Tuesday, June 30, 2015

Is Donor Egg IVF Eggxactly the Right Treatment for You?




Today, it’s not really a novelty to see women in the 40+ age range wanting to have children. We have a number of patients who have trouble with conceiving at that age. While some may have deferred motherhood because they needed to build their career first, others want to try having a second baby. When many of the latter are unable to get pregnant and are told (after looking at test reports) that they are suffering from infertility, it throws them off balance.

Perplexed Patients

This is because they already have a child and never in their wildest of dreams felt that having another one later in life will pose a challenge. But it does; the fact is that with age, there is a decline in ovarian reserve and many older women are unable to produce their own eggs.  In those who do, the quality of the eggs may not be upto the mark to make a viable embryo. However, it’s now possible for older women to use donor eggs to have babies of their own.

This issue is a very sensitive one, and it doesn’t go down too well with many couples on the emotional level and is completely out-of-line with their sensibilities. Every couple has to make their own decisions. Though the use of donor eggs dramatically improves pregnancy rates in older women, this decision is one that most couples find hard to come to terms with.

Why Egg Donation?

In addition to the age factor, there are a number of other reasons why the use of donor eggs may be considered, such as:

Premature menopause
Ovaries surgically removed
Ovaries have been affected by prior chemotherapy
Risk of passing-on a genetic disease
Prior IVF treatments that have indicated that the egg quality is poor

Fresh vs. Frozen Donor Eggs

In conventional egg donation the prospective egg donor is recruited and undergoes a detailed screening  process
The recipient’s cycle is synchronized with the donor’s cycle
The eggs are then collected and fertilized
This process can take up to 3-6 months


Using Frozen Eggs

The other option is to use frozen donor eggs. This is the option we prefer.
When these are used:

The recipient’s cycle doesn’t have to be synced with the donor’s, as the eggs have already been  retrieved and frozen
This dramatically reduces the wait time as the frozen eggs are available when required
When frozen eggs are used, it’s much easier  to match the egg donor’s physical traits with that of the recipient
The success rates  of  IVF using  frozen donor eggs is on par with that  of  the  fresh donor egg process

Is it Eggxactly the Right Treatment for You?

There are a number of considerations that have to be taken into account when donor eggs are to be used (fresh/frozen)

We  have seen that most patients who use donor eggs are not happy with the fact that the child will not be  genetically-related  to them
This is one feeling they will have to balance with their deep desire to actually experience pregnancy and give birth to a child
Many of our patients are also very grateful to the egg donors, as they wouldn’t have  been able  to have a baby  if it weren’t  for the latter
Donor egg costs can be quite high and this fact has to be taken into consideration too. This will have to be added to the cost of  the IVF treatment

It’s clear  that donor egg IVF is not easy sailing and we make every effort  to extensively  counsel patients, so that they are able to make a more informed decision about which route would be the best  one to take them to the path  to parenthood.

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!







Doctors Should be Patient with Patients Who Make Mistakes


When there is talk about medical errors, we tend to shine the spotlight on the mistakes doctors or the medical staff make. However, the truth is that patients often make mistakes as well. There are a number of reasons for these mistakes.

At times, patients are confused, because the doctor didn’t explain  things with clarity
They don’t understand the doctor’s medical jargon
Many are scared to cross question the doctor
They are reluctant to display their ignorance
They continue to dumbly nod their head, and the doctor is misled into thinking that the patient has understood what  he is telling them

An Example

For example, a patient has been prescribed 0.2 ml of Lupride, and she ends-up taking 2 ml by mistake; this was because she didn’t understand what the decimal point meant. Mistakes such as these are upsetting and irritating for both, the patient and the doctor. The patient is scared that in taking more than the recommended dose, she is harming her health or that she may have to cancel the cycle because she has messed up her medications.

The doctor is irritated, because he feels that he did an excellent job with giving all the right instructions and explaining how the medicine has to be taken; if she didn’t understand, why didn’t she simply ask him for clarification and cross-check with him, rather than pretending to understand? Doctors sometimes forget that patients can be quite intimidated by them!

Why Do Patients Cover-Up Their Mistakes?

It’s important to understand that all of us make mistakes and being charitable and understanding  is the best way to move beyond the situation- after all, a goof-up is a goof-up and its not been done deliberately. Rather than start assuming that all patients are idiots, these mistakes can prove to be ideal learning opportunities. The fact is that patients make mistakes more often than we realize. They cover up these mistakes because they are scared it will upset the doctor and get him angry and that he will admonish them for the slip up.

How Mistakes Can Advance Medical Science

If patient has enough confidence in the doctor, she will let him know when she made a mistake; then it's up to him to resolve it. Sometimes these are not much more than minor issues, which can be safely ignored. Of course there are times when these mistakes can create major problems; however, these too can be tackled only if the patient is willing to confide in her doctor. Interestingly, sometimes these mistakes can be serendipitous events, which can actually help to advance medical science!

The Positive Side

For instance, if the patient takes a lower dose than the one prescribed, and still has a good therapeutic response, the doctor might just start prescribing the lower dose to all his patients, because it may be as effective as the standard recommended dose. This is especially true when patients are taking alternative medicines.

They will often hide this information from their doctor, because they are scared he may get upset with them for doing non-standard treatment. However, if they get better and share this information, the doctor can learn from their experience, if he is willing to keep an open mind. Maybe he can even start advising other patients to try out alternative medicines!

Patient education can play a very important role in reducing the errors which patients inadvertently make; and it's important that doctors and hospitals invest in tools and techniques that will help patients become better informed.

Need more information about how you can mimimise making mistakes ? 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!

Monday, June 29, 2015

What do SER clusters in IVF eggs mean ?

Calming The Qualms of Infertile Patients over 40



Infertility treatment can be very challenging in terms of the toll it takes on your emotions and every couple that walks into our clinic has some very common fears. Over the years, I have found that the fears of patients above 40 fall into these 3 main groups:

•    Fear of Failure- The fact is that the fear of failure is one of the most prominent fears that a large number of patients harbor.  I treat a number of female patients above 40 years of age, who already have one child and want to add to their families. While many are worried about whether their age will become a hurdle in the path of a successful pregnancy, others worry whether they will be able to afford the time and money required for infertility treatment

•    Fear of Miscarriage- This is another major fear that women over the age of 40 have. It’s true that miscarriages are more common in older women and almost 50% of all pregnancies in women of this age will end in a miscarriage. Once again, these women fear failure, disappointment and sadness, which prevent their pregnancy attempts. It’s understandable that miscarriages are extremely difficult to go through.
Whenever a urine pregnancy test shows up positive, there is a lot of excitement that is tinged with worry too. 

•    Fear of an Abnormal Pregnancy- In some cases, older women fear that they will have an abnormal pregnancy. They must have either been told by some “wise” women or may have also read on the Internet that the chances of an abnormal pregnancy increase with age.  The possible abnormalities that can show in the screening test are being pregnant with a child that has Down's syndrome ; or other serious chromosomal problem that is incompatible with life.

Sometimes, this fear takes another form; some women are fearful that they will have a healthy child and will find out only later that the child has schizophrenia or autism or some other disease they have heard is typically associated with children born of older mothers

List Your Fears

When I counsel women above 40 years  of age who are either planning a first child or wanting  to add another one  to their family, I always tell them to list  their fears and then discuss  them with me when  they  come in for a consultation. I also feel  that while you  will have  certain qualms and fears  and we as doctors are more than willing to  listen and help allay  them,  it’s also important  to  discuss and focus  on the joy that comes from  being pregnant and  having a child.

Don’t Overlook the Potential of Happiness

In many instances, the potential happiness truly does outweigh the fears that you may have. Today, there is technology which can help you conquer those fears. A lot of my patients are now considering IVF with PGS (Pre-Implantation Genetic Screening). Though this process is expensive, it does offer new hope.

IVF With PGS

The only method we know of how to prevent the primary reason for miscarriage in an older woman, is to ensure that we transfer an embryo that is chromosomally normal. IVF/PGS is used to screen the embryos for all chromosomal information; couples can then choose to not transfer any of their abnormal embryos. I make it a point to share this information with my patients above 40 years of age and encourage them to give IVF with PGS a shot. For many of them, just this chance of having a healthy baby is more than the risk of a failure.

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!



Saturday, June 27, 2015

Why doctors shy away from prescribing Information Therapy




I recently had a very interesting conversation with a senior doctor who was extremely skeptical about the value of empowering patients with information. In his opinion, it was no more than a fad which has the potential to open a Pandora’s Box of sorts.  He believed medicine was a complex subject – after all, it takes years of full-time training to become a surgeon, so how can one expect patients to understand the nuances of their medical problems in a few minutes?

The Concerns

His words to me were- “Isn’t it far better for them to trust their doctor, who is the true expert, and who can help them heal quickly?” These were his concerns:

He was very critical of patients who came with pages and pages of Internet printouts about their medical illnesses
He felt they were often very confused and ended wasting a lot of their own time and his by wanting to discuss options and alternatives that did not make any sense
He also felt that second-guessing just caused patients to doubt him
His belief was that this loss of faith and trust would end up harming patients and doctors too
In general, he was quite dismissive about “well-informed patients” who felt they had become “half-doctors” by reading and researching their medical problem online
He believed that half knowledge can be dangerous, and patients who think they know a lot about their disease often created more problems than they solved, by challenging their doctor’s decisions
He also highlighted the fact that doctors who aren’t used to having patients disagree with them, can often end up getting upset and angry with “well-informed” patients- this leads  to a confrontational rather than a cooperative doctor-patient  relationship

The Benefits

While everything he pointed out was true, it doesn’t mean that the concept of Information Therapy is incorrect and should not be encouraged. Like anything else, information can be used, misused and abused. In this  respect, doctors  can play a key role by ensuring that the information  they provide  their patients is reliable, updated, evidence-based and tailored to every patient’s needs. There are some distinct benefits to doing this:

If every doctor prescribed information, the patients wouldn’t find the need to look elsewhere  for it
On many levels, this would create a win-win situation. The patient would also trust the information as it was coming  from her  doctor and would not be inclined to scour  the Internet  for  clarification  or answers (most of which could  be potentially incorrect and inaccurate)
The doctor would also be more confident that the patient was well informed and had realistic expectations of his medical treatment
He would not get annoyed that his patients were trying  to challenge him, and he would be more  happy with  providing additional information and treatment

What is Information Therapy?

Information therapy can be defined as the prescription of the right information to the right person at the right time to help them make better health decisions
The ‘right’ information is accurate because it is evidence-based, approved by experts, up to date, easy to read and understand, available in many different formats (including local languages and audiovisual formats) and referenced
The ‘right’ person means this information needs to be delivered directly to the patient (and their caregivers). This information is best dispensed to a patient by her own doctor – the person she trusts the most when it comes to her health
The ‘right’ time means the information should be provided when the patient needs it – that is, in time to help them make the best possible medical decisions

On the Right Path

There are a number of ways of delivering this powerful tool – it can be clinician prescribed, system-prescribed, or consumer-prescribed. At present, most patients get information through their own research. As mentioned earlier, most of this is unreliable and incorrect.  It’s a fact that hospitals and medical centers that systematically implement Information Therapy applications will be in a better position to gain market share, profitability and prestige over those that don’t. Thanks to the Internet, we are also equipped with the technology needed to reach out to consumers- it connects anyone, anywhere, any time to quality information.

Things that Should Happen

These drivers create a compelling case for Information Therapy, which revolves around an expanded patient role. As healthcare evolves, the following should occur:

Every clinic visit, medical test and surgery is preceded or followed by information-therapy prescriptions
Information prescriptions should be sent between in-person visits; this will extend the continuity of care

Patients play an active role in shaping how they want information to be delivered to them. Information therapy is a very cost-effective solution that allows a doctor to put each patient at the heart of the care he or she provides.

As the renowned poet and writer Kahlil Gibran once said, “Progress lies not in enhancing what is, but in advancing toward what will be”.


Back to Basics

It’s important to keep in mind that the word doctor is derived from the Latin word docere, which means to teach or instruct. When doctors don’t do so, we are abdicating our responsibility and forsaking our patients, who feel lost and are then forced to fend for themselves.  We now have empowered consumers who demand time, information, control, service and a new focus on quality. The need of the hour is that doctors should guide their patients; and prescribing Information Therapy is a simple way of doing so.

Friday, June 26, 2015

How Information Therapy can Heal the Indian Healthcare System - Asian Hospital and Healthcare Management Journal

The Indian healthcare system is sick - what can we do to heal it? In fact, even the term healthcare system itself is a misnomer. In reality, what we have in India is a medley of doctors who are used to providing episodic care to people when they fall ill. Healthcare is fragmented and disorganised and there are too many specialists, most of whom have tunnel vision.

http://www.asianhhm.com/healthcare-management/how-information-therapy-can-heal-the-indian-healthcare-system

A sculpture of sperm babies at Vigeland Park, Oslo

We visited the Vigeland Park on our recent trip to Oslo, and I was very taken with this particular sculpture, which I call the Sperm-Babies !


How to delight your infertile patients - the BMJ Masterclass in Mumbai

What Are Blocked Fallopian Tubes ?


There are a number of reasons a woman can be infertile and a common reason is blocked fallopian tubes. It’s important for patients to understand why tubes get blocked;, how this causes infertility; and what potential treatments are.

What Are They?

The fallopian tubes are 2 thin tubes that are positioned, one on either side of the uterus; these help lead mature eggs from the ovaries into the uterus. Whenever an obstruction prevents the eggs from traveling down the tube, it’s referred to as a blocked fallopian tube and can occur on one or on both sides. The other term for this condition is tubal factor infertility and almost 40% of infertility cases are caused by it.  The block could be at the cornual ( uterine) end;  the ovarian end; or in the mid-segment of the tube.

How Does this Occur?

Every month, when ovulation takes place, an egg gets released from either one of the ovaries. This egg then travels from the ovary, right through the tubes, and moves to the uterus. The man’s sperm also need to swim through the fallopian tubes and get the egg. Generally, the egg gets fertilized while it’s traveling through the tube.

If both the tubes are blocked, the egg is unable to reach the uterus; and of course the sperm is unable to reach the egg. In effect, this prevents fertilization as well as pregnancy. In some cases, the tube only has a partial blockage. This may increase the risk of ectopic ( tubal)  pregnancy.

Blocked Fallopian Tubes- The Symptoms

Unlike anovulation, in which irregular menstrual cycles might indicate a problem, blockages in fallopian tubes rarely ever cause symptoms. In women with a hydrosalpinx ( also called a hydro on many IVF bulletin boards) , the blockage is at the ovarian ( terminal) end of the tube and this causes the fallopian tube to dilate and it fills up with fluid.  A hydrosalpinx  may cause lower abdominal pain in a few women.  Sometimes the cause of these blocked fallopian tubes ( such as pelvic inflammatory disease and endometriosis ) can cause painful sexual intercourse and painful menstruation. However, these symptoms don't always indicate that there are blockages in the tubes.


The Causes

•    Current/history of an STD infection, such as Chlamydia or Gonorrhea
•    History of a uterine infection caused by a miscarriage/abortion
•    History of abdominal surgery
•    History of a ruptured appendix
•    Previous ectopic pregnancy
•    Surgery involving the tubes
•    Endometriosis

Diagnosis

•    Generally, blocked fallopian tubes are diagnosed with a hysterosalpingogram (HSG). This is a specialized X-ray in which a tiny tube is used to place a dye in the cervix. X-rays will then be taken of the pelvic area. This helps in ascertaining whether there is a blockage in the tubes
•    A vaginal ultrasound can help the doctor to diagnose a hydrosalpinx. However, a vaginal scan cannot visualize normal fallopian tubes; and a normal scan does not mean that the tubes are not blocked
•    Blood-work to check for presence of Chlamydia antibodies (this may imply previous/current infection)
•    Many doctors still do a laparoscopy to check the tubal status, but this is too invasive and expensive in my opinion

Treatment

•    If one of your tubes is open and you are healthy in all other respects, it may be possible for you to get pregnant without any help, especially if you are young and your husband’s sperm count is normal.  One normal tube is enough for normal fertility.
•    Laparoscopic surgery may be useful rarely to  remove scar tissue ( peritubal adhesions). The chances of success in this procedure is dependent on your age (the younger, the better), and if the inner lining of your tubes is normal. Damaged fallopian tubes ( those where the block is at the ovarian end) cannot be repaired , as they cannot function normally even after surgery, since their inner lining ( the cilia) has been damaged. You can read more about this at www.drmalpani.com/blockedtubes.htm


IVF

Based on your individual condition and also on whether there are any male infertility issues with your partner, and your age,  your doctor may suggest that you skip surgery. In cases such as these, IVF becomes your best bet. It’s also important to note that post tubal blockage surgery, the risk of an ectopic pregnancy is much higher. If you get pregnant, your doctor will have to monitor you carefully when you do get pregnant.

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!

Thursday, June 25, 2015

Why do Infertility Doctors Treat Abnormalities which are of No Clinical Importance ?



Modern medical practice seems to be based largely on ordering tests and scans, and relying on these to make a diagnosis. This seems to be true for infertility specialists as well. These procedures have nudged into the shadows the time-tested traditional methods of taking a medical history and doing a clinical examination. The problem with most of these tests is that they also pick up a lot of minor abnormalities, which have absolutely no clinical importance.

In fact, the more expensive the test (because it’s brand new or uses highly sensitive technology), the greater the chances of the results coming back as abnormal! While many of these abnormalities are also found in fertile couples as well, doctors tend to get very excited when they find these. Many doctors take pride in finding and highlighting these abnormalities- and there are many reasons they do so.

The Reasons

•    For one, doctors are trained to look for problems, find abnormalities and make a diagnosis. Remember that infertility specialists do not see fertile couples– they only see infertile patients, which means they have a very jaundiced viewpoint
•    Since they are often clueless about the natural history of a disease and the prevalence of the abnormality in the general population, they tend to over diagnose and over-treat. They jump to erroneous conclusions, based on the flawed belief that where’s there’s smoke, there must be fire !
•    During training, they are taught to take pride in finding various lesions and abnormalities which other doctors have missed. If you are trained to do something, you tend to do it and it takes time to develop the maturity to understand the harmful consequences of some of this training
•    IVF doctors can be extremely competitive and enjoy playing the game of one-upmanship. If one doctor finds something another one has missed, according to them, this is proof of their own medical expertise
•    Also, when a doctor orders a test, he also has to justify the cost of these expensive tests, to his patients. The most  plausible way  of doing this is to highlight  the abnormality  that showed up in the test- this proves to the patient that the doctor is competitive and effective

The Common “Abnormalities” in Infertile Couples

It’s very common to find small ovarian cysts or tiny fibroids when vaginal ultrasound scans are done for infertile women. This sets up a positive virtuous cycle for the doctor, who can claim that he has finally made the right diagnosis, and is now justified in doing additional procedures to solve the problem. However, from the patient's point if of view, this becomes a negative vicious cycle, because a lot of these abnormalities are just incidental findings which are of no clinical importance and are best left alone.

However, patients now start stressing about these little incidental findings. They don’t want to feel that they have left any stone unturned and permit the doctor to subject them to unnecessary interventions and procedures; in most instances, this causes more harm than good. A common example is a laparoscopic surgery to “treat” a small cyst. The sonographer highlights these abnormalities by printing them in bold or in italics.

Contradictory Information

When the patient reads the report, she is upset that she is abnormal , and one of the first things she will do is Google the term. The tidal wave of information the Internet throws at her leaves her even more confused- she finds contradictory information and confusing terms, all of which add to her stress and worry.  When she finally sees the doctor, he triumphantly points out the abnormality and says that once I treat this, you’ll get pregnant! To a certain degree, the reason we are seeing an epidemic of over-testing and overtreatment today is because of the manner in which doctors are economically incentivized to practice medicine.  You can read about this problem at www.drmalpani.com/wasteful-infertility-tests.htm

Not in the Patient’s Interest

Doctors get paid to order tests and do procedures, and many of them will unthinkingly be inclined to do this. Unfortunately, none of this is in the patient's best interest. The biggest tragedy is that the poor patients don’t even realize that they have been subjected to unnecessary testing! When the test  reports some abnormality, they just feel a sense  of relief  that their  brilliant  doctor  has been able  to find  the problem, it will get “treated” and their chances of getting pregnant will increase.

Masterly Inactivity

It’s only the more mature and experienced doctors who understand the importance of masterly inactivity. Unfortunately, doctors don’t get paid to do nothing – and not enough patients have the maturity to understand that only a superior doctor will advise a hands-off approach.  There are some patients who are proactive in learning more about infertility and who actively participate in their treatment. These patients are well-informed and they know that there is no need to worry about every little abnormality seen on a scan, & that often the best treatment is to do nothing.

Get a Second Opinion

Intelligent patients can also try to protect themselves from overtreatment by getting a second opinion. Unfortunately, this effort too trends in the same direction; as the doctor who provides the second opinion is incentivized to perform a procedure and the patient gets caught in a vicious circle of sorts. This is why it’s important to get a second opinion from a retired surgeon, who has years of experience and expertise, and who doesn't operate anymore, because he will be able to explain to you why a hands-off approach is in your best interests.

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!

Wednesday, June 24, 2015

I'll be speaking at the TiE EMR and mHealth conference in Mumbai


Living a Childfree Life-The Freedom of Choice


Over the years, I have counselled thousands of infertile couples. There have been many hits - and a few misses too. Not every IVF cycle has a successful outcome and it’s not always possible for every infertile couple to walk out with a smile on their face. Though IVF technology and other infertility treatments have advanced in a significant manner, nature tends to throw curve balls at us every once in a while , and we are unable to do much about it.

Various Alternatives

When this happens and patients go through a number of failed IVF cycles, and are told that if they want to have children, they will have to consider alternative options such as adoption, it leaves them shattered.  I have spoken and consulted umpteen patients who are inconsolable when they are told that they will not be able to have a child via IVF. They delude themselves into believing that once they have a baby, all their problems will be solved; and they start feeling that a life without children will be empty and meaningless.  When I talk to these patients , I empathize with them, and offer them additional options.

Living Childfree

One option is to choose to live childfree.  Infertility creates a lot of stresses amongst couples and in some cases can lead to a breakup too.  But  if  your  sanity, peace  of mind and your  relationship with your spouse or partner is something you  want to keep,  choosing  to be childfree  can actually be very rewarding.  There are a number of myths floating around with reference to this topic. Take a look at what they are and let’s bust them:

Some Myths and Facts

Myth- Childfree couples are selfish
Fact- If you look at it objectively, opting not to have kids is far less selfish than actually choosing to have them. Many  people  have kids for all the wrong reasons-  they want  their  children  to care  for them in their old age, while some try to have children  in order  to keep  their marriage  together. When you choose to live childfree, you are  making a responsible decision for yourself , and defining who you are on the basis  of  the role  you  play as a human  being , and not just as a potential parent

Myth- Couples who live childfree never wanted children
Fact- Just as choosing to have children is a choice, so is choosing to be childfree. Some people  just  feel that  living  childfree is  right  for them, while there are others who have  gone through the rollercoaster ride of IVF treatments and have  eventually  decided  to  live childfree. Though the journeys of people may be different, the final choice of living childfree is about a personal choice and living a particular lifestyle


Myth- Individuals who live childfree have empty lives
Fact- Many people who choose to live childfree live a life is just as fulfilling, happy ( as well as problem-ridden ) as the life people with children do. The important thing is to recognize the advantages that this particular path presents , and live life to its fullest.  Childfree is not better or worse - it;s just different, and you need to have the courage of your convictions to pursue the untrodden and unconventional path.

Many  people  who do not have children find  they are free  of the  time, financial and societal  commitments  and burdens of bringing-up children; they have  the option  to devote all these resources  towards the betterment of society, their families , other people’s children, as well as themselves- and this  can add a lot of purpose and meaning to their  lives

The World Will Always Judge- Be Your Own Judge

I always  tell patients who eventually  take  the decision  to be childfree, that  it’s important  for them to do the things  they feel are right and which work for them. They need to decide what works for them.  It’s very easy  for people around  and society at large, to be  judgmental  of people who live  lives  that are  different  from theirs. But  I also know for a  fact, that  though  not everyone will admit  it, many people will also secretly  envy  your decision and  your independent lifestyle. Remember that childless does not  that your life will be any less meaningful than someone else's !

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!




How to improve IVF pregnancy rates by blastocyst vitrification



As the Chief Embryologist at Malpani Clinic, Dr Sai attended the ESHRE 2015 in Lisbon to update and polish his skills.
Dr Sai says, " ESHRE is one of the world's largest conferences on IVF and ART and I learned a lot.  
These lessons  help us to improve our IVF techniques, and maximise our ability to give you a baby !

I'd like to share what I learned with you.

The IVF lab is often a mysterious black box for most patients, and this series of posts will help you understand what we do to keep upto date, so we can pamper your embryos in the lab, to help them to become babies !"

Tuesday, June 23, 2015

Dr Malpani as an angel investor

I have evolved over time,and along with being an IVF specialist, I am now also an Information Therapist as well as being an Angel Investor. Putting on  many hats allows me to learn a lot, and I can apply what I learn in one field to others !

You can check out some of the companies I have invested in at http://www.solidarity.in/portfolio.html#prettyPhoto

My interview at IVF Gurus is now live !

Dr. Aniruddha Malpani is one of the most well-known fertility specialists in India in the field of IVF treatment. He is the Managing Director of Malpani Infertility Clinic, Mumbai – a highly sought after clinic by both Indian and International patients. Here’s a brief excerpt of an interview by Pragya Mishra of ivfgurus.com with Dr. Malpani.

http://www.ivfgurus.com/interview-dr-aniruddha-malpani

IVF success story for patient from Canada



We got married in August 25, 1999 and first three years passed without worrying about infertility issues. In 2003, we started visiting clinics mainly in US. We started at Mayo Clinic in Rochester which is one of the best hospitals in USA. After a many examinations of me and my husband, our doctor suggested to do four IUIs before even considering IVF. We did two sets of IUIs but we were not happy of what we experienced at the clinic. Junior employees of hospital were performing the IUIs instead of the doctor himself. Because my cervix was tight, the person doing procedure could not successfully transfer the sperm to uterus. He used a piece of metal many times to open the cervix and it was painful. In addition, there was lack of privacy in the room. Two male and one female trainees were there watching the whole episode without my consent. Unprofessional!!! Both IUIs were not successful.

We moved to Minneapolis and we did two more IUIs without success.

In 2005 my husband and I moved to Canada and we started contacting infertility clinics there. Wherever we went, we felt the same, helpless! All doctors seem that they do not care for you but for your pocket. We did four more IUIs in Canada without conception. 

In 2009, my cousin and her husband went to India and met with Dr. Malpani. She got pregnant of twin babies after her second cycle of IVF. We asked questions about the doctor and she said many good things about Dr. Malpani and gave us his website. We got a lot of information and knowledge from his website. We also asked some extra question to the doctor himself. All our concerns and questions were answered within hours.

Finally we met with the Dr. Malpani and his team in July 2010. My first reaction was “this is the place I want to be”.
 
Both Dr.Aniruddha and Dr.Anjali Malpani are highly professional and supportive to their clients. Their staff has been so kind and helpful.

After taking some pills I got my first IVF. It did not work this time.  My husband had only 15 days of leave from work so we decided to go home this time and come back and spend more time in future. It took us almost four years to come back to India for some personal reasons. But we knew that we will not go to any other doctor but Dr. Malpani

Finally we met with Dr. Malpani in August 22, 2014. After treatment for two weeks, he transferred two embryos on September 13, 2014. Wow, I conceived twin babies in my first cycle. After 37 weeks, I gave birth for two baby boys on May 17, 2015. Both babies are in perfect healthy.

We wish them all the best in their endeavour to help infertile couples become proud parents.

ahmedshnur@hotmail.com

Monday, June 22, 2015

The next IVF cycle


Most IVF cycles go as planned, and most eggs and embryos behave themselves. However , every once in a while we will have an outlier , where a patient doesn’t perform as well as we expected . For example, even though the follicles look great , we don’t get eggs from each of them; and even if the eggs look great , they don’t fertilize. We then need to figure out what went wrong , and we need to start planning what we’re going to do in order to fix the problem. Now usually there's very little we can do in the same cycle itself, which means we need to start thinking about what we can do differently in the next cycle. This is why a lot of IVF specialists talk about what they will do in the next cycle , based upon what they have learned in the current cycle, because the information is "fresh" in their mind.

However, the moment the patient hears the word " next cycle ", her heart sinks. Every patient starts every IVF cycle with the hope that this will be her first and last - that will end with a baby , and she won’t ever need to go through the ordeal again.

She feels that because doctors do so many IVF cycles, one cycle is like any other , and therefore if one doesn't work , we are happy to just try again. This sometimes give patients the impression that doctors are hardhearted and cold-blooded , and they couldn’t care less, but this is not true. We need to be able to look at each IVF cycle analytically , rather than purely emotionally, and while our hearts do break when things don’t go well , we also need to think with our head , and try to figure out what we can do in order to fix the problem.

Even if the IVF cycle doesn’t lead to a baby , it does give us valuable information , based upon which we can tweak the protocol and maximize the patient's chances of getting pregnant in the next cycle.  When patients find out that things aren’t going well m some of them go to pieces , and will just not be able to get their courage together again to attempt another next cycle. Fortunately , most are much more mature , because they have realistic expectations, and have done their homework . They understand that IVF is not a sure shot attempt , and they are willing to be patient , and to think about what the next action steps should be .

They just need breathing space, where they can collect themselves and gather their strength , and gear themselves  to try again. In fact, second cycles are often much easier , simply because the doctor is in a better position to know how your body performs , and can therefore maximize your chances by tweaking the treatment plan.


Want to know what you do differently in your next IVF cycle to improve your chances of success ? 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 !




Saturday, June 20, 2015

When infertile patients get confused on the net



When infertile women try to follow my advice and do their homework on the net, many get thoroughly confused. Many get lost, because there's so much information out there, that they don’t know what to read. What’s even worse is that often the information on one website is the diametric opposite of  what another website says, and they don’t know whom to trust. They can’t make sense of what they read, and many just give up in frustration, preferring to take the path of least resistance. They feel that ignorance is bliss, and that it’s much easier to just leave everything upto the doctor – after all, he the expert and isn’t this his job ? Aren’t you paying him big bucks for his expertise ? Why not trust him and  let him make all the decisions ? Why waste time trying to countercheck on them ? Doing so just eats into their time, and corrodes their trust  in the doctor – and when they try to ask questions to clarify their doubts, this just ends up irritating the doctor as well.

It’s true that patients get confused as a result of online information , but this just means that the information is of low quality and is confusing. The solution is not to give up, but to find good quality information.  Well written information will clarify, not confuse !

A lot of information which is published online is not trustworthy because it is contaminated by a hidden agenda, where someone is trying to sell you something. Other  information is  dense and poorly written because it's written by a doctor who is confused himself, and who then ends up confusing the patient as well. This is true during a consultation with this kind of doctor as well,  when the patient is often left with more doubts and uncertainty at the end of the visit as compared to its start !

It’s the quality of the information and how it’s presented which will decide whether the patient who reads it will get confused or enlightened ! Just like a good school teacher can help to make even a complex subject like calculus fun and exciting; and a bad teacher can make any subject dry, dull and boring .

If doctors want to educate their patients, they need to remember that they need to start from where the patient is – from the basics. They need to think back and remember what they learned in school from their best teachers – teachers who made learning their subjects interesting, because they were passionate about the topic ; knew a lot about it ; and could transmit that knowledge painlessly .

Doctors too need to start learning how to teach. We need to adopt modern teaching tools , such as videos , e-learning and graphic comic books, to get information across to our patients .

I tell my patients that if you find you are confused after visiting a website or after talking to our doctor, the fault lies with your doctor, not with you ! Communication is a two-way process, and it’s the job of the teacher to make sure the message being delivered is as crystal clear as possible. If the doctor cannot do a good job, that’s because he doesn’t know how to teach ! However, patients often underestimate their intellectual abilities, just like students do. Many students feel that if they cannot understand a particular topic, it’s because they are dumb or stupid, while the reality is that they cannot grasp the subject because their teacher is not good at simplifying it and explaining it.

If I was teaching you how to cook French dishes, and gave you the recipe in French , you would be able to figure out the general scheme, but you would not be able to make sense of it. You might end up concluding that you were dumb , and would never be able to master French cooking. However, if I took the time and trouble to translate that same recipe into English, you would know exactly what's going , and be able to follow it easily !

The good news is that there’s now lots of high-quality , well-produced accurate information available online for patients today, so that it’s become much easier for you to do your homework . Even better, if you are willing to be patient and take your time searching for a clearly written website, you will get better at understanding what’s happening to you during your infertility journey. It does get easier over time as you mater the skills – and this is a worthwhile investment of your time and energy !

Need help in making sense of the online information you have found ? 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 !




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