Monday, August 31, 2015

Can Donor Eggs give you the Baby you Want ?




Over the years of our practice, we have seen scores of couples struggling with infertility. In some , all the pieces of the IVF jigsaw puzzle fall in place and they get the baby they crave to have, while in others a missing piece or two do not allow them to complete that picture, and their family in the way they had planned. This is a dejection point, not just for our patients, but for us too. After all, it’s our aim to get all our patients pregnant.

When a patient fails multiple IVF cycles with her own eggs, she always wonders whether it’s the end of the road and whether she will have to cope and live with the idea that she will never be able to have babies of her own.

A Difficult Decision

The fact is that we do consult our patients about all the possibilities and limitations of IVF treatment. As part of the initial consultation, they are also informed about other options available to them, such as donor eggs in case their IVF cycles fail (based on what the reason for the failure is).

But if and when they actually come face-to-face with this situation, most patients struggle with the decision of using donor eggs. Some couples embrace the idea willingly and move through the process quickly, while there are some who aren’t really ready to entertain the thought at all. As their IVF doctor, I do counsel these couples and help them recognize as well as focus in a more concerted manner, on their overall ultimate goal- to have the baby they want.

A Change of Heart

In most instances, it becomes a journey of transitioning through various unsuccessful treatments which eventually leads to the donor egg option. This also means that along with the dejection of failure, in some cases, there is also an increased sense of desperation. However, it’s imperative to understand the implications that are associated with choosing this option. In addition to getting consulted for it, it’s also important to communicate with other couples that have gone through the same situation.

Through this process, some of our patients eventually move ahead and accept this option- in many ways the desire to have a baby supercedes any of the biological issues; over time many couples do begin to welcome the idea.  For many of these couples, they are finally able to see the light at the end of the tunnel.

And so, with the first major hurdle being navigated; it may seem like the rest of it would be easy, from an emotional perspective. The truth is that there are some other inhibitions and concerns that patients have when it comes to using donor eggs to have a baby.

The Concerns

Most couples that I consult worry about whether they will actually feel connected to their baby if it doesn’t resemble them. I hear a lot of patients talking about the lack of any genetic connection and the manner in which it will affect their child’s life; the questions that crop up in their minds are:

Will this baby really be mine ? Will she/he have anything at all from me? Exactly how am I going to feel towards this child?  Will I be able to love her ? What will she look like ? Whose personality will she have ? Will she talk and smile like me ? Or will she resemble  the egg donor -  someone who I have never seen or met.  As you can guess, this can be a scary proposition, and lots of patients will have nightmares and fantasies about their donor.

Will anyone guess that I have used donor eggs ?

I always suggest that my patients go in for professional counseling before they make a decision.  In fact, it's always the ones who worry a lot about making this decision who end up making the best decision.

Nature, Nurture and Epigenetics?

After birth, the child picks up her parent's traits and mannerisms - after all, if you speak Hindi at home, so will your child. And your child will mimic your smile and your laugh. Even as regards the genes, while it's true that the genes come from the egg donor and not from you, please remember the key role of epigenetics. This is the mechanism via which various non-genetic factors influence gene expression . This means that even if the baby does not have your DNA, you do play an important role in how the genes of your child will be expressed in utero. In many ways, this can be a big comfort to couples who are considering the use of donor eggs. What eventually pulls the trigger so to speak is a person’s attitude, lifestyle and environment; this despite the fact that genetics loads the gun.

The Thing that Finally Matters

One of my patients who had eventually opted for donor eggs after several years of vacillating between her emotions of wanting to have a baby and not wanting to have one using another woman’s eggs, recently came to meet me. She told me that her moment of awakening was when she realized that there was nothing so special about her genetics. Many people feel that genes are immutable; the truth is that the notion of selfless and unconditional love is the only thing that’s truly unalterable.

And this is the love that parents have for their children- whether biological, born using donor eggs, adopted or otherwise.  At the end of the day, the path you take to become a parent becomes inconsequential and the only thing that matters is your baby.

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





Saturday, August 29, 2015

The patient's guide to making sense of your semen analysis report

The semen analysis report is the basic test for testing a man's fertility. It's a surprisingly complex test to interpret correctly ! If you need help in making sense of your sperm test report, check out our interactive test report at http://www.slideshare.net/malpani/sperm-test-semen-analysis-report

There’s Nothing Artificial about the ART of IVF




IVF treatment has been around for over three decades and today it has phenomenal success rates too. Despite this, a number of patients have their qualms about doing IVF. This is because they think it is an “artificial” process. Their concern is that any baby that is made by artificial processes in a lab will be abnormal and weak. The slightly more sophisticated patients are concerned that since the embryos are inserted artificially into the uterus, they will have to take bed rest post the transfer as the embryo will “fall out” if they don’t do so.

The fact is that when it comes to IVF treatment, myths and misconceptions abound. This is even more evident with reference to the care that patients have to take once they get pregnant. Most of this misinformation is propagated thanks to the influx of online forums and bulletin boards.

Why Myths are Aplenty

It’s not difficult to figure out why these myths are so prevalent- they just make a lot of intuitive sense. Just think of it- if the doctor is putting the embryos via the cervix into the uterus, isn’t  it logical  to believe that if the woman sneezes, coughs or strains, the embryos will fall out? This is exactly why women are advised to take so many precautions post the embryo transfer. While some of these warnings come from doctors, other advice comes from friends and relatives, or even women who have undergone IVF treatment in the past.

Regardless of whether the patients think this is logical and true, they follow it- they only want to maximize their chances of success and make sure that their embryos come to no harm. And so, we find ourselves telling our patients over and over again that they don’t really need  to take any special precautions after IVF and that there isn’t really any need to create an extensive list of do’s and don’ts.

Mimicking the Natural Process

Nothing they do will either lower or up their chances of success. We keep telling our patients that ART is an acronym for Assisted Reproductive Technology and not Artificial Reproductive Technology. IVF allows us to perform in the IVF lab what is not happening naturally in the bedroom for infertile couples. Of course, we are fertilizing the eggs and sperm In vitro, in the lab; but we are only mimicking the natural In vivo process. In the case of fertile couples, this is something which occurs in the fallopian tubes, while in this case is taking place in an IVF lab, that’s all.

Navigating Hurdles

Another important fact to keep in view is that once the embryo has been transferred to the woman’s uterus, whether it spent 3 days in the fallopian tubes or 3 days in the lab, is totally inconsequential. Once the embryos implant, the pregnancy is just like any other normal pregnancy.

In the uterus, the embryos follow the completely natural biological process of in utero implantation- it means that the final common pathway remain the same. Just think of IVF as a technique that allows us to navigate the obstacles that eggs and sperm of infertile couples encounter in the bedroom.

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 !

Friday, August 28, 2015

Raksha Bandhan Special - Crowdfunding for SAFER Smart Jewellery

Leaf Innovation Pvt. Ltd. , a startup in which I am an angel investor, is launching its crowdfunding campaign on Ketto.org for SAFER smart jewellery on Raksha Bandhan. The goal is to raise Rs. 5,00,000/- on Ketto, Asia’s largest crowdfunding website.

SAFER, the pendant that keeps women safe and connected, has been designed and created by 5 engineers who want to change the world – first, by making it a safe place for women to live, learn and work.

If a woman feels threatened, all she has to do is press her SAFER twice. This will send out an alert to pre-selected people called Guardians, who will then be able to track her movement in real-time on maps. The SAFER pendant works with the SAFER app on the wearer’s mobile phone.

In September, Leaf will be at Silicon Valley as one of the Top 10 Innovators of India, an initiative sponsored by DST-Lockheed Martin’s India Innovation Growth Programme. One of the events Leaf looks forward to is Prime Minister Narendra Modi’s reception on his US visit to focus on innovation and the digital economy.

Pre-order here: https://ketto.org/safer and More information: http://leafwearables.com

Genetic Causes of Male Infertility




Getting pregnant is a very complex process. On the surface, it may seem very simple, but a lot of things have to be on the right track at the right time for you to conceive. A lot is talked and written about infertility in women, while very little is discussed about male factor infertility. The fact is that increasingly men are emerging as the “problem” when it comes to a couple not being able to conceive.

Male factor infertility is essentially diagnosed whenever there are problems with the man’s sperm or even his ability to actually deliver the sperm into his female partner’s uterus. Today, we find male factor infertility in almost 50% of the couples who come to our clinic to seek treatment. Though there are a range of reasons that can lead to male infertility, certain genetic defects can cause the man’s sperm to be abnormal.

One big problem is that genetic testing is now being misused for the infertile man. It should only be done for azoospermic men – those with a zero sperm count. However, we find that lots of doctors do this for all infertile men, which is a complete waste of time and money. Even worse, they use unreliable test such as sperm DNA integrity testing and DNA FISH testing, and when these are abnormal, they tell the patient that this is the reason they IVF cycle failed, and they then advice them to use donor sperm.

Genetic testing should be used selectively, and only for men whose sperm count is zero ( this is called azoospermia), Even for these men, it should be used wisely and selectively.


These are some of the common genetic causes of infertility in men:

Klinefelter Syndrome- This occurs when the man has an extra X-chromosome. This gives him XXY sex chromosomes versus the normal XY ones. This genetic problem is fairly common and it occurs in 1 out of every 500-1000 men. People who have this syndrome may have very low sperm count or no sperm in their semen at all.

Their testosterone levels will also be lower than normal. In some instances, men with Klinefelter syndrome might have sperm in their testicles. We are able to extract this and use them to fertilize the female partner’s eggs in our lab via a procedure called ICSI (intracytoplasmic sperm injection).

Cystic Fibrosis Gene Mutation- Men who have cystic fibrosis don’t generally have a vas deferens (this is the tube that carries the sperm from the testicles into the urethra). If we find that the man has this condition, we then recommend that the woman be tested to check whether she carries a cystic fibrosis mutation; this helps us identify whether their child will be at risk.  Most of the men who have this condition are able to produce sperm naturally. This makes it possible to extract sperm and use ICSI to fertilize the woman’s eggs in our lab.

Y Chromosome Micro deletions- In some cases, segments of the Y chromosome, that relate to male fertility may be missing, which can lead to male factor infertility. We use certain tests to determine whether it will be possible to find sperm in the man’s testicles. If a man with this particular condition has male children (either via ART or naturally), they will also have this genetic condition. Female children  don’t get affected as they don’t have the Y-chromosome at all

Other Chromosomal Problems- It’s possible to find certain other genetic abnormalities using genetic testing. In some cases of repeated miscarriages & unexplained infertility, one of the partners will be identified to have chromosome rearrangements- these are referred to as balanced relocations. If these are identified, we may recommend IVF with PGD (preimplantation genetic diagnosis). We may use this particular testing when either one or both the partners are carriers of a chromosomal abnormality/ have a history of genetic disorders.

PGS (preimplantation genetic screening) is a related procedure that doesn’t look for any specific diseases; however it uses the techniques used in PGD to look for embryos that may have an abnormal number of chromosomes.  Regardless of which procedure is used, your eggs will be fertilized in our lab, with your partner’s sperm.  We will also genetically test the embryos before we transfer them into your uterus. Using this procedure, we are able to choose the embryos that are unaffected by any chromosomal abnormalities and transfer only the healthy ones.

If genetic issues are found in the male partner, we may recommend genetic counseling; this helps the couple determine whether they will be able to have children with the man’s sperm and which alternatives are open to them. Some of our patients opt for donor sperm. This can be a difficult decision to make and we ensure that our patients are counseled well; it helps them make a more well-informed and prudent 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!


Thursday, August 27, 2015

When Embryos Refuse to Implant




It’s normal for patients who have failed an IVF cycle to be desperate. It can be very difficult to come to terms with this failure. Most IVF patients don’t consider the possibility of failure and they feel that one attempt will be enough to give them the baby they want. But when their cycle fails, they begin looking for solutions to up their chances of success in the next one.

Most of the patients will have had pretty good embryos as well as an easy embryo transfer; when a cycle fails, it means that their embryos didn’t implant and this is what most call a “failed implantation”. So, logically if the embryos have failed to implant, the one way to change the equation will be to find ways and means to make them stick- maybe some sort of embryo glue will do the trick and ensure they stay where they are meant to be?

Genetic Problems Lead to a Failed Implantation

Sophisticated patients and doctors might find it quite amusing when a patient expresses her desires in these simple terms. This is because many people still have a number of misconceptions and myths about the entire process of what actually happens to the embryo once it is transferred into the uterus. The truth is that a large percentage of good looking embryos don’t implant. We also know that in most cases, it’s a genetic problem in the embryos that results in a failed implantation.

It’s also a fact that this is something we can’t really diagnose, even with the highly advanced genetic technology such as whole genome testing, array CGH and next generation sequencing (NGS), that we have access to today. This is simply because embryos that appear normal on genetic testing might still have certain anomalies that we are unable to pick up.  Despite all the advances, we are only able to count the number of chromosomes via genetic testing; we can’t really analyze individual genes using these tests.

A Complex Process

When it comes to the complex process of embryo implantation, there are a number of variables in play. Apart from the embryos, the uterine lining has a key role to play too.  In turn, this is affected by a number of complex variables such as:

Blood supply to the endometrium
Hormone receptors on the endometrium
Complex crosstalk between the embryo and the endometrium

The problem stems from the fact that most patients don’t understand these technicalities and doctors don’t bother to explain them to the patients. The latter believe that it’s something they themselves did wrong that dislodged the embryos from their uterus. The different things they think of are:

Maybe I put  too much pressure  on my uterus by lifting a bucket
Maybe driving through that large pothole caused my embryos  to fall out
My diet may have been too spicy
I probably  didn’t rest enough
Other  ( you can fill in your own favourite reason here)

As myriad possibilities run amok in their head, they are unable to find straight answers. To a certain degree, they feel that their questions and doubts are stupid and they abstain from getting these cleared from their doctor. Misinformation and myths abound on bulletin boards and this just adds fuel to the fire.

An Immune Dysfunction?

It’s important that doctors help their patients understand that science has its limitations and we don’t really know and can’t begin to explain why embryos don’t implant. Some doctors distort the truth, telling their patients that the implantation failure is an indication that something is wrong with the patient’s body and that an “immune dysfunction” is causing it. With this as a premise, multiple tests will be ordered and a significant amount of money will be poured into identifying these purported problems and then on “treating” them too.

Sure, all of this seems very sophisticated, but these tests are nothing but a whole load of hogwash and have no basis. Contrastingly an honest doctor will categorically tell his patient that once they have transferred the embryos into the uterus, it is essentially in no-man’s land and that biological processes cannot be controlled by any doctor, no matter how competent he is.

The Wrong Vocabulary

But then words like “luck” and “destiny” don’t fit into a doctor’s vocabulary, and patients don’t want to hear it from them either; and the unvarnished truth is something that many patients can’t digest. It’s sad that patients will very willingly believe things like they have a “pregnancy  destroying  factor” that will require treatment before they will be able to conceive (which is what some doctors will tell them), and they get caught in this unending  and unnecessary  cycle of tests and treatments that they find  difficult  to yank themselves out of .

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 !


Wednesday, August 26, 2015

When IVF Doctors Test a Patient’s Patience by Ordering Too Many Tests !




One of the things IVF doctors most commonly do is order tests. The uncharitable explanation for why they do so many tests is simple- financial reasons. It’s an open secret that the diagnostic laboratories and scan centers often give doctors a kickback (commission) on each test. This means the more tests they do, the more money they make. However, there are a number of doctors who don’t get kickbacks; but they still end up ordering a lot of tests. Why is this the case?

One of the reasons is a very common psychological fallacy most of us are fooled by. We often believe that the more the data we have, the more accurate our diagnosis will be. Doctors confuse more information with more accuracy. From a logical viewpoint, this seems to make sense. This is why when doctors encounter patients with a complex problem, they order more tests to get more information. They hope that the test results will give them more insight into the right diagnosis.

Increasing Confidence Levels

However, psychologists have shown that more information does not always improve accuracy . In reality, more data has the pernicious side effect of increasing the confidence levels of the doctor in his diagnosis. This is not a problem which is unique to doctors - it actually applies to experts in all fields, including financial advisors. Because lots of doctors are not aware of this common cognitive bias, they over-order tests when they are stumped; they hope it will improve the accuracy of their diagnosis, without realizing that they are not doing much good!

Catering to Patient’s Expectations

One more reason why doctors order excessive tests is because this is what patients demand and expect ! Most patients are no longer satisfied by a clinical examination (even though this is far more valuable than any number of tests !). Current day patients have more peace of mind if they have those scans and computer printouts in their hands.

They rely on technology to back up the diagnosis that the  doctor has presented them. Many patients are extreme in this context and will also feel that their doctor isn’t being efficient , thorough and careful, if he doesn’t order tests. This is exactly why there are times when doctors order tests – to keep their patients happy.

Excessive Tests can be Harmful

This is ironic, because only a very confident and competent doctor will actually refuse to order tests. A dirty little secret is that many of these tests can actually be harmful, as they lead to a lot of unnecessary overtreatment. More is not always better!  However, patients are not sophisticated enough to question the doctor. The key question they need to learn to ask when the doctor orders a test is simple – “How will this change my treatment ?”

Because they do not do so, the explosion of new technology means there is also an exponential rise in the number of tests that doctors can order. Also, when doctors attend conferences, they want to learn “what’s hot and what’s new”. They are seduced by attractively produced presentations, which tom-tom the accuracy and efficiency of the newest tests. No one bothers to highlight their limitations, because these keynote speakers are usually sponsored by the company that is selling the tests.

About ERA

Let’s look critically at the newest test that is being marketed for IVF patients today. This is called the endometrial receptivity assay (ERA). It uses genetic markers as an endometrial function test (to test if the endometrium will allow an embryo to implant). This is a very new, sophisticated test that is very expensive and to date, is offered by only one company.

Since failed embryo implantation is such a distressing problems, IVF specialists are very happy to order this test for patients who have failed IVF cycles. However, because doctors understand precious little about genetics, they end up fooling themselves - and their patients. Thanks to a lot of slick marketing, with tons of genetic jargon that doctors don’t understand, it’s not surprising that doctors are taken for a ride !

New Tests Translates to Unreliable Tests

Because doctors want to be “one-up” on other doctors, they are happy to order the “latest tests” – which are often much more expensive, because they are new. This newness  also means they are much more unreliable, because we don’t have enough clinical experience with them!

Ironically, patients don’t seem to mind paying for all these unnecessary tests. In fact, most of them are quite happy when the test results come back as normal, because they naively believe that these means they are fine! They don’t seem to consider the money spent on the test as a waste! Actually, the purpose of tests when used judiciously is to confirm or rule out a clinical diagnosis, based on the doctor’s clinical examination.

It cannot be a hunting expedition, where the doctor uses a “spray and pray” approach to try to find an abnormality, which may be of no clinical importance. The reality is that more knowledge can reduce the accuracy of prediction of uncertain outcomes, and simultaneously increase the doctor’s confidence in their incorrect  predictions.

As the Nobel laureate Daniel Kahneman pointed out, "Overconfident professionals sincerely believe they have expertise, act as experts and look like experts. You will have to struggle to remind yourself that they may be in the grip of an illusion."

Doctors need to learn from his wise words - “Be honest with yourselves! Admit what you don’t know!”

The bottom line is that before ordering a test,  doctors need to ask themselves- “How will this change the patient’s treatment options ?” Let’s not lose sight of this in our enthusiasm for ordering  tests ! (And if the doctor does not ask this question, the patient needs to learn to do so !)

Want to maximize your chances of IVF success? 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 !


Tuesday, August 25, 2015

When Infertility and Depression Do a Tango



Very recently, I saw an infertile couple; the wife was talking about how she was constantly stressed and had reached a point where she felt she was slipping into depression too. As I listened to her, I reviewed a number of other patients who had come to consult me over the years and I assured her that she wasn’t alone and very importantly, that what she was feeling was normal under the circumstances.

Many infertile couples find this unwelcome guest of depression in their lives and the sad part is that a number of doctors don’t really address these issues while dealing with patients.

The fact is that depression isn’t very well understood and very little is known about how infertility results in depression. However, when you look at it from a logical viewpoint, there are certain complicated psycho-dynamics at play, which may contribute to the incidence of depression in people who are dealing with infertility.

The Effect of Isolation

There are a numerous reasons for depression; but a number of these get exacerbated when it comes to infertility. This occurs due to the feelings of isolation from family, friends and society at large; some couples also grow away from each other and this adds to the feeling of isolation.

Many couples who I consult have gone to other clinics for treatment before coming to ours. This also means they aren’t alien to the entire infertility treatment process and are carrying the burden of one or more failed cycles as they trudge wearily along the infertility route; just in the hope that they will eventually see light at the end of the tunnel.

Emotional Disorientation

For many couples, even the act of lovemaking becomes forced rather than impromptu and it ends up becoming a repetitive opportunity for failures versus being an important part of a normal relationship that couples share. Many patients also find that they are unable to place the blame anywhere else and they end up blaming themselves.

Feelings of anger and loss of control are the other contributing factors to emotional disorientation.  It is truly said that depression is actually anger turned inwards and that is also what I perceive when I talk to some of my patients during the course of the consultation.

Just Too Much to Deal With

I generally recommend that the couple opt for talk therapy; in the right setting, it can be quite helpful.  Though it’s a fact that a number of these feelings could be irrational, the other fact is that for many couples, they are also very real. Women are at higher risk of developing depression , compared to men. In an infertile couple, the man doesn’t have a major role to play, either during the course of the diagnostic workup or during the treatment phase. On the other hand, women have to deal with:

Dramatic hormonal changes (infertility treatments which involve hormone stimulation make this worse)
Many treatments involve dye injection, shots, and biopsies (some of which can be painful, and all of which can cause anxiety and apprehension)
Fear of  miscarriage/ birth defects
In cases of unexplained infertility, the family tends to attribute the couple’s inability to conceive, to “poor uterine environment” or “bad eggs”; in short, they are casting blame on the woman for certain factors that she has zero control over

Which Came First- Infertility or Depression?

But this isn’t where the story ends; there is another side to the coin too. In many ways emotional problems including depression and anxiety themselves tend to contribute to reduced fertility. After all, a depressed woman has diminished libido, and this will reduce her fertility. In addition, infertility treatment can be very expensive and this also stresses the patient. It’s no wonder then that women feel lost, without hope and helpless when their IVF cycle fails. Multiple failures can result in the situation spiraling out of control.

Since this is a reactive depression, there are good chances of it being amenable to improvement by increasing self-awareness of the effect of anger and isolation that surrounds the state of infertility.

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!


Monday, August 24, 2015

How to ask for a second opinion

Many IVF patients want to get a second opinion, but don’t do so . Some are worried that their doctor will get offended if they ask for a second opinion , and the one thing patients don’t  want to do is to upset their doctor. This is why even though they feel they want some more information to make sure that they are on the right track , they are often scared to ask for a second opinion behind their doctor’s back.  Others don’t don't know how to get a second opinion . Whom should I contact ? How do I know he is reliable ?  Will I be able to trust him ?  How can I believe someone whom I have never met ? Finally, some are worried that if they get a second opinion and it's different from the first , then they will get confused , and won't know what to do . This is why they prefer to believe that it's better to trust your own doctor, rather than try to second-guess him . After all, if you have a good doctor, then why do you need to bother to get a second opinion ?

However, the truth is that two heads are often better than one, and the good news is that it’s become much easier to get a second opinion online. This is an option you should explore because often the second opinion is better than the one your first doctor gives you.

For one, it's objective and unemotional . Since it’s not face to face, the specialist providing a second opinion can be dispassionate . He can take an overall holistic perspective , and often he has no axe to grind, because he is not your primary treating doctor.

Also, the fact that your current doctor has ordered your basic tests and provided you with an opinion means that the doctor who is providing you with a second opinion can improve it by providing you with additional options, you may not have been aware of.

If a second opinion confirms that you're on the right track , your confidence in your own doctor will actually increase . If it provides you with a different perspective , it will help you ask your doctor more intelligent questions , so you are certain that  you're getting the best possible treatment . If there is a major difference , you need to do some more homework and research before making a final decision.

It’s not always that the second opinion will be better than the first . It’s just that exploring a different perspective will help you to make sure that you have covered all your bases . This is extremely important when you're dealing with an expensive treatment like IVF , where the outcome is always uncertain .

Getting a second opinion is a low cost/ zero cost option, and you have practically nothing to lose by exploring it. If nothing else , the process of getting a second opinion will force you to organise your own medical records , and get your act together . This will help you become a better patient , and increase your odds of success.

Need a no-strings attached free second from an IVF specialist ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you ! !





Saturday, August 22, 2015

When to ignore your IVF doctor’s advice



Infertile patients are vulnerable , and when they go to an IVF doctor , they expect to get good advice . Traditionally , most patients have blindly followed what the doctor tells them to do . After all , the doctor is the expert , and because he is a trusted professional , all the patient needs to do is to follow his advice,  and they will get a baby ! Thus, most patients will do whatever the doctor orders them to , without asking too many questions . They will follow his orders, whether it’s doing lots of expensive tests, or even undergoing surgery, in order to fulfill their dream of having a baby.

When all goes well , the doctor is a hero, but then the cycle fails ( as it often will), then the doctor is berated. A lot of patients do not trust their doctor. The nexus between the referring family physician and the IVF consultant ; as well as the fact that the IVF specialist is often incentivized by pharma companies to prescribe their brands is now an open secret . Patients are understandably concerned about the quality of the advice which they are getting from their doctor. They worry as to whether their doctor is advising IVF  because it’s in their best interests, or his !

They are worried that the doctor’s hidden financial agenda is contaminating the quality of his
advice . This is especially true when they can see that the doctor doesn't have enough time to listen to them; or they feel that the IVF clinic is run like an assembly line, where all patients are being herded together , using a one size fits all treatment policy.

It’s hard for patients to judge the quality of the doctor’s advice , and this is why they are often confused . A lot of them will then get second opinions , or cross check with other doctors ; or perhaps friends and famiy members who happen to be doctors . Some will spend hours on the net , trying to find out what their options are , so they can make the right decision for themselves .

This is why Information Therapy can play such a stellar role in healing the Indian healthcare ecosystem.  However, this needs to be high quality, reliable, unbiased, updated information , which provides the patient with actionable information , so she can actually make decisions after factoring in her own personal preferences .

Patients need to understand that the doctor’s advise is just one of the many factors which they need to consider when making a decision , and they cannot afford to leave everything up to the doctor. They need to apply their own mind and do some due diligence before making a final decision . There will always be multiple options , and sometimes doctors may be too busy to discuss these with the patient, because they prefer taking a “one size fits all” approach, which makes their life much easier. They end up providing generic generalized advice to all their patients, without tailoring it to their personal circumstances.

Sadly, sometimes patients don't bother to do their homework. They only wake up after their cycle fails, and then when they find out that the quality of advice which they received from their doctor was poor, this causes major heartburn . They lose confidence , not just in their own doctor, but in the entire medical profession , which just makes a bad situation even worse , because they deprive themselves of receive high quality medical treatment at a better IVF clinic.

This doesn’t mean that you have to mistrust your doctor either – it’s just that you need to confirm his advice is right for you.  This is why high quality online information can be so valuable . For one thing , it's in black and white , so patients can read it multiple times, until they understand all the nuances and subtleties. Secondly, the site will explain the reasoning behind whatever options it offers , so patients know what they are doing and why, and can weigh the pros and cons of all options, because information is not censored. Thirdly, these sites respect the patient's intelligence , and help them to make their own decision for themselves. Finally, they don’t do away with the doctor. In fact, they emphasise the key role the doctor plays in the final decision, and encourage patients to discuss the results of their research with their doctor, so they can make a joint decision

Online information therapy complements the role of a good doctor, and patients who do their homework using reliable high quality decision tools will find that they can trust their doctor even more. When they realise that the information which the doctor is providing them with is correct because it fits in with the online information which they have discovered for themselves, they will respect their doctor a lot more, and he will have rightfully earned their confidence.

Patients need to listen to both their heart and their head, and they also need to respect their intelligence so that they'll be able to figure out stuff for themselves , preferably with the assistance of their doctor. Ignorance is not bliss, and knowledge is power when battling with infertility !

Want to make sure you are getting the best possible IVF 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 better !




Friday, August 21, 2015

More reasons to do IVF - The expanding role of the IVF specialist



In the past , IVF specialists would primarily treat infertile couples - couples who could not have a baby because of a medical problem, such as low sperm count or blocked tubes . Today, there are lots more reasons for doing IVF, and these are expanding every day.

One big medical group is for the prevention of genetic diseases, such as haemophilia or thalassaemia , where we use the genetic technology of preimplantation genetic diagnosis ( PGD) which allows us to ensure that we transfer only genetically normal embryos. As our genetic knowledge increases, this group will increase by leaps and bounds.

Along with extending the use of IVF for medical reasons, we are now also using IVF for lots of non-medical reasons .

One group of patients are those who do IVF for lifestyle reasons. These are ambitious power couples, who are so busy  climbing the corporate escalator, that they don’t have time to have sex. This might seem amusing, and some people might even find it sad that they need to resort to doing IVF to have a baby, but this is a well-thought decision they make for themselves, because they find IVF cost effective, given the fact that it saves them time. The second group is those who do IVF for social reasons . For example, these are ambitious young women who want to postpone childbearing because they want to pursue a career . They therefore choose to freeze their eggs, because they know that as they get older, their fertility will decline, and they want to be able to have their cake and eat it too ! This is conscious decision they make, which allows them more control over their reproductive fate, so that biology is no longer destiny. This is an example of how women are using reproductive technology to expand their reproductive choices , and just like contraception allows them to choose how many babies to have and when to have them , IVF technology also allows them to postpone childbearing , so they can have babies when they are ready to. They now have more control over their life.

The other group is lesbians, gays and single women, who want to have a baby to complete their family and need to use IVF to do so. Many orthodox people may find this uncomfortable, but the world is becoming more tolerant and pluralistic, and people should be free to choose for themselves.

Finally, we have the celebrity copycats, who want to do IVF because they find out that this what celebrities like Aamir Khan and Sharukh Khan are doing, and they want to follow in their footsteps.

While some of these “ indications “ for doing IVF maybe controversial , there is very rarely a black or white answer , and people should be free to decide for themselves . Of course, just because we can do something doesn't mean we should be doing it ; but on the other hand , just because we may not personally approve of single women doing IVF, we should not infringe on their right to choose for themselves.


Thursday, August 20, 2015

Why IVF doctors need to consult with their patients


When we talk about a doctor-patient consultation, we typically refer to the fact that when someone falls ill, they go to a doctor, who then tells them what to do. This is generally perceived as a one-way street and the doctor is in charge. He takes your medical history, will do an examination and then order tests. Once he has made a diagnosis, he will then provide the appropriate treatment.

However, in most cases there is one key component missing. Doctors need to consult with their patients as well. ! The medical field is advancing at a very rapid pace and current-day patients have a number of choices. It’s important to understand that each patient is different and there will be differences in their personality, world-view, religion and culture; the option they choose will be based on all these factors.  This is especially important for conditions such as infertility, where the patient has many options, and the treatment is elective.

It also means that there is no single right answer; after all doctors aren’t mind readers either and they have to keep the patient’s personal preferences in view while consulting with them.  They will be able to do this only by talking to the patient.

Giving the Patient a Choice

The simple fact is that doctors can’t afford to guess, and it’s important that they don’t impose their choices on their patients either. They must be non-directive as well as non-judgmental and give the patient the space and scope to make their own decision. It’s important that they ask the patient which treatment they would prefer instead of riding roughshod over them. This is not a sign of weakness on the part of the doctor – it’s actually a sign of strength!

The Incorrect Perception

There are also times when patients get confused when the doctors ask them for their opinion. At this point, their perception is that the doctor is confused and is unsure of what has to be done and that is why he’s asking for their advice. The truth is that a doctor who does this is a true professional who is being respectful. He knows that patients need to provide their inputs so that he can help them to make a decision that suits them best.

And so, when it comes to a doctor-patient relationship, it has to be a 2-way street and both have to be contributors; it’s the one way to ensure the patient gets the best care possible. Though this may seem to be a very obvious thing to do, it’s amazing how rarely doctors follow this practice in real life. The main problem is that most doctors have bloated egos; this is especially true of the renowned specialists in big towns.

A Narrow View

They are essentially know-it-alls and feel they have the all the answers and will dish out these to any patient who consults them, and this becomes the starting point of all the problems. In many ways specialists wear blinkers when they are dealing with medical issues; and so for a cardiologist, every chest pain originates in the heart, because he doesn’t understand anything about the stomach!

As long as everything is fine, patients have been conditioned to meekly agree with everything the doctor says. They are passively compliant, but when things go wrong (as they are bound to do in any complex biological system), they become angry and vengeful.

It’s important that medical decisions be made on a shared basis, and the doctor and patient should provide their inputs; and take responsibility for the outcomes. Sadly, most doctors continue to believe that shared decision making means- Here's my decision, let me share it with you! Its time doctors started respecting their patients and their choices!

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, August 19, 2015

Egg Freezing- Reproductive Insurance against Future Infertility



Over the course of my practice I have treated thousands of infertile women, and the one major change that has been evident over the years is that a number of women now come into our clinic to ask about personal reproductive insurance. Fertility preservation has become a major area of concern today, because many women are aware of the concept of reproductive aging . This is a topic that impacts all women, but it’s rarely discussed openly.

About Egg Production

Every woman is born with all the eggs she will ever have; when I tell my patients this in the course of their consultation, many of them are genuinely shocked. Men are able to produce new and viable sperm right through their life ;by contrast, a woman’s eggs start aging even before birth  , and this process of depletion continues until they are finally  exhausted at menopause.

Today a number of career-minded women  put off motherhood and the fact that they have a depleting egg count  can be downright  terrifying to them. But that’s not how  it needs to be. Modern day reproductive technologies have made possible various options that enable women to have children much later in their life.  The key lies in knowing your options, so you can exercise them intelligently.

The Effective and Simple Procedure

Egg freezing is now one of the simplest ways  in which a woman can radically slow-down  her biological  clock; this option is one I recommend to young women who are concerned about their fertility.

I get a lot of questions about egg freezing and this prompted me to post this FAQ’s page on egg freezing. Hopefully this information will answer most of the questions you have about the procedure:

Q: At what age should I freeze my eggs?
A. Its best to freeze your eggs when you are in your 20’s & 30’s. This is because younger eggs are of better quality, which means they will withstand the freeze and thaw procedure better. They also have a much better chance of fertilizing, because their mitochondrial energy levels are higher, which means they provide you a better chance of having a baby.

Q. Exactly how is egg freezing done?
A. The egg freezing process isn’t all that complex. Once you qualify as a candidate for egg freezing, we will then plan a cycle around your menstrual cycle. As soon as it begins, we begin administering fertility hormones. These are in the form of daily injections and you are required  to take them for about 10 days ,  after which your eggs will be extracted at the clinic. The 30 minute procedure is  done under light sedation, is quick and painless. Your eggs are then frozen by the embryologist in the IVF lab, using a flash freezing
( vitrification) protocol. Survival rates are nearly 100%.


Q. Will freezing my eggs now make me run out of them later?
A. This is a misconception, and a very common one at that. This is because we are  only freezing the eggs which you would otherwise have lost. Typically, only one egg gets ovulated each month, but 30-40 follicles start the maturation process. These normally die every month, because they undergo atresia. With the fertility hormone treatment, we are effectively disrupting this loss , which means we are saving those eggs  which would have died under natural circumstances. You also need to keep in mind that the hormonal injections we use are natural hormones, which get excreted promptly, and don’t have any long-term side effects.


Q. Is egg freezing  covered by insurance?
A. Indian insurance companies  don’t cover  ART procedures (egg freezing included). But interestingly, companies such as Apple and Facebook are covering egg freezing costs  for their employees. It’s more of a retention incentive, but the women benefit too as egg freezing isn’t  inexpensive  !

Q: How long will my frozen eggs last?
A. Theoretically, for ever ! The eggs are frozen at -196, which means they are in a state of suspended animation , and will remain here until we thaw them, because all their metabolic activity has been stopped at this low temperature. The technology has been used for over a decade now and there are healthy children from eggs which have been frozen for 5-9 years.

Q. Are babies that have been  created using  frozen eggs as healthy as all other babies?
A. Regardless of whether IVF babies have been created using fresh or frozen eggs ( or frozen sperm or embryos for that matter) , they are as healthy as any babies that have been born naturally.

I know that this is just the tip of the iceberg when it comes  to questions about egg freezing , but these are the basics; maybe we can tackle a few more in another post soon.

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!




Tuesday, August 18, 2015

Repeat IVF cycle - second time lucky ?


Women who are doing their second IVF cycle often find their experience very different from their first IVF cycle. In many ways, the second cycle is a smoother ride as patients know what to expect, and they understand the procedure; plus they have dealt with failure! In effect, this makes them stronger and more resilient from an emotional viewpoint; they are able to cope with the peaks and troughs much better.

By this time, they have also built a strong relationship with the team at the IVF clinic and they find it much easier to connect with them. In most instances, the response in a repeat cycle is better too, as we have a better understanding about how the patients’ body behaves. This helps us tweak the treatment protocol based on our learning from the first treatment cycle for that patient.

However, regardless of whether it’s the 1st cycle or the 5th, the one thing that makes any cycle difficult is the excruciatingly lengthy and much dreaded 2ww. The uncertainty is a definite stress point for the patient, and not knowing whether this will finally be the cycle in which they will get pregnant, can be killing. Despite the fact that we have been doing this for the last 25 years, this wait is as stressful for us as it is for the patient.

Uncertainty that Sears Feelings

The suspense and uncertainty lingers like fog while we simply wait for the HCG results with as much anxiety as our patients do, because we want all our patients to get pregnant. However, despite all the efforts we put into the treatment, there are times when all our hard work and efforts are in vain and the cycle fails. And deep down at the bottom of our hearts we feel that tinge of sadness even though we know that we have done our best and that any other clinic wouldn’t have been able to do any more or better.

Our patients come to us with confidence and trust and most of all – hope. And in one sense, when a cycle fails, it also means we have let our patient down by not being able to give her a baby.  However, we have no option but to pick up the pieces and move on with our lives. The only salve for our wounded feelings is the fact we have peace of mind that we have given our patient the best medical treatment possible; and the best shot at getting pregnant.

Transparent Dealings

In order to achieve this end, we go to great lengths to educate and counsel our patients; even before they come in for a consultation- we do this through our website. During the course of this treatment, we make sure to share documentation and are very open and transparent with communicating progress with our patients. This helps in aligning expectations and our patients are able to deal with some of the uncertainties that are a part and parcel of IVF, in a much better way.

Need help in bouncing back after a failed IVF cycle? 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!

Monday, August 17, 2015

Tick Tock- Has Your Biological Clock Stopped Ticking?




The Biological Clock- Its just 2 little words; but what an impact they can have, based on who you’re saying them to. For instance, a woman who’s in her 20’s will simply smile and move on. Of course, if she is highly career minded, she will probably start giving egg freezing a thought. A woman who’s in her early 30’s might just feel a tinge of fear, but the more obvious feeling may be one of irritation- she just doesn’t want to be  reminded  of the obvious now, does she?

But any woman who’s in her late 30’s will surely have a certain amount of respect  for the stark reality that their Biological Clock presents them with- that’s because it really isn’t a myth. The fact is that for a woman in her 40’s, fertility can seem like an unscalable mountain.

Fertility in Your late 30’s: How the Biological Clock Affects it

Of course there are quite a few 40+ women who conceive naturally (without any specific infertility treatment), but this is not the norm. As a matter of fact, most of the pregnancies that occur in women over 40 are accidental ones which occur in women who have had babies in the past (they must have grown lax with their contraceptive methods) as they presumed that their biological clock had stopped ticking. Your biological clock doesn’t seize up and stop ticking the minute you cross 35, but there is a definite decline in fertility at that age.

Is There a Solution?

There are certain things that can be done to increase your chances of conceiving after 35:

Map your Cycle- If you haven’t done it already, start mapping your cycle. This will help you establish the days you are ovulating. Apart from rudimentary math and conventional tick-marks on the calendar, there are a number of free apps you can use as well. Check out www.myfertilitydiary.com.   It’s important for you to know that sperm stays live for upto 5 days in a woman’s body. Instead of just waiting till you ovulate, begin having sex  for a number of days right up to ovulation. This means there will be plenty of sperm there when your egg gets released

See a Fertility Specialist- Typically, if you have been trying unsuccessfully to have a baby, this is one of the first things you should be doing. The IVF doctor will do a work-up to ensure that neither you nor your partner have any issues that could make natural conception a challenge.

Remember that the sooner we identify issues like low sperm count/poor motility, endometriosis or PCOS, the easier it will be for you to make the right choices about your plan of action.

Understand More about IVF Success Rates- Conduct a certain amount of research on the different reproductive technologies and their success rates as well as various other statistics related to IVF. This will also help you choose the best clinic and will help you make more sense of exactly which IVF treatment will be more  effective  in your case (based on your age as well as fertility diagnosis).  IVF is quite a complex procedure, can be emotionally stressful as well as financially demanding (since insurance plans don’t cover it).

Consider the Donor Eggs Option- Its natural for you to want to use your own eggs, but you should also read up on and understand how the donor eggs procedure works. The fact  to keep  in mind here is that women who opt to use donor eggs will have the same IVF success rate as that of the egg donor. It means that if you are 42 years old and choose to use eggs which have been donated by a 25-year-old woman, your success rate will be as high as a 25-year old – which means we can actually reverse the clock , if you are comfortable with this option.

If you are above the age of 40 and feel that your biological clock is running slowly, please don’t delay in getting a medical opinion.

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!


Sunday, August 16, 2015

Non-IVF Fertility Treatments


  
The minute people hear the term Infertility Treatment, the only thing that comes to their mind is In Vitro Fertilization (IVF) and the seemingly interminable hormone injections. Of course, there’s a good reason for this. Over the last 10 years, IVF has emerged as the ultimate treatment for people facing infertility issues. Technology has also advanced at super fast speed and today IVF success rates are in the 50-55% range in women under 35.  It’s also possible to do genetic testing of embryos using PGD; and even inject only 1 sperm into an egg (ICSI) to overcome male infertility issues. Today, IVF has become the last resort for a number of infertile couples. When I have patients walking into my consulting room, I sometimes see frustration and despair (especially in patients who have come in for a second or third opinion.

But contrastingly, I also sense hope. They  come to us  hoping for a miracle- we don’t promise them any, but we definitely leave no stone unturned in  diagnosing what the root   cause of their infertility is, and then treating it to the best of our ability, using the latest technology. In some cases, IVF becomes the only option for couples to conceive, but in a number of cases there are a range of options that work for patients, instead of IVF.

Take a look at what the non-IVF treatment options for infertility are:

·         Basic tests - We do lab work as well as imaging studies to look for anatomical or hormone factors. At times, we find that a patient has hormone imbalance and we correct it with medication; this may help the patient conceive without any other intervention/treatment. For example, a thyroid condition that hasn’t been diagnosed (and which can affect ovulation). Similarly, if we find an anatomical issue, such as a polyp, it’s possible to remove it. Once the uterus is in a better shape to support a pregnancy, it may just be possible for the patient to conceive naturally.

·         HSG (X-ray of the Uterus) - An HSG is a very routine X- Ray procedure that we do to examine the fallopian tubes and the uterus. We do this to check for any possible obstructions that may be preventing the patient’s egg from reaching the uterus. In this procedure, a catheter is inserted into the uterus and dye injected through the fallopian tubes. It may clear out any obstructions that may be caused by debris or mucus.

Even if this isn’t the answer, we may discuss some other conservative treatment options with the patient. If everything is normal, we may recommend a closely –monitored natural cycle. Many people lead very busy lives nowadays and are unable to conceive on their own because they miss having sex during their fertility window.

·    Clomiphene Citrate (Clomid) - In cases where ovulation isn’t taking place naturally, medication might just help. Clomid is a very effective medication that can help 70 to 80 percent of women with PCOD to ovulate. It’s a pill that has to be taken once daily for around 5 days. By taking this medication as well as monitoring that cycle very closely via lab work and ultrasound, and getting the couple to time intercourse right, the chances of a pregnancy are about 10% per cycle.

·         Intrauterine Insemination (IUI) - In order to up the odds for conception via medication and close monitoring, we may sometimes use IUI instead of telling the couple to have intercourse. This is a very quick procedure that can be performed at our clinic. Once it has been determined that you are ovulating/ are near ovulation, we will schedule the IUI. The sperm sample from your partner can then be collected at home or at the clinic.  The semen sample will be “washed” (which increases motility), and the semen will then be placed in the uterus with the use of a flexible, thin catheter. The procedure takes only 30-minutes and we may advice you to have intercourse on that day or the following one to further improve the odds of conception.

Infertility can take a very heavy toll physically, emotionally as well as financially; but with so many different treatment options available, the chances of successful conception are greatly increased.

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, August 15, 2015

The Tale of my Ectopic Pregnancy


This is a guest post from a patient. I am very impressed by how well organised she is. It's because she did so much homework and research, that she could manage her own ectopic pregnancy ( with some help from her doctors !) She remained in control of her illness, and her life. This is my model of an expert patient, and doctors need to learn to respect their patients, and to partner with them, if they want to make the most of them.

I took my first HCG test 12 days after embryo transfer by Dr. Malpani.  I was traveling for work and was at Jamshedpur for the first HCG test.  The diagnostic facility in Jamshedpur is small and because of an unexpected curfew, I do not get my results until 5 days later.  I was so excited to get my first positive pregnancy test at the age of 44.  I took another HCG test a week later in Delhi and the value had risen well.  A week later when I travelled to Hyderabad, I had severe stomach ache and vomiting and started bleeding a little bit which prompted me to get an ultrasound scan immediately.  The HCG had again risen well but the uterus did not show any pregnancy sac inside the uterus.  Dr. N who did the ultrasound told me that the embryos were taking a long time to implant and I needed to take a week’s rest and then return for another scan.  However when Dr. Malpani heard about the result of the scan he suspected an ectopic pregnancy and urged me to take another ultrasound immediately. 

The next day I went to a reputed diagnostic facility in Hyderabad and the scan showed an empty uterus and an unknown mass near the right ovary.  Dr. Malpani immediately referred me to his colleague in Hyderabad Dr. D who is very well known and an experienced fertility doctor.  Dr. D was kind enough to see me right away and after taking another scan was clearly able to see, confirm and measure the ectopic pregnancy.  She called Dr. Malpani and they discussed next steps.  She was very worried and wanted me to do a laparoscopy immediately to remove the ectopic pregnancy.  As the yolk sac and fetal node were very clearly seen she did not feel that any other options were available to me.  Since the measurement of the ectopic pregnancy was not bursting size yet and would not be for a few more days, Dr. Malpani wanted to take the more conservative route which involved giving me a methotrexate injection instead, to kill the pregnancy. It was a Saturday and Dr. D was going to be away for the weekend so she referred me to Dr. P who is part of a big multi-specialty hospital in Hyderabad.  Dr. P and her assistant Dr. G looked at my ectopic diagnosis and insisted I get admitted into the hospital from Saturday evening until Monday morning. 

Looking at the worried and serious faces of Dr. D, Dr. P and Dr. G, I started getting a bit panicky.  They looked at me like I was fragile and likely to collapse any second.  Dr. P would not examine me as she said the ectopic might burst if she touched my stomach and also suggested I get a laparoscopy immediately.  The severe stomach pain and vomiting returned that day.  Dr. Malpani was calm and on the phone explained to me that the severe pain and vomiting was most probably food poisoning and that the ectopic was not large enough to burst and I should get the methotrexate injection.  When I told Dr. G about the severe pain she said I should get a laparoscopy immediately, but when I checked with her about the size of the ectopic she confirmed that it was not large enough to burst.   I asked for the methotrexate injection and not the laparoscopy and was given the injection. I stayed overnight in the hospital and realized that I was fine the next morning and got myself discharged on Sunday.

The next few days I talked to Dr. Malpani on the phone or e-mailed him regularly and while the tenderness and soreness in my stomach had gone up I wasn’t having any other pain.  Three days after the first methotrexate injection, the HCG levels had gone up again but hadn’t doubled this time which gave me some hope.  Dr. Malpani prescribed a second dose of methotrexate injection.  I went to Dr. N (the first doctor I visited for a scan) since her clinic is very close by for the injection.  However when she saw the results of the HCG test she panicked and insisted that I get a laparoscopy immediately.  She made me sign a waiver that I was refusing a laparoscopy and only then gave me another injection.  My mother also started counselling me to go ahead with the laparoscopy.  At this point I wasn’t very sure what was going on with the ectopic mass in the tube, but after a few days of seeing worried expressions on doctors and family’s faces, I packed my overnight bag and asked Dr. Malpani about what symptoms to expect if the tube burst in my stomach.  I monitored my symptoms carefully and reported them to Dr. Malpani daily who also monitored my condition long-distance.

A week after the scan with Dr. D, I went back to her for another scan.  The tenderness and soreness in my stomach had steadily gone up for a week and since the HCG values had also gone up, Dr. Malpani prepared me for the possibility of a laparoscopy.  However the scan showed that the ectopic was resolving and all of us breathed a sigh of relief.  I baked a cake to celebrate.  The next two HCG tests have shown that the value is coming down and the ectopic is since resolving.

I learned a few lessons from this experience.  Different doctors, each with many years of experience, will prescribe different remedies for the same problem.  For my personality, I prefer having options and data.  Also I am able to accept a certain amount of uncertainty, can monitor myself and focus on the data even under stressful circumstances.  With four experienced doctors telling me I needed a laparoscopy immediately it took all my will power and patience to focus on the data and stay calm when I sometimes felt like there was a bomb ticking in my stomach.  I also ask a lot of questions and want information which some of the doctors were reluctant to give.  Having a doctor like Dr. Malpani who was willing to take a conservative approach unless a laparoscopy was unavoidable worked in my favor.  Also Dr. Malpani invested a lot of time in remotely monitoring my condition daily, answered my questions, focused on the data and kept a cool head throughout. The other doctors I consulted with in these past two weeks would have much preferred getting a laparoscopy done immediately and knowing for sure that the problem was taken care of rather than waiting for a week for it to get resolved.  I am however very happy that I didn’t have to get an invasive laparoscopy done.  I am also very impressed with Dr. Malpani’ s ability to remotely diagnose a problem, prescribe an appropriate solution and monitor my condition until it was resolved.  The moral of the story is to choose a doctor who matches your personality, keep your eye on the data, seek opinions from other doctors and choose medical options that make sense to the symptoms you are feeling.

My HCG plot is below with the points where doctors insisted I get a laparoscopy marked in red


If you want to learn more about how to make the diagnosis  of an ectopic pregnancy early, please check out www.hcgexpert.in !


What men need to know about making babies - the guy's guide to fertility



From having sex every day to avoiding donning tight pants, there are a number of misconceptions about what men should do to enhance their fertility. One would think that when it came to sex and having babies, men (and women) would know enough to actually be able to have one easily. But the truth is that a surprising number of couples that walk into our clinic surely know “how” babies are made, but are unsure about a number of other related conception concepts.

And so if  you and your wife or partner are trying  to conceive or even planning to add to your family in the future, it’s important that you know the facts about the manner in which the male reproductive system  functions; many men are also curious to know what their chances of  conception are.

Sperm Production

Unlike women who’re born with all the eggs they will ever have; men produce sperm right through their lifetime. The production of sperm starts in the testes, which is also where testosterone (the male hormone) is produced. The entire process of the production of sperm and maturation takes a little less than 3 months.

Even in fertile, healthy men there is a constant fluctuation in the sperm count and it can fluctuate in the 15 million/ml- 80million/ml range. Since sperm is constantly being produced, in case the man suffers a major illness, it can impact the quality of the sperm negatively. This is also why we typically repeat the semen analysis after 2 months, to confirm its result.  Some of the men whose semen analysis test results show up as abnormal the first time around, may actually find they have normal sperm in the second test.

Don’t Worry About Having Sex

Many couples are under the  impression that making love everyday will reduce the man’s sperm count, while others are more focused on having sex only when the wife is ovulating. In many cases, this can actually act against your efforts  of conceiving; it’s not uncommon for  couples  to miss  the very important fertile window if they  have sex only when  they think the woman is ovulating.

The best time to conceive is before ovulation – what is called the fertile time.  You can calculate this using the free fertility calculator at www.myfertiletime.in or downloading our free MyFertilityDiary android app at www.myfertilitydiary.com

Since sperm is able to survive in the woman’s fallopian tubes for a duration of  48- 72 hours, we recommend that  you have sex as frequently as you like and enjoy making a baby  in your bedroom. Of course, you  can pay extra attention to those few days before ovulation as it will increase your  chances  of conception.

Lifestyle and Health- Both of Them Matter

Reduce Alcohol Intake- While there is nothing  to prove that moderate alcohol  consumption has an adverse effect on sperm quality, excessive alcohol consumption can have long-term effects such as reduced libido, erectile dysfunction or even subnormal sperm production. Just as with most other things in life, moderation is important in this too

Quit smoking- There are a number of studies which suggest that smoking has a negative impact on sperm production, morphology (shape) and motility (ability to swim).  If  you are a smoker and a heavy one at that, it’s best  to quit; it will do wonders  for your  fertility and your health will thank you for it too

Recreational Drugs- It goes without saying that you should avoid steroids and recreational drugs. Certain drugs like marijuana can impact sperm motility and density; it can also increase abnormal sperm count. Cocaine can impact erectile function as it suppresses the production of testosterone and causes impotence. So if you’re a recreational user, you need to stop right away.

Please don’t worry about stuff like the length of your penis or sexual problems such as premature ejaculation. These do not affect your fertility !

Many men also worry that if their semen is “thin”, this means it’s not strong. This is a misconception, because semen is meant to liquefy, so that the sperm can swim into the cervix !

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, August 14, 2015

What can you learn from your IVF cycle ?




For most patients, IVF is primarily a treatment that can help them have a baby. After all, the goal of IVF is a successful pregnancy, and when the IVF treatment results in a baby, everyone is happy. However, it’s important to keep in mind that there is a lot of uncertainty attached to it , and the outcome can swing either ways.

The other aspect is that even if an IVF cycle doesn’t result in a baby, it can give us invaluable diagnostic and prognostic medical information; this is something we would never be able to otherwise get.

Unexplained Infertility

And so, when we label a couple as having unexplained infertility , the reason we call it that is because we neither have the technology nor tools to be able to determine why the patient isn’t getting pregnant in her bedroom. If we do IVF for this couple, we might find that they have total fertilization failure; that the man’s sperm are not able to fertilize her eggs, despite the fact that:

His semen analysis report are completely normal
Sperm count is normal
Morphology and motility are also normal

In simple words it means that it was just because we did IVF that we were able to conclude that the “unexplained infertility” was in fact male fertility caused by sperm dysfunction. This condition can successfully be treated by doing ICSI. The point I’m trying to make here that we would never have been able to make this diagnosis had we not done IVF.

An Example

What’s even more important is that every IVF cycle gives us specific and useful prognostic information. Let’s look at another example. Every 38-year-old woman knows that her chances of getting pregnant are far less than those of a woman who is 25 years of age. Despite this, she wants a much more precise estimate and may ask- “Doctor, are my chances 5% or 25%?” Now, this can be an extremely difficult question for us to answer for an individual patient.

More Clarity in Prognosis

While we can test her AMH level and her antral follicle count (both allow us to estimate her ovarian reserve), we will never know how good her ovarian response will be until we actually start her IVF treatment and superovulate her. We have seen women with a low AMH level get pregnant – and those with a normal AMH level who grow poor quality eggs.

After all, these tests all have their own limitations when applied to individual patients. However, once we have done an IVF cycle, we have much more data based on which we can counsel her more intelligently. We can see:

How many eggs she grows
What the quality of the eggs is
Quality of the embryos her eggs form

More than a Treatment

Based on this information, even if her IVF cycle isn’t successful, we can confidently advice her whether another IVF cycle with her own eggs will be worth the effort, or whether using donor eggs might be a better option for her.

This is why it’s important for patients to understand that IVF is much more than just a treatment – it’s a great diagnostic and prognostic tool as well, which gives us information we can never get from any other test available today.

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, August 13, 2015

Gear Up and Get Rid of IVF Fear




Do you dread attempting IVF, despite knowing that it is the one treatment that maximizes your chances of having a baby? It’s quite likely your major fear (which is completely normal) is that IVF does not have a 100% success rate. Your worry is that even after spending all that money, time and effort, you may end up with nothing to show for it. It’s this aspect that renders patients into a state of inactivity.

You’re emotionally vulnerable, and the possibility that even the most advanced medical treatment may not actually give you the baby you want so badly, can give you sleepless nights and nightmares. Just as most people are unable to confront their own mortality, most couples simply shut out the thought that they may have to remain childless for the rest of their lives.

When Emotions Get in the Way

This worsens the problem; when you let emotions get in the way, you’re unable to think straight and make the right decisions. This impasse is often exacerbated by the fact that your spouse may not agree as to which treatment option is best for you. There are times when the husband might be open to adoption, while the wife will simply refuse to even consider it. Her concern may be that her family might not accept the adopted child.

The fact is that men tend to look for short-cuts, and overlook the underlying complexity of emotions and issues of the situation. On the other hand, women are more tuned to take a long-term perspective and weigh the pros and cons in a more level-headed manner. In addition, the social pressures that infertile couples are subjected to, tend to make matters worse. Different people tell you different things and at the end of it all, you just aren’t sure about who you can trust.

The Best Solution

In such a situation, the best solution is to move forward and take action; but it’s not something you should be doing in a hurry. You will have to carefully explore all your options and make a well-informed decision. What it also means is that you will have to do your homework and be realistic in your expectations about any treatment. The only thing in your hands is to follow the proper process. This way, regardless of whether you get pregnant or not, you will at least have peace of mind that you tried your best.

The problem is that in most instances, infertile couples are so fraught with stress and distress that the default action is to do nothing at all. Very frankly, this is the worst thing to do. It’s important that you listen to your heart as well as your head, and follow a very logical systematic framework. Make a detailed list of all the options before you and then methodically work your way through that list and look for an option that suits your circumstances the best.

The Impact

Being infertile is an extremely emotional experience. It affects your self-esteem, and makes you feel bad about yourself. It shakes you up as well as your faith in God and causes a drift between couples too. Infertility can draw a very heavy price from those who suffer from it.

On the other hand, if you think of it as a challenge and learn to overcome this, the strength which you can derive from this battle can be a very healing experience. Infertility can teach a lot of life lessons – it’s up to you to decide which lessons you want to learn!

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!




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