Monday, December 28, 2015

The power of a good IVF doctor !


IVF doctors tend to underestimate the power which they have. The truth is that they have an enormous ability to help their patients and create a positive impact in their life, by helping them to have a deeply loved child. This is why IVF specialists command so much respect - people understand how much good they do.

The problem is that today's IVF doctors think of themselves primarily as being intellectual scientists, whose job is to order the right tests, make the right diagnosis, and provide the right treatment. However, in reality this is a very small part of what we do to help our patients get better - our important tasks are far more intangible , and we need to use our heart much more than our heads to do them well !

We can be the bedrock of support whom the patient can fall back on when she is going through a rough patch in her life - someone she can trust and depend on during her darkest hours. The way we talk, the way we smile, the way we hold our patient's hands, and the way we connect with her has a far greater impact on the patient's life than just providing the right diagnosis or the right treatment.

This is something which we underestimate. During times of crisis - and every IVF cycle can be filled with stress and loneliness and angst, a patient needs to know that there is someone she can depend on - someone who know her, cares for her - someone who will provide her a shoulder to cry on, and provide a human connection. This is the kind of support which a doctor is privileged to be able to provide, and we need to understand the significance of this role which we can play in our patient's lives, which far outweighs anything we can do as regards diagnosis and treatment.

We are far more than technicians , and while we cannot always give all our patients a baby, we can always provide support and succour! We are blessed to be in this privileged position, where we are privy to another human's innermost fears and desires - let's learn to wield this power with care and compassion

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




Doctors tend to underestimate the power which they have. The truth is that they have an enormous ability to help their patients and create a positive impact in their life, which is why they used to command so much respect. The problem is that today's doctors think of themselves primarily as being intellectual scientists, whose job is to order the right tests, make the right diagnosis, and provide the right treatment. However, in reality this is a very small part of what we do to help our patients get better - our important tasks are far more intangible , and we need to use our heart much more than our heads to do them well ! We can be the bedrock of support whom the patient can fall back on when she is going through a rough patch in her life - someone she can trust and depend on during her darkest hours. The way we talk, the way we smile, the way we hold our patient's hands, and the way we connect with her has a far greater impact on the patient's life than just providing the right diagnosis or the right treatment. This is something which we underestimate. During times of crisis - and every illness can be filled with stress and loneliness and angst, a patient needs to know that there is someone she can depend on - someone who know her, cares for her, and will hold her hand during her darkest moments - someone who will provide her a shoulder to cry on, and a human connection. This is the kind of support which a doctor is privileged to be able to provide, and we need to understand the significance of this role which we can play in our patient's lives, which far outweighs anything we can do as regards diagnosis and treatment. We are far more than technicians , and while we cannot always cure our patients, we can always provide support and succour! We are blessed to be in this privileged position, where we are privy to another human's innermost fears and desires - let's learn to wield this power with care and compassion

Read more at: http://www.docplexus.in/articles/513ed59a-dade-4aec-a249-e86e34bc69d6/the-power-of-the-doctor
Copyright 2015 © Docplexus Online Services Pvt Ltd

Sunday, December 27, 2015

All IVF doctors are not the same !


Patients naively believe that all IVF doctors have similar skill sets, but the truth is that some are much better than others. Not only are some IVF specialists much more successful, they are able to connect better with their patients, and are often better diagnosticians as well. What differentiates a great IVF doctor from a good one ? What makes a doctor the doctor's doctor - the consultant everyone refers to when they are stuck?

This requires a combination of three different areas; the head, the heart and the gut. As far as the head goes, most doctors have an adequate medical knowledge base. I am assuming that good  doctors are well read, well informed and up to date ( sadly, this is not always true) . What makes the great doctor different is that he doesn't rely on only his analytical skills -  he is willing to think out of the box, especially when he comes across a patient with a rare problem - for example, total fertilisation failure after ICSI. He is better at diagnosing rare problems, because he thinks creatively, so that he picks up clues which other doctors miss. He is curious and always willing to learn. As a result of this, he gets better every year because his expertise grows along with his clinical experience. He has a lot more tacit knowledge which he can tap into every time he sees someone with a difficult problem. That is why he is the doctor who other doctors will refer their patients to when they are stumped.

The great doctor has a gut feel - an instinct, an ability to know that something doesn't seem right even though all the test results, labs and scanned images seem fine. This is the sixth sense which comes with a lifetime of experience, and that is why the great doctor is revered and respected. He is willing to trust his intuition because he knows his unconscious will provide him with useful signals.

Finally, the great doctor also has a heart. He's willing to connect with his patients emotionally and provide them with compassionate support so that even if he can't cure them, he can always hold their hand and support them in their time of need.

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




All physicians have similar skill sets, but we all know that some are much better than others. Not only are they much more successful, they are able to connect better with their patients, and are often better diagnosticians as well. What differentiates a good physician from a great physician? What makes a doctor the doctor's doctor - the consultant everyone refers to when they are stuck? This requires a combination of three different areas; the head, the heart and the gut. As far as the head goes, most physicians have an adequate medical knowledge base. I am assuming that good physicians are well read, well informed and up to date. What makes the great physician different is that he doesn't use only his analytical skills to think about diagnostic possibilities. He's willing to think out of the box, especially when he comes across a patient with complex problems. He is better at diagnosing rare problems, because he thinks creatively, so that he picks up clues which other doctors miss. He is curious and always willing to learn. As a result of this, he gets better every year because his expertise grows along with his clinical experience. He has a lot more tacit knowledge which he can tap into every time he sees someone with a difficult problem. That is why he is the doctor who other doctors will refer their patients to when they are stumped. The great physician has a gut feel - an instinct, an ability to know that something doesn't seem right even though all the test results, labs and scanned images seem fine. This is the sixth sense which comes with a lifetime of experience, and that is why the great physician is revered and respected. He is willing to trust his intuition because he knows his unconscious will provide him with useful signals. Finally, the great doctor also has a heart. He's willing to connect with his patients emotionally and provide them with compassionate support so that even if he can't cure them, he can always hold their hand and support them in their time of need.

Read more at: http://www.docplexus.in/articles/644c3dca-8205-42e2-8b71-ad74e95173c8/the-difference-between-a-good-and-a-great-doctor
Copyright 2015 © Docplexus Online Services Pvt Ltd
All physicians have similar skill sets, but we all know that some are much better than others. Not only are they much more successful, they are able to connect better with their patients, and are often better diagnosticians as well. What differentiates a good physician from a great physician? What makes a doctor the doctor's doctor - the consultant everyone refers to when they are stuck? This requires a combination of three different areas; the head, the heart and the gut. As far as the head goes, most physicians have an adequate medical knowledge base. I am assuming that good physicians are well read, well informed and up to date. What makes the great physician different is that he doesn't use only his analytical skills to think about diagnostic possibilities. He's willing to think out of the box, especially when he comes across a patient with complex problems. He is better at diagnosing rare problems, because he thinks creatively, so that he picks up clues which other doctors miss. He is curious and always willing to learn. As a result of this, he gets better every year because his expertise grows along with his clinical experience. He has a lot more tacit knowledge which he can tap into every time he sees someone with a difficult problem. That is why he is the doctor who other doctors will refer their patients to when they are stumped. The great physician has a gut feel - an instinct, an ability to know that something doesn't seem right even though all the test results, labs and scanned images seem fine. This is the sixth sense which comes with a lifetime of experience, and that is why the great physician is revered and respected. He is willing to trust his intuition because he knows his unconscious will provide him with useful signals. Finally, the great doctor also has a heart. He's willing to connect with his patients emotionally and provide them with compassionate support so that even if he can't cure them, he can always hold their hand and support them in their time of need.

Read more at: http://www.docplexus.in/articles/644c3dca-8205-42e2-8b71-ad74e95173c8/the-difference-between-a-good-and-a-great-doctor
Copyright 2015 © Docplexus Online Services Pvt Ltd
All physicians have similar skill sets, but we all know that some are much better than others. Not only are they much more successful, they are able to connect better with their patients, and are often better diagnosticians as well. What differentiates a good physician from a great physician? What makes a doctor the doctor's doctor - the consultant everyone refers to when they are stuck? This requires a combination of three different areas; the head, the heart and the gut. As far as the head goes, most physicians have an adequate medical knowledge base. I am assuming that good physicians are well read, well informed and up to date. What makes the great physician different is that he doesn't use only his analytical skills to think about diagnostic possibilities. He's willing to think out of the box, especially when he comes across a patient with complex problems. He is better at diagnosing rare problems, because he thinks creatively, so that he picks up clues which other doctors miss. He is curious and always willing to learn. As a result of this, he gets better every year because his expertise grows along with his clinical experience. He has a lot more tacit knowledge which he can tap into every time he sees someone with a difficult problem. That is why he is the doctor who other doctors will refer their patients to when they are stumped. The great physician has a gut feel - an instinct, an ability to know that something doesn't seem right even though all the test results, labs and scanned images seem fine. This is the sixth sense which comes with a lifetime of experience, and that is why the great physician is revered and respected. He is willing to trust his intuition because he knows his unconscious will provide him with useful signals. Finally, the great doctor also has a heart. He's willing to connect with his patients emotionally and provide them with compassionate support so that even if he can't cure them, he can always hold their hand and support them in their time of need.

Read more at: http://www.docplexus.in/articles/644c3dca-8205-42e2-8b71-ad74e95173c8/the-difference-between-a-good-and-a-great-doctor
Copyright 2015 © Docplexus Online Services Pvt Ltd

Saturday, December 26, 2015

I'll be speaking on digital health in Ahmedabad at HITCon 2016

HITCon 2016, organised by Management Medicos , is a first of its kind healthcare technology event for doctors and by doctors.

Doctors can  register at https://www.plexusmd.com/event/hitcon2016

Friday, December 25, 2015

Why did my IVF cycle fail ?


A patient just sent me an email and said, "I've had three failed attempts of IVF, but the doctor didn't give me any reason for the failure. In fact, he said 'No one can give you a reason for the failure.' Is that true? Is it true that IVF failure has no reason and that science can't tell us why IVF cycles fail?"

What was the reason for IVF failure ? This is a simple question, but one which has a complicated answer. The truth is that sometimes we can answer this question, and sometimes we can't.

Thus, if we can see the embryo quality is poor, then we can say the IVF cycle failed because the embryo was not able to implant. This is why getting photos of your embryos is so important. We can then drill down further, to do a root cause analysis, to determine why the embryo quality was poor. This could perhaps be because of poor lab conditions ; or a suboptimal super ovulation protocol .  Of course, this would just be a hypothesis, and we would then have to do another IVF cycle after correcting for this, to see if the answer was right.

However, when the embryo is a perfect blastocyst ; the endometrium is 8 mm and trilaminar, and the transfer was smooth, then once we have transferred the embryos into the uterine cavity, we can no longer determine why they don't implant. Both patients and doctors need to understand the limitations of IVF technology, so they can ask intelligent questions, and we can provide accurate answers.

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





Thursday, December 24, 2015

Alternative medicine in IVF


When patients come to me for IVF treatment , I often encourage them to use alternative medicine such as acupuncture, yoga and meditation. There is no medical proof that any of these things help , but I also think that these are treatment options which have little downside.

If patients find the right alternative medicine doctor, they can actually be quite happy with their treatment experience, even if this doesn't increase the pregnancy rate. The reason for this is that a lot of alternative medicine is very hands-on, and because these doctors are so good at touching the patient, they provide a lot of comfort and reassurance which can be very valuable for IVF patients , many of whom are very anxious , and find it difficult to cope with the stress of IVF treatment.

The trouble with IVF specialists is that we're so focused on the medical technical minutiae , that we spend most of our time either poking or prodding our patients; or doing blood tests and scans and procedures. We pride ourselves on our technical skills, and we often lose sight of the fact that IVF patients need a lot of emotional support, counselling, hand-holding and reassurance. This is something that alternative medicine practitioners do a far better job than most IVF doctors do, which is why they can play such a valuable complementary role.

At the end of the day, it's not important what works or why, as long as the patient get pregnant !


Need help in getting pregnant ? 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, December 23, 2015

Why the diagnosis does not matter for IVF patients


I did an interesting consultation today. The patient was a neurologist herself, and her first question was, "I want to know why I'm not getting pregnant. Please tell me what my diagnosis is." She'd already failed 3 IVF cycles and was desperately looking for answers.

I feel that the quality of my answer depends on the quality of the patient's question and I explained to her that this was a poor quality question . At the end of the day, we don't want to go looking  for problems - we want to find solutions ! Our focus in our clinic is on getting our patients pregnant and giving them a baby , rather than trying to find out exactly what the problem is. This is something which is better done in research clinics ! The job of an IVF clinic is to help patients to complete their family.

She was extremely unhappy and dissatisfied with my answer because she felt I wasn't being scientific at all. Her belief was that the rational practise of medicine required that we first establish a diagnosis, so we can find out what the problem is, and then go ahead and treat it.

I can understand why this is the way a neurologist would practise medicine, but this is not the right approach for IVF clinics.  This may not be very intuitive, and it may appear that we are taking shortcuts, but this works very well in clinical practice . Physicians are obsessed with making a diagnosis and assigning patients to the right bucket, because they enjoy thinking analytically and using their cognitive skills. However, this clinical expertise is of limited utility to the IVF patient, and while it may dazzle medical colleagues, it really doesn't help the patient achieve her goal of completing her family. The final common pathway remains the same - IVF; and why bother to establish the exact diagnosis, if this is not going to change the patient's treatment options ? After all, irrespective of whether the actual diagnosis is male factor infertility or unexplained infertility, our treatment options are limited .

Doctors need to learn to be more patient-centric and work backwards . They need to start from the patient's goals, and then help her to reach them , rather than mindlessly use a textbook cookbook style of practising medicine which is not appropriate for the infertile couple. I am not saying that tests don't need to be done - it's just that they should be ordered selectively, and only if they affect the patient's treatment options. There's no point in ordering tests, just because we can !

Our focus is a success based approach, and our technology for identifying problems is still not as good as our ability to bypass problems, so that we can give patients what they want - a baby !

Need help in getting pregnant ? 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, December 22, 2015

Why an IVF patient's personal preferences are so important


Most patients ask me - Doctor , what are my chances of getting pregnant in a IVF cycle?

This is one of those questions which is impossible to answer accurately, because we can't predict what an individual's response is going to be. All we can do is give them our clinic success rate - an average figure which applies to groups of patients.

However, my answer to this question is another question . I ask them - How will this number change your decision about whether or not to go ahead with IVF ?  That's what you need to think about !

There will be some patients who will say - Doctor, even if my chance is more than 1% I'm happy to go ahead ! I know that if I don't do IVF my chances are zero, and I want peace of mind that I gave it my best shot, and didn't leave any stone unturned, so that I have no regrets when I am 45 ! There will be other patients who'll say - If my chances are less than 50% , I don't want to do IVF, because I don't want to subject myself to all those shots and injections and scans, and I don't want to spend all that money.

Each patient will come up with a different answer - one which feels right for them. A doctor cannot read the patient's mind, and this is why listening to the patient's personal preferences is so important in IVF. After all, IVF is elective treatment, which is done to keep the patient happy. This is a uniquely personal perspective , and only the patient can decide what's right for them - not the doctor.

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




Monday, December 21, 2015

Our parenthood dream achieved at Malpani IVF Clinic


Finally after all the years of pain and desperation to have a baby (8yrs), we finally conceived our child. In the most humble way we want to convey our sincere gratitude to Dr. Malpani. My diagnosis was poor ovarian reserve (low amh, high fsh). Before starting our cycle at Dr. Malpani’s clinic, we went through several rounds of treatments in the past both in US and India – 4 clomids, 3 IUIs, laproscopy for checking for endometriosis, 2 failed IVF attempts and 1 failed donor tissue (egg) cycle(I am using “tissue” for a reason, it’s not my term, one of the RE in USA used it and I liked the concept and psychologically it simplifies and is soothing). Post all failed treatments, I completely lost faith -mainly on the doctors, because of the way the whole case was dealt, there was absolutely no compassion, no understanding and it was all money oriented treatment and exploiting patients at the vulnerable moments. Based on all such experiences (both in India and US) and the kind of doctors I came across made me doubt if I could ever believe in a doctor again.

I took a sabbatical from the doctors altogether for 3 yrs. That said, as and when the treatments were failing, my longing for a baby increased exponentially. There was a strong urge to not lose hope that I can have a baby in this life. I would like to share in detail 3 things via this testimonial:
1.    How did I arrive at donor decision?
2.    How did I arrive into Dr. Malpani’s safe hands?
3.    What really went well with my cycle at Dr. Malpani’s clinic

I am providing a very detailed account of my journey just for the sake of the new patients. Hope my journey will make your decisions easier.

How did I arrive at donor decision?

Not having a biological connection with your baby is heart wrenching. When I was given this option few years back, I wanted to scream at the top of my voice. I was devastated knowing that I couldn’t do it myself. Even my first egg sharing experience was not our choice. The doctor utilized the emotional moment and coaxed us into egg sharing and we succumbed to that moment. But after all the emotional turmoil, my longing for a child grew stronger. I started to google to find hope stories and that’s how I came across a remarkable person, Julia Indichova who is the author of the books “The Inconceivable” and “The Fertile Female” and her incredible work “FertileHeart OVUM Tools (Fertileheart.com)”.

After ardently practicing the visualization work with my heart and soul and by participating in Fertile Heart online teleconference sessions & attending the workshop in New York (in person), that were led by Julia Indichova, I realized that this whole fertility and baby journey was indeed a miracle and a blessing and not a curse or a burden. It strengthened my inner voice, allowed me to view myself as the supreme authority, take charge of mine and my not yet born baby’s welfare and develop immense faith and confidence and understand the fact that baby making is a miracle, no matter whichever route it happens – natural or via IVF/donor/adoption/surrogacy.  I understood the fact and bowed down to the current of life and let go of my control that the baby comes on his/her timetable and not mine.

After all the hard work for couple of years, I have naturally arrived at a point where my heart, her majesty clearly provided the guidance to follow my longing and welcome a child into my life no matter how he/she ended up, which is how I chose the donor route as it no longer mattered to me how my child arrived into my world, becoming a MOTHER was of utmost importance to me, while I completely trusted, respected , and ensured I had permission from my body baby to go this route because without its tremendous support I could have never become pregnant in the first place. I have never given up on myself. I still believe I can get pregnant by myself naturally or via ART, but my longing to be a MOM is clearer than having a biological connection with my child. This was definitely not an overnight, hasty decision. The visualization work really allowed the answer to come up on its own accord at physical, mental and emotional planes. My body, mind and soul were in unison about this decision and most importantly I had complete support of my husband. He was a pillar of support to me throughout this whole journey and it just strengthened our bond enormously with no leaps and bounds. And last but not least, we would like to thank the donor wholeheartedly. I pray to GOD to really bless her with health, wealth, and happiness.

I would encourage folks who are struggling on this journey to spend just few minutes of your time to watch this video – http://www.fertileheart.com/about-fertile-heart/fertile-welcome-victim-visionary/

How did I land at Dr. Malpani’s Clinic?

With that preface on the Fertileheart work and its impact, I would like to now focus on how I finally decided to go with Dr. Malpani. The fertileheart work taught me that it was absolutely necessary for us to take reigns into our hands, it’s our life, our baby and so we have vested interest to absolutely ask right questions and gain clarity before we begin the treatment.Once I made a decision to pursue donor route, it was utmost critical for me to find the right, trustworthy doctor.I have my own worse experiences & I have heard so many horror stories online, especially while embarking on donor route where we have no clue who the donor could be, what her background is, we are solely dependent on the doctor who will be making this decision on our behalf and so picking the right doctor was extremely crucial. Also this is pretty costly affair and I have already spent several thousands of dollars on all kinds of treatments in the past, not to forget the mental agony we had to face each time. Hence, this time I was not worried about how long it took to find the right doctor, I was in no hurry. I actually did my doctor research for 4-5months. I picked the most famous doctors from every nook and corner of India. With my rich experience of facing unreliable doctors&fraudulent clinics, I was sending emails to the doctors with similar content and carefully analyzed their responses:

•    How much time did they take to respond; who is corresponding with the patient - main doctor, junior docs or some admin folks?
•    How are they responding, what mode of communication do they prefer? Did they insist on seeing you in person before starting the treatment?
•    Did they ask for additional tests before commencement of the treatment, in spite of providing all the details?  Are they promising any guarantees for success? (I wasn’t expecting anyone to do this)
•    What’s their response on the diagnosis and my age (btn I am 35), are they saying it’s too late and I need to hurry and will be missing the baby bus if I delay further?
•    Do they have valid websites? If yes, what kind of staff do they have, what kind of equipment do they have?
•    what kind of treatment protocols were they following, what kind of information on the treatment did they provide on their websites and in the emails
•    When googled what kind of information I could get on the doctors (both positive and negative)
•    Last but most important of all, the testimonials that were published on their websites, are they detailed enough, did the patients provide their email ids, were the testimonials sharing detailed accounts of patients journey (one can’t make up this part, everyone’s journey is different)?

These were some of the key criteria that I used for my research. And the next step was to start sending out emails to the patients who provided emails ids in the testimonial websites. Actually other than Dr. Malpani’s website, I hardly found other websites where patient email ids were exposed. I have emailed around 10 patients of Dr.Malpani (some of them who went via donor process), guess what?? 8 out of 10 folks emailed me back, re-assuring I was making the best decision of my life. One of the patients was kind enough to email me her kids pictures (who went the donor route). I was so overwhelmed with her response and the faces of her beautiful children just melted my heart. That’s it, it was clear to me that I was going to place myself in the safest hands. There was no looking back.Building the trust was key for this process.

Details of Best in Class Treatment at Dr. Malpani’s clinic

I started my communication with Dr. Malpani and God really bless him, I have no clue how he manages to respond to the emails within just hours. He carefully guided me on what all tests and ultrasounds I had to get done in USA and how to order the medications etc& guided me through every small step with extreme patience to prepare towards my treatment cycle. Here’s what makes Dr. Malpani’s Clinic the best in class fertility clinic:

•    For patients like me who are overseas, all our conversations were via emails. In fact he clearly mentioned that he preferred email communication as that way it’s all documented and the scope for confusion is fairly low. So I directly met him on Day13 of my cycle. Trust me I just don’t think this is a possible with any other doctor.

•    Throughout the whole process, we have exchanged around 300 emails. Thank you so very much Sir for being patient and answering every silly question of mine

•    He always encouraged questions. This really makes him unique compared to other doctors. As most of them never like patients asking questions and don’t bother to answer them. That was the same be it in India or US. At least the doctors I met felt threatened or irritated when I asked them questions.

•    I finally went to Mumbai and stayed there exactly for 10 days. Everything was meticulously planned. The sperm collection box had our details clearly laid out, no chance of mess up. This might seem simple but things like this define the quality of the clinic (this was a huge issue at another famous Chennai IVF clinic where I went earlier).

•    Looks are deceptive, so don’t go with the outside look of the clinic and don’t judge. Clinic was neat, clean, high quality procedures, would say on par with USA standards, I was very surprised, especially based on my previous Chennai experience, which was a huge hospital.

•    Best part of Dr. Malpani when we met him in person was, he just simplifies everything and puts his patients at ease, provides complete clarity on the process. IVF process itself is such a complicated process and all my earlier experiences were pretty horrific, like a rolla-coaster ride. But this time, it was literally like a holiday for us, we spent quality time in Mumbai, free of tension (also because of the Fertileheart work, I learnt nothing was in my control and there is no point fretting over every small thing, so started letting go of controlling ever uncontrollable situation….lol)

•    On the day of transfer, Dr. Sai, embryologist showed us our embryos. It was a beautiful moment. I never saw my embryos earlier. He explained to us about the quality of the embryos. This I felt is a very crucial step and UNIQUE to Dr. Malpani’s clinic for 2 reasons: Firstly, this shows the confidence of the clinic and their exemplary work and secondly, it instantly connects us to the unborn child, triggering lots of psychological effects within the body. (At this juncture, I need to share my horrific experience at Chennai clinic where my ET was done along with another patient on Day2 (Yes you read it correctly), Doctor waited for Rahu Kalam to pass and there was horrific silence by embryologist when I asked how did they ensure that the embryos were not mixed up. 4 embryos were transferred. Same darn equipment was used….unhygienic. Rest you can imagine my plight, thank god that ivf failed)

•    Embryo transfer (ET) procedure was performed in such a sophisticated way on DAY5, using abdominal ultrasound that provides good picture of the uterus and helps to transfer the embryos more accurately. Day 5 transfer again proves the confidence the clinic has in their staff, processes and best in class technology. I have never seen using ultrasound even in US for ET.

•    Dr. Malpani’s bed side manners were just impeccable. He continuously engaged me in a conversation on what all I did in Mumbai for the past week while transferring the embryos and were talking to the embryos to nicely stick with “momma”. It was such a sweet moment. Before we left the clinic, we got pictures of the embryos along with our medical file. Again we never saw this in our 8yrs of experience. This sets the clinic at a totally different level compared to other clinics.

•    Dr. Malpani is very open and frank. He clearly mentioned no need of any kind of bed rest post ET (whereas for my last failed ivf in Chennai, I was put on very strict bed rest, not even allowed to change from side to side, it was so much torturous, they made us stay in their hospital for  15 days post transfer. I now realized their fraudulent act, too late but at least this info might help you guys who are reading this testimonial). In fact I travelled back to US 3 days after ET.

•    Another thing that I greatly appreciated was that he clearly said that he and his team have the best expertise, state of art, best in class equipment but post embryo transfer its all left to nature as no one till date have exact answer on what happens during implantation and didn’t guarantee the result but asked to maintain positive attitude, at the same time not to blame myself for failure, if at all it fails. And if at all the cycle fails, we are first to blame ourself – Oh maybe I shouldn’t have travelled, taken bed rest, oops I sneezed, coughed. He clearly said the embryos cannot be touched by any external force and are safe in uterus and will not be impacted any of our gestures.I really was amazed at his frankness. Most of the patients might not like to hear it, but that’s truth. He did all he can to his best ability. No wonder baby making is a miracle, else all of us could have our babies using IVF without issues. That’s where I strongly feel GOD comes into play to prove his magic.

•    Even though I am not in Mumbai and successfully got into my 2nd trimester, till date if I have any questions, Dr. Malpani always answers them promptly. Even my US Obgyn keeps asking me to check with him for any questions !

•    Lastly, he has excellent source of information on his website. It’s like a mini library and the blogs he writes, especially encouraging folks to do the homework, ask questions, importance of meditation, encourages alternate medicine and patients to make their own decision etc just shows his impeccable, compassionate human being and that is what makes him BEST doctor

•    Lastly, I just have one complaint SIR, when all the work that you are doing is so FERTILE, why do you call your clinic as “Infertility Clinic”? Please change the name to Dr. Malpani Fertility Clinic Sir !!

Finally my conclusion, you are in best and safe hands if you plan to go with Dr. Malpani. I sincerely thank GOD for making me arrive at the right clinic finally after all these years. And thank you Sir for your all your expertise and finally introducing me and my husband to our long desired path of parenthood!

If I can be of any help to any of the patients, please feel free to send me an email to smymalladi@gmail.com

Saturday, December 19, 2015

Beautiful embryos


A perfect IVF cycle ! Seeing such beautiful embryos gladdens my heart !

IVF success story at Malpani Infertility Clinic

As I am holding my baby twins, it still seems like a miracle to me.  I know this phrase is a cliché, and my husband and I tend to be very rational, but there is truly no other way of describing what we experienced.  We started trying to have children in our mid-thirties.  By the time we met Dr. Malpani, we were in our mid-forties and we were pretty much resigned to the fact that we would not have children.  We had some very taxing years behind us.  We first tried several rounds of IUIs and then IVF.  I got pregnant, but miscarried the twins.  We were devastated by this loss.  Despite all kinds of testing, our infertility was never explained, although we suspected that maternal age was the most likely issue.

We then decided to adopt.  We spent several years on call, reviewing adoption files, slowly moving up the wait list and hoping every time that we would be chosen and possibly have a child within the next few weeks. We were matched twice, and twice, the adoptions fell through at the last minute.  Then, the agency we had worked with for several years, closed down from one day to the next.  It was the second agency we had worked with that closed. We were truly heartbroken.  And we started thinking that maybe it wasn’t meant to be for us to become parents.

After taking a break, we decided to start over and contacted an adoption lawyer.  We were in the process of redoing our homestudy, when we spent some time in Mumbai to visit family.  Almost every day, I went for a run in the Port Trust Gardens and on my way there began noticing the sign for Dr. Malpani’s clinic.  After a while I decided to look him up online.  I liked the way he made all the information easily accessible.  My husband was skeptical as we had been down that road before and it had been difficult.  But in the end, we felt we had nothing to lose and made an appointment.  We both immediately liked Dr. Malpani.  He listened carefully to us.  And he was reassuring without making any false promises.  He suggested that we try IVF with an egg-donor.  We had considered this option yearsearlier, but then had decided to pursue an adoption instead.  Egg donation seemed too “sci-fi” for us.  We were also worried about how our family would feel about it and how the child would feel about it as an adult.  By the time, we met Dr. Malpani, we had experienced adoption as a very arduous process with uncertain outcomes.  We liked the idea that at least my husband would be able to see himself in the children.  My gynecologist back home told me that in her experience donor-egg-IVF had about a 40% success rate.  And it was encouraging to me when Dr. Malpani pointed out that maternal age doesn’t affect the uterus as much as the eggs.  He was joking that with my uterus I could have children well into my sixties.

I will never forget the day of the embryo transfer.  Dr. Malpani asked everyone in the operating theater to pray and we all fell silent.  What I had previously experienced as a very technical procedure turned out to be a beautiful moment that was full of awe for the miracle of life.  Dr. Malpani and his team were all very encouraging and caring.  It meant a lot to us after what we had been through.  Dr. Malpani told me that all activities were fine and emphasized that things were not really in my control at this point.  It was good to hear this as I had driven myself crazy after my miscarriage over what I could have done differently.  After we left Mumbai, we were very careful not to get our hopes up too much and distracted ourselves the best we could.  The night before my gynecologist appointment to determine whether I was pregnant, I decided to take a home test.  I hadn’t told my husband, so when I saw the pink line, I started screaming.  He came running and we both cried and laughed at the same time.  We were overjoyed, when a little later the ultrasound revealed not only one, but two robust heartbeats.  

I had a wonderful and healthy pregnancy.  I had been resigned to the fact that I was never going to be pregnant.  I am so grateful that I was able to experience how my body transformed and how my children developed inside me. After seven weeks I suddenly had bleeding and rushed to the hospital.  Fortunately, it stopped and everything turned out to be fine.  When I e-mailed Dr. Malpani, he was very reassuring and mentioned that bleeding like this is very common in IVF pregnancies.  Dr. Malpani always answered our queries within a few hours and generally was very available.  We felt that we could ask him anything, even the most trivial questions.  He was always very patient and never condescending.  He deeply cares that his patients make informed decisions and he will go out of his way to make sure that they have access to all the information that they need to know.  We never felt like he was talking us into something or selling us something.  He always made sure that we were comfortable and knew exactly what we were getting into.  He also has a great sense of humor, which made the process less intimidating and easier for us.  And he is someone who has a strong intellectual interest in the matter and deeply cares about the people he works with.  Given our past experiences with reproductive technology, which is a big business in the US as well as in India, this was very refreshing.

If I hadn’t been running again and again past his clinic, all of this wouldn’t have happened.  We are still in disbelief that it turned out to be so easy in comparison to what we had been through.After all the research we did, after all the things we tried, after all the losses and the heartache that we experienced, it was pure serendipity that led us to Dr. Malpani.






Friday, December 18, 2015

The well organized IVF patient


It's always intrigues me why some patients are so happy with certain doctors, whereas other patients badmouth the same doctors. Maye it's not the doctor who's the problem- maybe it's the patient ?

Some of it is related to the chemistry between the doctor and the patient, and not every doctor is going to be right for every patient. However, a far more important variable is how well organized the patient is.

A well organized patient has taken the time and trouble to prepare a chronological history; organize the medical records; and prepare a one-page summary . He has done his homework , so he can make the best use of the doctor's limited time. We all know that the better the quality of the questions the patient asks, the better the quality of the doctor's answers. Smart patients understand this and will spend energy or preparing themselves for the doctor's consultation.

Doctors treat these patients with respect, which is why these patients often get much better medical care; and are usually happy with their doctors, because they are treated as intelligent adults. Of course, if you want your doctor to respect you, you do need to take a certain amount of effort. You cannot just turn up and the clinic and expect the doctor to treat you like a VIP if you don't bother to prepare for the appointment. Doctors are happy to teach their patients, but they don't want to spoon feed you !

While you cannot always pick and choose how good your doctor is, you  can always make sure that you've done your homework, so you can make the most of your doctor's expertise. This will help you to create a win-win interaction, so you are happy with your doctor - and he is happy with you ! This is something every patient needs to do.

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




Thursday, December 17, 2015

Irrational IVF doctors


A patient just sent me a copy of all the medicines her IVF doctor put her on after her embryo transfer.

No wonder patients get fed up and frustrated with IVF treatment ! This is an excellent example of irrational prescribing - most of the medicines are unnecessary and just waste the poor patient's money.

The only saving grace is that she'll be so busy taking medicines all day long during the 2ww, that she won't have time to worry about the outcome !

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




Coping with Anxiety - A guide for infertile couples


All of us have areas in our life which we worry about . Some of these  worries are rational, while many are emotional. We cannot explain why we have these, and have little control over them. Everyone understands worries are not very constructive , but we continue to worry in spite of ourselves , even though we know it does not help. After all , the head understands that worrying about something will not solve the problem - and it often makes it worse, because when you sit and obsess about it,  it just gets magnified even further. However, it's hard to stop your mind from playing games, and worrying about whether or not they will ever have a baby is a worry which prey's on the minds of many infertile couples.

An additional problem for infertile couples is that there are two people who are involved - and each has a different way of worrying , and a different style of coping with their worries.

Often the husband and the wife worry about completely different things. The husband may be worried about how much money they're going to have spend, while the wife may be worried about whether she will ever be able to experience motherhood.  Because the husband thinks the wife doesn't care about the money , he thinks she is impractical and short-sighted. The wife , on the other hand, feels her husband only cares about money -  that he is unempathetic and isn't bothered about her feelings.

When both the husband and wife worry about the same thing, their worries often feed off each other, until it becomes a negative vicious cycle, where they both start catastrophising, and get paralysed into inactivity. Some marriages will break up , because they cannot handle the anxiety.

On the other hand, when both are mature, they learn to support each other, so they can help the other to put their anxieties in the right perspective. This can help the marriage to become a lot stronger.

Need help in getting pregnant ? 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, December 16, 2015

IVF as a time machine


Most people think of IVF as being a medical technique, which uses assisted reproductive technology to help them to have a baby. However, IVF has a very interesting relationship with time as well.

For some couples, IVF helps them to telescope time. Fertile couples have a 20% chance of having a baby in their bedroom if they try on their own. However, if they use IVF technology, they can bump this up to 60% in one cycle ! This is because IVF allows us to grow multiple eggs in one cycle, which means instead of waiting for just one egg to mature every month, IVF allows us to collapse time , and improve their reproductive efficiency. This allows them to achieve their optimal family size when they're young, so they can enjoy parenting more; and also move on with their life more quickly.

IVF also allows us to pause time . Thus,  an infertile couple can freeze their supernumerary embryos, and come back and use them even after 10 years .Those embryos will still remain young and fresh , because freezing allows us to suspend all their metabolic activity. An IVF lab serves as Prince Charming , and can wake up Sleeping Beauty when she is ready to get up !

Finally, IVF allows us to expand time horizons as well. Thus, if a young woman wants to pursue a career, it's possible for her to freeze her eggs , so we can put her reproductive options on hold. She than has the additional luxury of waiting , until she reaches her desired status in her professional career ; or finds Mr Right, before starting her family, without having to worry about the ominous ticking of her biological clock or her inexorably declining ovarian reserve.


Need help in getting pregnant ? 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, December 15, 2015

IUI versus IVF for patients with unexplained infertility


 Patients with unexplained infertility are not sure whether to do IUI or IVF. Both options are applicable for them, but each of them has their pros and cons, and they're quite confused as to which one is the right one to select. Thus, IUI has a lower pregnancy rate, but is less expensive; with IVF, the pregnancy rate is much higher, but it's more expensive and more stressful because it involves more injections. Patients are often confused , and don't know how to decide.

Now, if they go to a gynecologist, the standard advice  is to do IUI , because gynecologists don't do IVF. If they go to an IVF specialist, often IVF clinics prefer doing an IVF because the pregnancy rate is better, and patients get pregnant more quickly ( and they make more money as well !)

However, this is not a decision which should be made by the doctor. It's a decision which should be made by the patient, and they need to weigh the pros and cons for themselves. Thus, for an older patient, it's perfectly sensible to take a shortcut and go to IVF directly, especially when finances are not a constraint.  However, for younger patients, IUI is a more sensible approach. However ,patients should design a treatment plan, and if they don't get pregnant in 3 IUI cycles, they should be willing to move on to doing IVF.

Sadly, gynecologists keeps on doing IUI after IUI, and refuse to refer the patient to an IVF specialist. Even when the patient changes doctors, the new gynecologist insists on repeating IUI cycles again, because he feels that the earlier doctor didn't do a good job. This kind of mindless repetition wastes a lot of time and money, and patients get fed up and frustrated. After 3 IUI cycles, they have reached the point of diminishing returns, and because the probability of a pregnancy has dropped, IVF is often a more cost effective option, as compared to doing another IUI cycle.

Conversely, we see IVF specialists who are extremely aggressive, and advice IVF straight away, without explaining the IUI option to patients . This is also not a balanced approach, which is why patients need to do their own homework, so they understand the doctor's biases, and can select the treatment which is right for them, given their personal preferences. This involves a lot of intangibles, and there is no easy right answer - one size never fits all in medicine !

IVF is often more cost-effective ( cost per baby)  than multiple IUI cycles, especially when you factor in emotional costs and the passage of time. It's true that some patients would get pregnant if they did more IUI cycles, but the truth is that every IUI cycle exacts an emotional toll , which is why IVF is a better option, because it has a higher success rate. It also allows couples to enjoy parenting more, because they are younger and have more energy to bring up their baby.

Our patients often say; "Maybe we would get pregnant if we tried more insemination cycles, but we're tired of this, and it is getting expensive. We just want a treatment with high success rates, which is why want to do IVF now."

So should all couples with unexplained infertility just do IVF directly ? Of course not. But some couples would benefit from doing IVF sooner rather than having more tests and more IUI cycles .

 As IVF success rates continue to improve over time, many couples are considering IVF treatment sooner than in the past.

You can check out the free IUI vs IVF comparison tool at http://www.ivf.com.au/fertility-treatment/iui-vs-ivf-comparison-tool

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






Monday, December 14, 2015

Not all patients with irregular cycles have PCOD


We often see that every patient who has irregular cycles is labeled as having polycystic ovarian disease or PCOD. Some patients diagnose it for themselves; in some cases, it's a skin doctor or a family physician who makes the diagnosis; and sometimes it's the gynecologist who make this misdiagnosis.

Often it's a result of mental laziness and excessive media coverage . PCO seems to have become the disease of the decade, and every girl who's a little overweight or who's got a little extra facial hair or whose periods are irregular is thought to have PCO. The trouble is that lots of doctors don't apply their mind, and it's easy to put a label on the patient, and then start treating here.

The reality is that there are lots of other reasons for irregular cycles, and not all patients with irregular cycles have PCOD. The reason for irregular cycles is anovulation, which means the woman doesn't produce eggs. Often, for the older women , the correct diagnosis is poor ovarian reserve, and their periods are irregular because they're perimenopausal. However, even young women can have poor ovarian reserve, and that's why doctors need to be think critically before labeling every patient with irregular cycles as having PCO.

It's important to confirm the diagnosis , rather than just go by symptoms or by gut feel, and an easy way to do this by checking the AMH level. Now patients with PCO will have high AMH levels, so that if you have irregular cycle and a low AMH level, you can pretty much rule out polycystic ovarian disease and start thinking about poor ovarian reserve as the correct diagnosis for your irregular periods.

Checking the antral follicle count by getting a scan done from a good sonographer is an other easy way of establishing this diagnosis, but the trouble is that lots of sonographers don't know how to do an antral follice count properly. They don't measure the antral follicles properly , and don't bother to measure the ovarian volume or the ovarian stroma. Many will just describe the ovaries as having MSF ( multiple small follicles), without bothering to take images or measurements.

Making the right diagnosis if you have irregular cycles can make a world of a difference if you want to maximise your chances of getting a baby.

Need help in getting pregnant ? 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, December 12, 2015

Why patients refuse to repeat IVF cycles


Infertile couples know that IVF gives them the best chance of getting pregnant. This is why they do their first IVF treatment cycle with a lot of hope - and with the fervent prayer that the cycle will be their first and their last. Every IVF patient hopes to hit the jackpot and have a baby in the first
attempt ! However, when the cycle fails, they often go to pieces, and are very reluctant to repeat a second cycle, even though they know that repeating the cycle would still be their best chance of getting pregnant. This is quite surprising, because you would expect that someone who has already done one IVF cycle would find it much easier to repeat it again - after all, they have " been there, done that " ?

There are many reasons for this reluctance , and this high IVF dropout rate tragically prevents many infertile couples from having their baby.

The biggest problem is the  unrealistic expectation they have that IVF cycles always work.  This is aggravated by the lack of counselling on the IVF clinic's part, who will often fail to prepare IVF patients for failure. Most IVF doctors are very happy to oversell their services, and they promise the Earth and the Moon to the patient in order to get them to sign up for IVF treatment in their clinic. Then, when the cycle fails, they abandon the patient, so the patient feels cheated, and is then not willing to trust any other doctor. This, of course, ends up hurting the patient, because they then deprive themselves of the best chance of getting pregnant, which is repeating a cycle at a better IVF clinic.

Patients need to understand that the failed cycle represents a sunk cost, and there is nothing they can do about this. Rather than feel bitter about the failure, they need to learn from the experience, and use this additional knowledge to find a better IVF doctor for their next attempt.

They need to learn from each cycle, and then start with a clean slate,  rather than carry emotional baggage, and treat all IVF doctors as being crooks . This attitude only ends up hurting them.


Need help in getting pregnant ? 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, December 11, 2015

Moments of truth in an IVF cycle


An IVF cycle is like a series of hurdles, all of which you need to cross in order to get a baby. How well you manage to negotiate these depends partly on the skill of the doctor - and some of it is in nature's hands. Thus, the ovarian reserve for the patient will determine how many eggs she grows; the doctor's skill at super ovulating and using the right treatment protocol will decide how many mature eggs we can retrieve; and the embryologist’s skill will influence how many embryos we have available for transfer, and what their quality is. Finally, once the embryos are inside the uterus, implantation is a biological variable which no one can control. Each of these hurdles is a moment of truth, and it's important that all these be cleared, before you reach the finish line.

Each moment of truth creates a lot of suspense and anxiety, both for the patient, as well as the doctor and the embryologist. There are multiple moving parts, and everyone needs to be involved, in order to make sure that the journey has a happy ending. Thus, how well does the sonographer do scans, so that he tracks follicular growth accurately ? How skillful is the doctor retrieving the eggs from the follicles at the time of egg collection ? These are multiple complex variables, all of which need to be done to perfection, in order to reach a happy ending.

    The first moment of truth is the follicular response. Has the patient grown any follicles or not, when five days of super ovulation are over? Has  the E2 level risen, and are the follicles growing?  Is it a synchronous cohort? The next moment of truth is the egg collection. Did we get any eggs? How good are they? How many are mature? The next is the fertilization check. How many fertilized? Then there's cleavage  - how  many are continuing to cleave? And how many go on to form blastocysts on day 5.  From a medical perspective, the embryo transfer is the big moment of truth.

Then there is the  horrible two-week wait, and the pregnancy test is the final moment of truth. Did the cycle work, or not? It's best to prepare yourself for these, and learn to live one day at a time, because time is the one this we cannot fast forward  !


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





Thursday, December 10, 2015

My doctor is very good, but very busy and doesn't have time to talk to me


A patient sent me an email after she had failed an IVF cycle.

I asked her, " After your failed cycle, when you went back to your doctor, what she advise you? "

She looked very sheepish and said, "My doctor is very good, but she is very busy. She only has five minutes for patients, so she didn't have much time to talk to me" , and I found this a little surprising.

What's the point of having a very good doctor if that doctor is so busy that they don't have time to talk to you? You, after all, want someone who is of course very good, but who also has enough time to spend with you so they can apply their expertise and their experience to your particular case.


After all , the reason you are spending so much money is to utilise their expertise ! No matter how good your doctor, if they don't focus their energy on your particular problem, their " goodness " is not going to help you in order to achieve your goal.

This is why it's so important that you find not only a doctor who is good, but also someone who can devote enough time and energy to you, not just applying their mind to your particular problem, but also counseling you and advise you so that you can maximize your chance of having a baby and you have peace of mind that you have received the best quality medical care.


Need help in getting pregnant ? 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, December 09, 2015

I will be mentoring healthcare startups at the Express Healthcare Event



What are my chances of getting pregnant?


The commonest question patients ask me before starting an IVF cycle is, "What are my chances of getting pregnant?"

For them , this is a key question , because that's going to help them decide whether to go ahead with the IVF cycle or not; and which IVF clinic to do it at . Unfortunately, it's the most difficult question to answer truthfully ! They are asking me to predict what the outcome of the treatment is going to be , and that's really not possible for anyone to do. I can talk to them about the IVF process and how we can take good care of them, but how can I predict what's going to happen for an individual patient ? What I can share with them is success rates for the entire clinic , and I can say our pregnancy rates for women less than 35 for whom we transfer two top quality blastocysts is 46%.

However, what does that mean for them as an individual? Very little, because we don't know how many blastocysts we will create for them, or what their quality will be, before starting the IVF cycle. This is not something I can predict accurately , because I don't know how many eggs they will grow; how many embryos they will form ; or what the quality of their embryos will be.

When I cannot provide a clear answer, some patients get upset because they feel I'm evading the
issue , or that I'm not being up front and honest. The reality is that the quality of an answer depends on the quality of the question. Patients need to understand the uncertainties involved with a biologically complex treatment like IVF, because there are so many unknown variables.

This is exactly what the law of small numbers predicts. While we know that out of a 100 patients we treat, 46 will get pregnant when we transfer two blastocysts, we don't know what will happen for the individual patient who's sitting in front of me . And she really doesn't care about what's going to happen to the other patients in my clinic - she only wants to know what's going to happen to her, and this is the one answer which I can't give her.

I think patients need to understand the limitations of a single number which is supposed to predict their chances of success. The number is a gross oversimplification, which is why we try to educate them , and explain to them what the pitfalls of quoting a number are. Just providing a simple number is not enough , and some unsophisticated patients will try to compare the " chances of success " numbers which doctors quote to them,  without realizing how meaningless this entire exercise can be.

Need help in getting pregnant ? 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, December 08, 2015

Leaf Wearables, a tech startup I invested in, raises the next round of funding


Leaf Wearables, a tech startup that makes smart jewellery products for women safety, has raised $250,000 (Rs. 1.6 crore) from a group of angel investors.Founded by students from IIT-Delhi and Delhi Technological University, Leaf Wearables will use the funds to expand its product offering of smart safety wearable devices.

Ajeet Khurana, a member of Mumbai Angels, Jinesh Shah, founding partner at Omnivore Ventures and Vikram Chachra, co-founder of Eight Capital participated in this funding round. Dr. Aniruddha Malpani, director at Solidarity Investment Advisors and Vijay Talreja co-founder at tech firm Adapty are other investors.

http://www.thehindu.com/business/Industry/women-safety-tech-startup-leaf-wearables-raises-rs-16-crore/article7958239.ece

A promising healthcare startup I have invested in !

"We are very fortunate to have a very, very good and ardent team. We have zero attrition till now, though, for a period of time, we were not able to pay them industry standard salaries on time. I'm thankful for that," Chinmoy, the Founder & CEO of AllizHealth expounds. Amidst emblematic startup challenges, AllizHealth is still making its presence prominent through a recent funding of Rs..2.2 Crores from Mumbai Angels led by Dr. Aniruddha Malpani, Dr. Ranjan Pai and Mr. Abhimanyu Munjal that has eventually availed them to retain employees.
http://www.siliconindia.com/magazine-articles-in/AllizHealth__A_Trident_Approach_to_Alleviate_Health_Risk-CKQU902787989.html

The doubts, worries and anxieties which plague infertile couples


A patient just send me this email.

My husband ejaculated accidentally through masturbation. My egg retrieval is scheduled for tomorrow. I am very upset and angry. Has he lost all his good sperm ? The doctor had told us to abstain for 3 days before the egg collection ? Will we be able get good embryos? Or is my cycle doomed because of his stupidity ?

For a doctor, this might seem to be a silly query, but the fact remains that infertile couples have thousands of doubts, and they are never sure of what the truth is. How does one check the "fertile time" ? Is it better to have sex daily ? or very alternate day ? Does the sexual position matter ? Should you worry if the semen all leaks out ? Is there any need to lie down with your legs up in the air after sex ?

The web is full of unreliable websites and bulletin boards which provide inaccurate information , and perpetuate myths and misconceptions . Infertile woman are hungry for information, and it's great that  the net makes it instantly available and easily accessible to them. However, many of them are not sophisticated enough to separate fact from fiction , and get misled by all kinds of rubbish.

A good doctor will do his best to dispel these doubts, but this can be a huge challenge, because patients are often not willing to discuss these openly with their doctor. The best way of doing this is to answer FAQs on the clinic's website, because patients can trust the information they get directly from the doctor !

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



 

Monday, December 07, 2015

Senior doctor in India sent to jail for not filling in forms properly under the PCPNDT Act

A cool startup I have invested in


Dr Aniruddha Malpani, investor at Mumbai Angels, who has invested in Instabounce, says there is a need for such startups in the otherwise unorganised sector. “The nightlife discovery apps are making the experience curated and more personal for a customer,” he says.
http://techcircle.vccircle.com/2015/12/07/the-party-has-just-started-say-nightlife-aggregators/

How and why Indian pharma needs to engage with the new millenial doctors and patients

When bad things happen during your IVF cycle

 
IVF treatment can be complex and because it involves multiple biological variables, no one can ever be sure what the outcome is going to be and it's possible to trip up at multiple times. Thus, for example, even though the sperm count seems fine and the eggs seem okay, you may end up with total fertilization failure, as a result of which there are no embryos to transfer. Or the doctor may not be able to collect any eggs at the time of retrieval, even though your follicles seem perfect - a condition called empty follicle syndrome.

This can be a major blow, but you need to learn to deal with some of these ups and downs. Your heart can be breaking but you still need to use your head so you can figure out what the next action steps are. There is no point in being emotional about it and getting paralysed into inactivity or cursing your fate - you need to move on.

Step number one is to document everything. Make sure you have copies of your medical records, including photographs of your unfertilised eggs. Step  number two is to think about what went wrong and corrective action can be taken. Sometimes it's possible to fix problem in that cycle itself - for example, by doing an emergency ICSI . Often you have to figure out what you can do differently in the next cycle in order to prevent the problem from happening again.

    Of course , prevention is the best solution, but the reality is that since some of these problems cannot be anticipated, we cannot always prevent them. We need to learn to be able to deal with them if and when and as they occur. Knowledge can be power and if you're aware of all the things which can possibly go wrong, you can think about what can be done in case we do encounter one of those problems. The important thing to keep in mind is it's not the end of the world, and that even if that problem has occurred, there is a lot which can be done - if perhaps not in this cycle, then the next one.

This is why it's so important to have realistic expectations even before the cycle starts. Because we're so worried about the risk of these unanticipated problems, we take an "at-risk" approach and put precautions in place to reduce the risks. Thus, we will routinely do ICSI for our patients, rather than do IVF, so we don't have to worry about the possibility of an unexpected total fertilization failure. Some clinics might think this is overkill, but we think it makes sense. Similarly, in order to make sure that we don't end up with empty follicle syndrome, we follow a set protocol ( for example, doing a urine pregnancy test on the morning of the egg collection to make sure that the patient has taken her HCG trigger shot properly) . All good clinics use techniques such as these to prevent problem.

Need help in getting pregnant ? 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, December 05, 2015

We didn't know IVF clinics were supposed to provide embryo photos


When I do a consultation for a patient who has failed an IVF cycle elsewhere, I ask them two basic questions:
1.  "Give me your treatment summary", and
2. Show me photos of your embryos. 

This is invaluable information, which allows me to learn from the failed IVF cycle, so I know what to differently the next time.

Often, the answer is - "We don't have these details", and "We weren't given any photos".

I ask them "Why?" and the standard answer is, of course, "Because the doctor didn't give them."

Then, when I ask, "Why didn't you ask for this basic medical information?" the response is, "We were not aware that we needed to get these details, and that IVF clinics provide embryo photos. "

I really don't think this is an acceptable answer in this day and age.  When patients are spending so much time, money and energy on doing an IVF cycle, the least they can do before starting such expensive treatment is to do their homework and find out what's involved in an IVF treatment, and what a good IVF clinic does.

The reality is that all good IVF clinics provide embryo photos to document that they've provided high-quality medical care. If your IVF doctor says he does not provide embryo photos, this is a red flag, and you should definitely find another clinic, rather than get stuck with poor-quality treatment, and reduce your chances of getting pregnant.

Please make sure you don't make this common error which you will regret later, because you will never be certain as to whether the cycle failed because you received poor medical care.

Need help in getting pregnant ? 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, December 04, 2015

Grieving after your IVF cycle needs to be cancelled because of a poor ovarian response


One of the hardest things an infertile patient can experience is to start an IVF cycle and then have to cancel it because the response is poor - when the doctor says, "Sorry, you haven't grown any follicles, and I can't continue with the IVF cycle." Patients with poor ovarian reserve understand that there is a possibility that the cycle may get cancelled because they don't grow any follicles, but when this actually happens, after taking so many days of expensive injections, their heart often breaks. It can be a very taxing time. You need to come to terms with this grim reality - that you may never be able to pass on your genes to your baby. Then, even after your head accepts the truth, in order for your heart to live with this means you need to go through a grieving process, because it is the death of a dream.

This is a huge blow and represents a major loss - the loss of a potential baby who would share your DNA. A bigger problem is that it's a hidden loss - you cannot share it with anyone else . Sometimes , even your husband can be surprisingly unsympathetic, because he may not be able to understand the pain which you are going through.

You had pinned so many hopes on this cycle .  IVF was your treatment of last resort - your final option. Now, when your follicles stubbornly refuse to grow, you find you are back to square one, and have to again go through the painful analytical process of deciding what plan B is going to be.
However, please do remember the silver lining at this time. Even if your cycle got cancelled, at least you have peace of mind that you gave it your best shot. You also now have far more information, because in the past your label was "poor ovarian reserve," and now your new label is "poor ovarian response," which means you need to come to terms with the fact your ovaries are not capable of responding, in spite of maximal super-ovulation. Of course, if the super-ovulation was not done well then might still be worthwhile to go to another clinic and try another treatment protocol. However, if this was an aggressive super-ovulation protocol, and you still failed to grow follicles, you will need to accept that you're going to have to consider alternative options in order to grow your family.

This could include either adoption, or donor eggs, or donor embryos, all of which are equally hard to accept. There is no right answer, and I would never say that one is better than the other. Keep an open mind and explore all your options, until you find the one which works best for you. Once you do that, and you're happy, not only will you keep yourself happy, you'll keep your husband and your child happy as well.

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




Thursday, December 03, 2015

The difference between a good doctor and a great doctor


All physicians have similar skill sets , but we all know that some are much better than others. Not only are they much more successful, they are able to connect better with their patients, and are often better diagnosticians as well.

What differentiates a good physician from a great physician ? What makes a doctor the doctor's doctor - the consultant everyone refers to when they are stuck ? This requires a combination of three different areas; the head, the heart and the gut.

As far as the head goes, most physicians have an adequate medical knowledge base. I am assuming that good physicians are well read, well informed and up to date. What makes the great physician different is that he doesn't use only his analytical skills to think about diagnostic possibilities. He's willing to think out of the box , especially when he comes across a patient with complex problems . He is better at diagnosing rare problems,  because he thinks creatively , so that he picks up clues which other doctors miss.

He is curious and always willing to learn. As a result of this, he gets better every year because his expertise grows along with his clinical experience .  He has a lot more tacit knowledge which he can tap into every time he sees someone with a difficult problem. That is why he is the doctor who other doctors will refer their patients to when they are stumped.

The great physician has a gut feel - an instinct, an ability to know that something doesn't seem right even though all the test results , labs and scanned images seem fine. This is the sixth sense which comes with a lifetime of experience , and that is why the great physician is revered and respected. He is willing to trust his intuition, because he know his unconscious will provide him with useful signals .
Finally, the great doctor also has a heart. He's willing to connect with his patients emotionally and provide them with compassionate support so that even if he can't cure them, he can always hold their hand and support them in their time of need.

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