conclusively prove that stress and fertility are directly correlated. However, there is a lot of evidence that supports the fact that a healthy & happy mind and body is a factor in the success rates of IVF. As more of these statistics  come to light, a larger number of IVF doctors are now suggesting that their patients opt for alternative treatments such as acupuncture, yoga, counseling, massage and herbal supplements.

Complementing Treatments

It’s important to understand that there is no clinical proof of the efficacy of these treatments with reference to infertility. Even though they are called alternative therapy, this does not mean that they are an alternative to the IVF treatments patients undergo at an IVF clinic. However, there is no harm in using them in conjunction with your standard treatment. They should be thought of as being complementary. Based on an individual patient’s situation, we routinely prescribe that they consider trying some of these therapies. Take a look at the different alternative treatments and how they can help couples boost their chances of successful IVF:

•    Counseling- A failed IVF treatment and a miscarriage eventually take their toll on the couple’s wellbeing. It is important that couples work as a team while they are going through this process. You can be counseled as an individual or as a couple and this helps you prepare better for what is yet to come. You can learn how to support each other  ; and this also helps when you finally get pregnant and embark upon your parenting  journey

•    Acupuncture- Lots of women believe this helps them cope better with the IVF treatment. This is a very "hands-on" treatment, and this can help the patient feel supported and nurtured, over and above its therapeutic effects.

•    Relaxation Techniques- The primary problem with correlating stress & infertility is that any kind of stress is very hard to quantify. Some women express very high-levels of stress while others may not be aware of stresses even though their physical & mental wellbeing gets affected. Using various relaxation techniques, including deep breathing, yoga, massage and meditation helps reduce the stresses and anxiety which plague IVF treatment

•    Herbal supplements - There is a connection between miscarriage & nutritional deficiencies. Ensure that you eat a very well-balanced diet. You can also speak with your IVF doctor about whether any dietary & herbal supplements can foster a healthier environment for your baby. Stay away from processed and fast foods or any other foods that will impact your physical well-being.

The Right Treatment - the best of both worlds !

The idea behind complementing your IVF treatment with alternative therapies is to improve your chances of a successful IVF outcome. It’s important to understand that these alternative treatments should never be taken without consulting your doctor. It’s also crucial that you go to qualified and experienced acupuncturists or yoga teachers. This will ensure that you get the right treatment that will prove to be beneficial to you.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!


What’s Lies in Store for My Stored Frozen Embryos?


Infertile couples are aware about the fact that their embryos can be frozen to increase the chances of IVF success. The embryo freezing process is simple. Unused embryos are frozen & stored in a tank-full of liquid nitrogen at -196° Celsius. During this freezing process, cryoprotectant is added to protect the embryos . In a good IVF clinic, practically all embryos will survive the freezing and thawing process ; and the pregnancy rate with vitrified embryos is as high as with fresh embryos

The Moment of Truth

This is why , if your first cycle is unsuccessful, the IVF doctor will advise that you can transfer the frozen embryos during the next cycle. These embryos can also be used for IVF cycles in the future, if you want to add another baby to your family. But many patients also wonder what happens to the spare embryos that are left over , in case they choose not to transfer them .

Most patients feel that they will not be too bothered about discarding their leftover embryos, once they have had the baby they wanted. After all, now that their family is complete, why should they care ? But when the first bill for the renewal of the embryo storage comes in from the IVF lab, patients realise that’s it not easy to abandon their embryos so easily.  After all, their embies are potential babies, and they have bonded with them once they have seen their photos .

The Options

Couples who have frozen their embryos and will not be using them for their own IVF cycles have a number of options available to them:

•    Continue Storing - You can continue paying for them and keep them frozen and stored for an indefinite period of time. But the truth is that storing fees for frozen embryos can be quite steep , and many couples do not find it to be a financially viable option.  This is especially true because  couples that now have children also have  to focus  on balancing their family budget.

•    Donate- You have the option to donate the embryos to other infertile couples. It can be hard to do this, because people can be quite possessive about their genes ! You may feel you are handing over your future baby to someone else, and you may worry about how well this future baby will be looked after.

If you are not going to be using your embryos, donating them to someone who needs them is a generous thing to do - you are gifting someone parenthood , which as you know from personal experience, can be one of the most cherished gifts someone can receive. However, this decision can be quite an emotionally draining one, because the donation is anonymous and confidential, so don’t minimize the impact. You may have nightmares and fantasies as to what’s happening to your other “babies” out there somewhere in the world. Do remember that infertile couples make great parents, and your embryos will be treasured by whoever is fortunate to receive them.

•    Donating to Medical Research- If you feel that you cannot handle the thought of your biological children being brought up by someone other than you, donating to medical research is another option. These embryos  can be used in stem-cell research for example, and can help to save lives by advancing medical science.

•    Thaw and Discard the Embryos- This is probably the most difficult choice of all. You can choose to thaw the stored, frozen embryos, which means they will no longer be viable. This is one option you will have to discuss with your IVF clinic in advance to check what is permitted and what isn’t. In most cases, patients choose to discontinue renewing their embryo storage; they just prefer that the clinic handle it for them.  Others opt to become involved , and want to be present when the thawing process takes place

 A Personal Choice

The decision about what a couple chooses to do with the frozen embryos is a very personal one , and is based on various factors. Please take all these into consideration before you make your final decision.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!



Friday, February 27, 2015

Infertile Women try to Untangle the Web of their Infertility via the Internet


A large number of infertile women spend hours on the Internet; they scour the Web for information and look for various treatment options & the best doctors too. This is especially true when they have failed an IVF cycle and are trying to find what they can do differently the next time, in order to improve their chances of success.

Infertile women need a lot of emotional support, which is why they are often glued to their PC, reading posts on bulletin boards, looking for nuggets of information on blogs, posting information about their problem & looking for answers from other infertile women. This occurs because their better halves are unable to provide them the emotional support they need and doctors do an even worse job of it. Therefore it becomes natural for them to look for support outside the realm of their immediate surroundings.

Online Communities Provide Support

The anonymity and instant access they receive from an online community makes this a safe and trusted resource; and their emotionally starved minds find a great amount of comfort in this online space. They are able to easily connect with other women who have gone through it all.  These expert patients become a credible source of information. What’s even more important is these women are not tainted by any commercial influences,  and this adds the flavor of trustworthiness to the advice they readily give.

A large majority of husbands tend to get irked by the amount of time that their wives spend on the Internet. They feel that it is an obsession or an addiction and strongly believe that it increases their wives’ stress levels and that it is a thorough waste of time. Most men also believe that since the doctors are the experts, they should be getting advice and counseling from him. Their fear is that some of the information available on the internet may be half-baked so to speak; and that it would do more harm than good.

Snowed Down with Information

A number of women also do get frustrated because they realize that a lot of the information that is available online is not trustworthy. They find starkly contrasting content on various “credible” sites and this causes a lot of confusion in the minds of infertile women who are just trying to glean all the information they can. They are not sure which sites are trustworthy, what action they should take etc. In most cases, this avalanche of information simply snows them down completely.

If they approach their doctor with questions about something they have read on the Internet,  he gets annoyed too and feels that these “internet worms” are a nuisance, both for him as well as to themselves. His rebuttal would generally be “Don’t waste your time hunting for information on the Internet. I am your doctor and I will provide you with the right solutions. You just need to trust me”

Watch Out

In my opinion, this is not a constructive approach at all. We must acknowledge that infertile women are hungry for reliable information, and the Internet is a great source of potentially valuable information. However, patients need to be taught how to use the net intelligently, so that they can then access reliable sites, rather than waste time on dodgy commercial sites. These are set up with the sole purpose of promoting their services & and their only objective is to cheat patients with their false promises and ridiculous claims (e.g: the Clear Passage Therapy website).

Deterring infertile women from surfing the Net is not a good idea - why throw out the baby with the bath water ? Doctors need to help their patients identify reliable websites, so that they can use Information Therapy to maximize their chances of getting pregnant.

Need more information? Get a free second opinion from me by filling in the Free Second Opinion form.

Thursday, February 26, 2015

Cancer Patients Can Combat Infertility with Egg Freezing


The estimate is that our country records 1.1M new cancer cases annually and accounts for 7.8% of the international cancer burden. What is probably even more worrisome is the fact that now a larger number of younger patients are falling victim to cancer.  The latest concern of the medical fraternity is about how best to preserve the fertility of young cancer patients.

The need of the hour is  to create more awareness about  methods such as egg freezing as these  could be a ray of hope for young women who are about to undergo  cancer treatment. Egg freezing is proving to be a boon for cancer patients who are in the reproductive age-group. Treatments such as radiation, chemotherapy and surgery tend to destroy a woman’s eggs which results in infertility. 

Banking on Eggs

Based on the age of the woman, the risk, the type of cancer & the treatment plan, we may recommend egg freezing for women who are diagnosed with certain kinds of cancer. Oocyte cryopreservation/egg freezing is a proven & established method used for fertility preservation in women. In egg freezing, the woman’s mature eggs are first removed & frozen. This particular process is called egg banking. When she feels that she is ready to have a child, the woman’s eggs can be thawed & fertilized and then transferred into the uterus.

De-Focus, Focus

There was a time when doctors who were treating cancer patients used to only focus on ensuring that their patients survived this deadly disease.  Neither the doctors nor the patients and their families every really thought about the impact the cancer treatment would have on the fertility of the women. But the landscape has now changed and with new medical technology and modalities, there is also a change in the survival expectations.

This has brought to the fore the topic of the risk of infertility in women who are slated to undergo cancer treatment.  The objective is that these women should be provided with all the information they need to make more informed decisions about their health and wellbeing. Young women who have not yet started families may want to have them in the future.  Going through cancer treatment without considering egg freezing may be a dead end for them as far as their fertility is concerned.

The Procedure

In the egg freezing method, multiple eggs are frozen. If the woman chooses to have a child after she has gone through cancer and beaten the disease, her uterus can be prepared, the eggs will be thawed & will be fertilized with her partner’s sperm via the ICSI- intracytoplasmic sperm injection - process. Since there will be more than one embryo, 2-3 can be transferred into the woman’s uterus and the rest can be frozen.

In case she wishes to come back for another child that too would now be possible. Over the years, though there have been a number of advances in cancer treatment in India, preservation of fertility in these patients is still in its nascent stages.

Other Avenues

In addition to egg freezing, other techniques such as using donor eggs and donor embryos are other options available to cancer survivors who find they are infertile . It’s important for oncologists and fertility specialists to be more aware about the issue. Doctors should take extra care to ensure that the patients and their family members are properly counseled about the different fertility preservation options before the patient embarks on cancer treatment

Want more information about egg freezing?  Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you in a better way!


Wednesday, February 25, 2015

Too many tests - The Tyranny of the Infertility Workup



The chakravyuha of tests

As a conservative infertility specialist, I try to do as few tests as possible. My focus is not on identifying problems, but rather on implementing solutions. Often, we are far better at using technology to bypass problems rather than wasting time in trying to identify the problem - after all, we are not a research clinic . Our focus is on giving our patients a baby !

Unfortunately, trying to make a diagnosis is the approach the majority of other doctors follow. After all, the first question every patient asks is not “What will you do to give me a baby?” but rather “What’s wrong with me? How can I have a baby in my own bedroom?” In a nutshell, patients ask the wrong questions to which doctors end up providing the wrong answers.

When patients come with the results of a large panel of so-called "routine" tests ordered by other doctors, this creates a lot of problems for me. Often these test results are abnormal, not because they have any clinical significance , but because there are lots of false positives in medicine. After all, every test has its own limitations. However, once we get an abnormal result, it tends to distract us because we are then forced to conduct further tests in order to evaluate the clinical significance of the abnormal result. We sometimes need to refer patients to other specialists and consultants , so they can dig in deeper into the "problem". For example, we often see patients who’ve gone through theTB-PCR tests for their endometrium, which come back as positive. They are then promptly referred to an infectious disease specialist for anti-TB treatment, which wastes one year of their time. It also exposes them to potentially toxic anti-TB drugs , without improving their fertility at all, because this test result is something that has no relevance at all to their infertility. However, once there is one abnormal result, it leads to a downward spiral of further testing , and this just ends up wasting the patient’s time and money.

You are ignoring  my abnormal test results Oh, then you’re a bad doctor!

Doctors have to be very careful when they see an abnormal test result. They can’t afford to ignore it, and are forced to practice defensive medicine in order to show the patient that they are doing everything possible, and are on top of the medical game. When you try to tell a patient that the abnormal test result is of no significance, the patient has very little confidence in your advice. She feels the very fact that the earlier doctor ordered the tests means the tests must be important, and that by refusing to do anything about it, you are not a good doctor. The patient’s worry is that you are not treating the underlying root cause for the infertility, and this will then reduce the prospects of a successful IVF. Doctors also need to protect their own interests, so they are happy to continue with the upward spiral of unnecessary tests. Even worse, this creates an entire group of patients who are absolutely fine, but who start getting worried because they have abnormal test results. This only serves to distract both the patient and the doctor from treating the infertility, and diverts their energies to dealing with something which is unimportant and irrelevant –a clinical red herring. Unfortunately,once the test has been ordered, most of the damage has already been done. It's a mathematical certainty that the more tests you do, the greater is the certainty of finding some problem, which may be of no clinical importance whatsoever. 

However, once the lab reports this "problem," or an ultrasound picks up an "abnormality,"it’s often highlighted, marked in bold, and printed out in red. All the energy then starts getting focused on "treating" this so-called problem. Doctors love to think of themselves as being the Sherlock Holmes of the medical world, who will do whatever needs to be done to fix the problem which the test results show, even though this may be of no clinical importance to the patient .

Be selective, be smart

More testing doesn’t mean better medical care. In fact, I believethat a doctor who orders too many tests is not a good doctorat all. A smart doctor uses tests very selectively in order to confirm what his clinical impression is, rather than going on a hunting expedition looking for problems , just because he is completely clueless and doesn’t know what to do next. Even worse, some of these newer tests can be very exotic and expensive, and doctors take a lot of perverse pride in ordering these tests. Patients naively believe that the fancier the test ordered by the doctor, or the more expensive it is, the greater is the skill of the doctor! After all, the very fact that he ordered an MRI scan, a test which no other doctor did, means that he must be far more up to date compared to his competitors !

The only way patients can protect themselves is by refusing to do the tests. The one question you must ask the doctor is: How will doing these tests change my treatment options? And if it won’t, then please, for heaven’s sake, don’t do the test !

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




Tuesday, February 24, 2015

HELP features in DNA ! Three unusual but promising libraries across Mumbai

Help Education Library for People (HELP) or most commonly known as Health Library is a unique library that is not only free but also aims at keeping you fit.


Can acupuncture help IVF patients ?

There is a lot of debate about whether acupuncture is effective in boosting fertility. But let’s keep that discussion aside for another day. The IVF process can be a very stressful one and it becomes important to find alternative healing methods to alleviate symptoms such as anxiety and depression (which many IVF patients experience). In this respect, acupuncture is a simple and risk-free method of reducing stress and anxiety.

An Age Old Form of Medicine

In the IVF process a woman’s eggs are extracted, fertilized in a lab and then reimplanted into her uterus. This is a highly-invasive procedure that tends to result in stress in many women, in addition to the stresses that infertility itself causes. Many studies have shown that a large percentage of women who undergo fertility treatments have very high anxiety levels. At our clinic we look for ways and means to counsel our patients to help them become less stressed and anxious. 

In this effort, we also do suggest to many of them, that they should consider acupuncture to reduce their anxiety levels. So where does acupuncture come into the picture? It is a conventional form of Chinese medicine. In this treatment, very fine needles are inserted into specific spots on the body (meridians) based on the health issues being treated.

The Acupuncture Study

Brazilian researchers conducted a study in 2012, the results of which were published in the Acupuncture in Medicine journal. In the study, 43 different IVF patients underwent 4 weekly-treatments of either conventional Chinese acupuncture/"sham" acupuncture (somewhat like a placebo), in which the needles were inserted in the vicinity of, but not at the required meridians.

After 4 weeks, these researchers found that the women in the conventional treatment group showed significantly lower anxiety scores, measured on the Hamilton Anxiety Rating Scale, compared to women who were in the “sham” treatment group. Apart from this, a large percentage of women in the conventional treatment group also experienced an anxiety score drop of more than 30%.

The Conclusion

The conclusion of this study was that acupuncture shows significant benefits with reference to treating anxiety in women undergoing IVF.  A number of other studies have also shown that acupuncture does have anxiety reducing effects. Research suggests that it helps activate the "relaxation response," of the parasympathetic nervous system and boosts the production of endorphins and encephalins.

Does Acupuncture Boost Fertility ?

 A number of researchers also believe that acupuncture increases blood flow to the uterus & promotes ovulation as well as production of fertility-regulating hormones. This could increase IVF conception rates, but this is still speculative.

The Positive Impact

Acupuncture has been used in China to treat a number of maladies and it has also been used to improve female reproductive health. There is no refuting the fact that complementing your IVF with appropriate acupuncture treatment (by a vetted specialist), can help you de-stress and help your body respond better to the IVF treatment you are undergoing. After all getting that anxiety and stress out of your system can only have a positive impact, isn’t it?

Want more information about infertility treatment?  Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you!

Monday, February 23, 2015

Is Your IVF Treatment Reducing Your Libido?


Women who are undergoing IVF treatment tend to be much more well-informed and  vocal about the challenges of the entire process compared to their spouses. You will find a number of women that use the blogosphere to share how regimented and soulless they find the entire process to be. They are also very open about how they ride the emotional highs & lows while they are going through the treatment.

However, the one aspect that very few patients & doctors talk about is the heavy toll that IVF treatment takes on the sex lives & sexual desires  of women. It’s not uncommon for couples that are undergoing infertility treatment to face sexual problems. Many studies have shown that women who undergo IVF tend to report lack of sexual interest, satisfaction, desire, orgasm & overall sexual function.  However, this is the elephant in the room which everyone is happy to wish away

Regimented Pleasure

The problem is that when a couple is going through IVF, sex tends to become more enforced and mechanical and loses its pleasure quotient. This is not the case only in India, but across the world too. The one problem in our country is that talking about sexual desires is still taboo. At our clinic, we find that patients do have questions related to what they can do to improve their sex life, but these patients are few and far between.  Most are very reluctant to bring up the topic – and IVF specialists are too focused on achieving a pregnancy to discuss sexual dysfunction.

Stress in the Relationship

Many patients have to be urged to consider counseling, which they will agree to very reluctantly or not at all.  Most couples going through IVF report that it impacts their libido. Some even go so far as to say that sexual stresses result in straining their relationship with their partner; and men and women are equally affected.

Factors in Play

Since this topic is kept under wraps (by both patients and doctors), patients are not too well- informed about why this occurs. There are a range of factors in play here:

•    Many infertile women experience a certain helplessness, depression and shame all at  once. Most of these feelings come from negative perceptions about their bodies and it can result in a significant negative impact  on a woman’s sexuality.
•    The medications uses for infertility treatment can also affect libido. Thus, Lupron switches off estrogen production. This makes the vagina dry, so that sex can become painful. The good news is that as the estrogen levels rise during superovulation, many women find their libido improves dramatically; and lots of women will report spontaneous orgasms during their sleep after the embryo transfer, because of increased pelvic blood flow ( as a result of the high levels of estrogen and progesterone).
•    The procedures themselves act as a dampener on sexual interest. For example, it’s natural that intercourse may not be much fun when you have just had a transvaginal ultrasound done that day – having a doctor poke and probe you can turn anyone
off !
•    There is a lack of spontaneity , and IVF treatment is extremely protocol-driven. Some vocal patients say that they feel like they are part  of a science project which kills their sexual urges and makes sex hard to enjoy.

Counselling and Therapy Can Help

The good news is that these problems can be fixed. It’s very important to discuss them openly, and you need to ask for help if you think you need this. There are many quick fix solutions, which can make a world of a difference. Self-awareness is the first step, and openly talking about sexual difficulties with your doctor and your partner  can help to solve many problems . Remember that the most important source of libido is the brain, and there are lots of tricks you can use to re-ignite your sexual desire ! You need to tackle the problem as a couple, and simple tools, such as using sexual toys and lubricants can put you back in control. The objective is to effectively re-associate sex with pleasure & enjoyment.

For someone who is undergoing IVF treatment, it’s very common for their libido to take a beating.  Infertility can be very hard and that is why you have to be tougher!

Want more information about how you can improve your sexual drive during infertility treatment?  Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you in a better way!



Sunday, February 22, 2015

Indian patients , doctors and Dr Google

Dr Aniruddha Malpani of Health Education Library for People (HELP) said, "While the digital medium makes accessing health information easy for patients, credibility remains an issue in India. Publishers need to take responsibility and make sure that only authentic information is made available. Also, patients, on their part, need to be able to differentiate between reliable and unreliable information."

http://timesofindia.indiatimes.com/city/mumbai/Half-of-net-users-tap-Dr-Web-for-health-info-Study/articleshow/46327152.cms

IVF success story for patient from Kenya

Even before we got married, my then fiancé and I knew of the problems we would encounter with her conceiving. I had a major surgical procedure (TURP, transurethral resection of the prostate,for treatment of an enlarged prostate) that prevented her from conceiving naturally.

Visiting to a doctor in Nairobi who indicated he can “prescribe a medicine that would allow the natural ejaculation of sperms and facilitate pregnancy”, his suggestions sparked a new interest in me. Thank God for the internet, I read where his suggestions were “untested and so far highly unsuccessful” so that idea was put to rest. It actually did more harm than good to those who tried.

Learning that there was an IVF Clinic in Nairobi, we both decided to give that a try. What a torment that has turned out to be when we compare what we have undergone/witnessed with the Malpani Clinic in Mumbai, India. At the clinic in Nairobi, my wife underwent excruciating pain and the end result was a failure. (more on that later). To say the least it was a disappointment and we were at a loss for lack of knowledge as to what to expect. Not so with Dr. Malpani’s Clinic, it was totally different with information provided by Dr. Malpani, his wife and their team.

My wife was so determined to fulfill this dream that after our marriage she found for herself Dr. Malpani’s Clinic on the internet and suggested we give it a try. Firstly, it cost less than what we paid in Nairobi (and from investigation other clinics elsewhere), and the available information on the website was tremendous in allowing us to form an informed opinion even before beginning our mission. To differentiate with our previous encounter the items being asked by Dr. Malpani to form an opinion (as if we are getting a second opinion) was like chalk and cheese. When we were asked for our reports from the Nairobi IVF clinic, we had none and they had very little to give, even to get the little we got was a challenge. There were no pictures of the eggs or embryos, no copies of scans were given to us, medical history and procedures. We took the challenge and got the necessary medical visa and visited Dr. Malpani’s clinic in Mumbai, India.

We were so anxious that when the time came for the sperm sample it was a challenge but eventually all went well and we were able to harvest and store fifteen (15) embryos. And our journey to becoming parents began. The first transfer was done with three (3) embryos and then we left for Kenya. This first procedure took a full three (3) weeks in Mumbai.

We were both excited as my wife experienced all the symptoms as explained in the handout and from DrsMalpani (husband and wife team). But this first try was not to be a success. I WAS DEVASTATED, COULD NOT WORK, EAT OR SLEEP WELL, (and so was my wife, totally inconsolable for weeks). We were consoled by friends and Dr. Malpani that this is often the case and to not lose faith and that our time would come as there were no reasons why she could not become pregnant in the future.

We gave each other sometime, especially to let go of the earlier disappointment and to have the courage to go over the procedure again, only this time it was only for implantation as the embryos were stored. I did not make the trip with my wife and maybe that helped (who knows).

After this second trip (our third try at conceiving) we knew that something good was happening. The intensity of the morning sickness was high, the nausea and vomiting was greater and we were only awaiting the B-HCG test to confirm the suspicion. We were so tense going for the results and when we received the report, people around us must have thought the worse (as it is the same place you go for HIV testing) when we both broke down crying in the parking lot. THEY WERE TEARS OF JOY. The readings were so high that we thought maybe that those reading are for twins or triplets. WE WERE OVERJOYED. We scanned the report and sent to Dr. Malpani straight away and he was also happy and told us what to do, steps to take, medication, etc., to prepare for this journey. In all we did two live (fresh) IVF cycles and one frozen cycle and the frozen one was successful.

During the pregnancy my wife had to be confined to bed on one occasion as complications arose. She did have one of the best, if not the best Ob-Gyn in Nairobi, who guided her thoroughly and professionally throughout the pregnancy.

Today, thank God, we are the proud parents of a beautiful baby girl (3.24 kgs at birth), but this was not without complications that are subject to a possible lawsuit. I almost lost both mother and child due to miscommunications or some other terminology with the medical staff at the delivery hospital.

My wife and I would like to thank the Malpani’s and the wonderful and supportive staff at their clinic for making us proud parents. When the time is right we would be back to complete our family with another child (one is not enough). The difference we have experienced with the level of information made available to us, the guidance and advice throughout the procedure and the after procedure support is first class and shows what a top rated clinic this is and to thank this  family and the work they are doing to make other families complete.

Saturday, February 21, 2015

Myths about Male Infertility



With infertility on the rise, it is but natural that there will be a lot of information and misinformation floating around. It’s also very natural for couples to assume that it's the woman who has a problem. Whenever a couple can’t have a baby, its women who are faulted for it. Have you ever heard a man being called “barren”?

The Myths and the Facts

But it’s time for that perception to be changed. Modern research has shown that 40-50% of all infertility is caused by male factors. Our clinic too has a number of men with infertility issues coming in for treatment. But, we have also seen that there are many old beliefs & new rumors about what can affect a man’s fertility.  Here are some that are true, some untrue and some just a “maybe”

#1 A man’s age has nothing to do with him being able to father a child

The fact is that the quantity & quality of a man’s sperm start declining after the age of 40; it declines further after the age of 50. However, it’s possible for a man to father a child after that age, as they don’t really go through any menopause-equivalent stage that women go through; and so they do not lose their ability to produce sperm. However, with progressing age there is a drop in the sperm count and it becomes one of the reasons why some older couples can’t conceive in their bedroom

#2 Boxers are better than briefs

This is false. The boxers vs briefs battle is an age old one. It surfaces in discussions that are far removed from fashion/ psychological aspects and gravitate towards the topic of sperm production. However, there really is no conclusive evidence that it is true. Ideally, men should wear what they are comfortable wearing

#3 Hot tubs are harmful

It’s true.  If you’re attempting to get pregnant, request your man to keep out of that hot tub, sauna or Jacuzzi; whether it’s just in your home or after a gym workout. Some men who regularly use hot tubs & saunas produce less sperm and their sperm also has lower motility (the ability to swim)

# 4 A laptop on his lap will kill his sperm

This one’s a maybe. There actually is some evidence that heat that a laptop generates can increase the scrotum’s temperature & might interfere with the production of sperm in the testes. It’s true that not all experts will be in agreement on this one; however, if you’ll are trying to have a baby, isn’t it just better to put that laptop on a table?

#5 A cigarette after isn’t really going to affect his infertility

It’s false. Smoking tobacco is linked to decreased fertility in men as well as in women. In the latter, it also reduces the chances of successful IVF treatment. Very simply, if he smokes, he’s affecting the chances of your having a baby

#6 If his pot belly shrinks, your family can grow

This is true. Maintaining healthy weight is good both for a man and woman, especially when they are facing infertility issues in men; it’s about the sperm as well as the ability to actually deliver them. In men, obesity is associated with a reduced sperm count & quality. It might also result in sperm not being shaped right (which means they cannot penetrate an egg). Studies have shown that a 10 kg increase in the man’s weight may lead to a 10% rise in the risk of infertility. Maintaining a healthy lifestyle and diet is good for the man , as well as for the woman , and increases their chances of having a baby.

Be Well-Informed

As you can see, there are a number of myths and facts about what causes male infertility - these are just a handful of them. The word of caution here is, don’t just believe everything blindly. If you have been attempting to get pregnant for a more than a year, it’s probably time to consult an IVF doctor. Want more information about infertility treatment?  Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you in a better way!



Friday, February 20, 2015

Infertility Treatment can be Emotionally and Physically Draining


Anyone who has gone through or is going through infertility treatment knows exactly how stressful it can be. You find people you know (friends and family) asking you well-meaning questions about whether you are planning on having kids and some insensitive ones will also want to know whether anything is “wrong” with either of you.

In most instances, infertility is a result of physiological issues and the physical problems could be with either or both. But the fact is that the emotional pain that results from this  can lead to major psychological problems. As a rule, every patient that comes to us for treatment is counseled and made to understand how the entire process works and what the possible outcomes of the treatment can be. Despite this, fertility treatments add emotional and physical stress to the couple.

The Challenges

Since most couples have gone through painful times dealing with their infertility problems, this strains their relationship further. As the cliche goes, Men and from Mars and Women are from Venus, and often communication between the two of you can break down . The husband often feels the wife is not coping well. He feels she should cheer up and hope for the best, rather than break down when her period starts. He feels she should grow up and deal with the problem as a mature adult, who can cope with life's challenges. The wife feels the husband is being insensitive and unempathetic, because he does not understand the heartbreak she is going through. Another factor is that some of the fertility drugs that are prescribed for the woman may cause emotional mood swings & physical side effects. 

Here is a peek into the issues that infertile couples face and the best way they can deal with them.

IVF- The Physical Challenges

The fertility drugs that women have to take to stimulate ovulation can cause certain side-effects These drugs are necessary as they help the eggs mature & prevent premature ovulation. They also help to prepare the lining of the uterus to receive the fertilized embryo/embryos.

Since they are hormones, they may cause hot flashes, mood swings, bloating or weight gain. In some cases they also cause nausea, breast tenderness and headaches. Based on the drugs that have been prescribed, the injections will be administered at different spots and skin irritation at that point is another common complaint. The good news is that these side effects are self limited , and disappear once  the drugs are excreted through the kidneys, into the urine.

IVF- The Psychological Challenges

Though the physical stresses that a patient goes through is no joke, the emotional stresses are equally traumatic. We see that patients who are going through their first cycle are the ones that tend to be the most stressed. To a certain degree, this is because it’s a new medical procedure that they are dealing with for the first time. Even though every attempt is made to keep patients updated about the procedure, they still feel they are doing a tight rope walk when it comes to going through that first cycle.

Once the embryos have been transferred, the waiting period begins; this is when patient’s stress levels peak, as they are eager to know whether they are pregnant or not.  The truth of the matter is that fertility treatment can’t be rushed - you have to live one day at a time !

What adds to the stress levels is the uncertainty about the outcome. Another distinct cause of worry for most patients is the cost factor. Many couples find themselves financially stretched and they are worried about whether they will be able to afford another cycle if the first one fails.

There is Scope to Cope

You can’t really change a situation,  but there are definitely some things you can do which will help you cope better Do your homework & plan ahead. Research and understand everything you can about IVF and get all your doubts clarified and questions answered from your IVF doctor. Being well- informed will give you more control over your feelings. Discuss all the implications ( social, financial or otherwise) with your partner and find a path towards the common goal.

When Counseling can Help

Focus on your relationships as well as yourself ; and find support from close friends. Engross yourself in work or anything else you like to do –it’s the one way of keeping the feeling of depression and isolation at bay. Consider getting help from a therapist or counselor. Understand that you and your partner are going through a difficult time and that you should nourish your relationship with him or her.

Want more information about how IVF works? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you in a better way!

Thursday, February 19, 2015

Why Pay for Performance will never work in healthcare

In order to get doctors to practise evidence-based medicine, administrators are trying to implement P4P ( pay for performance) schemes which incentivise doctors by rewarding them for doing "the right thing". This sounds very logical - after all, doctors are homo economicus, and will respond rationally to financial incentives. However, P4P is doomed to fail .

"  To the best of my knowledge, no controlled scientific study has ever found a long-term enhancement of the quality of work as a result of any incentive system. In fact, numerous studies have confirmed that performance on tasks, particularly complex tasks, is generally lower when people are promised a reward for doing them, or for doing them well. As a rule, the more prominent or enticing the reward, the more destructive its effects."
http://www.alfiekohn.org/article/folly-merit-pay/

Wednesday, February 18, 2015

How to Delight your Patients !

I was invited by Dr Meenu Aggarwal to give a talk at the POGS Conference on How to Delight your Patients. This is a topic which was close to my heart, but I didn't expect too many delegates to attend. After all, most doctors attend medical conferences to master new surgical skills. Many believe that the one thing they are good at is handling patients, so why would they want to listen to someone tell them such basic stuff ?

I was very pleasantly surprised to find that the hall was full ! It seems that while doctors do want to learn how to cut and stitch and manage diseases, they are also eager to learn how to manage their patients. Sadly, while disease management is taught in medical colleges, very few learn anything about how to manage the expectations of their patients in real life.

The Chairman of the session was the senior gynecologist, Dr Sanjay Gupte, who shared an interesting insight , and the  pearl he offered  distilled his years of clinical experience !  He said that only the most senior doctor should deal with a patient who is unhappy. He explained that the rule in his clinic was that any time a patient seems to be upset or raises his voice, he invites him into his consulting room to try to resolve the problem one-on-one. This is a great example of practical risk management in real life. The patient is pacified that the senior doctor has taken the time to intervene; and is pleased that the doctor cares. This helps to calm him down, and allows both of them to work together to find a quick resolution to the problem, before it escalates.

Fortunately, we had one of India's  most beloved doctors, Dr R P Soonawala in the clinic. Dr Russi, as he is fondly known, was one of my teachers, and is a legend.  Not only do his students respect him as a "teacher's teacher", all his patients also adore him. He provided two useful take home messages to the audience as to how to deal with an upset patient. Firstly, sit down and listen patiently, and allow the patient to vent. It's not easy for a doctor to learn to be patient, but this is the key to handling the patient when things go wrong. He emphasised the need to be humble, and why it's important to apologise if something is not right. This disarms the patient, and helps him to realise that you are on his side, and will do whatever is needed to fix the problem.

It was a simple talk, which only served to remind doctors them about the basics of good manners - but it seems that doctors need to hear this message repeatedly !


Tuesday, February 17, 2015

Which Doctor Should I Choose for My IVF Treatment?


The patient-doctor connect is a special one and this is especially true when it comes to a patient and her IVF doctor. The issue of fertility is private, intimate and sensitive and when a patient is choosing a doctor, they want to be sure that he is competent enough to provide them with the right advice and treatment. But that is not the only aspect you should be looking at.

As an IVF patient, you have to be sure that your doctor has the necessary credentials and experience to provide you the best possible treatment. But you also want to be sure that the doctor you decide to consult will understand you and your specific needs. Unfortunately, this is not something you will be able to ascertain via a referral through someone.

The Right Vibes

You may find that a doctor who synced perfectly with your friend, who underwent treatment at the same clinic, isn’t really sending the positive vibes you expect. IVF treatment can sometimes be a lengthy one; and you want a doctor who will be able to communicate well with you. This is something you will be able to figure out only during your first consultation with him.

Respect Matters

Respect is another aspect you should be looking at. Every IVF patient has some fears, some well founded,  and some not But if you find the doctor being dismissive when you voice your concerns or if he dissuades you from asking too many questions- these are definitely red flags for you. It’s important that your doctor treat you with respect and not be judgmental when you tell him something.

Being Well Informed

As a matter of fact, a good IVF doctor will go out of his way to ensure that his patient is educated in a detailed manner about the process. This helps the patient make more better decisions and not just go along with the current, not knowing where it is taking her. It’s also important for a patient to understand that when it comes to infertility treatments, there are many variables. The differences that make patients unique end up influencing the probability of the success of the treatment. And so, if a doctor is promising you the moon-beware.

Comprehensive Services

The factors that you should be taking into consideration while choosing a doctor are:

•    The clinic you choose should be able to provide all the necessary services under a single roof
•    Your IVF doctor should be a full-time IVF specialist , and should not be doing anything else . IVF is too complicated to be handled by a "jack of all trades" !
•    There should be a full-time embryologist at the clinic
•    They should have their in-house IVF lab , and should not be outsourcing this
   The clinic should routinely freeze embryos
The clinic should not transfer too many embryos to artificially inflate their pregnancy rates
•    The doctor should provide photos of the embryos- only a clinic that is confident about its medical skills will be proactive with  providing these photos

Other Factors

Check how the ambience of the clinic is and whether the staff is friendly and cooperative. Even more importantly, judge how the doctor’s bedside manner is. Keep in mind that you will be spending a considerable amount of time, money and effort on your IVF treatment; so make your choice wisely and then decide whether the doctor you have consulted is the right one for you.

Infertility treatment can be a frustrating and quite an emotionally challenging experience; and you want to be sure that the doctor you finally select is competent, honest, committed and who will be able to guide, educate and support you on your path to having a baby.

Want to make sure you've selected the right IVF clinic? Please send me your medical details by filling in the form at www.drmalpani.com/malpaniform.htm so that I can guide you properly !

Monday, February 16, 2015

Natueco Science : a new way of farming

Following the principles of Natueco Science and using a thought based on the soil fertility, Deepak Suchde succeeded to turn a cotton field with  poor soil into an abundant farm with a rich soil, without any chemicals, in only 8 years!

https://encheminverslaterre.wordpress.com/2015/02/08/natueco-science-a-new-way-of-farming/


How Meditation Helps Infertile Couples


For any couple that is attempting to cope with fertility-related stress, meditation is a definite gift.  It is a very simple yet effective practice that can help in changing the hue of the fertility journey from a mottled one to one that is more calm and positive. Dr Alice Domar, Director for- Mind-Body Center for Women is a world-renowned proponent of mind-body techniques such as meditation. She says that meditation calms down the patient and reduces his/her stress; which may well be the one thing that is keeping you from conceiving.

The Feel Good Factor

The relaxation response that meditation brings about in a person releases feel-good endorphins & turns-off stress hormones. Numerous studies have been conducted around this premise and there are a number of effects of meditation including:

•    Increased sense of calmness
•    Greater control over  thoughts & the mind
•    A deeper connect with oneself
•    Enhanced ability  to cope with various stressful situations 

Easy to Learn

Meditation is not too difficult to learn and I routinely suggest to my patients that they practice it in some form.  It involves focusing your thoughts and mind in such a fashion that it helps you contemplate, reflect and quiets your mind. Do not be too ambitious with your goals at the outset; choose a simple goal such as quieting your thoughts, or controlling them and then pick a meditation form that you feel will work for you. You have the option to go to a yoga teacher who will teach you the basics and techniques of meditation.

The Study

For those who are wondering whether there really is any evidence to prove that meditation helps infertile couples, read on. In 2000 Dr Alice Domar published results of her study in Fertility & Sterility. It showed that women who had participated in the program (that included relaxation & yoga) were almost 3 times more-likely to conceive compared to women who didn’t. In the 10-week long mind-body workshop that Dr Domar conducted, 184 women who had been struggling with infertility & attempting to get pregnant for 1-2 years were all put into a cognitive-behavioral group.

De-Stressing with Meditation

This particular group received various methods for nutrition, emotional expression, & exercise information. Very importantly, they received relaxation training which included meditation, yoga, muscle relaxation & imagery. The group also learned how to identify their recurrent negative thoughts (eg- I’m never going to be able to have a baby) and cognitive restructuring.

They were taught how to turn that negativity into positivity and tell themselves that they are doing everything they can to get pregnant. The results were impressive- 55% of the women from the group that was using yoga & other techniques ended up getting pregnant within one year. Contrastingly, only 20% of women from the control group conceived in that same time-frame.

Making an Impact

We cannot yet go so far as to say that meditation and yoga can  treat infertility. However , there is no doubt about the fact that complementing conventional & innovative medical intervention with the health-enhancing benefits of meditation can reduce the stress that is caused by infertility.

The minute you take away some of the stresses from your body, you automatically give it the chance to react more positively and the treatment you are undergoing has a better effect. You have waited for long to have that baby and made a lot of efforts too.  Meditation is probably something you haven’t tried and should- you may just find that it was the one thing that gives your body the impetus to do what your mind is telling it to do.

Even better, it doesn't cost anything; is simple to learn; and is a great tool to master to help you cope with the other ups and downs  which life will throw your way !

Need more information about meditation can help to improve IVF succces rates ? Get a free second opinion from Dr Malpani by filling in the Free IVF Second Opinion form.

Sunday, February 15, 2015

Why me? The Infertile Patient's Plaint


Many infertile couples come to our clinic and it’s not uncommon to see dejection and frustration in their demeanor. While some have walked into an IVF clinic for the first time, others have had some form of infertility treatment in the past. Most of these patients are eager  to know how we can help them but right through their consultations, the one common question that we keep hearing from them is - Why Me?

Leaving No Stone Unturned

Most couples that struggle with infertility leave no stone unturned when it comes to trying different treatments. Some may even switch doctors and try alternative therapies; and when everything fails, they wonder why they are the ones that have to face this issue. It’s not really nice to have to pump your body with hormones (and have some side-effects), go through egg retrieval and through the excruciating wait to hear which of the embryos have made it (and sometimes hear that none have).

Most of these scenarios don’t sit too well with most patients and when a cycle fails, they get upset and frustrated and many are also driven to the point of giving up on the idea of having a baby through IVF. What’s heartening to note is that many  of these patients who have gone through dejection and heartbreak also end up having a change  of heart and come to us because they want to give IVF another shot. 

The Learning Points

But between all these ups and downs of the IVF road are some hidden learning points:

•    Never Give Up- When it comes to infertility, this particular adage may elicit mixed feelings in many. But if after multiple failed cycles, there is even 1% of you that feels you must not give up- then just keep going. Try as hard as you can and for as long as you can, or else you are sure to regret it. There will be times when you feel you have reached your limit, but once you push yourself beyond that barrier, you will find you can travel even further

•    When saying stop is OK- This may seem like a contrasting point especially when it comes on the heels of the first one, but the fact is that everyone has different tolerance and patience levels. If you really feel that this is it, and can’t go any further with IVF treatment, maybe you should consider other options for having a baby, such as surrogacy or adoption. Or maybe you can be courageous and live childfree too. Regardless of what your decision is, the thing to keep in mind is that you are not a failure-you have simply taken a different route in the journey of life

•    Get Some Support- Though you may have your spouse to support you; he can by no means be the only source. You should get some support from people you know, a support group or maybe opt for counseling. It will help you cope with your infertility and thoughts in a better way

•    The Honesty Factor- It’s important for you to be honest about the way you feel. Shrug off that cloak of pretense that everything is allright. If something that your IVF doctor says or recommends does not sit right, simply say so. Be honest with yourself and your partner as that’s the only way to find the right road.

•    Stop Comparing Yourself- Its natural to find you comparing yourself to other women and their situations. This may make you feel that you haven’t really done all you could when they did a number of different things. It’s important to understand that every person’s biological makeup is different and circumstances are also unique. Just because something worked for someone you know, does  not mean it will work for you

A Climb That is Worth It

The climb to the top of the infertility mountain is never an easy one. But when you are climbing that mountain, try not to glance downward as you may lose your nerve; also try not to look upward as that can be distracting to. Simply know that you have to get to the top of that mountain; concentrate on all the handholds and footholds that you can see right in front of you and climb that mountain one step at a time- I assure you that once you have conquered infertility- the view from the top can be breathtaking.

Need some hand holding during your IVF journey ? Get a free second opinion from Dr Malpani by filling in the Free IVF Second Opinion form.



Saturday, February 14, 2015

What I have learnt as an Angel Investor


I have been investing for many years now. I like the idea of making my money work for me, and fortunately my investments have done well. My passive income ( from my investments) is more than my professional income, and today I practice medicine because I enjoy doing IVF – not because I need to treat patients in order to generate revenue. This allows me to practice better medicine, because it   allows me to put my patients first , and I don’t need to do unnecessary tests and treatments.

In the beginning, most of my investments were in the listed space. I was exceptionally lucky , because Rakesh Jhunjhunwalla was by guide, and he told me which shares to buy. I was smart enough to follow  his advice blindly, and my portfolio has done very well.  My equity investments are managed by portfolio managers; and my family office.

I started investing in startups as an angel investor about 5 years ago. I was inspired by my friend, Rajesh Jain, who was India’s internet poster boy during the 1999 dot com boom.

Over time, I have now invested in more than 6 startups, and have learned quite a bit in the process.

My first investment went belly up.  This was in the healthcare space, and was a strategic investment, because I felt I could add my domain expertise to make it a success. Sadly, the company was located in Bangalore, so it was hard to keep track of its activities. Even worse, the founder was a mature and seasoned manager, who really didn’t seem to want or need our advise, so we watched passively while the company went down the tubes.

The next 2 startups are still running, but they have not grown.

After this, I invested through syndicates , such as Mumbai Angels and I3N. This was much better, because it allowed me to learn from co-­‐investors who were much smarter and more experienced than me, and it’s been an interesting ride so far. It’s still early days, so it’s hard to predict what the fate of these companies will be. The problem with investing in a group is that there can be quite a lot of delay, because it’s sometimes hard to get buy-­‐in from everyone . It can take upto 14 days just to get all the investors to sign off on the documents ( though the processes are getting more efficient and streamlined these days).

For me, my most important agenda is to learn from the founders, and I find that the best way of doing so is by investing directly though my family office. I am very fortunate, because Manish Gupta has so much experience in managing early-­‐stage companies, and he provides a lot of value and insights to the entrepreneurs. He makes sure we follow the right processes, so we can act as effective partners, and offer value to the entrepreneur. This is an ongoing journey, and I hope to continue learning over time, so we become better catalysts as we gain experience.

What’s next ? It’s time to start exploring whether we can act as an accelerator for founders, and we will continue to explore new opportunities as these arise.

My family office is run by Manish Gupta whose website is at www.solidarity.in

Friday, February 13, 2015

Why did my IVF cycle fail, doctor ?


When an IVF cycle fails, the first question the patient asks the doctor is: What went wrong? The elephant in the room is - Did you do something wrong, doctor ? This is not a question which patients have the courage to ask the doctor, but it's a doubt they all entertain in their mind.

This question, Why did the IVF cycle fail, leaves most doctors flummoxed. This is because even in a perfect IVF cycle, where everything goes right, the success rate will be less than 50 percent. However, when the patient chooses such words to express his anguish, it suggests she is implying that the doctor was incompetent or negligent, or did something incorrectly, or simply wasn't proficient enough. This upsets the doctor and sometimes he starts getting defensive. Rather than being honest that he does not know why one particular cycle succeeded and why another one failed, he will order a battery of very expensive tests just to pacify the patient and show her that he is on a quest to find the answer to this rather unanswerable question.

Science too has limitations

Mature doctors will sit down and explain to patients that there is no technology available as yet to determine what happens to the embryo after it is transferred to the uterus. This is hardly surprising, given the fact that we are transferring a microscopic ball of living cells inside the uterus. Human reproduction remains an inefficient enterprise, whether it’s being assisted in the clinic or it’s being done within the confines of the bedroom.

However, not all patients are mature enough to understand the limitations of medical technology and science. Rather than explaining the limitations of our science, it's much easier for the doctor to order a battery of tests. This often fools the patient , who thinks that the doctor is now digging deeper in order to get to the root of the failure. Once he finds the problem, they will be able to get on right track. After all, and once he has figured out the abnormality and taken care of it, she will achieve success.

This is delusional thinking. After all, if there was a test which could provide this information, then every sensible IVF doctor would do it before starting the first IVF cycle itself. Why would they wait for IVF failure to order the test? No doctor wants his patients to fail! I’d be very happy if all our patients got pregnant in the first cycle itself. These happy patients would then refer lot of other patients to me, keeping me as busy as a bee – and I would not have to answer questions such as, “Doctor, what went wrong?”

Do your homework

However, because patients aren't willing to listen to the truth, doctors sometimes resort to manufacturing answers. This is actually a disservice to the patient who ends up wasting a lot of time and money chasing red herrings, and ultimately not getting any closer to her goal of having a baby. Patients need to do their homework before starting IVF, so that even if the cycle fails, they don't go to pieces and start looking for a scapegoat. They need to understand that even if nothing goes wrong, not every IVF cycle will end in a baby!


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




Thursday, February 12, 2015

Transferring 3 Embryos - When Too Much of a Good Thing Can Backfire



A number of IVF clinics in India continue to routinely transfer 4 or 5 embryos during a patient’s IVF treatment. This process is followed even in young patients who are doing their first IVF cycle. This is a worrisome trend, because the transfer of multiple embryos exposes these patients to a high risk of having a multiple pregnancy. Many end up having triplets and the preterm birth also increases the risk of them having babies with lifelong disabilities, while selective fetal reduction can result in a miscarriage in some patients.

So why do IVF doctors transfer do many embryos ? Are they irresponsible ? The truth is that from the doctor's point of view , this is a success for his clinic. He will proudly add the pregnancy to his clinic statistics as a ‘success”. However, from the patient’s perspective it’s actually been a disaster. This is because the IVF doctor doesn’t have to provide the pregnancy care or look after preterm babies; and he is blissfully unaware of the adverse consequences of his actions.

Quantity VS Quality

Patients must note that when a clinic is willing to transfer multiple embryos, it’s a sign that it is a mediocre one! They just don’t have sufficient amount of confidence in their lab & have no option but to resort to transferring a larger number of embryos- and this becomes a way of artificially inflating their success rates. A good clinic is one that can create good quality embryos which have a high implantation rate, so that they don't have to transfer more than 1- 2 embryos to get their patients pregnant !

At times, patients add to the dilemma as they pressurize the doctors to transfer a larger number of embryos and feel that it ups their chances of getting pregnant. Most have also reach breaking point in terms of dealing with their infertility; and even when their IVF doctor educates them about the possibility  of multiple births, they just feel it’s better than not getting pregnant at all. Little do they realize that they are jumping from the frying pan into the fire.

The Multiple Pregnancy Risk

Please remember that transferring more embryos does not increase success rates – it only increases the risk of a multiple pregnancy and this is a classic case of too much of a good thing doing more harm than good. Typically, a good clinic will transfer only 1 embryo (if it's a top-quality blastocyst). However for selected patients ( for e.g., older patients or those who have failed multiple IVF cycles), transferring more embryos may be a justification. In a good clinic, 50% of top-quality blastocysts will implant successfully.

This means their implantation rate is 50%. The reason why the other blastocysts don’t implant is because a lethal genetic problem (which we cannot identify) causes them to stop growing and prevents them from implanting. This is exactly why it is still not possible for us to predict which blastocyst will become a baby. It’s also why transferring three blastocysts would translate into an extremely high success rate – but would also result in a very high number of multiple pregnancies.

Complete your Family

A good clinic is confident they will have a high pregnancy rate even after transferring just 1 or 2 embryos and will discourage patients from transferring too many of them.  What’s even better is that spare embryos aren’t wasted. The supernumerary embryos can be cryopreserved (embryo freezing) safely, and used later on to complete that patient’s family! Worried that your IVF doctor wants to transfer too many embryos and that he is taking the risk of a multiple pregnancy too lightly?

Please send me your medical details by filling in the form at Free Second Opinion so I can guide you in a better way.  

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