Sunday, July 30, 2017

Does your IVFclinic offer xxxxxx treatment ?

One of the commonest questions patients ask us is - We read about the following advanced treatment option on google. Does your clinic offer this treatment ?

Now we have been doing IVF for over  25 years, and have seen many fashions and  fads come and go.  Yes, IVF is a science, but it is afflicted by lots of  hype as well, as clinics compete with each other to offer the "newest, latest and best" advance to their patients !

The additional advanced " tests and treatment" patients want depends upon their educational sophistication, and varies from:
-  ERA - endometrial receptivity assay
 - CAT - cumulus aided transfer
- PGD - preimplantation genetic diagnosis
- Endometrial scratching
- PRP - platelet enriched plasma
- Stem cells

Patients need to retain their sanity and their perspective.

Remember that not all new treatments are better  - many of them are still unproven, and best used in a research setting, because their clinical utility has not been established by controlled clinical trials.

Also, doctors fall in love with "shiny new object syndrome" and love trying out new stuff - not because the patient benefits, but because their bank balance does  - after all, you can always charge more for doing   more !

Doctors play a oneupmanship game, and it's their patients who suffer !

It's easy for us to offer these "add-ons" as well - after all, we are a fully equipped IVF lab, and can do what any other clinic does - we have the expertise, equipment and the technology to do so . The reason we don't is because we are conservative , and don't want to use our patients as guinea pigs. We don't want to experiment on them, and would rather wait for well done research to provide that an advance was clinical useful, before offering it to our patients. We aren't in a race to be the first for unproven tests and treatments !

Remember that if these advances were really useful, then all clinics all over the world would start offering them routinely, and the reason they don't is because a lot of these unnecessary procedures don't help. In fact, some have been proven to reduce pregnancy rates !

You can read more about this race to do more and the harm it causes patients at http://www.drmalpani.com/knowledge-center/infertility-testing/wasteful-infertility-tests

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, July 20, 2017

The IVF embryoscope scam

Many IVF clinics are in a technology arms race. They want to play the game of one-upmanship, by boasting that the have the "newest and latest" technology, which makes them better than the other clinics.

While this is a great marketing ploy, the tragedy is that many clinics take naive patients for a ride, by claiming to use technology when they don't actually do so .

To add insult to injury, the charge a bomb for doing procedures which they never did !

The poor patient is clueless, because they have no idea what goes on inside the 4 walls of the IVF lab, because these doctors refuse to share information.

Thus, there are clinics which claim to use an embryoscope. Now, this is device which allows the embryologist to take videos of the embryos while they are growing inside the incubator , which means the doctor should be able to provide photos of the embryos to the patient.

However, these labs don't do so , because they don't actually use the embryoscope - and just claim to do so !

If you want to make sure that your doctor is not taking you for a ride, please insist that they give you photos of your embryos. If they don't do this routinely and proactively, this means that they may be lying to you, so you need to beware !

Not sure if your IVF clinic is playing games with you ? 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, July 19, 2017

Times of India public awareness campaign to remove social stigma around IVF


This is part of their Fertile Conversations campaign to demystify IVF, and is being sponsored by Nova 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 !




Friday, July 14, 2017

Fertile Conversations ! A Times of India Fertility Awareness Campaign


I am very glad to see that the Times of India has taken the initiative to create more awareness about infertility by launching a campaign called Fertile Conversations

This is a combined, print, online and real world campaign.

It has been sponsored by Nova IVI, a chain of infertility clinics in India, which means the primary purpose of the exercise is commercial - to promote their practise by getting infertile couples to come to their clinic for treatment by driving traffic to their website and their free events.

While this is a great way for Nova IVI to acquire more customers, the good news is that it's also encouraging more people to start talking about  what used to a taboo topic, which still carries a lot of social stigma in India.

Hopefully, having open conversations will encourage infertile couples  to reach out for help, rather than bottle up their angst and frustration, and this is all for the best. . It's something we have been doing free of cost for many years, and I am glad other clinics are now following in our footsteps !

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 !




Times of India article on infertility

Dr Malpani, however, offers a different view. "Victim blaming is a big issue across India. People tell women that they are unable to conceive because they don't eat healthy or work too much. It is unfortunate that women feel stressed and inadequate due to the inability to have babies,'' he says. "I have had women crying and asking if they are too fat or if the anti-acne medicine they used previously is responsible for infertility .''

http://timesofindia.indiatimes.com/city/hyderabad/why-more-and-more-indians-cant-have-kids/articleshow/59587740.cms

Tuesday, July 11, 2017

How patients get taken for a ride !


I've noticed a disturbing trend these days. For-profit healthcare companies, clinics and hospitals are advertising direct to the public - either on hoardings, or by taking out full page ads in newspapers. They promise the equivalent of a miracle cure - and one of the most fashionable trends these days seems to be to use platelet-enriched fractions of plasma. These are  used for all kinds of treatments, from head to toe, depending upon the specialisation of the doctor. Neurosurgeons inject it in the CSF ( cerebrospinal fluid) to treat autism; trichologists inject these in the hair follicles to treat baldness ; and orthopedic surgeons inject these in the joints to treat arthritis. The fact that these are used anywhere and everywhere itself should make them suspect !
Let's look at just one area today - treating aching joints. These elixirs are supposed to regenerate aging joints and make them as good as new, so that patients don't have to undergo knee surgery. This is a tempting prospect, and the tragedy is that many patients get suckered by this kind of advertising.  The bigger tragedy is that there is no one to protect these patients !
A lot of these companies make all kinds of tall claims. Painful knee joints are very common, and because people are reluctant to undergo surgery, most of them are quite happy to try out these treatments, because they're non-invasive, and are marketed so cleverly. It's quite logical to believe - " Why not try it and see? What do I have to lose ? "  And the truth is that some patients will benefit, which will keep the buzz going. Every treatment has a placebo effect, so that even if it is completely useless, some lucky patients will definitely benefit from it.
    The problem is that none of these claims have ever been proven to be true. They sound scientifically plausible, because they talk about " bioactive growth factors" , and they claim that this is backed by sound scientific research.
But guess what? All this research is usually published in poor quality medical journals, who will be happy to publish any rubbish if you pay them for it. This is what breaks my heart - that patients are so gullible , that they're willing to accept all these ridiculous claims.
Part of the problem is that patients naively hope that the government will put a stop to all these scams, and we all know how inefficient the Indian government is.  Patients also expect the medical profession to regulate itself, but sadly this is not going to happen. There is a lot of money at stake, and doctors don't want to speak up against other doctors, because of their code of "professional ethics" .
Patients need to learn to protect themselves, because no one else is going to do this for them, which is why they need to learn to stop and think critically.
If this was really such a big breakthrough, then don't you think any researcher worth his salt who came up with this innovation would be happy to publish it in a reputable medical journal, such as the Lancet or the New England Journal of Medicine? After all, this publication would establish his professional reputation for the rest of his life. If he was sure that his results were trustworthy, then we would take the time and trouble to perform a controlled clinical trial; document his results; do the research stringently ; and get it peer reviewed. Once it was published in a world-class journal ( and any journal would be happy to publish such ground-breaking research) everyone would look up to the researcher as having come up a significant medical advance - the ultimate badge of honour for any doctor !
    The very fact that none of these papers have been published in these leading medical journals itself should tell you that something is rotten in the state of Denmark ! Please don't get cheated or swayed by some of the rubbish these clinics trot out, just because it is very cleverly dressed up in a lot of scientific garb. Patients need to beware and you cannot afford to leave your common sense at home. You need to be on your guard, otherwise you will end up harming yourself.  Please don't allow doctors to take you for a ride !

Thursday, July 06, 2017

The latest scam in IVF

It breaks my heart when I see all the scams IVF clinics use to cheat their patients. They disguise these in fancy scientific terms, and take their patients for a ride, by subjecting them to expensive, unproven treatments.

They use their patients as guinea pigs - and  to add insult to injury, they charge them for this privilege !

The latest scan is the use of "platelet-derived growth factors"  to "rejuvenate the ovaries" and " improve the endometrium". Lots of new startups have designed many different clever terms ( "autologous platelet rich plasma, PRP"  and "platelet activating factor"  to describe the same rubbish.

They basically collect the blood of the patient, separate the platelets, and then infuse the "platelet rich portion" into the endometrium; and/or the ovaries. This is the latest magic elixir, dressed up as a scientific potion, which is supposed to improve the thickness of the uterine lining; and get the ovary to regenerate new eggs, because the platelets are full of nourishing bioactive growth factors. This is simple cheap and easy to do, and any doctor can start offering this highly lucrative treatment to their patients.

The " clinical trials" they carry out are published in dodgy poor quality medical journals, who will print anything for a price. This gives them the instant imprimatur of respectability !

Sadly, infertile patients are so vulnerable and desperate, that they will sign up for anything which the doctor tells them will improve their chances. Lots of companies are peddling these potions,  which doctors are very happy to promote, because they get a huge chunk of the profits for doing these procedures.

Such a shame !


Sunday, July 02, 2017

Does it make sense to do a blastocyst transfer when you have only one embryo ?


This is a guest post from Dr. Sai, Chief Embryologist, Malpani Infertility Clinic Pvt. Ltd.

The biggest dilemma in IVF today is whether to transfer on day 2 or day 5, when we have only one embryo in the incubator.

When we have lots of embryos, the decision is very easy. We can sit back, culture the embryos beyond day 2/day 3, let the embryos compete and select the best ones for Embryo Transfer on day 5.
It keeps everyone happy - the patient, the doctor and the embryologist - since state of the art care has been provided.

On the contrary , when we do the transfer on day 3, we have a hard time selecting the best embryos for transfer, especially when we lots of embryos of the same quality. We arbitrarily select 2 or 3 embryos of the lot for the transfer, but are never satisfied and safe, as we always know that there is no guarantee that these would reach the blastocyst stage , no matter how good they look on Day 3.
 

We keep our fingers crossed for the 14 days post the day 3 transfer. If the beta HCG is positive and the patient conceives, we feel we hit the jackpot because we managed to select the right embryos, as they implanted.  But if it fails, we curse ourselves for not waiting and culturing the embryos till day 5.

So the best approach , when we have lots of Day 3 embryos, is to do a Day 5 Transfer, because blastocysts have a higher chance of implanting as compared to Day 3 embryos, since they have developed further. We can always freeze the spare blastocysts for future cycles.

 But what happens, when we have fewer Embryos?

Even with fewer Embryos, we feel the approach should be to transfer on day 5.

As we know , when we have fewer embryos, the possibility of freezing embryos is extremely low.  This is why we have nothing to lose when we culture the embryos till day 5 and look to transfer the best embryos. This is a better approach as compared to trying to hedge our bets by transferring some on day 2 or day 3 , and then trying to freeze the others for the next cycle.

For example:
If there are only 4 Embryos on day 2, all top quality, usually a defensive approach is to transfer 2 embryos on day 2 and freeze the other 2, in order to have another cycle.

The best approach would be to culture all 4 embryos till day 5, and then select the Best Embryo (Single Blastocyst) for transfer.  This way we actually increase the chances of conception . If we are lucky we might have a second blastocyst, which we can freeze for another cycle.
This way we not only increase chances of this cycle, but also have a gem for another one.

When we have only 1 Embryo, what should be the approach?

Even with 1 Embryo, the approach should still be to transfer on day 5.
With just 1 Embryo, one might feel, it's too risky culturing till day 5, as the embryo might get arrested at some stage and never reach blastocyst stage.

But we should not forget  that if the embryo fails to become a blastocyst in vitro (in incubator),  this means it would not have become a blastocyst in the uterus either , which means there would have been no point in transferring it on day 2 or day 3. We have just saved the patient the futile agony of the endless 2 week wait !

If fact , the advantage of culturing the single embryo till day 5 is that we can track its growth carefully, rather than just chuck into the uterus on Day 2 or 3 just to give the patient the satisfaction that we managed to get an embryo to transfer. Let's not forget that the patient wants a baby - not an embryo transfer !

If the single embryo becomes a blastocyst, all of us feel good, and we are hopeful about the result.  However, if it doesn’t become a blastocyst, this does cause short term heart break, but we haven't compromised the patient's chances, because this embryos would not have implanted even if we had transferred it into the uterus on Day 2 or 3, since it would never have formed a blastocyst in vivo either.



The other advantage of doing a day 5 transfer is that we know the fate of the cycle much sooner, as compared to doing the transfer on day 2 or day 3, where, we spend sleepless nights for 14 days till the beta HCG.

Yes, this requires a very high quality IVF laboratory and a skilled embryologist, and you need to make sure you select the best IVF lab for your treatment . There is a great feel good factor  in doing a day 5 Embryo transfer  for patients with only a single embryo, and good clinics will take pride in being able to do this !

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, June 28, 2017

The law against giving cuts in the healthcare system


I'm very pleased that the Maharashtra government is passing a law which makes the payment of cuts, kickbacks, and commissions to doctors an offense for which they can be punished. I've always been vocal about the fact that kickbacks have corrupted the medical profession and damaged the doctor-patient relationship. These cuts impose a burden on the honest doctors who refuse to give kickbacks ; and helps bad doctors who are willing to take shortcuts to enrich themselves. In the long run, it hurts patients as well , because the cost is passed on to them, and they end up paying for these under the table bribes.
A practise which was started by a few bad apples has spread wildly like a cancer, and caused irreparable harm to the reputation of the entire medical profession. Kickbacks seem to have become institutionalized , and it's become very difficult for an honest doctor to survive in private practice without giving these.
It's because this has been going on so blatantly for so many years that the government has finally had to step in and take stern action against this practice - or should I say malpractice ?
However, sometimes the cure is worse than the disease. Government actions may be well-intentioned, but they usually end up back firing, because all they are able to do with their ham-handed laws is pass regulations which punish offenders when they are caught. However, this is doomed to fail in real life, because kickbacks are exchanged between two willing parties ! How does one document the kickback? Who will complain ? and why would they ? and how would they prove the cut was given? And does one punish the person giving the kickback ? or the person taking it?
This is a difficult and complicated situation, and part of the problem is that the government is being short sighted by only addressing  the symptom , rather than the underlying cause of the disease. We need to step back , and rather than think about punishing people because they've given or taken a kickback, we need to think about what we can  do to remove the need to give kickbacks ! This would be far more productive  approach, because this is a better question to ask , and a more useful problem to solve.
The government needs to take enabling positive steps, rather than pass punitive legislation , which only punishes people after the event. Why not stop the event from occurring in the first place?
Let's go back to first principles. The only reason people give kickbacks is to increase their business. Thus, specialists need referrals from GPs, which is they give kickbacks to a family physician ; a hospital gives a cut to a specialist, in order to fill their beds; and pharma companies and medical device manufacturers want doctors to prescribe their drugs and products , which is why they incentivise them with commissions.
The government needs to get rid of the middlemen in the healthcare system, if it wants to clean it up !
The best way of doing this is to enable patients to reach out to good doctors directly. Then there would be no need for these good doctors to either give a kickback, or to accept one !
It's possible to do this digitally today. The government should publish an online directory of all qualified doctors registered with the Maharashtra Medical Council , or order the MMC to do so.  This would enable doctor discovery, so that patients would be easily able to find the doctor who is right for them , from the comfort of their home.
Obviously, a bare bone listing is not enough ! The doctors would be mapped, so that patients can make a short list of doctors who are in their locality, and start contacting them.  Patients would be encouraged to rate the doctors they have seen, so that other patients can get information about how patient-friendly the doctor is. These comments and ratings would be moderated, so that they are of high quality; and doctors get a chance to respond to complaints. This simple step would be a great way of introducing openness and transparency into the system, and doctors would be then far more likely to treat their patients better, because they know they are being evaluated by them online.
The next step would be to encourage doctors to have their own websites , and the directory could link the doctor's name to his personal website. This would allow patients to learn a lot about each doctor, so they could compare them without having to go physically to their clinic.  We have a new generation of young doctors who are willing to connect digitally; and we have empowered internet savvy patients, who don't want to waste time travelling to a doctor's clinic. A doctor's personal website will help to kick out the middleman by enabling direct doctor-patient communication, and this will help to create trust. Doctors will not be able to lie on their website, and this will help to keep them honest !
The government needs to provide Information Therapy on their website, so that this becomes a trusted source of reliable information about health and illness. It should become  the port of first call whenever any patient has a health related query. The site should be in local languages, and will allow patients to learn about their symptoms, diseases and  treatment options even before going to their doctor ! The website could cover lots of things, such as the average cost of medical procedures , so that patients are better prepared. It could also act as a nucleus around which patients can create online communities and talk to each other, thus helping each other when they are ill.
This is the kind of positive proactive patient friendly step which a government should take , because it has the power, the responsibility and the duty to do so, in order to keep its citizens healthy. This step will help patients to find the best doctor ; and help doctors to get patients without having to give kickbacks.
A progressive government will use technology cleverly to heal the healthcare system , by helping both patients and doctors.  This platform will help to reduce costs for patients, because they will be able to connect with experts who can provide video consultations. It will assist patients in small towns , as they will not need to travel to cities to get second opinions from leading experts. Junior doctors who have free time can create patient educational materials, and share these on the platform . This will help them to  attract more   patients . Finally, this will  also improve the productivity and efficiency of the interns and resident doctors in government medical colleges, who will be able to serve the needs of villagers remotely, by using leveraging telehealth tools, thus reaching out to the poor and underserved.
The government needs to adopt technology to empower patients and good doctors, rather than waste time passing laws which look great on paper , but never actually achieve anything because they're toothless tigers. Unfortunately, today our whole attitude towards doctors has become so negative , that we refuse to try to help them, and this is such a shame !

Sunday, June 11, 2017

Why is overtreatment of infertility so rampant?


Lots of Indian IVF doctors put their patients on anti-TB medicines . While some of them will do tests to decide which patients to treat with these toxic medicines, others routinely put all their patients on the drugs, irrespective of whether they actually have TB or not.  Thus, in the Ashvini Hospital of the Indian Navy in Mumbai, all infertile patients are put on anti-TB treatment " empirically".

I have often wondered why medical treatments which are completely unproven have become so prevalent. In this case, it's obviously not driven by financial considerations - after all, it's not as if the Navy doctor makes more money by prescribing this treatment !

The truth is that overtreatment is rampant because of a common fallacy which it's very easy for doctors to fall prey to. They suffer from skilled ignorance and unawareness. This is the fallacy of expertise , where they don't know what they don't know

If you give unnecessary treatment to infertile women who don't need it, lots of them are going to get pregnant. The point of course, is they would have got pregnant whether you'd put them on the anti-TB medicines or not, but you have no way of judging that.

Since all human beings are biased , and because doctors don't carry out controlled clinical trials, they naturally start believing that it was the anti-TB treatment which they prescribed which caused the patient to get pregnant. Patients also contribute to this misconception, because when they get pregnant , they go back to the doctor with a box of chocolates. When they don't get pregnant, they drop out. This is  why over-treatment has become so prevalent.

In fact, the same principle applies for many ineffective treatments. Thus, if you do IVF only for patients who actually need it, which is, for example, women with blocked tubes, then your pregnancy rates are going to be average. But on the other hand, if you start doing IVF for everyone who comes to you, whether they need it not, then obviously your IVF pregnancy rates will go through the roof, because then you'll start doing it for young women with unexplained fertility, or for women who are just getting anxious and didn't need IVF in the first place . These are the women who had an excellent chances of getting pregnant on their own even without the IVF.

However, when they do get pregnant, they tell ten of their friends that they got pregnant thanks to the IVF, so that the doctor gets even more patients ! This sets up a positive virtuous cycle, where the doctor ends up doing lots of unnecessary IVF , and achieves a high pregnancy rate because of clever patient selection.

The doctor then starts believing that his IVF pregnancy rates are far better than anyone else , but is actually deluding himself , because he is doing it for lots of patients who didn't actually require it ! However, this ploy means he starts attracting lots of infertile patients from the community , all of whom end up getting overtreated, because they demand the same IVF treatment which helped their friend to have a baby !

This is why IVF has become so overused and misused in some IVF clinics.

Not sure why your doctor is advising IVF ?

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, May 17, 2017

The many hats I wear


For most of my patients, I am just their IVF specialist.

However, I do wear lots of other hats as well - and if you are interested in what I do, you can follow my LinkedIn posts at https://www.linkedin.com/in/aniruddhamalpani/recent-activity/posts/, where I try to share what I am learning with the rest of the world !

Reducing IVF anxiety



Lots of patients are very scared of doing IVF. This is partly because they've heard lots of horror stories about how IVF babies are abnormal, or that the hormones will make them fat, or that if they grow too many eggs, they will either get menopausal sooner, or start getting ovarian cancer as they grow older. And, they've heard lots of horror stories from some of their friends, who've done IVF, about how painful the injections can be, or how many mood swings it causes, or the fact that you need bed rest or that there are lots of complications, or that the risk of miscarriage is higher after IVF.

There are lots of myths and misconceptions, and these obviously add to the patient's anxiety, because of the fear of the unknown, that you end up spending so much time, money and energy, and even after doing all that, not only may you not end up getting a baby, you may actually be worse off because of all the side effects you've put yourself through.

Somehow a lot of IVF seems very artificial and unnatural today, because patients think that you're doing stuff in the laboratory, you're manipulating things, you're doing stuff, which nature wasn't designed to do, as a result of which there are likely to be problems. They often don't trust doctors, and we tell them there won't be problems because most doctors will always try to reassure patients and their concern is that we're not aware of some of these long term side effects, or that we're trying to sell our treatment just because it's more profitable for us.

I think the only way of getting over all this anxiety and fear of unknown, is what I call information therapy. Patients need to read up about IVF from reliable websites so they understand what the truth is, and they can separate the myths, which are so prevalent and they don't get carried away by old wives tales, because otherwise they will end up depriving themselves of the best chance of getting pregnant, and regret this once they get older, and time doesn't come back.

You will find the free resources , which include an e-learning course at www.ivfindia.com very helpful !

You can download our IVF Comic Book free at www.slideshare.net/malpani/ivf-comic-book

Need more information about IVF 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, May 15, 2017

हिन्दी में आईवीएफ जानकारी


भारत में स्मार्ट फोन सस्ता हो गए हैं, और 4 जी व्यापक और सस्ती हो गई है। आधे से अधिक भारतीय आबादी अब ऑनलाइन है, और जब उनमें से ज्यादातर मनोरंजन के लिए स्मार्टफोन का उपयोग, वे भी जानकारी के लिए शिकार के लिए उपयोग शुरू कर दिया है। जबकि आम कारण सस्ते दामों पर और सौदों के लिए देखने के लिए है, उनमें से बहुत कुछ इंटरनेट का उपयोग कर रहे चिकित्सा समस्याओं के बारे में जानकारी खोजने के लिए। 

बांझपन आम चिकित्सा समस्या है जो 25 और 45 की उम्र के बीच लोग बुरा असर है - और इस समूह जो ऑनलाइन अपने समय के सबसे खर्च कर रहा है अब है। वे सख्त बांझपन और आईवीएफ के बारे में जानकारी के लिए देख रहे हैं। 

अच्छी खबर यह है कि हम कम से समझने के लिए हमारी वेबसाइट पर विभिन्न भारतीय क्षेत्रीय भाषाओं में, विश्वसनीय जानकारी आसान के 500 से अधिक पृष्ठों प्रदान करना है www.drmalpani.com , गूगल ट्रांसलेट का शुक्रिया। जबकि अनुवाद की गुणवत्ता अभी भी एक बहुत होना बाकी है, इस बांझ दंपतियों के लिए खुद को हिंदी में सूचना थेरेपी के साथ सशक्त बनाने शुरू करने के लिए के लिए एक महान शुरुआती बिंदु है, तो वे खुद के लिए सबसे अच्छा आईवीएफ क्लिनिक पा सकते हैं!

IVF information in Hindi


Smart phones in India have become cheaper, and 4G has become pervasive and affordable. More than half the Indian population is now online, and while most of them use the smartphone for entertainment, they have also started using it for hunting for information. While the commonest reason is to look for bargains and deals, lot of them are using the internet to find information about medical problems.

Infertility is the commonest medical problem which afflicts people between the ages of 25 and 45 - and this is the group which is spending most of its time online now. They are desperately looking for information on infertility and IVF .

The good news is that we provide over 500 pages of easy to understand, reliable information in various Indian regional languages on our website at www.drmalpani.com,  thanks to Google translate. While the quality of the translation still  leaves a lot to be desired, this is a great starting point for infertile couples to start empowering themselves with Information Therapy in Hindi, so they can find the best IVF clinic for themselves !

Why do IVF doctors abandon their patients?


Most IVF patients are mature enough to realize that the success rate in an IVF cycle is never going to be a 100%. No matter how perfect your embryos are; how good your doctor is; and how easy the transfer is , we still have no control over implantation, and cannot predict which embryos will become  a babies.  Patients come to terms with the risk of failure, because they know that doctors are not gods. 
However, they find that while the doctor can be extremely persuasive and charming when they go for their first consultation  ( because they are in sell mode and want the patient to sign up for the IVF treatment), when their IVF treatment fails, they often feel abandoned . They are desperately seeking answers, but they find no one is willing to provide them. 

When they reach out to the clinic, often the doctor's simply not available . When they try to meet him, they find  it's very difficult to get an appointment . Even when they finally get a chance to talk to him, they find he's very evasive, and refuses to provide any clear answers as to why the IVF cycle failed.  Even though patients understand that we can't always answer all their questions, they want to hear the truth from the doctor's mouth. The trouble is that doctors start equivocating, and come up with all kinds of flimsy answers which patients know are not truthful. 

The doctor who was very optimistic and hopeful at the time of the embryo transfer because he told you that they had created perfect top quality embryos for you, starts singing  a completely different tune when your cycle fails . He now claims that the reason for your failure is that " Your embryos weren't very good because your eggs weren't very good" and "Perhaps we should consider doing donor egg IVF for you, or surrogacy in your next cycle". Sadly, you don't have any photos of your embryos, and this advice comes as a bolt out of the blue . Patients are understandably upset, because the doctor is not being consistent and congruent.

This is why they start losing confidence in the doctor , and feel that they've been cheated .
When an IVF cycle fails, a good doctor realises you are hurting, and will proactively reach out to support you. He will invite you back , so you can analyse the cycle together, and  create a  plan of action for the future, based on what went right, and what needs to be tweaked.

Can't understand what your doctor is saying ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion and I will be happy to help you !


Sunday, April 30, 2017

Surrogacy ? or donor egg ?

I just received this email from a patient

My date of birth : 24/7/73 (43 years old)
My partner date of birth : 11/3/76 (41 years old)
Trying to conceive 4 years, since May 2013
One previous pregnancy in June 2013, first month of trying, ended in early miscarriage at 5.5 weeks.

Started IVF in September 2014 and have had 7 failed cycles to date.  Details below:

Cycle 1: October 2014

Gonal F - 600 units
4 eggs retrieved
1 fertilised with icsi
1 top grade 8 cell embryo (no fragmentation) was transferred on Day 3
No pregnancy

Cycle 2: April 2015

Fostimon - 600 units
Early ovulation before egg collection meant I lost at least 1 mature egg, but they still managed to collect 2 eggs
Both fertilised with IVF (we dropped ICSI on Dr's advice as sperm was good quality)
2 top grade embryos were frozen on Day 2 due to my progesterone levels being too high for fresh transfer as a result of early ovulation

FET Cycle: July 2015
The 2 embryos from the above cycle were transferred, both survived the thaw
No pregnancy

Cycle 3: August 2015

Due to early ovulation last time and poor response to stimulation, we opted for a mild/natural cycle
Fostimon/Merional - varied between 75-300 units daily
2 eggs retrieved, fertilised with IVF
2 top grade embryos transferred on Day 2
No pregnancy

Cycle 4: October 2015

Mild/natural cycle
Fostimon/Merional - 75/150 units daily
1 egg retrieved, fertilised with IVF
1 top grade embryo transferred on Day 2
No pregnancy

Cycle 5: February 2016

Mild/natural cycle
Fostimon/Merional - 75/150 units daily
2 eggs retrieved, fertilised with IVF
Both were frozen on day 2 as I wanted to try another cycle in order to batch together 3 or 4 embryos

Cycle 6: August 2016

Mild/natural cycle
Fostimon/Merional - 75/150 units daily
1 egg retrieved, fertilised with IVF
Top grade embryo, was transferred along with the 2 frozen embryos from the previous cycle (1 of these looked very weak after the thaw, but the other looked good, but they still transferred all 3)
No pregnancy

Cycle 7: December 2016

Fostimon/Merional - 600 units
4 eggs retrieved
1 fertilised normally with IVF
1 top grade embryo transferred on Day 3
No pregnancy

I then embarked on a 3-cycle package with a view to freezing and batching any embryos

Cycle 8 : March 2017

Fostimon/Merional - 450/600 units
4 eggs retrieved
3 fertilised with IVF
2, top quality embryos made it to Day 3 and were frozen 
(SO I now have one 7 and one 9 cell Day 3 embryos in the freezer)

Cycle 9: April 2017

Fostimon/Merional - 600 units
6 eggs retrieved
5 fertilised with IVF
5 made it to Day 3 (4 top quality, one lower as it has 50% + fragmentation) and we have for the first time ever decided to try to take them to Day 5 and see if I can produce any blastocysts.
As of today, these embryos are :  3 x 6 cells and 2 x 8 cells (one of the 8 cells is the one with the fragmentation which she thinks is likely to stop growing, and one of the 6 cells is a little elongated in shape but she said it still looks normal)

This brings you up to date as this last cycle is still active - we will know whether they make it to Day 5 by Tuesday.

Over laying all of the above I have had various immune work as I have ulcerative colitis, an auto immune disease, and so have been tested for NK cells/cytokines.

I have tried : Humira, Prednisolone, Intralipids, LIT treatment and also take clexane and aspirin in addition to the progesterone post transfer.

I hope this gives you a lot more information.  As you can see, we have few eggs/embryos per cycle but a very high fertilisation rate, with high grade embryos, but still none of them have led to a pregnancy. 

I am baffled as to whether this is an egg quality issue (I have been told this is probably the case due to my age - but I have been trying since age 39 and am a very fit and healthy person), or if it is a receptivity issue.  That's what makes it difficult to decide whether it's donor eggs (we are not keen on this) or surrogacy with my own eggs that we should be exploring or keep going with my own eggs/womb...any advice you can give is very much appreciated as we are desperate to have a family.
-------------------------------------------------------------------------------------------------------------------------

This is a very common dilemma many patients face, and they are very confused if they should change the uterus ( surrogacy) or change the eggs ( donor egg)

This was my answer.

 I am worried about your advanced age. This suggests you have diminished ovarian reserve, and this would explain your early miscarriage; as well as your repeated failed IVF cycles. Being fit or healthy does not translate into  having genetically fit eggs . As a woman grows older , her eggs accumulate genetic defects, because she does not produce any new eggs.

You can read more about this at http://www.drmalpani.com/knowledge-center/the-infertile-woman/oopause

Surrogacy is an expensive and complex treatment option, which is best reserved for women without a uterus, or whose uterus has been irreparably damaged. Research shows that the reason for failed implantation is much more likely to be genetically abnormal embryos ( because of poor quality eggs), rather than a uterine problem. The soil is passive - it is the seed which is active and is responsible for growth


I agree donor egg IVF is a very hard option to come to terms with, but this would maximise your chances of having 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 !




Monday, April 24, 2017

Do doctors charge too much ?


A doctor's income seems to have become an extremely sore issue in this day and age. Lots of people, right from the average citizen to the PM , feel that doctors charge way too much. Their belief is that medicine is supposed to be a noble profession,  and doctors should not allow their minds to be contaminated by base commercial considerations .  After all, doctors are highly educated professionals, and they should take delight in helping their patients to get better, rather than trying to maximize their income.
Lots of people believe that doctors have become too commercial and uncaring, and that their primary focus is on earning more, rather than providing good clinical care. This is why we are now seeing a backlash against doctors. They are getting beaten up by angry patients; the judiciary as well as the media are happy to criticise them; and  politicians are happy to pander to the masses by putting a price cap on procedures and medical equipment, so that they can make healthcare more affordable.
Doctors, on the other hand, feel very embittered that in spite of sacrificing the best years of their life burning the midnight oil in order to master medicine, they make a fraction of what corporate executives do. It burns them up that hot shot lawyers charge over 10 lakhs for making an appearance in court, irrespective of whether they open their mouth or not. They are knowledge workers, just as lawyers are, and yet people grudge them their fees. They can't understand why society uses such double standards when dealing with doctors. All a lawyer does is win a case, whereas a doctor can actually save your life - and how can anyone measure the worth of a life ? Doctors hare the fact that when a doctor messes up, judges are quick to  fine them crores of rupees, but when they perform life saving surgery, patients are reluctant to pay even a few thousand. Where's the justice in this ?
The problem is that we can't put a price on saving human life, which is why we expect doctors to be satisfied with compliments and gratitude. While these are great for enhancing a doctor's emotional income, how do they expect a doctor to survive on these ?
While an emotional income can be personally satisfying, how can the doctor use this to make a living ? He needs to pay money to buy a house to live in ; and send his children to school. Even if we wants to run a clinic to treat his patients, he still needs to buy the office space , the medical equipment, and pay the electricity bill.
The divide between doctors and patients is progressively widening. A doctor feels he gets grossly underpaid . No matter how many hours he may have spent in the middle of the night, struggling to save his patient's life, when the patient gets better, all he gets is gratitude. However, when the patient doesn't do well ( often for no fault of his) he becomes the patsy who is at the receiving end of the patient's ire.  This is why doctors feel they are getting an extremely raw deal.
There is no correlation between the amount of effort and time which he has invested in his career , and the return which he is now getting. This causes a lot of heartburn, and this is one of the reasons why doctors no longer want their children to become doctors anymore. They feel that all those years of hard work they have put in are never adequately compensated. Now it's not that doctors are greedy  - if they were, they would have become bankers - they are intelligent enough to have got into any profession of their choice ! They don't expect to roll in wealth , but they do want to make enough to be able to live comfortably.
I think we need to stop grudging them their fees. I agree there are a few greedy doctors, but by being miserly and by underpaying doctors, we're harming everyone in the healthcare system. It's because doctors are not paid well that they to resort to all kinds of underhand means in order to increase their income levels.
I think this is one of the problems we are seeing an epidemic of medical corruption today. It would be far healthier if doctors were paid freely and fairly for their professional services, and were given the value and the respect which they deserve.  Unfortunately, in India , we don't seem to value advice.  Thus, while patients are willing to pay surgeons a fat fee for doing an operation, they are not willing to pay family physicians for the advice they give , even though the advice may be far more valuable because it helps to save them from unnecessary surgery. Underpaying doctors just increases medical corruption because doctors can't live  on love and fresh air.

Saturday, April 22, 2017

All doctors need to become patientologists


Doctors take pride in mastering the scientific minutiae of medicine . On the top of the medical hierarchy are the super specialists - the ones who have a lot of technical expertise in a very narrow slice of medicine. They're usually looked up to by other doctors because they're the doctor's doctors. They know practically everything there is to know about their personal area of interest, and because they attract a lot of referrals, their depth of knowledge in their domain is enormous.

However, all this super specialization comes with a price. Because they are so focused on the little segment of medicine  which is of special interest to them, they sometimes fail to see the big picture. This is something which makes a lot of their patients extremely unhappy because they feel that these specialists have lost the human touch.

Doctors need to remember that while it's great to specialize - to be an interventional  cardiologist or a pediatric pulmonologist, they all need to be patientologists as well. They all need to specialize in learning how to take care of their patient's emotional needs.

Unfortunately, this key skill is often lacking. It's not as it doctors are not empathetic, it's just that this valuable trait is not emphasized during their training. In fact, residency can be very dehumanising, because the poor junior doctor is often made to work under conditions where he feels he is being treated like an animal. He is often sleep deprived, hungry, stressed, and subject to bullying by his seniors. It's high time we brought humanity back into the medical profession, and the first step in this direction is to handle young doctors more kindly, so that in turn, they also learn to treat their patients with tender loving care!

Thursday, April 20, 2017

Generic drugs vs branded debate



The recent move by the Modi government to make prescribing of generics compulsory has raised a lot of hackles. The objections have been pretty predictable. Obviously, the pharma companies are up in arms because they make most of their money from selling branded drugs. If this option is taken away from them, they're going to have to look for alternative means of generating revenue, and having to change a highly profitable business model is not easy for large corporates. Once the law gets teeth, it will no longer be business as usual, which is why they're upset. They are worried that their business will get commoditised and their margins will shrink. Since pharma CEOs are powerful , lots of observers are understandably cynical about the prospects of these new rules being implemented . Their belief is that they will be diluted so much that they will remain a toothless tiger.

Since the pharma companies guys can't complain directly that they are upset because this is going to eat into their profits, they are using doctors as their puppets. Doctors are upset with this move because they see this as an encroachment on their professional autonomy. They've been writing brand names for many years, and they don't see what they need to change an engrained habit. Yes, brand names are easier to remember, but the truth is that many of them get incentivized to prescribe a particular brand. They are obviously reluctant to say goodbye to this easy money. Also, they are worried that the locus of power has now shifted to the chemist, who will end up deciding which generic to dispense.

The general perception today seems to be that brands are of higher quality than generics. This is not true, since the active molecule in the drug remains the same - it's only the label which is slapped on it which changes. Yes, the government needs to make sure that the drugs are manufactured in a quality factory , and this is true for all drugs , whether or not they are generic or branded ! If you have a poor quality manufacturer, then whether he's marketing a generic molecule or a branded drug, its quality will remain equally poor . The FDA will have to become far more proactive , and as long as the medicines meet quality control standards, what the name on the box says makes no different at all to its therapeutic efficacy ! This is why private labels have become so popular in the FMCG industry - consumers are realizing that there is no point in spending extra on branding . This is as true for drugs as it is for FMCG products.

All pharmacology textbooks teach students and medical residents to prescribe generics. It's the active molecule which makes the drug effective, and this is what is drilled into the doctor's head during his training. The problem is that once a doctor starts practice, he forgets what his professors taught him, and gets influenced by the friendly medical representative, who is always welcomed because he comes bearing gifts.

There are many extraneous factors which come into play when a particular doctor chooses to prescribe a particular brand, but he never talks about this openly , because he's ashamed about the fact that he's not necessarily doing what's in the patients best interest. He needs to justify his actions, and the most convenient excuse is that brands are better than generics, even though he has no proof that this is true. He needs to salve his guilty conscience by bad-mouthing generics.

The healthcare industry needs to get back to basics . Pharma should focus on producing high-quality drugs at a reasonable cost, and stop wasting money on " marketing ". Once generics become mainstream, they will no longer need to employ an army of medical representatives to cajole and induce doctors to prescribe their brand - most of which are just "me-too" variants. This will help to reduce their marketing spends, because companies will not have to waste money on competing with other pharma companies for which particular brand the doctor chooses to prescribe. This is a step in the right direction , and we should all be pleased , because it'll make quality drugs more easily available to patients at an affordable cost. As with anything else, any time you change the status quo, some people are going to get upset, but over time this move will help to make sure that medicine is practiced more rationally and ethically in this country.

Pharmaceutical companies will now focus on improving the quality in their manufacturing plants, rather than wasting money on branding and marketing. Also, since they will no longer have to spend on cajoling doctors to prescribe their brands, they will be able to deploy this towards educating patients, so that patients are better informed about what medicines they are taking, and why.

Tuesday, April 18, 2017

How digital patient profiles can help doctors to understand their patients better


Service industries such as hotels use customer relationship management ( CRM ) systems extensively  in order to track the personal preferences of their clients , so they can provide them with high-quality services, tailored to their  individual tastes . Guest Experience  Management Systems allow them to delight their customers, allowing them to create guest loyalty. In order to do this efficiently, they need to capture a lot of  data about their customers, so they can learn more about their customer's needs and wants.  This is true even for websites like Amazon, who collect a lot of data about the past purchases of their customers, so they can customize what they display to each individual.
Why can't we apply these same lessons to medicine ? After all, patients are the healthcare industry's customers, and the more we know about our patients, the better the services we're going to be able to provide for them. Isn't it logical that we should have all this information about our patients at our fingertips whenever we do a consultation?
Ideally, whenever a patient signs up for an appointment, the EMR should be able to scrape online publicly-accessible databases and provide a summary about what her likes and dislikes are, so that the doctor is better prepared for the visit . Not only will the doctor be armed with the medical details about her illness, but will also have a better idea about what kind of  individual she is, and what her personality is.
Today, a good nurse or clinical assistant provides this information to the doctor just prior to the consultation , and this helps the doctor to create a personal connection with the patient. Over time, as we establish a relationship with our patient, we are able to understand our patients as unique individuals, and this allows us to create trust. Patients are comfortable with their doctor because they feel that he knows and understand them.
Why should it take multiple visits to create this bond?  We need to use technology intelligently  to help doctors to connect better with their patients , by helping them to understand their personal desires, wants and needs. This can help to strengthen the doctor-patient relationship, because the doctor will be able to see his patients as more than just someone who has a medical problem which needs treatment - he will see them as a fellow-human.  Wouldn't you be delighted if your doctor asked you about how your son was doing in school, because his EMR informed him that you had recently posted a photo of him winning the Math Olympiad on your Facebook page ?
Doctors today are often seen as impersonal and uncaring. Additional personal details about the patient will  make the doctor-patient interaction much richer, because it will help the doctor to connect better with the patient. It will encourage small talk and this kind of social lubrication can reduce the barriers  which impede doctor-patient communication. Most patients want to try to create a personal connection with their doctor, so that he will be more empathetic - let's help doctors to do this as well.  This is what made the family doctor of the past so special - he knew a lot about the family, and was often considered to be a part of it. We can use technology to create this same kind of magic again.
Interestingly, this kind of background information can help the doctor to provide better medical care. He can explore whether there is family support available at home; and who the caregiver is, so he can involve them in the treatment plan as well.
Perhaps when we ask patients to take an appointment, we should encourage them to fill in some of their personal details in the intake form, so we have a better sense of what their interests are. For example, they could add a link to their Facebook page, and this would help  doctors to improve their bedside manner by helping them to break the ice with their patients , since they now have some background information about their patient.
As William Osler  “The good physician treats the disease; the great physician treats the patient who has the disease.” Technology can help doctors to learn more about their patients !

Monday, April 17, 2017

When more is not better in IVF - IVF "add-ons" can harm patients

Finally, Dr Raj Mathur, consultant gynaecologist at Manchester Fertility and St Mary's Hospital, started by acknowledging that there does indeed appear to be a problem. Clinics advertise their use of add-ons as markers of quality or innovation, he said. With this comes a duty, however, to advertise responsibly, for example by placing the technique in its context and offering full information about it. Dr Mathur said that clinicians have a responsibility to protect their patients, who are at a heightened sensitivity and may be overly receptive to the claims linked to add-ons, and should take great care not to exploit unproven treatments for profit. - 

Read more at http://www.ivf.net/ivf/fertility-treatment-add-ons-do-they-add-up-o9895.html

Sunday, April 16, 2017

Is this a good quality embryo ?



We routinely show patients  their embryos before the transfer, and this can be quite an emotional moment for them. The commonest question they ask is - "Is this a good quality embryo?"
Of course, what they really want to know is if that embryo will become a baby, but they do realise that doctors aren't very good at predicting the fate of an embryo once we transfer it.
As a scientist , it's easy to explain to what a top quality blastocyst looks like; and that a eight-cell embryo with no fragments on Day 3 is a good quality embryo. However, from the patient's perspective , the only good embryo is one which becomes a baby !

The problem is we just cannot determine with today's technology which embryo will implant successfully and become a baby.

IVF technology has limitations , and both patients and doctors need to accept this gracefully. Thus, sometimes great looking embryos on day three will arrest on Day 4 and not form blastocysts on Day 5 in the laboratory. Conversely , we have embryos which look terrible on day three , and yet form good quality blastocysts.

The problem is that when we grade an embryo in the IVF lab, we have to depend upon eyeballing it - what does it look like ( the scientific word for which is morphology) .  How many cells does it have ? Are these cells equal and regular ? Does it have  fragments ? How fast does it divide ?  This grading allows us to select better looking embryos as compared to the ones which don't look so good, because we know the ones with better morphology have a higher chance of implanting. However, we still can't predict the fate of an individual embryo as yet. The problem is that implantation is a complex multifactorial biological process, which is affect by many variables which we can't tease apart. This is hardly surprising, given the fact that we are trying to follow the fate of a living ball of cells which we have put back in the uterus.

This is not for lack of trying. Thus , scientists have developed  additional technological tools such as PGS and CCS, where we biopsy the embryo to check its chromosomal constitution, because we know that aneuploid embryos ( those with chromosomal abnormalities ) have a lower chance of implanting.  Similarly, some labs use time-lapse technology in order to get a real-time video of how the embryo develops in vitro. However, while these tools provide additional data, none of them is clinically helpful , because it still doesn't answer the patient's million-dollar question  - will this embryo become a baby or not.

This can be frustrating not just for patients, but for doctors as well. Thus, we can say, "Okay, this particular embryo looks the best on day five." However , after we transfer it in the uterus, we can't track its fate, so that if doesn't implant , we can't pinpoint why it failed to do so . Did it stop dividing on Day 7 ? Or was the endometrium not receptive ?

This is what I call the " T plus 1" problem. While we can grade the embryo on that day, we don't know what will happen to it on the next day. Will it continue to grow well ? Or will it arrest ? Will the cells start fragmenting ? In the IVF lab, we have to live one day at a time, and there is no getting around this limitation as yet. In a perfect world, we would be able to grow the embryo to a baby in the lab, and then hand this over to the mother - a process called ectogenesis. However, we have not reached this level of sophistication as yet , except in science fiction

Having said this, it's still important that you have photographs of your embryos for documentation , so you can judge their quality. Other doctors can also look at your embryo photos and grade their quality. However, you do need to understand that not all good quality embryos will become a baby. Conversely, just because an embryo is of poor quality doesn't mean that it won't become a baby - and if it does, these babies are perfectly healthy and normal.

Need help in assessing the quality of your embryo ? 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, April 13, 2017

Fed up of being treated by assistants at your IVF clinic ?


I received this email from a doctor recently.

Dear Sir
I'm Dr BG, an orthopedic surgeon.
My sperm count is just 1 million per ml.
We have had 3 failed ICSI cycles.
In the first cycle , 10 eggs were retrieved and 5 embryos formed and day 5 blastocyst transfer  of 3 embryos was done. No embryos were frozen Second cycle 18 ova were retrieved, we got 8 embryos and 3 were transferred at blastocyst stage day 5.
In third cycle we changed our doctor, We got only 7 eggs 2 embryos and day 3 transfer was done
In all 3 cycles beta HCG was almost Zero.
Please guide us about what next can be done?
I'm very frustrated about the fact all the work in our cycles was done by the assistants of IVF experts. We felt that we were being treated by the assistants , and the IVF experts were just having an overview of treatment.
I'm very concerned about the fact that an IVF expert was not present at all the stages of cycle ; and was never actually involved in the process.
Please guide me and my wife about what we should do next.
Thanks and regards
Dr BG

Doctors are usually VIP patients, and get extra care and attention when they seek medical treatment for themselves. Imagine that if this is the way a doctor is being treated , how the other patients must be being mis-managed.

Sadly, this is the typical experience of most patients in IVF clinics today.

This is why we have made a conscious decision not to employ assistants. We provide all the treatment ourselves. We are  very hands-on, and this explains why our success rate is no high.

You can read about how we pamper our patients at http://www.drmalpani.com/knowledge-center/articles/pampered-ivf-patients

Is your IVF doctor always missing in action ? Are you looking for an IVF expert who will treat you himself ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




I am 43 - can I get pregnant naturally?


Since I provide free second opinion on my website, I get lots of queries from patients.  One of the common inquiries I get is from older women who want to know what their chances of getting pregnant are. Now, this is an easy question to ask, but as with a lot of simple questions, it can be extremely difficult to answer.
What a doctor needs to answer intelligently is the right context , and for this he needs more information.  The answer to whether a particular 43-year-old can get pregnant in her bedroom or not depends on many variables, such as : how long has she been trying to have a baby ; what the results of her fertility tests are; whether she's taken treatment before; and whether her cycles are regular or not.
This is why my usual response to this question is: I need more information ! I can answer intelligently only if I have more data, for which the patient needs to do some basic fertility tests. Remember that it's never the calendar age of the woman which matters - it's the age of her ovaries.  We know that as a woman gets older, her eggs start getting older, which is why her fertility drops, but there is no simple correlation between age and declining ovarian reserve , because every woman is different.
The problem is that individual women aren't interested in generalised statistics - they don't care about what happens to the other hundred 43-year-old woman who ask me the same question. They only want to know what's going to happen to them.
Our limitation is that doctors aren't fortunetellers , and we really can't predict for the individual patient what her future reproductive outcome is going to be - and this is true, whether she tries in her bedroom , or does IVF.
However, we do provide her with intelligent advice, customised to her situation, based on basic information such as what her antral follicle count and AMH levels are.  With this information, we can discuss her options with her. I do not censor information and try to be frank and forthright, but lots of patients aren't very happy with my bluntness . No one wants to hear bad news, but I think it's far better to be prepared so you can intelligently choose the option which works best for you, rather than waste time pursuing futile treatment. False hope can be very cruel !
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 12, 2017

Why being an IVF specialist is the best job in the world !


Patients need to use Dr Google wisely


Most doctors don't like patients who search for information on the internet . Their experience has been that because there is so much unreliable information on the internet , these patients get lost and confused; and are always trying to second-guess their doctor's advice. This is why they tell them to stay away from doctor Google ; and many doctors get irritated when patients bring a huge sheaf of printouts from dozens of website. Many doctors are convinced that all this online research is a waste of time, because patients don't have the maturity to be able to interpret the information they unearth. Not only do they lack context , a lot of the information they retrieve is of poor quality and outdated . The standard party line amongst doctors is that patients are worse off by going on the internet . They should instead just trust their doctor to do what's right for them.

In a perfect world , patients would be able to trust their doctor blindly, but we all know that this is not going to happen, because doctors have frittered away the trust patients used to repose in them. Also, the internet is always available , and it's perfectly natural that patients are going to use it, so it's quite silly to prohibit them from doing so.


When we tell our patients not to go on the internet, we are doing them a disservice, because we are throwing the baby out with the bath water.  All we need to do is to help our patients to learn to differentiate good sites from the bad ones . Patients also don't enjoy spending hours digging up medical information  when they go online - they'd much rather be watching movies on Netflix if they had a choice !  Patients will often get a headache when they try to do their research on their own, because they get confused when the come across conflicting information n different websites. They aren't sure whom to trust, and they resent the fact that their doctor is not willing to help them to separate the wheat from the chaff.

Doctors need to guide patients to go to  reliable websites - for example, those from Harvard Medical School; or Johns Hopkins; or the NIH ; or the UK NHS. This way both patients and their doctors confident that the information they will get will be updated, trustworthy and reliable. They should use these sites as the bedrock of their homework , and then build on this if they need more depth. This way they won't waste their time - and their doctors - by going to unreliable sites.

Yes, there are lots of unreliable sites online , but why do you need to worry about them if you're going to focus only on the reliable sites , which empower you with trustworthy information?

Need reliable information of IVF ? Check out www.ivfindia.com !

Monday, April 10, 2017

How to choose the best doctor


I am an IVF specialist , and when our patients get pregnant , they ask us to refer them to an obstetrician. The commonest question is, "Which obstetrician should we go to?" This is completely reasonable - after all , they trust me, and want me to refer them to a good doctor. Now , these obstetricians are my colleagues and friends, but I'm very reluctant to tell them whom to go to.
To get good care from the obstetrician during pregnancy, the most  important ingredient is the doctor- patient relationship, and the chemistry between the two should be just right. Rather than give them a name, this is the process I tell them to follow.

"Just assume for a moment that the technical competence of most gynecologists who have the right professional qualification is comparable . The key is that you need to find a doctor whom you feel is right for you. Make a short-list of at least two doctors . You can do this by doing a google search, or asking your friends for recommendations.  You then need to interview both these doctors. Pay for a consultation , and then pick which one you prefer . "

Do you like the ambience ? Is it close by ? Is parking easily available ? How communicative is the doctor ? How friendly is the staff ? Do the other patients in the reception area look happy ? How long do they make you wait ? What vibes do you get ? This should give you enough information to be able to pick and choose the one who is right for you."

"If you're still not sure , ask both of them this one question. "Why should I come to you as compared to going to doctor X?" Some doctors may take offense at this question , and that in itself is a red flag. After all , this is a perfectly valid question to ask , and patients do deserve an answer.

A good doctor will be happy to answer, and the right response is, "Yes, Doctor X is a good doctor , and there are lots of other doctors who will also take good care of you. However, I feel this is what makes us better. " This thoughtful response shows that he is mature; will not bad-mouth other doctors ; and is service oriented and keen to have you as a patient. This is the kind of doctor who you are likely to be happy with.

This is exactly the same model you should use when you are looking for the best IVF doctor 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 !





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