Friday, August 17, 2018

Complications and risks of IVF treatment



Most woman are worried about the possible risks and complications of doing IVF treatment, but part of the problem is the many myths and misconceptions which plague IVF . Thus, it is clear that IVF doesn't increase the risk of birth defects and it won't cause breast cancer or ovarian cancer, but lots of websites continue to disseminate this misinformation.
However, as with any other treatment, there are potential complications and this is why selecting a good IVF doctor is so important. One of the possible medical  risks is that of ovarian hyper-stimulation syndrome ( OHSS), but in a well-managed clinic, this risk should be virtually zero.
This is why it's so important that patients understand the medical details about their treatment , so they can check if their doctor is doing is following best practices. Obviously , the risk of complications is much higher in a poorly run clinic which doesn’t  have enough experience or expertise to monitor each patient properly .
There are other medical risks , and a clumsy doctor could cause bleeding , or an infection , after the egg collection . There is also the risk of multiple pregnancy, especially for clinics who transfer too many embryos .
Finally, there is a potential risk for an ectopic pregnancy , which means the embryo, instead of implanting in the uterus , may implant in the tube and this is not something which any doctor can do too much about.
Being actively involved in your treatment will help you reduce the risk of complications , because you can make sure that you go to a good clinic , where the complication rate is going to be lower because they know how to provide high quality care .
In reality, the most important complications of IVF are not medical ! They are the emotional trauma which patients go through, especially when the cycle fails ; and the financial risk, which means that in spite of spending all that money , there is no surety that the patient will get pregnant.
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Test tube baby clinics - quantity over quality




Many IVF doctors take pride in the large number of patients they treat , and they boast about the fact that they do a huge number of cycles every month .
While this may be great for their bragging rights - and their bank balance - this is often not in the patient's best interest , because these clinics are often like assembly line factories , where everyone is treated with exactly the same rigid protocol.
There is very little personalization , and no hands on care , because the doctor is so busy doing one procedure after another , that he really doesn't have the time or the energy to focus on you.
This is extremely unfair on patients , who end up feeling cheated , especially when the cycle fails.
 To add insult to injury, the doctor comes up with all kinds of flimsy excuses and reasons as to why the cycle failed – and to make matters worse, often ends up blaming the patient’s eggs ( and/or sperm and/or uterus) for the failure. He then suggests an even more expensive alternative treatment , such as using donor eggs or donor sperm or surrogacy , so he can make even more money !
He ends up singing a completely different tune after the cycle has failed , and rather than taking responsibility for this , or trying to explain to the patient what could have gone wrong , he washes his hands off, and tries to pin the blame on to the patient .
This is why patients are so unhappy and dissatisfied with the quality of IVF treatment they get in India .
Unfortunately , this is still an unregulated industry , which means patients need to be careful about whom they select for their test tube baby treatment – let the patient beware !
If you want hands on personalized care, you need to spend time and energy on selecting the right clinic ! Just because the clinic is very crowded doesn't necessarily mean it's the right clinic for you – please use your discretion when making such an important decision !
 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, August 16, 2018

The biggest mistake which IVF patients make in India



The biggest mistake which IVF patients make in India is blindly trusting the IVF doctor

It’s extremely important that you find a doctor you can trust – and it’s equally that you make sure that he earns that trust ! Trust is too important to be gifted to anyone .

The trust equation , as defined by David Maister, says that the doctor must prove that he is reliable and credible – and you need to check this before signing up for your treatment.

Is he willing to share information ? Is he upfront , open and transparent ? Or does he make a lot of promises because he wants to sell you on doing IVF treatment at his test tube baby clinic ? Is it a lot of hot air he is promising , or is he respectful , and makes sure that you have realistic expectations about what IVF treatment can offer you ?

Test tube baby treatment is expensive, and you have to be very careful about whom you select for as your IVF doctor.

The single question which all patients should ask their IVF doctors is – Do you do blastocyst transfers routinely ? and do you provide patients of photos of their embryos routinely ?
All good clinics do this routinely – and if you find out that the doctor doesn’t, then this is a red flag, and you should find a better clinic before burning your hard earned money !

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, August 15, 2018

The limitation of testing for ovarian reserve



The chances of getting pregnant after IVF depend on the quality of the embryos, and the quality of embryos depends on the quality of the eggs. This is why testing for ovarian function is extremely important before doing an IVF cycle. We know that patients who have better ovarian function have a higher chance of getting pregnant, which is why measuring antral follicle count, as well as the AMH level, is so important.
However, we need to understand the limitations of these tests. Thus, there are patients with low AMH levels who do get pregnant after IVF – and there are patients with normal AMH level who has a poor ovarian response.
While the quantity and quality of eggs usually go hand in hand, this correlation often breaks down.
This is because the quality of the embryo is determined by the energy which the mitochondria in the cytoplasm of the egg can provide, and this is not something we can measure based  on either an AMH level or an antral follicle count.
Sadly, there is no test as yet which allows us to assess the mitochondrial competence of the egg, and this is why an IVF cycle gives us information as regards egg quality which nothing else can as yet. How good the quality of the embryos is tells us far more about the quality of the eggs as compared to any other test !
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 14, 2018

The problem with ovarian functions tests



The chances of getting pregnant after IVF depend to a large extent on the quality of the woman's eggs, and this is why older women have lower pregnancy rates.
 This is why testing for ovarian reserve is so important, and we measure the AMH level as well as the antral follicle count , so we have some sense of how well the patient is going to respond to superovulation, and what her chances of getting good quality embryos is going to be.
The trouble is that these numbers only provide an estimate of static ovarian reserve – they are not dynamic functional tests. What we really want to know is how the patient will respond to the superovulation and we can only find this after actually doing the IVF cycle.
This is why an IVF cycle is not just a treatment procedure – it also provides invaluable diagnostic, as well as prognostic information.
Based on how you respond to the cycle, we are better positioned to know what to do differently in the next cycle. For example, do we change the protocol ? or do we consider using donor eggs? The only way to answer this key question is by actually doing the IVF cycle – there are no shortcuts !
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 !





Test tube baby clinics – judging the quality of the clinic




Because patients are not sophisticated enough to be able to judge the technical competence of an IVF doctor , most of them use other alternatives to decide which doctor to select the best.
This is why a lot of them will go to the busiest doctor , based on the assumption that if the doctor is busy , he must be good ! This is based on the concept of social proof , which is why a lot of follow a herd mentality when making a decision .
The danger is that these clinics are so busy that they are completely impersonal, unless you happen to be a VIP or a celebrity. The doctor doesn't have enough time or energy to spend on you , as a result of which the care you get is not tailored to your needs. The clinic follows a rigid protocol . because they function as an assembly line, which is designed to do an many cycles as possible every month.
This is why patients can't afford to leave everything up to the IVF doctor - especially in India , where there is no government regulation , and the success rates among clinics vary widely .
Sadly, doctors are not very honest about what their clinic’s success rates are, which is why everyone merrily claims a 70 percent success rate - even though this has no bearing with reality ! Because there is no one to check or verify these tall claims , they continue to get away with it , and this is why patients get taken for a ride .
Ironically , even though patients in India aren't really well equipped to be able to differentiate between good doctors and bad doctors , the burden of doing so actually falls disproportionately on their shoulders , because the government has failed in its duty to do this for them !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Monday, August 13, 2018

Why do patients do such a bad job of selecting IVF clinics



We all know that all IVF clinics are not created equal , and their success rates can be dramatically different !

And some can be much more expensive than others !

So how is the poor patient to decide who the right IVF doctor is ?

Sadly, a lot of patients naively assume that all doctors provide the same high quality of care , and this is where they make a huge mistake , because they end up wasting a lot of time and money doing their treatments in low cost clinics, just because they are cheap and convenient!

Typically, the doctors in these clinics talk very sweetly , because they want to sign up as many patients as possible. Their focus is on quantity rather than quality , and most of these clinics are like impersonal assembly line factories, which process patients mindlessly, and take pride in how many treatment cycles they perform every month – rather than on how well they take care of their patients !

This can be an extremely expensive mistake , because the pregnancy rates in these clinics is usually very low , which means patients end up wasting all their money and depriving themselves of a chance of having a baby .

This is why it's important that patients need to do their homework so they can be sure the clinic they select is technically competent .

If you end up in the wrong hands, this can be an expensive error , which you may not be able to recover from , and you will end up ruining your chances of you 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 !





The biggest mistake which IVF patients make



The biggest mistake which IVF patients make in India is blindly trusting the IVF doctor

It’s extremely important that you find a doctor you can trust – and it’s equally that you make sure that he earns that trust ! Trust is too important to be gifted to anyone .

Sadly, the government does a poor job of regulating IVF clinics, which means there are many fly by night operators who just want to exploit patients. And it's easy to do this because infertile patients are ignorant and vulnerable.

The trust equation , as defined by David Maister, says that the doctor must prove that he is reliable and credible – and you need to check this before signing up for your treatment.

Is he willing to share information ? Is he upfront , open and transparent ? Or does he make a lot of promises because he wants to sell you on doing IVF treatment at his test tube baby clinic ? Is it a lot of hot air he is promising , or is he respectful , and makes sure that you have realistic expectations about what IVF treatment can offer you ?

Test tube baby treatment is expensive, and you have to be very careful about whom you select for as your IVF doctor.

The single question which all patients should ask their IVF doctors is – Do you do blastocyst transfers routinely ? and do you provide patients of photos of their embryos routinely ?
All good clinics do this routinely – and if you find out that the doctor doesn’t, then this is a red flag, and you should find a better clinic before burning your hard earned money !


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, August 10, 2018

How doctors fool patients about the cost of test tube baby treatment.



Because test tube baby treatment is so expensive, patients will often doctor shop and go from clinic to clinic in order to find out who the cheapest clinic is, so that they can afford the treatment .
This is where some unethical clinics will take them for a ride.
They will take out full page ad in a newspaper and advertise an extremely low price to lure patients.
Then, in very small print, they'll say that medications cost extra; or ultrasound scans and lab procedures will need an additional fee.
This means that by the time the patient has completed the treatment cycle , they'll end up paying much more than they budgeted for , and they're obviously very bitter about this.
This is why patients need to demand transparency , and insist that they have an itemized bill of whatever the treatment costs are going to be upfront. What’s included ? What’s not ?
This way there are no unexpected surprises for them , and they don't get sticker shock and complain afterwards !
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, August 09, 2018

How much does a test tube baby treatment cost ?



Before starting an IVF treatment cycle , one of the first questions the patient needs to know is how much it is all going to cost .
They know that the success rate is not 100% and that they may have to repeat many cycles before getting pregnant.
IVF is expensive, and it's a big drain on the budget . Because it's not covered by insurance and they need to pay out of pocket , this is something which they need to be very careful about.
Now many IVF clinics take out a lot of ads , and in order to lure patients, they advertise a very low rate. However, they do not explain to the patient that this is just their initial sign up rate, and that as the cycle progresses, the patients will have to keep on paying more and more. These clinics keep on extracting  additional amounts during the treatment, as a result of which the total cost for the patient for that cycle balloons up so much that the poor patient end up spending twice as much as he had budgeted for !
This creates even more friction between the husband and the wife, as the husband finds he just does not have enough money to spend on fulfilling his wife's dream of having a baby.
This is why it's important to get an upfront cost - preferably a packaged, all-inclusive cost , so that there are no unpleasant surprises later on .
This is the best way of ensuring that you don't get taken for a ride. 
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, August 08, 2018

Treating women with a low AMH level



Treating women with poor ovarian reserve (as defined by a low AMH level and a low antral follicle  count  ) can be extremely difficult. A lot of these patients don't know what they should do because they get so much conflicting advice.
Should they be trying IVF with their own eggs ? with aggressive superovulation ? or with minimal stimulation ? Or should they continue trying in their own bedroom ?  or should they use donor eggs? Does it make sense to spend so much money on an IVF cycle if the success rate is going to be so poor?  However, it’s hard to accept that you will need to use donor eggs, because it’s not easy to come to terms with the fact that your baby will not carry your own DNA.
This is why so many older women start obsessing about their AMH level. They  track it religiously, and will try anything to get it to improve. They also go from one doctor to another , trying to find someone who will tell them what they want to hear.
The reality is that we don't actually treat an AMH number – we treat patients. In one sense, it doesn't matter whether your absolute number is 0.6 or 1.0 - we know that if the AMH is low, this means you have poor ovarian reserve and will most probably have a poor ovarian response to superovulation, which is why your chances of getting pregnant with IVF will be lesser as compared to someone with a normal AMH. However, the chance is not zero, and this doesn't mean that you should not attempt IVF with your own eggs. After all, these are decisions based on personal patient preference - not on lab values. These decisions are too important to be left to the doctor – they should be made by you, because you're the one who needs to live with the consequence of that decision.
As a doctor, I can counsel you as regards your success rates, and while it is true that the pregnancy rates with donor egg will definitely be better as compared to using your own eggs, it's not a simple black or white decision. The whole point is there is no right answer , because every patient is different.
Some patients will say, "I don't want to waste my time and money in doing IVF with my own eggs if the success rate is low, so let me just go for donor eggs, as this maximizes my chances of having a baby. I just want to get pregnant, have a baby, and move on with my life, and don’t care about whose DNA it is." And there'll be other women who will say, "No, I will not accept donor eggs under any circumstances." And some will decide, "I would like to try IVF at least once with my own eggs, and if it doesn't work it'll be much easier for me to emotionally reconcile myself to the fact that I need to use donor eggs."
Every patient is different, and a good doctor will allow you to make the decision for yourself, after explaining the pros and cons.


Why does the cost of test tube baby treatment in India vary so much ?



Patients are often confused as to why the cost of a test tube treatment is so different from one Indian IVF clinic as compared to another. They understand that it’s going to be more expensive in large cities like Mumbai, but there is still so much variation from clinic to clinic, that patients aren’t sure what the right cost should be .
Is it that the really expensive ones are better ? Or is it that the expensive ones are greedy , and want to make more money because they want to make a larger profit? And are the cheaper ones low-cost because they cut corners , and have lower pregnancy rates?
The problem is that there isn't always a direct correlation between cost and success rates.  This problem is compounded by the fact that there is a complete  lack of transparency , and clinics aren't open about what their success rates are.
It’s quite easy for the large corporate chains to lure them by offering a low cost, but they keeping on padding it by adding additional costs as the cycle goes by, which means patients eventually end up paying much more - and end up still not getting pregnant !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !





Tuesday, August 07, 2018

The need for transparency in the cost of test tube baby treatment




India is still a developing country and most patients are quite poor. Infertile patients find it very hard to afford test tube baby treatment , because insurance doesn't cover for it, and they need to pay for it out of their pocket. And since they're never really sure whether the IVF cycle is going to work or not , so mentally they have to be prepared for making maybe two, three, or more attempts, until they finally get a baby.
This is why they  worry a lot about the cost – can they afford it ?
The trouble is that a lot of IVF clinics aren't very up-front, transparent, or open about this important issue, because they want to lure the patient for IVF treatment to their clinic.
They will quote a low cost and get the patient to pay this as an advance, so they can start the IVF treatment. They then keep on adding more and more to this as the cycle progresses, saying this test costs extra, or that additional treatment costs more, but you need to do this if you want to improve your chances of success.
The poor patient is vulnerable and feels trapped. He doesn't know what to do, and is forced to listen to whatever the doctor tells him, because he wants to do whatever he can to maximize his chance of getting pregnant.
And this is why patients get taken for a ride by unscrupulous doctors.
This is why financial transparency is so important for test tube baby patients. You should ask for these details upfront, before starting a cycle, so there are no surprises !
And please be wary of doctors who want you sign up and pay an advance at the first consultation itself. IVF is planned treatment, and you can take your own time deciding when you want 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 !






Sunday, August 05, 2018

Why do doctors waste the patient’s money by doing a laparoscopy for infertile couples ?



Because infertility treatment can be so expensive, patients end up spending a lot of money on this.
Part of the problem is  because you're never sure whether the treatment is going to result in a baby or not, patients need to be very frugal. They will spend a lot of time searching for a doctor who does laparoscopies for infertility treatment for the least amount of money.
The reality is you should not be doing a laparoscopy for infertility. Part of the problem is that laparoscopy has become “routine”  , which means this has become a very over used, abused, and misused procedure.
Most gynecologists do it routinely, without even thinking about whether the patient needs it or not. When you have a hammer, everything looks like a nail, and because a laparoscopy is the only procedure the gynecologist can offer for an infertile woman, he says, "Fine, let's put a telescope inside, and see what's going on, so we can make a diagnosis."
But the problem is that just because it's “ minimally invasive” , and easy to do for the surgeon, this doesn't mean it's right for the patient ! The truth is that a laparoscopy does not change your treatment options, so you're far better off going to a gynecologist who doesn't do a laparoscopy for you, because he knows that you don't need it !
Instead, a good gynecologist will offer non invasive, lower cost options, such as a hysterosalpingogram, and an ultrasound , to check your uterus and tubes ! Why do surgery if you don’t need it ?
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !




                               


Saturday, August 04, 2018

Why the government of India should offer free test tube baby treatment.




The Indian government has a Ministry of Health and Family Welfare, which is supposed to help citizens to plan their families. The government is the largest health care provider, and we pay taxes so that they can provide us with healthcare services.
While the government provides a lot of free family planning ( FP) services, such as contraception , pregnancy termination and tubal ligation, family welfare doesn't just mean limiting the size of the family. It also means helping infertile couples who don't have a baby to have deeply loved babies – these will make great citizens for our country .
This is why the department should offer free IVF treatment in government hospitals for poor patients who can't afford IVF treatment in private hospitals.
This will be good for patients, lots of whom are citizens who pay their taxes. It will also be very good for government hospitals , who can do medical research in this field, to develop new low cost ways and innovative ways of treating infertile Indian patients. Let’s not forget their junior doctors also need training in how to do IVF when they graduate as MD gynecologists, so this is a win win for everyone !



Free and low cost test tube baby treatment




Reducing the cost of test tube baby treatment in India is a major priority today.
Lots of Indian couples would get pregnant if they could do IVF , but unfortunately they can't afford IVF treatment because it is so expensive.
Unfortunately , IVF today it's only available at private clinics most of whom are profit making organizations , as a result of which they charge a lot of money . Poor patients just can't afford this.
I think this is extremely unfair. It's high time that government hospitals started offering IVF to poor patients. After all they have medical staff and their junior doctors need to be trained in providing IVF.
By setting up low cost IVF units , not only will they be doing a great service to poor patients , they will also be better able to train their MD gynecologists , who will then be much able to start doing IVF once they graduate.
Today, it’s a tragedy that  gynecologists have no idea how to do IVF , because they have never treated any IVF patients during their postgraduate training ! This means their training is completely incomplete – and it’s high time this deplorable state of affairs was corrected.
Even better, these teaching hospitals and medical colleges will be able to develop new low cost ways and innovative ways of treating Indian patients, so they whey can afford to do test tube baby treatment, because it will be available at a fraction of the cost which they are being charged today !



Cost of IVF treatment in India




One of the major constraints for taking IVF treatment for most Indian patients is the fact that IVF treatment is so costly.
Now even if IVF treatment was expensive but they were sure they would get a baby, they would somehow scrounge up the money and go ahead and do it , but the problem is that you may end up spending a bomb and still get nothing in return.
This is why it's very hard for them to take this step , and many get paralysed into inactivity.
They will spend a lot of time doctor-shopping, and try to find the IVF clinic which provides the cheapest treatment .
The problem is they don't understand that there's a world of a difference between the quality of care IVF clinics provide , and that the cheapest IVF clinic is not always the best.
In fact, many end up wasting a lot of money doing IVF at low cost centers , which are low cost because they cut a lot of corners and have very low pregnancy rates.
Not only do they end up burning all their cash , but they also deprive themselves of having a baby, because then they can no longer afford to do treatment at a high quality clinic.
Remember it's not just a question of the cost of the treatment - it's also a question of cost effectiveness, and the pregnancy rate of the clinic make a big difference !
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, August 03, 2018

Why the cost of laparoscopy for infertile couples should be zero



A major problem with infertility treatment is that they can be so expensive.  This is a major limiting factor for infertile patients , who are obviously going to try looking out for the most cost effective doctor.
Thus, they will shop around and try to find out what the cost of a laparoscopy , so they can find the doctor who is cheapest and will do it for the lowest price.
The problem is lots of doctors will do laparoscopies cheaply , but they will not do a good job. Thus, they will not do any video documentation , as a result of which the patient doesn't know what was done. There is no video record of the surgery, so the patient is clueless about what the doctor did; what he found; and how he fixed it. This ignorance can be much more expensive in the long run, because it can mislead the patient !
The good news is that the actual cost of a laparoscopy for infertility treatment should be zero, because most infertile patients don't require a laparoscopy at all in the first place !
Why subject yourself to a surgical procedure , no matter how cheap it is if you don't require it at all? After all, nothing can cost less than zero, can it?
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 !

Surrogacy center in Mumbai and India




Surrogacy is the best treatment option for infertile women whose uterus is absent ; or irreparably damaged .
Now, this is an extremely expensive treatment and not something which should be taken lightly.
However, it's often overused and abused because a lot of surrogacy treatment today is being done for patients who don't need it in the first place. This is typically women who have failed two or three IVF treatment cycles , and the doctor then advices them to do surrogacy.
However, surrogacy is often the wrong treatment option for women with repeated implantation failure, but lots of surrogacy centers in Mumbai  and in India are happy to push this particular treatment option because they can charge a lot more for it.
This can actually be tragic , because the pregnancy rate does not improve for these patients who have repeated IVF failure. This is because the reason for the repeated failure of implantation is usually poor embryo quality, and changing the uterus will not help to improve this !
As a result, the pregnancy rate will not increase , but the cost will !
This is why you  need to be very careful and make sure you find an ethical, upright surrogacy center for your treatment !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !






Saturday, July 28, 2018

IUI versus IVF versus ICSI



Many infertile men get extremely poor quality treatment, and this is because most IVF specialists have no idea how to treat them. This is why there is so much confusion as to whether the right treatment for the man with a low sperm count is IUI, IVF or ICSI -  and the tragedy is that often doctors are as confused as patients.

For one thing, most gynecologists aren't able to interpret a sperm test report properly; and to make matters worse, the quality control in sperm testing laboratories is pretty abysmal. Many labs still don’t even know that a normal sperm count is more than 15 million – and they still print the normal range as being between 60 to 120 million per ml. This obviously confuses a lot of patients , and many gynecologists start “treating” men with a completely normal sperm count of 20 million per ml with medicines, because they label them as being infertile !

Even worse, lots of men with low sperm counts or poor motility are treated with IUI. They're told, " We'll wash your sperm, and after cleaning and concentrating them, we will put them directly into the uterus , so they'll be able to reach and fertilise the egg more easily." This just doesn't work, simply because these are functionally incompetent sperms. The fact that they're not motile means  sperm production is defective, and that even the ones which are motile may not work properly. No amount of “ scrubbing and processing “ them is going to make them able to fertilize the egg, which is why the pregnancy rates for IUI for men with low sperm counts is extremely poor. However, because gynecologists can’t offer IVF, they're quite happy to at least do an IUI for their patients – after all, isn’t something better than nothing ? And you never know when they’ll hit the jackpot.

Some have good intentions, and because they know that the pregnancy rate in many IVF clinics is very poor, they justify this by claiming that this will save the patient a lot of money, because they won’t have to do IVF  and waste a far larger sum on money ! The tragedy is that a lot of patients end up wasting a lot of their time and energy on doing useless IUI cycles . They go from one gynecologist to another, who mindlessly repeat the same treatment again and again. Patients get fed up, and lose confidence in all doctors, which is why they refuse to explore any further options such as ICSI, even if these are highly likely to work for them.

The same problem applies with the confusion between  IVF and ICSI as well. While IVF is fine for men with a good sperm count, it’s too risky to do this for men with a low sperm count or poor motility, because the functional capacity of the sperm to fertilise the egg on its own is doubtful.  However, because many clinics don’t have the expertise to do ICSI well, then try IVF on these patients, and when the IVF cycle fails, they  add insult to injury by telling the patient to use donor sperm , rather than referring them to a reliable IVF clinic which can do ICSI properly !

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 26, 2018

Should I freeze my embryos ?



When patients have only two blastocysts, they're often not sure what to do. Should they transfer both of them as fresh blastocysts? Should they freeze both of them and then do frozen transfers, one at a time? Or should they transfer one and freeze one?
To help you make the right decision, you need to remember that what you need to focus on is the cumulative pregnancy rate. This is not just the chance of getting pregnant in the first fresh cycle, but the overall chances over a period of time, after you have transferred all your blastocysts.
Yes, it's true that the pregnancy rate after transferring two blastocysts at a time will be better than transferring just one. Thus, if we assume a 25% implantation rate per fresh blastocyst, then if you transfer two fresh blastocysts, the pregnancy rate will be about 50% in that cycle.
On the other hand, if you freeze both and then transfer them, one at a time, the cumulative pregnancy rate jumps up to 60%. This is because the implantation rate for frozen blastocysts is 30% per blastocyst per cycle, because the endometrial receptivity is better in a frozen cycle.
Similarly, if you transfer one fresh blastocyst and freeze one because you want to have your cake and eat it too, then the cumulative pregnancy rate is 55% - 25% plus 30%.
The actual implantation rate per blastocyst will vary, depending on the quality of the blastocyst; the receptivity of the endometrium ; and whether the transfer is easy. However, this model will give you a framework so that you can make a well-informed decision.
Our advice for our patients is to freeze all their blastocysts, and then transfer one blastocyst at a time. We tell them - you can have as many babies as you like, but one at a time ! This is safest for your baby, because singleton pregnancies have a better outcome as compared to twins.
Yes, this option is more expensive,  especially if you don't live in Mumbai, because you need to add the expense of your travel  as well, but this is the best option from a purely medical perspective, as regards maximizing your success rates.
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, July 23, 2018

Which is the best test tube baby center in India ?


Since IVF is such an expensive treatment, patients want to maximise their chances of getting pregnant by going to the best IVF center, which is why the quest for the best test tube baby center is such an important one !

Now this is a difficult question to answer, because every IVF clinic is going to claim that they are the best.

Sadly, most clinics lie about their IVF success rates, and because the Government does not regulate IVF clinics, they claim 80% success rates - even though their actual rates may be only 15%. The tragedy is that there is no way patients can trust these claims or verify them, because any one can claim anything they like, and get away with it !

This is why it's so important that patients become well-informed and do their homework, before selecting the test tube baby center which is right for them !

Common mistakes include:
1. going to the one which is nearest, because this is most convenient. However, all IVF clinics are not created equal, and there is a marked difference in the success rates, depending upon their experience and expertise
2. going to the busiest one  - after all, if it's busy, it must be good, right ? The trouble is that then the doctor does not have time to spend with you, and the clinic adopts a mindless assembly line approach, because they want to treat a large number of patients as quickly as possible
3. choosing the one which is cheapest. The problem is that then the clinic may cut corners in order to save costs
4. selecting one based on an ad . Yes, ads can be catchy, but guess who pays for those full page ads ? You do !
5. going to one because your friend got pregnant there. The problem is that her medical issues may be very different from yours, and the doctor may not have the expertise to be able to manage your specific diagnosis
6. letting your family doctor decide. While this may have been a sensible option in the past, in this day and age of kickbacks and cuts, this is not a reliable way of selecting a good clinic.
7. choosing the one which all celebrities go to . Yes, this can be tempting, because you never know who you will meet at the clinic ! However , if you want to be treated as a VIP, you will be sadly disappointed, because it's the celebs who will get all the attention !

Make sure that the clinic you go to does only blastocyst transfers, and provides embryo photos routinely to all their patients !

Not sure what a blastocyst is ?

You can download a free IVF comic book at www.ivfindia.com !

Saturday, July 21, 2018

How doctors take advantage of IVF patient's ignorance

A patient sent me this email.
-----Original Message-----
From:
To: Aniruddha Malpani
Subject: Re: Two ivf cycles failed
Sir,
Can U pls suggest ivf success supplements?
Next month I m going for third cycle
Can I use mothers Horlicks?
How to get good eggs and embryos?
Any diet chart before, during and after embryo transfer?
Sir, pls kindly suggest me
Lifelong I will be really thankful to you
Now I m taking
1. apcod sachets
2. Metformin
3. Normoz
4. Ultra CoQ10
5. Folic acid
My previous ivf failure reasons are poor quality eggs and embryos, implantation failure and may be unexplained infertility reason 
Actually, the most likely reason for the IVF failure was a bad quality IVF clinic, and because I needed more medical details, so I asked her the following questions, and this was her reply.

1. DO YOU HAVE PHOTOS OF YOUR EMBRYOS ? No sir
2. What were the meds used for
superovulation ?
1. Normoz, 2. Glycomate 3. Folic acid,4. Vitamin d sachets, and some injections for egg growth and trigger injections ( they did not provide any injection names and dose)
In first ivf cycle 17 eggs released , 3 fertilised  second grade quality -  2 transferred - treatment failed
In second ivf cycle 15 eggs released , 2 fertilised  second grade quality -  2 transferred -treatment failed
What was the dose used ? I don’t know sir
How many follicles did you grow ?  17 first cycle and 15 second time
How many eggs were collected ? 17 first time and 15 second time
What was the E2 ( estradiol) level in the blood at the time of the HCG trigger ?   I don’t know sir
How many embryos were transferred ? First time 2 and second time 2
What was the embryo quality ? First time second grade and second time also second grade
What was the endometrial thickness ? Triple line thickness 

It breaks my heart when I see how IVF doctors take advantage of the patient's ignorance and exploit this by providing poor quality care. They keep their patients in the dark, which means patients have no clue as to what is happening.

What causes me even more heartburn is the fact that patients passively put up with this kind of treatment, even though they are spending so much money on their IVF treatment.
If patients don't ask questions, why will doctors bother to provide any answers ?

And if patients are happy to remain clueless about what is happening, is it surprising that doctors treat them so badly ? After all, they seem to be getting away with this with impunity !




LinkWithin

Related Posts Plugin for WordPress, Blogger...