Saturday, October 07, 2017

Why IVF patients need to be optimistic !


Most IVF patients are extremely optimistic that their IVF cycle is going to work for them. If every patient didn't think in their heart of hearts that the cycle was going to be successful, no one would ever have the courage to start one. After all, a failed cycle causes a lot of heartache and heartburn . Patients are putting a lot on the line when doing IVF - not just in terms of money, but also in the form of hope, time and energy .
 
 They know that a lot rides on the outcome of the cycle , and because IVF gives them the best chance of having a baby , they're gather up all their courage and start off on a cycle. Of course, they're also very worried that the cycle may fail, and the ones who are realistic and well-read and have done their homework understand that the odds are stacked against them. After all, human reproduction is not efficient, and embryo implantation is a biological process which no doctor in the world can control. 
 
Even after knowing that the chances of failure are more than the chances of success in a single cycle, the fact that they're still able to go ahead does mean that they need to be highly optimistic. And even if this optimism may seem to be irrational, it's often the only thing which allows them to start a cycle. 
 
IVF is not an easy ride , and tests the emotional resilience and maturity of a patient. Lots of them are never be able to start another cycle when the first cycle fails because they had so much hope invested in the first one. That's why it's important to find the right degree of balance between optimism and realism when starting the treatment.  Patients need to be prepared that it can take 3-4 cycles to have a baby, and these patients will have the courage to bounce back and give it another shot even if their cycle fails.
 
I agree this is not easy, and every patient needs to find what works best for them. Yes,  it's important to hope for the best, but it's equally important to prepare for the worst , so you don't go to pieces in case the cycle fails.  This is why it's important to step back and take a long-term perspective . Even though an individual cycle may fail, we still have the ability to learn a lot from that failed cycle, and can use this information to improve your odds of success for the next cycle. 
 
It's important to think of IVF as a process which may take three or four cycles before it gives you the deeply-loved baby you want , rather than think of it as a single shot affair. Of course, in a perfect world , every IVF cycle would work, but then patients wouldn't need any counseling at all ! IVF technology has not brought us to that point as yet, so you need to be able to shield yourself from the possibility of heartbreak.

Unnecessary testicular surgery for the infertile man


A common fashion these days in some IVF clinics is to do TESE-ICSI for men with severe oligoasthenospermia ( low sperm count).

This is justified by saying that these men with " abnormal sperm"  have  high sperm DNA fragmentation, and this will result in poor fertilisation and poor quality embryos.

The solution they propose is extracting sperm directly from the testes, by doing a TESE, the theory presumably being that testicular sperm will not have as much DNA fragmentation because they are "fresh".
Of course, it also goes without saying that doing an additional procedure allows the IVF clinic to charge more !

This is complete rubbish, and TESE should only be done for men with azoospermia ( zero sperm count).

If there are sperm in the semen, then these should be used for doing ICSI - there is no need to use testicular sperm at all

Please don't let the doctor assault your testes for no rhyme or reason !

IVF scams never seem to end !


I am always impressed by how creative IVF clinics are - at cheating their patients !

The latest scam is " Biologically Active Peptide Concentrate or BAPC , to improve a thin uterine lining ! This is completely untested and unproven, but is being "sold" to patients as the latest and most advanced treatment !

It's scary how easy it is to take advantage of a gullible infertile patient's emotional vulnerability. All you need to do is to coin a clever new acronym, and start selling your product ! Pay the doctor a hefty kickback, and he'll be happy to "treat" his patients using your clever new innovation - even if it's no better than sterile water!

What can patients do to protect themselves ?

Tuesday, October 03, 2017

Why an IVF doctor is an active angel investor


I am a full time practising IVF specialist, which is why people sometimes wonder why I am investing in startups so actively. Why do I want to wear a new hat at this stage of my life ?

There are many reasons why I am very glad I have gone down this path.

I believe you remain young as long as you keep on learning new stuff, and while I know a lot about IVF, there's lots of stuff I don't know about many other fields. I am curious and I like learning more, and a great way of learning is by investing in start-ups . These founders are domain experts, who have the courage to have a contrarian point of view. They  think they can do a better job than the existing incumbents, which is why they're willing to challenge them. This requires a lot of conviction, and I learn a lot about the domains I invest in, thanks to them.  This makes life much more interesting , because practically everything I read is grist to my mill, and can be of use to one of my founders.  I need to be interested in what is happening in many domains, rather than be myopic and think only about what I need to do for my IVF patients.

I believe in the T-shaped model of leading life, which means you acquire a lot of expertise and depth in one particular niche, and then apply it to other fields. Angel investing allows me to do this. If you want to be a good angel , you need to be a well read philosopher ! Because I invest across many different domains, I need to keep up to date on what's happening in all of them, so I can have intelligent discussions with entrepreneurs. This is why investing is the last liberal art !

Neither of my daughters  is a doctor, and  while one is doing her MBA at Stanford, the other is working in a clean-tech startup in San Francisco after completing her Masters in Environmental Management in Yale. I need to be able to understand what they are doing, and I don't want to lose their respect just because I cannot decipher cash flow statements. Angel investing allows me to keep up with them !

One problem with being a doctor is that you tend to hang out only with other doctors, and as doctors get older, they get a skeptical and cynical. They are always complaining about how people don't respect doctors anymore; and how patients are always on the internet,  trying to second guess their doctors. They keep on reminiscing about the good old days, but these aren't going to come back, so there's no point in wallowing in nostalgia ! The problem with hanging out with pessimists is that you become pessimistic yourself, and start thinking that the world is going to the dogs.

It's much more interesting to think about the future, and what we can do to make it better. Entrepreneurs have to be optimistic , because they're willing to invest time and energy on tackling complex challenges. My hope is that their optimism will rub off on to me as well !

Life has been kind, and because I have been lucky to have a friend like Rakesh Jhunjhunwalla ( India's Warren Buffett), I have more than enough money to be contented and happy.  Making more money is not going to change me or my lifestyle, so I would rather invest in startups, even though they are a riskier asset class. My investment in them has the potential to create much more good, especially because I have a soft corner for social impact investing. If I can help the next generation of entrepreneurs to make the world a better place by funding them, this is the best use I can find for my money ! This is why I find angel investing  very rewarding, and look forward to being an active angel investor in the future as well.

My next post will be on why being an IVF specialist helps me to become a better angel investor ! Stay tuned...




Monday, October 02, 2017

The poor infertile man


Male infertility is common, and is usually responsible for about 40% of all infertile cases. The commonest reason is the low sperm count, also known as oligospermia.

What breaks my heart is the poor quality of treatment which these men get. Typically, they go to a gynecologist who has no clue about how to deal with men , because all they do is deal with women. However, when confronted with something they don't understand, like most doctors, they mindlessly tick off lots of boxes on a laboratory order form, to "investigate" so they can make a "diagnosis". They usually order a panel of tests , including hormone levels ( such as FSH, LH, prolactin, tesosterone); karyotype                   ( chromosome test ) ;  and a doppler ultrasound ( to check for a varicocele). However, none of which these are any use whatsoever in a man with a low sperm count ! The very fact that the man has some sperm in his semen means all his tests are going to be normal ! Most minor abnormalities are of no clinical importance.
Even worse, these results don't provide any actionable information , because there's nothing we can do to increase the sperm count ! However, doctors are never happy just prescribing tests - they love to " treat" as well ! They advise a lot of lifestyle modification measures, such as eating a healthier diet; doing more exercise; taking cold water showers; wearing boxer shorts; reducing stress levels; taking holidays; as well all kinds of empirical therapy , such as antioxidants . All this expensive rubbish doesn't help with improving the man's fertility at all, but just ends up making him feel persecuted. Yes, a man's sperm count will occasionally increase , but this hardly helps - fluctuations in the sperm count are very common, even without treatment.
However, all this therapeutic meddling makes the poor man's life hell. As it is, he feels inferior and inadequate, because he can't get his wife pregnant - something which any normal man should be able to do with ease ! His low self-esteem just gets worse, and he blames himself for being the cause of his wife having to suffer taunts from the rest of the world.

Even after complying with all the onerous restrictions placed on him ( no social drinks, and not even an occasional smoke), most of the time there is no improvement in the sperm count at all. This is when he loses confidence completely in all doctors.

The man with a low sperm count should just accept the fact that there are lots of things doctors don't understand. One of these is why men have a low sperm count, which is why we can't do much to increase it.
If you are one of those unfortunate men who does happen to have a low sperm count, please stop beating up on yourself. Make sure you repeat the test again, preferably from another more reliable lab , to confirm the diagnosis. However, if the results  remain persistently poor, then your options are limited.

Some gynecologists and IVF centers will refer you to an andrologist , who's supposed to be a specialist in treating male infertility. However , the reality is there's very little this specialist can do for you.  Good andrologists will be honest and tell their patients, "Look, there's no point in wasting your money taking all the empirical therapy we're going to give you. It's far better to just go on and do ICSI".

However , this is not something which most patients want to hear, and they often pressurize the doctor into writing medicines for them. When the doctor can see the patient twist his arm for a prescription, he is happy to write this, so he can move on to the next patient , rather than wasting his time on these hopeless cases , for which he knows he really can't do anything. However, this means that another three months of the poor patient's life is wasted, and his poor wife keeps on getting older !

Sadly, the torture doesn't stop even after starting the right treatment, which is IVF/ICSI . If the embryo is of poor quality and the IVF/ICSI  cycle fails, many doctors blame the failure on the poor quality of the sperm, and suggest to the man that they use donor sperm the next time ! This is plainly ridiculous, since the only reason for doing the ICSI in the first place was the poor sperm . When doing ICSI, we need only 1 sperm to fertilise 1 egg , and it doesn't matter how poor quality the semen sample is at all !

The reason for poor quality fragmented embryos is much more likely to be a poor quality lab, but the doctor blames the man for this, and does even more pointless tests, such as sperm DNA fragmentation, to prove to him that the "fault" is his, and that it his poor sperm which are responsible for the IVF failure !

Saturday, September 30, 2017

Empirical therapy in IVF - good , bad and ugly


Doctors are very fond of prescribing treatments, and a lot of these are empirical - based on their personal clinical experience. This is especially true in IVF , because there's so much we don't understand about reproductive medicine. Thus, when we say someone has failed an IVF cycle because of " failed implantation" , this is just a label to disguise our ignorance , because we cannot study embryo implantation in utero.

The truth is that we have no idea why the embryo failed to implant, but patients don't want to hear the truth. This is why doctors don't want to admit that we are clueless ! The patient is very anxious, and if you acknowledge you are not sure , the patient will go hunting for a second opinion, because they want a doctor who can inspire confidence !

This is why empirical therapy has become so prevalent.  Empirical therapy simply means therapy based on experience. Its efficacy hasn't been verified by controlled clinical trials , because these are quite expensive .
Empirical therapy is of two type - good and bad.  Good empirical therapies are usually cheap, inexpensive, short-term and have no side effects. Thus, prescribing a 15-day course of antibiotics for a patient whom you suspect has endometritis is unlikely to do much harm.  Yes, it may not help, and that's something the patient needs to be aware of.

The big problem is that there a lot of very expensive empirical therapy as well, some of which can be harmful. Thus, many IVF specialists put all their patients on 9 months of anti-TB treatment based on unreliable TB PCR tests . Patients are subjected to expensive, time consuming treatment which can have a lot of toxicity - and this also harms the community by causing the spread of drug-resistant TB. You can read more about this at http://blog.drmalpani.com/2015/03/laboratory-tb-versus-genital-tb.html

Lots of other "treatments" are very expensive , and have many side effects . These include stuff like intravenous immunoglobulins ( IVIg); paternal lymphocyte immune therapy for treating " high levels of NK cells" ; intralipid infusions; and  PGS. It's a long list and that's why it's very important to explain to patients before starting  that this is therapy which has not been proven. The doctor needs to be honest and say, given the fact that we have limited options, we'd like to try this on you . However, we need to get informed consent from patients that this is treatment which has not been established as being scientifically sound because we don't have enough data, but if you want to try it, we're happy to go ahead and do this for you.

Sadly, most doctors don't do this, which is why IVF patients end up wasting so much money on wasteful and useless tests and treatments.

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 !





TB PCR testing is a waste of time and money, and causes harm

A patient just sent me this email

Sir I have 5 year baby girl...I have started treatment for conceive second baby before 4 year. ...but unfortunately I m not getting result... doctor give mi advice for doing laparoscopy because of both tubes are blocked.i have done laproscopy in april. after laproscopy I have try natural conceive for but result was not getting gud....I forgot to take report of tbpcr ...I was called the report in august.and unfortunately my tbpcr is come positive.and I was take AKT4 near about 15 days.but this medicine not suit to me.i stop medicine...and same month I conceive baby....I confused .....what I can do...baby pregnancy continue or abort.plz  give mi advice.thanku 
This poor patient never had genital TB, and was mis-diagnosed as having TB because of the TB PCR test result, which is extremely unreliable, because it is riddled with false positives .
Read more about this at http://blog.drmalpani.com/2015/03/laboratory-tb-versus-genital-tb.html

She fortunately decided to stop the medicines on her own, and then promptly got pregnant - without any medical "help".

However, she is now worried that her "TB" will harm the baby, and is thinking about terminating a completely healthy pregnancy.

Gynecologists should be ashamed of the harm they are causing to their patients by this kind of irrational prescribing !

Thursday, September 28, 2017

The futile quest for certainty in IVF treatment.


Every couple who does IVF wants to get pregnant in the first cycle, and of course, every IVF doctor wants their patients to get pregnant in the first cycle as well ! It's very fulfilling to be able to add so much happiness to your patients' life by giving them a deeply loved baby, and if we had a 100% success rate, our life would be much easier !

Unfortunately, our IVF technology still has a long way to go .While we're good at doing certain things, there are lots of gaps in our knowledge . This is especially true after we've transferred an embryo back into the uterus. This is literally a black box , and we have no idea what's going to happen to the embryo in utero.

Implantation is a biological process which we cannot study in vivo . Since you're putting a live embryo back into the body , we have no non-invasive way of being able to monitor its progress or track its fate .

We need to be mature and accept the fact that our technology has limitations. We don't have answers for all our questions, , and we need to learn to live with this uncertainty .

However,  this is something which patients are unhappy about. They desperately want answers, and they will often ambush doctors into providing these answers. They will often unknowingly push their doctors into ordering lots of completely pointless and unnecessary tests. Doctors then add insult to injury, by offering " treatments " based on these " abnormal" test results.

It's easy to justify these tests saying, " These tests will give us more information," but the bitter reality is they don't provide any useful clinical information at all , whether it's PGS ( preimplantation genetic screening)  or ERA ( endometrial receptivity assays) .  While these maybe useful research tools, they  should be used only during clinical trials, and patients should not have to pay for the privilege of serving as guinea pigs !  Some Indian doctors are so creative that they offer tests which are available only in India ( such as PAMP testing) because these have never been validated anywhere else in the world !

While these tests may seem to make  a lot of scientific sense, sadly many of the equally logical treatments  touted widely in the past have failed to live up to their original hype - and this includes treatments such as paternal lymphocyte immune therapy;  or intravenous immunoglobulins ( IVIg);  or NK cell testing  -  it's a long list of useless tests and wasteful treatments.

This is why patients should be extremely careful before accepting the justifications which doctors trot out for justifying the use of these tests. The standard reply is - In my experience, it's helped other patients, so let's try it for you ! Any treatment can be justified by calling it empirical treatment - treatment based on experience, but not on evidence.

Fads and fashions come and go in medicine, and they change every few years, but the reality is that none of these treatments have been proven to be of any value at all. I think it's unfair that doctors use their patients as guinea pigs and try out  all these expensive and unproven experiments on them. Even worse, they charge their patients an arm and a leg for carrying out treatments which have not been  proven to be effective.

Yes, doctors would also love to attain certainty, and this is great if you're a researcher in a laboratory where you want to explore reproduction and embryo implantation in a mouse model - after all, that's the job of a researcher. We need to advance our understanding in the laboratory so we can apply this in the clinical setting.

However, clinicians should not be doing this kind of research outside of clinical trial, and it's completely unfair to patients who are being used as subjects of clinical trials.

Doctors add insult to injury by charging them for interventions which have not been proven to be effective in clinical practice, Not only do doctors need to shape up and improve by being more open and transparent with their patients, patients also need to start pushing back when doctors suggests these tests and treatments ! Please ask for medical journal articles from reputed medical journals, which prove that the .treatment being offered has been proven to work in a controlled clinical trial !

Want to make certain your doctor is giving you good advice ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Tuesday, September 26, 2017

The ovarian rejuvenation scam using PRP


I had this email conversation with a patient recently
Greetings. Writing to you from Mumbai. I am 40 years old with an extremely low AMH  and regular periods. Wanted to find out if you are doing ovarian rejuvenation using PRP ( platelet rich plasma) ? If yes, how do I go about getting in touch with your team ? I know doctors are doing it in Gujarat, Hyderabad and Chennai but not sure if anyone is doing this in Mumbai. Kindly revert at the earliest. 
I wrote back to her :
This is now the latest scam in IVF and reproductive medicine. Doctors offer to inject autologous "stem cells"  ( derived from the patient's own blood) into the ovary, with the promise that this will "rejuvenate" old ovaries and get them to start producing young eggs again.
Doctors are promising older women that they have now found the "elixir of life", and will be able to help them to have a baby, even though their ovaries are no longer producing any eggs.
The truth is that this just does not work, and these unscrupulous and unethical doctors are taking their patients for ride. They are using them as guinea pigs - and even worse, charging them for the privilege of serving as experimental subjects !
She replied :

Dear Dr Aniruddha,


Thank you so much for replying. My husband is also not a fan of this experimental treatment primarily happening in Greece, California, New York and a few places here and there. He doesn't believe in it. But Dr I am a part of a patient community and online forum, and lots of ladies who have  done PRP claim that their hormones have balanced out , and their AMH has also increased. Maybe it's a temporary increase , but I am really tempted to try it. I have even heard about PRP done in the endometrium, which helps strengthen the lining. My husband feels that this is just a fad and I should not go for it and stick to tried and tested fertility treatments but I am still confused with all this information coming by way. 

This was my reply :

Don't trust everything you read on online bulletin boards ! Many of these so-called patients are actually agents of the IVF clinic , who are paid to post positive reviews for them. The reviews are false and designed to deliberately mislead.
Please use your common sense ! If this really worked, then wouldn't all IVF clinics offer the treatment to their patients ?

The problem is that it's easy to take emotionally vulnerable , desperate patients for a ride - after all, hope lives eternal in the human breast !

Patients will continue getting cheated by crooked doctors out to make a quick buck at their expense, because good doctors don't speak up against these unethical and unproven practices ,and allow their patients to be duped !

Monday, September 25, 2017

Why are we seeing an epidemic of new IVF clinics in India?


There seems to be a new IVF clinic starting in practically every nook and corner in every town in India. Why this sudden spurt of IVF clinics coming up all over the place? Is it that the number of infertile couples has increased so dramatically that the requirement for IVF has gone up so sharply?

The reason is actually far more crass and commercial. Senior obstetricians and gynecologists who are tired of delivering babies and hysterectomies want to do something new and different and cutting-edge. Many think IVF is a very lucrative field, and rather than referring their patients to an IVF specialist and  losing all that potential income, they feel, "Why don't I just start an IVF clinic myself? After all, how difficult could it be? I've been a gynecologist for so many years, and with my expertise and experience, I am sure I could IVF equally well ! "

Because so many gynecologists want to get on the IVF band wagon, lots of companies have sprung up which are happy to help gynecologists to set up their own IVF clinics. They do this on a turn-key basis, and their charges vary from Rs 10 lakhs to Rs 1 crores, depending on the pay capacity of the gynecologist. This means that you make your payment, and you have an IVF  laboratory set-up for you in a few weeks !  You then just have to attend a workshop, or two, get trained in doing IVF in a few days, and you can call yourself a gynecologist and IVF specialist ! No one can stop you from doing this in this great country of ours, because no one really checks to see whether you have the adequate training ; skills ; experience ; expertise; manpower; or equipment to actually do the IVF for your patients. Once you are ready to go, since you are a practising gynecologist, you already have a captive patient population, and can start doing IVF on them .  In India, it's perfectly acceptable to use your patients as guinea pigs - they are trusting and naive, and don't know any better. And if you want, you can always hire a traveling embryologist and a visiting IVF specialist to come and do the IVF procedures for you, if you don't want to do them yourself !

As long as you're making money, everything's hunky dory , because no one really cares about your success rates - and no one is going to check them ! The tragedy is that this has been going on now for many years now, and the pace has been accelerating over the last four or five years. Sadly, medical colleges don't provide IVF treatment to their patients, which means most MD gynecologists don't have any practical exposure to doing IVF, or even seeing IVF patients.

Finally, it's the poor patients who end up being been taken for a ride . They don't understand any better, and they assume that any doctor who calls himself an IVF specialist must be a good doctor, especially when they're so senior and have been practising a gynecologists for so many years. Sadly, the government of India has turned a blind eye to this exploitation of infertile couples, so that even though the Indian Council of Medical Research is supposed to regulate IVF clinics and make sure that they have the equipment and expertise which is required, they do this purely on paper only.

Most IVF clinics in India do not have the infrastructure or manpower needed to do IVF, and the majority have not even bothered to register with the ICMR, and yet they continue functioning merrily. The Law which was supposed to regulate IVF in this country in order to protect infertile patients is still on the back-burner, and no one knows when it's ever going to be passed. As a result of this, infertile patients continue being taken for a ride, and this is tragic , because doctors who should be speaking up are all keeping quiet, because we don't want to speak any ill of our colleagues.

Indian patients cannot rely on either the government  to protect them; or on doctors to regulate themselves. They need to learn to ask their doctors pointed questions about the IVF treatment they offer , otherwise they will continue being exploited.

The good news is that you need to ask only one question to find out if your IVF doctor is any good. The simple question you need to ask is - Do you give photos of embryos before transferring them ? If the doctor says no, this is a red flag , and means this particular laboratory is not well equipped. If you don't want to get cheated, you need to find someone else !

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, September 21, 2017

Is it worth transferring poor quality Day 3 embryos into the uterus?



Some patients will end up with all their embryos being of poor quality on Day 3, and then they're not certain what to do. Traditionally , most doctors will want to put all of their embryos back into the uterus as quickly as possible , no matter what their quality.

After all, once they've done an embryo transfer, they can tell the patient, "Look , I completed your IVF treatment, and have done everything humanly possible " , so the patient is happy that the doctor did a good job. Of course, it's highly likely that the cycle will fail, but then they can say - Yes, your embryo didn't implant, but that's your bad luck/ kismet/ karma. We now need to study the reason for the failed implantation, so we will run additional tests, so we can improve the chances of embryo implantation for the next cycle."

Unfortunately, this just creates false hope for the patient , and causes a lot of harm.  After all, we know that the chances of poor quality embryos implanting are very poor, and that the reason for the failure was the poor quality of the embryos. However, after the failure, they convince the patient to go through a battery of very expensive, exotic tests , to check her uterus and her immune system, to make sure that her body is not "rejecting" her embryos. These don't provide any useful information at all, but it's not hard to take IVF patients for a ride, because they are so emotionally vulnerable .

So why do doctors do this ? This is because they're not confident about the skills of their own IVF laboratory. However, it's easy to justify transferring on Day 3 ( and even Day 2) by telling the patient - Rather than throw the embryo away, isn't it better to at least put it back inside your uterus ? This way you have a chance, even if it's low?

Ideally, these embryos should be grown to day five blastocysts, and if they arrest in the laboratory before this point, then there is really no point in doing an embryo transfer at all. After all, once the transfer has been done, we create false hope  in the patient, because she's optimistic that she may get lucky and the cycle may work for her. When it doesn't , she is heartbroken , and her willingness to start another cycle drops dramatically , because she has lost confidence , either in the doctor and in her own body.

Much more importantly, the ability to learn from the IVF cycle has been wasted. After all, once you put an embryo back in the uterus , you have no idea what's going to happen to it. On the other hand, if it's in the incubator,  we can monitor it. If it arrests, we can at least tell the patient, "Look , this is the reason why you are not getting pregnant". We can analyse this intelligently, so we can focus on what's important , which is usually the quality of the egg , rather than worry about uterine receptivity.  The truth is that the uterus is usually a passive recipient, and it's very rare that the uterus is the reason for failed implantation, especially when poor quality embryos have been transferred.

So why send patient on a wild goose chase? Why not be upfront and honest with her? This is because most gynecologists don't understand much about embryology , and they don't have full time qualified embryologists who are able to grow embryos to day 5 routinely in the lab. This is because many of them depend on traveling embryologists, who don't have the time or energy to culture embryos all the way to day five. Taking all these shortcuts ends up harming the patient.  Yes, of course patients do get pregnant after Day 3 transfers, but these are good prognosis patients, and it's not right to confuse the two.

Yes, if the embryo arrests in the lab , this does cause a lot of short term heartache, but it gives us valuable information , so we can make changes and maximize the chance of achieving a pregnancy in the next cycle. Patients may have to suffer some short term pain to achieve long term gains.

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 !





Sunday, September 17, 2017

The stem cell therapy racket in India


The stem cell therapy racket in India from Dr Aniruddha Malpani

This is the presentation I gave at the Academy of Clinical Embryologists of India Conference held recently in Hyderabad, India

Wednesday, August 30, 2017

Indians in the Gulf and infertility


One major problem which confronts Indian labourers in the Middle East is that of involuntary childlessness. Because they are forced to leave their wife behind in India, many of them get to spend only 1-2 months every year with their spouse. This obviously means that their chances of getting pregnant are very slim, as a result of which they are often labelled as being infertile. Now while they may not have any medical problems, this childlessness causes major social issues.

The wife feels inadequate, lonely and incomplete; and has to suffer all the taunts of her neighbours, because she doesn't have any children. The poor husband feels guilty, because he cannot do anything about this. This marital distress causes a lot of disharmony, and makes a bad situation worse.

Also, as the woman gets older, her fertility starts declining, and her chances of needing medical  assistance to have a baby go up as she ages, and her egg quality starts dropping.

Often these couples will seek medical assistance when the husband comes to India on his annual holiday, However, the care they receive is often poor and inadequate. They need to understand that time is at a premium for them, because if she does not get pregnant in this visit, she will have to wait for another year to try again.

For these couples, it's important to go to an infertility specialist, so he can expedite the process , without wasting valuable time. Ideally, the tests should be completed even before he comes to India, so no further time is wasted. The good news is that the tests for fertility are simple and inexpensive, and can be completed quickly.

For these patients, rather than wait for nature to take its own course, it's important to assist nature, so that they can complete their family as soon as possible. This is where IVF comes in, and the good news is that IVF treatment is easily available in India now, and the treatment can be completed in 15 days. We suggest that the husband freeze and store his sperm, so that the treatment can proceed in his absence as well.
Because the number of IVF clinics has risen steeply in India, this makes ‘choosing the best’ all the trickier. While most IVF doctors attract patients based on their marketing or word of mouth publicity, it is highly advisable that you undertake research before opting for any IVF doctor.

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










Tuesday, August 29, 2017

Infertility is not your fault!


Lots of infertile  women are depressed  because they think life is being very unkind to them. The fact that beggars can have children at the drop of a hat, but they can't even perform such a basic biological function ( which millions of others can perform effortlessly ) hurts their self-esteem. This spills over into other parts of their life, and affects their personal relationships and their professional productivity as well.
Their unspoken plea is – ‘Why me?  After all , I haven't hurt anyone, and am likely to be a good mother, so why is God punishing me ? ' They start blaming themselves, and believe it must have been something they may have done in the past ( or in an earlier lifetime !) which is causing them to become infertile.

  You need to stop beating up on yourself - infertility is a medical problem, and it was not caused by something you did or did not do ! God does not punish anyone, and you need to learn to look at your problem more objectively, so you can deal with it constructively.

1)            Take control
While this can be a distressing diagnosis, at least being able to put a name on the problem can help you take a step in the right direction to solving it. The good news is that there are many options available for family building - both medical and non-medical - so you can start exploring this. You don't need to remain a passive bystander or leave everything upto fate !

2)            Learn to be kind to  yourself
Stop blaming yourself , and don't mull over the past or wallow in self-pity. Playing the "woulda, coulda, shame" game just makes a bad situation worse, and doesn't change matters. You need to move forwards, and remind yourself that  this is a medical problem which needs a medical solution - and the good news is that this is now easily available.

3)            Talk to your friends and family
Sharing your feelings with your loved ones is great way to help you get through the grief.  Let your family and close friends be the support you need through this tough time and instill positivity around you. Keeping a personal diary and journal can also help, as it allows you to vent safely. You can also find lots of other infertile women online, who will support you without being judgmental.

4)            Be Proactive
Stop thinking about your past and start working on your future.  While the final outcome is not in your hands, if you do your homework properly, you will have peace of mind you did your best.
Staying positive is a big step towards leaving behind the self-blame game. Infertility is difficult to handle,  but with internal positivity and external support, you can find a solution !


Tuesday, August 22, 2017

Dr Anjali Malpani interviewed in Mid-Day on problem of rising infertility in Mumbai

In this city of dreams, conceiving a child seems to have become a nightmare for more and more couples, data procured through the RTI Act has revealed.
Statistics show that in the last five years, since 2012, more than 32,000 people have opted for in vitro fertilization, pushing worried doctors to sound the alarm - changes in lifestyle is to be blamed for the rise in infertility among Mumbaikars.

Thursday, August 17, 2017

The hurtful things people say to infertile women

One of the hazards of being infertile is having to cope with all the unsolicited advice you get from friends and relatives.

Anyone who has had a baby thinks they are an expert on babymaking, and they are happy to give you tons of gratuitous and uncalled for advice

They are often completely clueless about the basics of reproduction, but they believe that since you are not able to have a baby , you are the one who must be clueless, and they are happy to tell you how they got pregnant, so you can follow in their footsteps !

They will tell you all about the "fertile time"; how and when to have sex; who the best doctor is; and how their cousin got pregnant after going to a temple in Varanasi.

Please don't get irritated when they share this rubbish.

Yes it can be painful and hurtful, but remember that most of them are doing with good intentions. It's because they care for you and want to see you happy that they offer this well-meaning advice. Sadly, they don't understand how much pain they inadvertently cause you; or that a lot of the suggestions they offer are just old wife's tales, and are factually wrong !

Just nod politely ; smile and thank them for their concern and interest; and tell them that you are taking all the right steps by going to a medical expert, so they stop haranguing you.

If you feel they are doing it to harass you, then you need to fight fire with fire ! Ask them to show you their MD degree;  or offer to pay their medical consultation fees for all their expert advice - this will make sure they understand that it's best for them to keep quiet, rather than to hassle you !

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 !


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