Friday, April 29, 2016

Free iOS app to help you manage your IVF treatment


MyFertilityDiary , a free app for your iPhone, will help you manage your IVF treatment.

IVF treatment can be complex and confusing , since it involves taking injections daily; doing scans and blood tests; and going to the doctor regularly to check on your progress. It needs a lot of coordination and monitoring , and you cannot afford to mess up. The complexity can be overwhelming, because there are so many things happening at the same time. You need to know in advance what is going to happen when, so you can plan your IVF schedule. If you forget your medicines or miss your appointments , you may end up causing your cycle to fail, which can be a major disaster !
Most fertility apps available today are just basic ovulation trackers , which are useful for normal women who have no fertility issues. All they do is help you track your fertile time and plan baby making sex time.

MyFertilityDiary is much more !

The unique heart of the app is the IVF Treatment Calendar. This has schedules for the commonest IVF treatment protocols, including the following:

Long downregulation with Lupron
Short downregulation
Antagonist cycle
Natural cycle
Frozen thaw
Minimal stimulation IVF

All you need to do is to select your prtocol and enter the day your cycle starts ( Day 1), and My Fertility Diary will automagically and intelligently fill in your IVF schedule for you !

You can edit and modify this schedule , so that you can follow the exact treatment protocol as prescribed by your doctor. Your IVF doctor will be very impressed when he sees how well organised you are, thanks to this app !

The app is designed around a Calendar , which allows you to organize your life. You can set alarms and reminders, so you remember your appointments and your medications.

Becoming a well-informed and organised IVF patient will improve your chances of getting pregnant !
You can download the app free at https://itunes.apple.com/in/app/my-fertility-diary-ivf-rx/id1103747074?mt=8
 

Monday, April 25, 2016

What Amazon India needs to do to delight its customers



Amazon takes pride in its superb customer service, and it's true that they do a great job. I'm happy to vouch for this. I've been a faithful customer and buy practically all my books from Amazon these days.

While Amazon does a stellar job at ensuring direct customer delight, there are many additional ways of doing so by helping their sellers to do a better job at servicing customers via its marketplace. Right now initiatives such as Amazon Tatkal which helps sellers create catalogues through a mobile studio is great. However, there's a lot more they could be doing to make the small shopkeeper - the Indian Baniya and the Patel store owner - more successful. A key approach is to understand all the pain points of the small shopkeeper and develop technology to help them resolve these. The small seller would love to deploy technology to become more efficient, but cannot afford to do so - and this is where Amazon can step in !

Help the Shopkeeper build a brand for themselves.
Ultimately, the more the shopkeepers who go online, the better it will be for the end customer. While some of these transactions will occur through the Amazon marketplace, others will take place on other platforms as well - for example, the shopkeeper's own website.  If Amazon starts providing shopkeepers tools to help them grow, everyone in the ecosystem will benefit! The shopkeeper will get more customers; the customer will be happier because he has a personal relationship with the local shopkeeper; and as the overall volume of business transacted online grows, Amazon's share will grow as well. Technology can allow us to marry the convenience of online shopping with the logistic efficiency of the real world shopkeeper.  High tech with high touch can create customer delight for the shopper.

Educate the seller
Shopkeepers need to move with the times, and they will include their website address on their stationary, to encourage their customers to come back.  After all, they also need technology to compete with the big boys, but don't know how to deploy this in a cost effective fashion. Lots of younger shopkeepers will come up with clever new ways of reaching out to consumers online, so that the boundaries between online and offline will start to disappear for the shopper. These clever home-grown innovations can be shared with other shopkeepers, thus allowing them to scale up organically.

Right now, shopkeepers may think of Amazon as being a threat to them. However, one they find that they order volume improves because they can leverage the online marketplace, they will be happy to cooperate with Amazon, thus creating a win -win for all the players in the ecosystem.

Provide a Technology Boost
Amazon could not only help shop keepers to create their own apps, they can provide them with digital tools to catalog and track their inventory and integrate it with a POS system. They could possibly partner with solutions like Primaseller to help them in this endeavor.


Provide Consulting
Amazon India could appoint a Seller Delight Officer, whose job it is to help small retailers to thrive. His job will be to understand what the retailer's pain points are, and provide solutions for them - all the way from, "How do I manage to create an accurate inventory of all my products? How do I digitize it? How can I get accounting integrated with my inventory? How do I tie this in with logistics? How do I train my assistants in customer service?". All this is stuff which Amazon has a great understanding of, because they do it themselves all the time - after all, they are the world's largest retailer.

How can they develop tools to help the small shopkeeper become as efficient and effective as Amazon, so that each can play to their individual strengths, and jointly create shopper delight is a question they have to smartly answer in order to win this competitive game.



Thursday, April 21, 2016

Our IVF babies smarter than babies made in the bedroom ?


I just received this email today.

Our daughter KIMAYA turned 1 year on 15th April. We took her to Singapore to celebrate a very special and memorable birthday which a toddler can enjoy - undivided and uninterrupted attention of both parents mixed with loads of 'first time' fun activities for her.

Got back yesterday and thought of a few people to thank for making this day possible in our lives and the first name was definitely - Dr. Malpani. You are not God, but definitely not meaning anything less than that to us and I am sure to many fortunate parents benefited by your treatment.

Having 'Kimaya' as a daughter has been a blessed 1 year of parenthood journey. She is a gorgeous and intelligent baby (never fails to amuse me with her socio-motor developments ahead of time). Most importantly, she just seems to be as perfect a baby as I ever dreamt of, with handpicked best qualities from both of us. I know you disagree to my thought, but being in medical research for 10 years, I can bet anything on my observation (based on several IVF babies of closely known couples) that IVF produces the BESTEST baby a couple can!!

For the sake of science, do look into it. After all, we defy nature's change of random selection from a large sperm & ova pool and select the best quality raw material for this production !!

And on a very serious note - I have always believed, that God bestowed his divine blessings on us through your blessed hands. From the bottom of my heart, I pray to God to empower your hands with immense healing powers and no couple shall return fortuneless from your doors ever.

God bless you and all your patients with success always.

Regards
Sneha



drsnehalimaye@gmail.com

While we are happy to take the credit for making super-smart babies, I don't think we t deserve it ! The reality is that IVF babies have a headstart over other babies, because their parents dote on them , and lavish so much love and energy on them. I agree they are truly blessed !

Wednesday, April 20, 2016

The IVF specialist's quandary



One of the problems I still grapple with, even after 25 years of doing IVF, is how optimistic to be with my patients. It's always a hard call, because while it's easy to be hopeful, I'm worried that if I'm excessively optimistic , patients will start assuming they will definitely get pregnant , especially when they have great quality blastocysts; a good endometrium, and a smooth transfer. However, if they don't get pregnant ( and because this is a biological variable and IVF is full of uncertainty, we still can't predict for the individual patient whether or not a particular cycle will work for her), my fear is that they'll go to pieces , and it'll be very hard for them to cope with their broken heart and their shattered expectations.

This is why I try to be as realistic as possible , and explain to them that there's a good chance that they will get pregnant, but they need to be prepared for failure.

Lots of patients don't like this. They feel I'm being too negative, and too pessimistic. Most patients want a doctor who's all pumped up , and who charges them up - someone who provides them with a lot of optimism and support. Many patients believe that being hopeful increases their chance of getting pregnant.

It's not hard for me to smile and be cheerful  - I am an optimist by nature. However, I do need to think about the long-term consequences, so that if I'm excessively optimistic and the cycle fails, and then the patient comes back and asks me, "Doctor, you said everything was going well, so why did the cycle fail," and how can I answer the question at that point?

This is why I try to prepare patients as best as I can , so that they know that even though we've done our best, the final outcome is not in our hands. We educate them about the process itself , so they have peace of mind they have received high quality care.

The problem is that there are lots of different kind of patients we have to treat.  Some are intelligent, some are educated, and some aren't. It's very hard to know how to individualize the degree of optimism for each patient - and how to titrate the information  and the way I provide it to these patients.

The problem is that one size can't fit all, but it's very difficult to know what the individual patient sitting in front of me needs. This is a challenge which I still struggle with. I want to give my patients hope, but the one thing I don't want to do is to  give them false hope - and this is a hard balance to find.


Thursday, April 14, 2016

How can "unexplained infertility" be a diagnosis ?


A patient was very upset when I told her that her diagnosis was " unexplained infertility" . She said - " How can you possibly call that a diagnosis , when unexplained means that you don't have an explanation for why I am not getting pregnant ? How does putting a label on it help ? "

I can understand her confusion , and I explained to her why it's important for doctors to assign patients into diagnostic buckets. It makes easier for us to categorize them, so that we can then design treatment plans based on our experience with lots of other patients with a similar diagnostic label.

Unexplained infertility is often a wastepaper diagnosis . What we are really telling the patient is - We don't have a clue why you're not getting pregnant. This can be very upsetting for some patients , who naively believe that medical technology should be able to solve all their problems . They believe that a doctor who can't even tell you why you're not having a baby is incompetent , and pressurise him to order more tests, so that he can get to the " root " of the problem and fix it.

This is why they will often demand the doctors do lots of additional tests , and most doctors are happy to humour them, even though they know that the tests are useless .  A good doctor will tell them the truth and say - There's no point in running any more tests , because these additional tests are not cost effective or reliable , and they do not provide us with any useful information.  Patients don't want to hear this, because  medical ignorance and uncertainty make them uncomfortable. Their fear is that if the doctor cannot even identify the problem, then how on earth will he be able to solve it ? They will often switch doctors, until they get someone who keeps on running battery after battery of expensive tests, until he finally unearths an "abnormality". This is quite likely to be an irrelevant red herring, but the patient is finally happy, because this clever , new doctor has finally made the right diagnosis !

The good news is that unexplained infertility doesn't mean it's untreatable infertility.
All it means is that while our technology cannot pinpoint what the defect is. This is hardly surprising,  given the fact that human reproduction is such a complex process ! However, we can often bypass problems , without identifying them. This is the beauty of ART ( assisted reproductive technology) , because it allow us to do in the lab what's not happening in the bedroom , no matter what the reason for this may be. Sometimes this is a reason which we can identify - such as a low sperm count ; and sometimes it is a reason we can't, which is when we label it as unexplained infertility.  Our solution is equally effectively in both groups of patients !

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, April 11, 2016

Google, the infertile woman and stress



A lot of husbands are worried when they see their wives spend hours googling infertility and IVF treatment. They are worried that this incessant googling will cause additional stress. They are fearful that their wives will end up spending so much time and energy on technical minutiae,  that they will start becoming negative and fearful, especially when they read about risks and complications. 


They're concerned that their wife  is not able to interpret the information properly ; and feel that the details of medical treatment are best left up to the doctor. They want to find a doctor whom they can trust, and then leave everything is his capable hands, rather than trying to second-guess him. They believe that the wife shouldn't be spending so much energy trying to become an expert by talking to other infertile couples online . They feel IVF is the doctor's domain, and that it's dangerous to become half a doctor, because a little knowledge can be dangerous. 


However, the reality is that they're confusing cause and effect - it's not the googling which causes the stress, it's the stress which an infertile woman is going through which causes her to google . She needs to find out more information , so she can be comfortable and confident that she's on the right track, and that the doctor is providing her with the right treatment.

She cannot afford to be passive and leave everything up the doctor because ignorance is not bliss. She needs to retain control of her life , and know that while it's important to trust your doctor, it's equally important to verify that what your doctor is doing is right.

For lots of these women , googling actually reduces  their stress ! When their husbands prohibit them from going online to find out more information , they get extremely infuriated and even more stressed out . Not only are they upset about the fact that most doctors do not bother to share information with them, they're even more upset about the fact that the husband is not supportive , and is not helping them in their quest for information .  What upsets them is that the husband  seems to take a hands off, disinterested approach in the treatment rather than trying to be actively involved. When he ignores and rejects the information she has found by saying - The Doctor knows best" , she feels belittled and patronised . She jumps to the conclusion that he is uncaring, and this makes a bad situation even worse.



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, April 09, 2016

Why are we so unkind to overweight infertile women?


Being overweight and infertile often go hand in hand.  Obesity reduces fertility, and it's well known that a high BMI reduces IVF pregnancy rates.  This is why many IVF specialists refuse to treat obese women until they get their BMI into the normal range. Now this may seem to be a sensible thing to do - after all, we do want our patients to get pregnant, which means this advice is in their best interests, correct ? However, the problem is more complicated than it appears at first blush,.

No one wants to be fat  ( there, I used the  dreaded "f" word) , and most women who are overweight have already  tried their best to lose weight and to get in to shape - after all, fat people don't need a doctor to tell them that they need to lose weight - this is something they already know. However, ( as most of can vouch from personal experience) , it's very hard to lose weight.  For most of us, every time we lose a kilo, we end up putting on two.  This can be extremely frustrating, and then having people go on and on telling you that you are fat just adds insult to injury.


Now, if you happen to be infertile as well, the problem gets compounded. A lot of people will look at you and say - Oh, you're not getting pregnant because you're too fat, and you feel even worse about yourself. Not only can't you lose weight, you can't even have a baby ! Even doctors can be unkind , and will refuse to treat infertile women until they can bring their BMI down to the magic number recommended by medical guidelines.

I think this is extremely unfair and unkind. Fat women don't like being fat.  A lot of them have done their best to try to lose weight , but they just haven't been able to. It's common for doctors to blame their lack of will-power for their inability to lose weight, but this makes a bad situation worse , because it just adds to their guilt. When doctors refuse to treat them because they're overweight, they feel trapped and hopeless. They've already tried everything possible to lose weight and failed - and telling them to lose weight doesn't really help. They need concrete  solutions, which most IVF doctors are not able to provide, because this is not their area of interest.  The truth is that they've tried most of these solutions , but these have not worked . The trouble is that most doctors blame the patient's poor will-power for their inability to lose weight - an attitude which is unfair and untrue.

Infertile fat women find themselves in a catch-22 situation  when doctors refuse to treat them because they're overweight. This often causes them to put on even more weight ! They don't feel like going out, they don't want to exercise , and because they feel sorry for themselves, they stay at home and eat more , and can't figure out what to do about it. Their infertility and their inability to lose weight makes their self-esteem even worse , and this becomes a negative vicious cycle.

Infertility doctors need to learn to be a little bit kinder to women who are overweight. Telling her to lose weight is very easy to do, but if she says she's tried and she's failed; or if you've given her a concrete solution and she implements it faithfully and yet she doesn't lose weight, you shouldn't refuse to treat her infertility. By fobbing her off , you make her infertility even worse, because she loses valuable time in her futile pursuit of trying to lose weight - and this is precious time which is never going to come back.

So how do we tackle infertile women who are overweight ? We need to offer them concrete solutions with  a well-defined weight-loss plan , and help them to implement it, in partnership with dieticians, bariatric physicians and gyms. We also need to be empathetic, and appreciate that if they've done their best to lose weight  and failed , there's no reason to refuse to treat them just because they are fat, no matter what the guidelines say.  Instead of focussing on the BMI , we  need to learn to focus on the patient !

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, April 06, 2016

Can PGD/PGS help to reduce the risk of a miscarriage?



Woman who miscarry after IVF treatment are often quite distraught . They worry about whether they'll be able to have healthy baby.

Miscarriage is a complex issue , which is hard to analyse for many reasons. For one, there are so many old wife's tales which shroud it , that women get confused and are not sure whom to believe.  This is because it is surprisingly common, which means that everyone and their grandmother has an opinion about what causes a miscarriage and how to prevent it, and are more than happy to share it. Because it causes so much emotional distress, women who have miscarried  are very vulnerable and find it hard to think straight. They are happy to clutch and straws and false hope.

Even doctors don't agree about what the cause of a miscarriage is in every patient. Because there are so many moving parts involved in a pregnancy loss, we often cannot pinpoint the right diagnosis in an individual patient .

While we do know that the commonest reason for a miscarriage is a genetic problem in the fetus, this is actually a "waste-paper basket" diagnosis, because it doesn't specify what the defect is in that particular embryo.

Inspite of this, many patients come to the apparently logical conclusion that " if we do IVF, genetically analyse the embryos using PGD, and then selectively transfer only the euploid
( chromosomally normal) embryos , then we will be able to reduce the risk of another miscarriage."  This sounds extremely sensible, but unfortunately doesn't work out well in real life.  Even women who've had IVF PGS with the transfer of euploid embryos can and do miscarry.

The reason for this is that the commonest reason for a miscarriage is not always aneuploidy.  An
aneuploid embryo is one where the number of chromosomes is abnormal,  and while these embryos will miscarry, aneuploidy is only one of the many causes for a miscarriage. The problem is that this is the only cause which PGS will allow us to pick up as far as the genetic reasons for a miscarriage go.

There are lots of other genetic reasons for a miscarriage . Thus, many embryos are euploid ( their chromosomes appear completely normal ) but they nevertheless still harbor defects at the gene level,  which prevent the embryo from growing beyond a particular phase, and result in a miscarriage.   Our genetic technology is still not mature enough to test for these, because the tests we have are still very crude.  This is why it's important that patients have realistic expectations , and doctors should not allow the promise of PGS to be over sold. Over promising causes a lot of heart burn , and when the patient does miscarry after PGD , this will end up in giving PGS/ PGD a bad reputation .

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 !





How we maintain sterility in the IVF lab using a laminar flow hood

Monday, April 04, 2016

Why did I get such poor quality blastocysts ?



BLASTOCYST TRANSFER

The easiest way of selecting embryos which have the highest potential of Implantation is by transferring them at blastocyst stage. Since many Embryos do not reach the Blastocyst Stage in the lab ( because they arrest in vitro) , this option allows us to select the best Embryos and transfer these, and  thus increase your chances of getting pregnant.

The limitation is that since not all the embryos will grow and develop to form blastocysts, we may not be able to do a Day 5 Transfer for Patients who have very few Eggs to start with.  This means that we may end up with having no embryos at all to transfer for them.

You can see what blastocysts look like at www.drmalpani.com/blastocystimages

BLASTOCYST CONVERSATION RATE

Blastocyst conversation rate for top quality Day 3 embryos is about 40 %.  This means that if there are 10 top quality Embryos on day 3 (i.e  8-cell Grade A), then about 4 are expected to become blastocysts by day 5.
In some patients, we see a very high Blastocyst Conversion rate (more than 50 %)

These patients include:
•    Young  women
Young women usually have good ovarian reserve and produce lots of good quality Eggs and high Embryos, most of which grow to become good quality blastocysts

•    Patients with Good AMH Levels
Patients with good AMH levels  produce good quality Eggs which have a higher chance of becoming good quality Blastocysts

•    Patients undergoing Donor Egg cycle
Patients who undergo donor Egg cycle, where we use Eggs from a young fertile donor, who usually produce lots of good quality Eggs, usually have more high quality Blastocysts.

Low Blastocyst conversion rate

In some patients we see very low blastocyst conversion rates.

First Group of Patients

In some patients the low blastocyst rate is associated with low AMH levels, poor ovarian reserve and fewer Eggs. As these patients, usually start off with few eggs, they have a low fertilisation rate, poor grade Embryos and eventually poor blastocyst conversion rates. This is a continuum of poor reproductive performance, which may be related to poor mitochondrial function in their eggs.

Second Group of Patients

However, in some good prognosis patients (good AMH levels , lots of Eggs, and plenty of high quality Day 3 embryos) , where we expect to get a good blastocyst conversion rate, we sometimes see that we eventually get very few blastocysts, and this can be very disappointing and disheartening.
These patients usually start off with a high number of good quality Eggs; and we usually get very good fertilization rate, which means we usually have  lots of good quality Embryos on day 2 and day 3 (4-cell grade A on day 2 and 8-cell Grade A on day 3.)

The problem starts only after day 3.  Many embryos stop growing ( they arrest), while only a few ( approximately 20% or less) reach the blastocyst stage on Day 6. In some patients , none of the embryos become blastocysts, even though they grew very well until day 3.
                                     
TOP QUALITY EMBRYO ON DAY 2                 


TOP QUALITY EMBRYO ON DAY 3



POOR QUALITY BLASTOCYST ON DAY 5



The Late paternal Effect is the reason behind the poor blastocyst formation in these patients, even though they had a promising performance until day 3.

It is known that repeated failure of assisted reproduction treatment (ART) can be due to a paternal effect

What is Paternal Effect ?
While eggs have a much more important role to play in embryo development, the sperm contribute at two different times. These are called the "early paternal effect" and the " late paternal effect".

During fertilization, the sperm transmits nuclear DNA and oocyte activation factor (OAF) through its Acrosome (a Cap like structure on head of the sperm) which is critical for fertilization. If the sperm doesn’t have an acrosome (such Sperms are called “round head sperms” or globozoospermia ), the oocyte is not activated and it fails to fertilise.  Thus , total failure of fertilisation in IVF and ICSI ( when there are lots of eggs is because of a sperm problem).

However, once fertilization occurs, further development is entirely managed by Egg. The division of Cells is powered by the energy provided by the mitochondria in the Egg.  This the Embryos reach 8-cell stage, it is the egg which drives the process and the sperm only play the role of kick starting the process.

The Paternal genome is switched on only after the embryo reaches the 8-cell Stage , which means it does have an influence of subsequent development  - to  blastocyst formation .

This means the Sperm DNA comes into play only after the 8-cell stage.  This means sperm with damaged DNA ( abnormal DNA Fragmentation) doesn’t have any impact on Early Embryo Development (on Day 1, Day 2, Day 3).  Sperm carrying damaged DNA can complete the initial process of fertilization; however, the developmentally necessary genes in the damaged sperm DNA may hinder embryonic development upon activation of the embryonic genome at the 8-cell stage, which results in failure of blastocyst formation or poor quality blastocyst formation.
This is Called the LATE PATERNAL EFFECT

Evaluation of Sperm  Quality to avoid Late paternal Effect
Labs have tried to diagnose Sperm DNA damage using DNA FRAGMENTATION tests, but these tests are not accurate or reliable.

This means we usually learn about it the hard way - during the IVF cycle, when the 8-cell embryos do not  form as many blastocysts as expected.

Late paternal effect is suspected :
1.     When patients have poor blastocyst conversation rate in repeated cycles
2.    When patients Embryos grow well till day 3 and then start to deteriorate.
3.    When the patients have poor blastocyst rate,  even when we use donor eggs for 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 !









Saturday, April 02, 2016

How optimistic should an IVF specialist be?



This is always a difficult problem for an IVF doctor and I work hard at trying to find the right balance between being optimistic and realistic when talking to my patients.

It's easy to be optimistic when a patient comes to you for a consultation. You feel your IVF clinic is the best, and because you want the patient to sign up for treatment, you are happy to promise her the earth and the moon.

It's also very easy to be optimistic at the time of the embryo transfer. " These are great embryos ! Your uterine lining is perfect and the transfer went off smoothly, so you have a great chance of getting pregnant ! " And it's easy to take pride in the fact that you did a good job when the beta HCG is positive. However, what  happens when the HCG is negative?

Your optimism caused the patient to  build up  her hopes, and even though her head understands that the pregnancy rate in an IVF cycle is not 100%, in her hearts of hearts she is certain she's  going to get pregnant because of your positivity.

However, when the cycle fails, she goes to pieces. To add insult to injury, this is often the time when doctors abandon the poor patient, so that she has nowhere to turn to.  She feels lost and cheated.  “When the doctor was so sure that I would get pregnant when doing the embryo transfer, then why did the cycle fail ? Did I do something wrong? Or did the doctor lie to me ? Did he do something wrong?"  When she goes back to ask her doctor this question, she doesn't get any straight answers.  The  doctor comes up with all kinds of cock-and-bull reasons, and says, "Let's do some more tests to try to figure out why you had " implantation failure".

The poor patient is then left wondering, "Why didn't you discuss the possibility of failure at the time of the embryo transfer? Why are you telling me this after the result is negative?" She loses trust in that doctor - and starts losing trust in all IVF doctors. She starts believing  that all IVF doctors just talk sweetly - that they over-promise, and under-deliver.

While it's easy to be cheerful , I do my best to make sure my patients have realistic expectations, and are ready to accept for the possibility of failure. Sometimes patients complain -  "You're so negative and pessimistic. You're always talking about failure and preparing us for the fact that the cycle may not work. We'd much rather have a happy, smiling, cheerful doctor who tells us all is going to be well."

It's easy for me to be optimistic because  I am an optimist by temperament. However,  I need to be careful that the patient's expectations don't get too high, because if the cycle fails, she will go to pieces and will find it hard to recover. Every patient is different, and I try to adapt my style to make sure that the patient has realistic expectations of our treatment.


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, April 01, 2016

What does a 20% IVF Success Rate Mean?



Lots of patients want to know what their chances of getting pregnant are before starting an IVF cycle. This is obviously the first question everyone's going to ask, so that they can decide whether they should go ahead with IVF , or consider alternative options.  It's easy for us to quote a number, but we need to think a little bit about what that number actually means.

So let's suppose I tell a patient, "Your chance of getting pregnant is 20%."  We need to understand that this is a guesstimate, and it could very well be anywhere from 10% to 30%.  These are very imprecise numbers.

Also, lots of IVF clinics will inflate their figures , because they want patients to come to them for treatment, rather than go to the IVF clinic down the block. They will often end up over-promising, without ever being able to document what their actual success rates are. And even if their success rates are well documented, you need to understand that these apply to groups of patients - not to you as an individual. The fact is that every individual is different means we cannot apply these statistics precisely to your own individual case. Your chances could actually be much better than that 20%  - or much worse. Our ability to predict the outcome is very limited.

The reality is that we can only give a precise estimate ( I know this is an oxymoron, but this is the best we can do given today's technology) after the cycle is over. Your chances of getting pregnant depend upon multiple variables, such as how many eggs your grow, and how well your embryos develop in the IVF lab - information we can put our hands on only after the embryo transfer ! How your cycle evolves gives us very valuable information in real-time.

Also, the success rate for an individual patient is either 0 or 100% - there is nothing  in between.  In order to put this in the right perspective, you need to ask yourself - what are my chances of getting pregnant if I don't do IVF ? If it's 0, then obviously anything is better than 0. But how much time, money and energy you're going to invest , and what the magic number is - what that threshold should be before you're willing to sign up for an IVF cycle, is a call only you can make.

Finally, you need to remember that you should not focus on just the success rate of a single cycle - try to estimate the cumulative conception rate - the chances of success over multiple IVF cycles . This will give you a far better picture of your odds of having a baby with IVF.

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 !






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